声脉冲辐射力弹性成像对乳腺实性结节的诊断价值研究

发布时间：2018-02-04 11:37

本文关键词： 乳腺癌超声检查声脉冲辐射力成像技术剪切波弹性成像技术　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:近年来,乳腺肿瘤发病率呈逐步上升趋势,严重威胁着妇女的身心健康。超声检查有很多优点,已成为乳腺恶性肿瘤诊断和筛查的重要手段。声脉冲辐射力弹性成像(acoustic radiation forceimpulse,ARFI)技术是通过超声探头发射低频脉冲,计算组织局部形变后产生的横向剪切波的速度,定量检测组织硬度的超声弹性成像技术。本研究运用声脉冲辐射力成像技术对乳腺实性结节进行弹性定量研究,探讨该技术在乳腺实性结节中的诊断价值。方法:1研究对象2016年在邢台市第三医院应用声脉冲辐射力弹性成像技术行乳腺超声检查,并经手术或穿刺活检取得病理结果的患者。2检查方法记录乳腺实性结节患者的年龄、病史、触诊等信息。对所有乳腺实性结节进行常规二维超声检查并记录。行彩色多普勒超声检查,观察实性结节内部及周边的血供特点。对所有结节运用声触诊组织成像技术(virtual touch tissue imaging,VTI)获得VTI弹性图,接着运用声触诊组织定量技术(virtual touch tissue qualification,VTQ)依次获得结节内部区域、结节周边区域、结节同等深度正常乳腺组织的剪切波速度(shear wave velocity,SWV),同一位置分别测量5次取中位数。机器的量程为“0~9m/s”,在排除操作的方法学错误后,如果重复测量后VTQ值无明确数值显示时(即为“X.XXm/s”),参照VTI图像,图像显示为黑色,即可排除囊性病变,VTQ值记录“9m/s”,若为囊性病变,记录“0m/s”并剔除。记录术后病理,并整理资料。3统计学分析所有病灶以术后病理结果为金标准,分析各病理类型及不同大小、不同深度的乳腺实性结节的VTQ值是否有统计学差异。应用SPSS24.0软件包进行统计分析。计量资料采用均数±标准差,以P0.05认为有统计学意义。结果:1病理结果79例患者103个乳腺实性结节中,良性结节72个,包括纤维腺瘤53个,腺病7个,肉芽肿性小叶炎5个,导管内乳头状瘤6个,青春期巨纤维腺瘤1个;恶性结节30个,其中浸润性导管癌21个,导管原位癌5个,浸润性小叶癌1个,弥漫性大b细胞性淋巴瘤2个,腺样囊性癌1个;非典型增生1个。2arfi技术的诊断效能良性组内部区域的vtq值平均值为(2.53±1.35)m/s,恶性组为(6.85±2.62)m/s,两者之间具有显著统计学差异,p0.01。绘制roc曲线,曲线下面积0.900,以vtq值为3.46m/s为参考值,其灵敏度为83.9%,特异度为91.7%,误诊率8.3%,漏诊率16.1%,正确率89.3%。mcnemar配对卡方检验p值为1.00,p0.05,诊断准确性高。良性组内部区域与同一深度正常腺体组织的swv比值平均值为1.76±1.15,恶性组为4.93±2.56,两者之间具有显著统计学差异,p0.05。绘制roc曲线,曲线下面积0.889,以swv比值3.66为参考值,其灵敏度为74.2%,特异度为97.2%,误诊率2.8%,漏诊率25.8%,正确率90.3%。mcnemar配对卡方检验p值为0.109,p0.05,诊断准确性高。3良、恶性两组之间比较患者年龄、结节大小(最长径和平均径)、结节中心深度也都具有统计学差异,p0.05;两组间结节与乳头的距离,与结节同等深度正常腺体的swv值均不具有统计学差异,p0.05。4乳腺实性结节内部swv值相关性乳腺实性结节内部swv值与距乳头距离相关性p值0.794,p0.05,无统计学意义,此2者无统计学相关性;与结节最长径相关性p值0.003,与结节平均径相关性p值0.000,与结节中心深度相关性p值0.000,均具有统计学相关性。5不同病理的乳腺实性结节内部swv值的比较结节内部swv值从大到小排列分为3等,第1等为浸润性导管癌,第2等为导管原位癌和肉芽肿性小叶炎,第3等为导管内乳头状瘤、纤维腺瘤和腺病,这也代表着它们硬度由硬到软的顺序。结论:声脉冲辐射力弹性成像技术是一项非助力式超声弹性成像新技术,能提供组织硬度的定性、定量信息,在常规超声检查的基础上进行感兴趣区的弹性定量测量,受外界和主观因素影响较小,重复性好,在乳腺实性结节的诊断上具有很大的临床价值。本研究认为,其中VTQ技术应用的关键在于正确的操作并测量出结节内部、周边及结节同等深度正常乳腺组织的SWV值,以结节内部VTQ值为3.46m/s为参考值;计算结节内部与同等深度正常乳腺组织SWV值比值,以3.66为参考值,作为诊断乳腺恶性结节的标准。本研究的局限性:由于乳腺病理的多样性且有些病理类型的例数过少等原因导致该技术一致性欠佳,所以要结合多种检查方法以及临床表现做出综合诊断,对于可疑病灶需进行穿刺活检,提高诊断准确率。
[Abstract]:Objective: in recent years, the incidence of breast tumors showed a gradual upward trend, a serious threat to women's physical and mental health. Ultrasound has many advantages, has become an important means of breast cancer diagnosis and screening of acoustic radiation force impulse imaging (acoustic radiation forceimpulse ARFI) technology is the pulse through the ultrasonic probe emission frequency, transverse wave shear calculation of local tissue after deformation speed, ultrasonic elastography quantitative measurement of tissue hardness. The use of acoustic radiation force impulse imaging of breast solid nodules were of elasticity, to explore the value of the technique in diagnosis of breast solid nodules. Methods: 1 subjects in Xingtai city in 2016 third the hospital application of acoustic radiation force impulse imaging technique for breast ultrasound examination,.2 examination methods and patients by surgery or biopsy pathology results obtained records of milk Gland nodule with age, history, and other information. By palpation of conventional two-dimensional ultrasound examination of all breast solid nodules were recorded. The color Doppler ultrasound examination, observation of solid nodules inside and peripheral blood supply features. All the nodules using virtual touch tissue imaging technology (virtual touch tissue imaging, VTI) obtained VTI elastic graph, and then use the virtual touch tissue quantification (virtual touch tissue qualification, VTQ) in order to get inside the area of nodules, nodules surrounding area, the shear wave velocity of the same depth nodules of normal breast tissue (shear wave, velocity, SWV), the same position were measured 5 times median. The machine range is "0~9m/s" study, error in the method of eliminating operation, if repeated measurements of VTQ value without a clear numerical display (i.e. "X.XXm/s"), referring to the VTI image, the image display is black, can be eliminated by cystic The lesion, VTQ recording of "9m/s", if the cystic lesions, and remove the record "0m/s". Record postoperativepathologic, arranging and analyzing the data of.3 were all lesions with postoperative pathological results as the gold standard, analysis of various pathological types and different size of breast solid nodules in different depth of the VTQ value is significant difference. SPSS24.0 software package was used for statistical analysis. Measurement data using standard deviation, P0.05 was considered statistically significant. Results: 1 pathological results of 79 patients with 103 breast solid nodules and 72 benign nodules, including 53 fibroadenoma, 7 adenosis, 5 lobular granulomatous inflammation. 