本文關(guān)鍵詞： 乳腺腫塊 三維超聲 匯聚征 三維彩色血管能量成像　出處：《廣西醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：運(yùn)用三維超聲成像技術(shù)對乳腺腫塊邊緣形態(tài)特征進(jìn)行觀察,探討三維超聲匯聚征在乳腺良惡性腫塊中的診斷價(jià)值,及其在不同病理類型乳腺癌中的表達(dá)規(guī)律、預(yù)后評估中的意義；利用三維彩色血管能量成像(Three dimensional color power angiography,3D-CPA)技術(shù)對乳腺良惡性腫塊內(nèi)部及周邊的血管形態(tài)及血供情況進(jìn)行觀察,并采用血流直方圖定量分析乳腺腫塊內(nèi)及周邊血供情況,評價(jià)3D-CPA定性及定量分析在乳腺良惡性腫塊中的診斷價(jià)值。 方法：對165位乳腺腫塊患者術(shù)前行三維超聲檢查,觀察腫塊邊緣形態(tài)特性,與病理結(jié)果對照,分析良惡性腫塊匯聚征在冠狀面上的顯示情況,并將惡性腫塊匯聚征顯示率與病理類型,腫塊直徑、組織學(xué)分級、淋巴結(jié)狀態(tài)及雌激素受體(Estrogen receptor, ER)、孕激素受體(Progesterone receptor, PR)、人表皮生長因子2(Human epidermal growth factor2, CerbB-2)、Ki-67表達(dá)作對比,分析它們之間的關(guān)系。在三維重建的基礎(chǔ)上運(yùn)用3D-CPA技術(shù)觀察乳腺腫塊內(nèi)及周邊的血供情況,客觀評價(jià)其血流分級；并采用不規(guī)則體積測量(Virtual organ computer-aid analysis, VOCAL)軟件中的血流直方圖定量分析腫塊內(nèi)及周邊3mm的血流參數(shù),將良惡性腫塊的結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)比較。 結(jié)果：匯聚征診斷乳腺惡性腫塊的靈敏度、特異度分別為67.7%,93.1%。93例乳腺癌腫塊中,浸潤性癌和非浸潤性癌匯聚征的顯示率分別為80.3%,11.8%,兩者間差異具有統(tǒng)計(jì)學(xué)意義(P0.001)。 匯聚征在乳腺癌預(yù)后中的評估：①匯聚征顯示率與腫塊直徑和組織學(xué)分級有關(guān)(P0.05)。匯聚征多見于直徑≤2cm,組織學(xué)分級Ⅱ級的非特殊型浸潤性癌；②與無匯聚征組相比,匯聚征組的ER、PR陽性表達(dá)率相對較高(P0.05)；③兩組的淋巴結(jié)狀態(tài)、CerbB-2、Ki-67表達(dá)間差異均未見統(tǒng)計(jì)學(xué)意義(P0.05)。 按3D-CPA分級分析,良性腫塊以Ⅰ、Ⅱ級血流為主(81.9%),惡性腫塊以Ⅱ、Ⅲ級血流為主(90.3%)。Ⅰ、Ⅱ、Ⅲ級血流情況在乳腺良惡性腫塊中存在明顯統(tǒng)計(jì)學(xué)差異(P0.001),且各級間比較也均存在統(tǒng)計(jì)學(xué)差異(P0.05)。 血流直方圖血流定量參數(shù)血管指數(shù)(Vascularization index, VI)、血流指數(shù)(Flow index, FI)和血管血流指數(shù)(Vascularization-flow index, VFI)在乳腺良惡性腫塊的鑒別診斷中具有一定的應(yīng)用價(jià)值,其中VI-in、VFI-in、 VI-out、FI-out及VFI-out在乳腺良惡性組間差異存在統(tǒng)計(jì)學(xué)意義((P0.05)。根據(jù)受試者工作特征曲線(Receiver operating characteristic curve, ROC)確定的診斷截值上述指標(biāo)均具有較高的敏感性和特異性,以VI-out≥2.630作為診斷乳腺惡性腫瘤的界值,敏感性92.2%,特異性83.3%；以VI-in≥1.725作為診斷界值,敏感性92.2%,特異性74.1%；以VFI-in≥0.411作為診斷界值,敏感性90.6%,特異性74.1%；以VFI-out≥0.648作為診斷界值,敏感性87.5%,特異性79.6%；以FI-out≥23.030作為診斷界值,敏感性85.9%,特異性48.1%。指標(biāo)V-in、V-out及FI-in在良惡性兩組中測值均未見明顯統(tǒng)計(jì)學(xué)差異(P0.05)。 結(jié)論：三維超聲可立體、直觀地顯示乳腺腫塊的形態(tài)及其與周邊組織間關(guān)系。冠狀面的匯聚征對乳腺良惡性腫塊的鑒別診斷及乳腺癌的預(yù)后評估具有重要意義。此外,3D-CPA定性及定量分析在乳腺良惡性腫塊的鑒別診斷中具有一定的運(yùn)用價(jià)值,病灶周邊血供情況的定量分析為無創(chuàng)性評估腫塊血供豐富程度提供了一種新方法。
[Abstract]:Objective: using three-dimensional ultrasound imaging were observed in breast tumor edge morphological characteristics, discusses value of three-dimensional ultrasound in the diagnosis of syndrome of benign and malignant breast tumors, and its expression pattern in different pathological types of breast cancer, prognostic significance; using three-dimensional color power angiography (Three dimensional color power angiography, 3D-CPA) the technology of vascular morphology and blood of benign and malignant breast tumor and peripheral donor were observed and analyzed for breast mass and peripheral blood flow using histogram quantitative diagnostic value in benign and malignant breast tumors in the qualitative and quantitative analysis and evaluation of the 3D-CPA.
