乳腺癌超聲造影定量分析參數(shù)值及增強模式與分子分型的相關(guān)性初步研究
發(fā)布時間：2018-12-15 23:50
【摘要】：目的本研究對乳腺癌高頻圖像形態(tài)學(xué)特征進行觀察，并進行超聲造影，，然后與病理免疫組化結(jié)果進行對照，對乳腺癌超聲造影定量分析參數(shù)值及增強模式與其分子分型的相關(guān)性進行初步分析研究，以期為乳腺癌個性化治療方案的選擇及預(yù)后的評估提供影像學(xué)基礎(chǔ)。 方法收集2012年1月至2013年8月，于廣西壯族自治區(qū)人民醫(yī)院肝膽腺體外科住院的60例女性乳腺癌患者。所有患者術(shù)前均接受乳腺常規(guī)超聲和超聲造影檢查。首先觀察病灶的常規(guī)二維超聲聲像圖，然后運用彩色多普勒技術(shù)觀察病灶的血流信號。最后經(jīng)肘靜脈團注SonoVue(聲諾維)2.4ml,連續(xù)實時觀察增強強度、增強方向（向心性、離心性、彌漫性增強）、造影劑分布特征及造影后病灶范圍有無變化。造影結(jié)束后,分析記錄時間-強度曲線(TIC)及伽馬變量曲線（Gamma Variate）各參數(shù)值。記錄病灶峰值強度變化（A）、始增時間（AT）、峰值時間（PT）、峰值強度(PI）、峰值減半差值時間（HT）、梯度（Grad）、上升支斜率(RS)、半降斜率(DS)、曲線下面積（AUC）。術(shù)后病理及免疫組織化學(xué)（IHC）結(jié)果證實，確定分子分型。乳腺癌超聲造影定量分析參數(shù)值及增強模式與其分子分型的相關(guān)性。將數(shù)據(jù)進行統(tǒng)計學(xué)分析。 結(jié)果 一、乳腺癌超聲造影增強征象： 60例乳腺癌中，（1）增強水平：50例呈高增強，占83.3%（50/60）；(2)增強方向：56例呈向心性增強，占93.3（56/60）；（3）造影劑分布特征：51例呈不均勻性增強（51/60，85.00%）；9例呈均勻性增強（9/60，15.00%）。增強后23例病灶分界清晰，占38.33%（23/60），37例病灶分界不清，占61.67%（37/60）。37例病灶邊緣放射狀匯聚，占61.67%（37/60）；39例腫塊內(nèi)見穿支血流，占65.00%（39/60）；22例腫塊內(nèi)造影劑灌注缺損，占37%（22/60）。（4）造影前后病灶范圍大小的變化：56例造影后病灶范圍增大占93.33%(56/60)。 二、不同分子分型乳腺癌超聲造影上具有特征性表現(xiàn)： （1）管腔上皮型：ER、PR陽性表達的乳腺癌患者增強后病灶邊緣放射狀匯聚的幾率增加，與ER、PR陰性表達的乳腺癌患者差異比較有統(tǒng)計學(xué)意義（P0.05）。 （2）HER2過表達型：HER2陽性表達的乳腺癌患者腫塊中，造影劑灌注缺損的出現(xiàn)的概率增加，與HER2陰性表達者比較，差異具有統(tǒng)計學(xué)意義（P0.05）。 （3）基底樣型：增強造影邊界較清晰 三、乳腺癌定量分析參數(shù)與ER、PR、Ki-67、HER2相關(guān)性： Ki-67與Grad、RS呈正相關(guān)（P均0.05），與AT、PT、HT、PI、AUC、DS無顯著相關(guān)（P均0.05）。 結(jié)論：1、乳腺癌超聲造影定量分析參數(shù)值及增強模式與其分子分型有一定聯(lián)系，可為臨床診斷及個性化治療乳腺癌提供有價值的信息。2、不同分子分型乳腺癌超聲造影增強特征及定量分析參數(shù)值之間存在差異。3、乳腺癌的細胞增殖相關(guān)蛋白Ki-67表達與超聲造影灌注參數(shù)梯度Grad、時間-強度曲線上升支斜率RS呈正相關(guān)，為定量評價乳腺腫瘤新生血管生成提供依據(jù)。4、超聲造影能夠間接反映腫瘤癌基因及細胞因子的存在和表達引起的組織病理學(xué)改變。
[Abstract]:Objective To study the morphological characteristics of high-frequency image of breast cancer, and to carry out the ultrasound contrast, and then compared with the results of the pathological immunohistochemistry, to carry out a preliminary analysis on the correlation between the parameter value of the quantitative analysis of breast cancer and the correlation between the enhancement mode and its molecular typing. so as to provide an imaging basis for the selection of the individualized treatment scheme of the breast cancer and the evaluation of the prognosis. Methods 60 cases of female breast cancer were collected from January 2012 to August, 2013 in the hospital of the hepatobiliary gland of the People's Hospital of Guangxi Zhuang Autonomous Region. Patients. All patients were subject to routine breast ultrasound and ultrasound contrast prior to the procedure. The conventional two-dimensional ultrasound image of the lesion was first observed, and then the blood flow of the lesion was observed by color Doppler. No. of the final cubital vein bolus, SonoVue (SonoVue), 2. 4ml, continuous real-time observation of the intensity of the enhancement, the enhancement of the orientation (concentric, off-center, diffuse enhancement), the distribution of the contrast agent, and the presence or absence of the lesion in the post-contrast range After the contrast is completed, the parameters of the recording time-intensity curve (TIC) and the gamma variable are analyzed. Values. Record lesion peak intensity change (A), start-up time (AT), peak time (PT), peak intensity (PI), peak-to-half difference time (HT), gradient (Grad), ascending branch slope (RS), half-drop slope (DS), area under curve (AUC). The results of postoperative pathology and immunohistochemistry (IHC) confirmed that the molecular point was determined. The correlation between the parameter value of the quantitative analysis of breast cancer and its correlation with its molecular typing sex. Statistical analysis of data Analysis. Results One, the ultrasound of breast cancer image enhancement: in 60 cases of breast cancer, (1) enhancement level: 50 cases were high, accounting for 83.3% (50/ 60); (2) enhanced direction: 56 cases were concentric enhancement, accounting for 93.3%. (56/ 60); (3) contrast agent distribution: 51 cases were non-uniformity (51/ 60, 85. 