三阴性乳腺癌3.0 T磁共振的诊断价值

The diagnostic value of triple-negative breast cancer using 3.0 T MRI

目的探讨三阴性乳腺癌MRI动态增强及DWI影像学特征性表现,为临床术前评估提供依据。材料与方法选取2012年8月-2014年6月间术前接受MRI检查并经手术及病理证实的乳腺癌251例,其中三阴性乳腺癌70例,非三阴性乳腺癌[ER(+)/PR(+)/HER-2(-)型]181例。比较两种病理亚型乳腺癌的MRI动态增强及DWI影像学表现并进行相应统计学分析。结果与ER(+)/PR(+)/HER-2(-)型乳腺癌比较,三阴性乳腺癌表现多为单一病灶(P=0.018),肿瘤较大(P=0.002),组织学分级较高(P<0.001);MRI动态增强病灶多表现为肿块样强化(P=0.026),分叶状(P<0.001)、边缘光滑(P=0.005)、环形强化(P<0.001)及T2WI上病变中心呈高信号(P<0.001)为其特征性表现。DWI三阴性乳腺癌的ADC均值(1.034±0.37)×10-3 mm2/s高于ER(+)/PR(+)/HER-2(-)型乳腺癌(P=0.031)。结论对乳腺癌病人术前进行MRI检查,有助于三阴性乳腺癌与ER(+)/PR(+)/HER-2(-)型乳腺癌鉴别,可成为乳腺癌术前评估主要无创检查方法之一,为临床治疗方案确定提供依据。

Objective： To invstigate the specific findings of triple-negative breast cancer （TNBC） with dynamic contrast-enhanced MRI and DWI, and to provide the reference for presurgical evaluation. Materials and Methods：Two hundred and iffty-one patients with breast cancer who underwent operation from Augest, 2012 to June, 2014 were included. Seventy patients were TNBC, while 181 patients were ER（＋）/PR（＋）/HER-2（-） cancer. Comparing the dynamic contrast-enhanced breast MRI and DWI imaging findings of these two subtypes and making the appropriate statistical analysis. Results：Compared to ER（＋）/PR（＋）/HER-2（-） tumors, TNBC cancers were presented with single （P=0.018）, larger tumor size （P=0.002）, higher histologic grade （P〈0.001）. MRI features associated with TNBC tumors included mass enhancement （P=0.026）, lobulated （P〈0.001）, smooth margins （P=0.005）, ring-enhancement （P〈0.001） and areas of intratumoral high T2 signal intensity （P〈0.001）. Moreover, the TNBC appeared higher ADC value （P=0.031）. Conclusions：Preoperative MRI is helpful in differentiating TNBC and contrast enhanced ER （＋） /PR （＋） /HER-2 （-） cancer. It would be one of the most important noninvasive examination methods to preoperatively evaluate the breast cancer, and provide imaging basis for clinical treatment.