本文選題：聲觸診組織定量技術(shù)　切入點(diǎn)：乳腺癌　出處：《皖南醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討常規(guī)超聲在乳腺癌腋窩淋巴結(jié)轉(zhuǎn)移的臨床應(yīng)用價(jià)值及探討聲觸診組織定量技術(shù)(VTQ)對乳腺癌腋窩淋巴結(jié)轉(zhuǎn)移的鑒別診斷價(jià)值,并分析影響VTQ技術(shù)的相關(guān)因素;通過繪制ROC曲線來找到判斷乳腺癌腋窩淋巴結(jié)轉(zhuǎn)移與否的最佳VTQ截點(diǎn)值,為臨床醫(yī)生提供判斷乳腺癌腋窩淋巴結(jié)轉(zhuǎn)移與否新的觀察值;比較常規(guī)超聲、聲觸診組織定量技術(shù)及二者聯(lián)合對乳腺癌腋窩淋巴結(jié)轉(zhuǎn)移的診斷價(jià)值;最后應(yīng)用Logistic回歸模型分析影響乳腺癌腋窩淋巴結(jié)性質(zhì)判斷因素的相關(guān)性,并篩查出判斷乳腺癌腋窩淋巴結(jié)性質(zhì)的超聲敏感指標(biāo)。方法:收集2015年10月--2016年10月期間以“乳腺包塊”為主訴收住皖南醫(yī)學(xué)院第一附屬醫(yī)院甲乳外科共75例患者,所選取患者均為女性,最小年齡35歲,最大年齡82歲,中位年齡57歲。入選標(biāo)準(zhǔn):(1)在做乳腺超聲檢查前未做放化療治療;(2)在做乳腺超聲前未做穿刺活檢。(3)在做乳腺彩超檢查前未做鉬靶等檢查;(4)臨床檢查、超聲檢查未發(fā)現(xiàn)腋窩淋巴結(jié)腫大及未做腋窩淋巴結(jié)清掃術(shù)者排除;(5)患有全身感染性疾病及皮膚疾病及病理結(jié)果隨訪不理想的排除。利用西門子ACUSON S2000的高頻探頭9L4(4--9MHZ)對所選取患者進(jìn)行常規(guī)超聲及聲觸診組織定量技術(shù)檢查。囑患者平臥位或側(cè)臥位(必要時(shí)可將患者肩部墊起),上臂外展80o;對乳腺及腋窩淋巴結(jié)先進(jìn)行常規(guī)超聲檢查,重點(diǎn)觀察腋窩淋巴結(jié)的聲像圖,包括淋巴結(jié)位置,形態(tài),皮髓質(zhì)分界,皮質(zhì)厚度,淋巴血供等,當(dāng)淋巴結(jié)以最大切面顯示時(shí),穩(wěn)定圖像,測量淋巴結(jié)最大長徑、短徑及皮質(zhì)最厚處,然后對淋巴結(jié)啟用聲觸診組織定量(VTQ)技術(shù),獲取同一深度7次VTQ值;之后對所測值取平均值,最終選取平均值、最大值、最小值為觀察指標(biāo),計(jì)量資料用(?)±S表示。對于腋窩淋巴結(jié)多發(fā)者,選取距離乳腺較近的常規(guī)超聲高度可疑轉(zhuǎn)移性淋巴結(jié)作為觀察對象,最終以手術(shù)病理為金標(biāo)準(zhǔn)。常規(guī)超聲、聲觸診組織定量技術(shù)、常規(guī)超聲聯(lián)合聲觸診組織定量技術(shù)采用評分法評估乳腺癌腋窩淋巴結(jié)性質(zhì),統(tǒng)計(jì)學(xué)處理應(yīng)用SPSS 19.0軟件,計(jì)量資料用(?)±S表示,聲觸診組織定量(VTQ)值判斷乳腺癌腋窩淋巴結(jié)性質(zhì)采用獨(dú)立樣本t檢驗(yàn)。通過繪制受試者工作特征(ROC)曲線,獲取最佳截點(diǎn),計(jì)算常規(guī)超聲、聲觸診組織定量技術(shù)及常規(guī)超聲聯(lián)合聲觸診組織定量技術(shù)的敏感性、特異性及ROC曲線下面積并進(jìn)行分析比較;分析腋窩淋巴結(jié)的常規(guī)超聲及聲觸診組織定量技術(shù)特征聲像圖,包括縱橫之比(L/S),皮質(zhì)厚度、血流分級、血流分型、VTQ最大值、最小值、平均值,將其定為自變量,腋窩淋巴結(jié)轉(zhuǎn)移作為因變量。同時(shí)給予每個(gè)觀察指標(biāo)進(jìn)行賦值,與腋窩淋巴結(jié)轉(zhuǎn)移有關(guān)的指標(biāo)賦值1,其他指標(biāo)均賦值0。單因素分析采用t檢驗(yàn),多因素檢驗(yàn)采用Logistic回歸模型。最終以病理結(jié)果為金標(biāo)準(zhǔn),P0.05,有統(tǒng)計(jì)學(xué)意義。結(jié)果:本研究結(jié)果最終以腋窩淋巴結(jié)清掃術(shù)后病理結(jié)果為標(biāo)準(zhǔn),轉(zhuǎn)移性淋巴結(jié)44例,反應(yīng)性增生性淋巴結(jié)31例;常規(guī)超聲對乳腺癌腋窩淋巴結(jié)良惡性鑒別診斷的敏感度86.0%、特異度77.4%;聲觸診組織定量技術(shù)(VTQ)對乳腺癌腋窩淋巴結(jié)良惡性鑒別診斷的VTQ平均值的最佳截點(diǎn)值為1.83m/s,相對應(yīng)的敏感性、特異性分別為93.2%、90.3%,ROC曲線下面積(AUC)為0.991;常規(guī)超聲聯(lián)合聲觸診組織定量(VTQ)技術(shù)對乳腺癌腋窩淋巴結(jié)性質(zhì)鑒別診斷的敏感度86.4%、特異度91.9%。比較常規(guī)超聲、聲觸診組織定量技術(shù)、常規(guī)超聲聯(lián)合聲觸診組織定量技術(shù)在診斷乳腺癌腋窩淋巴結(jié)轉(zhuǎn)移與否的敏感性、特異性及ROC曲線下面積,得出聲觸診組織定量(VTQ)技術(shù)敏感性最高(93.2%);常規(guī)超聲聯(lián)合聲觸診組織定量技術(shù)特異性最高(91.9%);聲觸診組織定量技術(shù)ROC曲線下面積最高(0.991);轉(zhuǎn)移性、反應(yīng)性增生性淋巴結(jié)的VTQ最大值、最小值識別乳腺癌腋窩淋巴結(jié)性質(zhì)的最佳截點(diǎn)值分別為1.96m/s、1.76m/s,最大值敏感性較高(97.7%),最小值特異性較高(95.1%),最大值ROC曲線下面積較高(0.995);經(jīng)單因素分析應(yīng)用t檢驗(yàn)得出各指標(biāo)的顯著性SIG均為0.000(P0.05),有統(tǒng)計(jì)學(xué)意義。多因素Logistic分析顯示縱橫徑比、血流分級、血流分型、最大值、平均值等五項(xiàng)指標(biāo)是乳腺癌腋窩淋巴結(jié)轉(zhuǎn)移的危險(xiǎn)因素(回歸系數(shù)0,優(yōu)勢比1),皮質(zhì)厚度、最小值為乳腺癌腋窩淋巴結(jié)轉(zhuǎn)移的保護(hù)因素(回歸系數(shù)0,優(yōu)勢比1)。結(jié)論:聲觸診組織定量技術(shù)(VTQ)是一種新型的超聲檢查技術(shù),可以對乳腺癌腋窩淋巴結(jié)的質(zhì)地做出定量評價(jià),從而判斷其良惡性,為臨床醫(yī)生判斷提供了一個(gè)新的觀察指標(biāo);通過單因素分析及多因素分析結(jié)果發(fā)現(xiàn)縱橫之比、血流分級、血流分型、VTQ平均值、最大值對判斷腋窩淋巴結(jié)性質(zhì)具有一定程度的影響;聲觸診組織定量技術(shù)結(jié)合常規(guī)超聲對乳腺癌腋窩淋巴結(jié)良惡性診斷有了進(jìn)一步的提高,同時(shí)應(yīng)用Logistic回歸模型對影響乳腺癌腋窩淋巴結(jié)性質(zhì)判斷的多個(gè)指標(biāo)進(jìn)行分析,有助于我們在今后的工作中從多個(gè)方面進(jìn)行綜合評估,進(jìn)一步提高超聲診斷腋窩淋巴結(jié)性質(zhì)的準(zhǔn)確性。
