本文選題：SWE + 經(jīng)陰道超聲��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:1.經(jīng)陰道超聲剪切波彈性成像技術(shù)(Shear-wave elastography SWE)測(cè)量宮頸癌、宮頸上皮內(nèi)瘤變(cervical intraepithelial neoplasia CIN)及正常宮頸組織的彈性模量值,評(píng)價(jià)其定量鑒別診斷宮頸良惡性病變的價(jià)值。2.經(jīng)陰道超聲SWE顯示宮頸癌、CIN及正常宮頸組織的彈性圖像,評(píng)價(jià)其定性鑒別診斷宮頸良惡性病變的價(jià)值。3.研究并評(píng)估超聲綜合評(píng)分法、彈性模量最大值和彈性模量平均值鑒別診斷良惡性宮頸病變的價(jià)值。方法:選取2014年12月到2016年12月在本院就診的150例宮頸病變患者,共有150個(gè)病灶,所有患者均經(jīng)手術(shù)病理確診,其中宮頸癌53例,CIN 97例。另外選取健康受試者30例作為對(duì)照組。按照病理結(jié)果將上述受試者分為宮頸癌組,CIN組和正常組。150例患者在手術(shù)切除前通過(guò)使用法國(guó)Super Sonic Imagine Aix Plorer超聲診斷儀進(jìn)行經(jīng)陰道二維超聲、彩色多普勒及SWE檢查。健康受試者均進(jìn)行經(jīng)陰道二維超聲檢查及經(jīng)陰道SWE檢查。觀察三組受試者的彈性圖像差異,并測(cè)定彈性模量最大值和平均值。用((?)±s)表示計(jì)量資料,采用單因素方差分析比較多組間的差異,兩組間的比較采用S-N-K檢驗(yàn)。綜合評(píng)分常規(guī)超聲指標(biāo)和彈性模量值,評(píng)分指標(biāo)為:(1)血流的分級(jí);(2)頻譜多普勒RI值;(3)彈性模量最大值;(4)彈性模量平均值,根據(jù)超聲各診斷標(biāo)準(zhǔn)對(duì)宮頸良惡性病變進(jìn)行診斷,將各個(gè)指標(biāo)的結(jié)果量化為分值,然后將分值累加為綜合評(píng)分,即為(5)超聲綜合評(píng)分法。以病理檢查結(jié)果為金標(biāo)準(zhǔn),繪制(3)、(4)與(5)診斷宮頸良惡性病變的受試者工作曲線(xiàn)(Receiver Operating Characteristic curve ROC)曲線(xiàn),比較三種不同檢查方法的診斷價(jià)值。采用z檢驗(yàn)對(duì)(3)、(4)、(5)曲線(xiàn)下面積(Area under the curve AUC)進(jìn)行比較,利用卡方檢驗(yàn)對(duì)(3)、(4)、(5)的敏感度、特異度進(jìn)行比較。結(jié)果:1.宮頸惡性病變的彈性圖像表現(xiàn)為紅色或橘紅色占主要部分,其間或夾雜著綠色;CIN病變彈性圖像表現(xiàn)為分布均勻的藍(lán)色;正常宮頸彈性圖像也表現(xiàn)為分布均勻的藍(lán)色。2.經(jīng)陰道超聲SWE檢查顯示,宮頸癌組與CIN組的彈性模量最大值和平均值比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。宮頸癌組與正常組的彈性模量最大值和平均值之間差異也有統(tǒng)計(jì)學(xué)差異(P0.05)。CIN組與正常組的彈性模量最大值和平均值之間差異無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。3.彈性模量最大值以32.38k Pa為診斷良惡性的臨界點(diǎn)時(shí),其診斷宮頸癌的準(zhǔn)確度、敏感度、特異度、陽(yáng)性預(yù)測(cè)值(Positive predictive value PPV)和陰性預(yù)測(cè)值(negative predictive value NPV)分別為89.33%,86.79%,90.72%,83.64%,92.63%。4.彈性模量平均值以30.16k Pa為診斷臨界點(diǎn)時(shí),其診斷宮頸癌的準(zhǔn)確度、敏感度、特異度、PPV和NPV分別為75.33%,66.04%,80.41%,64.81%和81.25%。5.超聲綜合評(píng)分法以3分為臨界值時(shí),其診斷宮頸癌的準(zhǔn)確度、敏感度、特異度、PPV和NPV分別為92.00%、90.57%、92.78%、87.27%和94.74%。6.超聲綜合評(píng)分法較彈性模量最大值的敏感度,特異度高(χ~2=21.49、34.62;P0.05);超聲綜合評(píng)分法較彈性模量平均值的敏感度、特異度高(χ~2=5.22、12.87;P0.05);彈性模量最大值的敏感度、特異度較彈性模量平均值高(χ~2=9.63、8.15;P0.05)。7.超聲綜合評(píng)分法、彈性模量最大值和平均值定量鑒別診斷宮頸癌的AUC分別為0.92、0.91和0.79,超聲綜合評(píng)分法準(zhǔn)確率較彈性模量平均值高(z=2.81,P0.05),與彈性模量最大值診斷的準(zhǔn)確率差異無(wú)統(tǒng)計(jì)學(xué)意義(z=0.65,P0.05)。彈性模量最大值與彈性模量平均值診斷的準(zhǔn)確率差異有統(tǒng)計(jì)學(xué)意義(z=2.62,P0.05)。結(jié)論:1.通過(guò)經(jīng)陰道超聲SWE技術(shù)觀察病灶內(nèi)充填的顏色,可以定性鑒別診斷宮頸癌及癌前病變。2.經(jīng)陰道超聲SWE技術(shù)在宮頸癌定量診斷方面有明顯的幫助;在診斷CIN方面沒(méi)有明顯的幫助。3.超聲綜合評(píng)分法診斷宮頸癌的準(zhǔn)確率與彈性模量最大值無(wú)明顯統(tǒng)計(jì)學(xué)差異,但是靈敏度和特異度均比彈性模量最大值高。4.超聲綜合評(píng)分法診斷宮頸癌的準(zhǔn)度率、靈敏度和特異度均比彈性模量平均值高。5.彈性模量值最大值診斷宮頸癌的準(zhǔn)度率、靈敏度和特異度也均比彈性模量平均值高。
