3.0T-MRI表观扩散系数在乳腺癌预后和病理分型的应用价值

Study on the Application Value of 3.0T-MRI Apparent Diffusion Coefficient in Prognosis and Pathological Type of Breast Cancer

目的探讨3.0T-MRI表观扩散系数在乳腺癌预后和病理分型的应用价值。方法回顾性收集2018年2月~2022年1月于我院诊断为乳腺癌患者136例纳入试验组。根据5年内随访情况分为未复发组(104例)和复发组(32例)。同期选择136例术后病理证实良性肿瘤患者为对照组。收集受试者的一般资料、病理资料及ADC值。比较试验组与对照组患者的DWI信号强度分布情况,不同b值下不同病理类型乳腺癌ADC平均值,ROC曲线分析ADC对乳腺癌病理分型的预测价值;比较未复发组和复发组患者的一般临床资料,使用Logistic回归分析患者复发的影响因素,ROC曲线分析ADC值对乳腺癌患者术后复发的预测价值,并进行生存曲线分析。结果试验组的ADC值明显低于对照组;不同病理类型均表现为,b=2000s/mm^(2)时的ADC值低于b=1000s/mm^(2)时的ADC值;b分别为1000s/mm^(2)、2000s/mm^(2)时试验组和对照组均表现为,浸润型癌(小叶原位癌、导管内原位癌)平均ADC值明显低于非浸润型癌(浸润型导管癌、浸润型小叶癌);b值分别为1000s/mm^(2)、2000s/mm^(2)时,ADC对乳腺癌病理分型的预测AUC分别为0.718(95%CI:0.692~0.852,P<0.001)、0.846(95%CI:0.724~0.872,P<0.001);ADC值是影响患者术后复发的独立因素;ADC值取1.046×10^(-3)mm^(2)/s时,具有较高的敏感度(83.46%)和特异度(76.33%),ROC曲线下面积(AUC)为0.718。根据术后复发ADC最佳临界值1.046×10^(-3)mm^(2)/s将试验组患者分为高风险组(38例)和低风险组(98例),高风险组患者5年复发风险为92.11%(35/38)明显高于低风险组76.53%(75/98);差异有统计学意义(P<0.05)。结论DWI对乳腺癌良恶性评估有一定临床意义;不同b值下ADC值对于乳腺癌病理分型有一定的临床诊断意义,且可为预测乳腺癌患者术后5年复发情况提供依据。

Objective To explore the application value of 3.0T-MRI apparent diffusion coefficient in prognosis and pathological type of breast cancer.Methods 136 patients with breast cancer diagnosed in our hospital from February 2018 to January 2022 were collected and included in the trial group.According to the follow-up within 5 years,the patients were divided into non-recurrence group(n=104)and recurrence group(n=32).In the same period,136 patients with non-malignant tumors confirmed by postoperative pathology were selected as the control group.The general clinical data,pathological data and ADC value of breast cancer patients were collected.The distribution of DWI signal intensity was compared between the experimental group and the control group,the average value of ADC in different pathological types of breast cancer under different b values,and the predictive value of ADC in pathological type of breast cancer analyzed by ROC curve.The general clinical data of nonrecurrent group and recurrent group were compared.Logistic regression analysis was used to analyze the independent risk factors of postoperative recurrence of breast cancer patients.Results the ADC value of the trial group was lower than that of the control group,and the average ADC value of invasive carcinoma(lobular carcinoma in situ and ductal carcinoma in situ)was lower than that of non-invasive carcinoma(invasive ductal carcinoma and invasive lobular carcinoma)when b was 1000s/mm^(2)and 2000s/mm^(2),respectively.When the b values were 1000s/mm^(2)and 2000s/mm^(2)respectively,the AU C of ADC for pathological type of breast cancer were 0.718(95%CI:0.692~0.852,P<0.001)and 0.846(95%CI:0.724~0.872,P<0.001).ADC value was an independent risk factor for postoperative recurrence of breast cancer.When the ADC value is 1.046×10^(-3)mm^(2)/s,it had high sensitivity(83.46%)and specificity(76.33%),and the AU C was 0.718.According to the optimal critical value of postoperative recurrence ADC 1.046×10^(-3)mm^(2)/s,the patients in the trial group were divided into high risk group(n=38)and low risk group(n=98).The 5-year recurrence risk in high risk group(92.11%)was significantly higher than that in low risk group(76.53%).Conclusion DWI has certain clinical significance in the evaluation of benign and malignant breast cancer,the DWI images of breast cancer patients are mainly high signal intensity,and the ADC values under different b values have certain clinical significance for the pathological type of breast cancer,and can provide a basis for predicting the recurrence of breast cancer patients 5 years after operation.