原发性肝细胞癌的实时组织弹性成像与病理指标相关的初步研究

发布时间：2018-05-05 13:45

本文选题：超声弹性成像 + 原发性肝癌　；参考：《第二军医大学》2014年硕士论文

【摘要】：研究背景及目的原发性肝癌是最常见的恶性肿瘤之一。在世界范围内，男性原发性肝癌发病率居第五，死亡率在肿瘤中居第二；女性发病率居第七，死亡率在肿瘤中居第六。原发性肝细胞癌又是其中的最主要的病理类型，占全球原发性肝癌的70%-85%。我国是原发性肝细胞癌的高发区，这些发病和死亡的病例其中一半来自中国，目前主要依靠早诊断早治疗来提高患者生存率。超声检查是诊断肝脏疾病最常用的手段之一，由于其方便、无创、价廉等特点，被广泛的应用在各种肝脏疾病的诊断和鉴别诊断中，包括原发性肝细胞癌的诊断和鉴别。超声弹性成像技术是近年发展起来的新技术，它通过了解所检测组织的硬度以判别其良恶性，与常规超声和超声造影获取到的信息完全不同，有其独特性。实时组织弹性成像作为超声弹性成像技术的一种，，采用评分法和SR值法对肝实性占位性病变进行检查，得到病灶的弹性测值，有助于肿瘤的良恶性诊断。但由于肝实性占位性病变的特殊性，除了病灶病理类型的差异外，病灶的硬度可能受某些病理指标的影响，如分化程度、有无包膜、有无瘤内出血、有无坏死等，这方面目前暂无相关研究。本课题以原发性肝细胞癌患者为研究对象，进行实时组织弹性成像检查，获取弹性测值，用病理指标分组进行对照和相关分析，初步探讨在原发性肝细胞肝癌中病理指标与实时组织弹性成像测值的相关性和对与良性局灶性病变鉴别诊断效能的影响。研究方法 1、病例选择：第一部分研究分析了2011年8月～2013年8月在我院经手术病理证实的原发性肝细胞癌患者73例，其中男性65例，女性7例。第二部分研究分析了2011年8月～2013年10月在我院经手术病理证实的原发性肝细胞肝癌73例，良性局灶性病变患者39例（肝血管瘤14例、局灶性结节性增生9例、肝腺瘤6例、血管平滑肌脂肪瘤7例及孤立性坏死性结节、硬化结节、脂肪浸润各1例）。其中男性83例，女性29例。以上研究均在检查前告知患者及家属本研究的方法、目的和可能存在的风险，并签署《知情同意书》。 2、拟行原发性肝细胞癌的实时组织弹性成像与病理指标相关性研究： 73例原发性肝细胞肝癌患者均行实时组织弹性成像检查，获取弹性评分和SR值，将评分和SR值分别在包膜、瘤内出血、坏死、微血管癌栓、组织类型和癌旁肝组织分型中作分组比较；将癌旁肝组织类型设为偏相关因素，对病理各指标与SR比值进行Pearson偏相关分析。 3、拟行实时组织弹性成像中肝硬化对原发性肝细胞肝癌与良性局灶性病变鉴别诊断的影响：运用实时组织弹性成像技术对上述73例原发性肝细胞肝癌患者及39例良性局灶性病变患者分为肝硬化组与非肝硬化组，分别以≥3分、SR≥3.47为恶性肿瘤为诊断标准，将评分法和SR值法的诊断结果与病理结果做比较，分析两组诊断效能的差别。结果 1、各项病理指标分组比较显示评分和SR值在不同癌旁组织分型（肝硬化组和非肝硬化组）中有统计学差异（P0.05）。将癌旁肝组织类型设为偏相关因素，对病理各指标与SR比值进行Pearson偏相关分析。结果显示，消除癌旁肝组织不同类型影响后，SR值与瘤内出血呈负相关，表明有瘤内出血病人其SR值较无出血病人低，其余指标与SR值无相关关系。 2、结果显示评分法和SR值法在总的和肝硬化组的诊断效能均与病理诊断不一致（P0.05），非肝硬化组的诊断效能均与病理诊断一致（Kappa值分别为0.5412和0.5698，P均为0.0000）。非硬化组中评分法和SR值法的一致百分率、灵敏度、特异度、误诊率、漏诊率分别为77.27%和78.79%、76.32%和78.95%、78.57%和78.57%、21.43%和21.43%、23.68%和21.05%。评分法和SR值法在非硬化组的诊断效能高于硬化组。结论 1、原发性肝细胞肝癌硬度测值与癌旁肝组织肝硬化和瘤内出血有关。 2、原发性肝细胞肝癌与良性病变的鉴别诊断受病灶旁肝组织肝硬化的影响。
[Abstract]:Background and purpose of research
Primary liver cancer is one of the most common malignant tumors. In the world, the incidence of male primary liver cancer is fifth, the mortality rate is second in the tumor, the incidence of female is seventh, the mortality rate is sixth in the tumor. Primary hepatocellular carcinoma is the most important type of disease, which accounts for the 70%-85%. of the primary liver cancer in the world. It is a high incidence area of primary hepatocellular carcinoma. Half of these cases and deaths are from China. It is mainly based on early diagnosis and early treatment to improve the patient's survival rate.
Ultrasonic examination is one of the most commonly used methods for the diagnosis of liver diseases. Because of its convenience, noninvasive and inexpensive, it is widely used in the diagnosis and differential diagnosis of various liver diseases, including the diagnosis and identification of primary hepatocellular carcinoma. Ultrasound elastography is a new technology developed in recent years. It has been used to understand the detected tissues. It is different from conventional ultrasound and ultrasound contrast and has its uniqueness. As one of the ultrasonic elastic imaging techniques, the real-time tissue elastic imaging is used to examine the liver solid occupying lesions by scoring and SR values, and the elastic measurement of the lesion is helpful to the diagnosis of benign and malignant tumors. However, due to the specificity of the liver solid space occupying lesions, in addition to the pathological types of the lesions, the lesion's hardness may be influenced by some pathological indexes, such as the degree of differentiation, or without capsule, or without tumor, and whether there is necrosis or not, and there is no related Research for the present.
This subject takes the patients of primary hepatocellular carcinoma as the research object, carries on the real-time tissue elastic imaging examination, obtains the elastic measurement, uses the pathological indexes to carry on the contrast and correlation analysis, and preliminarily discusses the correlation between the pathological indexes of the primary hepatocellular carcinoma and the real-time tissue elastography and the identification of the benign focal lesions. The effect of breaking efficiency.
