超声BI-RADS分级假阴性乳腺癌临床病理特征的回顾性分析  

Retrospective Analysis of the Clinicopathological Features of False Negative Breast Cancer with Ultrasound BI-RADS Classification

作　　者：吴颖 吴坤河[1] 凌月仙[1] 郭玉娟[1] 郜红艺[1] WU Ying;WU Kun-he;LING Yue-xian;GUO Yu-juan;GAO Hong-yi(Department of Pathology,Guangdong Women and Children Hospital,Guangzhou 511400,China)

机构地区：[1]广东省妇幼保健院病理科,广东广州511400

出　　处：《中山大学学报（医学科学版）》2020年第4期635-643,共9页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省医学科研基金(A2016240)。

摘　　要：【目的】回顾性分析乳腺癌超声假阴性与真阳性病例的临床病理参数和分子生物学特性之间的差异,总结该类病例的临床特点。【方法】选取广东省妇幼保健院2018年01月01日至2019年12月31日确诊为浸润性乳腺癌的女性患者414例,结合乳腺影像报告数据系统(BI-RADS)分级标准分为假阴性组和真阳性组,比较分析两组患者的发病年龄、肿瘤大小、组织学分级、淋巴结转移情况以及肿瘤细胞雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER2)、肿瘤增殖抗原(Ki-67)表达、组织纤维反应、血管增生、淋巴细胞浸润和坏死情况之间的差异,对差异有统计学意义的指标再行多因素二元Logistic回归分析。【结果】414例浸润性乳腺癌病例中有43例超声假阴性和371例真阳性,两组的病理组织学类型无统计学差异(P=0.250)。假阴性组中,管腔A型(32.6%)和基底样型(27.9%)比例分别高于真阳性组(17.8%和14.3%),HER2过表达型(6.9%)的比例低于真阳性组(32.1%),差异均有统计学意义(P<0.05);而管腔B型(32.6%)的比例和真阳性组(35.8%)无统计学差异(χ^2=0.182,P=0.669)。与真阳性组相比,超声假阴性组的肿瘤组织学分级(χ^2=5.129,P=0.077)、ER表达(χ^2=1.666,P=0.197)、PR表达(χ^2=0.290,P=0.590)、HER2表达(χ^2=3.378,P=0.066)、组织纤维反应(χ^2=5.353,P=0.069)、淋巴细胞浸润(χ^2=2.023,P=0.155)和坏死情况(χ^2=0.468,P=0.494)均无统计学差异;肿瘤大小(P<0.001)、淋巴结转移(χ^2=43.184,P<0.001)、Ki-67表达(χ^2=9.293,P=0.010)、年龄(χ^2=10.334,P=0.006)和血管增生情况(χ^2=5.937,P=0.015)的差异均有统计学意义。假阴性组中肿瘤大小≤2 cm(81.4%,35/43 vs.33.7%,125/371)、无淋巴结转移(97.7%,42/43 vs.44.7%、166/371)、Ki-67表达>70%(18.6%,8/43 vs.5.9%,22/371)、年龄≤45岁(65.1%,28/43 vs.41.2%,153/371)和血管增生数量≤3条的比例(74.4%,32/43 vs.55.0%,204/371)均高于真阳性组。多因素Logistic回【Objective】To retrospectively analyze the differences of clinicopathological parameters and molecular bio⁃logical characteristics between ultrasound false negative and true positive breast cancer cases and summarize the clinical characteristics of these cases.【Methods】A total of 414 invasive breast cancer cases in Guangdong Women and Children Hospital between January 1st,2018 and December 31st,2019 were enrolled in this study.According to the BI-RADS classification standard of ultrasound,they were divided into false negative group and true positive group.The differences of onset age,tumor size,tumor histological grade,lymph node metastasis,estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor(HER2),Ki-67,fiber reaction,vascular hyperplasia,lymphocyte infil⁃tration and necrosis between the two groups were compared and analyzed.The differences with statistical significance were analyzed by multivariate logistic regression analysis.【Results】These 414 invasive breast cancer cases were composed of 43 false negative cases and 371 true positive cases.There was no significant difference in histopathological type between the two groups(P=0.250).In the false negative group,the rate of luminal A(32.6%)and basal-like(27.9%)cases was respectively higher than that of the true positive group(17.8%,14.3%),whereas the rate of HER2 overexpression(6.9%)cases was lower than that of the true positive group(32.1%),with statistical significance(P<0.05).The rate of luminal B cases in the false negative group(32.6%)was not significantly different from that in the true positive group(35.8%,χ^2=0.182,P=0.669).Compared with the true positive group,there was no significant difference in tumor his⁃tological grade(χ^2=5.129,P=0.077),ER expression(χ^2=1.666,P=0.197),PR expression(χ^2=0.290,P=0.590),HER2 expression(χ^2=3.378,P=0.066),fiber reaction(χ^2=5.353,P=0.069),lymphocyte infiltration(χ^2=2.023,P=0.155)and necrosis(χ^2=0.468,P=0.494),whereas the differences of the tumor size(P<0.00

关 键 词：乳腺癌 假阴性 乳腺超声 乳腺影像报告与分级系统 临床病理 

分 类 号：R737.9[医药卫生—肿瘤]