宫颈癌患者淋巴脉管间隙浸润的影响因素及ADC值结合DISCO参数在宫颈癌淋巴脉管浸润中的诊断价值

Influencing factors of lymphatic vascular invasion in patients with cervical cancer and the diagnostic value of ADC value combined with DISCO parameters in lymphatic vascular invasion of cervical cancer.

目的探讨宫颈癌患者淋巴脉管间隙浸润(LVSI)的影响因素及表观扩散系数(ADC)值结合超快动态增强扫描(DISCO)参数在宫颈癌LVSI中的诊断价值。方法回顾性分析2021年11月至2022年10月南京医科大学附属妇产医院(南京市妇幼保健院)收治的129例早期宫颈癌患者的病例资料。采用GE SIGNA Architect 3.0T MR仪行盆腔扫描,根据患者是否出现LVSI,分为LVSI阳性组(n=94)及LVSI阴性组(n=35)。分析LVSI阳性组与LVSI阴性组患者的基础资料[年龄、术前国际妇产科联盟(FIGO)分期、组织学类型、组织学分级、浸润深度、脉管内癌栓、神经侵犯、宫旁侵犯、淋巴结转移、鳞状细胞癌抗原(SCCA)、病灶最大径、平均ADC值、血管外细胞外间隙容积比(Ve)、增强曲线下初始面积(IAUGC)、速率常数(Kep)、铜蓝蛋白(CER)、最大增强斜率(MaxSlope)、容量转移常数(Ktrans)、肩胛间棕色脂肪组织(BAT)];采用多因素Logistic回归分析对宫颈癌患者LVSI影响因素进行分析;采用受试者操作特征(ROC)曲线评估ADC值、DISCO参数对宫颈癌LVSI的诊断效能。结果LVSI阳性组与LVSI阴性组患者的年龄、ADC值、术前FIGO分期、组织学类型、浸润深度、脉管内癌栓、神经侵犯、淋巴结转移、Ve、Kep、MaxSlope、Ktrans比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,LVSI阳性的影响因素包括神经侵犯、淋巴结转移、ADC值降低、Ve增加、Kep降低、MaxSlope降低、Ktrans增加(P<0.05)。ROC结果显示,ADC、Ve、Kep、MaxSlope、Ktrans诊断宫颈癌LVSI阳性的曲线下面积(AUC)分别为0.988、0.886、0.909、0.957、0.854,各指标对宫颈癌LVSI阳性均具有较好的诊断效能(P<0.05)。结论LVSI阳性的影响因素包括神经侵犯、淋巴结转移、ADC值降低、Ve增加、Kep降低、MaxSlope降低、Ktrans增加。ADC值结合DISCO参数均可用于宫颈癌LVSI阳性的诊断。

Objective To investigate the influencing factors of lymphovascular space invasion(LVSI)in patients with cervical cancer and the diagnostic value of apparent diffusion coefficient(ADC)value combined with differential subsampling with cartesian ordering(DISCO)parameters in LVSI of cervical cancer.Methds The clinical date of 129 patients with early cervical cancer admitted to the Women's Hospital of Nanjing Medical University(Nanjing Maternity and Child Health Care Hospital)from November 2021 to October 2022 were retrospectively analyzed.Pelvic scans were performed using GE SIGNA Architect 3.0T MR instrument.According to whether patients had LVSI,they were divided into LVSI positive group(n=94)and LVSI negative group(n=35).The basic data of LVSI positive group and LVSI negative group patients,including age,preoperative International Federation of Gynecology and Obstetrics(FIGO)staging,histological type,histological grading,infiltration depth,intravascular cancer thrombus,nerve invasion,parametrial invasion,lymph node metastasis,squamous cell carcinoma antigen(SCCA),maximum lesion diameter,average ADC value,extracellular space volume ratio(Ve),initial area under the enhancement curve(IAUGC),rate constant(Kep),ceruloplasmin(CER),maximum enhancement slope(MaxSlope),volume transfer constant(Ktrans),and brown adipose tissue(BAT)between scapula were analyzed.The influencing factors of LVSI in patients with cervical cancer were analyzed by multivariate Logistic regression analysis.The diagnostic efficacy of ADC value and DISCO parameters for LVSI of cervical cancer was evaluated by receiver operating characteristic(ROC)curve.Results There were statistically significance differences in age,ADC value,preoperative FIGO stage,histological type,depth of invasion,intravascular cancer thrombi,nerve invasion,lymph node metastasis,Ve,Kep,MaxSlope and Ktrans between LVSI positive group and LVSI negative group(P<0.05).Multivariate Logistic regression analysis showed that the influencing factors of LVSI positive included nerve invasion,lymph node metastasis,decreased ADC value,increased Ve,decreased Kep,decreased MaxSlope and increased Ktrans(P<0.05).ROC results showed that the area under the curve(AUC)of ADC,Ve,Kep,MaxSlope and Ktrans in the diagnosis of cervical cancer LVSI positive were 0.988,0.886,0.909,0.957 and 0.854,respectively,and each index had good diagnostic efficacy for cervical cancer LVSI positive(P<0.05).Conclusion The influencing factors of LVSI positivity include nerve invasion,lymph node metastasis,decreased ADC value,increased Ve,decreased Kep,decreased MaxSlope,and increased Ktrans.ADC value combined with DISCO parameters can be used for the diagnosis of LVSI positive cervical cancer.