在体^1H-MRS在肿块型浸润性乳腺癌分期诊断和预后评估中的应用价值

Value of in vivo^1H-MRS in staging diagnosis and prognostic evaluation of massive invasive breast cancer

目的:分析胆碱(Cho)浓度与浸润性乳腺癌组织学分级和病理分期的关系,探讨氢质子磁共振波谱(1H-magnetic resonance spectroscopy,1H-MRS)在乳腺癌术前分期和预后评估中的应用价值。方法:选取经手术证实的98例浸润性乳腺癌患者,使用3.0T MR扫描仪,于术前2周内行单体素1H-MRS检查,测量3.2 ppm处胆碱积分[I(Cho)]、胆碱与水积分比值[I(Cho)/I(Water)],应用非参数Kruskal-Wallis检验比较不同组织学分级和病理分期之间I(Cho)和I(Cho)/I(Water)的差异。结果:98例浸润性乳腺癌中,组织学分级Ⅰ级27例、Ⅱ级47例、Ⅲ级24例,病理分期Ⅰ期41例、Ⅱ期36例、Ⅲ期21例。I(Cho)和I(Cho)/I(Water)随着组织学分级和病理分期的增加而增高。组织学分级Ⅰ级、Ⅱ级、Ⅲ级间均存在显著性差异(P<0.05);病理分期Ⅰ期与Ⅲ期、Ⅱ期与Ⅲ期间差异亦有统计学意义(P<0.05)。结论:不同组织学分级和病理分期的乳腺癌Cho浓度不同,1H-MRS有助于浸润性乳腺癌的术前分期诊断和预后评估。

Objective To analyze the relationship between Cho and histological grading and pathological staging of invasive breast cancer,and to explore the application value of^1H-MRS in preoperative staging and prognosis of breast cancer.Methods A total of 98 patients with invasive breast cancer confirmed by surgery were examined using a 3.0T MR scanner.Monomer^1H-MRS was performed within 2 weeks before surgery,and the choline integral([I(Cho)])and ratio of choline integral to water integral([I(Cho)/I(Water)])at 3.2 ppm were measured.The differences in I(Cho)and I(Cho)/I(Water)ratios between different histological grades and pathological stages were compared using Kruskal-Wallis test.Results Among 98 cases of invasive breast cancer,27 cases were gradeⅠ,47 cases were gradeⅡand 24 cases were gradeⅢ;41 cases were stageⅠ,36 cases were stageⅡand 21 cases were stageⅢ.I(Cho)and I(Cho)/I(Water)ratios increased with increasing histological grade and pathological stage.Significant differences were found in histological gradesⅠ,Ⅱ,andⅢ(P<0.05);pathological stages were also significantly different between stagesⅠandⅢ,and stagesⅡandⅢ(P<0.05).Conclusion The total choline contents of breast cancer are diverse in different histological grades and pathological stages.^1H-MRS is helpful for the preoperative staging diagnosis and prognostic evaluation of invasive breast cancer.