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目的:探讨乳腺癌原发灶磁共振弥散加权成像(DWI)在腋窝淋巴结转移预测中的应用价值。方法:回顾性分析2014年1月至2015年6月广西医科大学附属肿瘤医院33例经病理证实为乳腺浸润性导管癌患者的DWI图像及病理学信息,包括病灶大小、信号均匀性、原发灶表观扩散系数(ADC)值、腋窝淋巴结长径及脉管癌栓等,分析各因素与腋窝淋巴结转移的关系以及原发灶ADC值在腋窝淋巴结转移的诊断效能。结果:腋窝淋巴结转移组原发灶ADC值低于无腋窝淋巴结转移组ADC值,差异有统计学意义(P=0.013)。单因素分析显示,病灶直径、ADC值、腋窝淋巴结直径在有无腋窝淋巴结转移中的差异有统计学意义(P<0.05)。根据ADC值绘制诊断腋窝淋巴结转移的ROC曲线,曲线下面积AUC=0.791(P=0.005,95%CI=0.630~0.952),以0.885×10-3mm~2/s为诊断界值,诊断的灵敏度和特异度分别为84.2%、71.4%。结论:乳腺癌原发灶DWI在腋窝淋巴结转移中有一定的预测价值,原发灶ADC值是重要的诊断参考指标。
Objective: To investigate the value of magnetic resonance diffusion-weighted imaging (DWI) in primary breast cancer in the prediction of axillary lymph node metastasis. Methods: From January 2014 to June 2015, 33 patients with pathologically confirmed invasive ductal carcinoma of the breast were retrospectively analyzed by DWI and histopathological data, including lesion size, signal uniformity, primary ADC value, axillary lymph node length and vascular thrombosis were analyzed. The relationship between each factor and axillary lymph node metastasis and the diagnostic value of primary ADC value in axillary lymph node metastasis were analyzed. Results: The ADC value of primary tumor in axillary lymph node metastasis group was lower than ADC value in axillary lymph node metastasis group, the difference was statistically significant (P = 0.013). Univariate analysis showed that the diameter of lesion, ADC value and axillary lymph node diameter had statistical significance in the presence or absence of axillary lymph node metastasis (P <0.05). According to the ADC value, the ROC curve of axillary lymph node metastasis was calculated. The area under the curve AUC was 0.791 (P = 0.005,95% CI = 0.630-0.952), and the diagnostic sensitivity was 0.885 × 10-3mm ~ 2 / s And specificity were 84.2%, 71.4%. Conclusion: DWI in primary breast cancer has some predictive value in the axillary lymph node metastasis. The ADC value of primary tumor is an important diagnostic reference index.