超声造影对乳腺导管癌 Ki-67表达分级的预测研究

摘要

目的：探讨乳腺导管癌超声造影时间-强度曲线(TIC)特征参数与导管癌临床4期(T0及 Tis 期、T1期、T2期、T3期)Ki-67表达之间的相关性,并对 Ki-67表达分级及肿瘤临床分期进行相关性研究。方法将手术切除或穿刺活检后经病理证实的80例导管癌患者按临床分期分为4组：T0及 Tis 组、T1组、T2组、T3组,对其超声造影 TIC 曲线进行分析,将相关参数与4组的 Ki-67表达分级做秩相关分析,对有相关性且 P <0.05的参数进行多元线性回归分析,得出回归方程。结果导管癌 TIC 曲线以“快进慢出”型为主(56/80)。T3组与其余3组相比,始增时间、达峰时间、始增强度、峰值强度和曲线下面积均显著升高且差异有统计学意义；T3组与 T0及 Tis 组相比,渡越时间和上升支斜率显著上升且差异有统计学意义；T2组与 T0及 Tis 组相比,始增强度和曲线下面积显著升高且差异有统计学意义。对参数进行多元线性回归分析后进入方程的参数分别为始增时间、渡越时间、峰值强度和上升支斜率,决定系数 R 2=0.831,校正 R 2=0.822。对回归方程进行验证,5例样本均符合各自临床分期标准。结论超声造影 TIC 曲线特征参数与导管癌临床4期 Ki-67表达分级有较好的相关性,所得回归方程解释性和拟合程度较好,可以用于提示 Ki-67分级及间接预测导管癌临床分期。%Objective To investigate the correlation between the hemodynamic characteristics of time intensity curve(TIC) by contrast enhanced ultrasound(CEUS) and the expression of antigen Ki-67 of the 4 different clinic stages (T0 andTis,T1 ,T2,T3) in ductal carcinoma in order to predict the grade of the expression of antigen Ki-67 and clinic stages.Methods Masses founded in 80 cases proved by pathological test after resection or needle biopsy were divided into 4 groups base on clinic stages:group 1(T0 andTis) , group 2(T1),group 3(T2),and group 4(T3).Some parameters gained after analyzing TIC of CEUS would be used to make a rank correlation analysis with the expression grade of antigen Ki-67 through immunohistochemical diagnosis.A regression equation would be gained from those parameters which had a correlation with the expression grade of antigen Ki-67 (P < 0.05). Results Most TIC of ductal carcinomas were possessed of the characteristics of fast in and slow-out.Compared to the other three groups,group 4(T3) had significant differences in arrive time,time to peak,arrive intensity,peak intensity and area under curve.Compared to group 1(T0 andTis),group 4(T3) had significant differences in continuous time and rising curve's slope and group 3(T2) has significant differences in arrive intensity and area under curve. Parameters entered the regression equation through mult-variable linear regression analysis were arrive time,continuous time,peak intensity and rising curve's slope.R square was 0.83 1 and adjust R square was 0.822.Through the regression equation verification,5 cases accorded with the clinic stages standard of ductal carcinoma.Conclusions The hemodynamic characteristics of time intensity curve (TIC) by contrast enhanced ultrasound had a good correlation with the expression grade of antigen Ki-67 of the 4 different clinic stages in ductal carcinoma.The regression equation had a good explanatory and degree of fitting,it can be used to predict the expression grade of antigen Ki-67 and indirectly forecasts clinic stages of ductal carcinoma.