摘要
目的探讨定性及定量PET/MRI在评估乳腺癌腋窝淋巴结转移中的价值。方法回顾性收集2022年2至8月东部战区总医院33例乳腺癌患者术前PET/MRI图像,均为女性,年龄34~73(51.4±11.3)岁。以病理学及随访结果作为金标准,由2名经验丰富的乳腺影像诊断医师独立进行评估。定性PET/MRI评估为首先阅读MRI图像对腋窝淋巴结进行分类,然后结合MRI及PET图像对腋窝淋巴结进行重分类,采用R语言(RStudio)计算净重分类改善指数(NRI)。定量PET/MRI评估为2名医师分别测量腋窝淋巴结最大标准摄取值(SUVmax),取其平均值与金标准比较,创建受试者工作特征(ROC)曲线以选择SUVmax最佳阈值。基于此阈值及MRI分类结果,将腋窝淋巴结分为定量PET/MRI阳性及阴性。比较MRI与定量PET/MRI评估腋窝淋巴结转移的灵敏度、特异度及准确度,并比较两者的ROC曲线下面积(AUC)。结果MRI与定量PET/MRI评估乳腺癌淋巴结转移的灵敏度、特异度及准确度差异均无统计学意义(81.82%比95.46%;81.82%比100%;81.82%比96.97%)(均P>0.05);AUC差异具有统计学意义[0.82(95%CI:0.65~0.93)比0.98(95%CI:0.85~1.00),P=0.026]。根据金标准,同侧腋窝淋巴结未转移11例,SUVmax为0.83±0.18;淋巴结转移22例,SUVmax为[4.36(1.77,5.85)]。与MRI相比,定性PET/MRI评估腋窝淋巴结转移的NRI为36.36%(P=0.021)。结论与MRI相比,定量PET/MRI评估乳腺癌腋窝淋巴结转移的AUC更高,定性PET/MRI对腋窝淋巴结转移评估具有更好的重分类效果。
Objective To investigate the value of qualitative and quantitative PET/MRI in the evaluation of axillary lymph node metastasis in patients with breast cancer.Methods A total of 33 patients with breast cancer underwent preoperative PET/MRI examinations in Jingling Hospital from February to August in 2022 were retrospectively collected.All these patients were female,aged from 34 to 73(51.4±11.3)years.Histopathological results and follow‑up data were deemed as the referent standard,and the images were independently evaluated by two experienced breast imaging radiologists.The qualitative PET/MRI evaluation procedures were designed to evaluated the MRI alone to classify the axillary lymph nodes firstly,and then,the axillary lymph nodes status was reclassified by combining MRI and PET images.The net reclassification improvement index(NRI)was calculated using the R Programming Language(RStudio).The quantitative PET/MRI evaluation of the maximum standard uptake value(SUVmax)of axillary lymph nodes were measured by two radiologists,respectively,and the average value was compared with the referent standard to conduct a receiver operating characteristic(ROC)curve to select the optimal cutoff value of SUVmax.Based on the cutoff value and MRI classification results,axillary lymph nodes status was divided into quantitative PET/MRI positive or negative.The sensitivity,specificity and accuracy of MRI and quantitative PET/MRI in evaluating axillary lymph node metastasis were compared,and the area under the ROC curve(AUC)was compared.Results There was no significant difference in sensitivity,specificity and accuracy between MRI and quantitative PET/MRI in evaluating lymph node metastasis of breast cancer(81.82%vs 95.46%;81.82%vs 100%;81.82%vs 96.97%)(all P>0.05).The AUC had a statistically significant difference[0.82(0.65 to 0.93)vs 0.98(0.85 to 1.00),P=0.026)].According to the referent standard,in the 11 cases without ipsilateral axillary lymph node metastasis,the SUVmax was 0.83±0.18,while in the 22 cases with ipsilateral ax
作者
陈随
霍立群
罗松
汪小霞
徐舒嘉
马延
顾海峰
顾军
卢光明
张龙江
Chen Sui;Huo Liqun;Luo Song;Wang Xiaoxia;Xu Shujia;Ma Yan;Gu Haifeng;Gu Jun;Lu Guangming;Zhang Longjiang(Department of Diagnostic Radiology,Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210002,China;Research Institute of General Surgery,Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210002,China;Department of Pathology,Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210002,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第31期2433-2439,共7页
National Medical Journal of China
基金
东部战区总医院院内课题(22JCYYYB9)
关键词
乳腺肿瘤
正电子发射断层显像
磁共振成像
腋窝淋巴结
转移
横断面研究
Breast neoplasms
Positron emission tomography
Magnetic resonance imaging
Positron emission tomography
Axillary lymph node
Metastasis
Cross‑sectional study
