三阴性乳腺浸润性导管癌的MRI影像学表现

MR imaging of triple negative breast cancer with histological type: Invasive ductal carcinoma not otherwise specified

目的探讨三阴性乳腺浸润性导管癌的MRI特征。方法收集2011年1月—2012年12月在3.0T MRI检查,且获得病理证实的浸润性导管癌共234例,其中三阴性乳腺癌78例、非三阴性乳腺癌156例。回顾性分析其临床及MRI资料。根据美国放射学会的乳腺报告及数据系统标准评估其MRI表现,记录病灶形态(非肿块/肿块)。若为肿块,则继续从肿块形状(圆形/卵圆形/分叶状/不规则形)、边缘(光滑/不规则/毛刺)、内部强化特征(均匀/不均匀/环形)等方面进行分析,同时记录病灶数目(单灶/多灶)。若为非肿块,则分析病灶分布形式(段样/区域样/弥漫)、内部强化特征(不均匀/点簇状/网状)。在T2WI上记录病灶信号特点(低或等/高/高亮)。采用单因素及多因素分析三阴性乳腺癌与非三阴性乳腺癌的差异。结果 78例三阴性乳腺癌中,69例为肿块样强化、9例为非肿块样强化。156例非三阴性乳腺癌中,120例为肿块样强化、36例为非肿块样强化。单因素分析显示,三阴性乳腺癌与非三阴性乳腺癌的病灶形态(P=0.035)、肿块边缘(P<0.001)、内部强化特点(P<0.001)及T2WI信号(P<0.001)差异有统计学意义,三阴性乳腺癌更多表现为肿块样强化、边缘光滑、环形强化及T2WI上高亮信号。其中边缘、内部强化特点进入回归模型,比值比(OR)分别为3.279和4.577。受试者工作特征曲线(ROC)证实,病灶表现为边缘光滑及环形强化的特点具有较高的诊断价值[曲线下面积(AUC)为0.812]。结论边缘光滑及呈环形强化的肿块样强化为三阴性浸润性导管癌较为特征的MRI表现。

Objective To evaluate the MR imaging features of invasive ductal carcinoma not otherwise specified （IDC NOS）. Methods From January 2011 to December 2012, a total of 234 patients with immunohistochemically confirmed invasive ductal carcinoma not otherwise specified in our hospital were chosen, 78 with triple-negative breast cancer, and 156 with non-triple negative breast cancer. The clinical and MRI morphologic features by Breast Imaging Reporting and Data System （BI-RADS） including lesion shape （round, oval, lobulated, or irregular）, margin （smooth, irregular, or spiculated）, internal en- hancement pattern （homogeneous, heterogeneous, or rim enhancement）, size, as well as signal intensity （low/equal, high, or bright high） on T2-weighted image （T2WI） were evaluated. Univariate and multivariate logistic regression analyses were used to predict the related factors. Results Compared with non-triple negative breast caner, mass lesion （P=0.035）, smooth margin （P〈0.001）, rim enhancement （P〈0.001）, and very high intratumoral signal intensity on T2WI （P〈0.001） were significantly associated with triple-negative breast cancer. Smooth margin and rim enhancement entered into the regression model, with odd rate （OR） value of 3.279 and 4.577, respectively. The receiver operating characteristic curve （ROC） confirmed that mass margin combined with internal enhancement can be helpful in predicting triple-negative breast cancer （AUC=0.812）. Conclusion Several MRI features such as smooth margin and rim enhancement might be used to detect triple-negative breast cancer.