双源双能量CT定量评价预测乳腺癌腋窝淋巴结(ALNs)转移

Quantitative Prediction of Axillary Lymph Node Metastasis(ALNs)in Breast Cancer by Dual Source Dual Energy CT

目的 评价双能量CT定量参数对乳腺癌患者转移性腋窝淋巴结(ALNs)的诊断效能。方法 连续收集2018年6月至2021年03月期间于张家港澳洋医院行双能量增强CT检查的26名女性乳腺癌患者的资料。采用卡方检验及计量资料统计方法分析比较转移性和非转移性ALNs的双能量CT定量参数和形态学表现。通过受试者工作特征曲线(ROC曲线)分析形态学和定量参数的诊断效能,计算其敏感性、特异性及准确性。使用多因素logistic回归模型分析ALNs的危险因素。结果 研究共纳入26名女性乳腺癌患者,共纳入141个ALNs,根据组织病理学结果分为两组:转移性ALNs (59个)和非转移性ALNs (82个)。转移性ALNs的静脉期能量曲线斜率(λHu)、静脉期标准化碘浓度(nIC)及静脉期标准化有效原子数(nZeff)均高于非转移性ALNs。ROC曲线分析显示,CT定量参数中的静脉期能量曲线斜率(λHu)对乳腺癌ALNs转移的诊断效能高于常规形态学参数。Logistic回归分析表明,静脉期λHu与静脉期nIC是预测转移性ALNs的最佳参数指标。结论 双能量CT定量参数可作为鉴别乳腺癌患者ALNs的一种补充的非侵入性检查方法。

Objective To evaluate the diagnostic efficiency of dual-energy CT quantitative parameters for metastatic axillary lymph nodes(ALNs)in breast cancer patients.Methods Twenty-six female patients with breast cancer who underwent dual-phase enhanced CT examination in Zhangjiagang Aoyoung Hospital from June 2018 to March 2021 were collected.The quantitative parameters and morphological features of dual-energy CT of metastatic and non-metastatic ALNs were analyzed and compared by chi-square test and measurement data.The diagnostic efficacy of morphological and quantitative parameters was analyzed by receiver operating characteristic(ROC)curves,and sensitivity,specificity,and accuracy were calculated.Multivariate logistic regression model was used to predict the risk factors for ALNs.Results A total of 141 ALNs were included in 26 women with breast cancer,divided into two groups based on histopathology:metastatic ALNs(59)and non-metastatic ALNs(82).Among the quantitative parameters of dual-energy CT,the slope of energy spectrum curve(λHu)in the venous phase,the standardized iodine concentration(nIC)in the venous phase and the standardized effective atomic number(nZeff)in the venous phase of the metastatic ALNs were all higher than those in the non-metastatic ALNs.ROC curve analysis showed that the slope of energy spectrum curve(λHu)of CT quantitative parameters was more effective than conventional morphological parameters in the diagnosis of breast cancer ALNs metastasis.Logistic regression analysis showed that the slope of venous energy spectrum curve(λHu)was the best parameter to detect metastatic ALNs.Conclusion Dual-energy CT quantitative parameters can be used as a complementary non-invasive method to identify ALNs metastasis in breast cancer patients.