| Objective:According to the parotid pleomorphic adenoma(PA)in patients with clinical,imaging and pathological data,to explore diagnosis and treatment of parotid pleomorphic adenoma mathematic model and validation and analysis of clinical cases,in a more objective and quantitative method to study the tumor.Methods:Divided into the first group,the second group,the third group respectively were studied.Among the first group:to investigate the parotid pleomorphic adenoma and differential diagnosis of mathematic model,analyzed retrospectively from January2012 to December 2017 during Wan nan medical school first affiliated hospital Yi ji shan hospital patients after surgery,definite pathological diagnosis of parotid pleomorphic adenoma and up to the standard of this study include 210 cases and 207cases of hospitalized patients with clear by surgery pathology diagnosis of parotid Warthin’T(worthing tumor),chronic lymphadenitis,cyst of pleomorphic adenoma of the parotid gland neoplasm of hospitalized patients with clinical,imaging and pathological data.First by single factor analysis in patients with preoperative data in parotid pleomorphic adenoma and parotid gland neoplasm other differences,and the multi-factor Logistic regression analysis was selected in the diagnosis of parotid pleomorphic adenoma of the variable,build a preoperative diagnosis criterion probability forecasting model,using statistical software to draw its the receiver-operating characteristics(receiver operating characteristic,ROC)curve,it is concluded that the appropriate cut-off value T and evaluation;In addition,continue to add intraoperative and postoperative related indicators,using the above methods to further build mathematical model and evaluation.The second group:to explore the operative treatment of parotid pleomorphic adenoma mathematic model,a retrospective analysis in January 2012 to December 2017 during Wan nan medical school first affiliated hospital Yi ji shan hospital,210 cases of clear by surgery pathology diagnosis of parotid pleomorphic adenoma of hospitalized patients with preoperative data,First through factor analysis of the relationship between the indexes,and the multiple linear regression analysis on parotid pleomorphic adenoma resection of length to diameter by conventional pathology report(the"gold standard"tumors had long diameter)of the indicators,building mathematical prediction models;In addition,continue to add intraoperative and postoperative related indicators,using the above methods to further build mathematical model and evaluation.The third group:test first and the second group of mathematical prediction models,for the first set of test data was analyzed retrospectively between January 2018 and July 2018 hospital ofWan nan medical school first affiliated hospital Yi ji shan hospital during the period of 28 cases after the surgery,definite pathological diagnosis of parotid pleomorphic adenoma and 27 cases of hospitalized patients with clear by surgery pathology diagnosis of parotid Warthin’T(worthing tumor),chronic lymphadenitis,cyst of pleomorphic adenoma of the parotid gland neoplasm of hospitalized patients with clinical,imaging and pathological data,into the mathematical forecasting model of the first cohort,calculate the probability value,and ROC curve drawing,the corresponding assessment;For a second set of test data for retrospective analysis between January 2018 and July 2018 hospital of medical school first affiliated hospital Yi ji shan hospital during the 33 cases clear by surgery pathology diagnosis of parotid pleomorphic adenoma of hospitalized patients with clinical,imaging and pathological data,in the second group get the mathematical forecasting model of probability values computed using statistical software ROC curve drawing,and make the corresponding evaluation.Results:1,the single factor analysis found that gender,age,past medical history,personal history,site,disease period,imaging for the situation of the tumors had coated,imaging acquisition tumors had relationship with the facial nerve dissection(buccal branch as an example)in parotid pleomorphic adenoma and parotid gland neoplasm other between statistical difference(P<0.05).Multiariable Logistic regression analysis showed that age,marriage,past medical history,personal history,disease period,imaging examination for tumors of length to diameter,imaging acquisition tumors had coated,imaging for tumors with facial nerve anatomic relationship between parotid pleomorphic adenoma and parotid gland neoplasm other statistical differences(P<0.05),is the independent factors in the diagnosis of parotid pleomorphic adenoma.Build mathematical forecasting model of P(the diagnosis of parotid gland PA)=e~X/(1+e~X),X=-0.08+2.228*age marriage past history-3.055*personal history+0.009*time of illness+0.61*ill imaging examination for tumors of length to diameter imaging for tumors capsular is+1.149*imaging of anatomical relationship between tumor body and facial nerve+1.02*imaging for tumors had relationship with the facial anatomy.E for the natural logarithm.Area under the ROC curve(Area under the curve,AUC)was0.881(95%CI:0.848-0.913),medium for diagnostic accuracy.Select cut-off value T=0.621.The sensitivity of the model is 93.33%,55.07%,positive predictive value was67.82%,negative predictive value of 89.06%.Perioperative single factor analysis of the remaining variables found in tumors had coated,intraoperative tumors and the condition of the coating adhesion,intraoperative observation whether tumors had nodular,intraoperative tumors had relationship with the facial nerve dissection(buccal branch,for example),the structure of the conventional pathology report tumors in parotid pleomorphic adenoma and parotid gland neoplasm other between statistical difference(P<0.05).2,factor analysis,the preoperative indicators have five factors:factor 1named"quantitative indicators";Factor 2 named"role";Factor 3 named"catalyst";Factor4 named"risk factors";Factor 5 named"confounding factors.The relationship between different variables in the form of mathematical equations.Multiple linear regression analysis showed that specialized examination for tumors of length to diameter,imaging examination for tumors of length to diameter,imaging acquisition guidance parotid tumors had coated by PA operation excision of tumors in length to diameter of the independent factors,and according to the result of multiple linear regression analysis,build the regression equation:conventional pathology report tumors had long diameter=0.222*specialized examination for tumors of length to diameter+0.65*imaging examination for tumors of length to diameter+0.271*imaging for tumors had coated.Specialized examination for tumors of length to diameter,imaging examination for tumors of length to diameter,the structure of the conventional pathology report tumors,immunohistochemical results for parotid gland tumors had PA routine postoperative pathology report length to diameter of the independent factors,and,according to the results of the multiple linear regression analysis to build the regression equation:conventional pathology report tumors had long diameter=-3.493+0.208*specialized examination for tumors of length to diameter+0.634*imaging examination for tumors of length to diameter+3.019*tumor structure revealed by routine pathological reports-3.406*immunohistochemical results.3,the first set of mathematical prediction model validation of the AUC value is 0.684(95%CI:0.540-0.828),usually for diagnostic accuracy.A second group of preoperative prediction model validation of AUC value of 0.750(95%CI:0.450-1),medium for diagnostic accuracy.Perioperative mathematical forecasting model of the AUC value is AUC 0.769(95%CI:0.607-0.931),medium for diagnostic accuracy.Conclusion:1,age,marriage,past medical history,personal history,disease period,imaging examination for tumors of length to diameter,imaging acquisition tumors had coated,imaging for tumors had relationship with the facial nerve dissection is an independent predictor of diagnosis of parotid pleomorphic adenoma.Specialized examination for tumors of length to diameter,imaging examination for tumors of length to diameter,imaging for guiding parotid tumors had coated by PA operation excision of tumors in length to diameter of independent factors.Specialized examination for tumors of length to diameter,imaging examination for tumors of length to diameter,the structure of the conventional pathology report tumors,immunohistochemical results for parotid gland tumors had PA routine postoperative pathology report length to diameter of the independent factors.2,parotid pleomorphic adenoma diagnosis and treatment of perioperative comprehensive mathematical prediction models to build success,to establish the prediction model has a certain accuracy,can be further used in clinical diagnosis and treatment work. |
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