DIFFERENTIATION BETWEEN MALIGNANT AND BENIGN OVARIAN TUMORS BY MAGNETIC RESONANCE IMAGING

Objective To determine the magnetic resonance （MR） imaging findings of an ovarian mass which are most predictive of malignancy and assess the value of intravenous gadolinium administration in the characterization of an ovarian mass. Methods Totally 74 consecutive patients with a clinically or sonographicaUy indeterminate adnexal mass underwent MR imaging, of whom 59 had subsequent surgical resection of 70 adnexal masses. These 59 patients formed the study population. MR imaging studies were prospectively and independently reviewed by a senior and a junior radiologist. The senior radiologist also reevaluated the studies in a blind fashion after a minimum 6 months interval. The sensitivity, specificity, positive predictive value, and negative predictive value of contrast-enhanced and unenhanced MR im- aging were evaluated Results The most predictive MR imaging findings for malignancy were presence of vegetations in a cystic lesinn and presence of necrosis in a solid lesion. The odds ratio was even higher when the ancillary finding of peritoneal metastasis or ascites was present. Contrast media contributed significantly to lesinn characterization. Total 70 ovarian masses were detected by contrast-enhanced MR imaging including 37 malignant ovarian masses and 33 benign ovarian masses with 87% （61/70）accuracy, 86% （32/37）sensitivity, 88% （29/33）specificity, 89% （32/36）positive predictive value, and 85% （29/34） negative predictive value, whereas 70 ovarian masses were detected by unenhanced MR imaging with 74% （52/70） accuracy, 73 % （27/37） sensitivity, 76 % （ 25/33 ） specificity, 77% （27/35） positive predictive value, and 71% （ 25/35 ） negative predictive value. There were significant differences in accuracy （ P 〈 0. 01 ）, sensitivity （ P 〈0. 01 ）, specificity （ P 〈0. 01 ） between contrast-enhanced and unenhanced MR imaging. Conclusion Contrast-enhanced MR imaging is highly accurate in detection and characterization of complex adnexal masses.

Evaluation the effect of fertility-preserving surgery on young patients with malignant ovarian tumors

Objection： To evaluate the impact of fertility-preserving surgery and adjuvant chemotherapy on survival and fertility of young patients with ovarian malignant tumors. Methods： Retrospective analysis of 39 patients with ovarian malignant germ cell tumors, 23 patients with malignant epithelial tumors and 4 patients with sexual cord mesenchymal tumors receiving conservative treatments. Results： Two patients lost follow-up （we do not statistics them）. Fifty-nine among 64 patients were alive up to now （92.19%）. The overall survival rate for ovarian epithelial malignancies, malignant germ cell tumors and sexual cord mesenchymal tumors were 95.45%, 89.47% and 100% respectively. Fifteen patients received second operation and recurrence was found in 6 patients. Among the 59 surviving patients, 53 patients have normal menstruation. Thirteen patients among 20 patients who want to pregnant have 15 pregnancies and 9 successful deliveries. Conclusion： The management of fertility-preserving surgery on patients with ovarian malignant germ cell tumors, whatever the FIGO staging is, is a safe option. For patients with ovarian epithelial carcinomas, fertility-preserving surgery only confined to low-stage （stage Ⅰ）, low-grade （G1）, and patients who want keep fertility function seriously. Cisplatinum-based combination chemotherapy is necessary. Standardized chemotherapy has no affection on fertility function.