Methods: 165 patients with breast masses underwent three-dimensional ultrasound observation of morphological characteristics of the edge of tumor, compared with pathologic results, analysis of benign and malignant tumors showed convergence sign in the coronal plane, and the mass convergence sign display rate and pathological type, malignant tumor diameter, histological grade, lymph node status and estrogen receptor (Estrogen receptor, ER), progesterone receptor (Progesterone receptor, PR), human epidermal growth factor 2 (Human epidermal growth FACTOR2, CerbB-2), the expression of Ki-67 for comparison, analysis of the relationship between them. The use of 3D-CPA technology to observe breast masses in and around the blood supply based on 3D reconstruction of objective evaluation the grade of blood flow; and the irregular volume measurement (Virtual organ computer-aid analysis, VOCAL) in the tumor and peripheral blood flow parameters of 3mm software in the quantitative analysis of flow histogram, will be good The results of malignant masses were compared statistically.
Results: the sensitivity and specificity of convergence sign in diagnosing malignant breast masses were 67.7%, respectively. In 93.1%.93 breast cancer, the rate of convergence in invasive breast cancer and noninvasive cancer was 80.3% and 11.8%, respectively, and the difference between them was statistically significant (P0.001).
Convergence sign evaluation in the prognosis of breast cancer: the convergence rate and sign the tumor diameter and histological grade (P0.05). The convergence sign was seen in less than 2cm in diameter, non special type grade II invasive carcinoma; and the non convergence sign group, convergence sign group ER, the expression of PR the positive rate is relatively high (P0.05); the two group of the lymph node status, CerbB-2, expression of Ki-67 had no statistical significance (P0.05).
According to the analysis of 3D-CPA classification of benign masses in I, II (81.9%), the main blood malignant masses in II, III (90.3%). The main flow of I, II, III were significant differences in blood flow of malignant and benign breast lesions (P0.001), and the levels of comparison were also statistically significant (in P0.05).
The blood flow parameters of quantitative histogram vascular index (Vascularization index, VI), flow index (Flow index, FI) and blood flow index (Vascularization-flow index VFI) has a certain application value in the differential diagnosis of benign and malignant breast tumors in which VI-in, VFI-in, VI-out, FI-out and VFI-out, there was significant difference in the breast malignant group ((P0.05). According to the receiver operating characteristic curve (Receiver operating characteristic curve, ROC) the diagnostic cut-off value determined the sensitivity indexes and has high specificity, with VI-out = 2.630 as the diagnosis of malignant breast tumor boundary value, the sensitivity was 92.2%, specificity was 83.3%; by over 1.725 as VI-in the diagnostic value, sensitivity of 92.2%, specificity of 74.1% to VFI-in; over 0.411 as a cut-off value, the sensitivity was 90.6%, specificity was 74.1%; with VFI-out over 0.648 as cut-off value, sensitivity 87.5%, the specificity was 79.6%; with FI-out over 23.030 as a cut-off value, the sensitivity of 85.9%, specificity of 48.1%. index of V-in, V-out and FI-in values were no statistically significant differences between benign and malignant in two groups (P0.05).
Conclusion: 3D ultrasound can visually display the stereo, breast shape and with the surrounding tissue. The relationship between the prognosis of coronary syndrome from breast cancer and differential diagnosis of benign and malignant breast tumors has important significance to the evaluation. In addition, the 3D-CPA qualitative and quantitative analysis of the use of a certain value in the differential diagnosis of benign and malignant breast tumors in for the situation, the quantitative analysis for the lesions of the peripheral blood tumor noninvasive assessment of blood supply and provide a new method.

【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.9;R445.1

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