MR表观扩散系数对乳腺浸润性导管癌诊断价值的探讨

发布时间：2018-04-14 06:37

本文选题：浸润性导管癌 + 分子亚型　；参考：《广西医科大学》2015年硕士论文

【摘要】：背景2011年第12届St. Gallen会议专家共识首次确定乳腺癌的分子分型标准,采用按照乳腺癌临床病理分型进行治疗、决策的方法,2013年第13届St Gallen大会专家组仍认为通过临床病理学分类是一种替代的分类方法,该临床病理分类使我们对乳腺癌的认识更深入,对预估乳腺肿瘤的预后及制定诊疗方案有重要的临床意义,使得乳腺肿瘤的治疗决策从“以危险因素为基础选择方案”过渡到更加精确的“根据分子分型制定方案”的个体化治疗阶段。组织标本的基因检测是乳腺癌确诊及分子分型确立的前提,如果可以从影像学特征或者某个影像学指标来鉴别乳腺良恶性病变及浸润性导管癌不同分子分型,将对临床医生对乳腺肿瘤性质的预判起到重要参考价值。目的探讨MR表观扩散系数(ADC)值对乳腺浸润性导管癌的诊断价值。材料和方法本院病理证实的浸润性导管癌患者278例,乳腺良性病变37例,依据278例浸润性导管癌的免疫组织化学检测结果,将浸润性导管癌患者分为luminal A、luminal B1、luminal B2、HER-2(+)及三阴性型5种分型,测量病变区域的ADC值。ADC值的诊断临界值通过ROC曲线确定,测量ROC曲线下的面积并比较,用SPSS16.0统计软件对各分型的ADC值进行分析。结果1.乳腺肿瘤良恶性病变的ADC值存在差异。经K-S正态性检验确定浸润性导管癌与良性病变的ADC值都符合正态分布,良恶性病变的ADC值分别为0.865±0.013,1.661±0.029,经t检验示p0.05,良恶性病变ADC值的差异有意义。2.乳腺良恶性病变的ADC临界值的确立。利用ROC曲线分析,标准为Youden指数最大,从而确定的ADC的最佳临界值为1.253×10-3 mm2/s,以此值为阈值判断良恶性病变,敏感度为96.0%,特异度为97.3%,ROC曲线下面积为0.987,说明ADC值具有较高的诊断效能。3.浸润性导管癌各分子分型ADC值的分析3.1浸润性导管癌的ADC值平均值为0.865×10 mm2/s,浸润性导管癌各分子分型间平均ADC值的差异有统计学意义(F=4.000,P=0.004),两两比较5个分子分型之间的差异有统计学意义(F=2.406,P=0.05)。3.2 ADC值与浸润性导管癌分子分型存在正相关(相关系数=0.156,p=0.009)。3.3分别将5组分型的ADC值与良性病变ADC值行ROC曲线分析,测定ROC曲线下面积最大为Luminal A组,95%可信区间为0.972-1.000,说明ADC值对浸润性导管癌中Luminal A型诊断效能最高,阈值为1.200×10-3 mmVs,敏感度为98.2%,特异度为97.3%。结论1、乳腺良恶性病变良恶性病变ADC值的差异有意义,良恶性病变的阂值为1.253×10-3 mm2/s：2、ADC值与浸润性导管癌分子分型存在正相关,对浸润性导管癌分子亚型中Luminal A型诊断效能最高。
[Abstract]:Background at the 12th St. Gallen Conference in 2011, experts agreed for the first time to determine the molecular classification criteria for breast cancer and treat it according to the clinicopathological classification of breast cancer.The Group of experts of the 13th St Gallen Congress in 2013 continued to believe that clinicopathological classification is an alternative method, and that this clinicopathological classification has given us a deeper understanding of breast cancer.It has important clinical significance for predicting the prognosis of breast tumor and making diagnosis and treatment plan.It makes the treatment decision of breast cancer transition from "risk factor based selection" to the more precise "molecular classification formulation" stage of individualized treatment.The gene detection of tissue specimen is the prerequisite for the diagnosis and molecular typing of breast cancer. If we can distinguish benign and malignant breast lesions from invasive ductal carcinoma by different molecular typing, we can distinguish benign and malignant breast lesions from some imaging parameters.It will play an important reference value for clinicians to predict the nature of breast tumors.Objective to evaluate the value of Mr apparent diffusion coefficient (ADCC) in the diagnosis of invasive ductal carcinoma of breast.Materials and methods 278 cases of invasive ductal carcinoma and 37 cases of breast benign lesions were confirmed by pathology. The results of immunohistochemical examination were based on 278 cases of invasive ductal carcinoma.The patients with invasive ductal carcinoma were divided into five types: luminal luminal B1 luminal B2HER-2 () and triple negative type. The diagnostic critical value of ADC value. ADCs value was determined by ROC curve, and the area under ROC curve was measured and compared.The ADC value of each type was analyzed by SPSS16.0 software.Result 1.The ADC values of benign and malignant breast tumors were different.The ADC values of invasive ductal carcinoma and benign lesions were confirmed by K-S normal test. The ADC values of benign and malignant lesions were 0.865 卤0.0131.661 卤0.029, respectively, and the difference of ADC between benign and malignant lesions was significant.Establishment of ADC threshold for benign and malignant Breast lesions.By using ROC curve analysis, the standard Youden index is the largest, and the best critical value of ADC is 1.253 脳 10 ~ (-3) mm ~ (2) / s, which is the threshold value to judge benign and malignant lesions, the sensitivity is 96.0, the specificity is 97.3r ~ (13), the area under the curve is 0.987, which indicates that the ADC value has higher diagnostic efficiency.Analysis of the ADC value of each molecular type of invasive ductal carcinoma the average ADC value of invasive ductal carcinoma is 0.865 脳 10 mm 2 / s, and the difference of the average ADC value among the molecular types of invasive ductal carcinoma is statistically significant.There was a positive correlation between the value of ADC and the molecular typing of invasive ductal carcinoma (correlation coefficient was 0.156%). The ADC value of 5 groups and the ADC value of benign lesions were analyzed by ROC curve, respectively.The maximum confidence interval of 95% under the ROC curve was 0.972-1.000, which indicated that the ADC value was the most effective for the diagnosis of Luminal A type in invasive ductal carcinoma, the threshold value was 1.200 脳 10 -3 mm vs, the sensitivity was 98.2 and the specificity was 97.3 mm.Conclusion 1. The difference of ADC value between benign and malignant breast lesions is significant. The threshold value of benign and malignant lesions is 1.253 脳 10 ~ (-3) mm ~ (2) / s ~ (-2)% ~ (2) ADC value, which is positively correlated with the molecular classification of invasive ductal carcinoma, and Luminal A is the most effective in the molecular subtype of invasive ductal carcinoma.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R737.9

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