MRI表观扩散系数诊断导管原位癌与浸润性导管癌的临床意义  

Clinical significance of ADC in the diagnosis of ductal carcinoma in situ and invasive breast cancer

作　　者：向旭[1] 殷洁[1] 吕国义[1] 李建灵[1] 尤国庆[1] 曾越灿[2] XIANG Xu;YIN Jie;LYU Guo-yi;LI Jian-ling;YOU Guo-qing;ZENG Yue-can(Nanyang City Center Hospital, Nanyang Henan 473009, China;Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China)

机构地区：[1]南阳市中心医院,河南南阳473009 [2]中国医科大学附属盛京医院放射科,辽宁沈阳110004

出　　处：《中国临床医学影像杂志》2018年第6期400-403,408,共5页Journal of China Clinic Medical Imaging

基　　金：国家自然科学基金(81201803)

摘　　要：目的:通过MRI表观扩散系数(ADC)与乳腺导管原位癌(Ductal carcinoma in situ,DCIS)和浸润性导管癌(Invasive breast cancer,IBC)的传统诊断指标诊断效能的比较,进而评价ADC值对于DCIS和IBC的诊断价值。方法 :选取2015年5月—2016年4月因乳房包块伴乳头溢液就诊于我科的女性118例为研究对象,患者就诊时记录其基线资料、ADC值、弹性评分、血清CA125、CA153及CEA水平。根据穿刺活检结果是否是DCIS和IBC将患者分为疾病组和对照组,单因素分析DCIS与IBC可能相关的危险因素,t(χ~2)检验显示具有影响力的因素在两组间的分布差异;运用多因素Logistic回归分析进一步评价具有统计学意义的所有因素对DCIS与IBC诊断可能性的影响程度;采用Pearson分析研究对象ADC值与传统诊断指标弹性超声评分之间的关系;运用ROC曲线分析5种指标对于DCIS与IBC的诊断效能的敏感性和特异性。结果:单因素分析研究对象年龄、BMI、ADC值、弹性评分、血清CA125、CA153及CEA水平诊断DCIS与IBC的可能性及影响程度,除年龄及BMI外,其余5项指标两组间的差异均具有统计学意义(P<0.05);多因素Logistic回归分析结果显示ADC值的对于DCIS与IBC的诊断可能性有显著影响(OR=2.273,95%置信区间:1.861～2.776,P=0.002);Pearson相关性分析表明,ADC值的增加与传统诊断指标弹性评分的升高呈正相关(r=0.475,P=0.000);而ROC曲线下ADC值的AUC为0.788(95%置信区间:0.677～0.899),其敏感性和特异性分别为0.784和0.732。结论:ADC值对DCIS与IBC有较好的诊断效能,有望应用于临床作为DCIS和IBC的早期检出指标之一。Objective： To explore the relationship between ADC parameters and the traditional diagnosis indexes of ductal carcinoma in situ（DCIS） and invasive breast cancer（IBC）, and to evaluate the ADC for the diagnosis of DCIS and IBC.Methods： One hundred and eighteen female with breast mass were involved from May 2015 to April 2016 and their baseline information, ADC, elastography score, serum CA125, CA153 and CEA were recorded after admission. According to pathological findings, patients were divided into disease group and control group. Single factor analysis was used to show the factors affecting the diagnosis of DCIS and IBC, and then Logistic proportional hazard regression model analysis was applied to evaluate the influencing degree of those factors on the diagnosis of DCIS and IBC patients. Pearson analysis was used to study relationship between the ADC value and the traditional diagnostic index of elastography score. Meanwhile, the difference of the selected factors from multivariate analysis of two groups was analyzed and the sensitivity and specificity of the factors in diagnosis of DCIS and IBC were calculated by ROC curves. Results： The results of single factor analysis revealed that the diagnosis of DCIS and IBC was affected by ADC, elastography score, serum CA125, CA153, CEA level, and ADC parameters is the most influential（OR=2.273, 95%CI： 1.861～2.776, P=0.002）. Pearson correlation analysis showed that the ADC and the traditional elastography score are positively correlated（r =0.475, P =0.000）. The ROC analysis showed that the AUC of ADC parameters was 0.788（95% CI： 0.677 ～0.899） and the sensitivity and specificity were 0.784, 0.732, respectively. Conclusion：ADC parameters may be used as a good diagnostic tool for DCIS and IBC, which is hoped to be used as an early indicator.

关 键 词：乳腺肿瘤 癌 导管 磁共振成像 超声检查 多普勒 彩色 

分 类 号：R737.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学]