瘤周最大ADC联合T2WI影像征象对淋巴结阴性浸润性乳腺癌脉管侵犯的预测价值

Peritumoral Maximum ADC and T2WI Imaging Features as Predictors of Lymphovascular Invasion in Node-negative Invasive Breast Cancer

目的探讨瘤周最大表观扩散系数(ADC)联合T2WI影像征象对淋巴结阴性浸润性乳腺癌脉管侵犯(LVI)的预测价值。方法收集150例淋巴结阴性浸润性乳腺癌患者,按术后LVI状态分为LVI+组25例,LVI-组125例,获得两组临床资料及MRI影像表现。采用χ^(2)/t检验对两组数据进行统计学分析,对两组有统计学差异变量绘制ROC曲线,分析其诊断效能。利用二元Logsitic回归选择与LVI相关变量建立模型,绘制ROC曲线评价此模型诊断效能。结果两组绝经史、组织学分级、雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(Her-2)、Ki-67、雄激素受体(AR)、表皮生长因子(EGFR)、钙黏蛋白E(E-Cad)表达、分子亚型差异无统计学意义(P>0.05);两组肿瘤形状、边缘、内部强化特征、TIC、肿瘤最大径、早期强化率、峰值强化率、肿瘤ADC值差异无统计学意义(P>0.05);而瘤周水肿、瘤周最大ADC值差异有统计学意义(P<0.05);瘤周水肿、瘤周最大ADC值对LVI的AUC为0.672、0.762,二者联合的AUC为0.787。结论瘤周最大ADC、瘤周水肿对淋巴结阴性浸润性乳腺癌LVI的预测有一定的价值,前者的诊断效能优于后者,二者联合可提高诊断的特异度。

Objective To evaluate the value of peritumoral maximum ADC combined with T2WI features for predicting lymphovascular invasion(LVI)in node-negative invasive breast cancer.Methods 150 patients with node-negative invasive breast cancers were divided into LVI+group(n=25)and LVI-group(n=125)according to postoperative LVI status.Clinical data and MRI manifestations of two groups were obtained.χ^(2)/t test was used to analyze differences.The ROC curves were drawn for the variables with statistical difference and diagnostic value was analyzed.Binary Logistic regression was used to select the variables related to LVI.The model was established and ROC curves drawn to evaluate diagnostic value.Results No significant difference was found for menopausal history,histological grade,ER,PR,Her-2,Ki67,AR,EGFR,E-Cad expressions and molecular subtypes(P>0.05).No significant difference was found for tumor shapes,margin,internal enhancement,TIC,maximum diameter,early enhancement rate,peak enhancement rate and ADC values(P>0.05).Significant difference was found for peritumoral edema and peritumoral maximum ADC values(P<0.05).The AUC of peritumoral edema,maximum ADC value for LVI was 0.672 and 0.762.The AUC of combination of them was 0.787.Conclusion The maximum peritumoral ADC value and peritumoral edema have a certain value in predicting LVI for node-negative invasive breast cancer with the former superior to the latter.The diagnostic ability of the combination of the two parameters can improve the diagnostic specificity.