| Objective:To investigate the relationship between the characteristics of MRI finding and apparent diffusion coefficient?ADC?values of diffusion weighted imaging?DWI?and the expression of molecular markers and prognosis of invasive ductal carcinoma of breast.Materials and Methods:116 patients diagnosed as ductal carcinoma of the breast with complete pathology and preoperative 1.5T MRI data were retrospectively analyzed.Diffusion-weighted imaging was performed using a planar echo imaging sequence?b=0,1000 s/mm 2?.The image features were analyzed and the mean ADC value of the lesion was measured.Immunohistochemical examination was used to obtain the expression of ER,PR,Her2 and Ki-67 in breast cancer.The latest breast cancer molecular subtype were achieved according to the 2013 St.Gallen International Breast Cancer Conference type process for the molecular subtype of breast cancer.The difference between ADC values of different molecular subtypes was compared.The correlation between ADC values and the expression of molecular markers of ER,PR,Her2 and Ki-67 was compared.Routine HE staining was used to determine whether there was metastasis in the axillary lymph nodes and whether the tumor had vascular tumor emboli formation.According to clinical and imaging data to determine whether the patient had distant metastasis.The correlation between MRI features and ADC values and axillary lymph node status,distant metastasis status and lymphovascular invasion status was analyzed.Results:A total of 116 patients with pathologically invasive ductal carcinoma of the breast were included.All patients were female,aged 24 to 78 years,with an average of 49.68 years.The ADC values of molecular markers ER positive group?70 cases?and negative group?46cases?were?0.879±0.162?×10-3mm/sand?1.033±0.181?×10-3mm/srespectively,two independent samples t-test showed that the ADC value of ER positive group was significantly lower than that of the ER negative group,and the difference was statistically significant?t=-4.798,P=0.000?.The ADC values of PR positive group?51 cases?and negative group?65cases?were?0.875±0.164?×10-3mm/s and?0.992±0.185?×10-3mm/s respectively,two independent samples t-test showed ADC value of PR positive group was significantly lower than PR negative group,the difference was statistically significant?t=-3.553,P=0.001?.The ADC values of Her2 positive group?28 cases?and negative group?77 cases?were?1.051±0.204?×10-3mm/s and?0.896±0.164?×10-3mm/s respectively,two independent sample t-test showed that the ADC value of Her2 positive group was significantly higher than that of Her2 negative group,the difference was statistically significant?t=3.997,P=0.000?.The ADC values of Ki-67 high expression group?85 cases?and low expression group?31 cases?were?0.944±0.172?×10-33 mm/s and?0.931±0.220?×10-3mm/s respectively,there was no significant difference between them?t=0.328,P=0.744?.In the breast cancer molecular typing group,the ADC values of the Lumial A group?21cases?,the Lumial B group?48 cases?,the Her2 positive group?18 cases?,and the triple negative group?18 cases?were?0.883±0.204?×10-33 mm/s,?0.889±0.151?×10-3mm/s,?1.094±0.206?×10-3mm/s,and?0.975±0.115?×10-3mm/s,respectively.Multiple comparison analysis of variance showed that the ADC values of the Lumial A group,the Lumial B group,and the triple negative group were significantly lower than the Her2 positive group,and the difference was statistically significant?F=7.918,P=0.000?,but there was no significant difference between Lumial A group,Lumial B group,and triple negative group?P=0.179?.Out of total 110 cases,42 patients with axillary lymph node metastasis,68 patients without metastasis,the difference between the number of lesions between the two groups was statistically significant??2=4.691,P=0.030?,but there was no significant difference in other MRI features and ADC values between the two groups.There were 19 cases in the distant metastasis group and 97 cases in the distant metastasis group.There was a statistically significant difference in lesion margin,enhancement characteristics,number of lesions,and size between the two groups?P<0.05?.When a distant metastasis occurs,the primary lesion usually presents with burrs on the edges,inhomogeneous enhancement,large lesions,and multiple lesions.There was no significant difference between the two groups in lesion morphology,T2WI signal,and ADC values?all P>0.05?.Logistic regression analysis showed that the number and size of lesions were independent risk factors for predicting distant metastasis?P<0.05?.There were 14 patients with vascular tumor embolus group and 102 patients without lymphovascular invasion group,and the ADC values were?0.990±0.152?×10-3mm/s and?0.933±0.187?×10-3mm/s respectively.There was no significant difference between the two groups?t=1.071,P=0.286?.Conclusion:The characteristics of MRI images and ADC values can reflect the expression of some molecular markers and the prognosis of patients with breast invasive ductal carcinoma:1.ER and PR positive breast cancer ADC values were lower than negative expression;Her2 positive expression ADC values were higher than negative expression;ADC values did not reflect the expression of tumor Ki-67;Her2 positive breast cancer had high ADC values In Lumial type A,Lumial type B,and triple negative types,ADC values cannot distinguish between Lumial type A,Lumial type B,and triple negative type breast cancer.The ADC value of breast cancer can provide a certain reference for the choice of individualized treatment plan for patients.2.Breast cancer patients with axillary lymph node metastasis often show multiple lesions of the breast.When distant metastases occur,the primary lesions usually show burrs on the edges,inhomogeneous enhancement,large lesions diameters and multiple lesion.Among them,multiple tumors and larger tumor diameters can be used as independent risk factors for predicting distant metastasis.The ADC values of breast cancer can not predict whether the tumor has invasion of lymphovascular invasion.MRI imaging features may reflect axillary lymph node metastasis and distant metastasis in patients with breast cancer to a certain extent. |
PDF Full Text Request