00%); 9 cases were enhanced (9/ 60, 15. 00%). The boundary of 23 cases of the enhancement was clear, accounting for 38. 33% (23/ 60). The boundary of 37 cases was not clear, accounting for 61.67% (37/ 60). The peripheral edge of 37 cases was radially convergent, accounting for 61.67% (37/ 60). In the 39 cases, the blood flow was seen in the tumor, accounting for 65. 00% (39/ 60); and the contrast medium perfusion defect in 22 cases, accounting for 37%. (22/ 60). (4) The change of the size of the lesion before and after contrast: the focal range of 56 cases increased by 93.3%. (56/ 60). Ultrasound for breast cancer with different molecular types Characteristic expression in the shadow: (1) tube cavity epithelial type: ER, PR-positive expression of breast cancer patient enhanced post-lesion edge radial The probability of aggregation is increased, and the difference of breast cancer patients with ER and PR negative expression is more systematic. Statistical significance (P0.05). (2) HER2-overexpressing type: In the breast cancer patient with HER2-positive expression, the probability of the presence of the contrast agent perfusion defect is increased, compared with the HER2-negative expression, the difference is There was a significant difference (P0.05). 3) substrate-like type: the enhanced contrast border is clear, and the quantitative parameters of the breast cancer quantitative analysis and ER, PR, Ki-67 and HER2: Ki-67 was positively correlated with Grad and RS (P 0.05), and AT, PT, HT, PI, There was no significant correlation between the AUC and DS (P <0.05). Conclusion: 1. The value of the quantitative analysis of the ultrasound contrast of breast cancer and the mode of enhancement are associated with their molecular typing. the diagnostic and individualized treatment of breast cancer provides valuable information. There is a difference between the contrast-enhanced features of breast cancer with different molecular types and the parameters of the quantitative analysis. the time-intensity curve ascending branch slope RS is positive correlation, and provides the basis for quantitatively evaluating the angiogenesis of the breast tumor, 4, the ultrasound contrast can indirectly reflect the tumor oncogene,
【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
[Abstract]:Objective To study the morphological characteristics of high-frequency image of breast cancer, and to carry out the ultrasound contrast, and then compared with the results of the pathological immunohistochemistry, to carry out a preliminary analysis on the correlation between the parameter value of the quantitative analysis of breast cancer and the correlation between the enhancement mode and its molecular typing. so as to provide an imaging basis for the selection of the individualized treatment scheme of the breast cancer and the evaluation of the prognosis. Methods 60 cases of female breast cancer were collected from January 2012 to August, 2013 in the hospital of the hepatobiliary gland of the People's Hospital of Guangxi Zhuang Autonomous Region. Patients. All patients were subject to routine breast ultrasound and ultrasound contrast prior to the procedure. The conventional two-dimensional ultrasound image of the lesion was first observed, and then the blood flow of the lesion was observed by color Doppler. No. of the final cubital vein bolus, SonoVue (SonoVue), 2. 