本文選題：淋巴結(jié) + 轉(zhuǎn)移��； 參考：《廣西中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:探討二維灰階超聲聯(lián)合超微血管顯像技術(shù)(super microvascular imaging,SMI)在鑒別乳腺癌腋窩淋巴結(jié)轉(zhuǎn)移的價(jià)值,同時(shí)評(píng)價(jià)SMI在判斷腋窩淋巴結(jié)內(nèi)血流形態(tài)及分布類型的優(yōu)勢(shì)以及價(jià)值,為臨床鑒別腋窩淋巴結(jié)性質(zhì)提供新的思路。方法:篩選符合納入標(biāo)準(zhǔn)的乳腺癌患者的67枚腋窩淋巴結(jié)。使用Toshiba Aplio 500型彩色多普勒超聲診斷儀,14L5線陣探頭,頻率14.0MHz,配備SMI顯像內(nèi)置軟件。首先進(jìn)行常規(guī)的二維灰階超聲檢查,在二維超聲檢查的基礎(chǔ)上,使用彩色多普勒血流顯像(CDFI)及超微血管顯像(SMI)的標(biāo)準(zhǔn)程序?qū)α馨徒Y(jié)內(nèi)血管進(jìn)行顯像,選取淋巴結(jié)內(nèi)血管分布密度最大,分支最多、血流最豐富的切面,觀察血流分布狀況并記錄動(dòng)態(tài)影像以備分析。最后同一切面行超聲造影(CEUS)檢查,儲(chǔ)存動(dòng)態(tài)圖像以備分析。以病理檢查結(jié)果為定性診斷金標(biāo)準(zhǔn),分別計(jì)算二維灰階超聲聯(lián)合CDFI、二維灰階超聲聯(lián)合SMI及CEUS鑒別診斷淋巴結(jié)良惡性的敏感性,特異性,陽(yáng)性預(yù)測(cè)率,陰性預(yù)測(cè)率以及準(zhǔn)確率。再以CEUS判斷淋巴結(jié)內(nèi)微血管分布類型的結(jié)果為標(biāo)準(zhǔn),分析CDFI及SMI與CEUS對(duì)淋巴結(jié)內(nèi)微血管分布類型的一致性。最后對(duì)二維超聲征象及SMI評(píng)估腋窩淋巴結(jié)的血流分布類型及螺旋血管進(jìn)行多因素logistics回歸分析。結(jié)果:(1)以病理檢查結(jié)果為金標(biāo)準(zhǔn),二維灰階聯(lián)合CDFI診斷乳腺癌患者腋窩淋巴結(jié)的良惡性的準(zhǔn)確率73.1%。二維灰階聯(lián)合SMI診斷乳腺癌患者腋窩淋巴結(jié)的良惡性的準(zhǔn)確率86.6%。二維灰階聯(lián)合CEUS診斷乳腺癌患者腋窩淋巴結(jié)的良惡性的準(zhǔn)確率89.6%。二維聯(lián)合CEUS與CDFI準(zhǔn)確率差別有顯著統(tǒng)計(jì)學(xué)意義(χ2=5.950,P0.01);二維聯(lián)合SMI與CDFI準(zhǔn)確率差別有統(tǒng)計(jì)學(xué)意義(χ2=3.757,P0.05);二維聯(lián)合CEUS與SMI準(zhǔn)確率差別無(wú)統(tǒng)計(jì)學(xué)意義(χ2=0.284,P0.05)。(2)良性淋巴結(jié)內(nèi)微血管分布類型以II型-淋巴門型為主,轉(zhuǎn)移性淋巴結(jié)結(jié)內(nèi)微血管分布類型以IV型-混合型為主。以CEUS判斷淋巴結(jié)內(nèi)微血管分布類型的結(jié)果為標(biāo)準(zhǔn),CDFI與CEUS結(jié)內(nèi)血流分布的一致性比較高(Kappa=0.7070.75),SMI與CEUS結(jié)內(nèi)血流分布的一致性相當(dāng)高(Kappa=0.8580.75)。并統(tǒng)計(jì)分析發(fā)現(xiàn)CDFI、SMI及CEUS對(duì)淋巴結(jié)內(nèi)II型-淋巴門型的血流分布判斷存在非常高的一致性,其次是IV型-混合型。(3)使用SMI模式發(fā)現(xiàn)在轉(zhuǎn)移性淋巴結(jié)中特異性螺旋血管的檢出率為51.6%,進(jìn)行單因素logistics回歸分析OR值為18.133,OR值的95%可信區(qū)間為3.696~88.972,P0.05。(4)多因素logistics回歸分析結(jié)果顯示,SMI下腋窩淋巴結(jié)四種血流分布類型OR值為24.332,腋窩淋巴結(jié)中螺旋血管OR值為23.044,兩者回歸方程預(yù)測(cè)曲線的AUC 0.815,95%可信區(qū)間為0.709~0.921。結(jié)論:(1)二維聯(lián)合SMI與CEUS評(píng)價(jià)腋窩淋巴結(jié)性質(zhì)相比CDFI準(zhǔn)確率差別均有統(tǒng)計(jì)學(xué)意義,SMI與CEUS之間并無(wú)統(tǒng)計(jì)學(xué)差異,提示SMI及CEUS在評(píng)估腋窩淋巴結(jié)的性質(zhì)方面更具優(yōu)勢(shì)。(2)CDFI及SMI對(duì)淋巴結(jié)內(nèi)血流判斷的一致性均比較高,但SMI的Kappa0.75達(dá)到更高的一致性,提示了SMI對(duì)腋窩淋巴結(jié)內(nèi)血流分布類型的評(píng)估更加可靠。(3)SMI可以清晰顯示轉(zhuǎn)移淋巴結(jié)內(nèi)特異性螺旋血管,對(duì)SMI內(nèi)螺旋血管進(jìn)行單因素logistics回歸分析OR值為18.133,提示了SMI顯像發(fā)現(xiàn)螺旋血管有可能成為超聲評(píng)估淋巴結(jié)性質(zhì)的獨(dú)立風(fēng)險(xiǎn)因素。(4)SMI技術(shù)評(píng)估腋窩淋巴結(jié)血流分布類型及腋窩淋巴結(jié)中螺旋血管的多因素logistics回歸分析中提示了兩者的檢出為腋窩淋巴結(jié)性質(zhì)的重要預(yù)測(cè)因素,預(yù)測(cè)效果較好。
[Abstract]:Objective: To evaluate the value of super microvascular imaging (SMI) in the identification of axillary lymph node metastases in breast cancer, and to evaluate the advantages and value of SMI in determining the form and distribution of the blood flow in the axillary lymph nodes, and to provide a new way of thinking for the identification of axillary lymph nodes. 67 axillary lymph nodes of breast cancer patients were selected in accordance with the inclusion criteria. The Toshiba Aplio 500 color Doppler ultrasound diagnostic apparatus, the 14L5 linear array probe, the frequency 14.0MHz, and the built-in SMI imaging software were used. First, the conventional two-dimensional gray scale ultrasound examination was performed on the basis of the two-dimensional ultrasound examination, and the color Doppler flow imaging (CDFI) was used. The blood vessels in the lymph nodes were scintid with the standard procedure of SMI, and the maximum distribution density, the most branches and the most abundant tangent surfaces in the lymph nodes were selected. The distribution of blood flow was observed and the dynamic images were recorded for analysis. Finally, the dynamic images were stored for analysis with all surfaces, and the dynamic images were stored for analysis. The results of the examination were qualitative diagnostic gold standard. The sensitivity, specificity, positive