声触诊组织定量技术在乳腺癌腋窝淋巴结转移的临床应用研究

发布时间：2018-03-22 01:18

本文选题：声触诊组织定量技术　切入点：乳腺癌　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨常规超声在乳腺癌腋窝淋巴结转移的临床应用价值及探讨声触诊组织定量技术(VTQ)对乳腺癌腋窝淋巴结转移的鉴别诊断价值,并分析影响VTQ技术的相关因素;通过绘制ROC曲线来找到判断乳腺癌腋窝淋巴结转移与否的最佳VTQ截点值,为临床医生提供判断乳腺癌腋窝淋巴结转移与否新的观察值;比较常规超声、声触诊组织定量技术及二者联合对乳腺癌腋窝淋巴结转移的诊断价值;最后应用Logistic回归模型分析影响乳腺癌腋窝淋巴结性质判断因素的相关性,并筛查出判断乳腺癌腋窝淋巴结性质的超声敏感指标。方法:收集2015年10月--2016年10月期间以“乳腺包块”为主诉收住皖南医学院第一附属医院甲乳外科共75例患者,所选取患者均为女性,最小年龄35岁,最大年龄82岁,中位年龄57岁。入选标准:(1)在做乳腺超声检查前未做放化疗治疗;(2)在做乳腺超声前未做穿刺活检。(3)在做乳腺彩超检查前未做钼靶等检查;(4)临床检查、超声检查未发现腋窝淋巴结肿大及未做腋窝淋巴结清扫术者排除;(5)患有全身感染性疾病及皮肤疾病及病理结果随访不理想的排除。利用西门子ACUSON S2000的高频探头9L4(4--9MHZ)对所选取患者进行常规超声及声触诊组织定量技术检查。嘱患者平卧位或侧卧位(必要时可将患者肩部垫起),上臂外展80o;对乳腺及腋窝淋巴结先进行常规超声检查,重点观察腋窝淋巴结的声像图,包括淋巴结位置,形态,皮髓质分界,皮质厚度,淋巴血供等,当淋巴结以最大切面显示时,稳定图像,测量淋巴结最大长径、短径及皮质最厚处,然后对淋巴结启用声触诊组织定量(VTQ)技术,获取同一深度7次VTQ值;之后对所测值取平均值,最终选取平均值、最大值、最小值为观察指标,计量资料用(?)±S表示。对于腋窝淋巴结多发者,选取距离乳腺较近的常规超声高度可疑转移性淋巴结作为观察对象,最终以手术病理为金标准。常规超声、声触诊组织定量技术、常规超声联合声触诊组织定量技术采用评分法评估乳腺癌腋窝淋巴结性质,统计学处理应用SPSS 19.0软件,计量资料用(?)±S表示,声触诊组织定量(VTQ)值判断乳腺癌腋窝淋巴结性质采用独立样本t检验。通过绘制受试者工作特征(ROC)曲线,获取最佳截点,计算常规超声、声触诊组织定量技术及常规超声联合声触诊组织定量技术的敏感性、特异性及ROC曲线下面积并进行分析比较;分析腋窝淋巴结的常规超声及声触诊组织定量技术特征声像图,包括纵横之比(L/S),皮质厚度、血流分级、血流分型、VTQ最大值、最小值、平均值,将其定为自变量,腋窝淋巴结转移作为因变量。同时给予每个观察指标进行赋值,与腋窝淋巴结转移有关的指标赋值1,其他指标均赋值0。单因素分析采用t检验,多因素检验采用Logistic回归模型。最终以病理结果为金标准,P0.05,有统计学意义。结果:本研究结果最终以腋窝淋巴结清扫术后病理结果为标准,转移性淋巴结44例,反应性增生性淋巴结31例;常规超声对乳腺癌腋窝淋巴结良恶性鉴别诊断的敏感度86.0%、特异度77.4%;声触诊组织定量技术(VTQ)对乳腺癌腋窝淋巴结良恶性鉴别诊断的VTQ平均值的最佳截点值为1.83m/s,相对应的敏感性、特异性分别为93.2%、90.3%,ROC曲线下面积(AUC)为0.991;常规超声联合声触诊组织定量(VTQ)技术对乳腺癌腋窝淋巴结性质鉴别诊断的敏感度86.4%、特异度91.9%。比较常规超声、声触诊组织定量技术、常规超声联合声触诊组织定量技术在诊断乳腺癌腋窝淋巴结转移与否的敏感性、特异性及ROC曲线下面积,得出声触诊组织定量(VTQ)技术敏感性最高(93.2%);常规超声联合声触诊组织定量技术特异性最高(91.9%);声触诊组织定量技术ROC曲线下面积最高(0.991);转移性、反应性增生性淋巴结的VTQ最大值、最小值识别乳腺癌腋窝淋巴结性质的最佳截点值分别为1.96m/s、1.76m/s,最大值敏感性较高(97.7%),最小值特异性较高(95.1%),最大值ROC曲线下面积较高(0.995);经单因素分析应用t检验得出各指标的显著性SIG均为0.000(P0.05),有统计学意义。多因素Logistic分析显示纵横径比、血流分级、血流分型、最大值、平均值等五项指标是乳腺癌腋窝淋巴结转移的危险因素(回归系数0,优势比1),皮质厚度、最小值为乳腺癌腋窝淋巴结转移的保护因素(回归系数0,优势比1)。结论:声触诊组织定量技术(VTQ)是一种新型的超声检查技术,可以对乳腺癌腋窝淋巴结的质地做出定量评价,从而判断其良恶性,为临床医生判断提供了一个新的观察指标;通过单因素分析及多因素分析结果发现纵横之比、血流分级、血流分型、VTQ平均值、最大值对判断腋窝淋巴结性质具有一定程度的影响;声触诊组织定量技术结合常规超声对乳腺癌腋窝淋巴结良恶性诊断有了进一步的提高,同时应用Logistic回归模型对影响乳腺癌腋窝淋巴结性质判断的多个指标进行分析,有助于我们在今后的工作中从多个方面进行综合评估,进一步提高超声诊断腋窝淋巴结性质的准确性。
[Abstract]:Objective: To explore and discuss conventional ultrasound in breast cancer axillary lymph node metastasis and the clinical value of virtual touch tissue quantification (VTQ) and differential diagnosis for metastatic breast cancer axillary lymph nodes, and the related factors analysis of the influence of VTQ technology; through ROC curves to find breast cancer axillary lymph node metastasis and the best VTQ the cut-off point, whether axillary lymph node metastasis of breast cancer and whether the new observation value for clinicians; compared with conventional ultrasound, virtual touch tissue quantification and the combination of the two breast cancer axillary lymph node metastasis diagnosis value; finally the application of Logistic regression model to analyze the effects of axillary lymph node in breast cancer nature judgment factor correlation. And screening ultrasound sensitive indicators to determine the nature of the axillary lymph node in breast cancer. Methods: from October 2015 October --2016 year period to "breast mass" as the chief complaint admitted A breast surgery the First