常规超声联合弹性成像对乳腺癌放疗前区域淋巴结转移的评估

发布时间：2017-12-27 07:01

本文关键词：常规超声联合弹性成像对乳腺癌放疗前区域淋巴结转移的评估　出处：《河北医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:探讨常规超声联合声辐射力脉冲成像(ARFI)在评估乳腺癌放疗前区域淋巴结转移的应用价值。方法:收集2015年1月至2016年2月收入河北医科大学第四医院放疗科行放疗的女性乳腺癌患者,选择放疗前常规超声(US)或定位CT上提示颈部或淋巴引流区存在异常的淋巴结前瞻性入组,共27例患者,29枚区域淋巴结。所有淋巴结均行先行US后行ARFI检查,记录其特征性测量参数。淋巴结转移以超声引导下穿刺病理阳性为金标准。收集入组患者的基本信息和疾病资料进行相关分析。对人群及淋巴结连续性变量计算平均值(标准差),分类变量(包括衍生变量)计算百分数。比较分类变量关系时采用χ2检验。单因素逻辑回归分析各个变量与淋巴结阳性的关系。多因素逻辑回归分析声触诊组织定量(VTQ,ARFI主变量)在其他变量参与下与淋巴结阳性的关系,计算风险比(OR)、95%可信区间(CI)和P值。双侧P0.05定义为有统计学意义。统计软件为SPSS 22.0。结果:1人群特征:本研究入组病人27例,平均年龄为49.7(±12.1)岁,年龄区间为25~70岁,绝经前55.6%(15例);2超声淋巴结特征:入组淋巴结29枚,其中2例患者各收集2枚淋巴结。淋巴结短长轴比平均值为0.57(±0.20),边界欠清率为41.4%(12枚),VTQ平均值为2.50(±1.48)m/s。淋巴结转移率34.5%(10/29枚);3单因素逻辑回归分析结果:年龄分组(≥50岁vs.50岁)及淋巴结边界状态(欠清vs.正常)与淋巴结阳性有统计学意义,其相应OR(P值)分别为6.856(P=0.037)和15.00(P=0.005)。月经状态(绝经后vs.绝经前)和淋巴结门结构(缺失vs.存在)与淋巴结阳性有边缘性统计学意义,其相应OR(P值)分别为5.506(P=0.056)和8.100(P=0.069)。VTQ值(≥1.90m/s vs.1.90m/s)在单因素逻辑回归中显示无统计学意义(P=0.511)。4多因素逻辑回归分析结果:增加两个水平下多因素逻辑回归分析显示调节变量为临床T分期和脉管瘤栓时,VTQ值(≥1.90m/s vs.1.90m/s)相关OR(P值)为1.785(P=0.619);调节变量为临床T分期和脉管瘤栓及两个US参数时,VTQ值相关OR(P值)为1.083(P=0.975),均无统计学意义下的相关性。多因素分析显示常规超声淋巴结边界状态(欠清vs.正常)与淋巴结短长轴比(≥0.6 vs.0.6)的相应OR(P值)分别为37.800(P=0.019)和1.171(P=0.896)。提示淋巴结边界状态仍有统计学意义。结论:1常规超声淋巴结边界欠清可以作为乳腺癌放疗前阳性淋巴结的独立预测指标。2弹性成像的VTQ值判断阳性淋巴结的价值尚不确定,需要增加样本量进行研究。
[Abstract]:Objective: To evaluate the value of conventional ultrasound combined with acoustic radiation force pulse imaging (ARFI) in assessing regional lymph node metastasis of breast cancer before radiotherapy. Methods: collected from January 2015 to February 2016 the income of radiotherapy in the fourth hospital of Hebei Medical University underwent radiotherapy of breast cancer patients before radiotherapy, choice of conventional ultrasound (US) or positioning CT tips or neck lymph nodes in abnormal lymph nodes were prospectively enrolled, a total of 27 patients, 29 lymph nodes. All lymph nodes were examined by ARFI before US, and their characteristic parameters were recorded. The lymph node metastases were confirmed by ultrasound guided biopsy as the gold standard. The basic information and disease data of the patients were collected and analyzed. Calculate the average value (standard deviation) for the continuous variables of the population and lymph nodes, and calculate the percentage of the classified variables (including the derivative variables). The x 2 test was used to compare the relationship between the classified variables. The relationship between the variables and the lymph node positive was analyzed by single factor Logistic regression. Logistic regression analysis was used to analyze the relationship between voice palpation tissue quantification (VTQ, ARFI principal variable) and lymph node positivity under other variables. The risk ratio (OR), the 95% confidence interval (CI) and the P value were calculated. The definition of bilateral P0.05 is statistically significant. The statistical software is SPSS 22. Results: 1, the characteristics of the population: 27 cases were enrolled in this study, the average age was 49.7 (12.1 years), the age range was 25~70 years old, 55.6% cases were premenopausal (15 cases), 2 ultrasound lymph node characteristics: 29 lymph nodes, 2 patients were 2 lymph nodes. Lymph node short axis ratio average value is 0.57 (+ 0.20), ill defined rate was 41.4% (12), the average value of VTQ is 2.50 (+ 1.48) m/s. The lymph node metastasis rate was 34.5% (10/29); 3 single factor Logistic regression analysis showed that age group (aged 50 vs.50 years old) and lymph node status (unclear boundary normal vs.) and positive lymph node had statistical significance, the corresponding OR (P) were 6.856 (P=0.037) and 15 (P =0.005). The menstrual status (postmenopausal vs. premenopausal) and lymph node structure (absence of vs.) were statistically significant with lymph node positive, and the corresponding OR (P value) were 5.506 (P=0.056) and 8.100 (P=0.069), respectively. The value of VTQ (1.90m/s = vs.1.90m/s) showed no statistical significance in univariate logistic regression (P=0.511). The more than 4 factor Logistic regression analysis results: increased two multivariable logistic regression analysis showed that the level of conditioning variables for clinical T stage and vascular invasion, VTQ value (vs.1.90m/s = 1.90m/s) OR (P) 1.785 (P=0.619); adjusting variables for clinical T staging and tumor thrombus and two US parameters when the value of VTQ OR (P) 1.083 (P=0.975), there was no statistically significant correlation between the. Multivariate analysis showed that lymph node status (conventional ultrasound boundary less clear than normal vs.) the length of minor axis and lymph node (vs.0.6 = 0.6) of the corresponding OR (P) were 37.800 (P=0.019) and 1.171 (P=0.896). It is suggested that the boundary status of lymph nodes is still statistically significant. Conclusion: 1 the irregular boundary of lymph nodes of conventional ultrasound can be used as an independent predictor of positive lymph node before radiotherapy for breast cancer. The value of the VTQ value of 2 elastography to determine the positive lymph nodes is still uncertain, and it is necessary to increase the sample size for study.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.9

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