乳腺非肿块型病变超声声像图与病理诊断的对照性研究

发布时间：2018-04-10 02:22

  本文选题：超声　切入点：非肿块型病变　出处：《郑州大学》2017年硕士论文

【摘要】：背景与目的乳腺疾病是一种常见病、多发病,是危害妇女身心健康及生存质量的主要疾病,主要分为乳腺炎、增生、纤维腺瘤、囊肿、癌等,其中乳腺癌的发病率居高不下,位居女性恶性肿瘤之首,并且其发病日渐年轻化,导致乳腺疾病发生发展的因素比较复杂,若发现不及时、治疗不恰当就可随时导致生命危险,因此乳腺疾病的早期准确的诊断是至关重要的。超声检查以其实时、简便、快捷、无辐射、无创、患者的依从性好、价格低、可反复进行等一系列优点,是目前鉴别乳腺病灶的常规检查方法。在乳腺疾病的超声检查中,我们经常遇到一些不符合肿块定义的病变,例如:边界模糊的低回声、杂乱回声、管状低回声等。这类病变中不乏乳腺恶性病变,因此对这类非肿块型病变的准确诊断不容忽视。然而乳腺影像报告与数据系统(breast imaging-reporting and data system,BI-RADS)分类的超声部分并没对“非肿块”的定义。以往研究显示在超声中发现的不符合肿块定义的病变在磁共振成像(magnetic resonance imaging,MRI)中通常表现为非肿块型强化方式,且超声上不符合肿块定义的病变经病理证实为乳腺癌的病变中,95%在磁共振成像中也表现为非肿块样强化方式。据此,本研究回顾性分析磁共振成像上表现为非肿块样强化(non-mass like enhancement,NMLE)病灶的超声表现,并与病理诊断结果对比分析,旨在提高超声对非肿块型乳腺病变的认识和诊断水平。资料与方法1.第一部分:收集2013.01~2014.01间在我院放射科完成乳腺磁共振及超声检查且有病理结果的156例NMLE患者,均为女性,年龄28~72岁(平均45±8岁),临床资料完整,无磁共振检查禁忌证,乳腺MRI检查时间为月经后3天~2周。纳入标准:在MRI上由2位5年以上经验的医师共同判断为NMLE(平扫T1WI病灶信号与周围腺体信号无明确分界,增强扫描无明确的占位效应),同时行超声检查;均有术后病理组织诊断结果,经由2位5年以上经验的病理医师复验切片,且结果一致。2.第二部分:选取第一部分中超声表现为片状低回声的病灶,对其进行剪切波弹性成像,Q-Box的直径为2mm,置于病灶最硬的区域,得到其杨氏模量平均值,获得最佳诊断界值,以探讨弹性成像对其诊断价值。结果1.156例乳腺非肿块样强化病变中,术后病理诊断为良性的病变92例(59.0%),恶性病变64例(41.0%);超声上表现为片状低回声96例(61.5%)、杂乱回声16例(10.3%)、乳腺导管扩张18例(11.5%)、簇状分布的微钙化4例(2.6%)、超声表现为阴性22例(14.1%)2.BI-RADS分类2类的病变10例,3类的病变52例,4类的病变58例,5类的病变14例。超声诊断的敏感性77.8%、特异性59.5%、阳性预测值77.8%、阴性预测值80.6%。3.恶性组的腋窝异常淋巴结、血流信号(+)发生率均高于良性组(前者x2=7.809,P=0.005;后者x2=36.914,P=0.000)。合并钙化的病灶共14例,4例为良性,10例为恶性。4.剪切波弹性成像对超声表现为片状低回声的病灶进行鉴别诊断的曲线下面积(AUC)为0.879,良性组的杨氏模量平均值为(37.76±8.21)kPa,恶性组的杨氏模量平均值为(78.84±24.21)kPa,最佳诊断界值为45.53kPa,以此界值鉴别诊断其良恶性时,诊断的敏感性、特异性分别为83.5%、77.2%。结论1.乳腺非肿块型病变在常规超声中可表现为片状低回声、杂乱回声、乳腺导管扩张、簇状分布的微钙化等,也可表现为(-)。2.其中合并腋窝异常淋巴结的病灶、血流信号(+)的病灶恶性可能性更大,病变内部钙化灶的存在对恶性诊断有一定意义。3.乳腺非肿块型病变在常规超声中多表现为诊断不明确的BI-RADS分类3、4类的片状低回声,常规超声对其诊断的敏感性尚可,特异性较低。4.剪切波弹性成像对超声表现为片状低回声的非肿块型病变具有一定的诊断价值。
[Abstract]:Background and objective: breast disease is a common disease, frequently occurring disease, are the main diseases endangering the physical and mental health and quality of life of women, mainly divided into mastitis, hyperplasia, fibroadenoma, cyst, cancer, the incidence of breast cancer is high, ranking the first female malignancy, and its incidence is younger, causes the occurrence and development of breast disease is more complex, if not timely, inappropriate treatment can lead to danger, therefore the early diagnosis of breast diseases accurately is very important. Ultrasound to actually, convenient, fast, no radiation, non-invasive, patient compliance is good, the price is low, a series of advantages can be repeated, is currently in differential diagnosis of breast lesions. Ultrasound in routine examination of breast diseases, we often encounter some do not meet the definition of mass lesions, for example: fuzzy boundaries of low echo, clutter Echo, low echo and so on. Some of the tubular lesions in breast malignant lesions, therefore the accurate diagnosis of this kind of non mass lesions can not be ignored. However, breast imaging reporting and data system (breast Imaging-Reporting and data system, BI-RADS) ultrasound part classification did not define "non mass". Previous studies show that in ultrasound does not meet the definition of mass lesions in magnetic resonance imaging (magnetic resonance, imaging, MRI) is usually non mass enhancement, and ultrasound does not meet the definition of mass lesions pathologically confirmed breast cancer lesions, 95% in magnetic resonance imaging as well as non mass like enhancement accordingly, this study retrospectively analyzed the magnetic resonance imaging showed non mass like enhancement (non-mass like enhancement, NMLE) ultrasound manifestations and pathological diagnosis of lesions, and results of the comparative analysis, in order to To improve the ultrasonic understanding of non palpable breast lesions and diagnosis. Materials and methods 1. the first part: a collection of 2013.01~2014.01 in our hospital radiology breast MRI and ultrasound examination and 156 cases of NMLE patients with pathological results, all female, aged 28~72 years old (average 45 + 8 years), with complete clinical data no, MRI contraindications, breast MRI examination time is 3 days after menstruation ~2 weeks. Inclusion criteria: MRI by 2 more than 5 years experience of physicians together to determine the NMLE (scan T1WI lesion signal and surrounding gland signal without clear boundary scan, no space occupying effect, clear enhancement) at the same time with ultrasonography; postoperative pathological diagnosis results, by 2 pathologists for more than 5 years experience in re inspection section, and the results were consistent with.2. second parts: the first part selected ultrasound showed patchy hypoechoic lesions of the elastic shear wave 鎴愬儚,Q-Box鐨勭洿寰勪负2mm,缃�浜庣梾鐏舵湥�

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