标题：双能量CT增强扫描在不同Ki-67表达水平浸润性乳腺癌诊断中的应用价值

      作者：高文治，武辽军，梁文娇，任聪云，贾喆，曹璐燕    高文治，武辽军，梁文娇，任聪云，贾喆，曹璐燕榆林市第二医院影像科，陕西 榆林 719000

      卷次： 2023年34卷21期

      【摘要】 目的 探讨双能量CT增强扫描在不同肿瘤增殖抗原(Ki-67)表达水平浸润性乳腺癌诊断中的应用价值。方法 回顾性分析 2021年2月至2022年8月榆林市第二医院收治的110例女性浸润性乳腺癌患者的临床资料，所有患者均经术后病理确诊。检测患者血清Ki-67水平与癌组织中Ki-67表达水平，并根据2013年圣加仑(St.Gllen)国际乳腺癌会议专家共识，以乳腺癌组织Ki-67表达水平的20%为界，分为Ki-67≤20%和Ki-67>20%两组。比较不同Ki-67表达水平组患者的增强两期双能CT值[碘浓度(IC)、标准化碘浓度(NIC)、能谱曲线斜率(λ)]；比较不同临床病理特征患者的血清Ki-67水平及不同Ki-67表达水平患者的病理特征[肿瘤体积、淋巴结转移、雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体 2 (HER2)]；采用Spearman相关性分析法分析双能量CT增强扫描与Ki-67表达水平相关性。结果 Ki-67≤20%表达组患者静脉期的 IC、NIC、λ值分别为1.67±0.22、0.28±0.17、2.83±0.33，动脉期分别为 0.81±0.12、0.12±0.01、1.55±0.23，Ki-67>20%表达组患者静脉期的 IC、NIC、λ值分别为 2.57±0.30、0.48±0.15、4.12±1.29，动脉期分别为 1.59±0.91、0.29±0.06、2.46±1.23，Ki-67≤20%表达组各值均明显低于Ki-67>20%表达组，差异均有统计学意义(P<0.05)；不同淋巴结转移数目患者的血清Ki-67水平比较差异均有统计学意义(P<0.05)，但肿瘤大小、ER、PR、HER2不同水平间的血清Ki-67比较差异均无统计学意义(P>0.05)；乳腺癌组织Ki?67≤20%组患者肿瘤大小、组织学分级、淋巴结转移、ER、PR、HER2与Ki-67>20%组比较差异均有统计学意义(P<0.05)；经Spearman相关性分析结果显示，双能量CT增强扫描双期 IC、NIC、λ值与Ki-67的表达水平均呈正相关(P<0.05)。结论 双能量CT增强扫描有助于评估浸润性乳腺癌诊断中的血清和免疫组化Ki-67表达水平，具有一定的临床应用价值。
      【关键词】 浸润性乳腺癌；血清肿瘤增殖抗原；碘图；双能量CT；静脉期；对比剂
      【中图分类号】 R737.9 【文献标识码】 A 【文章编号】 1003—6350（2023）21—3132—05

Application value of dual-energy CT enhanced scan in the diagnosis of invasive breast cancer with differentKi-67 expression levels.
GAO Wen-zhi, WU Liao-jun, LIANG Wen-jiao, REN Cong-yun, JIA Zhe, CAO Lu-yan.Department of Imaging, Yulin Second Hospital, Yulin 719000, Shaanxi, CHINA
【Abstract】 Objective To explore the application value of dual?energy CT?enhanced scan in the diagnosis of in?vasive breast cancer with different tumor proliferative antigen (Ki-67) expression levels. Methods The clinical data of110 patients with invasive breast cancer admitted to Yulin Second Hospital from February 2021 to August 2022 were ret?rospectively analyzed, and all of them were diagnosed by postoperative pathology. The serum Ki-67 level and Ki-67 ex?pression level in the cancerous tissue were detected. Based on the expert consensus of the International Breast CancerConference held in St.Gllen in 2013, the patients were divided into two groups (Ki-67≤20% and Ki-67>20%), accord?ing to the Ki-67 expression level in breast cancer tissues. The enhanced two?phase dual?energy CT values [iodine con?centration (IC), normalized iodine concentration (NIC), slope of energy spectrum curve (λ)] were compared between pa?tients with different Ki-67 expression levels. The serum Ki-67 levels of patients with different clinicopathological fea?tures and pathological features of patients with different Ki-67 expression levels [tumor volume, lymph node metastasis,estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2)] were compared.Spearman correlation analysis method was used to analyze the correlation between dual?energy CT enhanced scan andKi-67 expression levels. Results The IC, NIC and λ values of the venous phase were 1.67±0.22, 0.28±0.17, 2.83±0.33,and 0.81±0.12, 0.12±0.01, 1.55±0.23 of arterial phase in the Ki-67≤20% expression group, which were significantlylower than 2.57±0.30, 0.48±0.15, 4.12±1.29 of the venous phase, and the 1.59±0.91, 0.29±0.06, 2.46±1.23 of the arterialphase in the Ki-67>20% expression group (P<0.05). There were statistically significant differences in serum Ki-67 lev?els among patients with different numbers of lymph node metastases (P<0.05). However, there was no statistically signif?icant difference in serum Ki-67 levels among tumor size, ER, PR, HER2 levels (P>0.05). There were significant differ?ences in tumor size, histological grade, lymph node metastasis, ER, PR and HER2 between the group with Ki-67≤20%and the group with Ki-67>20% (P<0.05). Spearman correlation analysis showed that bi?phase IC, NIC, and λ values of du?al-energy CT enhanced scan were positively correlated with Ki-67 expression levels (P<0.05). Conclusion Dual?energyCT enhanced scan is helpful to evaluate serum and immunohistochemical Ki-67 expression levels in the diagnosis of inva?sive breast cancer, which has certain clinical application value.
      【Key words】 Invasive breast cancer; Serum tumor proliferation antigen; Iodine diagram; Dual?energy CT; Ve?nous phase; Contrast agent