Prognostic Significance of Hormonal Receptor Status of Malignant Ovarian Tumors

The objective of this study is to investigate hormonal receptor status of MOT （malignant ovarian tumor） and to evaluate its clinical and prognostic significance. Retrospective analysis of the case reports of 284 patients with MOT of different histogenesis, stages I-IV, and immunohistochemical study of paraffin-embedded tissues were performed. Hormonal receptor status of tumors with different morphology genesis was studied and hormonal receptor phenotype of serous OC （ovarian cancer） was determined. The analysis of correlation between the expression of steroid hormone receptors （receptors to estrogens （ER）, progesterone （PR） and testosterone （TR）） in ovarian tumors, histological type of tumors and clinical morphological parameters were performed. Overall and relapse-free survival rates of the patients with serous OC depending on the hormonal receptor phenotype of the tumor were assessed. Presence of positive expression of steroid hormone receptors in serous OC （ER-66.4%, PR^53.4%, TR-53.0%）, mucinous OC （ER-88.0%, PR-84.0%, TR-60.0%） and in sex cord stromal tumors （ER-74.1%, PR and TR-77.8%） is proved by correlation of all steroid receptors expression with morphology type of ovarian tumors （ER - r = 0.4; PR - r = 0.4; TR - r = 0.3; p 〈 0.05）. Direct correlation between hormonal receptor phenotype of serous OC and the age period of the patients was established （r = 0.5; p = 0.002）： postmenopausal women patients reported the most increased frequency of serous OC with positive hormonal receptor tumor phenotypes （52.4%）, in particular during their late post-menopausal period （39.0%）. Significantly low overall survival among the patients with positive hormonal receptor phenotype of serous OC was recorded （29.5±3.4%） in comparison with the same score in the patients with negative phenotype of tumors （44.5±3.7%） （p 〈 0.05）. Multifactor analysis of Cox-regression model has defined that positive hormonal receptor phenotype of serous OC increases the risk of disease relapse （HR 1.4; 95.0% CI 1.1-1.7）, significantly decreases overall survival rates in the patients （HR 1.4; 95.0% CI 1.1-1.8）. Positive hormonal receptor status of MOT is an independent factor of unfavorable clinical progress of tumor process which can be regarded as the criterion for development of the methods of hormonal therapy application in complex treatment of the patients, and demands further large-scale multi-center studies in that direction.

Frequency of Benign and Malignant Tumors in Localized Vitiligo in Comparison to Generalized and Universal Vitiligo

Background: Autoimmune diseases like pemphigus and systemic lupus erythematosus are protective against skin malignancies like basal cell carcinoma and squamous cell carcinoma. Objective: As vitiligo is an autoimmune diseases, the aim of the present work is to record the frequency of all benign and malignant skin tumors among patients with different severity of vitiligo and to be compared with the skin tumors in healthy control. Patients and Methods: This is a case series, descriptive study done in the Department of Dermatology—Baghdad Teaching Hospital, Baghdad, Iraq, during the period from May 2014-May 2015. History was taken from each patient with vitiligo regarding age, gender, duration, personal and family history of vitiligo and other autoimmune diseases such as diabetes mellitus, thyroid dysfunction, and alopecia areata. Patients were assessed for past and present history of photodermatosis and any skin cancers. Healthy control was considered. Results: Three hundred and fifty patients with vitiligo were included in this study: 50 patients with universal vitiligo, 100 patients with generalized vitiligo, and 200 patients with localized vitiligo as well as 500 subjects as a healthy control. The ages of all studied subjects ranged between 31 and 77 years. Twenty four(48%) patients with universal vitiligo were males and 26 (52%) were females;49(49%) patients with generalized vitiligo were males and 51(51%) were females;101(50.5%) patients with localized vitiligo were males and 99(49.5%) were females and 235(47%) of control were males and 265(53%) were females. All skin tumors were seen to be high in healthy subjects and lower or absent in patients with vitiligo. Also patients with mild vitiligo had a higher frequency of skin tumors including benign and malignant than patients with severe vitiligo especially in patients with universal vitiligo. In addition, no photosensitivity or actinic reticuloid was detected in patients with vitiligo. Conclusions: Vitiligo especially generalized and universal type as an autoimmune disease had a protective action against photodamage, photosensitivity and skin tumors whether benign or malignant.

