摘要
目的探讨对比增强能谱乳腺摄影(CESM)影像特征对非肿块样强化(NME)乳腺导管癌不同组织学类型与腋窝淋巴结(ALN)转移的诊断价值。方法回顾性纳入完成CESM检查的NME乳腺癌女性病人63例,经病理确诊为导管原位癌(DCIS)或浸润性导管癌(IDC)。根据组织学类型分为DCIS组(32例)和IDC组(31例);根据有无微浸润将32例DCIS病人分为单纯DCIS组(18例)和DCIS伴微浸润(DCIS-MI)组(14例);根据ALN转移情况分为转移阳性组(19例)和转移阴性组(44例)。采用t检验、Mann-Whitney U检验、χ^(2)检验比较各分组的CESM影像特征的差异。将筛选出来有统计学意义的CESM影像特征行多因素Logistic回归分析,确定IDC、DCIS-MI及ALN转移的独立预测因素。绘制受试者操作特征(ROC)曲线,计算并比较ROC曲线下面积(AUC)、敏感度、特异度。结果DCIS与IDC间在内部强化方式、头足位减影影像相对强化比值(%RSCC)及时间信号强化曲线(TIC)类型存在统计学差异(均P<0.05);单纯DCIS与DCIS-MI的最大截面面积、%RSCC及TIC类型间差异有统计学意义(均P<0.05);ALN转移阳性组与阴性组间内部强化方式、形态分布特征、%RSCC及TIC类型差异有统计学意义(均P≤0.05)。%RSCC>3.42%和集簇/簇环强化是IDC的独立预测因素(均P<0.05),其AUC值分别为0.732、0.704;%RSCC>2.47%和最大截面面积大于4.37 cm2是DCIS-MI的独立预测因素(均P<0.05),其AUC值分别为0.802、0.764;%RSCC>2.71%和集簇/簇环强化是ALN转移的独立预测因素(均P<0.05),其AUC值分别为0.717、0.786。结论在CESM上测得的%RSCC、最大截面面积、TIC、形态分布特征及内部强化特征对于非肿块型乳腺导管癌组织学类型及ALN转移具有一定的诊断价值,可为临床医生决策及病人预后提供参考依据。
Objective To explore the diagnostic value of contrast-enhancement spectral mammography(CESM)features for different histological types of non-mass enhancement(NME)ductal carcinoma of the breast and axillary lymph node(ALN)metastasis.Methods A retrospective study was conducted on 63 female patients with NME breast cancer who underwent CESM and were pathologically diagnosed with ductal carcinoma in situ(DCIS)or invasive ductal carcinoma(IDC).Patients were divided into DCIS group(32 cases)and IDC group(31 cases)based on histological type.Additionally,the DCIS group was subdivided into pure DCIS(18 cases)and DCIS with microinvasion(DCIS-MI)(14 cases).Based on ALN metastasis,patients were categorized into the metastasis-positive group(19 cases)and the metastasis-negative group(44 cases).Differences in CESM imaging features between groups were compared using t-tests,Mann-Whitney U tests,and chi-square tests.Statistically significant CESM imaging features were analyzed using multivariate logistic regression to identify independent predictors of IDC,DCIS-MI,and ALN metastasis.Receiver operating characteristic(ROC)curves were plotted,and the area under the curve(AUC),sensitivity,and specificity were calculated and compared.Results The%RSCC,TIC,and internal enhancement patterns were significantly different between the DCIS and IDC groups(all P<0.05).The cross-sectional area,relative enhancement ratio of cycranio caudal subtraction angiograph(%RSCC),and pattern of time-signal intensity curve(TIC)were significantly different between DCIS and DCIS-MI groups(all P<0.05).The%RSCC,TIC and internal enhancement patterns were significantly different between the ALN metastasis positive and negative groups(all P<0.05).%RSCC>3.42%and clustered/ring enhancement were independent predictors of IDC(both P<0.05),with AUC values of 0.732 and 0.704,respectively.%RSCC>2.47%and cross-sectional area>4.37 cm2 were independent predictors of DCIS-MI(both P<0.05),with the AUC values of 0.802 and 0.764,respectively.%RSCC>2.71%and clustered/ring enhancement were independent predictors of ALN metastasis(both P<0.05),with AUC values of 0.717 and 0.786,respectively.Conclusion The%RSCC,cross-sectional area,TIC and internal enhancement patterns characteristics measured on CESM have diagnostic value for histological types and axillary lymph node(ALN)metastasis.These features can provide reference information for clinical decision-making and patient prognosis.
作者
陈军
葛金丹
魏盼盼
杨光
华蓓
王勇
荣小翠
全冠民
CHEN Jun;GE Jindan;WEI Panpan;YANG Guang;HUA Bei;WANG Yong;RONG Xiaocui;QUAN Guanmin(Department of Radiology,The Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Radiology and Nuclear Medicine,The First Hospital of Hebei Medical University;Department of Medical Imaging,The Second Hospital of Hebei Medical University)
出处
《国际医学放射学杂志》
2024年第3期321-327,共7页
International Journal of Medical Radiology
基金
河北省医学科学研究重点课题项目(20230897)
河北省医学科学研究重点课题项目(20242016)。
关键词
非肿块型乳腺病变
对比增强能谱乳腺摄影
导管原位癌
浸润性导管癌
Breast non-mass-like lesions
Contrast enhancement spectral mammography
Ductal carcinoma in situ
Infiltrating ductal carcinoma
