| 钙化性乳腺癌MRI表现及其与预后因子的相关性分析 |
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| 引用本文： | 邵真真,刘佩芳,张淑平,赵玉梅,鲍润贤,朱鹰.钙化性乳腺癌MRI表现及其与预后因子的相关性分析[J].中国肿瘤临床,2013,40(7):389-394. |
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| 作者姓名： | 邵真真 刘佩芳 张淑平 赵玉梅 鲍润贤 朱鹰 |
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| 作者单位： | ①.天津医科大学附属肿瘤医院乳腺影像诊断科，乳腺癌防治教育部重点实验室，天津市肿瘤防治重点实验室（天津市300060） |
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| 基金项目： | 天津市科技计划项目12ZCDZSY16000 |
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| 摘 要： | 目的 探讨钙化性乳腺癌的动态增强MRI表现及其与预后因子的相关性。 方法 术前经乳腺X线检查检出为钙化性乳腺癌108例(111个病灶), 并同时行乳腺MRI检查。分析肿块与非肿块样病变的MRI动态增强表现和扩散加权成像上表观扩散系数(apparent diffusion coefficient, ADC), 并研究MRI表现和ADC值与肿瘤的组织学分级、肿瘤大小、淋巴结转移、ER、PR、c-erb-B2、Ki-67、P53表达的相关性。 结果 在111个病灶中, 肿块占66.7%(74/111), 非肿块样病变占33.3%(37/111)。MRI对钙化性病变诊断的敏感性为96.4%(107/111)。漏诊4例, 1例为导管原位癌(DCIS), 3例为浸润性导管癌, 病灶最大径均 < 2 cm。肿块比非肿块样病变的ER阳性率高(χ2=4.681, P=0.038)。肿块的形态与大小存在相关性(χ2=7.688, P=0.043), 肿块中最大径≤2 cm约54.9%(28/51)表现为圆形; 肿块中最大径 > 2 cm约47.8%(11/23)表现为不规则形。平均ADC值Ki-67阳性组为(1.046 8±0.2180 5)×10-3 mm2/s, 阴性组为(1.189 6±0.30348)×10-3 mm2/s, 二者差异有统计学意义(t=-2.594, P=0.011)。 结论 钙化性乳腺癌的MRI表现在一定程度上可反映乳腺癌的生物学行为和预后。
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| 关 键 词： | 乳腺癌 钙化 磁共振成像 预后因子 |
| 收稿时间： | 2012-10-15 |
Correlation among the findings of contrast-enhanced magnetic resonance imaging,values of apparent diffusion coefficient,and prognostic factors in breast cancer with microcalcification |
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| Abstract: | Objective This study aims to evaluate the correlation among the findings of contrast-enhanced magnetic resonance imaging(MRI), values of mean apparent diffusion coefficient(ADCmean), and prognostic factors in mass-like and non-mass-like breast cancer with microcalcification. Methods Preoperative X-ray examination of the breast showed 111 breast lesions in 108 calcified breast cancer cases.Contrast-enhanced MRI was conducted to analyze the dynamic manifestations of mass-like and non-mass-like lesions, ADC on diffusion weighted imaging, and correlation with histological grading of the tumor, tumor size, lymph node status, and expression of estrogen receptors(ER), progesterone receptors(PR), c-erb-B2, Ki-67, and P53.The time-signal intensity curve(TIC), early-phase enhancement rate, and the ADCmean values of the lesions with microcalcification were calculated.American Society of Clinical Oncology-College of American Pathologists guideline recommendations for immunohistochemical testing of ER and PR in breast cancer were developed in 2010.The guideline established the standard that ER and PR assays be considered positive if at least 1% of the positive tumor nuclei are observed in the sample.Correlations between MRI findings and prognostic factors were analyzed by Pearson's χ2 test and Pearson correlation.ADCmean values between groups were compared using the t test for two independent samples. Results The 111 microcalcification lesions consisted of 74(66.7%) mass-like-lesions and 37(33.3%) non-mass-like lesions.MRI sensitivity for diagnosing the calcified lesions reached 96.4%(107/111) of the cases.Four cases with missed diagnosis were identified, including 1 intraductal carcinoma(i.e., ductal carcinoma in situ) and 3 infiltrating carcinomas.The positive rate of ER in the mass-like lesion was higher than that in the non-mass-like lesion(χ2=4.681, P= 0.038).A correlation was observed between the form and the size of the lumps(r=0.256, P=0.028).Among the ≤2 cm lumps, 54.9%(28/ 51) consisted of round lumps; among the > 2 cm lumps, 47.8%(11/23) consisted of irregular lumps.The average ADC value was(1.046 8± 0.218 05)×10-3 mm2/s in the Ki-67-positive group and(1.189 6±0.303/48)×10-3 mm2/s in the Ki-67-negative group.Significant differences were indicated between the two groups(t=-2.594, P=0.011). Conclusion MRI findings reflect to a certain extent the biological behavior and prognosis of breast cancer with microcalcification. |
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