本文選題：二維超聲 + 三維超聲��； 參考：《山西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的探討三維超聲在乳腺良惡性疾病中的診斷價(jià)值及在BI—RADS分級(jí)評(píng)估中的可行性。 方法回顧性分析經(jīng)病理確診的242例315個(gè)乳腺病灶的超聲聲像圖特征，首先用二維超聲收集病灶的形狀、前后徑/長徑、內(nèi)部回聲、鈣化、后方回聲、周緣、周圍組織改變、邊緣、血流，之后用三維超聲記錄病灶冠狀面的周邊特性，，依據(jù)乳腺影像報(bào)告與數(shù)據(jù)系統(tǒng)（BI—RADS）分級(jí)標(biāo)準(zhǔn)，對(duì)比分析二維與三維超聲分級(jí)結(jié)果，并用Logistic回歸進(jìn)行多因素分析，分析超聲各征象在乳腺良惡性疾病中的診斷價(jià)值。 結(jié)果 1.315個(gè)乳腺病灶中良性188個(gè)、惡性127個(gè)。二維超聲、三維超聲的定性診斷準(zhǔn)確率分別是82.54%、97.46%，兩者差異有統(tǒng)計(jì)學(xué)意義（P＜0.001）。2.11項(xiàng)超聲征象，包括形狀、前后徑/長徑、內(nèi)部回聲、鈣化、后方回聲、周緣、 周圍組織改變、邊緣、血流、界面回聲和“匯聚征”在乳腺良惡性病灶中差異均有統(tǒng)計(jì)學(xué)意義（P＜0.001）。其中4項(xiàng)進(jìn)入回歸模型，其標(biāo)準(zhǔn)化回歸系數(shù)排序?yàn)橹芫墸?.1557）＞前后徑/長徑（1.1434）＞周圍組織改變（0.9480）＞內(nèi)部回聲（0.5564）。 3.在BI—RADS分級(jí)評(píng)估中，二維和三維超聲在4級(jí)判斷中差異有統(tǒng)計(jì)學(xué)意義（P=0.020），在3級(jí)和5級(jí)中差異無統(tǒng)計(jì)學(xué)意義（P=1.000、P=0.577）。3級(jí)的174個(gè)病灶中，96個(gè)冠狀面中表現(xiàn)為完整的界面回聲反射，占55.17%；5級(jí)的110個(gè)病灶中，100個(gè)在冠狀面中表現(xiàn)為“匯聚征”，占90.91%�！皡R聚征”和完整界面回聲反射在良惡性分布中差異有統(tǒng)計(jì)學(xué)意義（x2=61.177，P＜0.001）。 結(jié)論 1.三維超聲比二維超聲在乳腺良惡性疾病診斷中準(zhǔn)確性較高。 2.在二維超聲和三維超聲冠狀面的共11項(xiàng)征象中，對(duì)鑒別乳腺良惡性疾病影響度最大的是周緣。 3.三維超聲冠狀面征象包括界面回聲反射和“匯聚征”。完整界面回聲反射在良性病變中表現(xiàn)為著，傾向于BI—RADS3級(jí)；“匯聚征”在惡性病變中表現(xiàn)為著，傾向于BI—RADS5級(jí)。 4.與二維超聲相比，三維超聲有助于合理分配BI—RADS分級(jí)情況，降低4級(jí)病灶的數(shù)量，從而減少不必要的活檢。
[Abstract]:Objective to evaluate the diagnostic value of three-dimensional ultrasound in benign and malignant breast diseases and the feasibility of BI-RADS grade evaluation. Methods the ultrasonographic features of 315 breast lesions in 242 cases confirmed by pathology were analyzed retrospectively. The shape, anteroposterior / long diameter, internal echo, calcification, posterior echo, circumference and surrounding tissue of the lesions were collected by two-dimensional ultrasound. The peripheral characteristics of the coronal plane of the lesion were recorded by three-dimensional ultrasound. According to the BI-RADS classification standard of breast image reporting and data system, the results of two-dimensional and three-dimensional ultrasound grading were compared and analyzed, and the multivariate analysis was performed by Logistic regression. To analyze the diagnostic value of ultrasound signs in benign and malignant breast diseases. Result Of the 315 breast lesions, 188 were benign and 127 malignant. The accuracy of qualitative diagnosis of two-dimensional ultrasound and three-dimensional ultrasound were 82.54 and 97.46, respectively. The difference between them was statistically significant (P < 0.001) .2.11 ultrasonic signs, including shape, anteroposterior / long diameter, internal echo, calcification, posterior echo, circumference. There were significant differences in peripheral tissue changes, edge, blood flow, interface echo and convergence sign in benign and malignant breast lesions (P < 0.001). Four of the items entered the regression model, and the standardized regression coefficients were ranked as follows: circumference 1.1557) > anteroposterior / long-diameter 1.1434) > peripheral tissue change 0.9480) > internal echo 0.5564). 3. In the evaluation of BI-RADS grade, there was significant difference between 2D and 3D ultrasound in grade 4 judgment. In grade 3 and grade 5, there was no significant difference. In 174 lesions of grade 0.577.3, 96 coronal planes showed complete interface echo reflex. Of the 110 lesions in grade 55.17, 100 showed "convergence sign" in the coronal plane, accounting for 90.91%. There was significant difference in the distribution of benign and malignant between "convergence sign" and complete interface echo reflex (P < 0.001). Conclusion 1. Three-dimensional ultrasound is more accurate than two-dimensional ultrasound in the diagnosis of breast benign and malignant diseases. 2. Among the 11 features of two dimensional ultrasound and three dimensional ultrasound coronal plane, the most significant influence on the differential diagnosis of benign and malignant breast diseases was peripheral. 3. The coronal features of three-dimensional ultrasound include interface echo reflection and convergence sign. The complete interface echo reflex was found in benign lesions and tended to BI-RADS3 grade, while convergence sign was found in malignant lesions and tended to BI-RADS5 grade. 4. Compared with two dimensional ultrasound, three dimensional ultrasound is helpful to reasonably distribute BI-RADS grade and reduce the number of 4 grade lesions, thus reducing unnecessary biopsy.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.9;R445.1

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