术前五种影像技术对乳腺癌大小精确性评价及其影响因素的研究

发布时间：2018-05-06 23:02

本文选题：乳腺癌 + 大小　；参考：《南方医科大学》2017年硕士论文

【摘要】：目的:评估术前二维超声(Two-dimensional ultrasound,2D-US)、三维容积超声(three-dimensional volume ultrasound,3D-US)、应力式超声弹性成像(strain ultrasounic elastography,SUE)、全视野数字乳腺 X 线摄影(full-feld digital mammography,FFDM)及数字乳腺断层摄影(digital breast tomosynthesis,DBT)对乳腺癌大小测量的精确性及其影响因素。方法:将我院2016年4月～2016年11月收集的101例乳腺癌患者(101个病变)纳入临床测量研究。在穿刺确诊前,运用超声(3D-US/2D-US/SUE)及乳腺X线摄影(FFDM/DBT)对病变最大径进行了测量。以病理测值为金标准,运用线性回归分析各影像技术评估乳腺癌大小的能力;运用Bland-Altman图及组内相关系数(ICC)对五种影像技术测值与病理测值行一致性分析;运用卡方检验(或Fisher's确切概率法)分析各临床病理因素及影像特征对各影像技术测值准确性的影响。结果:对于乳腺癌病变大小的评估,各影像技术效果由好到差依次为3D-US/2D-US/SUE/DBT/FFDM(R2=0.80/0.65/0.61/0.47/0.32)。分析 Bland-Altman图及ICC发现乳腺超声(3D-US/2D-US/SUE)一致性界限范围窄,界外点少,数值分布集中,与病理测值相关性好,其中以3D-US 一致性效果最佳,其次为2D-US及SUE;乳腺X线摄影(DBT/FFDM)一致性界限范围较广,界外点较多,数值分布较散,其中以FFDM差异最大。比较各临床病理因素(年龄、绝经、新辅助化疗、病变大小、病理分级、ER、PR、HER2、Ki67表达、腋淋巴结转移、浸润性导管癌伴导管内原位癌、病理类型)及影像征象(乳腺密度、病变类型、微钙化、距皮深度、生长方向、病变形态及边缘)对五种影像技术测值准确性的影响,发现3D-US在年龄40岁组测值准确率高;2D-US在浸润性导管癌(Invasive ductal carcinoma,IDC)不伴导管内原位癌(ductal carcinoma in situ,DCIS)、无微钙化、病变边缘清晰、病变≤2cm及浸润性导管癌组测值准确率高;SUE在IDC不伴DCIS、无微钙化及病变边缘清晰组测值准确率高;DBT在腺体疏松、病变为肿块型、病变距皮深度≤2cm、HER2阴性、腋淋巴结无转移及病变形态规则组测值准确率高;FFDM在腺体疏松、病变为肿块型、病变距皮深度≤2cm组、病理分级0～Ⅱ级、HER2阴性、ER/PR阳性及病变边缘清晰组测值准确率高;差异均有统计学意义(P≤0.05)。患者在有无绝经、是否行新辅助化疗、Ki-67表达及病变生长方向方面对五种影像技术测值准确性无明显影响,差异均无统计学意义(P0.05)。结论:①对于乳腺癌大小的测量,五种影像技术测值的准确性由高到低依次为3D-US2D-USSUEDBTFFDM;其中3D-US测值的准确性受临床病理因素及影像学征象影响最小,对于病变大小的测量及保乳术切缘的确定效果最佳;而FFDM测值的准确性受临床病理因素及影像学征象影响最大,对于病变大小的测量及保乳术切缘的确定效果最差。②当乳腺癌患者为致密型乳腺,病变在乳腺X线摄影上表现为非肿块型,病变位置较深(2cm)或HER2表达阳性时,乳腺超声检查较X线摄影对病变大小评价效果更佳。③乳腺癌患者病变伴有微钙化或DCIS时,乳腺X线摄影较超声更敏感,可在乳腺X线摄影的基础上结合超声检查以增加对病变大小测值的准确性。④结合病人的临床病理因素及影像征象,利用乳腺超声和X线摄影两类影像技术的优势对乳腺癌病变大小进行综合评价,更有利于临床个体化治疗的精准实施。
[Abstract]:Objective: To evaluate Two-dimensional ultrasound (2D-US), three-dimensional volume ultrasound (three-dimensional volume ultrasound, 3D-US), stress ultrasonic elastic imaging (strain ultrasounic elastography, SUE), digital mammography and digital mammography. Reast tomosynthesis, DBT) accuracy of breast cancer size measurement and its influencing factors. Methods: 101 cases of breast cancer (101 lesions) collected in our hospital from April 2016 to November 2016 were included in the clinical survey. The maximum diameter of the lesion was measured by ultrasound (3D-US/2D-US/SUE) and mammography (FFDM/DBT) before the puncture was confirmed. Quantity. The ability to evaluate the size of breast cancer by linear regression analysis was used to evaluate the size of breast cancer by linear regression analysis. Bland-Altman and ICC were used to analyze the conformance of five imaging techniques and pathological values, and the clinicopathological factors and image characteristics were analyzed by chi square test (or Fisher's). The effect on the accuracy of each imaging technique. Results: for the evaluation of the size of the breast cancer, the effect of each image from good to poor was 3D-US/2D-US/SUE/DBT/FFDM (R2=0.80/0.65/0.61/0.47/0.32). The Bland-Altman map and the ICC found that the limits of the consistency of the breast ultrasound (3D-US/2D-US/SUE) were narrow, the out of boundary points were few, and the numerical distribution set was small. Among them, the correlation was good with the pathological test, among which 3D-US was the best result, followed by 2D-US and