本文關(guān)鍵詞： 乳腺癌 超聲檢查 聲脈沖輻射力成像技術(shù) 剪切波 彈性成像技術(shù)　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:近年來,乳腺腫瘤發(fā)病率呈逐步上升趨勢,嚴(yán)重威脅著婦女的身心健康。超聲檢查有很多優(yōu)點,已成為乳腺惡性腫瘤診斷和篩查的重要手段。聲脈沖輻射力彈性成像(acoustic radiation forceimpulse,ARFI)技術(shù)是通過超聲探頭發(fā)射低頻脈沖,計算組織局部形變后產(chǎn)生的橫向剪切波的速度,定量檢測組織硬度的超聲彈性成像技術(shù)。本研究運用聲脈沖輻射力成像技術(shù)對乳腺實性結(jié)節(jié)進行彈性定量研究,探討該技術(shù)在乳腺實性結(jié)節(jié)中的診斷價值。方法:1研究對象2016年在邢臺市第三醫(yī)院應(yīng)用聲脈沖輻射力彈性成像技術(shù)行乳腺超聲檢查,并經(jīng)手術(shù)或穿刺活檢取得病理結(jié)果的患者。2檢查方法記錄乳腺實性結(jié)節(jié)患者的年齡、病史、觸診等信息。對所有乳腺實性結(jié)節(jié)進行常規(guī)二維超聲檢查并記錄。行彩色多普勒超聲檢查,觀察實性結(jié)節(jié)內(nèi)部及周邊的血供特點。對所有結(jié)節(jié)運用聲觸診組織成像技術(shù)(virtual touch tissue imaging,VTI)獲得VTI彈性圖,接著運用聲觸診組織定量技術(shù)(virtual touch tissue qualification,VTQ)依次獲得結(jié)節(jié)內(nèi)部區(qū)域、結(jié)節(jié)周邊區(qū)域、結(jié)節(jié)同等深度正常乳腺組織的剪切波速度(shear wave velocity,SWV),同一位置分別測量5次取中位數(shù)。機器的量程為“0~9m/s”,在排除操作的方法學(xué)錯誤后,如果重復(fù)測量后VTQ值無明確數(shù)值顯示時(即為“X.XXm/s”),參照VTI圖像,圖像顯示為黑色,即可排除囊性病變,VTQ值記錄“9m/s”,若為囊性病變,記錄“0m/s”并剔除。記錄術(shù)后病理,并整理資料。3統(tǒng)計學(xué)分析所有病灶以術(shù)后病理結(jié)果為金標(biāo)準(zhǔn),分析各病理類型及不同大小、不同深度的乳腺實性結(jié)節(jié)的VTQ值是否有統(tǒng)計學(xué)差異。應(yīng)用SPSS24.0軟件包進行統(tǒng)計分析。計量資料采用均數(shù)±標(biāo)準(zhǔn)差,以P0.05認(rèn)為有統(tǒng)計學(xué)意義。結(jié)果:1病理結(jié)果79例患者103個乳腺實性結(jié)節(jié)中,良性結(jié)節(jié)72個,包括纖維腺瘤53個,腺病7個,肉芽腫性小葉炎5個,導(dǎo)管內(nèi)乳頭狀瘤6個,青春期巨纖維腺瘤1個;惡性結(jié)節(jié)30個,其中浸潤性導(dǎo)管癌21個,導(dǎo)管原位癌5個,浸潤性小葉癌1個,彌漫性大b細(xì)胞性淋巴瘤2個,腺樣囊性癌1個;非典型增生1個。2arfi技術(shù)的診斷效能良性組內(nèi)部區(qū)域的vtq值平均值為(2.53±1.35)m/s,惡性組為(6.85±2.62)m/s,兩者之間具有顯著統(tǒng)計學(xué)差異,p0.01。繪制roc曲線,曲線下面積0.900,以vtq值為3.46m/s為參考值,其靈敏度為83.9%,特異度為91.7%,誤診率8.3%,漏診率16.1%,正確率89.3%。mcnemar配對卡方檢驗p值為1.00,p0.05,診斷準(zhǔn)確性高。良性組內(nèi)部區(qū)域與同一深度正常腺體組織的swv比值平均值為1.76±1.15,惡性組為4.93±2.56,兩者之間具有顯著統(tǒng)計學(xué)差異,p0.05。繪制roc曲線,曲線下面積0.889,以swv比值3.66為參考值,其靈敏度為74.2%,特異度為97.2%,誤診率2.8%,漏診率25.8%,正確率90.3%。mcnemar配對卡方檢驗p值為0.109,p0.05,診斷準(zhǔn)確性高。3良、惡性兩組之間比較患者年齡、結(jié)節(jié)大小(最長徑和平均徑)、結(jié)節(jié)中心深度也都具有統(tǒng)計學(xué)差異,p0.05;兩組間結(jié)節(jié)與乳頭的距離,與結(jié)節(jié)同等深度正常腺體的swv值均不具有統(tǒng)計學(xué)差異,p0.05。4乳腺實性結(jié)節(jié)內(nèi)部swv值相關(guān)性乳腺實性結(jié)節(jié)內(nèi)部swv值與距乳頭距離相關(guān)性p值0.794,p0.05,無統(tǒng)計學(xué)意義,此2者無統(tǒng)計學(xué)相關(guān)性;與結(jié)節(jié)最長徑相關(guān)性p值0.003,與結(jié)節(jié)平均徑相關(guān)性p值0.000,與結(jié)節(jié)中心深度相關(guān)性p值0.000,均具有統(tǒng)計學(xué)相關(guān)性。5不同病理的乳腺實性結(jié)節(jié)內(nèi)部swv值的比較結(jié)節(jié)內(nèi)部swv值從大到小排列分為3等,第1等為浸潤性導(dǎo)管癌,第2等為導(dǎo)管原位癌和肉芽腫性小葉炎,第3等為導(dǎo)管內(nèi)乳頭狀瘤、纖維腺瘤和腺病,這也代表著它們硬度由硬到軟的順序。結(jié)論:聲脈沖輻射力彈性成像技術(shù)是一項非助力式超聲彈性成像新技術(shù),能提供組織硬度的定性、定量信息,在常規(guī)超聲檢查的基礎(chǔ)上進行感興趣區(qū)的彈性定量測量,受外界和主觀因素影響較小,重復(fù)性好,在乳腺實性結(jié)節(jié)的診斷上具有很大的臨床價值。本研究認(rèn)為,其中VTQ技術(shù)應(yīng)用的關(guān)鍵在于正確的操作并測量出結(jié)節(jié)內(nèi)部、周邊及結(jié)節(jié)同等深度正常乳腺組織的SWV值,以結(jié)節(jié)內(nèi)部VTQ值為3.46m/s為參考值;計算結(jié)節(jié)內(nèi)部與同等深度正常乳腺組織SWV值比值,以3.66為參考值,作為診斷乳腺惡性結(jié)節(jié)的標(biāo)準(zhǔn)。本研究的局限性:由于乳腺病理的多樣性且有些病理類型的例數(shù)過少等原因?qū)е略摷夹g(shù)一致性欠佳,所以要結(jié)合多種檢查方法以及臨床表現(xiàn)做出綜合診斷,對于可疑病灶需進行穿刺活檢,提高診斷準(zhǔn)確率。
