探讨表观扩散系数与MRI技术在三阴型乳腺癌早期筛查中的应用价值

To Explore the Value of Apparent Diffusion Coefficient and MRI Technique in Early Screening of Triple-negative Breast Cancer

目的 探讨表观扩散系数(apparent diffusion coefficient, ADC)与动态对比增强MRI(Dynamic contrast enhanced MRI,DCE-MRI)技术进行早期筛查三阴型乳腺癌(Triple negative breast cancer, TNBC)的临床价值。方法 选取2015年1月至2022年1月于本院收治手术病理证实的乳腺癌患者94例作为研究对象,回顾性分析患者的临床资料,所有患者于术前均接受DCE-MRI检查,患者病灶ADC值与相对ADC(rADC)值于b=800 s/mm2时测量;根据免疫组化结果将乳腺癌患者分为Ⅰ组(确诊TNBC患者)与Ⅱ组(非TNBC患者),比较两组间ADC值、半定量参数、定量参数差异,绘制ROC曲线图分析诊断效能。结果 本组94例患者经过手术病理证实,其中确诊TNBC患者31例、非TNBC患者63例。结果Ⅰ组患者中TIC类型与Ⅱ组患者TIC类型对比,差异无统计学意义(P>0.05)。Ⅰ组患者ADC值、rADC1值检测水平高于Ⅱ组,差异有统计学意义(P<0.05),而Ⅰ组与Ⅱ组患者rADC2值对比,差异无统计学意义(P>0.05)。Ⅰ组与Ⅱ组患者TTP指标对比,差异有统计学意义(P<0.05),Ⅰ组与Ⅱ组患者W-out、W-in、Ve、Kep、Ktrans等参数对比,差异无统计学意义(P>0.05)。ADC+TTP联合诊断效能水平较单一ADC或TT诊断效能更高。结论 在TNBC的早期筛查诊断中使用DCE-MRI或ADC单独进行筛查均具有一定的诊断价值,但联合DCE-MRI+ADC筛查可更好的提高诊断准确率与诊断效能,值得推广。

Objective To observe the use of apparent diffusion coefficient(ADC) and dynamic contrast enhanced MRI(DCE-MRI)techniques for early screening of triple negative breast cancer(TNBC) of clinical value. Methods A total of 94 patients with breast cancer confirmed by surgery and pathology who were admitted to our hospital from January 2015 to January 2022 were included in this study. The clinical data of the patients were retrospectively analyzed. Value and relative ADC(rADC) value were measured at b=800 s/mm~2;breast cancer patients were divided into group Ⅰ(diagnosed TNBC patients) and Ⅱ(non-TNBC patients) according to the results of immunohistochemistry, and the ADC values between the two groups were compared, semi-quantitative parameters, quantitative parameter differences, draw ROC curve to analyze the diagnostic efficacy.Results Ninety-four patients in this group were confirmed by surgery and pathology, among which 31 were diagnosed with TNBC and 63 were non-TNBC. Results There was no significant difference between the TIC types in group Ⅰ and group Ⅱ(P>0.05). The detection levels of ADC value and rADC1 value in group Ⅰ were higher than those in group Ⅱ, with statistical significance(P<0.05), but there was no statistical significance in rADC2 value between group Ⅰ and group Ⅱ(P>0.05).The comparison of TTP indexes between group Ⅰ and group Ⅱ was statistically significant(P<0.05), and there was no statistical significance in the comparison of W-out, W-in, Ve, Kep, Ktrans and other parameters between group Ⅰ and group Ⅱ(P<0.05).The diagnostic efficacy level of ADC+TTP combination was higher than that of single ADC or TT.Conclusion The use of DCE-MRI or ADC screening alone in the early screening and diagnosis of TNBC has certain diagnostic value, but the combined DCE-MRI+ADC screening can better improve the diagnostic accuracy and diagnostic efficiency, which is worthy of promotion.