本文選題：超聲　切入點(diǎn)：非腫塊型病變　出處：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景與目的乳腺疾病是一種常見(jiàn)病、多發(fā)病,是危害婦女身心健康及生存質(zhì)量的主要疾病,主要分為乳腺炎、增生、纖維腺瘤、囊腫、癌等,其中乳腺癌的發(fā)病率居高不下,位居女性惡性腫瘤之首,并且其發(fā)病日漸年輕化,導(dǎo)致乳腺疾病發(fā)生發(fā)展的因素比較復(fù)雜,若發(fā)現(xiàn)不及時(shí)、治療不恰當(dāng)就可隨時(shí)導(dǎo)致生命危險(xiǎn),因此乳腺疾病的早期準(zhǔn)確的診斷是至關(guān)重要的。超聲檢查以其實(shí)時(shí)、簡(jiǎn)便、快捷、無(wú)輻射、無(wú)創(chuàng)、患者的依從性好、價(jià)格低、可反復(fù)進(jìn)行等一系列優(yōu)點(diǎn),是目前鑒別乳腺病灶的常規(guī)檢查方法。在乳腺疾病的超聲檢查中,我們經(jīng)常遇到一些不符合腫塊定義的病變,例如:邊界模糊的低回聲、雜亂回聲、管狀低回聲等。這類病變中不乏乳腺惡性病變,因此對(duì)這類非腫塊型病變的準(zhǔn)確診斷不容忽視。然而乳腺影像報(bào)告與數(shù)據(jù)系統(tǒng)(breast imaging-reporting and data system,BI-RADS)分類的超聲部分并沒(méi)對(duì)“非腫塊”的定義。以往研究顯示在超聲中發(fā)現(xiàn)的不符合腫塊定義的病變?cè)诖殴舱癯上?magnetic resonance imaging,MRI)中通常表現(xiàn)為非腫塊型強(qiáng)化方式,且超聲上不符合腫塊定義的病變經(jīng)病理證實(shí)為乳腺癌的病變中,95%在磁共振成像中也表現(xiàn)為非腫塊樣強(qiáng)化方式。據(jù)此,本研究回顧性分析磁共振成像上表現(xiàn)為非腫塊樣強(qiáng)化(non-mass like enhancement,NMLE)病灶的超聲表現(xiàn),并與病理診斷結(jié)果對(duì)比分析,旨在提高超聲對(duì)非腫塊型乳腺病變的認(rèn)識(shí)和診斷水平。資料與方法1.第一部分:收集2013.01~2014.01間在我院放射科完成乳腺磁共振及超聲檢查且有病理結(jié)果的156例NMLE患者,均為女性,年齡28~72歲(平均45±8歲),臨床資料完整,無(wú)磁共振檢查禁忌證,乳腺M(fèi)RI檢查時(shí)間為月經(jīng)后3天~2周。納入標(biāo)準(zhǔn):在MRI上由2位5年以上經(jīng)驗(yàn)的醫(yī)師共同判斷為NMLE(平掃T1WI病灶信號(hào)與周圍腺體信號(hào)無(wú)明確分界,增強(qiáng)掃描無(wú)明確的占位效應(yīng)),同時(shí)行超聲檢查;均有術(shù)后病理組織診斷結(jié)果,經(jīng)由2位5年以上經(jīng)驗(yàn)的病理醫(yī)師復(fù)驗(yàn)切片,且結(jié)果一致。2.第二部分:選取第一部分中超聲表現(xiàn)為片狀低回聲的病灶,對(duì)其進(jìn)行剪切波彈性成像,Q-Box的直徑為2mm,置于病灶最硬的區(qū)域,得到其楊氏模量平均值,獲得最佳診斷界值,以探討彈性成像對(duì)其診斷價(jià)值。結(jié)果1.156例乳腺非腫塊樣強(qiáng)化病變中,術(shù)后病理診斷為良性的病變92例(59.0%),惡性病變64例(41.0%);超聲上表現(xiàn)為片狀低回聲96例(61.5%)、雜亂回聲16例(10.3%)、乳腺導(dǎo)管擴(kuò)張18例(11.5%)、簇狀分布的微鈣化4例(2.6%)、超聲表現(xiàn)為陰性22例(14.1%)2.BI-RADS分類2類的病變10例,3類的病變52例,4類的病變58例,5類的病變14例。超聲診斷的敏感性77.8%、特異性59.5%、陽(yáng)性預(yù)測(cè)值77.8%、陰性預(yù)測(cè)值80.6%。3.惡性組的腋窩異常淋巴結(jié)、血流信號(hào)(+)發(fā)生率均高于良性組(前者x2=7.809,P=0.005;后者x2=36.914,P=0.000)。合并鈣化的病灶共14例,4例為良性,10例為惡性。4.剪切波彈性成像對(duì)超聲表現(xiàn)為片狀低回聲的病灶進(jìn)行鑒別診斷的曲線下面積(AUC)為0.879,良性組的楊氏模量平均值為(37.76±8.21)kPa,惡性組的楊氏模量平均值為(78.84±24.21)kPa,最佳診斷界值為45.53kPa,以此界值鑒別診斷其良惡性時(shí),診斷的敏感性、特異性分別為83.5%、77.2%。結(jié)論1.乳腺非腫塊型病變?cè)诔Ｒ?guī)超聲中可表現(xiàn)為片狀低回聲、雜亂回聲、乳腺導(dǎo)管擴(kuò)張、簇狀分布的微鈣化等,也可表現(xiàn)為(-)。2.其中合并腋窩異常淋巴結(jié)的病灶、血流信號(hào)(+)的病灶惡性可能性更大,病變內(nèi)部鈣化灶的存在對(duì)惡性診斷有一定意義。3.乳腺非腫塊型病變?cè)诔Ｒ?guī)超聲中多表現(xiàn)為診斷不明確的BI-RADS分類3、4類的片狀低回聲,常規(guī)超聲對(duì)其診斷的敏感性尚可,特異性較低。4.剪切波彈性成像對(duì)超聲表現(xiàn)為片狀低回聲的非腫塊型病變具有一定的診斷價(jià)值。
