定量DCE-MRI参数、ADC值与乳腺癌p53、CK56表达状态相关性研究

Correlation between quantitative DCE-MRI parameters,ADC values and the expressions of p53 and CK56 in breast cancer

目的探讨定量动态增强磁共振成像(DCE-MRI)参数、表观扩散系数(ADC)值与乳腺癌抑癌基因p53、角蛋白56(CK56)表达状态的相关性。方法回顾性分析145例表现为p53、CK56不同表达状态的女性乳腺癌病人资料。病人年龄25~95岁,平均(51.2±11.6)岁。依据p53、CK56结果将病人分为阳性组和阴性组,其中p53阳性者77例,阴性者60例;CK56阳性者31例,阴性者58例。所有病人术前均行乳腺DCE-MRI和扩散加权成像检查。采用t检验比较阳性组与阴性组间病人DCE-MRI定量参数[容积转移常数(Ktrans)、速率常数(k_(ep))、血管外细胞外间隙容积比(ve)]、半定量参数[对比剂流入浓度强化率(W-in)、对比剂流出浓度衰减率(W-out)、对比剂浓度达峰时间(TTP)]及ADC值的差异,采用Spearman相关分析上述变量与p53、CK56表达状态的相关性,采用受试者操作特征(ROC)曲线分析并计算其敏感度、特异度和相应曲线下面积(AUC)。结果p53阳性组的k_(ep)、W-in值高于阴性组,而W-out值低于阴性组(均P<0.05);CK56阳性组的ADC值低于阴性组(P<0.05)。p53表达状态与k_(ep)、W-in、W-out均呈弱相关(均P<0.05),CK56表达状态与ADC值呈弱相关(P<0.05)。比较k_(ep)、W-in、W-out及三参数联合的诊断效果,W-out值诊断p53阳性的敏感度最高(0.850),k_(ep)值和三参数联合诊断p53阳性的特异度最高(0.900),三参数联合诊断p53阳性的AUC最高(0.640),k_(ep)的AUC最低(0.609),三参数联合较单参数k_(ep)的诊断效能提高了3.1%;ADC值鉴别CK56阳性的敏感度、特异度和AUC分别为0.862、0.548和0.657。结论定量DCE-MRI参数k_(ep)、W-in、W-out能够鉴别p53表达状态,ADC值能够鉴别CK56表达状态,但诊断效能均偏低。

Objective To investigate correlation between quantitative DCE-MRI parameters,ADC values and the expressions of breast tumor suppressor genes p53 and cytokeratin 56(CK56).Methods The data of 145 breast cancer women with different expression levels of p53 and CK56 were retrospectively analyzed.The age range of all patients was 25-95 years,and the mean age was 51.2±11.6 years.Patients were divided into positive group and negative group according to the expressions of p53 and CK56.Among them,77 patients were p53-positive and 60 patients were p53-negative,31 patients were CK56-positive and 58 patients were CK56-negative.All patients underwent preoperative DCE-MRI and diffusion-weighted imaging scans.DCE-MRI quantitative parameters(Ktrans,k_(ep),and ve),semiquantitative parameters(W-in,W-out,and TTP),and ADC values were compared between positive and negative groups by using the t test,and Spearman correlation was used to analyze the correlation among above parameters,p53,and CK56 status.The sensitivity,specificity,and area under the curve(AUC)were calculated by receiver operating characteristic(ROC)curve analysis.Results The values of k_(ep) and W-in were higher in the p53 positive group than in the negative group,and the value of W-out was lower in the p53 positive group than in the negative group(all P<0.05).ADC value was lower in the CK56 positive group than in the negative group(P<0.05).The p53 expression had weak correlations with k_(ep),W-in,and W-out(all P<0.05),the CK56 expression had a weak correlation with the ADC values(P<0.05).Comparing the diagnostic efficiency k_(ep),W-in,W-out,and combining three parameters,the W-out achieved the highest sensitivity of 0.850,the k_(ep) and the combination of three parameters achieved the highest specificity of 0.900 in predicting p53 positive status.The combination of three parameters achieved the highest AUC of 0.640 in predicting p53 positive status,with 3.1%AUC increase compared with the lowest AUC of 0.609 from k_(ep).The sensitivity of 0.862,specificity of 0.548,and AUC of 0.657 for ADC were achieved in predicting CK56 positive status.Conclusion The quantitative DCE-MRI parameters of k_(ep),W-in,and W-out might be able to predict p53 status,and ADC value might be able to predict CK56 status,but both with lower diagnostic efficiency.