乳腺癌超声及超声造影特征与ER、PR、HER2及Ki-67的相关性

目的 :探讨乳腺癌超声及超声造影表现特征与生物学预后因子之间的相关性。方法 :对239例乳腺癌患者术前行超声及超声造影检查,术后免疫组化法观察肿瘤组织ER、PR、HER2以及Ki-67的表达情况,采用Spearman等级相关和二元Logistic回归方法分析上述指标阳性表达与超声及超声造影表现的相关性。结果 :肿块边缘、钙化、周边回声晕、肿块形态及超声造影增强方式与ER、PR、HER2及Ki-67的相关性无统计学意义(P>0.05)。乳腺癌后方回声衰减是ER阳性表达的预测因素;乳腺癌直径≥2 cm是HER2、Ki-67表达阳性的预测因素。乳腺癌超声造影表现为早增强、慢消退是HER2表达阳性的预测因素。结论 :乳腺癌超声及超声造影表现与乳腺癌预后因子之间存在一定相关性。     

超声弹性成像与弥散定量分析评估肝纤维化程度

目的:分析超声弹性成像与弥散定量分析评估肝纤维化程度的临床参考价值。方法:比较病理诊断明确的S0~S4期共194例肝纤维化患者肝脏弹性图像差异以及各弥散定量参数分布特征,运用Spearman相关性分析、ROC曲线,考察超声弹性成像与弥散定量分析评估肝纤维化程度的参考价值。结果:194例患者中,149例(76.80%)合并肝纤维化,其中,S1期41例,S2期40例,S3期17例,S4期51例。S0期患者超声弹性图以绿色为主,随着肝纤维化分期的加剧,患者超声弹性图蓝色比例逐渐上升,且直方图由正态分布转为偏态分布。随着患者肝纤维化程度的加剧,其MEAN、KURT、ENT逐渐降低,SD、PA、COMP、SKEW、CONT、IDM、ASM及弹性指数逐渐升高,差异有统计学意义(P<0.05)。MEAN、ENT与肝纤维化分期呈负相关,SD、PA、COMP、SKEW、CONT、IDM、ASM及弹性指数与肝纤维化分期呈正相关(P<0.05)。结论:超声弹性成像与弥散定量分析可用于肝纤维化程度的无创评估,结合图像特点以及弥散定量参数变化能够为患者病情进展的预测提供可靠参考。     

Her-2与ALDH1在乳腺癌中表达与相关性研究

目的:探讨乳腺癌组织中Her-2及ALDH1的表达相关性及其临床意义。方法:选取105例原发性乳腺癌标本。采用免疫组化法检测Her-2、ALDH1蛋白的表达,并结合临床病理特征进行相关性分析和无病生存期分析。结果:(1)Her-2与ALDH1在乳腺癌中的表达率分别为29.52%、66.67%。(2)乳腺癌原发灶中Her-2蛋白的表达与肿瘤大小、ER呈正相关(P≤0.05),与年龄、民族、组织学分期及病理类型、PR均无相关性(P>0.05)。ALDH1蛋白表达与年龄、民族、组织学分期及病理类型、肿瘤大小、淋巴结转移、ER、PR均未发现有相关性(P>0.05)。(3)Her-2与ALDH1在乳腺癌表达中呈正相关(r=0.192,P≤0.05)。(4)Her-2高表达患者2年无病生存率显著低于Her-2阴性患者(P<0.05),ALDH1阳性患者与阴性患者2年无病生存期无明显差异(P>0.05)。(5)COX回归模型分析结果显示Her-2是影响患者预后的独立因素(P=0.008)。Her-2的相对危险度=6.284>1。结论:ALDH1与Her-2在乳腺癌组织中的表达呈正相关。Her-2表达与乳腺癌术后患者预后呈负相关,而ALDH1表达与乳腺癌术后患者的预后无明显相关性。     

