乳腺癌超声光散射断层成像与预后及病理学对照研究

【作者】 牛司华；

【导师】 姜玉新；

【作者基本信息】 北京协和医学院 ， 影像医学与核医学， 2014， 博士

【摘要】 目的探讨乳腺癌超声光散射断层成像与预后的相关性。资料与方法2007年10月至2010年2月,经手术证实、进行腋窝淋巴结评价、术后进行系统治疗、影像学资料完备、定期随诊的原发性乳腺癌195例(207个病灶)。术前进行常规超声检查,记录病灶超声特点,并用超声定位光散射断层成像系统测量病灶的总血红蛋白浓度,生成光吸收图。术后查阅患者门诊及住院病历,并进行电话随访,记录患者临床特点、术后治疗及复查情况。分析乳腺癌超声光散射断层成像总血红蛋白浓度(THC)与预后的相关性结果1.THC与病灶的大小密切相关,最大径>2cm者THC明显高于≤2cm者(P=0.000)；THC与乳腺癌病理类型密切相关(P=0.041),非特殊类型浸润性乳腺癌THC明显高于特殊类型浸润性乳腺癌；THC与乳腺癌pTNM分期有关,Ⅰ期病灶THC明显低于Ⅱ期和Ⅲ期(P值分别为0.002和0.001),Ⅱ期和Ⅲ期之间THC无明显统计学差异(P=0.369)。2.THC与患者预后明显相关,术后有复发或转移的乳腺癌THC值明显高于术后无复发、转移者(P=0.023)。3.THC与术后复发或转移时间呈负相关,但是差异未达统计学显著性(相关系数r=-0.254,P=0.241)。4.THC与转移部位之间无统计学相关性(P=0.139)。结论1.THC与病灶大小、病理类型、pTNM分期、术后有无复发或转移有相关性。2.THC与术后复发或转移的时间、部位无明显相关性。目的1.分析转移组和未转移组THC值高低产生的病理学基础。2.探讨总血红蛋白浓度(THC)与血管生成因子(HIF-1α、OPN、VEGF)、微血管密度(MVD)及血管生成拟态的关系。资料与方法对2007年10月至2010年2月间195例术前进行超声光散射断层成像的原发性乳腺进行随访,其中术后发生复发或转移者23例,将所有发生复发或转移的病例按照pTNM分期进行1：2配对,共计69例。对69例患者石蜡包埋的组织切片进行缺氧诱导因子-1α(HIF-1α)、骨桥蛋白(OPN)、血管内皮细胞生长因子(VEGF)、CD34染色及血管生成拟态染色(CD34和PAS双重染色),并对染色切片进行评价,分析其与THC的相关性。结果1.转移组THC与HIF-1α相关,未转移组THC与HIF-1α无相关性。2.THC与VEGF、OPN无统计学相关性3.THC与MVD、MVD+VM呈直线相关,VM对乳腺癌总体血供影响不大。结论1.转移组THC与HIF-1α相关,未转移组THC与HIF-1α无相关性,两组THC高低均与VEGF和OPN无明显相关性。2.THC与MVD、MVD+VM之和呈直线相关,VM对总体血供影响不大。更多还原

【Abstract】 ObjectiveTo probe the correlation between the ultrasound-guided diffused optical tomography(DOT) of breast cancer and prognosis.Materials and methods195patients (207lesions) from October2007to February2010with primary breast cancer, verified by pathology, evaluated with axillary lymph nodes, treated systematicly, with detailed imaging examination data and follow-up, were enrolled in the research. Every patients took routine preoperative ultrasonography and were recorded with all ultrasound characters. Then Ultrasound localization of light scattering tomography was used to measure the total hemoglobin concentration within lesions and generated the optical absorption map.We checked all patients’medical records and clinic medical records and recorded their clinical characters, therapy projects and the results of follow-up. Then we probe the correlation between the ultrasound-guided diffused optical tomography(DOT) of breast cancer and prognosis.Results1. The THC of breast cancer and size of lesion were closely related, The THC of lesions lager than2cm was obviously higher than those smaller than2cm(P=0.000); The THC of breast cancer was closely related with the pathology type (P=0.041), The THC of non-special type of invasive breast cancer was obviously higher than that of special type of invasive breast cancer;The THC of breast cancer was closely related with the pathology TNM stage;The THC of I stage was obviously lower than that of II and III stage(P=0.002,0.001, respectively), there was no correlation between the THC of II and III stage(P=0.369).2. The THC of breast cancer was closely related with the prognosis, and the THC of patients with recurrences or metastasis after operation was obviously higher than those without recurrences or metastasis(P=0.023). 3. The THC of breast cancer was negatively correlated with the time of recurrences or metastasis, but there was no statistical significance(r=-0.254, P=0.241).4. There was no statistical significance between THC and metastatic locations after operation(P=0.139).Conclusion1. There was correlation between the THC of breast caner and the size, pathology type, pTNM stage and recurrences or metastasis after operation.2. The THC of breast cancer was negatively correlated with the time of recurrences or metastasis Objective1. To analyse the pathology mechanism of the total hemoglobin concentration of the metastastic and non-metastasic groups.2. To analyze correlation of the THC and HIF-1α、OPN、VEGF、MVD and VM.Materials and methodsTo follow-up the195patients with primary breast cancer diagnosed from October2007to February2010, we found23patients to relapse or metastasize after operation. All these cases were matched with the non-metastastic cases according to the proportion of1:2, and there were69cases. We carried out immumohistochemical staining of HIF-1a, OPN, VEGF, CD34and double staining of CD34and PAS, then we graded all the section stained and analyzed the correlation of the angiogenesis factor and THC.Results1.THC of the metastastic group was closely related with HIF-1α and THC of the non-metastastic group was not related with HIF-1α.2.There was no relation between THC and VEGF. OPN.3. THC was rectilinearly correlated with MVD and MVD+VM. VM contributed little to the blood supply of the breast cancer.Conclusion1. THC of the metastastic group was closely related with HIF-1α and THC of the non-metastastic group was not related with HIF-1α. THC of both group was not related with VEGF and OPN.2. THC was rectilinearly correlated with MVD and MVD+VM. VM contributed little to the blood supply of the breast cancer.更多还原