【作者】 李越；

【导师】 王欣；

【作者基本信息】 天津医科大学 ， 肿瘤学， 2010， 硕士

【摘要】 目的乳腺癌是女性最常见的恶性肿瘤之一,大量的流行病学资料表明环境因素和遗传因素等的影响,导致了全球乳腺癌的发病率呈明显上升趋势。随着临床诊断水平的提高,发现早期乳腺癌的比例正逐渐增加。早期乳腺癌的诊出能做到早期治疗,有效提高患者的生存率及生活质量。因此早发现、早诊断、早治疗是提高恶性乳腺肿瘤患者生存质量的关键。超声光散射乳腺成像系统(OPTIMUS)是多模式的可以进行早期乳腺癌普查,诊断及疗效检测的系统。本文回顾经手术病理证实的160例乳腺肿瘤的OPTIMUS系统表现与病理结果对比分析,来评价OPTIMUS系统的临床应用价值。另外通过对4例术前新辅助化疗患者的跟踪来评价OPTISCAN对化疗疗效跟踪上的应用价值。材料与方法2009年2月至2009年12月在我院手术治疗且资料完整的乳腺肿瘤患者160例。回顾经手术病理证实160例乳腺肿瘤的OPTIMUS系统表现,与病理结果对比分析,通过计算一致性检验Kappa值判断其与病理的吻合度,同时与B超及钼靶进行一致性检验,判断其吻合度。并绘制受试者工作特征(receiver operating characteristic, ROC)曲线,计算曲线下面积(aera under the curve,AU C),比较OPTIMUS.彩色多普勒超声、钼靶X线检查的准确性,评价OPTIMUS的临床应用价值。对4例术前新辅助化疗患者化疗前一天及化疗后一天的跟踪数据采集来评价患者化疗后肿瘤特征的变化,主要是肿瘤内部血红蛋白含量的改变,通过与病理切片MVD的对比,来判断该系统在新辅助化疗疗效跟踪上的应用价值。结果1.160例患者术后病理诊断良性病变60例,恶性病变100例。OPTIMUS系统诊断良性病变53例,恶性病变107例,7例被过度诊断为恶性。2. OPTIMUS、超声、钼靶与病理的一致性检验Kappa值分别为0.904、0.613、0.665。OPTIMUS与超声、钼靶的一致性检验Kappa值分别为0.543,0.569。3. OPTIMUS.彩色多普勒超声、钼靶X线检查的ROC曲线下面积(area under the curve.AUC)分别为0.887(95%CI：0.826-0.948)、0.878(95%CI：0.818-0.937)及0.881(95%CI：0.828～0.933)。4. OPTIMUS、彩色多普勒超声、铝靶X线检查敏感性分别为100.0%、80.0%及82.0%,敏感性较彩色多普勒超声、钼靶X线检查明显为高。5.4例新辅助化疗患者在化疗前后肿瘤内部血红蛋白含量出现明显变化,经化疗后,总血红蛋白含量明显降低。经与切片MVD对比后,显示OPTISCAN系统诊断新辅助化疗后,血红蛋白含量明显降低。结论本组乳腺肿瘤患者160例OPTIMUS、彩色多普勒超声及钼靶X线检查三种方法的数据统计分析后,OPTIMUS、彩色多普勒超声及钼靶X线检查与病理的一致性检验均有较好的一致性。与临床上应用价值得到肯定的超声铝靶相比,OPTIMUS与其也有较好的一致性。三者ROC曲线下面积分别为0.887(95%CI：0.826～0.948),0.878(95%CI：0.818～0.937)及0.881(95%CI：0.828～0.933)。敏感性分别为100.0%、80.0%及82.0%。由此可见OPTIMUS系统对诊断乳腺恶性肿瘤的准确性及敏感性较高,是提高乳腺良恶性病变鉴别诊断的有效方法。可以提高乳腺癌患者的检出率,减低漏诊率。另外例4术前新辅助化疗患者,通过与计数病理MVD对比,显示化疗后肿瘤内部血红蛋白总量显著降低。更多还原

【Abstract】 Objective:In China, breast cancer is the most common malignant tumor in women.. Amount of epidemiology material shows that, the disease incidence is ascending year after year as the influence of environmental factor and hereditary factor. With the development of the clinical diagnosis, the proportion of early breast cancer detection is increasing which could raise the survival rate and the quality of life. As a result, early detection, early diagnosis and early treatment is the key to increase the quality of life of the breast cancer patients. OPTIMUS system is a system of diffused optical tomography with ultrasound. It provides dual modality images for early diagnosis of breast cancer. The aim of this study was to evaluate the OPTIMUS system on diagnosis of breast disease. And according to follow up the volume of the total Hb in the 4 cases who underwent neoadjuvant chemotherapy, we could evaluate the efficiency of the neoadjuvant chemotherapy.Material and Methods:OPTIMUS system was applied to 160 breast tumor patients. All patients had received surgical treatment and had definite pathological diagnosis. OPTIMUS system was evaluated as diagnostic tool of breast tumor in this study to evaluate its clinical value. These patients were also checked by ultrasonography and mammography. The consistency with ultrasonography and mammography was studied by Kappa test while the accuracy was studied by ROC test. According to follow up the volume of the total Hb in the 4 cases who underwent neoadjuvant chemotherapy, OPTISCAN could reveal the change of total Hb, which was compared to MVD of pathology section. With this method, we could find whether the neoadjuvant chemotherapy was efficient.Results：1. In these 160 cases,60 cases were proved benign tumor and 100 cases were proved malignant tumor by pathology. Whereas,53 cases were diagnosed as benign tumor and 107 cases were as malignant tumor by OPTIMUS system.2. The value of Kappa of Optimus, ultrosonogrphy and mammography with pathology is respectively 0.904,0.613,0.665. And the value of Optimus with ultrosonogrphy and mammography is respectively 0.543,0.569.3. The AUC of these 3 methods was respectively 0.887 (95% CI:0.826-0.948),0.878 (95% CI:0.818-0.937) and 0.881 (95% CI:0.828-0.933). 4. The sensitivity of OPTIMUS system, ultrasonography and mammography were 100.0%,80.0% and 82.0% respectively and showed significant difference. 5. Content of total Hb in 4 cases have a significant change after neoadjuvant chemotherapy, which was significantly lower than before. The conclusion was proved by MVD of the pathological section.Conclusion:OPTIMUS has a good consistence with pathology, ultrasonography and mammography. As a result, OPTIMUS system is a non-invasive and highly effective diagnostic tool for breast disease and it could be used as assistant diagnostic tool for breast tumor. In neoadjuvant chemotherapy, OPTIMUS could reveal the change of total Hb, which was proved by MVD of pathology section.更多还原