患者女,74 岁,发现外阴肿块进行性增大半年,伴疼痛 2 个月;既往孕4 产3,绝经18 年,高血压病史30 年.体格检查:老年型外阴,左侧大阴唇见 10.0 cm×5.0 cm×5.0 cm长条状菜花样肿物,上达阴蒂,紧邻尿道外口,下达会阴体,右侧达阴道口,质地糟脆;周围大阴唇红肿、压痛;阴道通畅.

ObjectivesThe potential role of shear wave elastography (SWE) and superb microvascular imaging (SMI) for early assessment of treatment response to neoadjuvant chemotherapy (NAC) in breast cancer remains unexplored. This study aimed to identify potential factors associated with the pathological response to NAC using these advanced ultrasound techniques.MethodsBetween August 2021 and October 2022, 68 patients with breast cancer undergoing NAC were recruited. Patients underwent conventional ultrasonography, SMI, and SWE examinations at baseline and post-2nd cycle of NAC. Maximum tumor diameter (Dmax), maximum elastic value (Emax), peak systolic velocity (PSV), and resistance index (RI) at baseline and the rate of change of these parameters post-2nd cycle were recorded. After chemotherapy, all patients underwent surgery. Using the Miller-Payne’s grade, patients were categorized into response (grades 3, 4, or 5) and non-response (grades 1 or 2) group. Parameters were compared using t-tests at baseline and post-2nd cycle. Binary logistic regression analysis was used to identify variables and their odds ratios (ORs) related to responses and a prediction model was established. ROC curves were drawn to analyze the efficacy of each parameter and their combined model for early NAC response prediction.ResultsAmong the 68 patients, 15(22.06%) were categorized into the non-response group, whereas 53(77.94%) were categorized into the response group. At baseline, no significant differences were observed between the two groups (p>0.05). Post-2nd cycle of NAC, rates of change of Emax, PSV and RI (ΔEmax, ΔPSV and ΔRI) were higher in responders than non-responders (p<0.05). Binary logistic regression analysis revealed that ΔEmax (OR 0.797 95% CI, 0.683–0.929), ΔPSV (OR 0.926, 95%CI, 0.860–0.998), and ΔRI (OR 0.841, 95%CI, 0.736–0.960) were independently associated with the pathological response of breast cancer after NAC. The combined prediction model exhibited higher accuracy in the early evaluation of the response to NAC (AUC 0.945, 95%CI, 0.873–1.000).ConclusionSWE and SMI techniques enable early identification of tumor characteristics associated with the pathological response to NAC and may be potentially indicative of an effective response. These factors may eventually be used for the early assessment of NAC treatment for clinical management.

孕妇26 岁,孕1 产0 ,外院超声示胎儿左上腹囊实性包块;无特殊病史及家族史.查体及实验室检查均未见明显异常.孕36 周超声:胎儿左上腹近中线处?腹主动脉左前方?左肾与左肾上腺之间3. 6 cm × 2.6 cm 囊实性包块,边界较清,周边见绕行血管(图1A) ;考虑左肾上腺出血.

患者女,53岁,阴道不规则出血4天并曾晕厥,伴下腹部持续性胀痛;孕1产1,近9个月月经紊乱,停经3个月.查体:体温36.3℃,脉搏85次/分,血压130/70 mmHg;腹部膨隆,压痛、反跳痛及移动性浊音阳性;宫颈肥大,举痛阳性.实验室检查:人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)16 000.00 mIU/ml,红细胞计数 3.01×1012/L,血红蛋白96.0 g/L,血小板计数161.0×109/L,凝血功能未见明显异常.

患者女,62岁,乏力伴消瘦3月余;左肩背部皮肤恶性黑色素瘤局部切除术后3年,发现颅内占位1周,考虑脑转移癌.查体:右侧肢体轻度活动障碍,右手精细动作欠佳;左肩背部见12 cm × 12 cm术后瘢痕.实验室检查:大便隐血(+).全腹CT:子宫左前方直径4.7 cm类圆形软组织密度影,增强后呈渐进性不均匀强化并包裹小肠(图 1A ).

目的 探讨超声造影(CEUS)及彩色多普勒超声(CDUS)评估乳腺癌新辅助化疗(NAC)疗效及早期应答预测价值.方法 对39例乳腺癌患者进行NAC前后应用CEUS,对比病灶大小、造影参数.结果 在NAC前后,CEUS在测量病灶大小方面优于CDUS.CEUS定量参数TTP、AUC前后相对变化率与M.P分级之间差异有统计学意义(P＜0.05).CEUS评价乳腺癌NAC疗效的灵敏度、特异度、准确率分别为64.29％、88.0％、79.49％;CDUS评价乳腺癌NAC疗效的灵敏度、特异度、准确率分别为42.11％、80.00％、61.54％.结论 CEUS在乳腺癌NAC前后测量病灶大小方面优于彩色多普勒超声,CEUS较彩色多普勒超声对NAC早期疗效有更好的预测效能,定量参数AUC、TTP相对变化率有助于评估乳腺癌新辅助化疗疗效及化疗早期应答的预测.

目的 通过制备聚乳酸/羟基乙酸共聚物(PLGA)包载声敏剂二氢卟吩(Ce6)和全氟戊烷(PFP)的相变型纳米粒(Ce6@PFP/PLGA NPs),联合低强度聚焦超声(LIFU)的辐照作用,探讨其增强超声显影、促进乳腺癌细胞凋亡和抑制转移的能力.材料与方法 采用双乳化法制备Ce6@PFP/PLGA纳米粒,观察不同功率LIFU辐照下其相变和体外显影情况,并验证其安全性.采用2,7-二氯二氢荧光素二乙酸荧光探针检测其活性氧产生情况.Calcein/PI双染法验证其声动力治疗效果,并检测其抑制4T1乳腺癌细胞转移效果.结果 Ce6@PFP/PLGA纳米粒镜下形态规则,粒径(230.0±50.5)nm.经过LIFU辐照后,显示4 W时相变及显影效果最佳.纳米粒和4T1乳腺癌细胞共孵育后,细胞存活率>85％;LIFU和纳米粒共同作用后,细胞凋亡明显增加,细胞迁移明显受到抑制,迁移面积分别为(187.72±4.02)、(129.90±11.22)、(120.83±10.47)和(31.87±1.16)平方像素,差异有统计学意义(F=131,P<0.05).结论 Ce6@PFP/PLGA纳米粒在LIFU辐照下对超声显影、声动力治疗及抑制肿瘤细胞转移方面具有重要作用,有望成为乳腺癌治疗的新模式.