SUE, and the line of DBT/FFDM was wide, more out of boundary, more scattered, and the difference of FFDM was the largest. Comparison of various clinicopathological factors (year of age, menopause, neoadjuvant chemotherapy, pathological size, pathological grading, ER, PR, HER2) Ki67 expression, axillary lymph node metastasis, invasive ductal carcinoma with intraductal carcinoma in situ, pathological type) and imaging signs (breast density, lesion type, microcalcification, cortex depth, growth direction, lesion morphology and edge) were affected by the accuracy of five imaging techniques, and 3D-US was found to have high accuracy in the age 40 year group; 2D-US was in infiltrative guide. Invasive ductal carcinoma (IDC) was not accompanied by intraductal carcinoma in situ (ductal carcinoma in situ, DCIS), no microcalcification, clear edge of the lesion, and high accuracy rate in the group of invasive ductal carcinoma and not 2cm and invasive ductal carcinoma. The depth of the cortex was less than 2cm, HER2 was negative, and the accuracy rate of the measured value of the axillary lymph node no metastasis and the lesion morphologic rule group was high; FFDM was loose in the gland, the lesion was a mass, the lesion was less than 2cm, the pathological grade was 0 to second grade, the HER2 negative, the ER/PR positive and the clear edge of the lesion were higher, the difference was statistically significant (P < 0.05). The difference was statistically significant (P < < 0.05). No menopause, new adjuvant chemotherapy, Ki-67 expression and the direction of the growth of the lesions had no significant influence on the accuracy of the five imaging techniques. The difference was not statistically significant (P0.05). Conclusion: (1) the accuracy of the measurement of the size of the breast cancer from high to low is 3D-US2D-USSUEDBTFFDM, in which the values of 3D-US are measured by 3D-US. The accuracy was the least influenced by the clinical pathological factors and imaging features. The measurement of the size of the lesions and the cutting edge of the breast conserving surgery was the best. The accuracy of the FFDM was most affected by the clinical pathological factors and imaging features, and the least effect on the measurement of the size of the lesions and the margin of the breast conserving surgery. Dense breast, the lesion in mammography shows non lump type, the position of the lesion is deep (2cm) or HER2 expression positive, the breast ultrasound examination is better than the X-ray photography to evaluate the size of the lesion. (3) the breast radiography is more sensitive than the ultrasound when the lesions of the breast cancer patients are accompanied by microcalcification or DCIS, and can be combined on the basis of mammography. Ultrasound examination to increase the accuracy of the measurement of the size of the lesion. (4) combined with the clinicopathological factors and imaging features of the patients, using the advantages of two types of imaging techniques of breast ultrasound and X-ray photography to evaluate the size of the breast cancer, which is more conducive to the precise implementation of the clinical individualized treatment.

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9;R445.1;R730.44

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