Histochemical Patterns of Collagenic Fibers in the Benign and Malignant Breast Lesions

Cancer is one of the leading causes of death worldwide and breast cancer is the most commonly diagnosed cancer among women. An increased incidence of different types of breast cancer has been reported. This study was designed to evaluate the different types of breast cancer and its possible risk of neoplasmic transformation to an advanced malignant stage from a benign tumor. The histochemical patterns of collagen fibers in the benign and malignant breast lesions were evaluated. From the 50 tissue samples, 25 were malignant breast lesions and 25 were benign breast tumor. Hematoxylin and Eosin (HE), Van Gieson staining were performed to detect a benign and malignant tumor as well as collagen fibers. We found that significant cases after age of 35 were associated with ductal carcinoma while most of the cases within the age of 25 years were associated with fibrocystic changes. The intensity of collagen fiber was higher to Ductal Carcinoma while negative and less intense for Fibroblastic changes. Furthermore, a consistent association of other lesions, such as Lobular Carcinoma, Fibroadenoma, Papilloma and Fat necrosis and noticeable staining for collagen was observed for the different lesion. Our study suggested that women with age of 25 with benign lesion of fibrocystic change and ductal carcinoma are highly susceptible to develop advanced malignant tumor with age. Therefore, quantitative measurement of collagen fiber and regular follow-up are recommended to avoid the possible risk of developing advanced malignant lesions.

Differentiation of malignant and benign lesions of the osseous spinal axis with three dimensional computed tomography image appearences: dirty interface sign

Purpose: We aimed to make a fast and accurate distinction of malignant and benign lesions in cases with predominantly solitary or multifocal involvement using latest technology software and hardware systems in computed tomography. Materials and Methods: 53 cases were included in the study. Primary (n = 42, 31 benign, 11 malignant) or metastatic (n = 11) tumors were detected at various locations in the bone structure of the cervical to coccygeal vertebrae in all cases. 3D CT images taken using the same system and biopsy or post-operative histopathology findings were available for all cases. Thin section images taken retrospectively from the archives were converted to 3D images using the same program and parameters, which were then recorded in the same window settings by two radiologists. Only 3D images were then analyzed to investigate the presence or absence of the dirty interface sign. Results: Dirty interface sign was present in 17 malignant lesions and absent in the remaining 5 lesions. As for benign lesions, the sign was present in only two lesions and the remaining 29 were negative for the sign. There was a high level of consistency between the two radiologists. In conclusion, malignant and benign lesions affecting the bone spinal axis were distinguished based on the presence or absence of the dirty interface sign with 77.3% sensitivity, 93.5% specificity and 86.8% accuracy. Conclusion: When evaluated with standard bone window views, 3D views can be used successfully for the distinction of malignant and benign bone tumors. At least, 3D views generated using low dose regimes in highly developed systems can be used with similar purpose to that of diffusion weighted MRI sequences that give roughly outlined but fast and accurate information about the lesion.

Oncology and reproductive outcomes over 16 years of malignant ovarian germ cell tumors treated by fertility sparing surgery

BACKGROUND Malignant ovarian germ cell tumors(MOGCT)are rare and frequently occur in women of young and reproductive age and the oncologic and reproductive outcomes after fertility-sparing surgery(FSS)for this disease are still limited.AIM To evaluate the oncology and reproductive outcomes of MOGCT patients who underwent FSS.METHODS All MOGCT patients who underwent FSS defined as the operation with a preserved uterus and at least one side of the ovary at our institute between January 2005 and December 2020 were retrospectively reviewed.RESULTS Sixty-two patients were recruited for this study.The median age was 22 years old and over 77%were nulliparous.The three most common histology findings were immature teratoma(32.2%),dysgerminoma(24.2%),and yolk sac tumor(24.2%).The distribution of stage was as follows;Stage I,74.8%;stage II,9.7%;stage III,11.3%;and stage IV,4.8%.Forty-three(67.7%)patients received adjuvant chemotherapy.With a median follow-up time of 96.3 mo,the 10-year progressionfree survival and overall survival were 82.4%and 91%,respectively.For reproductive outcomes,of 43 patients who received adjuvant chemotherapy,18(41.9%)had normal menstruation,and 17(39.5%)resumed menstruation with a median time of 4 mo.Of about 14 patients who desired to conceive,four were pregnant and delivered good outcomes.Only one case was aborted.Therefore,the successful pregnancy rate was 28.6%CONCLUSION The oncology and reproductive outcomes of MOGCT treated by FSS are excellent.Many patients show a long survival time with normal menstruation.However,the obstetric outcome is not quite satisfactory.

