三维超声成像在乳腺肿块诊断中的临床应用

发布时间：2018-02-09 21:20

本文关键词： 乳腺肿块三维超声汇聚征三维彩色血管能量成像　出处：《广西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：运用三维超声成像技术对乳腺肿块边缘形态特征进行观察,探讨三维超声汇聚征在乳腺良恶性肿块中的诊断价值,及其在不同病理类型乳腺癌中的表达规律、预后评估中的意义；利用三维彩色血管能量成像(Three dimensional color power angiography,3D-CPA)技术对乳腺良恶性肿块内部及周边的血管形态及血供情况进行观察,并采用血流直方图定量分析乳腺肿块内及周边血供情况,评价3D-CPA定性及定量分析在乳腺良恶性肿块中的诊断价值。方法：对165位乳腺肿块患者术前行三维超声检查,观察肿块边缘形态特性,与病理结果对照,分析良恶性肿块汇聚征在冠状面上的显示情况,并将恶性肿块汇聚征显示率与病理类型,肿块直径、组织学分级、淋巴结状态及雌激素受体(Estrogen receptor, ER)、孕激素受体(Progesterone receptor, PR)、人表皮生长因子2(Human epidermal growth factor2, CerbB-2)、Ki-67表达作对比,分析它们之间的关系。在三维重建的基础上运用3D-CPA技术观察乳腺肿块内及周边的血供情况,客观评价其血流分级；并采用不规则体积测量(Virtual organ computer-aid analysis, VOCAL)软件中的血流直方图定量分析肿块内及周边3mm的血流参数,将良恶性肿块的结果进行统计学比较。结果：汇聚征诊断乳腺恶性肿块的灵敏度、特异度分别为67.7%,93.1%。93例乳腺癌肿块中,浸润性癌和非浸润性癌汇聚征的显示率分别为80.3%,11.8%,两者间差异具有统计学意义(P0.001)。汇聚征在乳腺癌预后中的评估：①汇聚征显示率与肿块直径和组织学分级有关(P0.05)。汇聚征多见于直径≤2cm,组织学分级Ⅱ级的非特殊型浸润性癌；②与无汇聚征组相比,汇聚征组的ER、PR阳性表达率相对较高(P0.05)；③两组的淋巴结状态、CerbB-2、Ki-67表达间差异均未见统计学意义(P0.05)。按3D-CPA分级分析,良性肿块以Ⅰ、Ⅱ级血流为主(81.9%),恶性肿块以Ⅱ、Ⅲ级血流为主(90.3%)。Ⅰ、Ⅱ、Ⅲ级血流情况在乳腺良恶性肿块中存在明显统计学差异(P0.001),且各级间比较也均存在统计学差异(P0.05)。血流直方图血流定量参数血管指数(Vascularization index, VI)、血流指数(Flow index, FI)和血管血流指数(Vascularization-flow index, VFI)在乳腺良恶性肿块的鉴别诊断中具有一定的应用价值,其中VI-in、VFI-in、 VI-out、FI-out及VFI-out在乳腺良恶性组间差异存在统计学意义((P0.05)。根据受试者工作特征曲线(Receiver operating characteristic curve, ROC)确定的诊断截值上述指标均具有较高的敏感性和特异性,以VI-out≥2.630作为诊断乳腺恶性肿瘤的界值,敏感性92.2%,特异性83.3%；以VI-in≥1.725作为诊断界值,敏感性92.2%,特异性74.1%；以VFI-in≥0.411作为诊断界值,敏感性90.6%,特异性74.1%；以VFI-out≥0.648作为诊断界值,敏感性87.5%,特异性79.6%；以FI-out≥23.030作为诊断界值,敏感性85.9%,特异性48.1%。指标V-in、V-out及FI-in在良恶性两组中测值均未见明显统计学差异(P0.05)。结论：三维超声可立体、直观地显示乳腺肿块的形态及其与周边组织间关系。冠状面的汇聚征对乳腺良恶性肿块的鉴别诊断及乳腺癌的预后评估具有重要意义。此外,3D-CPA定性及定量分析在乳腺良恶性肿块的鉴别诊断中具有一定的运用价值,病灶周边血供情况的定量分析为无创性评估肿块血供丰富程度提供了一种新方法。
[Abstract]:Objective: using three-dimensional ultrasound imaging were observed in breast tumor edge morphological characteristics, discusses value of three-dimensional ultrasound in the diagnosis of syndrome of benign and malignant breast tumors, and its expression pattern in different pathological types of breast cancer, prognostic significance; using three-dimensional color power angiography (Three dimensional color power angiography, 3D-CPA) the technology of vascular morphology and blood of benign and malignant breast tumor and peripheral donor were observed and analyzed for breast mass and peripheral blood flow using histogram quantitative diagnostic value in benign and malignant breast tumors in the qualitative and quantitative analysis and evaluation of the 3D-CPA.
Methods: 165 patients with breast masses underwent three-dimensional ultrasound observation of morphological characteristics of the edge of tumor, compared with pathologic results, analysis of benign and malignant tumors showed convergence sign in the coronal plane, and the mass convergence sign display rate and pathological type, malignant tumor diameter, histological grade, lymph node status and estrogen receptor (Estrogen receptor, ER), progesterone receptor (Progesterone receptor, PR), human epidermal growth factor 2 (Human epidermal growth FACTOR2, CerbB-2), the expression of Ki-67 for comparison, analysis of the relationship between them. The use of 3D-CPA technology to observe breast masses in and around the blood supply based on 3D reconstruction of objective evaluation the grade of blood flow; and the irregular volume measurement (Virtual organ computer-aid analysis, VOCAL) in the tumor and peripheral blood flow parameters of 3mm software in the quantitative analysis of flow histogram, will be good The results of malignant masses were compared statistically.
