超声光散射成像对乳腺肿块良恶性鉴别诊断的应用研究

发布时间：2018-02-21 15:04

本文关键词： 超声光散射成像血红蛋白血氧饱和度综合诊断　出处：《青海大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨超声光散射成像系统在鉴别乳腺良、恶性肿物的应用价值;利用光散射成像技术(Diffuse optical tomography,DOT)提供肿物内量化的血红蛋白、血氧饱和度,探讨营养代谢对乳腺肿物良恶性的鉴别价值。方法:收集在2015年6月至2017年1月期间,青海大学附属医院乳甲外科行乳腺超声光散射成像检查并行肿物切除的患者98例,其中共包括102个乳腺肿物。将超声光散射成像得出的肿物内的量化指标(如血红蛋白总量、血氧饱和度,综合诊断指数)与病理行相关性分析,评价超声光散射成像系统的灵敏度、特异度、准确率、阳性预测值、阴性预测值。将恶性肿物以最大内径为1cm分为两组,比较肿物大小与肿物内血红蛋白、血氧饱和度之间的关系。根据病理结果将乳腺肿物分成良、恶性组,将两组肿物内的参数值(血红蛋白总量、血氧饱和度)作比较,明确良恶性肿物内上述参数有无差异。分别以血红蛋白、血氧饱和度、综合诊断指数为指标,绘制受试者工作特征(ROC)曲线,获得曲线下面积(AUC),以明确上述指标(血红蛋白、血氧饱和度、综合诊断指数)对乳腺良恶性肿物鉴别价值,根据ROC曲线,找出最佳阈值,在该阈值处其相应的敏感度和特异度之和最大。结果:1、102个乳腺肿物,病理检出乳腺恶性肿物52个,检出良性肿物50个。超声光散射成像系统检出乳腺恶性肿物62个,检出良性肿物40个。超声光散射诊断乳腺肿块的敏感性94.23%,特异性74%,准确率84.31%,阳性预测值79.03%,阴性预测值92.5%。2、将恶性肿物以最大内径为1cm分为两组,最大内径小于、等于1cm的肿物内血红蛋白:186.67±75.57umol/L,低于最大内径大于1cm的肿物内血红蛋白:241.59±57.72umol/L,其差异有统计学意义(P0.05)。最大内径小于、等于1cm的肿物内血氧饱和度:1.05±0.25,高于最大内径大于1cm的肿物内血氧饱和度:0.87±0.20,其差异有统计学意义(P0.05)。3、良性肿物内血红蛋白值155.16±49.27umol/L,恶性肿物内血红蛋白值225.75±67.46umol/L,其差异有统计学意义(P0.05)。良性肿物血氧饱和度值1.23±0.30,恶性肿物血氧饱和度值0.93±0.23,其差异有统计学意义(P0.05)。4、以血红蛋白为指标,绘制ROC曲线,ROC曲线下面积为0.826,最佳阈值为205.5umol/L,其相应的敏感度和特异度之和最大,它的特异性是90%,敏感性是71.2%。以血氧饱和度为指标,绘制ROC曲线,ROC曲线下面积为0.784,最佳阈值为1.075,其相应的敏感度和特异度之和最大,它的特异性是78.8%,敏感性是66%。以综合诊断指数为指标绘制ROC曲线,ROC曲线下面积为0.918,最佳阈值为133.5,其相应的敏感度和特异度之和最大,它的特异性是70%,敏感性是100%。结论:1、超声光散射诊断乳腺肿物的敏感性及阴性预测值较高,提示超声光散射成像系统在乳腺肿物的诊断及鉴别诊断方面可能具有一定的临床应用价值。2、超声光散射成像提供的肿物内量化指标(血红蛋白总量、血氧饱和度,综合诊断指数)与肿物的良恶性有直接相关性,可为临床诊断及治疗提供更多的参考指标。3、综合诊断指数诊断乳腺良恶性肿瘤价值明显高于单一指标(血红蛋白、血氧饱和度),有助于乳腺肿瘤患者的筛查。
[Abstract]:Objective: To investigate the ultrasound scattering imaging system in differential diagnosis of breast benign and malignant tumor, the application value; using light scattering imaging technique (Diffuse optical tomography, DOT) with tumor in quantification of hemoglobin, oxygen saturation, to explore the value of nutrition and metabolism for the identification of benign and malignant breast tumors. Methods: collected in the period from June 2015 to January 2017, Affiliated Hospital of Qinghai University of breast and thyroid surgery for breast ultrasound scattering imaging examination of 98 cases of parallel tumor resection patients, which included 102 breast lesions. The light scattering of ultrasound imaging of tumor in the quantitative indicators (such as total hemoglobin, oxygen saturation, comprehensive diagnosis index) and pathological correlation analysis, sensitivity evaluation of ultrasound scattering imaging system the specificity, accuracy, positive predictive value, negative predictive value. The maximum diameter of 1cm with malignant tumor were divided into two groups, compared with large mass With the small tumor in the relationship between hemoglobin and oxygen saturation. According to the pathological results of breast tumor were divided into benign and malignant groups, two groups within the mass parameter values (total hemoglobin, oxygen saturation) for comparison, clear the parameters of benign and malignant tumor have no difference. At different hemoglobin, oxygen saturation, comprehensive diagnosis index as the index, the receiver operating characteristic (ROC) curve, obtained the area