超声引导下麦默通真空辅助微创旋切术在乳腺肿物中的应用

科研成果详情

题名	超声引导下麦默通真空辅助微创旋切术在乳腺肿物中的应用
其他题名	The Application of Ultrasound Guided Vacuum-assisted Minimally Invasive Rotatory Cutting System for the Resection of Breast Lesions
作者	方玲慧
学位类型	硕士
导师	曹飞麟
答辩日期	2019-05-25
学位授予单位	温州医科大学
学位专业	肿瘤学
关键词	麦默通，乳腺肿物，超声引导
摘要	目的回顾性分析在浙江省台州医院住院的行超声引导下麦默通（Mammotome,MMT）真空辅助微创旋切手术的患者的临床结果，特别是BI-RADS分类4A类肿物的术后病理。探讨超声BI-RADS 分类中的超声特征和相关临床资料在BI-RADS分类4A肿乳腺物良恶性中的鉴别意义，以提高恶性病变的检出率。综合各方面评价麦默通对良性、恶性肿物的诊断、治疗价值，从而更好地指导临床工作。资料与方法回顾性分析2010年6月至2017年6月在浙江省台州医院应用超声引导下麦默通乳腺微创旋切手术的3383例乳腺肿物患者的临床特征、病理结果，对比术中快速冰冻切片结果与常规石蜡切片病理结果的符合情况。重点分析634例患者667个BI-RADS分类4A类乳腺肿物的良恶性比例，对各个影响因素包括患者年龄与 BI-RADS 4A 类肿物出现的超声特征等进行回顾性单因素分析及多因素 Logistic 回归分析。结果 3383例患者术后常规病理为良性有3215人，占95.0%，以纤维腺瘤为主，病理结果为恶性的有168人，以浸润性导管癌为主。将3383例患者的5816个冰冻切片结果与常规石蜡切片或免疫组化检查结果进行对照，结果相符合率为99.8%。其中，634例患者的667个BI-RADS分类为4A类乳腺肿物常规病理为良性的有581个，恶性的有86个。行单因素变量分析，BI-RADS4A类肿物恶性概率与患者年龄、肿物大小、边界、形态、数目、钙化情况、纵横比大小有明显统计相关性。多因素 Logistic 回归分析中，进一步筛选出边界、形态、钙化情况、纵横比大小等有意义的变量。结论超声引导下麦默通真空辅助微创旋切术广泛运用在乳腺良性肿物的切除和恶性肿物的活检切除中。术中快速冰冻切片可以明确麦默通微创手术标本的性质，但仍有0.2%病理与常规石蜡切片不符。对临床中常见但有一定恶性可能性的BI-RADS4A类肿物，特别是形态不规则、边界模糊、有微钙化、纵横比大于1的肿物要提高警惕，以提高恶性检出率。
其他摘要	Objective: Through the retrospective study of the clinical results of patients with breast lessions who were received Mammotome surgery in our hospital , we analyze the ultrasonographic features of mammography BI-RADS 4A in breast lesions, so as to improve the detection rate of malignant by combining postoperative pathological results.In this paper,we also evaluate the application value of Mammotome in breast mass excision and diagnosis objectively，so as to guide clinical work better . Subjects and Methods： This research reviewed the 3383 cases breast masses excision with Mammotome in Taizhou Hospital of Zhejiang Province,since from June 2010 to June 2017. We totally collected the information of 634 female patients who were diagnosed as BI-RADS 4A category in their preoperative diagnosis. Pathological results were used as dependent variables, ultrasound signs and age as independent variables, using binary Logistic regression based on maximum likelihood estimation in partial forward step-wise, then to filter the significant factors. Results: 3383 cases with breast lesions were under biopsy. The pathological results showed 3215 cases were benign, accounted for 95.0%, mainly in fibroadenoma, 168 cases of malignant tumor, mainly in IDC. The coincidence rate of frozen sections compared with those of conventional paraffin sections or immunohistochemical examination is 99.8%. The pathological results of the BI-RADS 4A breast lesions, showed 581 cases were benign, 86 cases of malignant tumor. After two-class unconditional logistic regression analysis,4 high efficiency indexes were obtained from the ultrasound characteristics of the BI-RASD 4A lesions including the shape of the lesion, margin, calcification, orientation. Conclusions: Mammotome has a good application prospect in breast benign excision. For some breast lesions, it has synchronous diagnostic and therapeutic effect. And the meaningful characteristic variables of ultrasonic BI-RADS for the diagnosis of breast cancer can be screened out , in which the shape of the lesion, margin, calcification, orientation are important ultrasonic variables, can guide clinicians for clear diagnosis and precise treatment.
学号	161001258
发布年限	2022-06-30
毕业论文分类号	R73
原始专题	第一临床医学院、信息与工程学院
学位论文研究方向	肿瘤外科
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全文文件名	161001258方玲慧2019肿瘤学.pdf\|161001258方玲慧2019肿瘤学.pdf
文献类型	学位论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/177764
专题	温州医科大学
作者单位	溫州医科大学第一临床医学院、信息与工程学院
第一作者单位	温州医科大学
推荐引用方式 GB/T 7714	方玲慧. 超声引导下麦默通真空辅助微创旋切术在乳腺肿物中的应用[D]. 温州医科大学,2019.