常规超声、弹性成像与磁共振诊断乳腺癌腋窝淋巴结性质的研究

发布时间：2018-06-29 14:57

本文选题：乳腺癌 + 腋窝淋巴结　；参考：《河北北方学院》2017年硕士论文

【摘要】：乳腺癌已成为女性发病率最高的恶性肿瘤,而腋窝淋巴结有无转移作为一项重要相关因素,关系着患者治疗方式的选择及预后的疗效评估,因此正确诊断淋巴结性质非常重要。以往淋巴结清扫术为诊断淋巴结是否发生转移的最可靠方法,但因具有创伤性及术后并发症被前哨淋巴结活检术渐趋替代,但仍为有创方法。因而如何术前无创性准确评估腋窝淋巴结状态非常重要,并成为了研究的热点,本研究旨在提出超声与磁共振多因素综合分析并对比评价以求探寻可靠的无创性诊断方法,提高诊断效能。选择2015.4~2016.8在中国人民解放军第307医院确诊的188例乳腺癌患者,其中2例患者为双侧病变,术前行同侧腋窝淋巴结超声检查,共190例,术后病理证实淋巴结发生转移127例,未发生转移63例。超声检查内容包括:二维超声检查并记录淋巴结长短径之比、形态是否规则、皮质厚度及淋巴结门结构是否存在;彩色多普勒超声观察淋巴结血流类型、血流分级、收缩期最高血流速度(peak systolic velocity,PSV)、血流阻力指数(resistance index,RI);弹性成像检查记录淋巴结的弹性评分、弹性应变率比值(elastic strain rate,SR)。以术后病理结果为标准,弹性成像在二维超声分级中的作用通过ROC曲线进行分析,常规超声及弹性成像各单因素分析采用卡方检验,多因素建立二分类Logistic回归模型并采用ROC曲线评估效能;并对同时行乳腺线圈联合体线圈冠状位扫描的60例腋窝淋巴结进行超声与磁共振诊断的对比分析,其中转移淋巴结34例,未转移淋巴结26例,磁共振扫描后经工作站进行薄层重建观察记录淋巴结长径、短径、内部信号、轮廓边缘、形态。采用卡方检验对体线圈扫描的价值及磁共振各因素进行分析,各因素与病理结果的一致性采用Kappa检验;常规超声、弹性成像与磁共振三者对比诊断的ROC曲线行Z检验。研究结果显示,弹性评分及SR联合应用于单纯依靠皮质厚度及淋巴结门结构的二维淋巴结分级有着重要的作用,两种方法诊断的ROC曲线下面积(Area under curve,AUC):二维分级为0.742,联合弹性成像后分级为0.869,两者相比具有统计学意义(P0.05);超声各单因素分析结果显示,淋巴结长短径之比、形态、皮质厚度和淋巴结门结构、血流类型、PSV、RI、弹性评分、SR为诊断淋巴结性质的相关因素,而淋巴结的血流分级为不相关因素(P0.05),对8项相关因素进行二分类Logistic回归,结果显示,血流类型、弹性评分及SR被纳入模型,其OR(odd ratio)值分别为5.896,10.272,9.729,95%可信区间分别为1.214~28.642,1.805~58.461,1.751~54.072,回归模型为Logist(P)=-2.221+1.774X4+2.329X7+2.275X8,模型诊断的灵敏度为93.75%,特异度为88.7%,绘制多参数回归模型的ROC曲线,AUC为0.952(S.E.=0.015,P0.001,95%CI=0.922~0.982),该模型对于诊断淋巴结性质具有较好的拟合度;将体线圈联合乳腺线圈冠状位扫描有助于淋巴结的检出与诊断,与单独乳腺线圈对于腋窝淋巴结的检出两者相比具有统计学意义(p0.05);磁共振征象与诊断淋巴结性质相关的因素有短径10mm、长短径之比、内部信号是否均匀、轮廓边缘是否规则及形态是否为类圆形,Kappa值分别为0.321,0.225,0.607,0.435,0.485;三种方法诊断的ROC曲线下面积:常规超声0.781,弹性成像0.937,磁共振0.834,弹性成像与常规超声、磁共振诊断效能相比均具有统计学意义(p0.05),体线圈联合乳腺线圈的冠状位扫描较常规超声的诊断效能有所提高,但两者相比不具有统计学意义(P0.05)。综上所述,弹性成像在乳腺癌腋窝淋巴结的诊断分析中占有优势,而与常规超声多因素综合分析可进一步提高诊断效能;体线圈应用于乳腺癌腋窝淋巴结的扫描具有一定的临床意义,能够弥补乳腺线圈单独用于腋窝淋巴结扫描及诊断中的不足;超声与磁共振两种诊断方法为临床无创评估腋窝淋巴结性质提供了很好的价值,以减少不必要的前哨淋巴结活检,为指导临床治疗起到了重要的意义。
[Abstract]:Breast cancer has become the highest incidence of malignant tumors in women, and whether or not the axillary lymph node metastasis is an important related factor is related to the choice of the treatment and the evaluation of the prognosis of the patients. Therefore, it is very important to correctly diagnose the properties of the lymph nodes. The method, however, is gradually replaced by sentinel lymph node biopsy because of its traumatic and postoperative complications, but it is still a invasive method. Therefore, it is very important to evaluate the status of axillary lymph nodes without invasive and accurate preoperation, and it has become a hot spot of research. This study aims to propose a comprehensive analysis and comparison of multiple factors of ultrasound and magnetic resonance in order to seek for reliability. 188 cases of breast cancer diagnosed by 2015.4~2016.8 in No.307 Hospital of PLA of Chinese people were selected, of which 2 cases were bilateral lesions, and 190 cases were examined by ultrasonic examination of the ipsilateral axillary lymph nodes before operation. 127 cases of lymph node metastases were confirmed by pathology after operation, and 63 cases were not metastasize. The volume included: two-dimensional ultrasound examination and recording the ratio of length and diameter of lymph nodes, morphological rules, cortical thickness and lymph node portal structure; color Doppler ultrasound observation of lymph node blood flow type, blood flow classification, peak systolic velocity, PSV, resistance index, RI; elastography. The elasticity score of the lymph nodes, the ratio of elastic strain rate (elastic strain rate, SR). The role of the postoperative pathological results as the criterion, the role of elastic imaging in the two-dimensional ultrasound classification was analyzed by the ROC curve. The chi square test was used in the analysis of the single factor analysis of conventional ultrasound and elastography, and the two classification Logistic regression models were established by multiple factors. The ROC curve was used to evaluate the effectiveness. The diagnosis of 60 cases of axillary lymph node with the coronal scan of the coils of the breast coils was analyzed by ultrasound and magnetic resonance. 