[Abstract]:Objective: in recent years, the incidence of breast tumors showed a gradual upward trend, a serious threat to women's physical and mental health. Ultrasound has many advantages, has become an important means of breast cancer diagnosis and screening of acoustic radiation force impulse imaging (acoustic radiation forceimpulse ARFI) technology is the pulse through the ultrasonic probe emission frequency, transverse wave shear calculation of local tissue after deformation speed, ultrasonic elastography quantitative measurement of tissue hardness. The use of acoustic radiation force impulse imaging of breast solid nodules were of elasticity, to explore the value of the technique in diagnosis of breast solid nodules. Methods: 1 subjects in Xingtai city in 2016 third the hospital application of acoustic radiation force impulse imaging technique for breast ultrasound examination,.2 examination methods and patients by surgery or biopsy pathology results obtained records of milk Gland nodule with age, history, and other information. By palpation of conventional two-dimensional ultrasound examination of all breast solid nodules were recorded. The color Doppler ultrasound examination, observation of solid nodules inside and peripheral blood supply features. All the nodules using virtual touch tissue imaging technology (virtual touch tissue imaging, VTI) obtained VTI elastic graph, and then use the virtual touch tissue quantification (virtual touch tissue qualification, VTQ) in order to get inside the area of nodules, nodules surrounding area, the shear wave velocity of the same depth nodules of normal breast tissue (shear wave, velocity, SWV), the same position were measured 5 times median. The machine range is "0~9m/s" study, error in the method of eliminating operation, if repeated measurements of VTQ value without a clear numerical display (i.e. "X.XXm/s"), referring to the VTI image, the image display is black, can be eliminated by cystic The lesion, VTQ recording of "9m/s", if the cystic lesions, and remove the record "0m/s". Record postoperativepathologic, arranging and analyzing the data of.3 were all lesions with postoperative pathological results as the gold standard, analysis of various pathological types and different size of breast solid nodules in different depth of the VTQ value is significant difference. SPSS24.0 software package was used for statistical analysis. Measurement data using standard deviation, P0.05 was considered statistically significant. Results: 1 pathological results of 79 patients with 103 breast solid nodules and 72 benign nodules, including 53 fibroadenoma, 7 adenosis, 5 lobular granulomatous inflammation. 6 intraductal papillomas, 1 adolescent giant fibroadenoma; 30 malignant nodules, 21 were invasive ductal carcinomas, 5 ductal carcinoma in situ and invasive lobular carcinoma in 1, diffuse large B cell lymphoma in 2, adenoid cystic carcinoma, 1 atypical hyperplasia; 1.2a Diagnostic efficacy of benign group within the region of the RFI vtq value (2.53 + 1.35) m/s, malignant group (6.85 + 2.62) m/s, with a significant difference between the two, p0.01. ROC curve, the area under the curve of 0.900, with the vtq value of 3.46m/s for reference, the sensitivity was 83.9%. The specificity was 91.7%, the misdiagnosis rate was 8.3%, the misdiagnosis rate of 16.1%, the correct rate of 