双层探测器光谱CT评估乳腺癌患者免疫组化表达的价值

The value of dual-layer detector spectral CT in evaluation of immunohistochemical expression in breast cancer patients

目的探讨双层探测器光谱CT在术前评估乳腺癌患者免疫组化表达水平的价值。方法回顾性分析2020年10月至2021年1月在西南医科大学附属医院术前接受光谱CT胸部扫描的乳腺癌患者的临床、病理及影像资料。共纳入70例患者,根据免疫组化分为雌激素受体(ER)阳性或阴性、孕激素受体(PR)阳性或阴性、人类表皮生长因子受体2(HER2)阳性或阴性、细胞增殖相关核抗原(Ki-67)阳性或阴性。采用Philips工作站及Spectral Diagnostic Suite软件分析所有图像,记录病灶CT值及碘浓度(IC)值,病灶动、静脉期有效原子序数(Z_(eff)),并计算动、静脉期标准化CT值(NCT)、标准化碘浓度(NIC)值、keV-CT值曲线斜率(K)以及动静脉期CT差值、动静脉期IC差值。采用独立样本t检验比较免疫组化指标阳性与阴性患者能谱参数的差异,并采用ROC曲线分析能谱参数鉴别诊断不同免疫组化指标阳性与阴性的效能。结果ER阴性患者动脉期及静脉期Z_(eff)、NIC、K值、CT值、IC值和静脉期NCT均高于ER阳性患者,差异具有统计学意义(P<0.05);HER2阳性患者静脉期Z_(eff)、NIC、K值、IC及动静脉期CT差值、动静脉期IC差值高于阴性患者,差异具有统计学意义(P<0.05);Ki-67阳性患者动脉期K值大于阴性患者,差异具有统计学意义(P<0.05)。以动脉期K值=1.22作为阈值,其鉴别诊断ER阳性与阴性的效能最高(曲线下面积0.791,灵敏度84.00%,特异度65.00%);以动静脉期IC差值为0.47 mg/ml作为阈值,其鉴别诊断HER2阳性与阴性的效能最高(曲线下面积0.736,灵敏度76.32%,特异度65.62%)。结论双层探测器光谱CT对乳腺癌患者免疫组化表达有一定的诊断价值,可以为临床诊疗提供参考。

Objective To investigate the value of dual-layer detector spectral CT in preoperative evaluation of immunohistochemical expression levels in breast cancer patients.Methods The clinical,pathological and imaging data of breast cancer patients who received preoperative spectral CT chest scan in Affiliated Hospital of Southwest Medical University from October 2020 to January 2021 were retrospectively analyzed.A total of 70 patients were divided into positive or negative estrogen receptor(ER)group,positive or negative progesterone receptor(PR)group,positive or negative human epithelial growth factor receptor 2(HER2)group,and positive or negative Ki-67 group according to the immunohistochemistry.Philips workstation and Special Diagnostic Suite software were used for processing and analysis.The CT value and iodine concentration value(IC)of the lesion and the effective atomic number(Z_(eff))of the lesion in the arterial and venous phases were measured,and the standardized CT value(NCT),standardized iodine concentration value(NIC),slope(K)of the keV-CT value curve in the arterial and venous phases as well as the CT difference and the IC difference in the arteriovenous phase were calculated.Independent sample t test was used to compare the differences in spectral parameters between patients with positive and negative immunohistochemical parameters,and ROC curve was used to analyze the efficacy of spectral parameters in the differential diagnosis of positive and negative different immunohistochemical parameters.Results Z_(eff),NIC,K value,CT value,IC value of arterial and venous phase and NCT value of venous phase in negative ER group were higher than those in positive ER group,the difference was statistically significant(P<0.05).Z_(eff),NIC,K value,IC,CT difference in arteriovenous phase and IC difference in arteriovenous phase in positive HER2 group were higher than those in negative HER2 patients,the difference was statistically significant(P<0.05).The arterial K value in positive Ki-67 group was higher than that in negative Ki-67 group,the difference was statistically significant(P<0.05).Taking arterial phase K value of 1.22 as the diagnostic threshold,it had the highest diagnostic efficiency in differential diagnosis of ER positivity versus negativity(area under curve of 0.791,sensitivity of 84.00%,specificity of 65.00%).Taking the arteriovenous phase IC difference of 0.47 mg/ml as the diagnostic threshold,it had the highest performance in differential diagnosis of HER2 positivity versus negativity(area under curve of 0.736,sensitivity of 76.32%,specificity of 65.62%).Conclusion Dual-layer detector spectral CT has certain diagnostic value for the immunohistochemical expression of breast cancer patients,which can provide reference for clinical diagnosis and treatment.