Ectopic Hormone Production from Ovarian Tumor: A Review

Although ectopic hormone-production is uncommon complication, certain tumors can produce symptoms due to the secretion of various bioactive substances accompanied by the aberrantly located tumors. Because of the potential for the ovary to act as a source of aberrant hormone secretion, in the literature, ectopic hormone production from ovarian tumor includes granulocyte-colony stimulating factor (G-CSF), parathyroid hormone-related protein (PTHrP), adrenocorticotropic hormone (ACTH), peptide-YY, gastrin and insulin. All patients may present with syndromes of hormone excess. Failure to localize the ovarian tumor preoperatively may be associated with a significantly higher risk of subsequent unnecessary ablative procedures. Better characterization of hormonal forms relatively specific for neoplasia may enhance the clinical value of ectopic hormones as tumor markers, especially in malignancies that are commonly associated with ectopic hormone production. These circumstances may recommend complete preoperative evaluation of the pelvis in female patients presenting with nonlocalizable endocrine tumors.

FTIR assessment of the secondary structure of proteins in human breast benign and malignant tissues

The compositions of the secondary structures of protein in the human breast normal, hyperplasia, fibroadenoma and invasive ductal carcinoma tissues have been estimated from the Fourier self deconvolved spectra, the second derivative spectra and the curve-fitting analysis of the amide I bands in their spectra. Some parameters of the secondary structures of proteins in these 4 types of tissues are significantly different and located in separate ranges.

Expression of Wnt-1,beta-catenin and c-myc in Ovarian Epithelial Tumor and Its Implication

Objective： To investigate the expression of Wnt-1, beta-catenin and c-myc in normal ovarian epithelial cell and malignant ovarian epithelial tumor. Methods： Immunohistochemical staining with SP method was conducted to identify the expression of Wnt-1, beta-catenin and c-myc in 18 samples of normal epithelial tissue and 34 cases of malignant epithelial tumor of ovary. Results： The expression rate of Wnt-1 and c-myc in malignant epithelial tumors was higher than those in normal epithelial cell （P〈0.05）. The abnormal expression rate of beta-catenin in malignant ovarian epithelial tumors was higher than that in normal epithelial cell （P〈0.05）. A significant positive correlation was found between Wnt-1, beta-catenin and c-myc in malignant ovarian epithelial tumor （P〈0.05）. A significant difference of expressions of Beta-catenin and C-myc was found between serous and mucinous tumors （P〈0.05）. Conclusion： The abnormal expression of Wnt-1, beta-catenin and c-myc might indicate the malignant transformation in ovarian epithelial tumors.

Central pancreatectomy:a new technique for resection of selected pancreatic tumors

BACKGROUND:Pancreatic tumors located in the neck region usually require pancreaticoduodenectomy or splenopancreatectomy.For small benign tumors enucleation is not usually feasible due to their size and localization;then pancreatectomy is often needed.Central pancreatectomy consists of a limited resection of the midportion of the pancreas and can be offered in benign and low-grade malignant tumors of the neck of the pancreas.The study aimed to evaluate whether central pancreatectomy has a place in pancreatic surgery. METHODS:In this study,which covered a period of 14 months,we performed central pancreatectomy in four selected patients.Preoperative evaluation and operative frozen section biopsy in indicated cases allowed proper selection for the procedure.Operative details,complications and follow-up were recorded. RESULTS:Four patients,two with serous cystadenoma,and one with an islet cell tumor,and one with a hydatid cyst, were identified for the procedure.The mean tumor size was 3 cm,the mean operative time was 217.5 minutes,and the mean blood loss was 382.5 ml.There was no morbidity or mortality in this series.No endocrine or exocrine deficiency was observed in any patient during a mean follow-up of 22.7 months. CONCLUSIONS:Central pancreatectomy is a procedure that offers excellent results in benign and low-grade malignant tumors.It preserves functional elements(endocrine and exocrine)of the pancreas and also eliminates the infective and hematological effects of splenectomy.Thus,central pancreatectomy should be included in the armamentarium of pancreatic surgery,and in order to obtain good results,proper indications and adequate experience are recommended.

