三阴性乳腺癌磁共振影像特征的多因素及其诊断价值分析

A multivariate analysis of magnetic resonance imaging characteristics of triple negative breast cancer and their diagnostic value

目的三阴性乳腺癌(TNBC)磁共振(MRI)影像特征的多因素及其诊断价值分析。方法选取免疫组织化学检查雌激素受体(ER)、孕激素受体(PR)及人表皮生长因子受体2(HER-2)表达均为阴性的48例TNBC癌患者作为TNBC组,86例非三阴性乳腺癌(nTNBC)患者作为nTNBC组;比较2组患者的临床资料(年龄、肿瘤大小、绝经情况及乳腺癌家族史)、病理学结果(肿瘤病理类型及分级)、MRI影像学特征指标[病灶数及形态、强化方式、T2加强成像(T2WI)信号、瘤周血管增多、边界、时间-信号强度曲线(TIC)大小及表观弥散系数(ADC)值],采用多因素Logistic回归分析有差异的MRI影像学特征作为TNBC的独立影响因素,采用MRI影像学特征因素的受试者工作特征(ROC)曲线下面积(AUC)评价这些独立影响因素及联合分析对TNBC的诊断价值。结果2组患者年龄、病理类型及分级比较,差异有统计学意义(P<0.05);而2组患者的瘤体大小、绝经情况及家族史比较,差异无统计学意义(P>0.05);多因素Logistic回归分析结果显示病灶环形强化(OR=0.023,95%CI为0.001~0.962)、高T2WI信号(OR=0.023,95%CI为0.009~0.498)、瘤周血管增多(OR=0.036,95%CI为0.003~0.378)为预测TNBC的独立危险因素(P<0.05),边界特征不是TNBC的独立危险因素;病灶强化方式AUC=0.736(95%CI为0.636~0.836)、T2WI信号AUC=0.693(95%CI为0.588~0.799)、瘤周血管情况AUC=0.778(95%CI为0.695~0.862)及联合考虑(病变强化+T2WI+瘤周血管)AUC=0.976(95%CI为0.954~0.999)。结论TNBC的MRI表现具有一定特征性,环形强化、高T2WI信号、瘤周血管增多的影像学表现对临床上TNBC诊断具有一定提示性,特别是联合诊断的价值更高。

Objective To explore the magnetic resonance imaging characteristics of triple negative breast cancer(TNBC) and their diagnostic level. Methods In this retrospective study,134 patients with breast cancer(BC) confirmed by surgery and pathology were gathered and divided into two groups(TNBC group,n = 48 and non-triple negative breast cancer,nTNBC group,n = 86). Their preoperative MR images and clinical data were collected,and their clinicopathological features(age,tumor size,menopausal status,BC family history,tumor pathological type and grading) and MR signs(number,shape,degree of enhancement of lesions,T2WI signal,increased peritumor blood vessels,boundary,TIC,and ADC) were analyzed. Single-factor and multivariate analysis were employed to draw the receiver operating characteristic(ROC) curves and to calculate AUC. Results The age of TNBC patients was younger than that of the n TNBC group. There were no significant differences between the menopausal patients and the patients with family history. In terms of pathological features,most TNBC patients were invasive ductal carcinoma,grade Ⅲ. Among MR signs,multivariate Logistic regression analysis showed that tumor enhancement mode(OR = 0. 023,95% CI was 0. 001-0. 962),T2WI signal(OR = 0. 023,95% CI was 0. 009-0. 498),peritumor blood vessels(OR = 0. 036,95% CI was 0. 003-0. 378) were independent risk factors for predicting TNBC, and the corresponding AUC values were 0. 736(95% CI was 0. 636-0. 836),0. 693(95% CI was 0. 588-0. 799),0. 778(95% CIwas 0. 695-0. 862) and 0. 976(combined consideration,95% CI was 0. 954-0. 999),respectively. Conclusion The MR features of TNBC have certain characteristics,including ring enhancement,high T2WI signal,and increased peritumor blood vessels,which have certain suggestive value for clinical TNBC diagnosis,especially in combined diagnosis.