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

摘要
图/表
参考文献(20)
相关文章 (15)

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

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（χ2）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。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	向旭1
	殷洁1
	吕国义1
	李建灵1
	尤国庆1
	曾越灿2

关键词 ：乳腺肿瘤, 癌, 导管, 磁共振成像, 超声检查, 多普勒, 彩色

Abstract：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.

Key words： Breast neoplasms Carcinoma, ductal Magnetic resonance imaging Ultrasonography, Doppler, color

收稿日期: 2017-08-29

PACS:	Ｒ737.9
	Ｒ445.2
	Ｒ445.1

基金资助:国家自然科学基金（81201803）。

通讯作者: 向旭，南阳市中心医院核磁共振室，473009。E-mail：807902111@qq.com

作者简介: 向旭（1977-），男，河南南阳人，主治医师。E-mail：807902111@qq.com

引用本文:

向旭1，殷洁1，吕国义1，李建灵1，尤国庆1，曾越灿2. 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[J]. 中国临床医学影像杂志, 2018, 29(6): 400-403.
XIANG Xu1, YIN Jie1, LYU Guo-yi1, LI Jian-ling1, YOU Guo-qing1, ZENG Yue-can2. Clinical significance of ADC in the diagnosis of ductal carcinoma in situ and invasive breast cancer. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(6): 400-403.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2018/V29/I6/400

[1]韩露. 单纯乳腺导管原位癌（DCIS）MRI特征与HER2表达及病理核分级的相关性研究[D]. 沈阳：中国医科大学，2015.
[2]Zhao J, Guan H, Li M, et al. Significance of the ADC ratio in the differential diagnosis of breast lesions[J]. Acta Radiol, 2016, 57(4): 422-429.
[3]Bickel H, Pinkerdomenig K, Bogner W, et al. Quantitative apparent diffusion coefficient as a noninvasive imaging biomarker for the differentiation of invasive breast cancer and ductal carcinoma in situ[J]. Invest Radiol, 2015, 50(2): 95-100.
[4]贾红霞. 乳腺MRI与乳腺X线诊断导管原位癌的临床效果[J]. 中国实用医药，2016，11（10）：67-68.
[5]Cox J, Hancock H, Spratt J, et al. British society of breast radiology annual scientific meeting 2014[J]. Breast Cancer Research Bcr, 2015, 17(Suppl 1): 1.
[6]Ding JR, Wang DN, Pan JL. Apparent diffusion coefficient value of diffusion-weighted imaging for differential diagnosis of ductal carcinoma in situ and infiltrating ductal carcinoma[J]. J Cancer Res Ther, 2016, 12(2): 744-750.
[7]Fan X, Macleod K, Mustafi D, et al. Correlation of In Vivo and Ex Vivo ADC and T2 of In Situ and Invasive Murine Mammary Cancers[J]. PLoS One, 2015, 10(7): e0129212.
[8]Jha AK, Rodríguez JJ, Stopeck AT. A maximum-likelihood method to estimate a single ADC value of lesions using diffusion MRI[J]. Magn Reson Med, 2016, 76(6): 1919-1931.
[9]Lee CW, Wu HK, Lai HW, et al. Preoperative clinicopathologic factors and breast magnetic resonance imaging features can predict ductal carcinoma in situ with invasive components[J]. Eur J Radiol, 2016, 85(4): 780-789.
[10]张敏，董光，聂家秋，等. 动态增强MRI及DWI对乳腺导管原位癌和腺病的诊断[J]. 临床放射学杂志，2017，36（12）：1759-1762.
[11]王占秋，李京龙, 黄松涛, 等. 乳腺MRI与乳腺X线在导管原位癌临床诊断中应用的比较研究 [J]. 现代生物医学进展，2016，16（6）：1089-1091.
[12]Richa B, Viral S, Bharat A. Qualitative and quantitative diffusion-weighted imaging of the breast at 3T—A useful adjunct to contrast-enhanced MRI in characterization of breast lesions[J]. Indian J Radiol Imaging, 2015, 25(4): 397-403.
[13]吴洁莹. 钼靶X线联合MRI诊断乳腺导管原位癌的相关分析[J]. 临床医学，2015，35（2）：34-35.
[14]Santamaría G, Bargalló X, Fernández PL, et al. Neoadjuvant Systemic Therapy in Breast Cancer: Association of Contrast-enhanced MR Imaging Findings, Diffusion-weighted Imaging Findings, and Tumor Subtype with Tumor Response[J]. Radiology, 2017, 283(3): 663-672.
[15]Si L, Zhai R, Liu X, et al. MRI in the differential diagnosis of primary architectural distortion detected by mammography[J]. Diagn Interv Radiol, 2016, 22(2): 141-150.
[16]薛春升. 乳腺导管原位癌及微浸润的MRI影像学表现[J]. 深圳中西医结合杂志，2015，25（16）：75-76.
[17]张惠锋，杨慧芬，杜芳，等. 乳腺导管原位癌的磁共振特征与病理对照关系[J]. 中国现代医生，2016，54（6）：84-87.
[18]Ma L, Xu X, Zhang M, et al. Dynamic contrast-enhanced MRI of gastric cancer: Correlations of the pharmacokinetic parameters with histological type, Lauren classification, and angiogenesis[J]. Magn Reson Imaging, 2016, 37: 27-32.
[19]Yoon HJ, Kim Y, Kim BS. Intratumoral metabolic heterogeneity predicts invasive components in breast ductal carcinoma in situ[J]. Eur Radiol, 2015, 25(12): 3648-3658.
[20]Wang Y, Zhang X, Cao K, et al. Diffusion-tensor imaging as an adjunct to dynamic contrast-enhanced MRI for improved accuracy of differential diagnosis between breast ductal carcinoma in situ and invasive breast carcinoma[J]. Chin J Cancer Res, 2015, 27(2): 209-217.