A Gaussian Multivariate Hidden Markov Model for Breast Tumor Diagnosis

The stage of a tumor is sometimes hard to predict, especially early in its development. The size and complexity of its observations are the major problems that lead to false diagnoses. Even experienced doctors can make a mistake in causing terrible consequences for the patient. We propose a mathematical tool for the diagnosis of breast cancer. The aim is to help specialists in making a decision on the likelihood of a patient’s condition knowing the series of observations available. This may increase the patient’s chances of recovery. With a multivariate observational hidden Markov model, we describe the evolution of the disease by taking the geometric properties of the tumor as observable variables. The latent variable corresponds to the type of tumor: malignant or benign. The analysis of the covariance matrix makes it possible to delineate the zones of occurrence for each group belonging to a type of tumors. It is therefore possible to summarize the properties that characterize each of the tumor categories using the parameters of the model. These parameters highlight the differences between the types of tumors.

Expression levels of matrix metalloproteinases in ascites of patients with ovarian cancer and the relationship with pathological characteristics of ovarian cancer

Objective:To explore the expression levels of matrix metalloproteinase-2(MMP-2)and matrix metalloproteinase-9(MMP-9)in ascites in ovarian tumor and provide a theoretical basis for the diagnosis and prognosis evaluation of ovarian cancer ascites.Methods:ELISA was used to detect the levels of MMP-2 and MMP-9 in ascites samples from 73 cases of patients with malignant ovarian tumor,and RIA was used to detect the expression level of CA125 in the serum in these patients.Results:The expression levels of MMP-2 and MMP-9 in ascites in malignant ovarian tumor were higher than those in ascites in benign ovarian tumor(t=8.08,10.39,p<.01),and the difference was of statistical significance.The expression levels of MMP-2 and MMP-9 in patients with stage III and IV malignant ovarian tumors were higher than those in patients with stage I and II malignant ovarian tumors,and the difference was statistically significant(t=2.75,2.75,p<.05).There was no statistically significant difference in the expression levels of MMP-2 and MMP-9 among the patients with different pathological types,different histological grades,lymph node metastasis or not,different ascites volumes and different residual lesions(p>.05).The sensitivities of detecting MMP-2 and MMP-9 in ascites were 76.0%and 88.0%,respectively,which were significantly higher than those of ascites cytological examinations(χ^(2)=4.61,12.74,p<.05),but in comparison with serum CA125,there was no statistically significant difference(p>.05).The specificities of detecting MMP-2 and MMP-9 in ascites were 78.3%and 82.6%,respectively,which were significantly lower than those of ascites cytological examinations(χ^(2)=5.61,4.38,p<.05),but in comparison with serum CA125,there was no statistically significant difference(χ^(2)=1.64,2.68,p<.05).Conclusions:The levels of MMP-2 and MMP-9 in ascites may be markers for the differential diagnosis of benign and malignant ovarian lesions,and they are related to the prognosis in patients with malignant ovarian tumors.

Classification of submucosal tumors in the gastrointestinal tract

This review is part two of three, which will present an update on the classification of gastrointestinal submucosal tumors. Part one treats of the diagnosis and part three of the therapeutic methods regarding gastrointestinal submucosal tumors. In the past there has been some confusion as to the classification of gastrointestinal submucosal tumors. Changes in classifications have emerged due to recent advances in mainly immunohistochemistry and electron microscopy. The aim of this paper is to update the reader on the current classification. Literature searches were performed to find information related to classification of gastrointestinal submucosal tumors. Based on these searches the twelve most frequent submucosal tumor types were chosen for description of their classification. The factors that indicate whether tumors are benign or malignant are mainly size and number of mitotic counts. Gastrointestinal stromal tumors are defined mainly by their CD117 positivity. In the future, there should be no more confusion between gastrointestinal stromal tumors and other types of submucosal tumors.