BI-RADS联合UE技术对小乳腺癌的诊断价值分析

目的分析乳腺影像报告与数据系统(BI-RADS)联合超声弹性成像(UE)技术对小乳腺癌的诊断价值。方法以我院乳腺科2018年1月~2020年2月收治的274例乳腺肿块患者为研究对象,所有患者均进行病理检查,根据病理检查结果分为乳腺增生患者(165例)和小乳腺癌(109例)患者,比较乳腺增生患者和小乳腺癌患者BI-RADS和UE评分;根据病理结果,比较UE、BI-RADS单独检查和联合检查对小乳腺癌的检出情况,并分析UE、BI-RADS单独检查和联合检查对小乳腺癌的诊断价值。结果经病理检查结果显示,本研究纳入的274例乳腺肿块患者中乳腺增生患者占比为60.22%,小乳腺癌患者占比为39.78%。小乳腺癌患者UE、BI-RADS评分均显著高于乳腺增生患者(P<0.05)。UE、BI-RADS联合检查对小乳腺癌的检出率为91.74%,显著高于UE(76.15%)和BI-RADS(79.90%,P<0.05)。UE、BI-RADS联合检查诊断小乳腺癌的灵敏度(91.74%)、特异度(95.15%)、阳性预测值(92.59%)、阴性预测值(94.58%)和准确度(93.80%)均高于UE和BI-RADS单独检查(76.15%、78.18%、69.75%、83.23%、77.37%和78.90%、81.82%、74.14%、85.44%、80.66%,P<0.05)。结论小乳腺癌患者UE、BI-RADS评分均显著高于乳腺增生患者,BI-RADS联合UE技术对小乳腺癌的检出率高于两者单独检查,同时其对小乳腺癌的诊断价值高于两者单独检查,因此临床可联合两者对乳腺肿块患者进行检查,提高小乳腺癌的检出率,进而及时治疗以改善患者预后。     

超声联合弹性成像诊断甲状腺微小乳头状癌的临床价值研究

目的 :探究超声联合弹性成像诊断甲状腺微小乳头状癌的临床价值。方法 :常规超声及弹性成像检查资料完整的129枚甲状腺微小结节,将影像学检查结果与术后病理组织学检查结果进行对比,分析超声联合弹性成像诊断微小乳头状癌的灵敏度、特异性,总结其声像图特征。结果 :术后病理组织学检查共检出恶性结节57枚,占44.19,良性结节占55.81%(72/129)。微小乳头状癌与良性结节常规超声边界、内部回声、纵横比、微小钙化表现比较,差异有统计学意义(P<0.05),其血流分布比较,差异无统计学意义(P>0.05)。联合检查诊断的灵敏度、特异性、阳性预测值均高于常规超声、弹性成像单项检查。结论 :超声联合弹性成像诊断微小乳头状癌具有较高的灵敏度、特异性。     

超声弹性成像与超声引导下细针穿刺活检对甲状腺结节的诊断价值

目的:比较超声弹性成像与超声引导下细针穿刺活检对甲状腺结节的诊断价值,为甲状腺结节诊断方式的选择提供参考依据。方法:选取我院2014年6月~2015年6月收治均实施超声弹性成像及超声引导下细针穿刺活检的125例甲状腺结节患者,将弹性评分、细针穿刺活检结果与诊断结果进行对照分析,计算两种方案鉴别诊断甲状腺结节的灵敏度、特异性、准确率,比较其临床诊断价值。结果:125例患者共检出甲状腺结节147个,其中良性病变95个,恶性病变52个。所有结节均获得有效超声弹性成像及超声引导下细针穿刺细胞学病理标本,超声弹性成像诊断良性结节43个,恶性结节104个;超声引导下细针穿刺诊断良性结节90个,恶性结节39个,不确定39个;超声引导下细针穿刺诊断甲状腺结节的特异性、准确率均高于超声弹性成像,差异有统计学意义(P<0.05),超声弹性成像与超声引导下细针穿刺活检诊断甲状腺结节的灵敏度比较,差异无统计学意义(P>0.05)。结论:超声弹性成像诊断甲状腺结节的灵敏度较低,超声引导下细针穿刺活检诊断可能出现不确定结果,两种诊断方案均存在一定缺陷,联合应用可优势互补,提高甲状腺结节的早期诊断效能。     

