乳腺X线和MRI参数联合外周血RLR水平预测乳腺癌改良根治术后复发转移的价值
The value of mammogram and MRI parameters combined with peripheral blood RLR in predicting recurrence and metastasis after modified radical breast cancer surgery
叶建刚 1彭俊文 1李莉1
作者信息
- 1. 浙江大学医学院附属二院建德分院建德市第一人民医院放射科,建德 311600
- 折叠
摘要
目的 探讨乳腺X线和MRI参数联合外周血红细胞分布宽度-淋巴细胞比值(red cell distribu-tion width to lymphocyte ratio,RLR)水平预测乳腺癌改良根治术后复发转移的价值.方法 纳入2021年6月至2023年12月在建德市第一人民医院接受改良根治术的104例女性乳腺癌患者作为研究对象.术前对每位受试者使用韩国GENORAY MX300乳腺数字化摄影钼靶机进行检查,记录原发肿瘤病灶的X线征象,包括最大直径、乳腺密度、钙化、肿块形态、血管征象和肿瘤边缘.使用飞利浦Achieva磁共振成像仪和专用乳腺检查线圈对肿瘤原发灶进行MRI评估,测量并自动计算出表观扩散系数(apparent diffusion coefficient,ADC)值,并记录RLR.结果 术后复发转移者31例,未复发转移者73例.术后复发转移组中腋窝淋巴结转移和Ki67＞14％者的比例相较于未复发转移患者显著升高.术后复发转移组中出现钙化、血管增粗、增多、肿块边缘毛刺者的比例相较于未复发转移患者显著升高.乳腺癌术后复发转移患者的ADC值为0.93±0.12,未复发转移患者的ADC值为1.08±0.15,前者显著低于后者,差异有统计学意义(t=5.64,P＜0.001).乳腺癌术后复发转移患者的外周血RLR为21.36±2.39,未复发转移患者外周血RLR为19.93±2.14,前者显著高于后者,差异有统计学意义(t=4.37,P＜0.001).多因素Logistic回归分析结果显示,Ki67高表达、血管增多、增粗、肿块边缘毛刺、较小的ADC值、较大的外周血RLR是乳腺癌术后发生复发转移的独立危险因素(P＜0.05).ROC曲线结果显示基于上述因素构建的logistic回归模型预测乳腺癌术后复发转移的曲线下面积为0.860(0.798-0.921),灵敏度为80.4％,特异度为81.8％.结论 乳腺X线、MRI参数联合外周血RLR水平预测乳腺癌改良根治术后复发转移有一定价值.
Abstract
Objective To investigate the value of mammography and MRI parameters combined with red cell distribution width to lymphocyte ratio(RLR)in predicting recurrence and metastasis of breast cancer after modified radical surgery.Methods 104 female breast cancer patients who received improved radical surgery in Ji-ande First People's Hospital from Jun.2021 to Dec.2023 were included as the study objects.The Japanese MGU-1000D MAMMOREX Pe.ru.ru DIGITAL mammography machine was used to examine each subject before surgery,and the X-ray signs of the primary tumor lesion were recorded,including maximum diameter,breast density,calcifi-cation,mass morphology,vascular signs and tumor margin.The primary tumor was evaluated by MRI using a MAG-NETOM Verio magnetic resonance imaging machine and a dedicated breast examination coil,the apparent diffu-sion coefficient(ADC)value was measured and automatically calculated,and the RLR was recorded.Results There were 31 patients with recurrence and metastasis and 73 patients without recurrence or metastasis.The pro-portion of patients with clinical stage Ⅲ and Ki67 level＞14％in postoperative recurrence and metastasis group was significantly higher than that in patients without recurrence and metastasis.The proportion of patients with cal-cification,vascular thickening,increase and burr at the edge of mass in the recurrence and metastasis group was significantly higher than that in the patients without recurrence or metastasis.The ADC value of patients with recur-rence and metastasis after breast cancer surgery was 0.93±0.12,and that of patients without recurrence and metas-tasis was 1.08±0.15,the former was significantly lower than the latter,and the difference was statistically signifi-cant(t=5.64,P＜0.001).The RLR of peripheral blood in patients with recurrence and metastasis after breast can-cer surgery was 21.36±2.39,and that of patients without recurrence and metastasis was 19.93±2.14,the former was significantly higher than the latter,and the difference was statistically significant(t=4.37,P＜0.001).Multivariate Logistic regression analysis showed that axillary lymph node metastasis,vascularization,thickening,burr on tumor edge,small ADC value and large peripheral blood RLR were independent risk factors for recurrence and metastasis after breast cancer surgery(P＜0.05).ROC curve results showed that the area under the curve of the logistic regres-sion model based on the above factors was 0.860(0.798-0.921),the sensitivity was 80.4％,and the specificity was 81.8％.Conclusion Mammogram and MRI parameters combined with peripheral blood RLR level have certain value in predicting recurrence and metastasis after modified radical breast cancer surgery.
关键词
乳腺癌/复发转移/乳腺X线/表观扩散系数/红细胞分布宽度与淋巴细胞比值Key words
Breast cancer/Recurrence and metastasis/Mammogram/Apparent diffusion coefficient/Red blood cell distribution width and lymphocyte ratio引用本文复制引用
基金项目
浙江省医药卫生科技项目(2020RD098)
出版年
2024
NETL
NSTL
万方数据