摘要
目的探讨术前乳腺MRI联合腋窝超声预测乳腺浸润性导管癌脉管侵犯(LVI)状态的价值。方法回顾性分析2014年3月至2017年12月在山西省肿瘤医院就诊的160例乳腺浸润性导管癌患者的临床、病理及术前影像学资料。患者均为女性,年龄25~74(49±10)岁。依据术后大体病理标本确定的LVI状态分为LVI阳性组56例,LVI阴性组104例。采用独立样本t检验、Mann-Whitney U检验或χ^(2)检验比较LVI阳性组与LVI阴性组的临床指标、病理特征及影像学特征的差异。采用多因素logistic回归分析筛选预测LVI的独立危险因素,并构建预测模型。采用受试者操作特征(ROC)曲线及曲线下面积评估模型预测LVI的效能,用Hosmer-Lemeshow检验评估模型的校准度。结果LVI阳性组与LVI阴性组患者的年龄、绝经状态、雌激素受体状态、孕激素受体状态、人表皮生长因子受体2状态、Ki67及分子亚型差异均无统计学意义(P>0.05);LVI阳性组与LVI阴性组患者的肿瘤最大径、瘤周水肿、周围血管征、多灶或多中心、瘤周最大表观扩散系数(ADC)、瘤周-肿瘤ADC比值、MRI腋窝淋巴结阳性及超声腋窝淋巴结阳性差异均有统计学意义(P<0.05)。将单因素分析中有统计学意义的指标纳入到多因素logistic回归分析中,结果显示瘤周水肿(OR=3.367,95%CI 1.382~8.201,P=0.008)、多灶或多中心(OR=4.026,95%CI 1.268~12.776,P=0.018)、瘤周-肿瘤ADC比值高(OR=7.321,95%CI 2.226~24.079,P=0.001)及超声腋窝淋巴结阳性(OR=6.779,95%CI 2.819~16.303,P<0.001)为LVI的独立危险因素。以上述4项指标构建logistic回归模型,ROC显示该模型预测LVI的曲线下面积为0.882,优于其中任何单一指标(P<0.05);其预测LVI的灵敏度为80.36%,特异度为84.62%。Hosmer-Lemeshow检验表明该预测模型具有良好的校准能力(P=0.503)。结论术前乳腺MRI联合腋窝超声构建的预测模型有助于预测乳腺浸润性导管癌LVI状态。
Objective To investigate the value of preoperative breast MRI combined with axillary ultrasound in predicting lymphovascular invasion(LVI)of breast invasive ductal carcinoma.Methods The clinical,pathological and imaging features of 160 female patients[age 25-74(49±10)years]with breast invasive ductal carcinoma from March 2014 to December 2017 in Shanxi Cancer Hospital were retrospectively analyzed.According to the LVI status determined by postoperative pathology,160 patients were divided into LVI positive group(56 cases)and LVI negative group(104 cases).The clinical characteristics,pathological characteristics and imaging features of LVI positive group and LVI negative group were compared by the independent t test,Mann-Whitney U test orχ^(2)test.Multivariate logistic regression analysis was performed to identify independent predictors for predicting LVI and construct a predictive model.The receiver operating characteristic(ROC)curve and area under the curve(AUC)was used to evaluate the discrimination of the prediction model,and the Hosmer-Lemeshow test was used to evaluate its calibration.Results There was no significant difference in age,menopausal status,estrogen receptor,progesterone receptor,human epidermal growth factor 2,Ki67 index and molecular subtype between LVI positive group and negative group(P>0.05).Tumor size,peritumoral edema,adjacent vessel sign,multifocality or multicentricity,peritumoral maximum-apparent diffusion coefficient(ADC),peritumour-tumour ADC ratio,MRI axillary lymph node status and ultrasound axillary lymph node status between LVI positive group and LVI negative group showed significantly statistical difference(P<0.05).Variables with significant difference in the univariate analysis were entered into multivariate logistic regression analysis to explore predictors for LVI.Peritumoral edema(OR=3.367,95%CI 1.382-8.201,P=0.008),multifocality or multicentricity(OR=4.026,95%CI 1.268-12.776,P=0.018),high peritumoral-tumor ADC ratio(OR=7.321,95%CI 2.226-24.079,P=0.001)and positive ultrasound axillary lymph node(OR=6.779,95%CI 2.819-16.303,P<0.001)were independent predictors for predicting LVI.A logistic regression model was constructed using the above four indicators,and ROC showed AUC of this model for predicting LVI was 0.882,superior to any of the single indicator(P<0.05);its sensitivity was 80.36%and specificity was 84.62%.Hosmer-lemeshow test showed that the prediction model had good calibration(P=0.503).Conclusion The combined prediction model constructed by preoperative breast MRI and axillary ultrasound could help to predict the LVI status of breast invasive ductal carcinoma.
作者
张俊杰
崔艳芬
杨晓棠
苗燕
张婷
杨钊
Zhang Junjie;Cui Yanfen;Yang Xiaotang;Miao Yan;Zhang Ting;Yang Zhao(Department of MR&CT,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China;Department of Ultrasound,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2023年第1期60-66,共7页
Chinese Journal of Radiology
基金
国家自然科学基金(82171923,82001789)。
关键词
乳腺肿瘤
磁共振成像
超声检查
脉管侵犯
Breast neoplasms
Magnetic resonance imaging
Ultrasonography
Lymphovascular invasion