乳腺癌超声造影定量分析参数值及增强模式与分子分型的相关性初步研究

发布时间：2018-12-15 23:50

【摘要】：目的本研究对乳腺癌高频图像形态学特征进行观察，并进行超声造影，，然后与病理免疫组化结果进行对照，对乳腺癌超声造影定量分析参数值及增强模式与其分子分型的相关性进行初步分析研究，以期为乳腺癌个性化治疗方案的选择及预后的评估提供影像学基础。方法收集2012年1月至2013年8月，于广西壮族自治区人民医院肝胆腺体外科住院的60例女性乳腺癌患者。所有患者术前均接受乳腺常规超声和超声造影检查。首先观察病灶的常规二维超声声像图，然后运用彩色多普勒技术观察病灶的血流信号。最后经肘静脉团注SonoVue(声诺维)2.4ml,连续实时观察增强强度、增强方向（向心性、离心性、弥漫性增强）、造影剂分布特征及造影后病灶范围有无变化。造影结束后,分析记录时间-强度曲线(TIC)及伽马变量曲线（Gamma Variate）各参数值。记录病灶峰值强度变化（A）、始增时间（AT）、峰值时间（PT）、峰值强度(PI）、峰值减半差值时间（HT）、梯度（Grad）、上升支斜率(RS)、半降斜率(DS)、曲线下面积（AUC）。术后病理及免疫组织化学（IHC）结果证实，确定分子分型。乳腺癌超声造影定量分析参数值及增强模式与其分子分型的相关性。将数据进行统计学分析。结果一、乳腺癌超声造影增强征象： 60例乳腺癌中，（1）增强水平：50例呈高增强，占83.3%（50/60）；(2)增强方向：56例呈向心性增强，占93.3（56/60）；（3）造影剂分布特征：51例呈不均匀性增强（51/60，85.00%）；9例呈均匀性增强（9/60，15.00%）。增强后23例病灶分界清晰，占38.33%（23/60），37例病灶分界不清，占61.67%（37/60）。37例病灶边缘放射状汇聚，占61.67%（37/60）；39例肿块内见穿支血流，占65.00%（39/60）；22例肿块内造影剂灌注缺损，占37%（22/60）。（4）造影前后病灶范围大小的变化：56例造影后病灶范围增大占93.33%(56/60)。二、不同分子分型乳腺癌超声造影上具有特征性表现：（1）管腔上皮型：ER、PR阳性表达的乳腺癌患者增强后病灶边缘放射状汇聚的几率增加，与ER、PR阴性表达的乳腺癌患者差异比较有统计学意义（P0.05）。（2）HER2过表达型：HER2阳性表达的乳腺癌患者肿块中，造影剂灌注缺损的出现的概率增加，与HER2阴性表达者比较，差异具有统计学意义（P0.05）。（3）基底样型：增强造影边界较清晰三、乳腺癌定量分析参数与ER、PR、Ki-67、HER2相关性： Ki-67与Grad、RS呈正相关（P均0.05），与AT、PT、HT、PI、AUC、DS无显著相关（P均0.05）。结论：1、乳腺癌超声造影定量分析参数值及增强模式与其分子分型有一定联系，可为临床诊断及个性化治疗乳腺癌提供有价值的信息。2、不同分子分型乳腺癌超声造影增强特征及定量分析参数值之间存在差异。3、乳腺癌的细胞增殖相关蛋白Ki-67表达与超声造影灌注参数梯度Grad、时间-强度曲线上升支斜率RS呈正相关，为定量评价乳腺肿瘤新生血管生成提供依据。4、超声造影能够间接反映肿瘤癌基因及细胞因子的存在和表达引起的组织病理学改变。
[Abstract]:Objective To study the morphological characteristics of high-frequency image of breast cancer, and to carry out the ultrasound contrast, and then compared with the results of the pathological immunohistochemistry, to carry out a preliminary analysis on the correlation between the parameter value of the quantitative analysis of breast cancer and the correlation between the enhancement mode and its molecular typing. so as to provide an imaging basis for the selection of the individualized treatment scheme of the breast cancer and the evaluation of the prognosis. Methods 60 cases of female breast cancer were collected from January 2012 to August, 2013 in the hospital of the hepatobiliary gland of the People's Hospital of Guangxi Zhuang Autonomous Region. Patients. All patients were subject to routine breast ultrasound and ultrasound contrast prior to the procedure. The conventional two-dimensional ultrasound image of the lesion was first observed, and then the blood flow of the lesion was observed by color Doppler. No. of the final cubital vein bolus, SonoVue (SonoVue), 2. 4ml, continuous real-time observation of the intensity of the enhancement, the enhancement of the orientation (concentric, off-center, diffuse enhancement), the distribution of the contrast agent, and the presence or absence of the lesion in the post-contrast range After the contrast is completed, the parameters of the recording time-intensity curve (TIC) and the gamma variable are analyzed. Values. Record lesion peak intensity change (A), start-up time (AT), peak time (PT), peak intensity (PI), peak-to-half difference time (HT), gradient (Grad), ascending