外周血淋巴细胞亚群及病灶MRI特征辅助诊断乳腺癌ALN转移价值研究

Study on the added diagnostic value of peripheral blood lymphocyte subsets and MRI features for ALN metastasis in breast cancer

目的:探讨外周血淋巴细胞亚群及病灶磁共振成像(magnetic resonance imaging,MRI)特征与乳腺癌腋窝淋巴结(axillary lymph node,ALN)转移的相关性及其辅助提高ALN转移诊断准确度的价值。方法:回顾并分析348例乳腺癌外周血淋巴细胞亚群及其MRI特征,根据患者ALN外科评价结果将其分为ALN转移组和无转移组。分析临床病理学、外周血淋巴细胞亚群及乳腺MRI特征在两组患者中的差异,采用logistic回归分析乳腺癌ALN转移的独立影响因素,并采用受试者工作特征(receiver operating characteristic,ROC)曲线评价其诊断效能。结果:348例乳腺癌患者中ALN转移者103例和无转移者245例;多发病灶、人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阳性、Ki-67增殖指数>20%及淋巴管血管侵犯的患者易出现ALN转移(P<0.05)。总T淋巴细胞绝对数和细胞毒性T淋巴细胞绝对数在转移组患者中明显减低,且差异均有统计学意义(P分别为0.044和0.023)。MRI上病灶越大的患者越易发生ALN转移,且在两组患者中差异有统计学意义(P<0.001);按照MRI形态学诊断标准,本研究中共检出可疑ALN转移患者146例(42.0%),其诊断的灵敏度、特异度和准确度分别为77.7%、73.1%和74.4%。临床病理学特征及病灶MRI特征、淋巴结MRI形态学特征及两者联合3种方法诊断ALN转移的AUC分别为0.761、0.755和0.851。结论:外周血淋巴细胞亚群及病灶MRI特征与乳腺癌ALN转移有一定的相关性;临床病理学特征及病灶的MRI特征有助于提高乳腺癌ALN转移诊断的准确度。

Objective:To investigate the correlations of peripheral blood lymphocyte subsets and magnetic resonance imaging(MRI)features with axillary lymph node(ALN)metastasis of breast cancer and the value of improving the diagnosis accuracy of ALN metastasis.Methods:The data of peripheral blood lymphocyte subsets and MRI characteristics of 348 patients with breast cancer were retrospectively analyzed,and the patients were divided into lymph node metastasis group and non-metastasis group according to the results of surgical evaluation of ALNs.The differences in clinicopathology,peripheral blood lymphocyte subsets and breast MRI between the two groups were analyzed,and the independent factors of ALN of breast cancer were analyzed by logistic regression,and the diagnostic efficiency was evaluated by receiver operating characteristic(ROC)curve.Results:Among the 348 breast cancer patients,103 patients had ALN metastasis and 245 patients had no metastasis;and patients with multiple lesions,positive human epidermal growth factor receptor 2(HER2),Ki-67 proliferation index>20%and lymphovascular invasion were more likely to have ALN metastasis(P<0.05).The absolute numbers of total T lymphocytes and toxic T lymphocytes were decreased statistically in ALN metastasis group(P were 0.044 and 0.023,respectively).On MRI,patients with larger lesion size were more likely to have ALN metastasis(P<0.001);for MRI morphological diagnostic criteria,146(42.0%)patients with suspected ALN metastasis were detected in our study,and the sensitivity,specificity and accuracy were 77.7%,73.1%and 74.4%,respectively.For diagnosis of ALN metastasis,the AUCs of the methods of clinicopathology and lesion MRI,MRI morphological diagnostic criteria and the combined were 0.761,0.755 and 0.851,respectively.Conclusion:The clinicopathology,peripheral blood lymphocyte subsets and lesion MRI features were correlated with ALN metastasis in breast cancer,and clinicopathological and lesion MRI features are helpful to improve the accuracy of diagnosis of ALN metastasis.