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目的分析双模态超声在评估乳腺癌新辅助化疗疗效中的应用价值。方法选取2014年11月-2016年1月就诊于新疆医科大学附属肿瘤医院的单发乳腺癌女性患者42例,在新辅助化疗前、后行常规超声、常规超声联合超声造影检查(即双模态超声),全部化疗周期结束后行手术取得病理结果,采用Miller and Payne病理反应分级标准评估新辅助化疗疗效,将术后病理切片与治疗前活检病理切片相对比,癌细胞减少≤30%定义为无效,癌细胞减少>30%或者无浸润性癌成分定义为有效。结果有效组24例,无效组18例,以病理学评估结果为金标准做一致性检验,得到常规超声的Kappa值为0.507,双模态超声的Kappa值为0.667,差异有统计学意义(P<0.05);新辅助化疗前、后病灶的达峰时间(TTP)、平均增强时间(MTT)差异均无统计学意义(P>0.05),化疗后病灶的峰值强度(PI)和曲线下面积(AUC)均低于化疗前,且差异有统计学意义(P<0.05);有效组与无效组间病灶的峰值强度变化率、曲线下面积变化率差异有统计学意义(P<0.05)。构建ROC曲线,得到最佳诊断界值为0.379,可在最大程度上区分化疗的有效和无效。结论双模态超声可较准确地评估乳腺癌新辅助化疗疗效,同时超声造影参数具有一定的评估疗效的价值。
Objective To analyze the value of bimodulus ultrasound in evaluating the efficacy of neoadjuvant chemotherapy for breast cancer. Methods Forty-two women with solitary breast cancer were selected from November 2014 to January 2016 in Tumor Hospital Affiliated to Xinjiang Medical University. Conventional ultrasound and conventional ultrasound combined with contrast-enhanced ultrasonography (ie, dual-mode State ultrasound). The pathological results were obtained surgically after the completion of all chemotherapy cycles. The effect of neoadjuvant chemotherapy was evaluated using the Miller and Payne pathological grading criteria. The postoperative pathological sections were compared with those before biopsy and the reduction of cancer cells was ≤30%. To be ineffective, cancer cells reduced> 30% or non-invasive cancer components were defined as valid. The results of the effective group of 24 cases, 18 cases of ineffective group, the pathological evaluation of the gold standard consistency test, the Kappa value of conventional ultrasound was 0.507, bimodal ultrasound Kappa value of 0.667, the difference was statistically significant (P <0.05). There was no significant difference in the peak time (TTP) and mean enhancement time (MTT) between the two groups before and after neoadjuvant chemotherapy (P> 0.05). The peak intensity (PI) and area under the curve (P <0.05). There was a significant difference in the change rates of peak intensity and area under the curve between the effective group and the ineffective group (P <0.05). The ROC curve was constructed and the best diagnostic cutoff value was 0.379, which could distinguish the effective and ineffectiveness of chemotherapy to the maximum extent. Conclusion Bimodulus ultrasound can evaluate the effect of neoadjuvant chemotherapy more accurately, and the parameters of echocardiography have certain value in evaluating the curative effect.