[Abstract]:Background and objective: breast disease is a common disease, frequently occurring disease, are the main diseases endangering the physical and mental health and quality of life of women, mainly divided into mastitis, hyperplasia, fibroadenoma, cyst, cancer, the incidence of breast cancer is high, ranking the first female malignancy, and its incidence is younger, causes the occurrence and development of breast disease is more complex, if not timely, inappropriate treatment can lead to danger, therefore the early diagnosis of breast diseases accurately is very important. Ultrasound to actually, convenient, fast, no radiation, non-invasive, patient compliance is good, the price is low, a series of advantages can be repeated, is currently in differential diagnosis of breast lesions. Ultrasound in routine examination of breast diseases, we often encounter some do not meet the definition of mass lesions, for example: fuzzy boundaries of low echo, clutter Echo, low echo and so on. Some of the tubular lesions in breast malignant lesions, therefore the accurate diagnosis of this kind of non mass lesions can not be ignored. However, breast imaging reporting and data system (breast Imaging-Reporting and data system, BI-RADS) ultrasound part classification did not define "non mass". Previous studies show that in ultrasound does not meet the definition of mass lesions in magnetic resonance imaging (magnetic resonance, imaging, MRI) is usually non mass enhancement, and ultrasound does not meet the definition of mass lesions pathologically confirmed breast cancer lesions, 95% in magnetic resonance imaging as well as non mass like enhancement accordingly, this study retrospectively analyzed the magnetic resonance imaging showed non mass like enhancement (non-mass like enhancement, NMLE) ultrasound manifestations and pathological diagnosis of lesions, and results of the comparative analysis, in order to To improve the ultrasonic understanding of non palpable breast lesions and diagnosis. Materials and methods 1. the first part: a collection of 2013.01~2014.01 in our hospital radiology breast MRI and ultrasound examination and 156 cases of NMLE patients with pathological results, all female, aged 28~72 years old (average 45 + 8 years), with complete clinical data no, MRI contraindications, breast MRI examination time is 3 days after menstruation ~2 weeks. Inclusion criteria: MRI by 2 more than 5 years experience of physicians together to determine the NMLE (scan T1WI lesion signal and surrounding gland signal without clear boundary scan, no space occupying effect, clear enhancement) at the same time with ultrasonography; postoperative pathological diagnosis results, by 2 pathologists for more than 5 years experience in re inspection section, and the results were consistent with.2. second parts: the first part selected ultrasound showed patchy hypoechoic lesions of the elastic shear wave 鎴愬儚,Q-Box鐨勭洿寰勪負(fù)2mm,緗簬鐥呯伓鏈，

本文編號(hào)：1729240