目的：研究扩散加权成像表观扩散系数（ADC）值在诊断乳腺癌中的作用以及它与肿瘤体积和分子生物标志物（雌激素受体（ER）、孕激素受体（PR）、人类表皮生长因子受体2（c-erbB-2））的关联。材料与方法：经手术病理确诊的84例（53例乳腺癌，31例良性）乳腺病变的患者均接受1.5T常规DWI检查。记录所有病灶ER、PR、HER2的表达情况及ADC值。结果：恶性病变的平均ADC值（（1.02±0.13）×10-3 mm2/s）显著低于乳腺良性病变的ADC值（（1.56±0.29）×10-3 mm2/s）。ADC阈值为1.23×10-3 mm2/s（灵敏度88.5%，特异性85.1%，曲线下面积0.91）以区分乳腺恶性和良性疾病。与ER+，PR+和非三阴性（nTN）癌症相比，具有ER-，PR-和三阴性（TN）状态的乳腺癌分别显示出较大的肿瘤体积，更高的ADC值。结论：本研究表明ADC值可以提高DCE-MRI的诊断特异性，并且可用于临床工作中的治疗管理。
Abstract
Objective: To investigate the role of apparent diffusion coefficient(ADC) value in the diagnosis of breast cancer and its association with tumor volume and hormonal receptors(estrogen receptor(ER), progesterone receptor(PR), and human epidermal growth factor(HER2)). Materials and Methods: Fifty-three patients with pathology-proven breast cancer and 31 with benign pathology were detected by diffusion weighted imaging(DWI) on 1.5T MR. ADC value and tumor size were measured respectively. Results: Mean ADC of malignant lesions was significantly lower((1.02±0.13)×10-3 mm2/s) compared to benign ((1.56±0.29)×10-3 mm2/s) lesions. A cutoff ADC value of 1.23×10-3 mm2/s(sensitivity 88.5%, specificity 85.1%, area under the curve 0.91) was obtained to differentiate malignant from benign diseases. Breast cancers with ER+, PR+, and triple-negative (TN) status showed a significantly larger tumor volume compared to ER+, PR+, and non-triple-negative (nTN) cancers, respectively. Furthermore, TN tumors showed a significantly higher ADC compared to ER+, PR+, and nTN cancers. Conclusion: ADC may increase the diagnostic specificity of DCE-MRI and be useful for evaluating prognosis of the tumor and guiding clinical therapy.
关键词
乳腺肿瘤 /
免疫组织化学 /
磁共振成像
Key words
Breast neoplasms /
Immunohistochemistry /
Magnetic resonance imaging
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参考文献
[1]Jemal A, Bray F, Center MM, et al. Global cancer statistics[J]. CA cancer J Clin, 2011, 61(2): 69-90.
[2]Sharma U, Danishad KK, Seenu V, et al. Longitudinal study of the assessment by MRI and diffusion-weighted imaging of tumor response in patients with locally advanced breast cancer undergoing neoadjuvant chemotherapy[J]. NMR Biomed, 2009, 22(1): 104-113.
[3]Wolff AC, Hammond ME, Schwartz JN, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer[J]. J Clin Oncol, 2007, 25(2): 118-145.
[4]夏琬君，程敬亮. MR参数对乳腺良恶性疾病的诊断价值[J]. 实用放射学杂志，2015，31（10）：1733-1735.
[5]杨维珍，韦寅，陈鹏，等. 数字乳腺摄影与MR诊断乳腺癌的临床价值[J]. 医学影像学杂志，2016，26（9）：1620-1624.
[6]Cho GY, Moy L, Kim SG, et al. Evaluation of breast cancer using intravoxel incoherent motion(IVIM) histogram analysis: comparison with malignant status, histological subtype, and molecular prognostic factors[J]. Eur Radiol, 2016, 26(8): 2547-2558.
[7]王琪，常晓丹. 三阴性乳腺癌3.0T磁共振的诊断价值[J]. 磁共振成像，2015，6（4）：283-288.
[8]于学娟，柳善刚，陈兆秋，等. 3.0T磁共振成像表观扩散系数与乳腺浸润性导管癌组织学分级及分子生物学特征的相关性[J]. 中华肿瘤杂志，2014，36（8）：606-611.
[9]张婷婷，孙圣荣. 多模态磁共振诊断乳腺疾病及其与乳腺癌预后因子的相关分析[J]. 中华实验外科杂志，2015，32（10）：2534-2538.
[10]陈欣，郭佑民，康华峰，等. 乳腺浸润性导管癌磁共振表观扩散系数值与预后因子表达的相关性分析[J]. 实用放射学杂志，2012，28（3）：384-388.
[11]金观桥，苏丹柯，罗殿中，等. 磁共振DWI对乳腺癌分子亚型的鉴别诊断应用价值[J]. 实用放射学杂志，2015，31（6）：929-932.