A retrospective study of 2228 cases with eyelid tumors

AIM： To describe the histopathologic and clinical features of eyelid tumor cases from Tianjin Eye Hospital during 2002 to 2015. METHODS： In this retrospective study, a total of 2228 cases of eyelid tumors with pathologic diagnoses were enrolled. The eyelid tumors were classified into three groups according to tumor origin： epidermal, adnexal and miscellaneous, including melanocytic, neural and vascular lesions. Inflammatory tumor-like lesions were excluded. The clinical characteristics of the eyelid tumors were analyzed, including age, gender and lesion location. RESULTS： Most eyelid tumors were epidermal in origin（1080, 48.5%）, followed by miscellaneous（885, 39.7%） and adnexal tumors（263, 11.8%）. Among all the tumors, 292（13.1%） were malignant lesions, 1910（85.7%） benign and 26（1.1%） premalignant lesions. Most malignant tumors originated from epidermal cells（60.0%）, followed by adnexal cells（34.6%）. The most common malignant tumors were basal cell carcinomas（56.5%） followed by sebaceous carcinoma（34.6%）, squamous cell carcinomas（3.8%） and lymphoma/plasmocytoma（1.7%）. The benign and premalignant eyelid lesions mostly originated from epidermal cells（46.4%） followed by miscellaneous cell sources（45.2%）, including melanocytic nevus（33.8%）, seborrheic keratosis（13.7%）, squamous cell papilloma（13.0%） and epidermal cysts（11.5%）. CONCLUSION： Eyelid tumors are mostly epithelial in origin. Benign tumors are significantly more common than malignant tumors with an obvious female predominance, and the most frequent malignant tumor are basal cell carcinoma, sebaceous carcinoma and squamous cell carcinomas. The tumor clinical features varied among the different subtypes.

Imaging appearance of bone tumors of the maxillofacial region

This paper reviews the imaging appearance of benign and malignant bone tumors of the maxillofacial region.A benign bone tumor commonly appears as a well circumscribed lesion.The matrix of the tumor may be calcified or sclerotic.Malignancies often display aggressive characteristics such as cortical breakthrough, bone destruction,a permeative pattern and associated soft-tissue masses.Computed tomography scan is an excellent imaging modality for accurate localization of the lesion,characterization of the tumor matrix and detection of associated osseous changes such as bone remodeling,destruction or periosteal reaction.Magnetic resonance imaging is of limited value in the evaluation of maxillofacial bone tumors.

Pancreas-preserving duodenectomy for treatment of a duodenal papillary tumor:A case report

BACKGROUND Duodenal papillary tumor is a rare tumor of the digestive tract,accounting for about 0.2%of gastrointestinal tumors and 7%of periampullary tumors.The clinical manifestations of biliary obstruction are most common.Some benign tumors or small malignant tumors are often not easily found because they have no obvious symptoms in the early stage.Surgical resection is the only treatment for duodenal papillary tumors.At present,the methods of operation for duodenal papillary tumors include pancreatoduodenectomy,duodenectomy,ampullectomy,and endoscopic resection.CASE SUMMARY A 47-year-old man was admitted to because of a duodenal mass that had been discovered 2 mo previously.Electronic gastroscopy at another hospital revealed a duodenal papillary mass that had been considered to be a high-grade intraepithelial neoplasia.Therefore,we conducted a multidisciplinary group discussion and decided to perform a pancreas-preserving duodenectomy and a R0 resection was successfully performed.After surgery,the patient underwent a follow-up period of 5 yr.No recurrence or metastasis occurred.CONCLUSION According to our experience with a duodenal papillary tumor,compared with pancreaticoduodenectomy,the use of pancreas-preserving duodenectomy can preserve pancreatic function,maintain gastrointestinal structure and function,reduce tissue damage and complications,and render the postoperative recovery faster.Pancreas-preserving duodenectomy for treatment of a duodenal papillary tumor is feasible under strict control of surgical indications.