research method
1, case selection:
In the first part, 73 cases of primary hepatocellular carcinoma confirmed by surgery and pathology in our hospital from August 2011 to August 2013 were analyzed, including 65 males and 7 females.
The second part studied 73 cases of primary hepatocellular carcinoma confirmed by operation and pathology in our hospital from August 2011 to October 2013, 39 cases of benign focal lesions (14 cases of hepatic hemangioma, 9 cases of focal nodular hyperplasia, 6 cases of hepatic adenoma, 7 cases of angiomyolipoma and solitary necrotic nodules, sclerotic nodules, and 1 cases of fatty infiltration). Among them, 83 were male and 29 were female.
The above study informed the patients and their families about the method, purpose and possible risks before the examination, and signed the informed consent.
2, to study the correlation between real-time tissue elastography and pathological findings in primary hepatocellular carcinoma.
73 cases of primary hepatocellular carcinoma were examined by real time tissue elastic imaging to obtain elastic score and SR value. The scores and SR values were compared in the capsule, intratumoral hemorrhage, necrosis, microvascular tumor thrombus, tissue type and paracancerous liver tissue classification, and the type of para cancer liver tissue was set as partial correlation factor, and the pathological indexes and SR ratio were compared. Pearson partial correlation analysis was carried out.
3, the effect of cirrhosis in real-time tissue elastography on the differential diagnosis of primary hepatocellular carcinoma and benign focal lesions:
The 73 cases of primary hepatocellular carcinoma and 39 cases of benign focal lesions were divided into cirrhosis group and non cirrhosis group by real time tissue elastic imaging. The diagnostic criteria of malignant tumors were equal to 3 and SR 3.47, respectively. The diagnostic results of the scoring and SR values were compared with the pathological results, and the diagnostic efficiency of the two groups was analyzed. Difference.
Result
1, the pathological indexes showed that scores and SR values were statistically different (P0.05) in different paracancerous tissue types (cirrhosis group and non cirrhosis group). The type of para cancer liver tissue was set as partial correlation factor, and the Pearson partial correlation analysis was carried out on the pathological indexes and the ratio of SR. The results showed that the effects of different types of liver tissue were eliminated. The SR value was negatively correlated with intratumoral hemorrhage, indicating that the SR value of patients with intratumoral hemorrhage was lower than that of patients without bleeding. Other indicators were not related to SR value.
2, the results showed that the diagnostic efficiency of the score method and the SR value method in the total and liver cirrhosis group was not consistent with the pathological diagnosis (P0.05). The diagnostic efficiency of the non cirrhosis group was in accordance with the pathological diagnosis (Kappa value was 0.5412 and 0.5698, and P was 0 respectively). The percentage of the score, sensitivity, specificity, misdiagnosis rate and leakage rate in the non sclerosis group were the same as that in the SR value method. The diagnostic rates were 77.27% and 78.79%, 76.32% and 78.95%, 78.57% and 78.57%, 21.43% and 21.43%, and 23.68% and 21.05%. scores and SR values were higher in the non sclerosis group than in the sclerosis group.
conclusion
1, the hardness of primary hepatocellular carcinoma is related to liver cirrhosis and intratumoral hemorrhage.
2, the differential diagnosis between primary hepatocellular carcinoma and benign lesions is affected by Para hepatic cirrhosis.

【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.7;R445.1

【参考文献】