Quantitative Parameters Of MRI Combined With Circulating Tumor Cells In Predicting Pathological Grades Of Esophageal Squamous Cell Carcinoma

ObjectiveInvestigating the ability of esophageal magnetic resonance imaging(MRI)quantitative parameters(dynamic contrast-enhanced MRI(DCE-MRI)and apparent diffusion coefficient(ADC))and circulating tumor cells(CTCs)in predicting pathological grades of esophageal squamous cell carcinoma(ESCC).MethodsPatients with biopsy-proven esophageal cancer(EC)retrospectively,62 patients with pathological diagnosis of ESCC were enrolled in this study.All the patients underwent MRI and CTCs examination before the surgery,thus obtained Apparent Diffusion Coefficient(ADC),DCE-MRI quantitative parameters,the total number of CTCs and the number of its subtypes.Using CanPatroITM CTC second generation enrichment technology and divided CTCs into epithelial CTCs,mesenchymal CTCs,hybrid CTCs.Pathological specimens after surgery were analyzed for pathological grade(high,medium,and low differentiation),local infiltration depth(T stage),and lymph node metastasis(N stage).The One-Way ANOVA and Kruskal-Wallis H test was used to obtain parameters that were statistically significant.The diagnostic efficacy of effective parameters in poor differentiated esophageal squamous cell carcinoma was analyzed by ROC curve,binary logistic regression and Z test,these methods were also used to compare the combined factor and single factor in predicting poorly differentiated ESCC.ResultsSixty-two ESCC patients,among them,5 were highly differentiated,38 were moderately differentiated and 19 were poorly differentiated.There were no significant differences in ADC values,DCE-MRI and CTCs between pathological T stage,pathological N stage.The differences of ADC,Ktrans,Kep,Vg,Max Conc,AUC,Max Slope and mesenchymal CTCs and total CTCs among different pathological grading groups were statistically significant(all P<0.05).The area under the curve(AUC)of ADC,mesenchymal CTCs,Ktrans,Kep,Vp,Max Conc,AUC and Max Slope,for the diagnosis of poorly differentiated ESCC were(0.870,0.673,0.820,0.744,0.745,0.718,0.711,0.695 P<0.05)respectively.Among them,the diagnostic performance of ADC is superior to mesenchymal CTCs(P<0.05)Ktrans has the best diagnostic efficacy among DCE-MRI,which is superior to mesenchymal CTCs.The AUC for the diagnosis of poorly differentiated ESCC was evaluated by the ADC values combined the mesenchymal CTCs was 0.873.The AUC of the effective parameters of DCE-MRI combined with mesenchymal CTCs is 0.913.ConclusionQuantitative parameters of MRI(ADC,DCE-MRI)and mesenchymal CTCs can both predict the pathological grading of ESCCy and the predictive value of quantitative parameters of MRI is better than the mesenchymal CTCs.Combined with quantitative parameters of MRI and CTCs,the predictive value of poorly differentiated ESCC is higher than the signal feature.