磁共振成像表观弥散系数与乳腺浸润性导管癌组织学分级及预后因子的相关性

Correlations between apparent diffusion coefficient values with histological grade and prognostic factors of invasive ductal carcinoma

目的分析表观弥散系数(ADC)与乳腺浸润性导管癌(IDC)分级及其预后因子的相关性。方法回顾性分析我院2015年1月至2017年9月经病理证实为IDC的216例患者(共224个病灶),患者术前均行常规磁共振成像(MRI)、动态增强(DCE)-MRI及弥散加权成像(DWI)扫描(b=50和800s/mm^2),在ADC图上,在病灶最大层面的最低信号处选取感兴趣区(ROI)测量ADC值。分析其与IDC分级和预后因子[雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER-2)及Ki-67]表达间的相关性。结果 216例IDC中,Ⅰ级42例,Ⅱ级98例,Ⅲ级76例,IDCⅠ级ADC值为(1.044±0.124)×10^(-3) mm^2/s;IDCⅡ级ADC值为(0.880±0.123)×10^(-3) mm^2/s;IDCⅢ级ADC值为(0.740±0.151)×10^(-3) mm^2/s;3组间两两比较,差异均有统计学意义(P <0.01);ADC值与IDC组织学分级呈负相关关系(r=-0.790,P <0.01)。216例IDC中,ER阳性和阴性组的ADC值分别为(1.060±0.089)和(1.130±0.015)×10^(-3) mm^2/s(P <0.01),PR阳性和阴性组的ADC值分别为(1.055±0.101)和(1.121±0.106)×10^(-3) mm^2/s(P <0.01),HER-2阳性和阴性组的ADC值分别为(1.093±0.103)和(1.023±0.083)×10^(-3) mm^2/s(P <0.01),Ki-67高表达和低表达组的ADC值分别为(1.063±0.101)和(1.153±0.090)×10^(-3) mm^2/s (P<0.01)。ADC值与ER、PR及Ki-67的表达呈负相关(r分别为-0.308,-0.298,-0.428,均P <0.01),而与HER-2表达呈正相关(r=0.198,P <0.01)。结论 ADC值能反映乳腺肿瘤细胞的生物学特征,它与IDC的组织学分级呈负相关,且与影响预后的分子指标(ER、PR、HER-2、Ki-67)表达存在一定相关性,提示ADC值在一定程度上可用于指导IDC组织学分级,进行术前评估和预测预后情况。

Objective To assess the correlations between apparent diffusion coefficient(ADC)value with histological grade and prognostic factors of invasive ductal carcinoma(IDC).Methods This retrospective study included 216 patients(224 lesions)with IDC verified by pathology from Jan 2015 to Sep 2017.Conventional MRI(T1WI,T2WI),DCE-MRI and diffusion weighted imaging(DWI)examination were performed at 1.5 T with diffusion coefficient of 50 and 800 s/mm 2.The region of interest(ROI)was drawn on the lowest signal intensity region within the largest lay of the lesion.The correlations between ADC values and histological grade and prognostic factors were analyzed.Results Among all IDC patients,42 cases are with IDC grade 1,98 cases with IDC grade 2,76 cases with IDC grade 3;and the mean ADCs of gradeⅠ,Ⅱ,ⅢIDC were(1.044±0.124)×10-3 mm 2/s,(0.880±0.123)×10-3 mm 2/s,(0.740±0.151)×10-3 mm 2/s,respectively.A statistically significant difference was found among them(P<0.01),as well as a negative correlation between ADC value and pathological grade(r=-0.790,P<0.01).The mean ADC values were significantly higher in the ER-negative than in the ER-positive cases[(1.130±0.015)×10-3 mm 2/s vs(1.060±0.089)×10-3 mm 2/s,P<0.01],in the PR-negative than in the PR-positive cases[(1.121±0.106)×10-3 mm 2/s vs(1.055±0.101)×10-3 mm 2/s,P<0.01],in the HER-2 positive than in the HER-2 negative cases[(1.093±0.103)×10-3 mm 2/s vs(1.023±0.083)×10-3 mm 2/s,P<0.01]and in the Ki-67 negative than in the Ki-67 positive cases[(1.153±0.090)×10-3 mm 2/s vs(1.063±0.101)×10-3 mm 2/s,P<0.01].There were negative correlations between ADC values and expression of ER,PR and Ki-67(r=-0.308,r=-0.298,r=-0.428,respectively.P<0.01),and a positive correlation between ADC value and expression of HER-2(r=0.198,P<0.01).Conclusion ADC values revealed the biological characteristics of breast cancer,and showed negative correlation and histological grade.Meanwhile,ADC values of invasive ductal carcinoma was correlated with ER,PR,HER-2 and Ki-67.DWI features to a certain extent reflect the biological behaviors and histological grade of breast cancer,which can provide evidence for clinical planning and prognosis of breast cancer.