under the curve (AUC), to determine the index (hemoglobin, oxygen saturation, comprehensive diagnosis index) for differential diagnosis of benign and malignant breast tumor, according to the ROC curve, to find the optimal threshold, the threshold of the corresponding sensitivity and specificity and the largest. Results: 1102 breast tumor, malignant tumor of breast pathology was 52, 50 were benign tumor. Ultrasound scattering imaging system detection of malignant breast tumor and 62 benign tumor, 40. Ultrasonic detection The sensitivity of 94.23% light scattering in diagnosis of breast tumors, the specificity was 74%, the accuracy rate was 84.31%, the positive predictive value of 79.03%, negative predictive value of 92.5%.2, the maximum diameter of 1cm with malignant tumor were divided into two groups, the maximum diameter of less than, equal to 1cm tumor in hemoglobin: 186.67 + 75.57umol /L, lower than the maximum diameter greater than 1cm in the tumor hemoglobin: 241.59 + 57.72umol/L, the difference was statistically significant (P0.05). The maximum diameter is less than, equal to 1cm in the tumor blood oxygen saturation: 1.05 + 0.25, higher than the maximum diameter of more than 1cm in the tumor blood oxygen saturation: 0.87 + 0.20, the difference was statistically significant (.3, P0.05) in benign tumor hemoglobin value of 155.16 + 49.27umol/L in 225.75 malignant tumor, hemoglobin + 67.46umol/L, the difference was statistically significant (P0.05). Benign tumor oxygen saturation value of 1.23 + 0.30, malignant tumor blood oxygen saturation value of 0.93 + 0.23, the difference is Statistical significance (P0.05).4, with hemoglobin as the index, the ROC curve, the area under the ROC curve was 0.826, the optimal threshold is 205.5umol/L, its corresponding sensitivity and specificity and the largest, and its specificity is 90%, sensitivity is 71.2%. with oxygen saturation index, ROC curve, the area under ROC curve 0.784, the optimal threshold is 1.075, the sensitivity and specificity of the largest, and its specificity is 78.8%, sensitivity is 66%. with the comprehensive diagnosis index ROC curve, the area under the ROC curve was 0.918, the optimal threshold is 133.5, the sensitivity and specificity of the maximum. The specificity was 70%, sensitivity was 100%. conclusions: 1, predict the sensitivity and negative light scattering of ultrasound in the diagnosis of breast tumor is higher, suggesting that the ultrasonic scattering imaging system may have clinical in diagnosis and differential diagnosis of breast neoplasms The application value of.2 and ultrasound scattering imaging provides quantitative indicators in the tumor (total hemoglobin, oxygen saturation, comprehensive diagnosis index) and tumor has a direct correlation, can provide more.3 reference index for clinical diagnosis and treatment, the comprehensive diagnosis index of diagnosis of benign and malignant breast tumors was significantly higher than that of single value index (hemoglobin, oxygen saturation), screening is helpful to patients with breast cancer.

【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R737.9

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