Alteration of Sex and Non-Sex Hormones and Distribution Features of Blood ABO System Groups among the Women with Uterine Body Tumors

Objectives: The aim of the investigation was to study the hormonal status (sex hormones: estradiol (E2), progesterone (P), testosterone (T);non-sex gonadotropic hormones-luteinizing hormone (LH) and follicle-stimulating hormone (FSH)) of women with benign and malignant tumors of uterine body in the reproductive, menopause and postmenopause periods. Also the distribution features of the blood ABO system phenotype groups and their link to the development of uterine body tumors have been studied. Methods: The determination of hormones was made by the enzyme analysis method (ELAIZA), provided by the proper ELAIZA kits. For the study of blood ABO system antigens, internationally recognized immunoserology methods were used. Results: Investigations revealed the increased level of E2 and T on the background of the reduced P in the blood of the women with uterine tumors in the reproductive, menopause and post-menopause period. As for gonadotropic hormones, the decreased levels of LH and FSH have also been detected. From the ABO system phenotype groups A(II) group had the highest frequency between the women with malignant uterine tumor in the reproductive age. O (I) phenotype group was the most frequent in case of menopause and post-menopause women with uterine malignant tumors. Conclusions: Hormonal imbalance creates good conditions for the proliferation of uterine tissues and hence causes the development of benign and malignant uterine tumors. The imbalance of the sex steroid and gonadotropic hormones in the blood of post-menopause women indicates on the genotoxic mechanism of cancer development on the background of age-related changes. A(II) group had the highest frequency between the reproductive age women with uterine malignant tumor, while O (I) group was the most frequent in case of menopause and post-menopause patients.

基于瘤体及瘤周多参数MRI对乳腺病变良恶性诊断列线图预测模型的构建与评价

目的:建立基于瘤体及瘤周多参数MRI的乳腺病变良恶性鉴别诊断的列线图模型,并验证其预测效能。方法:纳入经病理学检查明确乳腺病变性质的100例患者作为研究对象,所有患者均行核磁共振(MRI)检查和病理检查,根据病理检查结果分为乳腺良性病变组(n=62)和乳腺恶性病变组(n=38)。收集患者临床资料、瘤体各参数、瘤周各参数以及乳腺病变良恶性情况。多因素Logistic回归分析筛选乳腺恶性病变的危险因素并构建列线图预测模型,采用受试者工作特征(ROC)曲线和Hosmer-Lemeshow拟合优度检验验证模型的预测效能及拟合优度;内部验证采用Bootstrap。结果:乳腺恶性病变组病灶直径、平均扩散峰度(MK)、MDp/t、瘤周与瘤体MKp/n高于乳腺良性病变组(均P<0.05);乳腺恶性病变组表观扩散系数(ADC)值、平均扩散率(MD)、非对称磁化转移率(MTRasym)、MKp/t、MDp/n低于乳腺良性病变组(均P<0.05)。多因素分析结果显示,病灶直径、MK、MDp/t、MKp/n升高,ADC值、MD、MTRasym、MKp/t、MDp/n降低是乳腺恶性病变的独立影响因素(均P<0.05)。基于上述独立影响因素构建乳腺恶性病变的列线图预测模型,曲线下面积(AUC)为0.827。Hosmer-Lemeshow拟合优度检验显示P值为0.004。采用Bootstrap法,生成的校准曲线拟合良好。结论:瘤体及瘤周多参数MRI对乳腺病变良恶性鉴别诊断具有重要预测价值,基于乳腺恶性病变的独立影响因素构建的列线图预测效果良好,能直观预测乳腺发生恶性病变的概率。