B超预测乳腺癌腋窝淋巴结转移的假阴性率及阴性预测值的影响因素

发布时间：2018-01-09 01:23

本文关键词：B超预测乳腺癌腋窝淋巴结转移的假阴性率及阴性预测值的影响因素　出处：《浙江大学》2016年硕士论文　论文类型：学位论文

【摘要】：背景乳腺癌腋窝淋巴结转移是影响乳腺癌治疗方案选择及其预后的重要因素,故其术前评估非常重要。B超作为一种简便、无创、经济的术前检查具有其独特的优势,但B超诊断乳腺癌腋窝淋巴结转移具有较高的假阴性率和较低的阴性预测值,故本文旨在探讨B超对其诊断的假阴性率及阴性预测值的影响因素。方法本文统计了2013年1月至2014年12月共308例于浙江大学医学院附属第二医院行手术治疗的乳腺癌患者。以术后病理作为金标准,并根据患者不同基本信息、免疫组化结果及B超结果分组,分别计算其假阴性率与阴性预测值,用卡方检验行单因素分析,找出其中有统计学意义的影响因素。对有统计学意义的因素进行Logistic多因素分析,找出独立影响因素。同时对连续性变量行非方差齐性t检验。结果Her-2 (p=0.006)、ER (p=0.049)为假阴性率的影响因素,Her-2阳性、ER阴性分别会降低假阴性率。而多因素分析显示只有Her-2 (p=0.034)为假阴性率的独立影响因素。肿瘤大小(p=0.000),Ki-67值(p=0.038)为阴性预测值的影响因素,肿瘤大小减小、Ki-67值减小会增加其阴性预测值。而多因素分析显示只有肿瘤大小(p=0.000)为阴性预测值的独立影响因素。结论Her-2阳性会降低术前：B超预测乳腺癌腋窝淋巴结转移的假阴性率；而肿瘤大小T≤2cm会增加其阴性预测值。因此,在临床上B超结合术前乳腺肿块穿刺病理及肿瘤大小对术前腋窝淋巴结转移的预测可能具有重要意义。
[Abstract]:The background of axillary lymph node metastasis in breast cancer is an important factor affecting the breast cancer treatment options and prognosis, so the preoperative evaluation is very important. Ultrasound is a simple, non-invasive, economical preoperative examination has its unique advantages, but the ultrasound diagnosis of breast cancer with axillary lymph node negative transfer has a high false negative rate and low predictive value, so this paper aims to explore the influence factors of ultrasound on the false negative rate and negative predictive value of the diagnosis. Methods based on the statistics from January 2013 to December 2014 a total of 308 cases of breast cancer patients underwent surgery in the Second Affiliated Hospital of Zhejiang University School of medicine. The postoperative pathology as the gold standard, and according to the patient different basic information, the results of immunohistochemistry and ultrasound results of grouping, calculate its false negative rate and negative predictive value, univariate analysis using chi square test, find out the significant influence for . multivariate Logistic analysis of statistically significant factors, find out the independent factors. At the same time of the continuous variables for the non homogeneity of variance t test. The results of Her-2 (p=0.006), ER (p=0.049) for the influence factors, the false negative rate of Her-2 positive and ER negative respectively will reduce the false negative rate and more. Factor analysis showed that only Her-2 (p=0.034) as independent factors affecting the false negative rate. Tumor size (p=0.000), Ki-67 (p=0.038) forecast the influence of negative factors, the tumor size decreased, Ki-67 value decreases will increase its negative predictive value. The multivariate analysis showed that only tumor size (p=0.000) independent predictor effect of value was negative. Conclusion positive Her-2 will reduce the preoperative B-mode ultrasound in the prediction of false negative breast cancer axillary lymph node metastasis rate and tumor size less than 2cm; T will increase its negative predictive value. Therefore, in clinical B combined with preoperative breast masses The pathology of the puncture and the size of the tumor may be of great significance for the prediction of axillary lymph node metastasis before operation.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.9

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