声触诊组织成像定量技术与声触诊组织定量技术鉴别BI-RADS 4级乳腺病变良恶性的价值

目的 :比较声触诊组织成像定量(virtual touch tissue imaging quantification, VTIQ)技术和声触诊组织定量(virtual touch tissue quantification,VTQ)技术鉴别诊断BI-RADS 4级乳腺肿块良恶性的价值。方法 :选取常规超声诊断为BI-RADS 4级的乳腺肿块患者90例,共101个病灶。进行VTQ和VTIQ检查,记录病灶内部剪切波速度(SWV)。以病理结果为金标准,分别比较两种方法检测乳腺肿块良恶性SWV的差异,绘制受试者工作特征(ROC)曲线,确定最佳诊断界值,并评价两种方法的诊断效能。结果:101个乳腺病灶病理证实恶性结节42个,良性结节59个。VTIQ技术检测的良性、恶性病灶SWV分别为(2.92±1.06)m/s、(5.45±1.76)m/s。VTQ技术测得的良性、恶性病灶SWV分别为(2.85±1.06)m/s、(5.22±2.02)m/s。两种方法测得恶性病灶的SWV均高于良性病灶,差异均有统计学意义(P <0.05)。两种方法的ROC曲线下面积(AUC)分别为0.867、0.848,差异无统计学意义(P> 0.05)。当VTIQ界值取3.96m/s时、VTQ界值取3.71m/s时,诊断效能最佳,其灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为85.71%、88.14%、87.13%、83.72%和89.66%;78.57%、72.88%、75.25%、67.35%和82.69%,VTIQ特异度和准确率高于VTQ,组间差异具有统计学意义(P <0.05)。结论 :VTIQ在BI-RADS 4级乳腺肿块良恶性的鉴别诊断中,具有较高的临床应用价值,其特异度和准确率高于VTQ。     

超声监测产程进展可行性及对分娩方式的预测价值探讨

目的探讨超声监测产程参数在分娩方式的预测价值。方法选取2020年1月至2020年12月在我院分娩的产妇450例,分析自然分娩和剖宫产产妇超声参数:宫口扩张4cm时胎头方向角(HD1)、脑中线角度(MLA1)、胎头下降距离(HPD1)和胎头进展角(AOP1),以及宫口扩张4cm后2h时HD2、MLA2、HPD2和AOP2。结果最终自然分娩产妇328例,剖宫产产妇122例;自然分娩组AOP1、HPD2和AOP2分别为(115.56±7.74)、(44.46±5.57)mm和(124.41±8.81)°,明显高于剖宫产组(P<0.05),而MLA2为(73.21±6.68)°,明显低于剖宫产组(P<0.05);自然分娩组和剖宫产组HD1、MLA1、HPD1和HD2比较差异无统计学意义(P>0.05);AOP1、MLA2、HPD2和AOP2预测自然分娩的ROC曲线下面积分别为0.876、0.714、0.654和0.749,P<0.05;Logistic回归分析显示:AOP1、MLA2、HPD2和AOP2是自然分娩的影响因素(OR=1.988、0.701、1.575和1.473,P<0.05)。结论超声监测产程参数在预测分娩方式中有较好的价值,值得临床使用。     