[Abstract]:Objective: 1. Shear-wave elastography SWE (transvaginal ultrasound shear wave elastic imaging) was used to measure the elastic modulus of cervical cancer, cervical intraepithelial neoplasia (cervical intraepithelial neoplasia CIN) and normal cervical tissue, and the value of its quantitative differential diagnosis of cervical benign and malignant lesions was evaluated by transvaginal ultrasound SWE display of cervical cancer, CIN and SWE Elastic image of normal cervical tissue, evaluation of the value of qualitative differential diagnosis of cervical benign and malignant lesions.3. study and evaluation of the value of ultrasonic comprehensive score, modulus of elasticity and modulus of elasticity in the differential diagnosis of benign and malignant cervical lesions. Methods: 150 cases of cervical lesions in our hospital from December 2014 to December 2016 were selected. There were 150 lesions in all patients, all of them were confirmed by operation and pathology, including 53 cases of cervical cancer and 97 cases of CIN. In addition, 30 healthy subjects were selected as the control group. According to the pathological results, the subjects were divided into cervical cancer group, and the CIN group and the normal group.150 patients were treated by the French Super Sonic Imagine Aix Plorer ultrasound before the operation. The diagnostic apparatus was examined by transvaginal two-dimensional ultrasound, color Doppler and SWE. All the healthy subjects were examined by transvaginal two-dimensional ultrasound and transvaginal SWE. The differences in the elastic images of the three groups were observed and the maximum and average values of the modulus of elasticity were measured. The measurement data were expressed with (?) + s) and the multiple groups were compared by single factor analysis of variance. The difference between the two groups was compared with the S-N-K test. A comprehensive score of conventional ultrasound and modulus of elasticity was used to score: (1) the classification of the blood flow; (2) the Doppler RI of the spectrum; (3) the maximum modulus of elasticity; (4) the average of the modulus of elasticity; the diagnosis of the benign and malignant lesions of the cervix according to the diagnostic criteria of the ultrasound, and quantifying the results of each index as a result. Score, and then add the score to a comprehensive score, that is (5) the ultrasonic comprehensive scoring method. With the pathological examination results as the gold standard, (3), (4) and (5) the Receiver Operating Characteristic curve ROC curve line for the diagnosis of cervical and malignant lesions, compare the diagnostic value of three different examination methods. (3), (4), (4). ) (5) comparison of the area under the curve (Area under the curve AUC), using chi square test to compare the sensitivity and specificity of (3), (4), (5). Results: the elastic images of 1. cervical malignant lesions were red or orange in the main part, or mixed with green; the elastic images of CIN lesions showed a uniform distribution of blue; normal uterus. The cervical elastic image also showed a uniform distribution of blue.2. by transvaginal ultrasound SWE examination showed that the maximum and average value of the modulus of elasticity of the cervical cancer group and the CIN group was statistically significant (P0.05). The difference of the maximum