本文選題：乳腺癌　切入點(diǎn)：腋窩　出處：《浙江大學(xué)》2015年碩士論文

【摘要】：目的： 探討超聲聲像圖特征與pNl期乳腺癌腋淋巴結(jié)轉(zhuǎn)移的相關(guān)性,并聯(lián)合臨床、病理信息建立多因素回歸模型預(yù)測腋淋巴結(jié)的pNl期轉(zhuǎn)移。 方法： 采用飛利浦HDII彩色超聲儀,5～12MHz高頻線陣探頭,對乳腺癌患者的乳腺病灶及腋窩淋巴結(jié)進(jìn)行全面、細(xì)致的超聲檢查。以前哨淋巴結(jié)活檢或腋窩淋巴結(jié)清掃的病理結(jié)果作為淋巴結(jié)轉(zhuǎn)移的金標(biāo)準(zhǔn)。選取經(jīng)病理證實(shí)的80例pN1期和pN0期乳腺癌患者臨床、病理和病灶超聲特征等22項(xiàng)參數(shù)和腋窩淋巴結(jié)超聲特征等6項(xiàng)參數(shù)與腋窩淋巴結(jié)狀態(tài)進(jìn)行分析。采用SPSS16.0統(tǒng)計(jì)軟件對以上28個(gè)參數(shù)進(jìn)行單因素及多因素分析,以P0.05作為檢驗(yàn)水準(zhǔn),并繪制受試者工作曲線檢驗(yàn)回歸模型的預(yù)測效能。 結(jié)果： 80例乳腺癌患者和92枚淋巴結(jié)分析顯示：年齡、病灶位置、病灶血流分級、有無毛刺、后方回聲、前方脂肪層回聲、乳腺后間隙、組織學(xué)分級、皮質(zhì)厚度、皮髓質(zhì)分界、皮質(zhì)均勻性、皮門比等以上12項(xiàng)參數(shù)為腋窩淋巴結(jié)轉(zhuǎn)移相關(guān)因素(P0.05)。多因素分析顯示：年齡40歲、病灶血流Ⅲ級、前方脂肪層回聲增強(qiáng)、乳腺后間隙消失為腋窩淋巴結(jié)轉(zhuǎn)移危險(xiǎn)因素,其Odd Ratio (OR)值分別為17.78(95%CI2.50～126.54),2.47(95%CI0.16～32.97),4.57(95%CI1.13～18.53),4.4(95%CI0.87-22.18);皮質(zhì)非均勻性改變、皮門比1.0為腋窩淋巴結(jié)轉(zhuǎn)移危險(xiǎn)因素,其Odd Ratio (OR)值分別為5.1(95%CI1.68～15.44),3.53(95%CI1.16～10.75)。繪制前方脂肪層回聲參數(shù)和多參數(shù)組合(年齡、病灶血流分級、前方脂肪層回聲、乳腺后間隙)的ROC曲線,2條曲線下面積(Area Under the Curve, AUC)分別為0.679(95%CI0.542～0.816),0.824(95%CI0.709～0.940).繪制皮質(zhì)均勻性、皮門比等參數(shù)以及多參數(shù)組合(皮質(zhì)均勻性、皮門比)的ROC曲線,3條曲線的AUC分別為0.696(95%CI0.569～0.823),0.670(95%CI0.541～0.799),0.757(95%CI0.640～0.873).繪制綜合所有指標(biāo)(年齡、病灶血流分級、前方脂肪層回聲、乳腺后間隙、皮質(zhì)均勻性、皮門比)的ROC曲線,曲線的AUC為0.909(95%C10.825～0.994)。綜合所有的指標(biāo)有較實(shí)用的術(shù)前預(yù)測價(jià)值,其靈敏度和特異度分別為72.7%和98.2%。本研究超聲評估pN1期腋淋巴結(jié)轉(zhuǎn)移的敏感性和特異性分別為91.67%和32.14%,陽性預(yù)測值和陰性預(yù)測值分別為46.48%和85.71%。 結(jié)論： 病灶超聲特征聯(lián)合臨床信息對乳腺癌患者pNl期腋淋巴結(jié)轉(zhuǎn)移有一定的預(yù)測價(jià)值(AUC為0.82),為腋窩淋巴結(jié)的掃查提供重要信息；腋窩淋巴結(jié)超聲皮質(zhì)非均勻性改變是腋淋巴結(jié)早期轉(zhuǎn)移的特征,結(jié)合淋巴結(jié)皮門比大于1預(yù)測pNl期腋淋巴結(jié)的轉(zhuǎn)移有一定的準(zhǔn)確性(AUC為0.76)；將病灶超聲特征、腋淋巴結(jié)超聲特征和患者年齡等信息結(jié)合在預(yù)測pNl期腋淋巴結(jié)的轉(zhuǎn)移上有較好的準(zhǔn)確性(AUC為0.909)。
[Abstract]:Objective:To investigate the correlation between ultrasonographic features and axillary lymph node metastasis in pNl stage breast cancer, and to establish a multivariate regression model for predicting axillary lymph node metastasis in pNl stage.Methods:The breast lesions and axillary lymph nodes of breast cancer patients were examined with Philips HDII color ultrasound instrument with a high frequency and 12 MHz linear array probe.Sentinel lymph node biopsy or axillary lymph node dissection was used as the gold standard for lymph node metastasis.Twenty-two parameters of pathology and ultrasonic characteristics of axillary lymph nodes and the status of axillary lymph nodes were analyzed in 80 patients with pN1 and pN0 stage breast cancer confirmed by pathology.The SPSS16.0 software was used to analyze the above 28 parameters by single factor and multivariate analysis. P05 was taken as the test level, and the predictive effectiveness of regression model was tested by drawing the operating curve of the subjects.Results:Analysis of 80 patients with breast cancer and 92 lymph nodes showed: age, location of lesion, blood flow grade of lesion, no burr, posterior echo, echo of anterior fat layer, posterior space of mammary gland, histological grade, thickness of cortex, dividing of dermatomedullary.The cortical homogeneity and the ratio of skin to hilum were all related to axillary lymph node metastasis (P 0.05).The Odd Ratio ORs were 5.1 / 95 CI = 1.68 ~ 15.44 ~ 3.53 ~ 95 CI 1.16 ~ 10.75g / I, respectively.The ROC curves of all indexes (age, blood flow grade, echo of anterior adipose layer, posterior space of mammary gland, cortex homogeneity, ratio of skin to hilum) were plotted. The AUC of the curve was 0.909 (950.825 鹵0.994).The sensitivity and specificity were 72.7% and 98.2%, respectively.The sensitivity and specificity of ultrasound in evaluating axillary lymph node metastasis in pN1 stage were 91.67% and 32.14% respectively. The positive predictive value and negative predictive value were 46.48% and 85.71% respectively.Conclusion:Ultrasound features combined with clinical information have certain predictive value for axillary lymph node metastasis in breast cancer patients at pNl stage. AUC is 0.82g, which provides important information for axillary lymph node scanning.The heterogeneity of axillary lymph nodes was the characteristic of early axillary lymph node metastasis. It was accurate to predict axillary lymph node metastasis in pNl with the ratio of lymph node dermatocutaneous to greater than 1. The ultrasonic features of axillary lymph nodes were analyzed.The combination of ultrasonic features of axillary lymph nodes and age of patients had a good accuracy in predicting axillary lymph node metastasis in pNl stage.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R737.9

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