predictive rate, negative predictive rate and accuracy of two-dimensional gray scale ultrasound combined with CDFI, two-dimensional gray scale ultrasound combined with SMI and CEUS in the differential diagnosis of lymph node benign and malignant, and the criteria for determining the microvascular distribution in the lymph nodes by CEUS were used for the analysis of CDFI and SMI. The pattern of microvascular distribution in the lymph nodes was consistent with CEUS. Finally, a multi factor logistics regression analysis was performed on two-dimensional ultrasound signs and SMI assessment of the distribution of the axillary lymph nodes and the spiral vessels. Results: (1) the pathological examination was the gold standard, and the two dimensional gray scale combined with CDFI in the diagnosis of the benign and malignant axillary lymph nodes of the breast cancer patients Accuracy of 73.1%. two-dimensional gray scale combined with SMI in the diagnosis of benign and malignant axillary lymph nodes in breast cancer patients the accuracy of 86.6%. two-dimensional gray scale combined with CEUS for the diagnosis of benign and malignant axillary lymph nodes in breast cancer patients 89.6%. two dimensional combination of CEUS and CDFI accuracy has significant statistical significance (x 2=5.950, P0.01); two-dimensional joint SMI and CDFI quasi accurate The difference in accuracy was statistically significant (x 2=3.757, P0.05); there was no statistically significant difference in the accuracy of the two dimensional combination of CEUS and SMI (x 2=0.284, P0.05). (2) the microvascular distribution in the benign lymph nodes was dominated by the II type lymphatic type, and the microvascular distribution in the metastatic lymph node was dominated by the IV type mixed type. The consistency of blood flow distribution in CDFI and CEUS is high (Kappa=0.7070.75). The consistency of blood flow distribution in SMI and CEUS is very high (Kappa=0.8580.75). Statistical analysis shows that CDFI, SMI and CEUS have very high consistency in judging the blood flow distribution of the II lymphohilus type in the lymph nodes, followed by IV type mixing. (3) the detection rate of specific spiral vessels in metastatic lymph nodes was found to be 51.6% by the SMI model. The OR value of single factor logistics regression analysis was 18.133, the 95% confidence interval of OR value was 3.696~88.972, and P0.05. (4) multiple factor logistics regression analysis showed that the OR value of four kinds of blood flow distribution in axillary lymph nodes under SMI was 24.332, The OR value of spiral vessels in the axillary lymph nodes was 23.044, and the AUC 0.815,95% confidence interval of the regression equation prediction curve was 0.709~0.921. conclusion: (1) the difference of CDFI accuracy was statistically significant compared with the SMI and CEUS in the evaluation of the axillary lymph node properties, and there was no statistical difference between SMI and CEUS, suggesting that SMI and CEUS were in the evaluation of axillary lymph nodes. (2) the consistency of CDFI and SMI in the determination of blood flow in the lymph nodes was higher, but the Kappa0.75 of SMI reached a higher consistency, suggesting that the assessment of the type of blood flow distribution in the axillary lymph nodes was more reliable. (3) SMI could clearly show the specific spiral vessels in the metastatic lymph nodes and the spiral vessels within the SMI. The OR value of single factor logistics regression analysis was 18.133, suggesting that SMI imaging found that spiral vessels may be an independent risk factor for evaluating the properties of lymph nodes. (4) the multiple factor logistics regression analysis of the distribution types of axillary lymph nodes and the spiral vessels in the axillary lymph nodes by SMI technique suggests the detection of both of the two. The important predictors of axillary lymph node properties are better predictors.