[Abstract]:Objective: To explore and discuss conventional ultrasound in breast cancer axillary lymph node metastasis and the clinical value of virtual touch tissue quantification (VTQ) and differential diagnosis for metastatic breast cancer axillary lymph nodes, and the related factors analysis of the influence of VTQ technology; through ROC curves to find breast cancer axillary lymph node metastasis and the best VTQ the cut-off point, whether axillary lymph node metastasis of breast cancer and whether the new observation value for clinicians; compared with conventional ultrasound, virtual touch tissue quantification and the combination of the two breast cancer axillary lymph node metastasis diagnosis value; finally the application of Logistic regression model to analyze the effects of axillary lymph node in breast cancer nature judgment factor correlation. And screening ultrasound sensitive indicators to determine the nature of the axillary lymph node in breast cancer. Methods: from October 2015 October --2016 year period to "breast mass" as the chief complaint admitted A breast surgery the First Affiliated Hospital of Wangnan Medical College, a total of 75 patients were selected, the patients were female, the minimum age of 35 years, the maximum age of 82 years old, the median age was 57 years. Inclusion criteria: (1) not done in radiotherapy and chemotherapy in the treatment of breast ultrasound; (2) in breast ultrasound before doing puncture biopsy. (3) not done in mammography, breast ultrasound examination before; (4) clinical examination, ultrasound examination showed no axillary lymph nodes and without axillary lymph node dissection were excluded; (5) suffering from systemic infectious diseases and skin diseases and pathological results exclude the ideal using follow-up. SIEMENS ACUSON S2000 9L4 high frequency probe (4--9MHZ) were examined by conventional ultrasound and virtual touch tissue quantification inspection on selected patients. The patients in supine position or lateral position (if necessary with shoulder pad), upper arm abduction 80O; on the breast and axillary lymph node by conventional ultrasound examination The investigation, observation on sonograms of axillary lymph nodes, including lymph node location, morphology, corticomedullary differentiation, cortical thickness, lymphatic blood supply, when the lymph nodes in the largest section display, stable image, measuring lymph node maximum diameter, short diameter and the thickness of cortex, and lymph node of virtual touch enabled quantitative tissue (VTQ) technology, to obtain the same depth of 7 VTQ; after the value measured by the average value, the final selection average value, maximum value, minimum value as observation indexes, measurement data with (?) + S. For the axillary lymph nodes of multiple, selected from conventional ultrasound from a breast in the highly suspected metastatic lymph nodes as the object of observation, the final surgical pathology as the gold standard. Conventional ultrasound, virtual touch tissue quantification, conventional ultrasound combined with virtual touch tissue quantification by evaluation of axillary lymph nodes in breast cancer, by SPSS 19 statistical software A measurement data with (?) + S, virtual touch tissue quantification (VTQ) values of axillary lymph node in breast cancer using independent samples t test. The receiver operating characteristic (ROC) curve, obtain the optimal cut-off point, calculation of conventional ultrasound, the sensitivity of virtual touch tissue quantification technique and conventional ultrasound combined with the virtual touch tissue quantification, specificity and the area under the ROC curve were analyzed and compared; analysis of axillary lymph node of conventional ultrasound and virtual touch tissue quantification sonographic characteristics, including aspect ratio (L/S), cortical thickness, blood flow, blood type VTQ, maximum value, minimum value, average value that will make it as independent variables, axillary lymph node metastasis as the dependent variable. At the