DWI评估宫颈鳞状细胞癌增殖和侵袭性

DWI in prediction of proliferation and invasiveness of cervical squamous cell carcinoma

目的探讨DWI不同ADC值预测宫颈鳞状细胞癌(CSCC)增殖和侵袭性的价值。方法对96例CSCC患者术前行盆腔常规MRI和DWI,测量肿瘤最小ADC值、平均ADC值和最小ADC率(最小ADC值/平均ADC值),比较不同Ki-67表达及临床病理特征患者间的差异。结果与低侵袭性宫颈癌相比,最小ADC值在Ki-67高表达、肿瘤最长径≥4cm、高FIGO分期、低分化、宫颈间质浸润深度≥1/2、宫旁受累、LVI、淋巴结转移和PNI阳性的高侵袭性宫颈癌患者中显著降低(P均<0.05)。与平均ADC值和最小ADC率相比,最小ADC值预测CSCC不同临床病理特性的ROC曲线下面积和效能较高,且与Ki-67指数呈负相关(r=-0.48,P<0.001),与其他临床病理特征如肿块大小、FIGO分期、病理分级、间质浸润深度、宫旁受累、LVI、淋巴结转移和PNI呈负相关(r=-0.36、-0.34、-0.27、-0.40、-0.33、-0.60、-0.61、-0.41,P均<0.05)。结论最小ADC值可有效反映CSCC的增殖和侵袭性。

Objective To investigate the diagnostic performance of ADC value for predicting proliferation and invasiveness of cervical squamous cell carcinoma（SCC）.Methods Totally 96 patients with pathologically confirmed SCC underwent preoperative conventional MRI and DWI.Mini-ADC value,mean-ADC value and mini-ADC ratio（mini-ADC/mean-ADC）were measured and compared for various patient groups divided based on Ki-67 labeling index and clinicopathological characteristics.Results The mini-ADC values were significantly lower in patients with high Ki-67 expression,tumor size≥4 cm,high FIGO staging,low pathological grade,depth of cervical stromal infiltrating ≥1/2,parametrial involvement,lymphovascular invasion（LVI）,lymph node metastasis and perineural invasion（PNI,all P〈0.05）.Compared with mean-ADC value and mini-ADC ratio,mini-ADC value exhibited the most effective diagnostic performance in predicting clinicopathological characteristics with the highest areas under the ROC curve and efficacy.Mini-ADC value showed negative correlation with Ki-67 index（r=-0.48,P〈0.001）as well as other clinicopathological characteristics,including tumor size,FIGO staging,pathological grading,depth of cervical stromal infiltrating,parametrial involvement,LVI,lymph node metastasis and PNI（r=-0.36,-0.34,-0.27,-0.40,-0.33,-0.60,-0.61,-0.41,respectively,all P〈0.05）.Conclusion Mini-ADC value can effectively reflect the proliferation and invasiveness of cervical SCC.