乳腺占位性病变自动乳腺全容积扫描冠状面成像特征及其临床病理相关性研究

发布时间：2018-03-21 02:04

  本文选题：自动乳腺全容积扫描　切入点：冠状面　出处：《复旦大学》2014年硕士论文　论文类型：学位论文

【摘要】：第一部分：乳腺占位性病变自动乳腺全容积扫描冠状面成像特征目的探讨自动乳腺全容积扫描(automated breast volume scanner, ABVS)冠状面成像在乳腺占位性病变诊断及鉴别诊断中的价值。方法选取我院手术(局部切除术或根治术)病理证实的130例女性患者,共138个(良性85个,恶性53个)乳腺病灶,从肿块自身表现(边界、边缘轮廓及包膜)和周边组织特征(无变化、汇聚征、低回声晕及高回声晕)两大方面分析病灶ABVS冠状面成像特征。通过x2检验得出对乳腺占位性病变鉴别诊断有价值的冠状面征象。结果1.浸润性乳腺癌、纤维腺瘤及乳腺病在ABVS冠状面的主要特征在ABVS冠状面上,浸润性乳腺癌主要表现为边界模糊(39/53,73.6%)、边缘虫蚀征(38/53,71.7%)、无包膜(52/53,98.1%)、周边组织汇聚征(27/53,50.9%)；纤维腺瘤主要表现为边界清晰(58/60,96.7%)、边缘光滑(46/60,76.7%)、周边组织无明显变化(45/60,75.0%)：腺病的主要表现和纤维腺瘤相似,包括边界清晰(18/25,72.0%)、边缘光滑或欠光滑(20/25,80.0%)、周边组织无明显变化(14/25,56.0%)。2.乳腺良恶性病变鉴别诊断(1)虫蚀征诊断浸润性乳腺癌的敏感性、特异性分别为71.7%和98.8%；汇聚征诊断浸润性乳腺癌的敏感性、特异性分别为50.9%和97.6%；联合虫蚀征和汇聚征诊断浸润性乳腺癌的敏感性、特异性分别为90.6%、97.6%。虫蚀征、汇聚征以及两者联合诊断浸润性乳腺癌的ROC曲线下面积分别为0.853、0.743和0.941。(2)把星芒征作为边界模糊的乳腺病和浸润性乳腺癌的鉴别诊断标准时,其诊断边界模糊的乳腺病的敏感性为71.4%,特异性高达98.1%,PPV和NPV分别为83.3%和96.3%。(3)低回声晕诊断乳腺良性病变敏感性和特异性分别为14.1%和100%。结论ABVS冠状面成像有助于乳腺占位性病变的诊断及鉴别诊断。第二部分：乳腺浸润性导管癌自动乳腺全容积扫描冠状面汇聚征与其临床病理特征相关性目的探讨自动乳腺全容积扫描(automated breast volume scanner, ABVS)冠状面汇聚征对乳腺浸润性导管癌(infiltrating ductal carcinoma,IDC)治疗敏感性及其预后的预测价值。方法选取于本院行乳腺癌根治性切除术、病理诊断为IDC患者46例,共47个病灶,分析病灶ABVS冠状面汇聚征与其临床病理(病灶大小、病理组织学分级、腋窝淋巴结状态以及ER、PR、HER2表达)相关性。结果汇聚征在不同大小和不同腋窝淋巴结状态IDC组中出现比例差异无明显统计学意义(P0.05)。汇聚征在病理分级Ⅱ级组中出现的比例高于Ⅲ级组,差异有统计学意义(P=0.01)。汇聚征在ER阳性组出现的比例高于ER阴性组,但差异无统计学意义(P=0.055)；在PR阳性组出现的比例高于PR阴性组,差异具有统计学意义(P=-0.004)；在HER2阴性组出现的比例高于HER2阳性组,差异也具有统计学意义(P=0.036)。结论汇聚征对IDC治疗敏感性及其预后有一定的预测价值。
[Abstract]:Part one: characteristics of automatic full volume scanning coronal imaging of breast mass lesions objective to evaluate the value of automatic full volume breast volume imaging in the diagnosis and differential diagnosis of breast occupying lesions. Methods 130 female patients who were pathologically proved by surgery (local excision or radical operation) were selected. A total of 138 breast lesions (85 benign and 53 malignant) were found in the breast, including their own features (boundary, margin, envelope) and surrounding tissue features (no change, convergence sign). Low echo halo and hyperechoic halo) were used to analyze the ABVS coronal imaging features of the lesions. By means of x2 test, valuable coronal features were obtained for the differential diagnosis of breast space occupying lesions. 1. Invasive breast cancer, The main features of fibroadenoma and mammary disease on the coronal plane of ABVS are on the coronal plane of ABVS. The main manifestations of invasive breast cancer are fuzzy border 39 / 53 / 73.6T, marginal worm erosion 38 / 53 / 71.7m, no capsule 52P / 53 / 98.1C, peripheral tissue convergence sign 27 / 53nb / 50.9A; fibroadenoma is characterized by clear boundary 58 / 53 / 6096.7m, smooth edge 4660607R / 77.There is no obvious change in peripheral tissue. 45 / 6075.00: the main manifestation of adenopathy is: adenopathy. The main manifestations of adenopathy are as follows: the main manifestations of adenopathy are as follows: the main manifestations of adenopathy are as follows: the main manifestations of adenopathy are as follows: the main manifestations of adenopathy are as follows: the main manifestations of adenopathy are as follows: the main manifestations of adenopathy are as follows:. Like fibroadenoma, These include clear boundaries of 18 / 25 / 72.0, smooth or unsmooth edges, 20 / 2580.0, and no significant changes in peripheral tissues. The sensitivity of invasive breast cancer is diagnosed by 14 / 2525 / 56.0. 2. Differential diagnosis of benign and malignant breast lesions. (1) the sensitivity of invasive breast cancer. The specificity was 71.7% and 98.8 respectively, the sensitivity of convergence sign in the diagnosis of invasive breast cancer was 50.9% and 97.6.The sensitivity of combined worm erosion sign and convergence sign in the diagnosis of invasive breast cancer was 90.6 and 97.6. The areas under the ROC curve of convergent sign and combined diagnosis of invasive breast cancer were 0.8530.73 and 0.941.2respectively) when the star sign was used as the differential diagnostic criterion for breast disease with fuzzy boundary and invasive breast cancer, the area under the ROC curve was 0.8530.43 and 0.941.2respectively. The sensitivity and specificity of hypoechoic halo in the diagnosis of breast benign lesions were 71.4 and 98.1respectively. The sensitivity and specificity of hypoechoic halo in the diagnosis of benign breast lesions were 14.1% and 1000.Conclusion ABVS coronal imaging is helpful in the diagnosis of mammary gland. Diagnosis and differential diagnosis of positional lesions. Part 2: coronal convergence sign of automatic full volume scanning of breast and its clinicopathological features objective to investigate the correlation between automatic full volume scan of breast breast volume scanner (ABVS). The value of coronal convergence sign in the treatment of infiltrating ductal carcinoma of breast and its prognostic value. Methods radical mastectomy was performed in our hospital. 46 patients (47 lesions) with IDC were diagnosed by pathology. The coronal convergence sign of ABVS and its clinicopathological features (size of lesion, histopathological grade) were analyzed. Results there was no significant difference in the proportion of convergence sign in IDC group with different size and different axillary lymph node status (P 0.05). The convergence sign appeared in pathological grade 鈪，

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