【作者】 胡聂；

【导师】 梁庆模；

【作者基本信息】 南华大学 ， 肿瘤学， 2011， 硕士

【摘要】 目的:通过彩色多普勒和能量多普勒超声,观察乳腺癌原发病灶及腋窝淋巴结在新辅助化疗前后,在形态学、血流分级及血流动力学等方面的变化情况,研究彩色多普勒和能量多普勒超声在新辅助化疗疗效评价中的临床应用价值。方法:对67例入选的乳腺癌患者,均于新辅助化疗后对其进行临床疗效评价、超声检查大小评价、彩色多普勒和能量多普勒超声评价及病理学疗效评价。所有选取病例于化疗前及每个化疗周期结束后48小时内,由同一个人进行超声检查。从多个切面对双乳进行扫查,观察肿瘤大小及形态,并引出彩色多普勒(CDFI)和能量多普勒(PDI)检测肿瘤血流分级,提取血流动力学参数:收缩期血流速度峰值(PSV)、阻力指数(RI)。常规扫查腋窝,测量腋窝淋巴结化疗前后大小变化,观察其形态、结构回声情况。临床疗效评价参照RECIST指南疗效判定标准,病理学疗效评价依照Miller&Payne的评价分级方法。全部数据的比较分析采用SPSS10.0软件进行统计学处理。结果:在接受新辅助化疗后对全部病例进行病理学疗效评价,其中5级3例,3-4级34例,1-2级30例,病理学评价NCT有效55.22%。临床疗效评价:按照触诊测量结果发现完全缓解(CR)7例,部分缓解(PR)44例,无变化(SD)14例,进展(PD)2例,有效率76.12%。临床疗效评价与病理学评价比较,敏感度(Se)0.7027,特异度(Sp)0.1667,Kappa值(K)-0.1667,可用度(DA)0.0106。超声检测病灶大小评价:发现乳腺癌原发灶消失5例,乳腺癌原发灶体积缩小40例,乳腺癌原发灶体积无明显变化19例,乳腺癌原发灶体积增大3例,有效率67.16%。超声检查病灶大小与病理学评价比较,敏感度(Se)0.8649,特异度(Sp)0.6217,Kappa值(K)0.6513,可用度(DA)0.5842。彩色多普勒超声评价:1、血流分级(型):CDFI检测出血流分级降低的乳腺癌病灶有53例,将发生血流分级降低的病灶认为NCT有效,有率为79.10%,与病理学评价比较,敏感度(Se)0.7568,特异度(Sp)0.1667,Kappa值(K)-0.0806,可用度(DA)0.0959;PDI检测出血流分型降低的乳腺癌病灶有57例,将发生血流分型降低的病灶认为NCT有效,有率为85.07%,与病理学评价比较,敏感度(Se)0.8919,特异度(Sp)0.2000,Kappa值(K)0.0981,可用度(DA)0.2927。2、PSV值:经CDFI检查NCT前后病灶PSV值,将PSV值降低的病灶认为NCT疗效,有效率70.15%,与病理学评价比较,敏感度(Se)0.7297,特异度(Sp)0.3333,Kappa值(K)0.0651,可用度(DA)0.1345。3、RI值:经CDFI检查NCT前后病灶RI值,将RI值降低的病灶认为NCT疗效,有效率64.18%,与病理学评价比较,敏感度(Se)0.8108,特异度(Sp)0.5667,Kappa值(K)0.5818,可用度(DA)0.5241。4、腋窝淋巴结:在NCT后,有48例乳腺癌患者腋窝淋巴结发生消失或缩小改变,将NCT前后腋窝淋巴结发生消失或缩小改变的乳腺癌患者经NCT后有效,有效率为71.64%,与病理学评价比较,敏感度(Se)0.7838,特异度(Sp)0.3667,Kappa值(K)0.0779,可用度(DA)0.2238。5、超声测量与RI值联合评价:将超声测量病灶大小与测量RI值联合(串联)来评价NCT疗效,二者均判断有效的30例,有效率44.78%,与病理学评价比较,敏感度(Se)0.7027,特异度(Sp)0.8667,Kappa值(K)0.5359,可用度(DA)0.5780。结论:1、通过超声检测乳腺癌病灶大小对新辅助化疗疗效进行评价,与病理学疗效评价一致性较好。2、通过彩色多普勒超声检测病灶内RI值的变化对新辅助化疗疗效进行评价,与病理学疗效评价一致性较好。3、应用彩色多普勒超声联合检测乳腺癌病灶大小和RI值的变化对新辅助化疗疗效进行评价效果好,具有临床应用价值。更多还原

【Abstract】 Objective Through exploring the changes of the morphology, blood mode and RI value in the primary lesions and axillary lymph nodes before and after NCT, the clinical value of CDFI and PDI are investigated in assessing curative effect of NCT in breast cancer treatment.Methods The primary lesions and axillary lymph nodes of the selected 67 patients with breast cancer were examined by Doppler ultrasound before and after NCT. All of the sonographical examinations were performed by the same operator with direct contact before NCT and within 48h after NCT. The primary lesions were observed at several sections, including its size, shape, edge, surrounding halo, internal echo and rear echo. Then the hemodynamics parameters were acquired, such as PSV, RI and etc. The axillary lymph nodes were examined, including its size, shape, internal echo and blood mode. Clinical evaluation followed the standard of RECIST, pathological evaluation adopted the classification method of Miller&Payne. The statistical analyses of above data were conducted with the statistical software package SPSS 10.0.Results There are 37 effective cases (55.22%) according to pathological evaluation. Seven cases with complete release, 44 cases with partial release, 14 cases without significant change and 2 cases with progressing lesions were revealed by palpation. Five cases with vanlish lesion, 40 cases with reducing lesion, 19 cases with unchangeable lesion and 3 cases with increasing size of lesion were showed under ultrasonographic observation. To sum up, it was effective to 67.16% patients. In CDFI and PDI examination:⑴53 cases (79.10%) with decreasing blood mode was uncovered with CDFI after treatment, and 57 cases (85.07%) in PDI examination.⑵70.15% cases were effective with drop of PSV in PDI observation.⑶64.18% cases were effective according to the reducing RI value.⑷changes of 71.64% axillary metastasis lymph nodes were found such as reducing in volume and decreasing of color Doppler signals.⑸If assessing with the size of lesion and RI value at the same time in ultrasonographic, the effective cases are only 18 (26.87%).Conclusions 1. CDFI is highly consistent with pathological evaluation at the size of lesion to evaluate the curative effect of NCT.2. The effectiveness rate based on RI value which is acquired from CDFI is close to that from pathological evaluation,.3. The method of combining the size and RI value of lesions in CFDI examination is superior to those methods which employ one single parameter. Furthermore this comprehensive approach has great clinical significance in assessing curative effect of NCT.更多还原