本文選題：乳腺癌 + 剪切波彈性成像�。� 參考：《山西醫(yī)科大學》2017年碩士論文

【摘要】：目的:應用實時剪切波彈性成像(Shear-wave elastography,SWE)技術(shù)分析乳腺癌腫塊彈性模量最大值Emax與腫塊大小、組織分級、免疫組化指標雌激素受體(ER)、孕激素受體(PR)、人類表皮生長因子受體2(C-erbB-2)、Ki-67表達情況及分子分型之間的關(guān)系,尋求一個可以評價乳腺癌生物學行為的新指標,為乳腺癌治療策略的選擇及預后判斷提供一定的參考依據(jù)。方法:選擇經(jīng)病理證實的乳腺癌患者160例(乳腺癌病灶171個),年齡28-75歲,平均(53.8±19.3)歲。術(shù)前均行常規(guī)超聲及SWE檢查,SWE模式下測量彈性模量最大值Emax,同一病灶重復測量3次,取平均值;二維聲像圖下分別測量腫塊的左右徑、上下徑、前后徑,取其中最大的徑線,將其分為10mm、10-20mm、20mm三組;術(shù)后根據(jù)病理結(jié)果記錄腫塊的組織分級、免疫組化ER、PR、C-erbB-2、Ki-67表達情況及分子分型情況。比較不同大小、不同組織分級腫塊的Emax值的差異;比較免疫組化ER、PR、C-erbB-2、Ki-67表達陽性與陰性者的Emax值的差異;比較不同分子分型間的Emax值的差異;將差異顯著的變量納入多元線性回歸分析,由偏回歸系數(shù)確定各指標貢獻程度,評估對Emax值影響最大的因素。結(jié)果:1.腫塊大小與腫塊彈性模量最大值Emax呈顯著正相關(guān),腫塊體積大者Emax值大于體積小者(rs=0.510,P0.05),Emax值較大者擁有較大的腫塊大小。2.C-erbB-2、Ki-67陽性表達者與陰性表達者Emax值存在顯著差異,C-erbB-2、Ki-67陽性表達者腫塊Emax值大于陰性表達者(t=-3.269、-2.079,P均0.05)。3.不同分子亞型的腫塊間彈性模量最大值Emax值差異顯著(P0.05),其中HER-2陽性型腫塊的Emax值最大,其次順序為Luminal B型、TN型、Luminal A型。分別將不同分子亞型腫塊的Emax值兩兩比較,Luminal B型與TN型差異無統(tǒng)計學意義(P0.05),余各型腫塊Emax值兩兩比較差異均具有統(tǒng)計學意義(P0.05)。4.多元回歸方程的調(diào)整后絕對系數(shù)Adjust R2=0.306(F=38.446,P0.05),腫塊大小和C-erbB-2表達情況可以解釋Emax值變異的30.6%,二者偏回歸系數(shù)分別為:0.500、0.237(P均0.05),腫瘤大小、C-erbB-2對腫物硬度影響最大。結(jié)論:1.乳腺癌腫塊大小和C-erbB-2、Ki-67表達情況對腫塊彈性模量最大值Emax有一定的影響,其中腫塊大小和C-erbB-2對Emax值的影響程度最大。2.不同分子亞型腫塊間Emax值不同,HER-2陽性型腫塊Emax值最大,其后依次為luminal B型、TN型、luminal A型,預后差的乳腺癌腫塊往往具有較高的Emax值。3.Emax可以在一定程度上反映乳腺癌的生物學特性,SWE可能成為一個新的手段,為乳腺癌的預后判斷及治療方案的選擇提供一定的依據(jù)。
[Abstract]:Objective: to analyze the maximum modulus of elasticity (Emax), tumor size and tissue grade of breast cancer by using Shear-wave elastography technique. The expression of estrogen receptor ERA, progesterone receptor PRA, human epidermal growth factor receptor 2C-erbB-2 and Ki-67 and their molecular typing were studied in order to find a new index to evaluate the biological behavior of breast cancer. To provide a certain reference for breast cancer treatment strategy selection and prognosis judgment. Methods: a total of 160 patients with breast cancer (171 breast cancer lesions aged 28-75 years, mean 53.8 鹵19.3 years) were selected. The maximum modulus of elasticity (Emaxmax) was measured by conventional ultrasound and SWE before operation, the same lesion was measured 3 times, the mean value was taken, and the diameter of left and right, upper and lower diameters, anteroposterior diameters of the masses were measured under two-dimensional sonogram, and the largest diameter was taken. They were divided into three groups: 10 mm 10 ~ 20 mm ~ 20 mm, the histological grade of the tumor was recorded according to the pathological results, the expression of C-erbB-2 Ki-67 and the molecular type of the tumor were observed by immunohistochemistry. The difference of Emax value in different tissue grade tumor, the difference of Emax value between positive and negative expression of C-erbB-2Ki-67 in ERT were compared, and the difference of Emax value among different molecular types was also compared. The variable with significant difference was incorporated into the multivariate linear regression analysis, and the contribution degree of each index was determined by partial regression coefficient, and the factors that had the greatest influence on Emax value were evaluated. The result is 1: 1. There was a significant positive correlation between the tumor size and the maximum modulus of elasticity (Emax). There was significant difference in Emax value between the positive expression of C-erbB-2Ki-67 and the negative expression in the Emax value of the large tumor than that in the small one (P < 0.05). There was significant difference between the positive expression of C-erbB-2Ki-67 and the Emax value of the negative expression. The Emax value of the tumor with the positive expression of C-erbB-2Ki-67 was higher than that of the negative expression (P < 0.05). There was significant difference in the maximum Emax value of elastic modulus among the different molecular subtypes. The Emax value of HER-2 positive tumor was the largest, followed by Luminal B type TN and Luminal A type. There was no significant difference in Emax value between luminal B type and TN type, but there was significant difference in Emax value of other types of tumor. The absolute coefficient of the multivariate regression equation, Adjust R2O 0.306FU 38.446, P0.05A, the tumor size and the expression of C-erbB-2 can explain the variation of Emax value. The partial regression coefficients of the two regression equations are respectively 0. 05 and 0. 05%, and the size of tumor C-erbB-2 has the greatest effect on the hardness of the tumor. Conclusion 1. The tumor size and the expression of C-erbB-2Ki-67 in breast cancer had a certain influence on the maximum modulus of elasticity (Emax), in which the tumor size and C-erbB-2 had the greatest influence on the Emax value. The Emax value of HER-2 positive tumors was the highest among different molecular subtypes, followed by luminal B type TN and luminal A type. Breast cancer masses with poor prognosis often have higher Emax value. 3. Emax can reflect the biological characteristics of breast cancer to some extent. It may become a new method for judging the prognosis of breast cancer and the choice of treatment plan.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.9;R445.1

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