经阴道超声剪切波弹性成像对宫颈良恶性病变的诊断价值

发布时间：2018-05-11 12:20

本文选题：SWE + 经阴道超声　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:1.经阴道超声剪切波弹性成像技术(Shear-wave elastography SWE)测量宫颈癌、宫颈上皮内瘤变(cervical intraepithelial neoplasia CIN)及正常宫颈组织的弹性模量值,评价其定量鉴别诊断宫颈良恶性病变的价值。2.经阴道超声SWE显示宫颈癌、CIN及正常宫颈组织的弹性图像,评价其定性鉴别诊断宫颈良恶性病变的价值。3.研究并评估超声综合评分法、弹性模量最大值和弹性模量平均值鉴别诊断良恶性宫颈病变的价值。方法:选取2014年12月到2016年12月在本院就诊的150例宫颈病变患者,共有150个病灶,所有患者均经手术病理确诊,其中宫颈癌53例,CIN 97例。另外选取健康受试者30例作为对照组。按照病理结果将上述受试者分为宫颈癌组,CIN组和正常组。150例患者在手术切除前通过使用法国Super Sonic Imagine Aix Plorer超声诊断仪进行经阴道二维超声、彩色多普勒及SWE检查。健康受试者均进行经阴道二维超声检查及经阴道SWE检查。观察三组受试者的弹性图像差异,并测定弹性模量最大值和平均值。用((?)±s)表示计量资料,采用单因素方差分析比较多组间的差异,两组间的比较采用S-N-K检验。综合评分常规超声指标和弹性模量值,评分指标为:(1)血流的分级;(2)频谱多普勒RI值;(3)弹性模量最大值;(4)弹性模量平均值,根据超声各诊断标准对宫颈良恶性病变进行诊断,将各个指标的结果量化为分值,然后将分值累加为综合评分,即为(5)超声综合评分法。以病理检查结果为金标准,绘制(3)、(4)与(5)诊断宫颈良恶性病变的受试者工作曲线(Receiver Operating Characteristic curve ROC)曲线,比较三种不同检查方法的诊断价值。采用z检验对(3)、(4)、(5)曲线下面积(Area under the curve AUC)进行比较,利用卡方检验对(3)、(4)、(5)的敏感度、特异度进行比较。结果:1.宫颈恶性病变的弹性图像表现为红色或橘红色占主要部分,其间或夹杂着绿色;CIN病变弹性图像表现为分布均匀的蓝色;正常宫颈弹性图像也表现为分布均匀的蓝色。2.经阴道超声SWE检查显示,宫颈癌组与CIN组的弹性模量最大值和平均值比较差异有统计学意义(P0.05)。宫颈癌组与正常组的弹性模量最大值和平均值之间差异也有统计学差异(P0.05)。CIN组与正常组的弹性模量最大值和平均值之间差异无统计学差异(P0.05)。3.弹性模量最大值以32.38k Pa为诊断良恶性的临界点时,其诊断宫颈癌的准确度、敏感度、特异度、阳性预测值(Positive predictive value PPV)和阴性预测值(negative predictive value NPV)分别为89.33%,86.79%,90.72%,83.64%,92.63%。4.弹性模量平均值以30.16k Pa为诊断临界点时,其诊断宫颈癌的准确度、敏感度、特异度、PPV和NPV分别为75.33%,66.04%,80.41%,64.81%和81.25%。5.超声综合评分法以3分为临界值时,其诊断宫颈癌的准确度、敏感度、特异度、PPV和NPV分别为92.00%、90.57%、92.78%、87.27%和94.74%。6.超声综合评分法较弹性模量最大值的敏感度,特异度高(χ~2=21.49、34.62;P0.05);超声综合评分法较弹性模量平均值的敏感度、特异度高(χ~2=5.22、12.87;P0.05);弹性模量最大值的敏感度、特异度较弹性模量平均值高(χ~2=9.63、8.15;P0.05)。7.超声综合评分法、弹性模量最大值和平均值定量鉴别诊断宫颈癌的AUC分别为0.92、0.91和0.79,超声综合评分法准确率较弹性模量平均值高(z=2.81,P0.05),与弹性模量最大值诊断的准确率差异无统计学意义(z=0.65,P0.05)。弹性模量最大值与弹性模量平均值诊断的准确率差异有统计学意义(z=2.62,P0.05)。结论:1.通过经阴道超声SWE技术观察病灶内充填的颜色,可以定性鉴别诊断宫颈癌及癌前病变。2.经阴道超声SWE技术在宫颈癌定量诊断方面有明显的帮助;在诊断CIN方面没有明显的帮助。3.超声综合评分法诊断宫颈癌的准确率与弹性模量最大值无明显统计学差异,但是灵敏度和特异度均比弹性模量最大值高。4.超声综合评分法诊断宫颈癌的准度率、灵敏度和特异度均比弹性模量平均值高。5.弹性模量值最大值诊断宫颈癌的准度率、灵敏度和特异度也均比弹性模量平均值高。
[Abstract]:Objective: 1. Shear-wave elastography SWE (transvaginal ultrasound shear wave elastic imaging) was used to measure the elastic modulus of cervical cancer, cervical intraepithelial neoplasia (cervical intraepithelial neoplasia CIN) and normal cervical tissue, and the value of its quantitative differential diagnosis of cervical benign and malignant lesions was evaluated by transvaginal ultrasound SWE display of cervical cancer, CIN and SWE Elastic image of normal cervical tissue, evaluation of the value of qualitative differential diagnosis of cervical benign and malignant lesions.3. study and evaluation of the value of ultrasonic comprehensive score, modulus of elasticity and modulus of elasticity in the differential diagnosis of benign and malignant cervical lesions. Methods: 150 cases of cervical lesions in our hospital from December 2014 to December 2016 were selected. There were 150 lesions in all patients, all of them were confirmed by operation and pathology, including 53 cases of cervical cancer and 97 cases of CIN. In addition, 30 healthy subjects were selected as the control group. According to the pathological results, the subjects were divided into cervical cancer group, and the CIN group and the normal group.150 patients were treated by the French Super Sonic Imagine Aix Plorer ultrasound before the operation. The diagnostic apparatus was examined by transvaginal two-dimensional ultrasound, color Doppler and SWE. All the healthy subjects were examined by transvaginal two-dimensional ultrasound and transvaginal SWE. The differences in the elastic images of the three groups were observed and the maximum and average values of the modulus of elasticity were measured. The measurement data were expressed with (?) + s) and the multiple groups were compared by single factor analysis of variance. The difference between the two groups was compared with the S-N-K test. A comprehensive score of conventional ultrasound and modulus of elasticity was used to score: (1) the classification of the blood flow; (2) the Doppler RI of the spectrum; (3) the maximum modulus of elasticity; (4) the average of the modulus of elasticity; the