發(fā)布時間：2018-11-28 19:14

【摘要】：目的： 探討并比較超聲彈性成像應(yīng)變率比值法與改良5分法對乳腺病灶良惡性鑒別診斷的價值。 材料與方法： 對130名女性乳腺病灶患者，行超聲彈性成像（UE）檢查，待彈性圖像穩(wěn)定后，獲得乳腺病灶UE圖像，先分析病灶區(qū)顏色分布，應(yīng)用改良5分法對病灶進(jìn)行評分（評分細(xì)則詳見正文表1）；再測量出乳腺病灶的應(yīng)變率比值（strain ratio，SR），每個病灶重復(fù)2～3次，取其平均值。所有病例均經(jīng)病理證實，將兩種方法所得結(jié)果與病理結(jié)果相對照，描繪受試者工作特征（ROC）曲線，獲得乳腺良惡性病灶SR的最佳診斷界值，比較兩種方法對乳腺病灶良惡性診斷的效能。 結(jié)果： （1）130名患者共155個乳腺病灶，其中良性120個，，惡性35個。乳腺惡性組SR值明顯高于良性病灶組SR值（3.93±1.06vs.1.82±0.83），兩者差異具有統(tǒng)計學(xué)意義（t=-4.339，P＜0.05）。（2）通過構(gòu)建ROC曲線分析，乳腺良惡性病灶SR的最佳診斷界值為3.05，其診斷乳腺惡性病灶的敏感性、特異性、準(zhǔn)確性、陽性預(yù)測值和陰性預(yù)測值分別為85.7%（30/35）、94.1%（113/120）、92.2%（143/155）、81.0%（30/37）和95.8%（113/118）。而改良5分法診斷乳腺惡性病灶的敏感性、特異性、準(zhǔn)確性、陽性預(yù)測值和陰性預(yù)測值分別為80.0%（28/35）、93.3%（112/120）、90.3%（140/155）、77.8%（28/36）和94.1%（112/119）。（3）SR值診斷乳腺惡性病灶的ROC曲線下面積為0.93，改良5分法診斷乳腺惡性病灶的ROC曲線下面積為0.89，兩者差異無統(tǒng)計學(xué)意義（Z=0.88，P＞0.05）。（4）彈性應(yīng)變率比值法與改良5分法診斷乳腺惡性病灶的敏感性、特異性、準(zhǔn)確性、陽性預(yù)測值和陰性預(yù)測值之間差異均無統(tǒng)計學(xué)意義（P均＞0.05）。 結(jié)論： 乳腺惡性病灶SR值高于良性病灶，SR診斷界值3.05對乳腺良惡性病灶鑒別診斷有較高的診斷效能。彈性應(yīng)變率比值法與改良5分法對乳腺病灶良惡性的診斷均具有較高價值，兩種方法診斷效能相近。彈性應(yīng)變率比值法可獲得半定量指標(biāo)，臨床更具實用性。
[Abstract]:Objective: to study and compare the value of strain rate ratio method and modified 5 score method in differential diagnosis of benign and malignant breast lesions. Materials and methods: a total of 130 female patients with breast lesions were examined by (UE). After the elastic images were stabilized, the UE images of the lesions were obtained, and the color distribution of the lesions was analyzed first. The lesion was graded by the modified 5-score method (detailed scoring details are shown in Table 1 of the text); The strain rate ratio (strain ratio,SR) of breast lesions was measured. All the cases were confirmed by pathology. The results obtained by two methods were compared with the pathological results, and the (ROC) curves of the subjects' operating characteristics were described to obtain the best diagnostic limit of SR for benign and malignant breast lesions. To compare the effectiveness of the two methods in the diagnosis of benign and malignant breast lesions. Results: (1) there were 155 breast lesions in 130 patients, of which 120 were benign and 35 malignant. The SR value of breast malignant group was significantly higher than that of benign lesion group (3.93 鹵1.06vs.1.82 鹵0.83). The difference between the two groups was statistically significant (t = -4.339, P < 0. 05). (2). The best diagnostic threshold of SR for benign and malignant breast lesions was 3.05. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of SR were 85.7% (30 / 35) and 94.1% (113 / 120), respectively. 92.2% (143 / 155), 81.0% (30 / 37) and 95.8% (113 / 118). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 80.0% (28 / 35), 90.3% (112 / 120), 90.3% (140 / 155), respectively. The area under ROC curve of 77.8% (28 / 36) and 94.1% (112 / 119). (3) of breast malignant lesions was 0.93, and the area under ROC curve of modified 5-score method was 0.89. There was no significant difference between the two methods (P > 0. 05). (4). The sensitivity, specificity and accuracy of the elastic strain rate ratio method and the modified 5 score method in the diagnosis of breast malignant lesions were not significant (P > 0. 05). (4). There was no significant difference between positive predictive value and negative predictive value (P > 0.05). Conclusion: the SR value of malignant breast lesions is higher than that of benign lesions. The diagnostic threshold value of SR is higher than that of benign and malignant breast lesions. Both the elastic strain rate ratio method and the modified five score method are of high value in the diagnosis of benign and malignant breast lesions, and the two methods have similar diagnostic efficacy. The elastic strain rate ratio method can obtain the semi-quantitative index, which is more practical in clinic.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R737.9

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