| PART1 The diagnostic and staging value of real-time ultrasonic elastography for cervical cancerObjectiveTo explore the value of real-time ultrasonic elastography in the differential diagnosis of cervical disease,and to evaluate the clinical stage of the cervical cancer.Methods40 cases of cervical cancer,40 cases of cervical benign tumor-like lesions and 40 normal persons to be hospitalized from October 2014 to January 2017 were collected.All patients underwent conventional ultrasound and ultrasonic elastography.The images and data were analyzed,and the diagnostic value of ultrasonic elastography imaging and conventional ultrasound imaging for cervical lesions were compared and analyzed.Results1.29 cases of cervical benign tumor-like lesions(12 cases of leiomyoma and 17 cases of polyps)on conventional ultrasound imaging can be given an accurate diagnosis,and the diagnostic accuracy rate was 72.5%(29/40).In details,the diagnosis accuracy of cervical myoma and cervical polyp were 75%vs.70.8%(12/16 vs 17/24).In contrast,32 cases of cervical cancer were given an accurate diagnosis by conventional ultrasound,and the diagnostic accuracy was 80%(32/40).2.? If the elasticity score that not more than 2 points was used as diagnostic criteria for cervical benign tumor-like lesions,38 of 40 cases(95%)met the diagnostic standard.If the elasticity score that not less than 3 points was used as diagnostic criteria for cervical cancer,38 of 40 cases(95%)met the diagnostic standard as well.? There was significant difference of strain ratio between the cervical cancer group and the cervical benign mass group(P<0.01).As show,the cervical cancer were distributed in 1.5 to 7.5 interval,while the benign tumor-like lesions of the basic distribution in the interval from 0 to 1.5.? The mean SWV of cervical cancer group was higher than that of cervical benign mass group and normal cervix group,and the difference was significant(P<0.05).However,there was little difference between cervical benign mass group and normal cervix group(P>0.05).3.? On measurement of lesion size,the elastography and pathological findings were larger than that of conventional ultrasound(P<0.05 and P<0.01),and the findings on elastography were similar to the pathological findings(P>0.05).? Compared to pathological diagnosis of focal infiltration of uterine and vaginal vault,the diagnosis accuracy of ultrasonic elastography was higher than that of conventional ultrasound.4.40 cases of cervical cancer patients had surgical pathology,and the staging accuracy of ultrasonic elastography was 85.0%(34/40).And,the ultrasonic elastography imaging of tumor staging was not significantly different from the surgical pathology,statistically(P>0.05).Also,when we using the ultrasonic elastography imaging to evaluate parametrial invasion,the sensitivity was 77.7%and the specificity was 92.8%.Conclution1.Ultrasonic elastography imaging can differentiate the benign and malignant lesions of the cervix.2.The elastic score,strain rate ratio and shear wave velocity of cervical carcinoma were higher than that of the cervical benign tumor-like lesions.3.Ultrasonic elastography imaging is of great significance for the staging and invasion of cervical cancer.PART 2 Evaluation and predictive value of real-time ultrasound imaging in the treatment of cervical cancerObjectiveTo explore the curative effect of three dimensional conformal radiation therapy(3D-CRT)combined with chemotherapy in the treatment of cervical cancer,and to evaluate the predictive value of the curative effect.Methods60 cases of advanced cervical cancer patients from October 2014 to January 2017 hospitalized were collected.All patients were treated with three dimensional conformal radiation therapy combined with chemotherapy therapy.The conventional ultrasound and ultrasonic elastography were obtained before treatment and 6 months after treatment.Whether the tumor residual or not were observed,and the residual tumor lesion size were recorded in 6 months after treatment.The elastic score,strain rate(SR)ratio and shear wave velocity(SWV)were recorded before treatment.The change of the elastic parameters of the tumor was analyzed before and after treatment.According to the residual tumor or not after treatment,the patients were classified as no tumor residual group and the residual group.The difference of elastic score,strain rate ratio(SR)and shear wave velocity(SWV)between the two groups of patients were analyzed.The difference of shear wave velocity(SWV)of residual lesions in patients with no residual tumor after treatment was analyzed.Results1.There were 31 cases of complete tumor remission(CR),accounting for 51.67%,19 cases of partial remission(PR),10 cases of stable disease(SD)and 0 cases of disease progression(PD).The rate of response rate was 83.33%,and the rate of clinical control was 100%.2.There were none residual tumor in 31 cases,and 29 cases had residual tumor.The cumulative survival rate of the none residual group was higher,but there was no significant difference between the two groups.3.The elastic score,strain rate ratio(SR)and shear wave velocity(SWV)of 60 cases of cervical cancer patients after treatment were decreased than before treatment,and the difference was significant.4.Compared to the patients in residual group,the hardness of the lesion before treatment was lower in no residual group.The change of SWV rate was lower in the residual group than that in the no residual group.5.There was no significant difference of the mean SWV between stable disease group and partial response group after treatment.Conclusions1.Real-time ultrasound elasticity imaging could give an evaluation to the curative effect of cervical cancer.2.Real-time ultrasound elasticity imaging has a certain value to predict the curative effect of cervical cancer.Main Innovative Points1.The study was to apply real-time ultrasound elasticity imaging to the diagnosis of cervical cancer by semi-quantitative and quantitative analysis.2.The study was to use real-time ultrasound elasticity imaging to explore the clinical staging of cervical cancer.3.The study was the first to use real-time ultrasound elasticity imaging to predict the therapeutic effect of cervical cancer,which could provide more comprehensive information before the treatment regimen established. |
PDF Full Text Request