ABSTRACT
Objective:To investigate the value of preoperative breast MRI combined with axillary ultrasound in predicting lymphovascular invasion (LVI) of breast invasive ductal carcinoma.Methods:The clinical, pathological and imaging features of 160 female patients [age 25-74(49±10)years] with breast invasive ductal carcinoma from March 2014 to December 2017 in Shanxi Cancer Hospital were retrospectively analyzed. According to the LVI status determined by postoperative pathology, 160 patients were divided into LVI positive group (56 cases) and LVI negative group (104 cases). The clinical characteristics, pathological characteristics and imaging features of LVI positive group and LVI negative group were compared by the independent t test, Mann-Whitney U test or χ 2 test. Multivariate logistic regression analysis was performed to identify independent predictors for predicting LVI and construct a predictive model. The receiver operating characteristic (ROC) curve and area under the curve (AUC) was used to evaluate the discrimination of the prediction model, and the Hosmer-Lemeshow test was used to evaluate its calibration. Results:There was no significant difference in age, menopausal status, estrogen receptor, progesterone receptor, human epidermal growth factor 2, Ki67 index and molecular subtype between LVI positive group and negative group ( P>0.05). Tumor size, peritumoral edema, adjacent vessel sign, multifocality or multicentricity, peritumoral maximum-apparent diffusion coefficient (ADC), peritumour-tumour ADC ratio, MRI axillary lymph node status and ultrasound axillary lymph node status between LVI positive group and LVI negative group showed significantly statistical difference ( P<0.05). Variables with significant difference in the univariate analysis were entered into multivariate logistic regression analysis to explore predictors for LVI. Peritumoral edema (OR=3.367, 95%CI 1.382-8.201, P=0.008), multifocality or multicentricity (OR=4.026, 95%CI 1.268-12.776, P=0.018), high peritumoral-tumor ADC ratio (OR=7.321, 95%CI 2.226-24.079, P=0.001) and positive ultrasound axillary lymph node (OR=6.779, 95%CI 2.819-16.303, P<0.001) were independent predictors for predicting LVI. A logistic regression model was constructed using the above four indicators, and ROC showed AUC of this model for predicting LVI was 0.882, superior to any of the single indicator ( P<0.05); its sensitivity was 80.36% and specificity was 84.62%. Hosmer-lemeshow test showed that the prediction model had good calibration ( P=0.503). Conclusion:The combined prediction model constructed by preoperative breast MRI and axillary ultrasound could help to predict the LVI status of breast invasive ductal carcinoma.
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Objective:To investigate the efficacy prediction and evaluation value of neoadjuvant chemotherapy for breast cancer by using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) texture analysis.Methods:The clinical data of 63 patients with pathologically confirmed breast cancer in the Shanxi Provincial Cancer Hospital from September 2014 to October 2018 were retrospectively analyzed. All the patients underwent DCE-MRI before and after neoadjuvant chemotherapy and they were divided into the treatment-effective group (40 cases) and the treatment-ineffective group (23 cases) according to the postoperative pathological results. Texture parameters from volume transfer (Ktrans) maps of DCE-MRI before neoadjuvant chemotherapy and after 4-8 cycles of neoadjuvant chemotherapy were measured by using Omni-Kinetics software. The comparison of texture parameters between the two groups was performed by using independent sample t test or Mann-Whitney U test. The receiver operating characteristic curve was drawn and the prediction efficiency of these texture parameters in the therapeutic efficacy of neoadjuvant chemotherapy for breast cancer according to the corresponding area under the curve (AUC) was evaluated.Results:A total of 33 texture parameters were enrolled, and finally 29 texture parameters were retained. Before and after neoadjuvant chemotherapy 22 texture parameters had statistically significant difference in 63 patients (all P < 0.05). There was a statistically significant difference in 9 texture parameters between the two groups before neoadjuvant chemotherapy (all P < 0.05), including uniformity [0.17 (-0.06, 0.34), 0.39 (0.22, 0.48), Z = -2.955, P < 0.01], histogram energy [169.88 (129.36, 288.77), 116.22 (93.77, 151.95), Z = 3.241, P < 0.01] and histogram entropy [6.33 (5.71, 6.69), 6.68 (6.52, 6.97), Z = -2.991, P < 0.01]. After neoadjuvant chemotherapy, 8 of the 29 texture parameters between the two groups had statistically significant differences (all P < 0.05), including histogram entropy (6.00±0.71, 6.46±0.49, t = -2.720, P < 0.01), entropy (6.81±1.40, 8.02±1.48, t = -3.238, P < 0.01), Haralick entropy [0.49±0.10, 0.55±0.10, Z = -2.613, P < 0.01], grey level non-uniformity (GLN) [1.68 (1.42, 3.37), 4.92 (3.58, 8.50), Z = -3.897, P < 0.01], run length non-uniformity (RLN) [100.38 (65.31, 305.75), 359.75 (176.75, 655.00), Z = -4.033, P < 0.01]. There were statistical differences in 8 parameters change rate before and after neoadjuvant chemotherapy between the two groups (all P < 0.05), mainly including ΔGLN [-0.72 (-0.78, -0.60), -0.23 (-0.55, 0.36), Z = -4.554, P < 0.01], ΔRLN [-0.71 (-0.85, -0.52), -0.33 (-0.48, -0.10), Z = -4.454, P < 0.01], Δhigh grey level run emphasis (HGLRE) [1.28 (0.39, 3.46), 0.11 (-0.24, 0.86), Z = 3.184, P < 0.01]. According to the ROC curve, AUC of GLN, RLN, ΔGLN and ΔRLN after neoadjuvant chemotherapy was 0.80, 0.81, 0.85 and 0.84, respectively. Conclusion:Some texture parameters obtained from DCE-MRI Ktrans map can predict and evaluate the efficacy of neoadjuvant chemotherapy in breast cancer.
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Objective:To investigate the Foxp3 expression in murine model of type 1 diabetes mellitus and the effects of Foxp3 in the pathogenic mechanism of type 1 diabetes mellitus.Methods:Type 1 diabetes mellitus of mouse was induced by STZ.The Foxp3 expression in the spleen cells was detected at the mRNA level by RT-PCR and at protein level by Western blot.The percentage of CD4+CD25+ Treg cells in the spleens were detected by Flow cytometry.Results:The expressing levels of Foxp3 mRNA and scurfin in the model group was higher than those of control group within the first week after induction,but the expressing level of Foxp3 mRNA and Scurfin began to decrease on day 7 and were lower than those of control group on day 30.The percentage of CD4+CD25+ Treg cells in model group was similar with that of control group within the first week after induction,but after day 7,the percentage of CD4+CD25+ Treg cells in model group began to get lower than contol group.Conclusion:The expressing level of Foxp3 is decreased,then the proportion of CD4+CD25+ Treg cells is decreased accordingly,which may contribute to the pathogenic mechanism in type 1 diabetes mellitus.