diagnosis of the benign and malignant lesions of the cervix according to the diagnostic criteria of the ultrasound, and quantifying the results of each index as a result. Score, and then add the score to a comprehensive score, that is (5) the ultrasonic comprehensive scoring method. With the pathological examination results as the gold standard, (3), (4) and (5) the Receiver Operating Characteristic curve ROC curve line for the diagnosis of cervical and malignant lesions, compare the diagnostic value of three different examination methods. (3), (4), (4). ) (5) comparison of the area under the curve (Area under the curve AUC), using chi square test to compare the sensitivity and specificity of (3), (4), (5). Results: the elastic images of 1. cervical malignant lesions were red or orange in the main part, or mixed with green; the elastic images of CIN lesions showed a uniform distribution of blue; normal uterus. The cervical elastic image also showed a uniform distribution of blue.2. by transvaginal ultrasound SWE examination showed that the maximum and average value of the modulus of elasticity of the cervical cancer group and the CIN group was statistically significant (P0.05). The difference of the maximum and average value of the modulus of elasticity between the cervical cancer group and the normal group was also statistically significant (P0.05).CIN group and the normal group. There was no statistical difference between the maximum and average modulus of modulus of elasticity (P0.05) the maximum value of.3. modulus of elasticity with 32.38k Pa as the critical point for diagnosis of benign and malignant, the accuracy, sensitivity, specificity, positive predictive value (Positive predictive value PPV) and negative predictive value (negative predictive value NPV) were 89.3 respectively. 3%, 86.79%, 90.72%, 83.64%, and 92.63%.4. modulus mean value of 30.16k Pa as the critical point of diagnosis, the accuracy, sensitivity, specificity, PPV and NPV of cervical cancer were 75.33%, 66.04%, 80.41%, 64.81%, and 81.25%.5., respectively, with 3 points as critical values, and the accuracy, sensitivity, specificity, PPV and NP of cervical cancer were diagnosed. The sensitivity of V 92%, 90.57%, 92.78%, 87.27% and 94.74%.6. was higher than the maximum modulus of elastic modulus (x ~2=21.49,34.62; P0.05), and the sensitivity of the ultrasonic comprehensive scoring method was higher than that of the elastic modulus (x ~2=5.22,12.87; P0.05); the sensitivity of the maximum modulus of elasticity was higher than that of the elastic modulus, and the specificity was higher than the elastic modulus. The mean value (x ~2=9.63,8.15; P0.05).7. ultrasonic comprehensive scoring method, the maximum value of modulus of elasticity and the average value of the quantitative differential diagnosis of cervical cancer were 0.92,0.91 and 0.79 respectively. The accuracy of the ultrasonic comprehensive scoring method was higher than that of the elastic modulus (z=2.81, P0.05). There was no statistical difference between the accuracy of the diagnosis of the maximum modulus of elasticity (z=0.65, P0.05). There was a significant difference in the accuracy of diagnosis between the maximum modulus of modulus of elasticity and the average modulus of modulus of elasticity (z=2.62, P0.05). Conclusion: 1. the color of the intralesional filling by transvaginal ultrasound SWE technique can be used to identify the qualitative diagnosis of cervical cancer and precancerous lesions by transvaginal ultrasound SWE technique in the quantitative diagnosis of cervical cancer. There was no significant difference in the accuracy and maximum modulus of modulus of elasticity for the diagnosis of cervical cancer in the diagnosis of CIN, but the sensitivity and specificity were higher than the modulus of elasticity with the maximum value of the modulus of.4. ultrasound in the diagnosis of cervical cancer, and the sensitivity and specificity were higher than the average of the modulus of elasticity. The maximum value of.5. elastic modulus is also higher than that of the modulus of elasticity for diagnosing the accuracy of cervical cancer.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R737.33

【参考文献】