Clinical significance of multimodal contrast ultrasonography for evaluating the efficacy of radiotherapy and chemotherapy in patients with radical mastectomy
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摘要:
目的 探究多模态超声造影技术对乳腺根治术患者放化疗疗效评估的临床意义。 方法 回顾性分析2015年7月~2019年1月我院收治的140例乳腺癌放化疗患者临床资料，患者在化疗前后行超声造影、弹性超声检查，以术后病理作为金标准，分析超声造影对放化疗疗效的评估价值。 结果 常规超声评估放化疗疗效的敏感度为52.63%，特异性为87.50%，准确度68.57%，经Kappa检验常规造影与病理检测一致性较差（Kappa=0.388）。超声造影评估化疗疗效的敏感度为94.7%，特异性为98.4%，准确度为96.4%；超声造影与病理的一致性分析显示Kappa=0.928，一致性较好。放化疗前所有患者肿瘤超声图像表现为高增强，放化疗后有效患者主要表现为低增强，无效患者主要表现为中、高增强；无效患者化疗前多见灌注区缺损和放射血管，而在有效患者中少见；放化疗后有效患者区域血流量、时间-强度的曲线下面积和弹性应变率比值均低于无效患者，弹性评分、达峰时间高于无效患者，差异具有统计学意义（P < 0.05）。 结论 多模态超声造影技术的部分定性和定量指标对乳腺根治术患者放化疗疗效具有一定评估价值。 Abstract:Objective To investigate the clinical significance of multimodal contrast ultrasonography for evaluating the efficacy of radiotherapy and chemotherapy in patients with radical mastectomy. Methods The clinical data of 140 patients with breast cancer undergoing radiotherapy and chemotherapy admitted to our hospital from July 2015 to January 2019 was retrospectively analyzed. The patients underwent contrast ultrasonography and ultrasonic elasticity-before and after chemotherapy. The postoperative pathology was used as the gold standard. The diagnostic value of the ultrasound contrast in radiotherapy and chemotherapy was analyzed. Results The curative effect of radiotherapy and chemotherapy evaluated by conventional ultrasound was 52.63%, the specificity was 87.50%, and the accuracy was 68.57%. The consistency between conventional radiography and pathology was poor by Kappa test (Kappa=0.388). The sensitivity, specificity and accuracy of contrast-enhanced ultrasound in evaluating chemotherapy efficacy were 94.7%, 98.4% and 96.4% respectively; The consistency analysis of contrast- enhanced ultrasound and pathology showed that Kappa=0.928, with good consistency. The ultrasound images of all patients showed high enhancement before radiotherapy and chemotherapy, while the effective patients after radiotherapy and chemotherapy showed low enhancement, the ineffective patients showed moderate and high enhancement (P < 0.05). After chemoradiotherapy, the regional blood flow, area under curve and strain ratio in effective patientswere were lower than those in ineffective patients, whereas the time to peak and elasticity scorewerehigher than the ineffective patients (P < 0.05). Conclusion Partial qualitative and quantitative indicators of multimodal contrast ultrasonography have some certain evaluation value for the efficacy of radiotherapy and chemotherapy in patients undergoing radical mastectomy. -
图 1 超声检查图像
A: 化疗前常规超声检查; B: 化疗后常规超声检查; C: 化疗前超声弹性成像分析; D: 化疗后超声弹性成像分析; E: 化疗前超声造影分析; F: 化疗后超声造影分析.
Figure 1. Ultrasound imagings.
表 1 常规超声与术后病理评估放化疗效果比较
Table 1. Comparison between conventional ultrasound and postoperative pathological evaluation of radiochemotherapy effect (n)
常规超声评估 病理检测 合计 有效 无效 有效 40 8 48 无效 36 56 92 合计 76 64 140 
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表 2 不同病理结果的多模态超声造影参数比较
Table 2. Comparison of multimodal contrast- enhanced ultrasound parameters with different pathological results (Mean±SD)
参数 病理检查 t P 有效（n=76） 无效（n=64） PI（dB） 6.22±0.41 6.31±0.55 1.108 0.27 TTP（s） 13.74±0.52 10.20±0.65 35.793 0.001 MTT（s） 36.16±5.13 35.92±5.09 0.277 0.783 AUC 85.12±10.53 136.56±22.61 17.694 < 0.001 RBV（mL） 2732.45±451.60 3546.41±361.30 11.621 < 0.001 弹性评分 3.51±0.73 2.61±0.78 2.315 < 0.001 SR 1.40±0.32 2.17±0.45 3.846 < 0.001 PI: 峰值强度; TTP: 达峰时间; MTT: 平均渡越时间; AUC: 曲线下面积; RBV: 区域血流量; SR: 应变率比值.
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表 3 超声造影与术后病理评估放化疗效果比较
Table 3. Comparison of contrast-enhanced ultrasound and postoperative pathology in evaluating the effect of radiotherapy and chemotherapy (n)
超声造影评估 病理检测 合计 有效 无效 有效 72 1 73 无效 4 63 67 合计 76 64 140
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