基于多模态DCE-MRI特征在乳腺癌腋窝淋巴结转移风险评估中的价值

目的探究多模态动态增强磁共振成像（dynamic contrast enhanced magnetic resonance imaging，DCE-MRI）在预测乳腺癌病人腋窝淋巴结转移风险中的价值。方法回顾性分析54例经手术病理证实的乳腺癌病人的术前临床及影像学资料，入组病人均在术前进行多模态DCE-MRI扫描。根据病人有无腋窝淋巴结（axillary lymph node metastasis，ALNM）分为腋窝淋巴结转移组（ALNM阳性组）19例和无腋窝淋巴结转移组（ALNM阴性组）35例，重点分析2组临床一般资料及DCE-MRI特征与腋窝淋巴结转移间的相关性。结果54例乳腺癌病人的临床一般资料（包括年龄、绝经史、生育史、肿块质地、肿块活动性）与ALNM无关（P>0.05）；在多模态DCE-MRI特征方面，ALNM阳性组肿块边缘模糊者比例明显高于ALNM阴性组（P < 0.01）；ALNM阳性组病人的肿块ADC明显低于ALNM阴性组（P < 0.01）；ALNM阳性组中ALN≥0.5 cm比例明显高于ALNM阴性组（P < 0.05）；多因素分析结果显示，肿块ADC值和肿块边缘方面是乳腺癌ALNM的独立危险因素（P < 0.01）；此外，肿块ADC值的AUC、敏感性、特异性和cut-off值分别为0.743、78.9%、71.4%和0.912×10-3mm2/s；肿块边缘的AUC、敏感性和特异性分别为0.750、84.2%和65.6%。结论多模态DCE-MRI中的边缘特征及ADC值与乳腺癌腋窝淋巴结转移的风险因素有助于乳腺癌病人治疗方案的制定及预后评估。

Value of the 3.0-T DCE-MRI features in the assessment of the risk of axillary lymph node metastasis in breast cancer

ObjectiveTo investigate the value of multimodal dynamic contrast enhanced magnetic resonance imaging(DCE-MRI) in predicting the risk of axillary lymph node metastasis(ALNM) in breast cancer patients.MethodsThe preoperative clinical and imaging data of 54 patients with breast cancer confirmed by surgical pathology were retrospectively analyzed.The multimodal DCE-MRI scan in all cases were detected before surgery.The patients were divided into the axillary lymph node metastasis group(ALNM+, n=19) and the non-axillary lymph node metastasis group(ALNM-, n=35) according to the presence or absence of ALNM.The correlation between the clinical and DCE-MRI features and ALNM were analyzed in two groups.ResultsThe general clinical data of 54 breast cancer patients(including age, menopausal history, fertility history, mass texture and mass activity) were not related to ALNM(P>0.05).In terms of multimodal DCE-MRI features, the proportion of patients with blurred mass edges in ALNM positive group was significantly higher than that in ALNM negative group(P < 0.01).The ADC in ALNM positive group was significantly lower than that in ALNM negative group(P < 0.01).The proportion of ALN ≥ 0.5 cm in ALNM positive group was significantly higher than that in ALNM negative group(P < 0.05).The results of multivariate analysis showed that the ADC value and tumor margin were the independent risk factors of ALNM in breast cancer(P < 0.01).In addition, the AUC, sensitivity, specificity and cut-off values of ADC values were the 0.743, 78.9%, 71.4% and 0.912×10-3mm2/s, respectively.The AUC, sensitivity and specificity of mass margin were the 0.750, 84.2% and 65.6%, respectively.ConclusionsThe marginal features of multimodal DCE-MRI, ADC value and risk factors of ALNM in breast cancer are helpful for the development of treatment plan and prognosis evaluation of breast cancer patients.