乳腺癌腋窝淋巴结转移与原发灶MRI及临床病理特征的相关性研究  

Investigation on the Correlation between Axillary Lymph Node Metastasis and Preoperative MRI and Clinicopathological Features of Invasive Breast Cancer

作　　者：陈艳虹 王丽君[1] 罗冉[1] 汪登斌[1] 刘欢欢[1] CHEN Yanhong;WANG Lijun;LUO Ran;WANG Dengbin;LIU Huanhuan(Department of Radiology,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院放射科,上海200092

出　　处：《中国医学计算机成像杂志》2022年第5期484-490,共7页Chinese Computed Medical Imaging

基　　金：国家自然科学基金(82071870,82101991);上海市科学技术委员会项目(21S31905000,19DZ1930504)。

摘　　要：目的:探讨浸润性乳腺癌腋窝淋巴结转移与原发灶术前乳腺MRI特征及临床、病理特征的相关性,为患者的个性化治疗提供帮助。方法:回顾性收集2018年11月至2019年10月在新华医院经手术或穿刺活检病理检查确诊的浸润性乳腺癌患者的资料。共入组201例患者(205个病灶),并按照腋窝淋巴结转移情况分为有转移组和无转移组,比较术前原发灶MRI、临床、病理特征在2组间的差异。采用单因素及logistic回归分析淋巴结转移的相关危险因素。结果:腋窝淋巴结转移组Ki-67表达更高(OR=1.091,95%CI1.003~1.187)、影像所示病灶更大(OR=2.865,95%CI1.533~5.356)。对于>2cm的肿块,腋窝淋巴结转移与更高的组织学分级(P=0.049)、人表皮生长因子受体2(HER-2)表达阳性(P=0.023)相关;对于≤2cm的肿块,腋窝淋巴结转移组与无转移组间所有临床、病理及影像特征均无差异。乳腺内出现局部水肿时,腋窝淋巴结转移的可能性更大(P=0.031),且与更高的N分期相关。结论:对于浸润性乳腺癌患者,术前乳腺MRI发现局部水肿及肿瘤体积较大提示腋窝淋巴结转移可能性大及更高的N分期,这有助于优化患者的个性化治疗方案。Purpose:To investigate the correlation between axillary lymph node metastasis and preoperative breast MRI and clinicopathological features of invasive breast cancer,in order to provide valuable information for patients’personalized treatment.Methods:The data of patients with invasive breast cancer diagnosed by pathological examination after surgery or biopsy in Xinhua Hospital from November 2018 to October 2019 were retrospectively analyzed.There were 201 patients with 205 lesions recruited in this study.All lesions were divided into two groups according to the presence or absence of axillary lymph node metastasis.The differences between the two groups in preoperative MRI and clinicopathological characteristics of the primary malignancy in breast were compared.Univariate and logistic regression were used to analyze the relevant risk factors of lymph node metastasis.Results:The patients with high expression of Ki-67(OR=1.091,95%CI 1.003-1.187)and larger lesions(OR=2.865,95%CI1.533-5.356)were more vulnerable to have axillary lymph node metastasis.For primary lesions>2 cm,axillary lymph node metastasis was associated with higher histological grade(P=0.049)and HER-2 positivity(P=0.023).For primary lesions≤2 cm,there were no differences in clinical,pathological,and imaging features between the two groups.Patients with focal edema in diseased breast were more likely to have axillary lymph nodes metastasis(P=0.031)and focal edema was also associated with a higher N stage.Conclusion:For patients with invasive breast cancer,the focal edema and relatively larger tumor size on preoperative breast MRI suggest axillary lymph node metastasis and a higher N stage,which would help to optimize the patients’personalized treatment.

关 键 词：乳腺癌 腋窝淋巴结转移 磁共振成像 水肿 相关性 

分 类 号：R445.2[医药卫生—影像医学与核医学]