MRI在乳腺癌空芯针穿刺活检与手术标本检测Ki-67表达差异中的预测价值

Predictive Value of MRI in Differences of Ki-67 Index Between Core Needle Biopsy and Surgical Specimens in Breast Cancer Patients

目的探讨MRI在空芯针穿刺活检(CNB)与手术切除标本检测乳腺癌Ki-67表达差异中的预测价值。方法回顾性分析2017年1月至2017年12月术前行MRI检查的乳腺癌患者87例,对比CNB标本和手术切除标本Ki-67的表达指数。根据CNB与术后Ki-67改变值分为增高组和未增高组,进行Logistic回归分析筛选术后Ki-67表达增高的影响因素。结果 CNB与手术切除标本Ki-67指数呈显著正相关(r=0.787),且具有较高的一致性[组内相关系数(ICC)=0.781]。CNB标本Ki-67指数明显低于手术切除标本(均数41.4%±24.5%vs.49.4%±26.1%,Z=-3.953,P<0.001)。此外,以Ki-67截断值为20%区分高增殖及低增殖,手术切除标本Ki-67高增殖病灶增加(χ2=34.548,P<0.001)。单因素及多因素Logistic回归分析显示,非Luminal型乳腺癌(OR=3.705,95%CI:1.180~11.634,P=0.025)与瘤周水肿(OR=4.161,95%CI:1.498~11.556,P=0.006)是影响切除术后Ki-67表达增高的主要因素。结论 Ki-67指数在CNB与手术标本检测存在差异,术后Ki-67指数高于CNB。非Luminal型乳腺癌、 MRI检查发现瘤周水肿是术后Ki-67表达增高的独立影响因素。

Objective To investigate the predictive value of MRI in the expression changes of Ki67 between core needle biopsy(CNB) and surgical specimens in breast cancer. Methods A total of 87 breast cancer patients with preoperative MRI between January 2017 and December 2017 were retrospectively analyzed. The Ki-67 index of CNB was compared with that of surgical excision. According to the expression changes of Ki67 between CNB and surgical specimens, the patients were divided into two groups(the increased group and the non-increasedgroup)and the factors influencing the expression changes of Ki67 were analysed by logistic regression analysis. Results Positive correlation(r=0.787) and good consistency(ICC=0.781)were demonstrated between CNB and surgical specimens. The Ki-67 index was significantly lower in CNB than in surgical specimens[mean 41.4%±24.5% vs. 49.4%±26.1%,Z=-3.953,P<0.001]. When a Ki-67 cutoff value(20%) was used for determining high proliferation and low proliferation, Ki-67 high proliferation lesions show significantly increased in surgical specimen(χ2=34.548,P<0.001). Univariate and multivariate logistic analysis proved that non Luminal-like breast cancers(OR=3.705,95% CI:1.180 ~11.634,P=0.025) and the presence of perilesional edema at MRI(OR=4.161,95% CI:1.498 ~11.556,P=0.006)was the main factor leading to the Ki-67 increase after surgery. Conclusion A significant difference in the Ki-67 index between biopsy and surgical specimens exists.The Ki-67 index is higher in surgical specimen than in core needle biopsies. The non Luminal-like breast cancers and the presence of perilesional edema at MRI are the independent influencing factors for Ki-67 increase.