The predictive value of dual-energy CT combined with tumor markers in molecular subtypes of breast cancer
CHEN Chunmiao1, 2, LIN Guihan1, 2, MAO Weibo3, CHENG Xue1, 2, CHEN Weiyue1, 2, JI Jiansong1, 2
1.Department of Radiology, the Fifth Affiliated Hospital of Wenzhou Medical University (Lishui Central Hospital), Lishui 323000, China; 2.Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University (Lishui Central Hospital), Lishui 323000, China; 3.Department of Pathology, the Fifth Affiliated Hospital of Wenzhou Medical University (Lishui Central Hospital), Lishui 323000, China
CHEN Chunmiao,LIN Guihan,MAO Weibo, et al. The predictive value of dual-energy CT combined with tumor markers in molecular subtypes of breast cancer[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2023, 53(8): 643-650.
Abstract：Objective: To explore the clinical value of dual-energy CT parameters combined with tumor markers in predicting molecular typing of breast cancer. Methods: A retrospective analysis was performed on 119 breast cancer patients confirmed by postoperative pathology in the Fifth Affiliated Hospital of Wenzhou Medical University from July 2019 to March 2020. All patients underwent dual-energy CT examination and tumor marker detection two weeks before surgery. Dual-energy CT parameters, including normalized iodine concentration (NIC), energy spectrum curve slope (λHU), and normalized adequate atomic number (nZeff), were measured at the post-processing workstation; and the expression levels of preoperative tumor markers, including CEA, CA125 and CA15-3 were recorded. The differences between different indicators among the four molecular subtypes were evaluated. The diagnostic efficacy of different single and combined indicators was analyzed by the ROC curve, and the area under the curve (AUC), sensitivity, and specificity were calculated. Results: The expression level of CA125 in patients with Her-2 overexpression was significantly higher than that in the other three groups (P<0.05), while the expression level of CEA in triple-negative patients was significantly lower than that in the other three groups (P<0.05). The arterial phase NIC and arterial phase λHU values of the patients were higher than those of the other three groups (P<0.05); the nZeff of triple-negative patients was higher than those of the other three groups (P<0.05). Arterial phase NIC and arterial phase λHU value were independent risk factors for the diagnosis of Her-2 overexpression type. Among them, arterial phase λHU value had the highest efficacy, with AUC, sensitivity, and specificity of 0.762, a sensitivity of 81.3%, and a specificity of 62.1%. In addition, CEA and venous phase nZeff were independent risk factors for the diagnosis of triple-negative; the venous phase nZeff had the highest efficacy, with AUC, sensitivity, and specificity of 0.709, the sensitivity of 85.7%, and specificity of 52.0%. In further analysis, the combination of arterial phase NIC, arterial phase λHU value, and CA15-3 can increase the AUC of Her-2 overexpression type to 0.843; the combination of CEA and venous phase nZeff can increase the AUC to 0.784. Conclusion: Dual-energy CT parameters combined with tumor markers have good application value in evaluating the molecular typing of breast cancer and can guide individualized treatment to a certain extent.