6 intraductal papillomas, 1 adolescent giant fibroadenoma; 30 malignant nodules, 21 were invasive ductal carcinomas, 5 ductal carcinoma in situ and invasive lobular carcinoma in 1, diffuse large B cell lymphoma in 2, adenoid cystic carcinoma, 1 atypical hyperplasia; 1.2a Diagnostic efficacy of benign group within the region of the RFI vtq value (2.53 + 1.35) m/s, malignant group (6.85 + 2.62) m/s, with a significant difference between the two, p0.01. ROC curve, the area under the curve of 0.900, with the vtq value of 3.46m/s for reference, the sensitivity was 83.9%. The specificity was 91.7%, the misdiagnosis rate was 8.3%, the misdiagnosis rate of 16.1%, the correct rate of 89.3%.mcnemar chi square test p value was 1, P0.05, high diagnostic accuracy. The ratio of SWV in benign group interior region and the same depth of normal gland tissue with an average of 1.76 + 1.15, 4.93 + 2.56 in the malignant group, the difference was statistically significant between the two, p0.05. ROC curve, the area under the curve of 0.889 to 3.66, the ratio of SWV for reference, the sensitivity was 74.2%, specificity was 97.2%, the misdiagnosis rate was 2.8%, the misdiagnosis rate of 25.8%, the correct rate of 90.3%.mcnemar chi square test p value was 0.109, P0.05, high diagnostic accuracy of.3 for good, evil Between the two groups of patients with age, nodule size (diameter, diameter of both the peace center) nodules have a significantly different depth, P0.05 and papillary nodules; distance between the two groups, with the same depth of normal gland nodules SWV values were not statistically significant, p0.05.4 breast solid nodules internal correlation between SWV value of breast solid nodules internal SWV value and P value of the correlation distance to the nipple 0.794, P0.05, no statistical significance, no significant correlation between the 2 and the longest diameter of nodules; correlation between P value of 0.003, and the average diameter of the p value of the correlation of 0 nodules, and the nodule center depth correlation of P value of 0, all have relatively significant correlation between internal SWV nodules.5 of different pathological breast solid nodules within the SWV values in order from large to small is divided into 3, first invasive ductal carcinoma, second were ductal carcinoma in situ and granulomatous lobular inflammation, third guided intraductal papilloma, Fibroadenoma and adenosis, it also represents their hardness from hard to soft order. Conclusion: acoustic radiation force impulse imaging technology is a new technology of non power ultrasonic elastography, can provide qualitative and quantitative information of microstructure and hardness, elastic quantitative measurement of region of interest in the basis of routine ultrasound examination. Less affected by the external and subjective factors, good repeatability, has great clinical value in the diagnosis of breast solid nodules. This study suggests that the key to the application of VTQ technology in the correct operation and measure the internal peripheral nodules, nodules and the same depth of normal breast tissue SWV value to VTQ value of thyroid nodules for the 3.46m/s reference value were calculated with the same depth; the internal normal breast tissue SWV value, reference value of 3.66, as the diagnosis of breast malignant nodules. The limitations of this study: in breast pathology Diversity and some cases with too few pathological types lead to poor consistency of the technology. Therefore, we should make comprehensive diagnosis combined with various examination methods and clinical manifestations. We need to make biopsy for suspicious lesions, so as to improve the accuracy of diagnosis.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R655.8;R737.9

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