and average value of the modulus of elasticity between the cervical cancer group and the normal group was also statistically significant (P0.05).CIN group and the normal group. There was no statistical difference between the maximum and average modulus of modulus of elasticity (P0.05) the maximum value of.3. modulus of elasticity with 32.38k Pa as the critical point for diagnosis of benign and malignant, the accuracy, sensitivity, specificity, positive predictive value (Positive predictive value PPV) and negative predictive value (negative predictive value NPV) were 89.3 respectively. 3%, 86.79%, 90.72%, 83.64%, and 92.63%.4. modulus mean value of 30.16k Pa as the critical point of diagnosis, the accuracy, sensitivity, specificity, PPV and NPV of cervical cancer were 75.33%, 66.04%, 80.41%, 64.81%, and 81.25%.5., respectively, with 3 points as critical values, and the accuracy, sensitivity, specificity, PPV and NP of cervical cancer were diagnosed. The sensitivity of V 92%, 90.57%, 92.78%, 87.27% and 94.74%.6. was higher than the maximum modulus of elastic modulus (x ~2=21.49,34.62; P0.05), and the sensitivity of the ultrasonic comprehensive scoring method was higher than that of the elastic modulus (x ~2=5.22,12.87; P0.05); the sensitivity of the maximum modulus of elasticity was higher than that of the elastic modulus, and the specificity was higher than the elastic modulus. The mean value (x ~2=9.63,8.15; P0.05).7. ultrasonic comprehensive scoring method, the maximum value of modulus of elasticity and the average value of the quantitative differential diagnosis of cervical cancer were 0.92,0.91 and 0.79 respectively. The accuracy of the ultrasonic comprehensive scoring method was higher than that of the elastic modulus (z=2.81, P0.05). There was no statistical difference between the accuracy of the diagnosis of the maximum modulus of elasticity (z=0.65, P0.05). There was a significant difference in the accuracy of diagnosis between the maximum modulus of modulus of elasticity and the average modulus of modulus of elasticity (z=2.62, P0.05). Conclusion: 1. the color of the intralesional filling by transvaginal ultrasound SWE technique can be used to identify the qualitative diagnosis of cervical cancer and precancerous lesions by transvaginal ultrasound SWE technique in the quantitative diagnosis of cervical cancer. There was no significant difference in the accuracy and maximum modulus of modulus of elasticity for the diagnosis of cervical cancer in the diagnosis of CIN, but the sensitivity and specificity were higher than the modulus of elasticity with the maximum value of the modulus of.4. ultrasound in the diagnosis of cervical cancer, and the sensitivity and specificity were higher than the average of the modulus of elasticity. The maximum value of.5. elastic modulus is also higher than that of the modulus of elasticity for diagnosing the accuracy of cervical cancer.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R445.1;R737.33

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