branch slope (RS), half-drop slope (DS), area under curve (AUC). The results of postoperative pathology and immunohistochemistry (IHC) confirmed that the molecular point was determined. The correlation between the parameter value of the quantitative analysis of breast cancer and its correlation with its molecular typing sex. Statistical analysis of data Analysis. Results One, the ultrasound of breast cancer image enhancement: in 60 cases of breast cancer, (1) enhancement level: 50 cases were high, accounting for 83.3% (50/ 60); (2) enhanced direction: 56 cases were concentric enhancement, accounting for 93.3%. (56/ 60); (3) contrast agent distribution: 51 cases were non-uniformity (51/ 60, 85. 00%); 9 cases were enhanced (9/ 60, 15. 00%). The boundary of 23 cases of the enhancement was clear, accounting for 38. 33% (23/ 60). The boundary of 37 cases was not clear, accounting for 61.67% (37/ 60). The peripheral edge of 37 cases was radially convergent, accounting for 61.67% (37/ 60). In the 39 cases, the blood flow was seen in the tumor, accounting for 65. 00% (39/ 60); and the contrast medium perfusion defect in 22 cases, accounting for 37%. (22/ 60). (4) The change of the size of the lesion before and after contrast: the focal range of 56 cases increased by 93.3%. (56/ 60). Ultrasound for breast cancer with different molecular types Characteristic expression in the shadow: (1) tube cavity epithelial type: ER, PR-positive expression of breast cancer patient enhanced post-lesion edge radial The probability of aggregation is increased, and the difference of breast cancer patients with ER and PR negative expression is more systematic. Statistical significance (P0.05). (2) HER2-overexpressing type: In the breast cancer patient with HER2-positive expression, the probability of the presence of the contrast agent perfusion defect is increased, compared with the HER2-negative expression, the difference is There was a significant difference (P0.05). 3) substrate-like type: the enhanced contrast border is clear, and the quantitative parameters of the breast cancer quantitative analysis and ER, PR, Ki-67 and HER2: Ki-67 was positively correlated with Grad and RS (P 0.05), and AT, PT, HT, PI, There was no significant correlation between the AUC and DS (P <0.05). Conclusion: 1. The value of the quantitative analysis of the ultrasound contrast of breast cancer and the mode of enhancement are associated with their molecular typing. the diagnostic and individualized treatment of breast cancer provides valuable information. There is a difference between the contrast-enhanced features of breast cancer with different molecular types and the parameters of the quantitative analysis. the time-intensity curve ascending branch slope RS is positive correlation, and provides the basis for quantitatively evaluating the angiogenesis of the breast tumor, 4, the ultrasound contrast can indirectly reflect the tumor oncogene,
【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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