基于MRI-T2WI乳腺浸润性癌乳腺水肿与临床病理因素的相关性研究

The Association Between Breast Edema of Invasive Breast Cancer on MRI T2-Weighted Imaging and Clinical-Pathologic Factors

目的:探究基于术前3.0 T MR-T2WI脂肪抑制序列乳腺浸润性癌乳腺内各类型水肿与临床病理因素的相关性。方法:回顾性分析术前行MRI检查并经穿刺活检或手术病理证实的166例乳腺浸润性癌患者。乳腺水肿定义为T2WI脂肪抑制序列肿瘤周围的水样高信号,根据T2WI脂肪抑制序列影像表现分成1级(无水肿)、2级(瘤周水肿)和3级(胸前区和/或皮下水肿)。采用χ^(2)检验分析各类型水肿与临床病理因素的关系。结果:(1)乳腺内水肿与绝经状态(P=0.03)、肿瘤大小(P<0.001)、组织学分级(P<0.001)、Ki-67表达(P=0.008)、雌激素受体(ER)状态(P=0.021)和孕激素受体(PR)状态(P=0.009)、不同分子分型(P=0.002)、腋窝淋巴结转移(P=0.009)等临床病理因素均具有显著相关性。(2)各类型水肿组间比较显示,绝经后患者更多表现为2级水肿,肿瘤越大、腋窝淋巴结转移者可出现2级和3级水肿,组织学Ⅲ级、Ki-67高表达、ER及PR阴性、分子分型为HER2阳性型及三阴型者更多表现为3级水肿。结论:乳腺浸润性癌乳腺水肿与临床病理因素具有一定的相关性,T2WI脂肪抑制序列检测乳腺水肿可作为乳腺癌术前临床病理因素的预测指标之一,对判断肿瘤的侵袭性、评估患者的预后有一定的意义,能为乳腺癌术前评估提供额外的预测信息。

Purpose:To investigate the association between different patterns of breast edema in patients with invasive breast cancer on preoperative 3.0 T MR T2-weighted imaging with fat suppression sequence and clinicalpathologic factors.Methods:A total of 166 patients with invasive breast cancer who had undergone preoperative MRI and confirmed by puncture biopsy or surgical pathology results were retrospectively enrolled.Breast edema was defined as water-like high intensity signal surrounding the tumor on fat-suppressed T2-weighted images,and was divided into 3 grades:grade 1,no edema;grade 2,peritumoral edema;grade 3,pre-pectoral and/or subcutaneous edema.The relationship between different grades of breast edema and clinical-pathologic factors of invasive breast cancer was evaluated using the χ^(2) test.Results:(1)There was significant association between breast edema and clinical-pathologic factors,including menopausal status(P=0.03),tumor size(P<0.001),histological grade(P<0.001),Ki-67 expression(P=0.008),estrogen receptor(ER)status(P=0.021),progesterone receptor(PR)status(P=0.009),different molecular subtypes(P=0.002)and axillary lymph node metastasis(P=0.009).(2)The comparison between groups of different grades of edema showed that the postmenopausal patients were more likely to show grade 2,the larger tumor size and axillary lymph node metastasis were more frequently found in grade 2 and grade 3,the histological gradeⅢand Ki-67 index,ER-negative,PR-negative,the molecular subtypes of HER2-overexpressing and triple-negative were more likely to show grade 3.Conclusion:There is a certain association between breast edema and clinical-pathologic factors,the detection of breast edema on fat-suppressed T2-weighted images should be used as one of clinical-pathologic factors predictors of preoperative breast cancer,and has certain significance in judging tumor invasiveness and evaluating the prognosis of patients,and it can provide additional value for preoperative evaluation of breast cancer.