高频超声对三种腮腺良性肿瘤的诊断价值

发布时间：2018-02-28 15:04

本文关键词： 腮腺多形性腺瘤 Warthin’s瘤基底细胞腺瘤超声诊断　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究高频超声对腮腺多形性腺瘤、Warthin’s瘤及基底细胞腺瘤的诊断及鉴别诊断价值,以提高诊断符合率,降低误诊率。材料和方法:本研究收集了腮腺内良性肿瘤,共50例65个肿瘤(其中多形性腺瘤21个,Warthin’s瘤32个,基底细胞腺瘤12个),术前均在我院行超声检查。依据病理结果将其分为3组,A组:多形性腺瘤,B组:Warthin’s瘤,C组:基底细胞腺瘤。比较各项超声特征(瘤体的形态,内部回声,后方回声,血流信号强度)诊断腮腺三种良性肿瘤的敏感性、特异性及符合率,并构建受试者作用特征(Receiver Operating Characteristic,ROC)曲线,探究各项超声特征对三种腮腺良性肿瘤的诊断及鉴别诊断价值。结果:1.多形性腺瘤、Warthin’s瘤、基底细胞腺瘤均可单发或多发。2.年龄及性别在三组之间存在统计学差异(P0.05),诊断时可做参考。3.对各型腮腺良性肿瘤形态是否规整,内部回声是否均匀、后方回声有无增强在单变量分析之中有统计学意义(P值分别为0.001、0.036和0.010)。多形性腺瘤组中表现为“分叶状”者最多(14/21);Warthin’s瘤内部回声多不均匀(24/32),后方回声多增强(23/32)。4.血流信号强度在单变量分析之中有统计学意义(P0.05),其中多形性腺瘤以0级和I级血流信号为主(17/21);Warthin’s瘤和基底细胞腺瘤以II级和III级血流信号为主(25/32,9/12)。5.边界是否清晰、内部回声性质、平均最大径对此三个肿瘤没有统计学差异(P值分别为0.489、0.565和0.358)。6.少血供在诊断多形性腺瘤的四项超声特征中符合率最高,为78.46%;多血供在诊断Warthin’s瘤中符合率最高,为69.23%;内部回声均匀在诊断基底细胞腺瘤中符合率最高,为67.69%。7.ROC及多变量观察值的ROC结果显示:形态不规整,后方回声无增强,少血供对多形性腺瘤的诊断准确性较高,三者联合后诊断效果较好;形态规整,多血供对Warthin’s瘤的诊断价值较高,两者联合可提高诊断准确性;形态规整,内部回声均匀,后方回声增强、多血供单独诊断基底细胞腺瘤没有统计学意义,四项超声特征联合诊断基底细胞腺瘤有一定准确性。结论:1.年龄及性别可以作为鉴别此三种腮腺良性肿瘤参考标准。2.形态不规整(分叶状)在多形性腺瘤中最多见;多形性腺瘤及Warthin’s瘤内部回声不均匀;三个良性肿瘤中,Warthin's瘤及基底细胞腺瘤后方回声增强多见。3.三种良性肿瘤中,Warthin’s瘤及基底细胞腺瘤以多血供为主,多形性腺瘤以少血供为主。4.各项超声特征单独诊断腮腺良性肿瘤有一定的价值,但对此三种腮腺良性肿瘤的鉴别诊断价值有限。应充分掌握这三种肿瘤各自的超声特征,多特征联合观察,有望提高诊断符合率。
[Abstract]:Objective: to study the value of high frequency ultrasound in the diagnosis and differential diagnosis of Warthins tumor and basal cell adenoma of parotid pleomorphic adenoma, in order to improve the diagnostic coincidence rate and reduce the misdiagnosis rate. Materials and methods: benign tumors in parotid gland were collected in this study. A total of 65 tumors (including 21 pleomorphic adenomas and 32 Warthins tumors) were found in 50 cases. Twelve basal cell adenomas were examined by ultrasonography in our hospital before operation. According to the pathological results, they were divided into 3 groups: group A: group B: pleomorphic adenoma group B: Warthins tumor group C: basal cell adenoma. The sensitivity, specificity and coincidence rate of posterior echo and blood flow signal intensity in the diagnosis of three kinds of benign tumors of parotid gland were analyzed, and the receiver Operating character curve was constructed. To explore the value of ultrasound features in the diagnosis and differential diagnosis of three kinds of parotid benign tumors. Results: 1. Pleomorphic adenoma Warthins tumor, Basal cell adenoma can be single or multiple. There are statistical differences in age and sex among the three groups (P 0.05). The diagnosis of benign parotid tumors can be made reference .3. whether the shape of various types of parotid benign tumors is regular, whether the internal echo is uniform. Enhancement of posterior echo was statistically significant in univariate analysis (P = 0.001, P = 0.036 and P = 0.010, respectively). In pleomorphic adenoma group, there were 14 / 21 / 21 Warthins tumors with abnormal internal echo and 23 / 32 / 32 / 4 posterior echo enhancement. The signal intensity was statistically significant in univariate analysis (P 0.05), in which 17 / 21 / 21 Warthinthins tumors and basal cell adenomas were characterized by grade 0 and grade I blood flow signals, and grade II and III grade 2 / 32 / 9 / 12 / 5, respectively. Whether the boundary was clear or not, There was no significant difference in the internal echo properties and the mean maximum diameter between the three tumors (P = 0.489n 0.565 and 0.358g 路6.The coincidence rate of the four ultrasound features of pleomorphic adenoma was 78.46, and that of multiple blood supply was the highest in the diagnosis of Warthin's tumor. The internal echo homogeneity was the highest in the diagnosis of basal cell adenoma, and the ROC results of 67.69k.7.ROC and multivariate observation value showed that the shape was irregular, the posterior echo was not enhanced, and the accuracy of diagnosis of pleomorphic adenoma with low blood supply was higher. After the combination of the three, the diagnostic effect is better, the shape is regular, and the diagnosis value of multiple blood supply to Warthin's tumor is higher, the combination of the two can improve the diagnostic accuracy, the shape is regular, the internal echo is homogeneous, and the echo in the rear is enhanced. Single diagnosis of basal cell adenoma with multiple blood supply has no statistical significance. Conclusion: 1. Age and sex can be used as reference criteria for differentiating these three benign parotid tumors. Shape irregular (lobular) is the most common in pleomorphic adenomas. The internal echo of pleomorphic adenoma and Warthin's tumor was not homogeneous, and the echo enhancement of Warthins tumor and basal cell adenoma was more common in the three benign tumors than that in benign tumor. 3. Among the three kinds of benign tumors, Warthins tumor and basal cell adenoma were mainly multi-blood supply. In pleomorphic adenoma, hypoglycemia is the main feature. Each ultrasonic feature has certain value in the diagnosis of parotid benign tumor alone, but the differential diagnosis value of these three kinds of benign parotid tumors is limited, so we should fully grasp the ultrasonic characteristics of these three kinds of tumors. Combined observation of multiple features is expected to improve the diagnostic coincidence rate.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R739.8

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