不同肿块类型MDE与IDC,DCIS的彩超影像分析

目的分析不同肿块类型乳腺导管扩张症(MDE)与浸润性导管癌(IDC)、导管原位癌(DCIS)在彩色多普勒超声(CDFI)下的影像表现。方法回顾性分析我院2017年4月至2019年3月收治的经病理证实为MDE的62例患者的临床资料进行研究(MDE组)。另分析同期经病理证实为乳腺癌患者95例的临床资料,其中IDC51例(IDC组),DCIS44例(DCIS组)。分析受试者术前彩色多普勒超声(CDFI)图像,比较三组的临床资料、肿块型病灶及导管型病灶影像学特征。结果MDE组的发病年龄明显低于IDC组、DCIS组(均P<0.05),MDE组位于外周的病灶明显少于IDC组、DCIS组(均P<0.05),MDE组更多病灶位于中央,此外MDE组囊实性及囊性肿块所占比例明显高于IDC组、DCIS组(均P<0.05);肿块型MDE组病灶最大径明显小于DCIS组(P<0.05),形态规则、边缘完整的肿块型病灶明显高于IDC组、DCIS组(均P<0.05),有强回声点、周边高回声晕、后方回声衰减的特征明显低于IDC组、DCIS组(均P<0.05),且0~Ⅰ级Adler血流血流检出率明显高于IDC组、DCIS组(均P<0.05),此外肿块型MDE病灶伴内部液性无回声区较IDC、DCIS多见(均P<0.05);导管型MDE有强回声点的特征明显低于DCIS组(均P<0.05),其余各项差异均无统计学意义(均P>0.05)。结论CDFI下MDE病灶多表现为肿块型,以囊实性或囊性肿块居多,与IDC、DCIS在CDFI下特征表现区别较大,对MDE的诊断及其与乳腺癌IDC、DCIS的鉴别诊断具有重要价值。     

多层螺旋CT及灌注成像对尘肺合并肺结核的诊断效果

目的:探析多层螺旋CT及灌注成像对尘肺合并肺结核的诊断效果。方法:筛选2018年11月至2020年11月经本院收治尘肺疑似合并肺结核120例患者进行研究,均进行多层螺旋CT影像及肺结核CT灌注成像检查,观察患者CT征象表现,测定并分析灌注成像参数变化,通过比对病理组织学“金标准”,分析单一及联合检查诊断效能。结果:120例尘肺合并肺结核患者,经病理证实尘肺合并肺结核86例,34例仅为单纯性尘肺;采用多层螺旋CT检查,共计有诸如多发性小结节、多发空洞、磨玻璃影、肺实变、树芽征、团块状、管壁增厚、胸膜增厚、支气管扩张及大结节影等10大征象;经CT征型分析,尘肺合并肺结核以结核球型、浸润型及空洞型多见,依次为13例、38例及23例,其他类型共计12例,较少发生;经CT灌注成像,单纯尘肺患者PF、BF及PI参数均高于尘肺合并肺结核,差异有统计学意义(P<0.05);而不同类型肺结核中,浸润型PF、BF值最高,空洞型PF值最低,结核球型BF值最低,经单因素方差分析,差异有统计学意义(P<0.05);多层螺旋CT影像、肺结核CT灌注成像单一及联合诊断Kappa值依次为0.50、0.64及0.79,均具备中高度一致性,以联合诊断一致性最好。结论:多层螺旋CT影像及肺结核CT灌注成像均可获有良好诊断效能,以联合检查诊断效能最佳。且结合临床症状,实时性分析患者CT影响及灌注参数变化,更利于尘肺合并肺结核的检出。     

Prognostic tumor microenvironment gene and the relationship with immune infiltration characteristics in metastatic breast cancer

The aim of this study was to reveal genes associated with breast cancer metastasis, to investigate their intrinsic relationship with immune cell infiltration in the tumor microenvironment, and to screen for prognostic biomarkers. Gene expression data of breast cancer patients and their metastases were downloaded from the GEO, TCGA database. R language package was used to screen for differentially expressed genes, enrichment analysis of genes, PPI network construction, and also to elucidate key genes for diagnostic and prognostic survival. Spearman’s r correlation was used to analyze the correlation between key genes and infiltrating immune cells. We screened 25 hub genes, FN1, CLEC5A, ATP8B4, TLR7, LY86, PTGER3 and other genes were differentially expressed in cancer and paraneoplastic tissues. However, patients with higher expression of CD1C, IL-18 breast cancer had a better prognosis in the 10 years survival period, while patients with high expression of FN1, EIF4EBP1 tumors had a worse prognosis. In addition, TP53 and HIF1 genes are closely related to the signaling pathway of breast cancer metastasis. In this study, gene expression of ATP8B4 and CD1C were correlated with cancer tissue infiltration of CD8⁺ T lymphocytes, while GSE43816, GSE62327 and TCGA databases showed that CD8⁺ T lymphocytes were closely associated with breast cancer progression. Functional enrichment analysis of genes based on expression differences yielded key genes of prognostic value in the breast cancer microenvironment.     

