【摘要】：目的:探討乳腺占位性病變超聲彈性成像定量指標(biāo)和半定量評(píng)分與成纖維細(xì)胞分布的關(guān)聯(lián)性,闡明超聲彈性成像定量指標(biāo)和半定量評(píng)分在乳腺腫瘤診斷中的價(jià)值。方法:對(duì)38例乳腺占位性病變進(jìn)行超聲彈性成像檢查,并對(duì)彈性圖像進(jìn)行定量分析,獲得11個(gè)特征量及相應(yīng)的彈性應(yīng)變率比值,進(jìn)行半定量評(píng)分,根據(jù)病理結(jié)果將其分為良性組和惡性組,采用免疫組織化學(xué)法分別檢測(cè)乳腺間質(zhì)穿膜糖蛋白(CD34)和α-平滑肌肌動(dòng)蛋白(α-SMA)的表達(dá),分析成纖維細(xì)胞在乳腺病變中的分布特征,研究乳腺?gòu)椥猿上穸吭u(píng)價(jià)指標(biāo)和半定量評(píng)分與成纖維細(xì)胞分布的關(guān)聯(lián)性。結(jié)果:惡性組乳腺組織中CD34表達(dá)水平明顯低于良性組,而惡性組α-SMA表達(dá)水平明顯高于良性組,CD34和α-SMA在良性和惡性乳腺占位病變中表達(dá)水平比較差異有統(tǒng)計(jì)學(xué)意義(P0.01)。惡性組彈性成像以藍(lán)色為主,良性組彈性成像以綠色為主,2組間彈性成像評(píng)分比較差異有統(tǒng)計(jì)學(xué)意義。CD34在乳腺腫瘤組織中的表達(dá)與彈性成像評(píng)分呈負(fù)相關(guān)關(guān)系(r=-0.423 7,P=0.027 3),α-SMA在乳腺腫瘤組織中的表達(dá)與彈性成像評(píng)分呈正相關(guān)性關(guān)系(r=0.397 0,P=0.014 2)。CD34與11個(gè)特征量中應(yīng)變均值及均等性、藍(lán)色區(qū)域百分比、峰度、偏度、雜亂度均有相關(guān)性(P0.05),其中與應(yīng)變均值(r=0.385 6,P=0.016 8)及均等性(r=0.380 5,P=0.018 5)呈正相關(guān)關(guān)系,與藍(lán)色區(qū)域百分比(r=-0.351 7,P=0.030 4)、峰度(r=-0.427 7,P=0.007 4)、偏度(r=-0.394 6,P=0.014 2)、雜亂度(r=-0.344 3,P=0.034 3)、一致性(r=-0.484 9,P=0.002 0)及彈性應(yīng)變率比值(r=-0.379 0,P=0.047 5)呈負(fù)相關(guān)關(guān)系,與標(biāo)準(zhǔn)偏差、復(fù)雜度、相關(guān)性和對(duì)比度無(wú)相關(guān)性(P0.05);而α-SMA與峰度(r=0.356 9,P=0.027 8)和偏度(r=0.323 0,P=0.047 9)、藍(lán)色區(qū)域百分比(r=0.382 0,P=0.021 6)以及彈性應(yīng)變率比值(r=0.403 3,P=0.012 0)有相關(guān)性,并呈正相關(guān)關(guān)系。結(jié)論:超聲彈性成像定量指標(biāo)和半定量評(píng)分與成纖維細(xì)胞在乳腺腫瘤中的分布具有相關(guān)性,有助于在術(shù)前通過無(wú)創(chuàng)手段初步判斷患者預(yù)后,可為乳腺癌的術(shù)前診斷、治療和手術(shù)時(shí)機(jī)選擇提供重要參考依據(jù)。
[Abstract]:Objective: to investigate the relationship between quantitative and semi-quantitative ultrasound elastography and fibroblast distribution in space-occupying lesions of mammary gland and to elucidate the value of quantitative and semi-quantitative ultrasound elastic imaging in the diagnosis of breast tumors. Methods: Elastography was performed in 38 cases of space-occupying lesions of mammary gland, and the quantitative analysis of elastic images was performed. Eleven characteristic quantities and the corresponding ratio of elastic strain rate were obtained, and the semi-quantitative score was obtained. According to the pathological results, it was divided into benign group and malignant group. The expression of interstitial glycoprotein (CD34) and 偽 -smooth muscle actin (偽 -SMA) were detected by immunohistochemical method, and the distribution characteristics of fibroblasts in breast lesions were analyzed. To study the relationship between quantitative evaluation index and semi-quantitative score of breast elastography and the distribution of fibroblasts. Results: the expression level of CD34 in malignant group was significantly lower than that in benign group, while the expression level of 偽 -SMA in malignant group was significantly higher than that in benign group (P0.01). The elastic imaging of malignant group was mainly blue. There was a negative correlation between the expression of CD34 in breast tumor tissue and the elastic imaging score (r-0.423 7), and the expression of 偽 -SMA in breast tumor tissue. There was a positive correlation between CD34 and elastic imaging score (r = 0.397 0 / 0. 0142). CD34 was correlated with the strain mean and equalization of 11 characteristic variables. The blue area percentage, kurtosis, skewness and disorder degree were all correlated (P0.05), and there was a positive correlation with the mean strain (r = 0.385 6) and equality (r = 0.3805 / P ~ (0.018). It has a negative correlation with the blue region percentage (r-0.3517), kurtosis (r-0.427 7), bias (r-0.394 6 ~ (6) P ~ (+) 0.0142), clutter degree (r ~ (-0.344 3) P ~ (0.034), consistency (r ~ (-0.484 9) P ~ (0.0020) and elastic strain rate ratio (r _ (0) -0.379 ~ (0) P ~ (0.047), and is negatively related to standard deviation, complexity, and complexity. There was no correlation between 偽 -SMA and contrast (P0.05), but 偽 -SMA was correlated with kurtosis (r = 0.356 9), bias (r = 0.323 0), blue area percentage (r = 0.382 0) and elastic strain rate ratio (r = 0.403 3P 0.0120), and there was a positive correlation between 偽 -SMA and kurtosis (r = 0.323, P = 0.027), blue area percentage (r = 0.382 0, P = 0.021) and elastic strain rate ratio (r = 0.403, P 0.0120). Conclusion: the quantitative indexes and semi-quantitative scores of ultrasound elastography have a correlation with the distribution of fibroblasts in breast tumors, which is helpful for the preliminary evaluation of the prognosis of breast cancer by non-invasive means before operation, and can be used for the preoperative diagnosis of breast cancer. The choice of treatment and operation timing provides important reference basis.
【作者單位】： 遼寧醫(yī)學(xué)院航天中心醫(yī)院研究生培養(yǎng)基地超聲科;遼寧醫(yī)學(xué)院航天中心醫(yī)院研究生培養(yǎng)基地病理科;
【基金】：遼寧醫(yī)學(xué)院航天中心醫(yī)院院內(nèi)項(xiàng)目資助課題(YN201406)
【分類號(hào)】：R737.9;R445.1

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