Affiliated Hospital of Wangnan Medical College, a total of 75 patients were selected, the patients were female, the minimum age of 35 years, the maximum age of 82 years old, the median age was 57 years. Inclusion criteria: (1) not done in radiotherapy and chemotherapy in the treatment of breast ultrasound; (2) in breast ultrasound before doing puncture biopsy. (3) not done in mammography, breast ultrasound examination before; (4) clinical examination, ultrasound examination showed no axillary lymph nodes and without axillary lymph node dissection were excluded; (5) suffering from systemic infectious diseases and skin diseases and pathological results exclude the ideal using follow-up. SIEMENS ACUSON S2000 9L4 high frequency probe (4--9MHZ) were examined by conventional ultrasound and virtual touch tissue quantification inspection on selected patients. The patients in supine position or lateral position (if necessary with shoulder pad), upper arm abduction 80O; on the breast and axillary lymph node by conventional ultrasound examination The investigation, observation on sonograms of axillary lymph nodes, including lymph node location, morphology, corticomedullary differentiation, cortical thickness, lymphatic blood supply, when the lymph nodes in the largest section display, stable image, measuring lymph node maximum diameter, short diameter and the thickness of cortex, and lymph node of virtual touch enabled quantitative tissue (VTQ) technology, to obtain the same depth of 7 VTQ; after the value measured by the average value, the final selection average value, maximum value, minimum value as observation indexes, measurement data with (?) + S. For the axillary lymph nodes of multiple, selected from conventional ultrasound from a breast in the highly suspected metastatic lymph nodes as the object of observation, the final surgical pathology as the gold standard. Conventional ultrasound, virtual touch tissue quantification, conventional ultrasound combined with virtual touch tissue quantification by evaluation of axillary lymph nodes in breast cancer, by SPSS 19 statistical software A measurement data with (?) + S, virtual touch tissue quantification (VTQ) values of axillary lymph node in breast cancer using independent samples t test. The receiver operating characteristic (ROC) curve, obtain the optimal cut-off point, calculation of conventional ultrasound, the sensitivity of virtual touch tissue quantification technique and conventional ultrasound combined with the virtual touch tissue quantification, specificity and the area under the ROC curve were analyzed and compared; analysis of axillary lymph node of conventional ultrasound and virtual touch tissue quantification sonographic characteristics, including aspect ratio (L/S), cortical thickness, blood flow, blood type VTQ, maximum value, minimum value, average value that will make it as independent variables, axillary lymph node metastasis as the dependent variable. At the same time to give each observation index assignment, axillary lymph node metastasis and 1 relevant indicators, other indicators are assigned 0. single factor analysis using t test, multi factor test using Log The istic regression model. Finally with pathological results as the gold standard, P0.05, have statistical significance. Results: the results of this