超微血管显像技术在乳腺癌腋窝淋巴结血流显像的研究

发布时间：2018-04-28 14:36

本文选题：淋巴结 + 转移　；参考：《广西中医药大学》2017年硕士论文

【摘要】：目的:探讨二维灰阶超声联合超微血管显像技术(super microvascular imaging,SMI)在鉴别乳腺癌腋窝淋巴结转移的价值,同时评价SMI在判断腋窝淋巴结内血流形态及分布类型的优势以及价值,为临床鉴别腋窝淋巴结性质提供新的思路。方法:筛选符合纳入标准的乳腺癌患者的67枚腋窝淋巴结。使用Toshiba Aplio 500型彩色多普勒超声诊断仪,14L5线阵探头,频率14.0MHz,配备SMI显像内置软件。首先进行常规的二维灰阶超声检查,在二维超声检查的基础上,使用彩色多普勒血流显像(CDFI)及超微血管显像(SMI)的标准程序对淋巴结内血管进行显像,选取淋巴结内血管分布密度最大,分支最多、血流最丰富的切面,观察血流分布状况并记录动态影像以备分析。最后同一切面行超声造影(CEUS)检查,储存动态图像以备分析。以病理检查结果为定性诊断金标准,分别计算二维灰阶超声联合CDFI、二维灰阶超声联合SMI及CEUS鉴别诊断淋巴结良恶性的敏感性,特异性,阳性预测率,阴性预测率以及准确率。再以CEUS判断淋巴结内微血管分布类型的结果为标准,分析CDFI及SMI与CEUS对淋巴结内微血管分布类型的一致性。最后对二维超声征象及SMI评估腋窝淋巴结的血流分布类型及螺旋血管进行多因素logistics回归分析。结果:(1)以病理检查结果为金标准,二维灰阶联合CDFI诊断乳腺癌患者腋窝淋巴结的良恶性的准确率73.1%。二维灰阶联合SMI诊断乳腺癌患者腋窝淋巴结的良恶性的准确率86.6%。二维灰阶联合CEUS诊断乳腺癌患者腋窝淋巴结的良恶性的准确率89.6%。二维联合CEUS与CDFI准确率差别有显著统计学意义(χ2=5.950,P0.01);二维联合SMI与CDFI准确率差别有统计学意义(χ2=3.757,P0.05);二维联合CEUS与SMI准确率差别无统计学意义(χ2=0.284,P0.05)。(2)良性淋巴结内微血管分布类型以II型-淋巴门型为主,转移性淋巴结结内微血管分布类型以IV型-混合型为主。以CEUS判断淋巴结内微血管分布类型的结果为标准,CDFI与CEUS结内血流分布的一致性比较高(Kappa=0.7070.75),SMI与CEUS结内血流分布的一致性相当高(Kappa=0.8580.75)。并统计分析发现CDFI、SMI及CEUS对淋巴结内II型-淋巴门型的血流分布判断存在非常高的一致性,其次是IV型-混合型。(3)使用SMI模式发现在转移性淋巴结中特异性螺旋血管的检出率为51.6%,进行单因素logistics回归分析OR值为18.133,OR值的95%可信区间为3.696~88.972,P0.05。(4)多因素logistics回归分析结果显示,SMI下腋窝淋巴结四种血流分布类型OR值为24.332,腋窝淋巴结中螺旋血管OR值为23.044,两者回归方程预测曲线的AUC 0.815,95%可信区间为0.709~0.921。结论:(1)二维联合SMI与CEUS评价腋窝淋巴结性质相比CDFI准确率差别均有统计学意义,SMI与CEUS之间并无统计学差异,提示SMI及CEUS在评估腋窝淋巴结的性质方面更具优势。(2)CDFI及SMI对淋巴结内血流判断的一致性均比较高,但SMI的Kappa0.75达到更高的一致性,提示了SMI对腋窝淋巴结内血流分布类型的评估更加可靠。(3)SMI可以清晰显示转移淋巴结内特异性螺旋血管,对SMI内螺旋血管进行单因素logistics回归分析OR值为18.133,提示了SMI显像发现螺旋血管有可能成为超声评估淋巴结性质的独立风险因素。(4)SMI技术评估腋窝淋巴结血流分布类型及腋窝淋巴结中螺旋血管的多因素logistics回归分析中提示了两者的检出为腋窝淋巴结性质的重要预测因素,预测效果较好。
[Abstract]:Objective: To evaluate the value of super microvascular imaging (SMI) in the identification of axillary lymph node metastases in breast cancer, and to evaluate the advantages and value of SMI in determining the form and distribution of the blood flow in the axillary lymph nodes, and to provide a new way of thinking for the identification of axillary lymph nodes. 67 axillary lymph nodes of breast cancer patients were selected in accordance with the inclusion criteria. The Toshiba Aplio 500 color Doppler ultrasound diagnostic apparatus, the 14L5 linear array probe, the frequency 14.0MHz, and the built-in SMI imaging software were used. First, the conventional two-dimensional gray scale ultrasound examination was performed on the basis of the two-dimensional ultrasound examination, and the color Doppler flow imaging (CDFI) was used. The blood vessels in the lymph nodes were scintid with the standard procedure of SMI, and the maximum distribution density, the most branches and the most abundant tangent surfaces in the lymph nodes were selected. The distribution of blood flow was observed and the dynamic images were recorded for analysis. Finally, the dynamic images were stored for analysis with all surfaces, and the dynamic images were stored for analysis. The results of the examination were qualitative diagnostic gold standard. The sensitivity, specificity, positive predictive rate, negative predictive rate and accuracy of two-dimensional gray scale ultrasound combined with CDFI, two-dimensional gray scale ultrasound combined with SMI and CEUS in the differential diagnosis of lymph node benign and malignant, and the criteria for determining the microvascular distribution in the lymph nodes by CEUS were used for the analysis of CDFI and SMI. The pattern of microvascular distribution in the lymph nodes was consistent with CEUS. Finally, a multi factor