男性原发性乳腺癌患者腋窝淋巴结转移的危险因素分析  

Risk factors of axillary lymph node metastasis in male patients with primary breast cancer

作　　者：王娇娇[1] 李晟磊[2] 董刚[1] 齐清华[1] WANG Jiaojiao;LI Shenglei;DONG Gang;QI Qinghua(Department of Ultrasound,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Pathology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院超声科,河南郑州450052 [2]郑州大学第一附属医院病理科,河南郑州450052

出　　处：《中华实用诊断与治疗杂志》2023年第9期916-920,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划项目(LHGJ20190158)。

摘　　要：目的观察男性原发性乳腺癌患者超声声像表现和组织病理特征,探讨其发生腋窝淋巴结转移的危险因素。方法2012年1月—2022年12月郑州大学第一附属医院诊治男性单发原发性乳腺癌患者72例,均行乳腺癌根治+腋窝淋巴结清扫术。术后组织病理检查结果证实发生腋窝淋巴结转移者29例为转移组,未发生腋窝淋巴结转移者43例为未转移组。2组术前均行乳腺超声检查。以术后组织病理检查结果为金标准,计算超声诊断男性原发性乳腺癌患者腋窝淋巴结转移的灵敏度、特异度、准确率;比较2组肿块部位(左侧、右侧)、肿块位置(中央区、非中央区)、肿块直径(<2 cm、≥2 cm)、肿块形态(圆形或椭圆形、不规则形)、肿块方位(与皮肤平行位、非平行位)、血流分级(Ⅰ级、Ⅱ~Ⅲ级)、组织病理类型(浸润性导管癌、其他)、组织病理分级(Ⅰ级、Ⅱ~Ⅲ级)、Ki-67(>14%、≤14%)及雌激素受体、孕激素受体、人表皮生长因子受体2阳性率等;多因素logistic回归分析男性原发性乳腺癌发生腋窝淋巴结转移的影响因素。结果(1)术前乳腺超声诊断可疑腋窝淋巴结转移17例,诊断男性原发性乳腺癌患者腋窝淋巴结转移的灵敏度、特异度、准确率分别为41.4%、88.4%、69.4%。(2)转移组肿块直径≥2 cm(65.5%)、非平行位(31.0%)、微钙化(34.5%)、血流分级Ⅱ~Ⅲ级(82.8%)、浸润性导管癌(89.7%)、组织病理分级Ⅱ~Ⅲ级(93.1%)、Ki-67>14%(82.8%)比率均高于未转移组(30.2%、11.6%、14.0%、53.5%、62.8%、74.4%、51.2%)(P<0.05),肿块部位、位置、形态,内部结构、内部回声、后方回声及雌激素受体、孕激素受体、人表皮生长因子受体2阳性率与未转移组比较差异均无统计学意义(P>0.05)。(3)肿块直径≥2 cm(OR=4.229,95%CI:1.207~14.818,P=0.024)、Ki-67>14%(OR=4.716,95%CI:1.181~18.833,P=0.028)、浸润性导管癌(OR=5.149,95%CI:1.187~22.342,P=0.029)是男性原发性乳腺癌患Objective To observe the ultrasonographic and histopathological features of primary breast cancer in male patients,and to investigate the risk factors of axillary lymph node(ALN)metastasis.Methods Seventy-two male patients with primary single breast cancer were diagnosed and treated from January 2012 to December 2022 in the First Affiliated Hospital of Zhengzhou University.All patients received radical mastectomy plus ALN dissection.The postoperative histopathological examination proved 29 patients with ALN metastasis(metastasis group)and 43 patients without ALN metastasis(non-metastasis group).Both groups underwent preoperative routine breast ultrasonographic examination.Taking the histopathological results as the gold standard,the sensitivity,specificity and accuracy of ultrasonography in the diagnosis of ALN metastasis in male patients with primary breast cancer were calculated.The side(left or right),location(central or non-central),diameter(<2 cm or≥2 cm),shape(circular,elliptical or irregular),orientation(parallel or non-parallel to the skin),blood flow grade(Ⅰ or Ⅱ-Ⅲ),histopathological classification(invasive ductal carcinoma or others),histopathological grade(Ⅰ or Ⅱ-Ⅲ),Ki-67(>14% or≤14%),and the positive rates of estrogen receptor,progesterone receptor and human epidermal growth factor receptor 2 were compared between two groups.Multivariate logistic regression analysis was done to assess the influencing factors of ALN metastasis in male patients with primary breast cancer.Results(1)In 72 patients,17 were suspected as ALN metastasis in preoperative breast ultrasonographic examination.The sensitivity,specificity and accuracy of preoperative ultrasound in diagnosing ALN metastasis in male patients were 41.4%,88.4% and 69.4%,respectively.(2)The percentages of patients with tumor diameter≥2 cm,non-parallel to the skin,microcalcification,blood flow grading Ⅱ to Ⅲ,and Ki-67>14% were higher in metastasis group(65.5%.31.0%,34.5%,82.8%,89.7%,93.1%,82.8%)than those in non-metastasis group(30.2

关 键 词：原发性乳腺癌 男性 腋窝淋巴结转移 超声声像特征 肿块直径 KI-67 浸润性导管癌 

分 类 号：R737.9[医药卫生—肿瘤]