【摘要】 目的分析超声弹性成像（UE）与扩散加权成像（DWI）对乳腺癌新辅助化疗（NAC）的早期预测价值。方法研究对象为2016年8月至2018年3月拟在我院接受TEC方案进行NAC治疗的37例（48个病灶）局部进展期乳腺癌患者,分析其NAC前、NAC4个周期时的UE、DWI资料,分别计算NAC 4个周期时病灶最大弹性值（Emax）、表观扩散系数（ADC）较NAC前的变化率（△Emax、△ADC）,绘制受试者工作特征（ROC）曲线分析UE与DWI对乳腺癌NAC疗效的早期预测价值。结果 37例乳腺癌患者共计完成210个化疗周期,Miller-Panye法评价p CR病灶15个,非病理完全缓解（p CR） 33个;较NAC前,p CR病灶、非p CRE_max均显著下降,ADC均显著上升,且非p CR病灶的△Emax、△ADC均显著低于p CR病灶（P<0.05）;单一UE参数预测NAC疗效时,△Emax敏感度、特异度最佳（73.30%、100.00%）,联合预测敏感度为80.00%,特异度为93.90%;单一DWI参数预测NAC疗效时,△ADC敏感度、特异度最佳（86.70%、75.80%）,DWI参数联合预测敏感度、特异度分别上升至93.30%、78.80%;UE参数联合DWI参数预测NAC疗效的AUC值为0.947,敏感度100.00%、特异度84.80%。结论 UE、DWI均可用于乳腺癌NAC早期疗效预测,且UE的预测效能不弱于DWI,联合应用可进一步提升早期预测效能,值得临床推介。更多还原

【Abstract】 Objective To analyze the early predictive value of ultrasound elastogra phy（UE） and d iff us ion-weighted imaging（DWI） on neoadjuvant chemotherapy（NAC） efficacy of breast cancer Methods Thirty-seven（48 lesions） patients with locally advanced breast cancer who underwent TEC regimen for NAC treatment from August 2016 to March 2018 were enrolled in the study.The UE and DWI data were analyzed before NAC and at 4 cycles of NAC,and the maximum elastic value（Emax） and apparent diffusion coefficient（ADC） at 4 cycles of NAC and the change rates compa red with before NAC(△E_max,AADC) were calculated,and the receiver operating cha racteristic（ROC） cu rve was used to analyze the early predictive value of UE and DWI on NAC efficacy of breast cancer.Results A total of 210 cycles of chemothera py were performed in 37 patients with breast cancer.The Miller-Panye method evaluated15 pCR lesions and 33 non-pathological complete regress（pCR）.Compared with before NAC,Emax values of pCR lesions,and non-pCR we re significa ntly decreased while ADC was significantly increased,and the △E_max and △ADC of non-pCR lesions were significantly lower than those of pCR lesions（all P<0.05）.In predicting NAC efficacy by single UE parameters,the sensitivity,and specificity of △E_maxwere the best（73.30%,100.00%）,and thesensitivityandspecificity of combined prediction were80.00% and 93.90%.In predicting NAC efficacy by single DWI parameters,the sensitivity and specificity of AADC were the best（86.70%,75.80%）,and thesensitivity and specificity of combined prediction of DWI parameters were increased to 93.30% and 78.80%,respectively.The AUC value,sensitivity and specificity of UE param eters combined with DWI pa rameters in predicting NAC effica cywere 0.947,100.00%,and 84.80%.Conclusion Both UE and DWI can be used for early prediction of NAC efficacy in breast cancer,and the predictive efficacy of UE is not weaker than DWI.Combined application can further improve ea rly predictive effica cy and is worthy of clinical recommendation.更多还原