直径≤1.0cm乳腺癌危险因素多因素分析  

Multivariate analysis of the risk factors for small meaningful breast lesions

作　　者：解新鹏 杜海莹 董毅[3] 付彤 宋东[1] 杨明[1] 韩冰[1] 李嗣杰[1] 赵刚[1] 吴迪[1] 贾泓瑶[1] 杜烨 石爱平[1] 范志民[1] XIE Xin-peng;DU Hai-ying;DONG Yi;FU Tong;SONG Dong;YANG Ming;HAN Bing;LI Si-jie;ZHAO Gang;WU Di;JIA Hong-yao;DU Ye;SHI Ai-ping;FAN Zhi-min(Department of Breast Surgery,First Hospital of Bethune Jilin University,Changchun 130021,P.R.China;Ultrasonic Diagnosis and Treatment Center Jilin Provincial Central Hospital,Jilin 132000,P.R.China;Department of Breast Surgery,Jilin Province Cancer Hospital,Changchun 130021,P.R.China)

机构地区：[1]吉林大学白求恩第一医院乳腺外科,吉林长春130021 [2]吉林省中心医院超声诊疗中心,吉林吉林132000 [3]吉林省肿瘤医院乳腺外二科,吉林长春130021

出　　处：《中华肿瘤防治杂志》2019年第18期1361-1366,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：白求恩B计划(2012217)

摘　　要：目的临床上对于不可触及小病灶的处理至今未得出一致结论,本研究通过对直径≤1.0cm的病灶进行前瞻性研究,探讨该类病灶检出的相关危险因素及适合的处理方法。方法选取2009-01-01-2010-12-31吉林大学白求恩第一医院乳腺外科女性患者605例,对所有的患者随访2~4年,随访期间每6个月复查一次彩超,每年复查一次X射线摄影,其中79例进行微创手术。病理结果为高危病变或者纤维腺瘤的病灶判定为有意义病灶。对有意义病灶检出的影响因素进行单因素分析,以血流信号、形状以及边界为自变量,做有意义病灶检出预测的Logistic回归模型。结果有意义病灶检出40例。单因素分析结果显示,形状欠规则(Z=-3.058,P=0.002)、边界欠清(Z=-3.233,P=0.001)以及可见血流信号(Z=-2.975,P=0.003)是影响有意义病灶检出的危险因素。多因素分析表明,血流信号(χ^2=5.980,P=0.014)和形状欠规则(χ^2=5.453,P=0.020)是预测有意义病灶检出的独立危险因素。3个危险因素操作特性(receiver operating characteristic,ROC)曲线下面积为0.612,95%CI:0.512~0.712,P=0.018。结论对于直径≤1.0cm的病灶,血流信号、形状以及边界对预测有意义病灶的检出有一定准确性。因此,对于影像学检查发现可见血流信号、形状欠规则以及边界欠清的病灶建议患者进行微创手术,以明确下一步治疗策略,而其他患者定期随访观察是安全的。OBJECTIVE No consensus has been reached on the treatment of non-palpable small lesions.This study aimed to prospectively investigate non-palpable lesions≥1.0 cm in diameter to explore the risk factors and appropriate treatment methods for such lesions.METHODS A total of 605 female patients in breast surgery of the First Bethune Hospital of Jilin University from January 1 st,2009 to December 31 st,2010 were selected.All patients were followed up for2 to 4 years.During the follow-up period,color Doppler ultrasound was reexamined every 6 months,and X-ray was reexamined every year.Totally 79 of them underwent minimally invasive surgery.Lesions identified as high-risk types of tumors on pathological examination were labeled meaningful lesions.Univariate analysis was made on the influencing factors of meaningful lesion detection.Logistic regression model was used to predict meaningful lesion detection with blood flow signal,shape and boundary as independent variables.RESULTS Meaningful lesions were detected in 40 cases.Univariate analysis showed that under-regular shape(Z=-3.058,P=0.002),unclear boundary(Z=-3.233,P=0.001)and visible blood flow signals(Z=-2.975,P=0.003)were the risk factors affecting the detection of meaningful lesions.Multivariate analysis showed that blood flow signals(χ^2=5.980,P=0.014)and shape irregularities(χ^2=5.453,P=0.020)were independent risk factors for predicting the detection of meaningful lesions.The area under ROC curve of three risk factors was 0.612,95%CI:0.512-0.712,P=0.018.CONCLUSIONS For lesions≤1.0 cm in diameter,blood flow signals,shapes and boundaries have certain accuracy in predicting the detection of meaningful lesions.Therefore,minimally invasive surgery is recommended for lesions with visible blood flow signals,irregular shapes and unclear borders on imaging examination to determine the next treatment strategy,while regular follow-up observation of other patients is safe.

关 键 词：不可触及的病灶 乳腺 彩超 X射线摄影 危险因素 多因素分析 

分 类 号：R737.9[医药卫生—肿瘤]