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预后指标的相关性研究

目的:探讨磁共振成像(MRI)表观扩散系数(ADC)与乳腺浸润性导管癌组织学分级及其预后指标的相关性。方法:收集2016年5月至2017年5月于我院就诊的并经手术病理确诊为乳腺浸润性导管癌的患者112例作为研究对象,选取患者乳腺癌组织样本作为病例组,同时选取患者对侧正常乳腺组织样本作为对照组,所有患者均行常规MRI和磁共振扩散加权成像(DW-MRI)检查,分别测量两组样本的ADC值,比较不同乳腺浸润性导管癌组织学分级与正常乳腺组织的ADC值,分析乳腺浸润性导管癌组织的ADC值与肿瘤直径大小、淋巴结转移状态、有无远处转移及雌激素受体(ER)、孕激素受体(PR)和Ki-67表达的关系,并分析ADC值与组织学分级及预后指标的相关性。结果:乳腺浸润性导管癌病理分级I级的ADC值低于对照组,病理分级II级的ADC值低于病理分级I级及对照组,病理分级III级的ADC值低于病理分级II级、I级及对照组,差异均具有统计学意义(P0.05)。乳腺浸润性导管癌患者中,肿块直径2 cm、无淋巴结转移、ER阴性、PR阴性、Ki-67阴性患者的平均ADC值均高于肿块直径≥2 cm、有淋巴结转移、ER阳性、PR阳性、Ki-67阳性患者,差异均具有统计学意义(P0.05);而有无远处转移患者之间比较差异无统计学意义(P0.05)。经Spearman秩相关分析结果显示,乳腺浸润性导管癌患者的ADC值与病理组织学分级呈现负相关关系(rs=-0.716,P=0.000);与肿块直径大小、有无淋巴结转移及ER、PR、Ki-67的表达均呈负相关(rs=-0.316、-0.545、-0.667、-0.598、-0.443,P均0.05),与有无远处转移无相关性(rs=0.091,P=0.887)。结论:乳腺浸润性导管癌的ADC值与癌组织学分级和预后相关指标存在一定相关性,可作为一种临床诊断和判断预后的重要指标,具有重要临床价值。

Correlation Between Apparent Diffusion Coefficient of Magnetic Resonance Imaging and Histological Grade and Prognosis Index of Invasive Ductal Carcinoma of Breast

ABSTRACT Objective: To investigate the correlation between the apparent diffusion coefficient (ADC) of magnetic resonance imaging (MRI) and histological grade and prognostic index of invasive ductal carcinoma of breast. Methods: 112 patients with invasive ductal carcinoma of breastwho had been diagnosed by surgery and pathology in our hospitalfrom May 2016 to May 2017 were collected as the subjects, the samples of patients with breast cancer were selected as the case group, the contralateral normal breast tissue samples were selected as the control group. All the patients underwent routine MRI and magnetic resonance diffusion weighted imaging (DW-MRI) examinations, the ADC value of the two groups were measured, the ADC value between different histological grading of in- vasive ductal carcinoma of breast and normal breast tissue were compared. The relationship between ADC value and tumor diameter, lymph node metastasis, distant metastasis, estrogen receptor (ER), progesterone receptor (PR) and Ki-67 expression in invasive ductal carcinoma of the breast were analyzed, and the correlation between ADC value and histological grade and prognostic index was ana- lyzed. Results: The ADC value in the pathological grade I invasive ductal carcinoma of breast were lower than that in the control group, the ADC value in the pathological grade II were lower than that in the pathological grade I and the control group, the ADC value in the pathological grade III were lower than that in the pathological grade II, the pathological grade I and the control group, the differences were statistically significant (P<0.05). In patients with invasive ductal carcinoma of breast, the average ADC value of tumor diameter less than 2 cm, without lymph node metastasis, ER negative, PR negative, Ki-67 negative patients were higher than those of the mass diame- ter over 2 cm, lymph node metastasis, ER positive, PR positive, Ki-67 positive patients, the differences were statistically significant (P<0. 05). There was no significant difference between the patients with or without distant metastasis (P>0.05). Spearman rank correlation analysis showed that there was negative correlation between ADC value and histopathological grading in invasive ductal carcinoma of the breast (rs=-0.716, P=0.000), it was negatively correlated with tumor diameter, lymph node metastasis, and the expression of ER, PR and Ki-67 (rs=-0.316, -0.545, -0.667, -0.598, -0.443, both P<0.05), there was no correlation between the patients with or without distant metastasis (rs=0.091, P=0.887). Conclusion: The ADC value of invasive ductal carcinoma of breast is relate to the histological grade and prognostic index, it can be used as an important index to judge the clinical diagnosis and prognosis, which has important clinical value.