MRI术前预测乳腺癌前哨淋巴结转移的价值  

Preoperative Prediction of Sentinel Lymph Node of Breast Cancer Based on MRI

作　　者：施益洁 陈青青 何杰 胡红杰[1,2] SHI Yijie;CHEN Qingqing;HE Jie;HU Hongjie(Department of Radiology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China;Medical Imaging International Scientific and Technological Cooperation Base of Zhejiang Province,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院放射科,浙江杭州310000 [2]浙江省医学影像国际科技合作基地,浙江杭州310000

出　　处：《中国医学影像学杂志》2024年第10期1021-1026,共6页Chinese Journal of Medical Imaging

摘　　要：目的探讨MRI多模态参数对乳腺癌前哨淋巴结(SLN)转移的预测价值,并制订有效预测模型,以降低SLN的不必要活检率。资料与方法回顾性分析2019年1月—2021年12月浙江大学医学院附属邵逸夫医院经手术病理证实的310例c N0乳腺癌的术前MRI影像资料,根据SLN有无转移分为阳性组及阴性组。由2名放射科医师独立评估乳腺病变的影像特征,比较两组参数差异,并筛选独立预测因子构建模型、评估诊断效能。结果SLN阳性组乳腺病变位于外上象限(χ^(2)=14.94)、非单发(χ^(2)=9.29)、环形强化(χ^(2)=9.23)及邻近血管增多征象阳性比例(χ^(2)=9.91)均高于阴性组,阳性组病变更大(Z=-2.97、-2.73)、早期强化率更高(t=-3.48)、最小表观扩散系数及相对表观扩散系数(病变最小表观扩散系数/腺体表观扩散系数)更低(Z=-7.33、-10.74),(P均<0.05)。Logistic回归结果显示,病变部位(OR=4.17,95%CI 1.86~9.35,P=0.001)、早期强化率(OR=1.01,95%CI 1.00~1.02,P=0.019)及相对表观扩散系数(OR=54.67,95%CI 23.72~126.02,P<0.001)是SLN转移的独立危险因子。联合病变部位和相对表观扩散系数的模型预测性能最佳,其阴性预测值为96.5%,可降低46.1%的不必要活检率。结论基于常规MRI特征参数的SLN术前预测模型(病变部位、相对表观扩散系数)具有可靠的阴性预测价值,有望降低近半数c N0期乳腺癌的不必要活检率。Purpose To investigate the value of MRI multimodal parameters in predicting sentinel lymph node(SLN)metastasis of breast cancer,and to develop an effective prediction model to reduce the unnecessary biopsy rate of SLN.Materials and Methods Preoperative MRI data of 310 patients with cN0 breast cancer confirmed by operation and pathology in Sir Run Run Shaw Hospital,Zhejiang University School of Medicine from January 2019 to December 2021 were retrospectively analyzed,and all patients were divided into positive group and negative group according to whether SLN metastasized.Imaging features of breast lesions were evaluated independently by two radiologists,differences in parameter between the two groups were compared,independent predictors were screened to build models and evaluate diagnostic efficacy.Results The breast lesions in SLN positive group were located in the upper quadrant(χ^(2)=14.94),non-single(χ^(2)=9.29),circular enhancement(χ^(2)=9.23)and the positive rate of adjacent angiogenesis(χ^(2)=9.91)were higher than those in SLN negative group.The lesions in SLN positive group were larger(Z=-2.97,-2.73),and the early enhancement rate was higher(t=-3.48).The minimum apparent diffusion coefficient and relative apparent diffusion coefficient(minimum apparent diffusion coefficient of lesions/apparent diffusion coefficient of glands,rADC)were lower(Z=-7.33,-10.74),all P<0.05.Logistic regression results showed lesion location(OR=4.17,95%CI 1.86-9.35,P=0.001),early enhancement rate(OR=1.01,95%CI 1.00-1.02,P=0.019)and rADC(OR=54.67,95%CI 23.72-126.02,P<0.001)were independent risk factors for SLN metastasis.The model combining lesion location and rADC had the best predictive performance,with a negative predictive value of 96.5%and a 46.1%reduction in unnecessary biopsies.Conclusion SLN preoperative prediction model(lesion location,rADC)based on conventional MRI characteristic parameters has reliable negative prediction value,which is expected to reduce the unnecessary biopsy of nearly half of the patients with st

关 键 词：乳腺肿瘤 前哨淋巴结 磁共振成像 病理学 外科 诊断 鉴别 预测 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]