The Clinical Application Research Of VTQ In The Differential Diagnosis Of Axillary Lymph Nodes In Breast Cancer

Objective : To explore the diagnostic value of conventional ultrasound in the differential diagnosis of axillary lymph nodes in breast cancer.;To explore the value of using VTQ technology in differentiating axillary lymph nodes in breast cancer.Analyzing the related factors having an impact on the VTQ technology;To get the cut-off value of differentiating axillary lymph nodes in breast cancer by measuring the ROC(Receive Operator Characteristic)Carve.Providing new reference for the clinical noninvasive assessment of axillary lymph nodes in breast cancer.;To compare the diagnostic value of conventional ultrasound and VTQ two methods in differentiating axillary lymph nodes in breast cancer.;Using logistic regression model analyzes the correlation of factors influencing the nature of the axillary lymph nodes of breast cancer judgment and screening out of sensitive indexes that diagnose nature of axillary lymph nodes of breast cancer.Methods:Collected during in October 2015 to the October 2016,"breast masses" as the chief complaint admitted medical school first affiliated hospital of WAN NAN a breast surgery,a total of 75 patients,Min 35 y,Max 82 y,the median age of 57 y..Inclusion criteria:(1)Don’t make radiation and chemotherapy treatment before making ultrasound for breast;(2)Don’t make biopsy before do ultrasound for breast;(3)Don’t make molybdenum target inspection before making ultrasonic for breast;(4)Clinical examination,ultrasonic inspection do not found axillary lymph node enlargement and do not make axillary lymph node cleaning performer ruled out;⑸Those that follow-up with systemic infectious disease and skin disease and pathological result is not ideal,are exclude.Using the Siemens ACUSON S2000 high frequency probe of 9L4(4-9MHZ)makes conventional ultrasonic and VTQ for selected patients.Telling patients the hypothesis or lateral position(when necessarily shoulder pads),upper arm abduction 80o;First make conventional ultrasound for breast and axiliary lymph nodes,focus on observation axillary lymph,including the location,size,boundary,cortex and medulla,cortical thickness,hilts blood supply,etc.When the hilts structure shows clear,stable image,measuring the biggest long diameter,short diameter and the thickness of cortex of lymph node.And then make VTQ technology for this lymph node,get seven VTQ value at the same depth,After the average of the measured value,finally selecting average of the measured values,maximum and minimum as observation indexes,taking standard(means ±SD).Were there many enlarged lymph nodes,we would select from the conventional ultrasonic highly suspicious lymph nodes and near breast as the observation object..Axillay lymph node metastasis of breast cancer or by surgery pathology as the gold.Using conventional ultrasonic、VTQ、two methods to evaluate the presence of axillary lymph nodes in breast cancer.Standard.statistical analysis was performed using SPSS19.0 software,To identify statistically significant differences using (?)±S,we used T test in the VTQ.Through mapping the receive-operating characteristic(ROC)care to obtain the best cut-off point,the calculation of conventional ultrasonic,VTQ and two methods of sensitivity and specificity.And the above method to compare the sensitivity and specificity.Access to the area under the ROC curve and carries on the analysis and comparison.We took conventional ultrasonic and VTQ characteristics(L/S,cortical thickness and grade of blood,flow blood type,VTQ of MAX,MIN,average),which will be as the independent variable,axillary lymph node metastasis as a dependent variable.As the same time,assignment give each observation indexes and index assignment 1 associated with axillary lymph node metastasis,other indexes value 0.Single factor analysis using T test,multiple factors analysis using logistic regression analysis.Ended with the pathological results as the gold standard,p<0.05 indicated statistical significance.Result: Of a total of 75 axillary lymph nodes,44 were metastatic,and 31 were no metastatic,The sensitivity,specificity of conventional ultrasound distinguishes between benign and malignant axillary lymph node were 86.0%,77.4%,The best cut-off point of VTQ value distinguish between benign and malignant axillary lymph node were 1.83m/s,sensitivity,specificity is 93.2%,90.3%,respectively;area under the curve(AUC)is 0.991,The sensitivity and specificity of conventional ultrasound combined with VTQ distinguish between benign and malignant,axillary lymph node were 86.4%,91.9%.Comparing to the sensitivity,specificity and area under the curve of conventional ultrasonic,VTQ,conventional ultrasonic combined with VTQ.Comparatively,max sensitivity is VTQ(93.2%);max specificity is conventional ultrasound combined with VTQ(95.1%);max area under the curve(AUC)is VTQ.The best cutoff point of VTQ value of MAX,MIN distinguish between benign and malignant axillary lymph node were 1.96m/s,1.76m/s,correspondingly,MAX’S the sensitivity is higher(97.7%);and MIN’S the specificity is higher(95.1%);MAX’S area under the curve(AUC)is higher(0.995).The index of single factor analysis using t test significant SIG(0.000 < 0.05),visible all the indexes have statistical significance.Multivariable Logistic analysis showed that the results it is concluded that L/S,blood flow grading,classification,maximum,average,and so on five indicators is axillary lymph node metastasis of breast cancer risk factors(regression coefficient > 0,odds ratio > 1).Conclusion cortical thickness,MIN for the protection of the axillary lymph node metastasis of breast cancer(regression coefficient < 0,odds ratio < 1).Conclusions:VTQ is a new type of ultrasonic inspection technology,which can make quantitative evaluation on the quality of a material of axillary lymph nodes of breast cancer,so as to determine its benign and malignancy,providing a new observation index for the clinical doctors determine.Single factor analysis and Multivariable logistic regression results show that L/S,grade of blood flow,type of blood flow,average,maximum of VTQ value is affecting the risk factor for the axillary lymph node properties.VTQ combined with conventional ultrasonic in distinguishing between the benign and malignant of axillary lymph nodes of breast cancer has improved further.Using the logistic regression analysis the multiple index of affecting the axillary lymph nodes of breast cancer,which can help us from multiple aspects comprehensive evaluation in the further work,to further improve the accuracy of ultrasonic diagnosis of axillary lymph node properties.