logistics regression analysis was performed on two-dimensional ultrasound signs and SMI assessment of the distribution of the axillary lymph nodes and the spiral vessels. Results: (1) the pathological examination was the gold standard, and the two dimensional gray scale combined with CDFI in the diagnosis of the benign and malignant axillary lymph nodes of the breast cancer patients Accuracy of 73.1%. two-dimensional gray scale combined with SMI in the diagnosis of benign and malignant axillary lymph nodes in breast cancer patients the accuracy of 86.6%. two-dimensional gray scale combined with CEUS for the diagnosis of benign and malignant axillary lymph nodes in breast cancer patients 89.6%. two dimensional combination of CEUS and CDFI accuracy has significant statistical significance (x 2=5.950, P0.01); two-dimensional joint SMI and CDFI quasi accurate The difference in accuracy was statistically significant (x 2=3.757, P0.05); there was no statistically significant difference in the accuracy of the two dimensional combination of CEUS and SMI (x 2=0.284, P0.05). (2) the microvascular distribution in the benign lymph nodes was dominated by the II type lymphatic type, and the microvascular distribution in the metastatic lymph node was dominated by the IV type mixed type. The consistency of blood flow distribution in CDFI and CEUS is high (Kappa=0.7070.75). The consistency of blood flow distribution in SMI and CEUS is very high (Kappa=0.8580.75). Statistical analysis shows that CDFI, SMI and CEUS have very high consistency in judging the blood flow distribution of the II lymphohilus type in the lymph nodes, followed by IV type mixing. (3) the detection rate of specific spiral vessels in metastatic lymph nodes was found to be 51.6% by the SMI model. The OR value of single factor logistics regression analysis was 18.133, the 95% confidence interval of OR value was 3.696~88.972, and P0.05. (4) multiple factor logistics regression analysis showed that the OR value of four kinds of blood flow distribution in axillary lymph nodes under SMI was 24.332, The OR value of spiral vessels in the axillary lymph nodes was 23.044, and the AUC 0.815,95% confidence interval of the regression equation prediction curve was 0.709~0.921. conclusion: (1) the difference of CDFI accuracy was statistically significant compared with the SMI and CEUS in the evaluation of the axillary lymph node properties, and there was no statistical difference between SMI and CEUS, suggesting that SMI and CEUS were in the evaluation of axillary lymph nodes. (2) the consistency of CDFI and SMI in the determination of blood flow in the lymph nodes was higher, but the Kappa0.75 of SMI reached a higher consistency, suggesting that the assessment of the type of blood flow distribution in the axillary lymph nodes was more reliable. (3) SMI could clearly show the specific spiral vessels in the metastatic lymph nodes and the spiral vessels within the SMI. The OR value of single factor logistics regression analysis was 18.133, suggesting that SMI imaging found that spiral vessels may be an independent risk factor for evaluating the properties of lymph nodes. (4) the multiple factor logistics regression analysis of the distribution types of axillary lymph nodes and the spiral vessels in the axillary lymph nodes by SMI technique suggests the detection of both of the two. The important predictors of axillary lymph node properties are better predictors.

【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R737.9

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