4ml, continuous real-time observation of the intensity of the enhancement, the enhancement of the orientation (concentric, off-center, diffuse enhancement), the distribution of the contrast agent, and the presence or absence of the lesion in the post-contrast range After the contrast is completed, the parameters of the recording time-intensity curve (TIC) and the gamma variable are analyzed. Values. Record lesion peak intensity change (A), start-up time (AT), peak time (PT), peak intensity (PI), peak-to-half difference time (HT), gradient (Grad), ascending branch slope (RS), half-drop slope (DS), area under curve (AUC). The results of postoperative pathology and immunohistochemistry (IHC) confirmed that the molecular point was determined. The correlation between the parameter value of the quantitative analysis of breast cancer and its correlation with its molecular typing sex. Statistical analysis of data Analysis. Results One, the ultrasound of breast cancer image enhancement: in 60 cases of breast cancer, (1) enhancement level: 50 cases were high, accounting for 83.3% (50/ 60); (2) enhanced direction: 56 cases were concentric enhancement, accounting for 93.3%. (56/ 60); (3) contrast agent distribution: 51 cases were non-uniformity (51/ 60, 85. 00%); 9 cases were enhanced (9/ 60, 15. 00%). The boundary of 23 cases of the enhancement was clear, accounting for 38. 33% (23/ 60). The boundary of 37 cases was not clear, accounting for 61.67% (37/ 60). The peripheral edge of 37 cases was radially convergent, accounting for 61.67% (37/ 60). In the 39 cases, the blood flow was seen in the tumor, accounting for 65. 00% (39/ 60); and the contrast medium perfusion defect in 22 cases, accounting for 37%. (22/ 60). (4) The change of the size of the lesion before and after contrast: the focal range of 56 cases increased by 93.3%. (56/ 60). Ultrasound for breast cancer with different molecular types Characteristic expression in the shadow: (1) tube cavity epithelial type: ER, PR-positive expression of breast cancer patient enhanced post-lesion edge radial The probability of aggregation is increased, and the difference of breast cancer patients with ER and PR negative expression is more systematic. Statistical significance (P0.05). (2) HER2-overexpressing type: In the breast cancer patient with HER2-positive expression, the probability of the presence of the contrast agent perfusion defect is increased, compared with the HER2-negative expression, the difference is There was a significant difference (P0.05). 3) substrate-like type: the enhanced contrast border is clear, and the quantitative parameters of the breast cancer quantitative analysis and ER, PR, Ki-67 and HER2: Ki-67 was positively correlated with Grad and RS (P 0.05), and AT, PT, HT, PI, There was no significant correlation between the AUC and DS (P <0.05). Conclusion: 1. The value of the quantitative analysis of the ultrasound contrast of breast cancer and the mode of enhancement are associated with their molecular typing. the diagnostic and individualized treatment of breast cancer provides valuable information. There is a difference between the contrast-enhanced features of breast cancer with different molecular types and the parameters of the quantitative analysis. the time-intensity curve ascending branch slope RS is positive correlation, and provides the basis for quantitatively evaluating the angiogenesis of the breast tumor, 4, the ultrasound contrast can indirectly reflect the tumor oncogene,
【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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