本文關鍵詞：常規(guī)超聲聯(lián)合彈性成像對乳腺癌放療前區(qū)域淋巴結轉移的評估　出處：《河北醫(yī)科大學》2016年碩士論文　論文類型：學位論文

  更多相關文章： 乳腺癌 淋巴結 常規(guī)超聲 聲輻射力脈沖成像 VTQ

【摘要】：目的:探討常規(guī)超聲聯(lián)合聲輻射力脈沖成像(ARFI)在評估乳腺癌放療前區(qū)域淋巴結轉移的應用價值。方法:收集2015年1月至2016年2月收入河北醫(yī)科大學第四醫(yī)院放療科行放療的女性乳腺癌患者,選擇放療前常規(guī)超聲(US)或定位CT上提示頸部或淋巴引流區(qū)存在異常的淋巴結前瞻性入組,共27例患者,29枚區(qū)域淋巴結。所有淋巴結均行先行US后行ARFI檢查,記錄其特征性測量參數(shù)。淋巴結轉移以超聲引導下穿刺病理陽性為金標準。收集入組患者的基本信息和疾病資料進行相關分析。對人群及淋巴結連續(xù)性變量計算平均值(標準差),分類變量(包括衍生變量)計算百分數(shù)。比較分類變量關系時采用χ2檢驗。單因素邏輯回歸分析各個變量與淋巴結陽性的關系。多因素邏輯回歸分析聲觸診組織定量(VTQ,ARFI主變量)在其他變量參與下與淋巴結陽性的關系,計算風險比(OR)、95%可信區(qū)間(CI)和P值。雙側P0.05定義為有統(tǒng)計學意義。統(tǒng)計軟件為SPSS 22.0。結果:1人群特征:本研究入組病人27例,平均年齡為49.7(±12.1)歲,年齡區(qū)間為25~70歲,絕經(jīng)前55.6%(15例);2超聲淋巴結特征:入組淋巴結29枚,其中2例患者各收集2枚淋巴結。淋巴結短長軸比平均值為0.57(±0.20),邊界欠清率為41.4%(12枚),VTQ平均值為2.50(±1.48)m/s。淋巴結轉移率34.5%(10/29枚);3單因素邏輯回歸分析結果:年齡分組(≥50歲vs.50歲)及淋巴結邊界狀態(tài)(欠清vs.正常)與淋巴結陽性有統(tǒng)計學意義,其相應OR(P值)分別為6.856(P=0.037)和15.00(P=0.005)。月經(jīng)狀態(tài)(絕經(jīng)后vs.絕經(jīng)前)和淋巴結門結構(缺失vs.存在)與淋巴結陽性有邊緣性統(tǒng)計學意義,其相應OR(P值)分別為5.506(P=0.056)和8.100(P=0.069)。VTQ值(≥1.90m/s vs.1.90m/s)在單因素邏輯回歸中顯示無統(tǒng)計學意義(P=0.511)。4多因素邏輯回歸分析結果:增加兩個水平下多因素邏輯回歸分析顯示調節(jié)變量為臨床T分期和脈管瘤栓時,VTQ值(≥1.90m/s vs.1.90m/s)相關OR(P值)為1.785(P=0.619);調節(jié)變量為臨床T分期和脈管瘤栓及兩個US參數(shù)時,VTQ值相關OR(P值)為1.083(P=0.975),均無統(tǒng)計學意義下的相關性。多因素分析顯示常規(guī)超聲淋巴結邊界狀態(tài)(欠清vs.正常)與淋巴結短長軸比(≥0.6 vs.0.6)的相應OR(P值)分別為37.800(P=0.019)和1.171(P=0.896)。提示淋巴結邊界狀態(tài)仍有統(tǒng)計學意義。結論:1常規(guī)超聲淋巴結邊界欠清可以作為乳腺癌放療前陽性淋巴結的獨立預測指標。2彈性成像的VTQ值判斷陽性淋巴結的價值尚不確定,需要增加樣本量進行研究。
[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.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R737.9

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