核磁共振弥散加权成像联合血清肿瘤标志物检测在乳腺癌诊断中的应用

Application of MR-DWI combined with detection of serum tumor markers in the diagnosis of breast cancer

目的探讨弥散加权成像(DWI)联合血清肿瘤标志物糖类抗原(CA)153、CA125和癌胚抗原(CEA)检测在乳腺癌诊断中的应用价值。方法选取乳腺结节患者143例,均完成DWI检查并计算表观扩散系数(ADC),同时检测血清CA153、CA125和CEA水平,并根据穿刺或手术病理检查结果将患者分为乳腺癌组和良性疾病组,比较两组DWI图像特征、ADC值和血清CA153、CA125和CEA水平,分析DWI和肿瘤标志物单独及联合应用对乳腺癌的诊断价值。结果143例患者经病理活检确诊为乳腺癌者86例,MRI检查显示T1WI低信号影71个,等信号影35个;fs-T2WI均表现为高信号或混杂信号;DWI均呈高信号,且乳腺癌病灶形状不规则、血管影增多、边界模糊、毛刺征及淋巴结肿大占比均高于良性病变(P<0.05);乳腺癌患者ADC值低于良性病变患者,血清CA153、CA125和CEA水平高于良性病变患者(P<0.05);血清CA153、CA125和CEA检测显示143例患者中阳性87例,阴性56例,诊断灵敏度和特异度分别为86.05%和77.19%;ROC曲线分析显示ADC诊断乳腺癌的AUC为0.831(95%CI:0.760~0.889),以≤1.204×10^-3mm^2/s为临界值时灵敏度为93.02%,特异度为66.67%;根据血清肿瘤标志物和ADC值进行联合诊断的灵敏度和特异度分别为90.60%和82.46%。结论DWI和血清肿瘤标志物CA153、CA125和CEA检测对乳腺癌诊断均具有良好参考价值,且联合应用可进一步提升诊断准确率。

Objective To investigate the application value of diffusion-weighted imaging(DWI)combined with detection of serum tumor markers of carbohydrate antigen(CA)153,CA125 and carcinoembryonic antigen(CEA)in the diagnosis of breast cancer.Methods We selected 143 patients with breast nodules.All patients underwent DWI examination,and the apparent diffusion coefficient(ADC)was calculated.At the same time,the levels of serum CA153,CA125 and CEA were measured.The patients were divided into breast cancer group and benign disease group based on the results of puncture or surgical pathology.The DWI image characteristics,ADC value and levels of serum CA153,CA125 and CEA were compared between the two groups.The diagnostic value of DWI,tumor markers and their combination on breast cancer was analyzed.Results Among the 143 patients,86 cases were diagnosed as breast cancer by pathological biopsy.MRI showed that there were 71 low-signal shadows and 35 equal-signal shadows in T1 WI.Fs-T2 WI showed high or mixed signals.DWI showed that high signals,and the proportions of breast cancer lesions with irregular shapes,increased angiography,blurred borders,spicule sign and lymphadenectasis were significantly higher than those of benign lesions(P<0.05).The ADC value of breast cancer patients was higher than that of patients with benign lesions.The levels of serum CA153,CA125 and CEA in breast cancer patients were higher than those of patients with benign lesions(P<0.05).The detection of serum CA153,CA125 and CEA showed that 87 patients were positive and 56 patients were negative among the 143 patients,and the diagnostic sensitivity and specificity were 86.05%and 77.19%,respectively.ROC curve analysis results showed that the AUC of ADC diagnosis of breast cancer was0.831(95%CI=0.760~0.889)and the sensitivity was 93.02%and the specificity was 66.67%when the threshold value was≤1.204×10^-3 mm^2/s.According to serum tumor markers and ADC value for diagnosis,the sensitivity and specificity were 90.60%and82.46%respectively.Conclusion DWI and detection of serum tumor markers CA153,CA125 and CEA have good reference value for breast cancer diagnosis,and the combined application can further improve the diagnostic accuracy rate.