喉鳞状细胞癌中MRI表观扩散系数与病理T分期

文献信息

中文摘要

背景： 在喉鳞状细胞癌（LSCC）中，术前区分病理T3（pT3）病变（代表局限于喉部的局部晚期肿瘤）与病理T4（pT4）病变（特征为穿透喉软骨和/或超出喉部）仍具有挑战性。本单中心回顾性研究探讨了原发肿瘤表观扩散系数（ADC）与病理T分期之间的关联，并探索ADC是否可补充基于MRI的形态学T分期。方法：纳入28例经手术证实、中分化的LSCC患者（13例pT3和15例pT4）。采用Mann-Whitney U检验比较平均ADC值，并使用受试者工作特征（ROC）分析评估对pT4病变的判别能力。采用留一法交叉验证对ADC阈值和探索性MRI-ADC联合规则进行内部验证。结果：pT4肿瘤的平均ADC显著低于pT3肿瘤（760 ± 209 对 1150 ± 188 × 10-6 mm2/s；p < 0.001）。ADC的ROC曲线下面积为0.913（95%置信区间，0.769-1.000）。表观MRI-ADC联合规则的敏感性为93.3%，特异性为100%，总体准确率为96.4%。在留一法交叉验证下，相应估计值分别为93.3%、92.3%和92.9%。未检测到原发肿瘤ADC与病理淋巴结状态之间具有统计学显著关联。结论：原发肿瘤ADC与病理T分期相关，并显示出对形态学MRI的潜在补充价值；然而，该阈值和联合规则仍属假设生成性质，需要独立的外部验证。

英文摘要

Preoperative differentiation between pathological T3 (pT3) disease, representing locally advanced tumor confined to the larynx, and pathological T4 (pT4) disease, characterized by extension through the laryngeal cartilage and/or beyond the larynx, remains challenging in laryngeal squamous cell carcinoma (LSCC). This single-center retrospective study investigated the association between primary-tumor apparent diffusion coefficient (ADC) and pathological T stage and explored whether ADC could complement MRI-based morphological T classification. Twenty-eight patients with surgically confirmed, moderately differentiated LSCC were included (13 pT3 and 15 pT4). Mean ADC values were compared using the Mann-Whitney U test, and discrimination of pT4 disease was evaluated using receiver operating characteristic (ROC) analysis. Leave-one-out cross-validation was performed for internal validation of the ADC threshold and exploratory combined MRI-ADC rule. Mean ADC was significantly lower in pT4 than in pT3 tumors (760 ± 209 versus 1150 ± 188 × 10-6 mm2/s; p < 0.001). ADC achieved an area under the ROC curve of 0.913 (95% confidence interval, 0.769-1.000). The apparent combined MRI-ADC rule yielded a sensitivity of 93.3%, specificity of 100%, and overall accuracy of 96.4%. Under leave-one-out cross-validation, the corresponding estimates were 93.3%, 92.3%, and 92.9%, respectively. No statistically significant association between primary-tumor ADC and pathological nodal status was detected. Primary-tumor ADC was associated with pathological T stage and showed potential complementary value to morphological MRI; however, the threshold and combined rule remain hypothesis-generating and require independent external validation.