本文選題：乳腺癌 + 大小　； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:評估術(shù)前二維超聲(Two-dimensional ultrasound,2D-US)、三維容積超聲(three-dimensional volume ultrasound,3D-US)、應(yīng)力式超聲彈性成像(strain ultrasounic elastography,SUE)、全視野數(shù)字乳腺 X 線攝影(full-feld digital mammography,FFDM)及數(shù)字乳腺斷層攝影(digital breast tomosynthesis,DBT)對乳腺癌大小測量的精確性及其影響因素。方法:將我院2016年4月～2016年11月收集的101例乳腺癌患者(101個(gè)病變)納入臨床測量研究。在穿刺確診前,運(yùn)用超聲(3D-US/2D-US/SUE)及乳腺X線攝影(FFDM/DBT)對病變最大徑進(jìn)行了測量。以病理測值為金標(biāo)準(zhǔn),運(yùn)用線性回歸分析各影像技術(shù)評估乳腺癌大小的能力;運(yùn)用Bland-Altman圖及組內(nèi)相關(guān)系數(shù)(ICC)對五種影像技術(shù)測值與病理測值行一致性分析;運(yùn)用卡方檢驗(yàn)(或Fisher's確切概率法)分析各臨床病理因素及影像特征對各影像技術(shù)測值準(zhǔn)確性的影響。結(jié)果:對于乳腺癌病變大小的評估,各影像技術(shù)效果由好到差依次為3D-US/2D-US/SUE/DBT/FFDM(R2=0.80/0.65/0.61/0.47/0.32)。分析 Bland-Altman圖及ICC發(fā)現(xiàn)乳腺超聲(3D-US/2D-US/SUE)一致性界限范圍窄,界外點(diǎn)少,數(shù)值分布集中,與病理測值相關(guān)性好,其中以3D-US 一致性效果最佳,其次為2D-US及SUE;乳腺X線攝影(DBT/FFDM)一致性界限范圍較廣,界外點(diǎn)較多,數(shù)值分布較散,其中以FFDM差異最大。比較各臨床病理因素(年齡、絕經(jīng)、新輔助化療、病變大小、病理分級、ER、PR、HER2、Ki67表達(dá)、腋淋巴結(jié)轉(zhuǎn)移、浸潤性導(dǎo)管癌伴導(dǎo)管內(nèi)原位癌、病理類型)及影像征象(乳腺密度、病變類型、微鈣化、距皮深度、生長方向、病變形態(tài)及邊緣)對五種影像技術(shù)測值準(zhǔn)確性的影響,發(fā)現(xiàn)3D-US在年齡40歲組測值準(zhǔn)確率高;2D-US在浸潤性導(dǎo)管癌(Invasive ductal carcinoma,IDC)不伴導(dǎo)管內(nèi)原位癌(ductal carcinoma in situ,DCIS)、無微鈣化、病變邊緣清晰、病變≤2cm及浸潤性導(dǎo)管癌組測值準(zhǔn)確率高;SUE在IDC不伴DCIS、無微鈣化及病變邊緣清晰組測值準(zhǔn)確率高;DBT在腺體疏松、病變?yōu)槟[塊型、病變距皮深度≤2cm、HER2陰性、腋淋巴結(jié)無轉(zhuǎn)移及病變形態(tài)規(guī)則組測值準(zhǔn)確率高;FFDM在腺體疏松、病變?yōu)槟[塊型、病變距皮深度≤2cm組、病理分級0～Ⅱ級、HER2陰性、ER/PR陽性及病變邊緣清晰組測值準(zhǔn)確率高;差異均有統(tǒng)計(jì)學(xué)意義(P≤0.05)�；颊咴谟袩o絕經(jīng)、是否行新輔助化療、Ki-67表達(dá)及病變生長方向方面對五種影像技術(shù)測值準(zhǔn)確性無明顯影響,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:①對于乳腺癌大小的測量,五種影像技術(shù)測值的準(zhǔn)確性由高到低依次為3D-US2D-USSUEDBTFFDM;其中3D-US測值的準(zhǔn)確性受臨床病理因素及影像學(xué)征象影響最小,對于病變大小的測量及保乳術(shù)切緣的確定效果最佳;而FFDM測值的準(zhǔn)確性受臨床病理因素及影像學(xué)征象影響最大,對于病變大小的測量及保乳術(shù)切緣的確定效果最差。②當(dāng)乳腺癌患者為致密型乳腺,病變在乳腺X線攝影上表現(xiàn)為非腫塊型,病變位置較深(2cm)或HER2表達(dá)陽性時(shí),乳腺超聲檢查較X線攝影對病變大小評價(jià)效果更佳。③乳腺癌患者病變伴有微鈣化或DCIS時(shí),乳腺X線攝影較超聲更敏感,可在乳腺X線攝影的基礎(chǔ)上結(jié)合超聲檢查以增加對病變大小測值的準(zhǔn)確性。④結(jié)合病人的臨床病理因素及影像征象,利用乳腺超聲和X線攝影兩類影像技術(shù)的優(yōu)勢對乳腺癌病變大小進(jìn)行綜合評價(jià),更有利于臨床個(gè)體化治療的精準(zhǔn)實(shí)施。
[Abstract]:Objective: To evaluate Two-dimensional ultrasound (2D-US), three-dimensional volume ultrasound (three-dimensional volume ultrasound, 3D-US), stress ultrasonic elastic imaging (strain ultrasounic elastography, SUE), digital mammography and digital mammography. Reast tomosynthesis, DBT) accuracy of breast cancer size measurement and its influencing factors. Methods: 101 cases of breast cancer (101 lesions) collected in our hospital from April 2016 to November 2016 were included in the clinical survey. The maximum diameter of the lesion was measured by ultrasound (3D-US/2D-US/SUE) and mammography (FFDM/DBT) before the puncture was confirmed. Quantity. The ability to evaluate the size of breast cancer by linear regression analysis was used to evaluate the size of breast cancer by linear regression analysis. Bland-Altman and ICC were used to analyze the conformance of five imaging techniques and pathological values, and the clinicopathological factors and image characteristics were analyzed by chi square test (or Fisher's). The effect on the accuracy of each imaging technique. Results: for the evaluation of the size of the breast cancer, the effect of each image from good to poor was 3D-US/2D-US/SUE/DBT/FFDM (R2=0.80/0.65/0.61/0.47/0.32). The Bland-Altman map and the ICC found that the limits of the consistency of the breast ultrasound (3D-US/2D-US/SUE) were narrow, the out of boundary points were few, and the numerical distribution set was small. Among them, the correlation was good