study to axillary lymph node dissection and postoperative pathological results as the standard, metastatic lymph nodes in 44 cases, reactive hyperplasia of lymph nodes in 31 cases; 86% sensitivity to conventional ultrasound for breast cancer diagnosis and differential diagnosis of axillary fossa benign and malignant lymph nodes, the specificity was 77.4%; the virtual touch tissue quantification (VTQ) optimal cut-off for differential diagnosis of benign and malignant breast cancer axillary lymph node of the average value of VTQ is 1.83m/s, the corresponding sensitivity, specificity were 93.2%, 90.3%, ROC area under the curve (AUC) was 0.991; ultrasound combined with virtual touch tissue quantification (VTQ) technique with sensitivity of 86.4% differential diagnosis for breast cancer axillary lymph, specificity 91.9%. compared with conventional ultrasound, virtual touch tissue quantification, conventional ultrasound combined with virtual touch tissue quantification in the diagnosis of breast The sensitivity of metastasis of cancer axillary lymph gland, specificity and area under the ROC curve, the virtual touch tissue quantification (VTQ) technique is the highest sensitivity (93.2%); conventional ultrasound combined with virtual touch tissue quantification the highest specificity (91.9%); the virtual touch tissue quantification ROC area under the curve of the highest (0.991); metastasis the maximum value of VTQ reactive hyperplasia of lymph node, the minimum value of the optimal cut-off of axillary lymph node identification of breast cancer were 1.96m/s, 1.76m/s, maximum sensitivity (97.7%), the minimum value of high specificity (95.1%), the maximum value of the area under the ROC curve of high (0.995); single factor analysis significant SIG application of t test of the index that was 0 (P0.05), there was statistical significance. Logistic regression analysis showed that the aspect ratio, flow classification, flow type, maximum value, average value of five indexes is axillary lymph node metastasis in breast carcinoma Risk factors (regression coefficient 0, odds ratio 1), cortical thickness, the minimum value for breast cancer axillary lymph node metastasis protective factors (regression coefficient 0, odds ratio 1). Conclusion: the virtual touch tissue quantification (VTQ) is a new type of ultrasonic inspection technology, can make a quantitative evaluation of breast cancer patients lymph node texture, thus aectffate provides a new observation index for clinical judgment; through single factor analysis and multi factor analysis results show that the aspect ratio, flow classification, flow type, the average value of VTQ, the maximum impact on the judgment of axillary lymph node properties have a certain degree of routine; ultrasound has been further improved for axillary lymph node in breast cancer diagnosis of benign and malignant virtual touch tissue quantification based on multiple factors determine the nature of axillary lymph node in breast cancer were analyzed by Logistic regression model, help We work in the future from several aspects of comprehensive assessment, to further improve the accuracy of ultrasound in the diagnosis of axillary lymph node in nature.

【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R737.9

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