乳腺肿块型浸润性导管癌MRI动态增强扫描征象与WHO病理分级的关系

Correlaiton Between Dynamic Contrast Enhanced Magnetic Resonance Imaging and WHO Histological Grade in Patients with Invasive Ductal Breast Cancer

目的探讨乳腺肿块型浸润性导管癌的MRI动态增强扫描（DcEMRI）征象与其WHO病理分级的关系。方法回顾性分析四川大学华西医院2012年6月至2013年12月期间92例经手术或活检病理证实为肿块型浸润性导管癌的DCEMRI征象，并分析其与WHO病理分级的关系。结果92例乳腺肿块型浸润性导管癌患者中肿瘤长径≤2cm者29例（31．52％），2～5cm者53例（57．61％），≥5cm者10例（10．87％）；病灶形态为圆形者3例（3．26％），卵圆形者7例（7．61％），分叶形者33例（35．87％），不规则形者49例（53．26％）。病灶边缘光整者11例（11．96％），不规则者47例（51．09％），毛刺状者34例（36．96％）。病灶早期均匀强化者15例（16．30％），不均匀强化者40例（43．48％），环形强化者37例（40．22％）。WHO病理分级：1级者5例（5．43％），2级者30例（32．61％），3级者57例（61．96％）。经统计分析，肿瘤大小、病灶形态及病灶早期强化特点与WHO病理分级有关（P=0．012，P=0．004，P=0．000），即病灶长径越大，WHO病理分级越高；圆形和卵圆形肿块的WHO病理分级相对较低，分叶状和不规则形肿块的WHO病理分级高；不均匀强化及环状强化的WHO病理分级高，均匀强化的WHO病理分级较低。病灶边缘形态与WHO病理分级无关（P〉0．05）。结论乳腺肿块型浸润性导管癌DCEMRI特征与WHO分级有一定关系，可根据MRI征象对病灶的生物学行为和预后进行评估。

Objective To investigate the relationship of dynamic contrast enhanced （DCE） MRI scan of the mass type of invasive ductal breast cancer to histological grade. Method The imagings of DCEMR/of 92 patients confirmed with operation or biopsy pathology and its correlation with WHO histological grade were analyzed. Results There were 29 （31.52%） patients with the tumor long diameter ≤2 cm, 53 （57.61%） 2-5 cm, 10 （10. 87%） ≥5 cm. There were 3 （3.26%） patients with round of the morphological lesions, 7 （7. 61%） oval, 33 （35.87%） lobulated shape, 49 （53.26%） irregular shape. There were 11 （11.96%） patients with smooth margin of the periphery of the lesions, 47 （51.09%） irregular shape, 34 （36. 96%） spiculate margin. There were 15 （16. 30%） patients with homogeneous enhancement, 40 （43.48%） heterogeneous enhancement, 37 （40. 22%） ring-like enhancement. WHO pathological grade： Grade 1 was in 5 cases （5.43%）, grade 2 in 30 cases （32.61%）, grade 3 in 57 cases （61.96%）. The statistical results showed that MRI dynamic enhancement characteristics of lesions in size, shape, and enhanced features were correlated with WHO pathological grade （P〈0. 05）, there was no correlation between the edge features of the tumor and WHO histological grade （P〉0. 05）. Conclusion There is a certain correlation between the breast cancer enhanced MR/features and WHO histological grade, which can be evaluated biological behavior and prognosis according to MR/signs of lesions.