摘要
目的探究多模态影像诊断浸润性乳腺癌的价值及与相关肿瘤标志物表达的关系。方法回顾性纳入2016年1月至2021年1月在连云港市第二人民医院经手术病理证实的乳腺癌患者120例,根据病理类型分为浸润组(浸润性乳腺癌,n=89)和非浸润组(非浸润性乳腺癌,n=31)。所有患者均接受超声造影(CEUS)、动态增强磁共振成像(DCE-MRI)扫描,分析其影像学特征、CEUS及DCE-MRI定量参数,评估多模态影像对浸润性乳腺癌的诊断价值,分析不同影像学定量参数与癌胚抗原(CEA)、组织多肽特异性抗原(TPS)和糖类抗原153(CA153)表达的相关性。结果两组患者的乳腺影像报告和数据系统(BI-RADS)分类(χ^(2)=10.561)、淋巴结转移(Fisher确切概率检验,P=0.000)和灌注情况(χ^(2)=10.094)均存在明显差异(P<0.05);浸润组患者的峰值强度(PI)、强化率和信号增强比率均明显高于非浸润组,峰值时间明显低于非浸润组(t值分别为6.210、4.247、2.218、9.651,P<0.05);浸润组时间-信号强度曲线(TIC)类型以Ⅱ型为主,与非浸润组比较差异有统计学意义(χ^(2)=8.703,P=0.013)。CEUS诊断浸润性乳腺癌的准确率为76.67%,灵敏度为81.11%,特异度为63.33%;DCE-MRI诊断浸润性乳腺癌的准确率为84.17%,灵敏度为87.50%,特异度为70.83%;其联合检测诊断浸润性乳腺癌的准确率为94.17%,灵敏度为96.63%,特异度为87.10%。CEUS联合DCE-MRI诊断结果与病理诊断的一致性高于CEUS、DCE-MRI单独诊断(Kappa值分别为0.846、0.417、0.541),诊断准确率明显高于单独诊断(χ^(2)=10.674,P<0.05)。浸润组患者的血清CEA、TPS和CA153水平均明显高于非浸润组(t值分别为4.864、3.348、7.673,P<0.05);PI、强化率、信号增强比率与血清CEA、TPS、CA153水平均呈正相关(PI:r分别为0.708、0.726、0.681,P<0.001;强化率:r分别为0.576、0.583、0.607,P<0.001;信号增强比率:r分别为0.496、0.527、0.573,P<0.001);峰值时间与血清CEA、TPS、CA153水平均呈负相关(r分别为-0.693、-0.651、-0.647,P<0.001)。结论多模态影像对浸润性乳腺癌具有良好的诊断价值,可提高浸润性乳腺癌的诊断准确率,且CEUS、DCE-MRI定量参数与血清肿瘤标志物存在明显相关性,可作为浸润性乳腺癌临床诊断及病情评估的重要指标。
Objective To explore diagnosic value of multimodal imaging for invasive breast cancer, and its relationship with expression of related tumor markers.Methods 120 patients with breast cancer confirmed by surgery and pathology in The Second Lianyungang Municipal People′s Hospital from January 2016 to January 2021 were reviewed.According to the pathological type, the patients were divided into invasive breast cancer group(n=89) and non-invasive breast cancer group(n=31).All patients underwent contrast-enhanced ultrasonography(CEUS) and dynamic contrast-enhanced MRI(DCE-MRI) scan.The imaging characteristics, quantitative parameters of CEUS and DCE-MRI in breast cancer were analyzed.The diagnostic value of multimodal imaging for invasive breast cancer was evaluated.The correlations of different imaging quantitative parameters with expression of carcinoembryonic antigen(CEA),tissue polypeptide specific antigen(TPS) and carbohydrate antigen 153(CA153) were analyzed.Results There were significant differences in Breast Imaging Reporting and Data System(BI-RADS) classification(χ^(2)=10.561,P<0.05),lymph node metastasis(Fisher′s precise probability test, P=0.000) and perfusion(χ^(2)=10.094,P<0.05) between the two groups.The peak intensity(PI),enhancement rate and signal enhancement ratio in the invasive breast cancer group were significantly higher than those in the non-invasive breast cancer group, while time to peak was significantly shorter than that in the non-invasive breast cancer group(t=6.210,4.247,2.218 and 9.651 respectively, all P<0.05).The time-signal intensity curve(TIC) of the invasive breast cancer group was mainly type Ⅱ,and there was a statistically significant difference compared with that in the non-invasive breast cancer group(χ^(2)=8.703,P=0.013).The accuracy, sensitivity and specificity of CEUS,DCE-MRI and their combination for the diagnosis of invasive breast cancer were 76.67%,81.11% and 63.33%(CEUS);84.17%,87.50% and 70.83%(DCE-MRI);and 94.17%,96.63% and 87.10%(CEUS+DCE-MRI),respectively.The consistency of CEUS combined with DCE-MRI with pathological diagnosis was higher than that of CEUS or DCE-MRI alone(Kappa=0.846,0.417 and 0.541 respectively),and its diagnostic accuracy rate was significantly higher than that of single CEUS or DCE-MRI(χ^(2)=10.674,P<0.05).The serum levels of CEA,TPS and CA153 of the patients in the invasive breast cancer group were significantly higher than those in the non-invasive breast cancer group(t=4.864,3.348 and 7.673 respectively, all P<0.05).Correlation analysis showed that PI,enhancement rate and signal enhancement rate were positively associated with serum CEA,TPS and CA153 levels(for PI:r=0.708,0.726 and 0.681 respectively, all P<0.001;for enhancement rate: r=0.576,0.583 and 0.607 respectively, all P<0.001;for signal enhancement rate: r=0.496,0.527 and 0.573 respectively, all P<0.001),while time to peak was negatively correlated with them(r=-0.693,-0.651 and-0.647 respectively, all P<0.001).Conclusion The multimodal imaging has a good diagnostic value for invasive breast cancer, which can improve the diagnostic accuracy rate.The quantitative parameters of CEUS and DCE-MRI are significantly associated with serum tumor markers, which can be applied as important indicators for clinical diagnosis and assessment of invasive breast cancer.
作者
任玉菊
巴双
李桂芬
REN Yuju;BA Shuang;LI Guifen(Department of Ultrasonography,The Second Lianyungang Municipal People's Hospital,Jiangsu Lianyungang 222000,China;Department of Ultrasonography,The First Lianyungang Municipal People's Hospital,Jiangsu Lianyungang 222000,China;Department of Medical Imaging,The Second Lianyungang Municipal Peoples Hospital,Jiangsu Lianyungang 222000,China)
出处
《中国妇幼健康研究》
2022年第1期80-87,共8页
Chinese Journal of Woman and Child Health Research
关键词
乳腺癌
浸润性
多模态影像技术
超声造影
动态增强磁共振成像
肿瘤标志物
breast cancer
invasive
multimodal imaging technology
contrast-enhanced ultrasonography(CEUS)
dynamic contrast-enhanced MRI(DCE-MRI)
tumor marker