应用声触诊组织定量分析技术测量脾脏弹性值

目的探讨应用声触诊组织定量分析（VTQ）技术对健康志愿者脾脏弹性值的评估价值。方法选取127例健康志愿者,其中青年健康志愿者55例,中年健康志愿者31例,老年健康志愿者41例,使用具有VTQ技术的超声仪器对志愿者进行检查,记录剪切波速度值（shear wave velocity,SWV,进行综合分析。结果脾脏平均SWV与身高,腰围,体重,BMI,脾脏厚度及长度比较及相关性分析均无显著性差异（P〉0.05）;不同年龄组之间无显著差异（P〉0.05）;脾脏SWV正常值范围为2.36±0.57m/s。结论声触诊组织定量分析技术可以反映脾脏的弹性强度,具有潜在的临床应用价值。     

乳腺癌前哨淋巴结不同检测方法效果研究

目的 :研究染色法、同位素法、联合法3种不同检测方法对乳腺癌前哨淋巴结检测的影响。方法:选取2007年9月²013年11月在我院就诊的早期女性乳腺癌患者为研究对象,将患者随机分为3组,蓝染料组、核素组、联合组。比较各组乳腺癌前哨淋巴结活检的成功率、准确率及假阴性率。结果 :与单纯使用染料的方法相比,联合法的假阴性率显著性降低,差异有统计学意义。与单用染料组及核素组相比,联合法发现的SLN数较多,但无统计学差异。结论:联合应用染料及同位素示踪较单一方法更能提高前哨淋巴结检测的成功率,降低假阴性率。     

Comprehensive bioinformatics analysis of CYB561 expression in breast cancer: Link between prognosis and immune infiltration

Background: Cytochrome b561 (CYB561) plays a critical role in neuroendocrine function, cardiovascular regulation, and tumor growth; however, the prognostic value of CYB561 in patients with breast cancer and the relationship between CYB561 expression and immune infiltration in breast cancer remain unclear. Methods: The mRNA expression and clinical data of patients with breast cancer were obtained from The Cancer Genome Atlas database. Functional enrichment analysis was used to explore underlying biological functions associated with CYB561. The methylation status of CYB561 was analyzed using the MethSurv database. The enrichment score of immune cell infiltration for CYB561 in breast cancer was calculated using single-sample gene set enrichment analysis. The prognostic value of CYB561 was evaluated using Kaplan-Meier method and Cox regression analysis. Based on the results of the multivariate Cox analysis, a nomogram was constructed to predict the effect of CYB561 expression on overall survival (OS). Results: The results showed that CYB561 was highly expressed in breast cancer tissues. Hypomethylation of CYB561 is associated with an unfavorable prognosis. In multivariate Cox regression analysis, CYB561 was an independent prognostic factor for OS. Functional enrichment analysis indicated that estrogen signaling pathway, inflammatory response, KRAS signaling pathway, epithelial-mesenchymal transition, leukocyte migration, and regulation of lymphocyte activation were strongly enriched in the low CYB561 expression group. Additionally, CYB561 expression was negatively correlated with immune infiltration of B cells, plasmacytoid dendritic cells, dendritic cells, and neutrophils. Conclusion: CYB561 may serve as a potential biomarker for breast cancer diagnosis and prognosis.     

Pathological examination of sentinel lymph node in breast cancer: potential problems and possible solutions

Sentinel lymph node (SLN) biopsy has emerged during the last few years as a viable option for staging the axilla in the treatment of breast carcinoma. This procedure can potentially identify patients who would be helped by full axillary lymph node dissection (the SLN-positive cases), and those who would not (the SLN-negative cases). Review of the literature confirms the promise of SLN; however, the possible problems in the pathological handling of SLN, including the microscopic misinterpretation of benign structures and "spurious" immunohistochemical staining, need wider recognition.     