89.3%.mcnemar chi square test p value was 1, P0.05, high diagnostic accuracy. The ratio of SWV in benign group interior region and the same depth of normal gland tissue with an average of 1.76 + 1.15, 4.93 + 2.56 in the malignant group, the difference was statistically significant between the two, p0.05. ROC curve, the area under the curve of 0.889 to 3.66, the ratio of SWV for reference, the sensitivity was 74.2%, specificity was 97.2%, the misdiagnosis rate was 2.8%, the misdiagnosis rate of 25.8%, the correct rate of 90.3%.mcnemar chi square test p value was 0.109, P0.05, high diagnostic accuracy of.3 for good, evil Between the two groups of patients with age, nodule size (diameter, diameter of both the peace center) nodules have a significantly different depth, P0.05 and papillary nodules; distance between the two groups, with the same depth of normal gland nodules SWV values were not statistically significant, p0.05.4 breast solid nodules internal correlation between SWV value of breast solid nodules internal SWV value and P value of the correlation distance to the nipple 0.794, P0.05, no statistical significance, no significant correlation between the 2 and the longest diameter of nodules; correlation between P value of 0.003, and the average diameter of the p value of the correlation of 0 nodules, and the nodule center depth correlation of P value of 0, all have relatively significant correlation between internal SWV nodules.5 of different pathological breast solid nodules within the SWV values in order from large to small is divided into 3, first invasive ductal carcinoma, second were ductal carcinoma in situ and granulomatous lobular inflammation, third guided intraductal papilloma, Fibroadenoma and adenosis, it also represents their hardness from hard to soft order. Conclusion: acoustic radiation force impulse imaging technology is a new technology of non power ultrasonic elastography, can provide qualitative and quantitative information of microstructure and hardness, elastic quantitative measurement of region of interest in the basis of routine ultrasound examination. Less affected by the external and subjective factors, good repeatability, has great clinical value in the diagnosis of breast solid nodules. This study suggests that the key to the application of VTQ technology in the correct operation and measure the internal peripheral nodules, nodules and the same depth of normal breast tissue SWV value to VTQ value of thyroid nodules for the 3.46m/s reference value were calculated with the same depth; the internal normal breast tissue SWV value, reference value of 3.66, as the diagnosis of breast malignant nodules. The limitations of this study: in breast pathology Diversity and some cases with too few pathological types lead to poor consistency of the technology. Therefore, we should make comprehensive diagnosis combined with various examination methods and clinical manifestations. We need to make biopsy for suspicious lesions, so as to improve the accuracy of diagnosis.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.1;R655.8;R737.9

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