Results: the sensitivity and specificity of convergence sign in diagnosing malignant breast masses were 67.7%, respectively. In 93.1%.93 breast cancer, the rate of convergence in invasive breast cancer and noninvasive cancer was 80.3% and 11.8%, respectively, and the difference between them was statistically significant (P0.001).
Convergence sign evaluation in the prognosis of breast cancer: the convergence rate and sign the tumor diameter and histological grade (P0.05). The convergence sign was seen in less than 2cm in diameter, non special type grade II invasive carcinoma; and the non convergence sign group, convergence sign group ER, the expression of PR the positive rate is relatively high (P0.05); the two group of the lymph node status, CerbB-2, expression of Ki-67 had no statistical significance (P0.05).
According to the analysis of 3D-CPA classification of benign masses in I, II (81.9%), the main blood malignant masses in II, III (90.3%). The main flow of I, II, III were significant differences in blood flow of malignant and benign breast lesions (P0.001), and the levels of comparison were also statistically significant (in P0.05).
The blood flow parameters of quantitative histogram vascular index (Vascularization index, VI), flow index (Flow index, FI) and blood flow index (Vascularization-flow index VFI) has a certain application value in the differential diagnosis of benign and malignant breast tumors in which VI-in, VFI-in, VI-out, FI-out and VFI-out, there was significant difference in the breast malignant group ((P0.05). According to the receiver operating characteristic curve (Receiver operating characteristic curve, ROC) the diagnostic cut-off value determined the sensitivity indexes and has high specificity, with VI-out = 2.630 as the diagnosis of malignant breast tumor boundary value, the sensitivity was 92.2%, specificity was 83.3%; by over 1.725 as VI-in the diagnostic value, sensitivity of 92.2%, specificity of 74.1% to VFI-in; over 0.411 as a cut-off value, the sensitivity was 90.6%, specificity was 74.1%; with VFI-out over 0.648 as cut-off value, sensitivity 87.5%, the specificity was 79.6%; with FI-out over 23.030 as a cut-off value, the sensitivity of 85.9%, specificity of 48.1%. index of V-in, V-out and FI-in values were no statistically significant differences between benign and malignant in two groups (P0.05).
Conclusion: 3D ultrasound can visually display the stereo, breast shape and with the surrounding tissue. The relationship between the prognosis of coronary syndrome from breast cancer and differential diagnosis of benign and malignant breast tumors has important significance to the evaluation. In addition, the 3D-CPA qualitative and quantitative analysis of the use of a certain value in the differential diagnosis of benign and malignant breast tumors in for the situation, the quantitative analysis for the lesions of the peripheral blood tumor noninvasive assessment of blood supply and provide a new method.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.9;R445.1

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