Weighted gene co-expression network analysis identifies a novel immune-related gene signature and nomogram to predict the survival and immune infiltration status of breast cancer

Breast cancer is one of the most common cancers in the world and seriously threatens the health of women worldwide. Prognostic models based on immune-related genes help to improve the prognosis prediction and clinical treatment of breast cancer patients. In the study, we used weighted gene co-expression network analysis to construct a co-expression network to screen out highly prognostic immune-related genes. Subsequently, the prognostic immune-related gene signature was successfully constructed from highly immune-related genes through COX regression and LASSO COX analysis. Survival analysis and time receiver operating characteristic curves indicate that the prognostic signature has strong predictive performance. And we developed a nomogram by combing the risk score with multiple clinical characteristics. CIBERSORT and TIMER algorithms confirmed that there are significant differences in tumor-infiltrating immune cells in different risk groups. In addition, gene set enrichment analysis shows 6 pathways that differ between high- and low-risk group. The immune-related gene signature effectively predicts the survival and immune infiltration of breast cancer patients and is expected to provide more effective immunotherapy targets for the prognosis prediction of breast cancer.     

The value of assessing cell proliferation in breast cancer

Using three methods to measure cell proliferation, namely DNA cell cycle; anti-proliferating cell monoclonal antibody (MAb) (Ki67, P145) analysis by flow cytometry; and the histological silver (argyrophilic) staining technique to visualize nuclear-organizing regions (AgNOR), twenty-two paired samples of primary breast tumour and axillary lymph node were analysed. The results showed variable levels of correlation between the methods used for the tumour group (r = 0.915, P <0.001 for Ki677 versus P145; r = 0.42, P <0.005 for percentage S/G2/M-phase versus P145; r = 0.16, P <0.5 for percentage S/G2/M-phase versus AgNOR; r = 0.400, P < 0.1 for Ki67 versus AgNOR). The lymph-node group showed slightly poorer correlations, yet involved nodes showed a consistently higher level of proliferation than non-involved nodes by all methods used. Overall, MAb binding of Ki67 or P145 was seen to be a good indicator of cycling cells, detecting G1-phase cells in addition to S/G2/M-phase cells indentified by the other methods used. However, no advantage was found over the usual DNA flow cytometric analysis of cells, which had clear prognostic value. AgNOR scores were found to be able to discriminate between diploid and aneuploid; and dividing and non-dividing cells, but areas of score overlap limited the application of this technique to that of a positive discriminator only.     

Characterization of squamous cell carcinomas of the head and neck using methods of spatial statistics

In the present study, 53 cases of squamous cell carcinomas of the head and neck were characterized by a quantitative histological texture analysis based on principles of spatial statistics. A planar tessellation of the epithelial tumour component was generated by a skeletonization algorithm. The size distribution of the virtual cells of this planar tessellation, and the size distribution of the profiles of the tumour cell nuclei were estimated in terms of area and boundary length. The intensity, the reduced second moment function (K‐function) and the pair correlation function of the point process of the centroids of the profiles of the tumour cell nuclei were also estimated. For both purposes, it is necessary to correct for edge effects, which we consider in this paper in some detail. Specifically, the point patterns of the tumour cell nuclei were considered as realizations of a point process, where the points exist only in the epithelial tumour component (the permitted phase) and not in the stroma (the forbidden phase). The methods allow to characterize each individual tumour by a series of summary statistics. The total set of cases was then partitioned into two groups: 19 cases without lymph node metastases (pN0), and 34 nodal positive cases (pN1 or pN2). Statistical analysis showed no significant differences between the intensities, the mean K‐functions and the mean pair correlation functions of the tumour cell nucleus profiles of the two groups. However, there were some significant differences between the sizes of the virtual cells and of the nucleus profiles of the nodal negative cases as compared to the nodal positive cases. In a logistic regression analysis, one of the quantitative nuclear size variables (mean nuclear area) was found to be a significant predictor of lymph node metastasis, in addition to tumour stage. The study shows the potential of methods of spatial statistics for objective quantitative grading of squamous cell carcinomas of the head and neck, and provides an example for modelling histological point patterns as realizations of planar point processes occupying a reference phase which is only a partial component of the total tissue.