same time to give each observation index assignment, axillary lymph node metastasis and 1 relevant indicators, other indicators are assigned 0. single factor analysis using t test, multi factor test using Log The istic regression model. Finally with pathological results as the gold standard, P0.05, have statistical significance. Results: the results of this study to axillary lymph node dissection and postoperative pathological results as the standard, metastatic lymph nodes in 44 cases, reactive hyperplasia of lymph nodes in 31 cases; 86% sensitivity to conventional ultrasound for breast cancer diagnosis and differential diagnosis of axillary fossa benign and malignant lymph nodes, the specificity was 77.4%; the virtual touch tissue quantification (VTQ) optimal cut-off for differential diagnosis of benign and malignant breast cancer axillary lymph node of the average value of VTQ is 1.83m/s, the corresponding sensitivity, specificity were 93.2%, 90.3%, ROC area under the curve (AUC) was 0.991; ultrasound combined with virtual touch tissue quantification (VTQ) technique with sensitivity of 86.4% differential diagnosis for breast cancer axillary lymph, specificity 91.9%. compared with conventional ultrasound, virtual touch tissue quantification, conventional ultrasound combined with virtual touch tissue quantification in the diagnosis of breast The sensitivity of metastasis of cancer axillary lymph gland, specificity and area under the ROC curve, the virtual touch tissue quantification (VTQ) technique is the highest sensitivity (93.2%); conventional ultrasound combined with virtual touch tissue quantification the highest specificity (91.9%); the virtual touch tissue quantification ROC area under the curve of the highest (0.991); metastasis the maximum value of VTQ reactive hyperplasia of lymph node, the minimum value of the optimal cut-off of axillary lymph node identification of breast cancer were 1.96m/s, 1.76m/s, maximum sensitivity (97.7%), the minimum value of high specificity (95.1%), the maximum value of the area under the ROC curve of high (0.995); single factor analysis significant SIG application of t test of the index that was 0 (P0.05), there was statistical significance. Logistic regression analysis showed that the aspect ratio, flow classification, flow type, maximum value, average value of five indexes is axillary lymph node metastasis in breast carcinoma Risk factors (regression coefficient 0, odds ratio 1), cortical thickness, the minimum value for breast cancer axillary lymph node metastasis protective factors (regression coefficient 0, odds ratio 1). Conclusion: the virtual touch tissue quantification (VTQ) is a new type of ultrasonic inspection technology, can make a quantitative evaluation of breast cancer patients lymph node texture, thus aectffate provides a new observation index for clinical judgment; through single factor analysis and multi factor analysis results show that the aspect ratio, flow classification, flow type, the average value of VTQ, the maximum impact on the judgment of axillary lymph node properties have a certain degree of routine; ultrasound has been further improved for axillary lymph node in breast cancer diagnosis of benign and malignant virtual touch tissue quantification based on multiple factors determine the nature of axillary lymph node in breast cancer were analyzed by Logistic regression model, help We work in the future from several aspects of comprehensive assessment, to further improve the accuracy of ultrasound in the diagnosis of axillary lymph node in nature.

【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.1;R737.9

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