【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.1;R737.9

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 金佳美;詹嘉;刁雪紅;柴啟亮;王海爾;陳悅;;超微血管顯像技術(shù)在鑒別診斷淋巴結(jié)良惡性中的應(yīng)用[J];中國(guó)醫(yī)學(xué)影像技術(shù);2015年12期

2 程令剛;何文;張紅霞;蔡文佳;寧彬;田鳳蘭;;超微血管成像評(píng)價(jià)頸動(dòng)脈斑塊內(nèi)新生血管[J];中國(guó)醫(yī)學(xué)影像技術(shù);2015年05期

3 詹嘉;陳璐;萬(wàn)敏;王慧芳;陳悅;;微血管成像技術(shù)探查BI-RADS 4類乳腺腫塊內(nèi)穿支血管的價(jià)值[J];中國(guó)超聲醫(yī)學(xué)雜志;2014年11期

4 李濤;林劍英;陳茹;劉觀成;;超聲增強(qiáng)型血流成像技術(shù)在乳腺癌腋窩轉(zhuǎn)移性淋巴結(jié)診斷中的應(yīng)用[J];廣東醫(yī)學(xué);2014年08期

5 位紅芹;文戈;李穎嘉;王偉鎮(zhèn);鄒禮正;;乳腺癌腋窩淋巴結(jié)超聲征象多元回歸分析[J];臨床超聲醫(yī)學(xué)雜志;2011年06期

6 蔣s，

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