with the pathological test, among which 3D-US was the best result, followed by 2D-US and SUE, and the line of DBT/FFDM was wide, more out of boundary, more scattered, and the difference of FFDM was the largest. Comparison of various clinicopathological factors (year of age, menopause, neoadjuvant chemotherapy, pathological size, pathological grading, ER, PR, HER2) Ki67 expression, axillary lymph node metastasis, invasive ductal carcinoma with intraductal carcinoma in situ, pathological type) and imaging signs (breast density, lesion type, microcalcification, cortex depth, growth direction, lesion morphology and edge) were affected by the accuracy of five imaging techniques, and 3D-US was found to have high accuracy in the age 40 year group; 2D-US was in infiltrative guide. Invasive ductal carcinoma (IDC) was not accompanied by intraductal carcinoma in situ (ductal carcinoma in situ, DCIS), no microcalcification, clear edge of the lesion, and high accuracy rate in the group of invasive ductal carcinoma and not 2cm and invasive ductal carcinoma. The depth of the cortex was less than 2cm, HER2 was negative, and the accuracy rate of the measured value of the axillary lymph node no metastasis and the lesion morphologic rule group was high; FFDM was loose in the gland, the lesion was a mass, the lesion was less than 2cm, the pathological grade was 0 to second grade, the HER2 negative, the ER/PR positive and the clear edge of the lesion were higher, the difference was statistically significant (P < 0.05). The difference was statistically significant (P < < 0.05). No menopause, new adjuvant chemotherapy, Ki-67 expression and the direction of the growth of the lesions had no significant influence on the accuracy of the five imaging techniques. The difference was not statistically significant (P0.05). Conclusion: (1) the accuracy of the measurement of the size of the breast cancer from high to low is 3D-US2D-USSUEDBTFFDM, in which the values of 3D-US are measured by 3D-US. The accuracy was the least influenced by the clinical pathological factors and imaging features. The measurement of the size of the lesions and the cutting edge of the breast conserving surgery was the best. The accuracy of the FFDM was most affected by the clinical pathological factors and imaging features, and the least effect on the measurement of the size of the lesions and the margin of the breast conserving surgery. Dense breast, the lesion in mammography shows non lump type, the position of the lesion is deep (2cm) or HER2 expression positive, the breast ultrasound examination is better than the X-ray photography to evaluate the size of the lesion. (3) the breast radiography is more sensitive than the ultrasound when the lesions of the breast cancer patients are accompanied by microcalcification or DCIS, and can be combined on the basis of mammography. Ultrasound examination to increase the accuracy of the measurement of the size of the lesion. (4) combined with the clinicopathological factors and imaging features of the patients, using the advantages of two types of imaging techniques of breast ultrasound and X-ray photography to evaluate the size of the breast cancer, which is more conducive to the precise implementation of the clinical individualized treatment.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.9;R445.1;R730.44

【參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 肖莉玲;李穎嘉;馬菲;洪少馥;張麗;張世玉;羅婉賢;羅淑儀;;青年與中老年乳腺癌患者的臨床病理及超聲表現(xiàn)對比[J];中國醫(yī)學(xué)影像技術(shù);2016年09期

2 陳萬青;鄭榮壽;;中國女性乳腺癌發(fā)病死亡和生存狀況[J];中國腫瘤臨床;2015年13期

3 羅葆明;曾婕;歐冰;智慧;;乳腺超聲彈性成像檢查壓力與壓放頻率對診斷結(jié)果影響[J];中國醫(yī)學(xué)影像技術(shù);2007年08期

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