摘要
目的探讨临床病理及病灶MRI特征与乳腺癌腋窝淋巴结(ALN)转移的相关性及其辅助提高ALN转移诊断的价值。方法回顾性分析842例病理证实为乳腺癌患者的临床病理及MRI特征,根据病理结果将患者分为ALN转移组和无转移组;分析两组患者在临床病理及MRI特征方面的差异,并用Logistic回归分析乳腺癌ALN转移的独立影响因素,绘制受试者工作特征曲线(ROC)评价其诊断效能。结果842例患者中ALN转移组307例,无转移组535例;病理分级、孕激素受体(PR)、人表皮生长因子受体-2(HER-2)、Ki-67及是否合并脉管癌栓在两组患者中差异均有统计学意义(P均<0.05)。MRI特征中病灶大小、数目、强化类型及乳腺影像报告和数据系统(BI-RADS)分类在两组患者中差异均有统计学意义(P均<0.05);以MRI上ALN形态学标准诊断ALN转移,本研究共检出可疑ALN转移患者390例(46.3%),无转移者452例(53.7%),其灵敏度、特异度、准确率分别为82.1%、74.2%和77.1%。Logistic回归分析显示PR低表达、HER-2阳性、合并脉管癌栓、病灶>20 mm及非肿块强化、BI-RADS 5类是乳腺癌ALN转移的独立危险因素(P均<0.05);基于MRI形态学标准、临床病理及病灶MRI特征、及二者联合诊断乳腺癌ALN转移的曲线下面积(AUC)值分别为0.781、0.739和0.848。结论临床病理及病灶MRI特征与乳腺癌ALN转移有一定的相关性,其与MRI上ALN形态学诊断标准联合可提高乳腺癌ALN转移的诊断效能。
Objective To investigate the correlations of clinicopathological and lesion MRI features with axillary lymph node(ALN)metastasis and the added diagnostic value of ALN metastasis in breast cancer.Methods The clinicopathological and breast MRI features of 842 breast cancer patients confirmed by pathology were analyzed retrospectively.According to the results of pathological evaluation,the patients were divided into ALN metastasis group and non-metastasis group;the differences of clinicopathological and breast MRI features between the two groups were analyzed,and the independent influencing factors of breast cancer ALN metastasis were analyzed by Logistic regression,then ROC curve was drawn to evaluate its diagnostic efficiency.Results Among 842 breast cancer patients,307 patients had ALN metastasis and 535 patients without ALN metastasis;and there were statistically significant differences in the aspects of pathological grade,PR,HER-2,Ki-67 and vascular tumor embolism between this two groups(all P<0.05).On MRI features,the lesion size,number,enhancement type and BI-RADS classification were significantly different between the groups of ALN metastasis and ALN non-metastasis(all P<0.05).According to the morphological criteria of MRI for ALN metastasis,a total of 390(46.3%)patients with suspected metastatic ALNs and 452(53.7%)patients without metastatic ALNs,and the sensitivity,specificity and accuracy were 82.1%,74.2%and 77.1%respectively.Logistic regression analysis showed that low expression of PR,positive HER-2,vascular tumor invasion,lesion>20 mm,non-mass enhancement and BI-RADS 5 category were independent risk factors for ALN metastasis in breast cancer,and the AUC values for diagnosing ALN metastasis based on MRI morphological criteria,clinicopathological and lesion MRI features,and the combination were 0.781,0.739 and 0.848 respectively.Conclusion The clinicopathological and MRI features of lesions have some correlations with ALN status in breast cancer,especially when combining with MRI morphological criteria,
作者
王贇霞
海梦璐
高扬
马蕾
吴亚平
李晓栋
王梅云
谭红娜
WANG Yunxia;HAI Menglu;GAO Yang(Department of Radiology,People's Hospital of Henan University,Henan Provincial People's Hospital,Zhengzhou,Henan Province 450003,P.R.China)
出处
《临床放射学杂志》
北大核心
2023年第10期1572-1578,共7页
Journal of Clinical Radiology
基金
河南省自然科学基金面上项目(编号:202300410081)
河南省医学科技攻关计划项目(编号:LHGJ20220055)。
