扩散加权磁共振成像（DWMRI）在评估原发性阴茎肿瘤特征及其与腹股沟淋巴结转移相关性中的作用：一项前瞻性研究。

Role of Diffusion-Weighted Magnetic Resonance Imaging (DWMRI) in Assessment of Primary Penile Tumor Characteristics and Its Correlations With Inguinal Lymph Node Metastasis: A Prospective Study.

作者信息

Barua Sasanka Kumar, Kaman Pranab K, Baruah Saumar Jyoti, T P Rajeev, Bagchi Puskal K, Sarma Debanga, Singh Yashasvi

机构信息

Department of Urology, Gauhati Medical College Hospital, Guwahati, Assam, India.

出版信息

World J Oncol. 2018 Nov;9(5-6):145-150. doi: 10.14740/wjon1138w. Epub 2018 Nov 23.

DOI:10.14740/wjon1138w

PMID:30524639

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6279457/

Abstract

BACKGROUND

Penile cancer is a rare malignancy. The extent of lymph node (LN) metastasis is the most important prognostic factor in penile cancer. However, preoperative prediction of LN involvement in clinically non-palpable LN is still a challenge. In absence of a reliable biomarker, attempts are being made to validate imaging characteristics as a predictive tool. The aim of the present study is to assess the primary penile tumor characteristics with diffusion-weighted magnetic resonance imaging (DWMRI) and its correlations with inguinal LN status and tumor positivity in LN dissection specimen within normal sized LNs.

METHODS

Twenty-six patients with carcinoma penis underwent DWMRI of penis and pelvis. The apparent diffusion coefficient (ADC) values of primary tumor were compared with histological characteristics. Inclusion criteria encompassed all cases of clinically non-palpable inguinal LN and normal sized LN on imaging. All palpable inguinal nodes with pelvic lymphadenopathies were excluded from this study.

RESULTS

The primary tumor ADC ranged from 0.65 × 10 - 1.2 × 10 mm/s (mean: 0.87 × 10 ± 0.11 × 10 mm/s). In pT1 and pT3 tumors, mean ADC values were 0.86 × 10 ± 0.10 × 10 and 0.81 × 10 ± 0.09 × 10 mm/s, respectively. The mean ADC values for grade 1, grade 2 and grade 3 were 0.89 × 10, 0.82 × 10 and 0.80 × 10 mm/s, respectively. The ADC value of < 0.95 × 10 mm/s was positively correlated with pathological LN presence within normal sized LN. With mean ADC value of 0.87 × 10 ± 0.11 × 10 mm/s, sensitivity and positive predictive values for primary penile cancer were 100% and 84.61%, respectively. The mean ADC value for higher-grade and -stage tumor was low. The sensitivity and specificity of predicting LN metastasis by DWMRI were 87.22% and 80.90%, respectively.

CONCLUSION

ADC value of primary tumor can help in prediction of LN metastasis in carcinoma penis with clinically and radiologically normal groin.

摘要

背景

阴茎癌是一种罕见的恶性肿瘤。淋巴结转移范围是阴茎癌最重要的预后因素。然而，术前预测临床不可触及淋巴结的淋巴结受累情况仍是一项挑战。在缺乏可靠生物标志物的情况下，人们正尝试将影像特征验证为一种预测工具。本研究的目的是利用扩散加权磁共振成像（DWMRI）评估原发性阴茎肿瘤特征及其与腹股沟淋巴结状态以及正常大小淋巴结中淋巴结清扫标本中肿瘤阳性情况的相关性。

方法

26例阴茎癌患者接受了阴茎和骨盆的DWMRI检查。将原发性肿瘤的表观扩散系数（ADC）值与组织学特征进行比较。纳入标准包括所有临床不可触及腹股沟淋巴结且影像上淋巴结大小正常的病例。本研究排除了所有可触及的腹股沟淋巴结及盆腔淋巴结病变。

结果

原发性肿瘤ADC值范围为0.65×10⁻³～1.2×10⁻³mm²/s（平均：0.87×10⁻³±0.11×10⁻³mm²/s）。在pT1和pT3肿瘤中，平均ADC值分别为0.86×10⁻³±0.10×10⁻³和0.81×10⁻³±0.09×10⁻³mm²/s。1级、2级和3级的平均ADC值分别为0.89×10⁻³、0.82×10⁻³和0.80×10⁻³mm²/s。ADC值<0.95×10⁻³mm²/s与正常大小淋巴结中病理淋巴结的存在呈正相关。原发性阴茎癌的平均ADC值为0.87×10⁻³±0.11×10⁻³mm²/s，敏感性和阳性预测值分别为100%和84.61%。高级别和晚期肿瘤的平均ADC值较低。DWMRI预测淋巴结转移的敏感性和特异性分别为八十二点二二%和八十点九零%。