本文選題：浸潤性導(dǎo)管癌 + 分子亞型�。� 參考：《廣西醫(yī)科大學》2015年碩士論文

【摘要】：背景2011年第12屆St. Gallen會議專家共識首次確定乳腺癌的分子分型標準,采用按照乳腺癌臨床病理分型進行治療、決策的方法,2013年第13屆St Gallen大會專家組仍認為通過臨床病理學分類是一種替代的分類方法,該臨床病理分類使我們對乳腺癌的認識更深入,對預(yù)估乳腺腫瘤的預(yù)后及制定診療方案有重要的臨床意義,使得乳腺腫瘤的治療決策從“以危險因素為基礎(chǔ)選擇方案”過渡到更加精確的“根據(jù)分子分型制定方案”的個體化治療階段。組織標本的基因檢測是乳腺癌確診及分子分型確立的前提,如果可以從影像學特征或者某個影像學指標來鑒別乳腺良惡性病變及浸潤性導(dǎo)管癌不同分子分型,將對臨床醫(yī)生對乳腺腫瘤性質(zhì)的預(yù)判起到重要參考價值。目的探討MR表觀擴散系數(shù)(ADC)值對乳腺浸潤性導(dǎo)管癌的診斷價值。材料和方法本院病理證實的浸潤性導(dǎo)管癌患者278例,乳腺良性病變37例,依據(jù)278例浸潤性導(dǎo)管癌的免疫組織化學檢測結(jié)果,將浸潤性導(dǎo)管癌患者分為luminal A、luminal B1、luminal B2、HER-2(+)及三陰性型5種分型,測量病變區(qū)域的ADC值。ADC值的診斷臨界值通過ROC曲線確定,測量ROC曲線下的面積并比較,用SPSS16.0統(tǒng)計軟件對各分型的ADC值進行分析。結(jié)果1.乳腺腫瘤良惡性病變的ADC值存在差異。經(jīng)K-S正態(tài)性檢驗確定浸潤性導(dǎo)管癌與良性病變的ADC值都符合正態(tài)分布,良惡性病變的ADC值分別為0.865±0.013,1.661±0.029,經(jīng)t檢驗示p0.05,良惡性病變ADC值的差異有意義。2.乳腺良惡性病變的ADC臨界值的確立。利用ROC曲線分析,標準為Youden指數(shù)最大,從而確定的ADC的最佳臨界值為1.253×10-3 mm2/s,以此值為閾值判斷良惡性病變,敏感度為96.0%,特異度為97.3%,ROC曲線下面積為0.987,說明ADC值具有較高的診斷效能。3.浸潤性導(dǎo)管癌各分子分型ADC值的分析3.1浸潤性導(dǎo)管癌的ADC值平均值為0.865×10 mm2/s,浸潤性導(dǎo)管癌各分子分型間平均ADC值的差異有統(tǒng)計學意義(F=4.000,P=0.004),兩兩比較5個分子分型之間的差異有統(tǒng)計學意義(F=2.406,P=0.05)。3.2 ADC值與浸潤性導(dǎo)管癌分子分型存在正相關(guān)(相關(guān)系數(shù)=0.156,p=0.009)。3.3分別將5組分型的ADC值與良性病變ADC值行ROC曲線分析,測定ROC曲線下面積最大為Luminal A組,95%可信區(qū)間為0.972-1.000,說明ADC值對浸潤性導(dǎo)管癌中Luminal A型診斷效能最高,閾值為1.200×10-3 mmVs,敏感度為98.2%,特異度為97.3%。結(jié)論1、乳腺良惡性病變良惡性病變ADC值的差異有意義,良惡性病變的閡值為1.253×10-3 mm2/s：2、ADC值與浸潤性導(dǎo)管癌分子分型存在正相關(guān),對浸潤性導(dǎo)管癌分子亞型中Luminal A型診斷效能最高。
[Abstract]:Background at the 12th St. Gallen Conference in 2011, experts agreed for the first time to determine the molecular classification criteria for breast cancer and treat it according to the clinicopathological classification of breast cancer.The Group of experts of the 13th St Gallen Congress in 2013 continued to believe that clinicopathological classification is an alternative method, and that this clinicopathological classification has given us a deeper understanding of breast cancer.It has important clinical significance for predicting the prognosis of breast tumor and making diagnosis and treatment plan.It makes the treatment decision of breast cancer transition from "risk factor based selection" to the more precise "molecular classification formulation" stage of individualized treatment.The gene detection of tissue specimen is the prerequisite for the diagnosis and molecular typing of breast cancer. If we can distinguish benign and malignant breast lesions from invasive ductal carcinoma by different molecular typing, we can distinguish benign and malignant breast lesions from some imaging parameters.It will play an important reference value for clinicians to predict the nature of breast tumors.Objective to evaluate the value of Mr apparent diffusion coefficient (ADCC) in the diagnosis of invasive ductal carcinoma of breast.Materials and methods 278 cases of invasive ductal carcinoma and 37 cases of breast benign lesions were confirmed by pathology. The results of immunohistochemical examination were based on 278 cases of invasive ductal carcinoma.The patients with invasive ductal carcinoma were divided into five types: luminal luminal B1 luminal B2HER-2 () and triple negative type. The diagnostic critical value of ADC value. ADCs value was determined by ROC curve, and the area under ROC curve was measured and compared.The ADC value of each type was analyzed by SPSS16.0 software.Result 1.The ADC values of benign and malignant breast tumors were different.The ADC values of invasive ductal carcinoma and benign lesions were confirmed by K-S normal test. The ADC values of benign and malignant lesions were 0.865 鹵0.0131.661 鹵0.029, respectively, and the difference of ADC between benign and malignant lesions was significant.Establishment of ADC threshold for benign and malignant Breast lesions.By using ROC curve analysis, the standard Youden index is the largest, and the best critical value of ADC is 1.253 脳 10 ~ (-3) mm ~ (2) / s, which is the threshold value to judge benign and malignant lesions, the sensitivity is 96.0, the specificity is 97.3r ~ (13), the area under the curve is 0.987, which indicates that the ADC value has higher diagnostic efficiency.Analysis of the ADC value of each molecular type of invasive ductal carcinoma the average ADC value of invasive ductal carcinoma is 0.865 脳 10 mm 2 / s, and the difference of the average ADC value among the molecular types of invasive ductal carcinoma is statistically significant.There was a positive correlation between the value of ADC and the molecular typing of invasive ductal carcinoma (correlation coefficient was 0.156%). The ADC value of 5 groups and the ADC value of benign lesions were analyzed by ROC curve, respectively.The maximum confidence interval of 95% under the ROC curve was 0.972-1.000, which indicated that the ADC value was the most effective for the diagnosis of Luminal A type in invasive ductal carcinoma, the threshold value was 1.200 脳 10 -3 mm vs, the sensitivity was 98.2 and the specificity was 97.3 mm.Conclusion 1. The difference of ADC value between benign and malignant breast lesions is significant. The threshold value of benign and malignant lesions is 1.253 脳 10 ~ (-3) mm ~ (2) / s ~ (-2)% ~ (2) ADC value, which is positively correlated with the molecular classification of invasive ductal carcinoma, and Luminal A is the most effective in the molecular subtype of invasive ductal carcinoma.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R737.9

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