發(fā)布時(shí)間：2019-03-30 17:44

【摘要】：乳腺癌是女性常見(jiàn)惡性腫瘤之一,盡管通過(guò)多樣的乳腺癌篩查手段越來(lái)越多的早期乳腺癌被發(fā)現(xiàn),但伴隨著逐年升高的發(fā)病率,乳腺癌仍嚴(yán)重威脅著女性的生命安全和生活質(zhì)量。乳腺癌的術(shù)前診斷意義重大,關(guān)系到患者治療方式的選擇。麥默通因其診斷準(zhǔn)確、損傷小、操作簡(jiǎn)單等優(yōu)點(diǎn)廣泛應(yīng)用于乳腺疾病的診斷和治療中。導(dǎo)管內(nèi)癌(ductal carcinoma in situ,DCIS)是腫瘤未突破基底膜,有發(fā)展成為浸潤(rùn)性乳腺癌傾向的一種乳腺惡性疾病,臨床診斷中容易出現(xiàn)病理低估。本研究回顧性分析了2009年至2015年間在吉林大學(xué)第一醫(yī)院乳腺外科經(jīng)麥默通穿刺活檢病理證實(shí)為DCIS且進(jìn)一步接受手術(shù)治療的病例46例,研究影響DCIS病理低估的因素,從而在臨床實(shí)踐中實(shí)現(xiàn)更高的病理準(zhǔn)確性。研究目的:探討影響經(jīng)麥默通穿刺活檢病理證實(shí)為DCIS病理低估的因素,為臨床個(gè)體化治療提供理論依據(jù)。研究方法:回顧性分析了2009年1月至2015年12月間于吉林大學(xué)第一醫(yī)院乳腺外科接受乳腺病灶麥默通穿刺活檢證實(shí)DCIS的病例46例。所有的統(tǒng)計(jì)數(shù)據(jù)以SPSS 22.0軟件進(jìn)行分析。組間差異比較采用卡方檢驗(yàn)或Fisher確切概率法,取P0.05為有統(tǒng)計(jì)學(xué)意義,并進(jìn)行多因素Logistic回歸分析,找到經(jīng)麥默通穿刺活檢診斷為DCIS病例出現(xiàn)病理低估的影響因素。研究結(jié)果:46例病例均為女性病例,平均年齡50.6歲。術(shù)后石蠟病理證實(shí)DCIS 31例、DCIS伴微小浸潤(rùn)10例、浸潤(rùn)性導(dǎo)管癌4例、浸潤(rùn)性篩狀癌1例。15例病例出現(xiàn)病理低估。麥默通穿刺活檢證實(shí)為DCIS的病理低估率為32.6%。對(duì)單因素分析具有統(tǒng)計(jì)學(xué)意義的3項(xiàng)因素(乳腺X線攝影是否伴有鈣化、超聲下腫物最大徑、活檢組織條數(shù))進(jìn)行多因素Logistic回歸分析后,發(fā)現(xiàn)乳腺X線攝影是否伴有鈣化、活檢組織條數(shù)被證實(shí)為病理低估發(fā)生的獨(dú)立預(yù)測(cè)因素,相對(duì)危險(xiǎn)度OR值分別為:5.114和5.756。當(dāng)腫物伴有鈣化或穿刺條數(shù)較少時(shí)容易發(fā)生病理低估。結(jié)論:麥默通穿刺活檢是公認(rèn)的準(zhǔn)確性較高的術(shù)前診斷方式,但經(jīng)麥默通穿刺活檢后仍有病理低估的發(fā)生,尤其當(dāng)穿刺病理診斷為導(dǎo)管內(nèi)癌時(shí)應(yīng)引起注意。乳腺X線攝影發(fā)現(xiàn)病灶伴有鈣化時(shí)可增加活檢組織條數(shù),會(huì)降低病理低估率,從而對(duì)手術(shù)方式的選擇提供合理依據(jù)。
[Abstract]:Breast cancer is one of the most common malignant tumors in women. Although more and more early breast cancer has been detected by various breast cancer screening methods, the incidence of breast cancer is increasing year by year. Breast cancer continues to pose a serious threat to the safety and quality of life of women. Preoperative diagnosis of breast cancer is of great significance, which is related to the choice of treatment. It is widely used in the diagnosis and treatment of breast diseases because of its accurate diagnosis, small damage, simple operation and so on. Intraductal carcinoma (ductal carcinoma in situ,DCIS) is a malignant breast disease which does not break through the basement membrane and develops into invasive breast cancer. It is easy to appear pathological underestimation in clinical diagnosis. In this study, 46 cases of DCIS and further surgical treatment were analyzed retrospectively in the breast surgery department of the first Hospital of Jilin University from 2009 to 2015. The factors influencing the pathological underestimation of DCIS were studied. In order to achieve higher pathological accuracy in clinical practice. Objective: to explore the factors that influence the pathological underestimation of DCIS confirmed by biopsy and provide theoretical basis for clinical individualized treatment. Methods: from January 2009 to December 2015, 46 cases of DCIS confirmed by Mammerton biopsy in the breast surgery department of the first Hospital of Jilin University were retrospectively analyzed. All the statistics were analyzed with SPSS 22.0 software. The differences between groups were compared by chi-square test or Fisher exact probability method. P0.05 was statistically significant, and multivariate Logistic regression analysis was carried out to find out the influencing factors of pathological underestimation in DCIS cases diagnosed by McMurton puncture biopsy. Results: all 46 cases were female with an average age of 50.6 years. 31 cases of DCIS, 10 cases of DCIS with microinfiltration, 4 cases of invasive ductal carcinoma and 1 case of infiltrating sieve carcinoma were confirmed by paraffin-embedded pathology. The pathological underestimation rate of DCIS confirmed by biopsy was 32.6%. Univariate Logistic regression analysis of three factors (X-ray radiography of breast with calcification, maximum diameter of tumor under ultrasound, number of biopsy tissue) showed that mammography was accompanied with calcification or not, and it was found that there was no calcification in mammography, and that there was no calcification in breast X-ray radiography. The number of biopsy tissues was proved to be an independent predictor of pathological underestimation. The OR values of relative risk were 5.114 and 5.756, respectively. Pathological underestimation occurs when the tumor is accompanied by calcification or the number of puncture strips is small. Conclusion: Mymerton puncture biopsy is recognized as a highly accurate method for preoperative diagnosis, but there is still a pathological underestimation after the biopsy, especially when the biopsy is diagnosed as intraductal carcinoma. Mammography can increase the number of biopsy tissues with calcification, and reduce the rate of pathological underestimation, thus providing a reasonable basis for the choice of surgical methods.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.9

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