合成MRI鉴别诊断乳腺癌不同分子分型及三阴性与非三阴性乳腺癌的价值  

The value of synthetic MRI in identifying different molecular types of breast cancer and triple negative and non triple negative breast cancer

作　　者：赵睿萌 杜思瑶 郭梁存 黄国梁 戚喜勋[1] 黎庶[1] 张立娜[1] Zhao Ruimeng;Du Siyao;Guo Liangcun;Huang Guoliang;Qi Xixun;Li Shu;Zhang Lina(Department of Radiology,the First Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院放射科,沈阳110001

出　　处：《中华放射学杂志》2022年第6期636-642,共7页Chinese Journal of Radiology

基　　金：国家自然科学基金(81971695)。

摘　　要：目的:探讨合成MRI定量参数鉴别诊断乳腺癌不同分子分型及三阴性与非三阴性乳腺癌的价值。方法:回顾性分析2019年3月至2020年9月在中国医科大学附属第一医院收治的经术后病理证实为浸润性导管型乳腺癌患者208例。所有患者均接受合成MR检查,并测量以下定量参数:肿瘤直径、体积、表观扩散系数(ADC)及T_(1)、T_(2)和质子密度(PD)的平均值和标准差。按免疫组化结果分成孕激素受体(PR)阳性122例、阴性86例,雌激素受体(ER)阳性123例、阴性85例,人表皮生长因子受体2(HER2)阳性79例、阴性129例,增殖指数(Ki-67)高表达149例、低表达59例;三阴性乳腺癌36例、非三阴性乳腺癌172例。采用独立样本t检验或Mann-Whitney U检验比较不同分子分型及三阴性与非三阴性乳腺癌患者定量参数的差异;以多因素logistic回归分析三阴性乳腺癌的独立预测因子,采用受试者操作特征曲线及曲线下面积(AUC)分析各参数单独及联合鉴别三阴性与非三阴性乳腺癌的效能。结果:PR阴性乳腺癌的T_(1)值、T_(2)值均高于PR阳性患者(t=2.30、Z=2.04,P<0.05);ER阴性乳腺癌的T_(1)值、T_(2)值均高于ER阳性(t=2.52、Z=2.48,P<0.05);HER2阳性的ADC和肿瘤直径显著大于HER2阴性患者(t=-3.21、Z=-3.22,P<0.05)。Ki-67高表达的T_(2)值、肿瘤体积及直径显著高于Ki-67低表达患者(Z分别为-3.47、-2.51、-2.84,P<0.05)];Ki-67高表达ADC值小于Ki-67低表达患者(t=3.94,P<0.001)。三阴性乳腺癌T_(1)、T_(2)值及肿瘤体积高于非三阴性乳腺癌(t=-3.26、Z=-5.58、Z=-2.02,P<0.05),ADC值低于非三阴性乳腺癌(t=3.07,P=0.002)。多因素logistic回归分析显示,T_(2)(OR=1.060,95%CI 1.028~1.093,P<0.001)、ADC值(OR=0.947,95%CI 0.911~0.984,P=0.005)是三阴性乳腺癌的独立预测因素。各参数单独及联合鉴别三阴性乳腺癌的效能显示,单参数中T_(2)值鉴别三阴性与非三阴性乳腺癌的AUC最大(0.759),且与各参数联合诊断的差�Objective To investigate the value of synthetic MRI quantitative parameters in identifying different molecular types of breast cancer and triple negative breast cancer(TNBC)and non-TNBC.Methods A retrospective analysis was performed on 208 patients diagnosed with invasive ductal breast cancer in the First Affiliated Hospital of China Medical University from March 2019 to September 2020.All patients underwent synthetic MR examinations and the following quantitative parameters were measured,including tumor diameter,volume,apparent diffusion coefficient(ADC),and corresponding values of T_(1),T_(2),and proton density(PD).According to the immunohistochemical results,there were 122 cases of progesterone receptor(PR)positive and 86 cases of PR negative,123 cases of estrogen receptor(ER)positive and 85 cases of ER negative,79 cases of human epidermal growth factor receptor-2(HER2)positive and 129 cases of HER2 negative,149 cases of Ki-67 high expression and 59 cases of Ki-67 low expression;there were 36 cases of TNBC and 172 cases of non-TNBC.Independent samples t test or Mann-Whitney U test were used to compare the quantitative parameters of different molecular types,TNBC and non-TNBC patients.Multivariate logistic regression was used to analyze independent predictors of TNBC,and receiver operating characteristic curve and area under the curve(AUC)were used to evaluate the efficacy of sole and combined parameters in identifying TNBC.Results T_(1) and T_(2) values in PR negative breast cancer patients were higher than those in PR positive patients(t=2.30,Z=2.04,P<0.05);the values of T_(1) and T_(2) in ER negative patients were higher than those in ER positive patients(t=2.52,Z=2.48,P<0.05);ADC value and tumor diameter of HER2 positive patients were larger than those in HER2 negative patients(t=-3.21,Z=-3.22,P<0.05).T_(2) value,tumor volume and diameter in patients with Ki-67 high expression were significantly higher than those in patients with Ki-67 low expression(Z=-3.47,-2.51,-2.84,P<0.05);ADC value in Ki-67 high expre

关 键 词：乳腺肿瘤 三阴性乳腺癌 合成磁共振成像 

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