摘要
目的:评估二维超声联合超声造影对乳腺癌新辅助化疗(neoadjuvant chemotherapy,NAC)效果的预测价值,以期指导NAC评价方式的选择。方法:纳入2020年6月—2021年12月于兰州大学第二医院接受NAC的69例乳腺癌患者为研究对象,化疗前均行常规超声及超声造影检查并接受6~8个周期NAC后手术,术后以Miller Payne(MP)病理反应分级标准进行病理学疗效评价,分为有效组和无效组。单因素分析比较两组患者NAC前的常规超声及超声造影的特征,logistic多因素分析乳腺癌NAC效果的独立预测指标,并建立预测模型,绘制受试者工作特征(receiver operating characteristic,ROC)曲线。结果:69例患者病理学有效者共有54例(78.26%),无效者共有15例(21.74%)。单因素分析示边缘毛刺、后方回声衰减、增强模式、增强后病灶范围扩大等特征与NAC的疗效相关(χ^(2)=4.438,P=0.035;χ^(2)=4.193,P=0.041;χ^(2)=4.277,P=0.039;χ^(2)=4.334,P=0.037)。将指标纳入二元logistic回归分析示病灶后方回声无衰减、超声造影后无病灶范围扩大是NAC有效的病理学独立预测因素。以后方回声衰减、造影后病灶范围等指标构建预测模型,诊断效能较高(曲线下面积为0.759,灵敏度为46.3%,特异度为100.0%)。结论:常规超声显示病灶后方回声衰减及超声造影后病灶范围扩大等指标可预测乳腺癌NAC的病理学疗效,该预测模型的预测能力较高,对乳腺癌NAC临床诊疗决策具有指导意义。
Objective:To evaluate the predictive value of conventional ultrasound combined with contrast-enhanced ultrasound for efficacy of neoadjuvant chemotherapy(NAC)in breast cancer to guide the selection of NAC evaluation method.Methods:Sixtynine patients with breast cancer who underwent NAC in Lanzhou University Second Hospital were enrolled.All patients underwent conventional ultrasound and contrast-enhanced ultrasound before chemotherapy and underwent 6-8 cycles of NAC after surgery.Univariate analysis was used to compare the characteristics of conventional ultrasound and contrast-enhanced ultrasound before NAC between the two groups.Logistic multivariate analysis was used to analyze the independent predictors of the efficacy of breast cancer NAC and the receiver operating characteristic(ROC)curve of the prediction model was established.Results:Among the 69 patients,54(78.26%)were pathologically effective and 15(21.74%)were not.Univariate analysis showed that edge burr,posterior echo attenuation,enhancement pattern,and enlarged lesion area after enhancement were correlated with the efficacy of NAC(χ^(2)=4.438,P=0.035;χ^(2)=4.193,P=0.041;χ^(2)=4.277,P=0.039;χ^(2)=4.334,P=0.037).The above indicators were included in binary logistic regression analysis,which showed that no attenuation of the echo behind the lesion and no expansion of the lesion after contrast-enhanced ultrasound were effective independent predictors of NAC pathology.The prediction model was constructed based on the parameters of posterior echo attenuation and lesion range after angiography,and the diagnostic performance of the model was high(area under curve was 0.759,sensitivity was 46.3%,specificity was 100.0%).Conclusion:Conventional ultrasound and contrast-enhanced ultrasound can predict the pathological efficacy of breast cancer NAC.The prediction model has high predictive ability,which has guiding significance for the clinical diagnosis and treatment of breast cancer NAC.
作者
朱佳丽
马艳强
王媛
ZHU Jiali;MA Yanqiang;WANG Yuan(Department of Ultrasound Medicine,The Second Hospital of Lanzhou University,Lanzhou 73000,China)
出处
《肿瘤影像学》
2023年第5期429-434,共6页
Oncoradiology
关键词
乳腺癌
新辅助化疗
超声
超声造影
Breast cancer
Neoadjuvant chemotherapy
Ultrasound
Contrast-enhanced ultrasound