34 cases of metastatic lymph nodes and 26 cases of non metastatic lymph nodes were observed. The length of lymph nodes, short diameter and internal letter were recorded by TLC reconstruction after magnetic resonance scanning. The value of the body coil scanning and the factors of magnetic resonance were analyzed by chi square test. The consistency of the factors and the pathological results was examined by Kappa test; the ROC curve of the three contrasts, conventional ultrasound, elastic imaging and magnetic resonance imaging, was tested by Z test. The thickness of the cortex and the two-dimensional lymph node classification of the lymph node portal structure were important. The area under the ROC curve (Area under curve, AUC) diagnosed by the two methods: the two-dimensional classification was 0.742 and the combined elastography was 0.869, compared with the two methods (P0.05). The results of the single factor analysis of ultrasound showed that the length and diameter of the lymph nodes were long. Ratio, morphology, cortical thickness and lymph node gate structure, blood flow type, PSV, RI, elastic score, SR as the related factors for the diagnosis of lymph node properties, and the blood flow classification of lymph nodes was uncorrelated (P0.05), and the 8 related factors were classified by two Logistic regression. The results showed that the type of blood flow, the elasticity score and SR were included in the model, and the OR (odd ratio). The value of 5.896,10.272,9.729,95% confidence interval is 1.214~28.642,1.805~58.461,1.751~54.072 respectively, the regression model is Logist (P) =-2.221+1.774X4+2.329X7+2.275X8, the sensitivity of the model diagnosis is 93.75%, the specificity is 88.7%, the ROC curve of multi parameter regression model is drawn, AUC is 0.952 (S.E.=0.015, P0.001,95%CI=0.922~0.982), and the model is 0.952. It has a good fitting degree for the diagnosis of lymph node properties, and the coronal scan of the body coil combined with the breast coils is helpful to the detection and diagnosis of the lymph nodes, and is statistically significant compared with the detection of the axillary lymph nodes in the solitary breast coils (P0.05). The factors associated with the diagnosis of the magnetic resonance imaging and the diagnosis of the properties of the lymph nodes have a short diameter 10mm, The ratio of the length to diameter, the internal signal is uniform, the contour edge is regular and the shape is round, the Kappa value is 0.321,0.225,0.607,0.435,0.485, the area under the ROC curve diagnosed by the three methods is 0.781, the elastic imaging 0.937, the magnetic resonance 0.834, the elastic imaging and the conventional ultrasound, the magnetic resonance diagnosis efficiency are all compared. P0.05, the coronal scan of body coil combined with breast coils is more effective than conventional ultrasound, but they are not statistically significant (P0.05). To sum up, elastography has the advantage in the diagnosis and analysis of the axillary lymph nodes of breast cancer, and the comprehensive analysis of multiple factors can be further improved. The application of body coil to the axillary lymph nodes of breast cancer has a certain clinical significance, which can make up for the deficiency of the breast coils for axillary lymph node scanning and diagnosis. The two diagnostic methods of ultrasound and magnetic resonance provide good value for the noninvasive evaluation of the axillary lymph nodes in clinical noninvasive evaluation in order to reduce unnecessary outposts. Lymph node biopsy plays an important role in guiding clinical treatment.
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9;R445

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