磁共振动态对比增强联合DWI可有效评估肿块型浸润性乳腺癌的术前诊断效能及生物学行为OA
Dynamic contrast-enhanced MRI combined with DWI effectively evaluates the preoperative diagnostic efficacy and biological behavior of mass-type invasive breast cancer
目的 探讨磁共振动态对比增强(DCE-MRI)联合DWI在肿块型浸润性乳腺癌术前诊断及预后评估中的价值,并与超声进行对比分析.方法 回顾性分析2022年1月～2024年12月广西壮族自治区人民医院收治的138例可疑乳腺癌患者临床及影像资料.以术后病理结果为金标准.比较两种方法的诊断指标(敏感度、特异度、AUC);分析影像学边界特征与Ki-67指数、分子分型等病理学指标的相关性.结果 术后病理证实恶性119例、良性19例.DCE-MRI+DWI诊断AUC值为0.844(95%CI:0.748～0.941),高于超声的0.759(95%CI:0.639～0.880),敏感度为81.5%,高于超声的67.2%;超声的特异度为84.2%,高于DCE-MRI+DWI的73.7%.两种方法对"边界不清晰"的判断高度一致(Kappa=0.796),MRI对毛刺征的检出率(52.1%)高于超声(24.4%).MRI非特异性不清晰边界(模糊/微分叶)与高Ki-67指数(P=0.048)及高风险分子亚型(三阴性/HER2过表达)(P=0.008)相关;而超声的"成角"与"毛刺"征在预测病理侵袭性方面的差异无统计学意义(P>0.05),即使合并为复合指标后仍未见有效预后分层能力.结论 DCE-MRI联合DWI在诊断效能及预测肿瘤生物学行为方面优于超声,超声则以高特异性作为有效补充,二者在术前评估中具有分层互补价值.
Objective To investigate the value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)combined with diffusion-weighted imaging(DWI)in the preoperative diagnosis and prognostic evaluation of mass-type invasive breast cancer,and to perform a comparative analysis with ultrasound.Methods Clinical and imaging data of 138 patients with suspected breast cancer treated at the People's Hospital of Guangxi Zhuang Autonomous Region from January 2022 to December 2024 were retrospectively analyzed.Postoperative pathological findings served as the gold standard.Diagnostic performance indicators(sensitivity,specificity and AUC)were compared between the two modalities.The associations between imaging margin characteristics and pathological indicators,including Ki-67 index and molecular subtypes,were also analyzed.Results Postoperative pathology confirmed 119 malignant and 19 benign lesions.DCE-MRI+DWI achieved an AUC of 0.844(95%CI:0.748-0.941),higher than that of US(0.759,95%CI:0.639-0.880).DCE-MRI+DWI showed a higher sensitivity(81.5%vs 67.2%),whereas ultrasound demonstrated a higher specificity(84.2%vs 73.7%).The two modalities showed high consistency in the assessment of"unclear margin"(Kappa=0.796).The detection rate of spiculated margin was significantly higher with MRI(52.1%)than with ultrasound(24.4%).On MRI,non-specific unclear margins(ill-defined/lobulated)were associated with high Ki-67 index(P=0.048)and high-risk subtypes(TNBC/HER2+)(P=0.008).In contrast,ultrasound-detected angular and spiculated margins showed no significant association with pathological aggressiveness(P>0.05),and even after combining them into a composite indicator,no effective prognostic stratification capability was observed.Conclusion DCE-MRI combined with DWI is superior to ultrasound in diagnostic performance and prediction of tumor biological behavior,whereas ultrasound serves as an effective complement with its high specificity.The two modalities have stratified and complementary value in preoperative assessment.
谢灵灵;梁秀群;覃海霞;梁惠
广西壮族自治区人民医院放射科,广西 南宁 530021广西壮族自治区人民医院放射科,广西 南宁 530021广西壮族自治区人民医院放射科,广西 南宁 530021广西中医药大学附属瑞康医院放疗科,广西 南宁 530021
浸润性乳腺癌动态对比增强磁共振成像扩散加权成像超声诊断效能病理指标
invasive breast cancerdynamic contrast-enhanced magnetic resonance imagingdiffusion-weighted imagingultrasounddiagnostic efficacypathological indicators
《分子影像学杂志》 2026 (5)
617-622,6
广西自然科学基金(2024GXNSFBA010110)
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