超声下乳腺影像报告和数据系统3类结节微创旋切术后确诊乳腺癌患者临床病理学特征及肿瘤残留影响因素分析  

An analysis of breast cancer patients with ultrasound BI-RADS 3 lesions after minimally invasive excision in clinicopathological features and influencing factors of residual tumor

作　　者：李亮[1] 冯泽群 张连芳[2] 王瑞卿[3] 张小霞[3] 刘丽媛[1] 于理想[1] 余之刚[1] 高忠诚 Li Liang;Feng Zequn;Zhang Lianfang;Wang Ruiqing;Zhang Xiaoxia;Liu Liyuan;Yu Lixiang;Yu Zhigang;Gao Zhongcheng(Department of Breast Surgery,the Second Hospital of Shandong University Institute of Translational Medicine of Breast Disease Prevention and Treatment,Shandong University Shandong Provincial Engineering Laboratory of Translational Research on Prevention and Treatment of Breast Disease,Jinan 250033,China;Department of Radiology,Linyi People′s Hospital,Linyi 276000,China;Department of Breast Surgery,Linyi People′s Hospital,Linyi 276000,China)

机构地区：[1]山东大学第二医院乳腺外科、山东大学乳腺疾病防治转化医学研究所、山东省乳腺疾病防治转化工程实验室,济南250033 [2]临沂市人民医院影像科,临沂276000 [3]临沂市人民医院乳腺外科,临沂276000

出　　处：《中华外科杂志》2024年第2期135-140,共6页Chinese Journal of Surgery

基　　金：医疗服务与保障能力提升(医疗卫生机构能力建设)项目(国卫办医函〔2019〕542号)。

摘　　要：目的探讨超声下乳腺影像报告和数据系统(BI-RADS)3类结节微创旋切术后确诊乳腺癌患者的临床病理学特征及肿瘤残留的影响因素。方法本研究为回顾性病例对照研究。回顾性收集2012年5月至2016年6月就诊于山东大学第二医院乳腺外科、临沂市人民医院乳腺外科的4151例乳腺超声BI-RADS 3类结节微创旋切术中确诊乳腺癌的69例患者的临床病理学资料,患者均为女性,年龄(43.4±8.2)岁(范围:22~70岁)。根据微创旋切术后有无肿瘤残留分为残留组和无残留组,采用χ^(2)检验、独立样本t检验比较两组患者的临床病理学资料。采用Logistic回归分析肿瘤残留的影响因素,应用Kaplan-Meier法进行生存分析并绘制生存曲线。结果乳腺超声BI-RADS 3类结节微创旋切术后确诊乳腺癌的患者占同时期该类患者的1.66%(69/4151)。其肿物最大径为(1.27±0.45)cm(范围:0.5~2.3 cm),28例肿物最大径≤1 cm,41例肿物最大径>1 cm,组织病理学结果为原位癌24例,浸润性癌41例,雌激素受体阳性47例,孕激素受体阳性43例,Ki-67指数升高26例。腋窝转移阳性率10.1%(7/69)。39例患者存在肿瘤残留,占乳腺癌患者的56.5%(39/69)。单因素分析结果显示,残留组雌激素受体阳性比例更高[91.9%(34/37)比61.9%(13/21),χ^(2)=7.838,P=0.012]。多因素分析结果显示,雌激素受体阳性(OR=16.852,95%CI:1.819~156.130,P=0.013)为术后肿瘤残留的独立影响因素。乳腺超声BI-RADS 3类结节乳腺癌患者5年无病生存率为97.1%,总体生存率为98.6%。结论可用微创旋切术处理的BI-RADS 3类结节具有一定恶性风险,约为1.66%。雌激素受体阳性的患者更易发生肿瘤残留。微创旋切术后存在一定的肿瘤残留,对确诊为乳腺癌患者,需进行二次手术确保残腔无肿瘤残留。Objectives To examine the clinicopathological characteristics and the influencing factors of the residual tumor of patients with Breast Image Report and Data System(BI-RADS)grade 3 lesions diagnosed with malignancy after minimally invasive excision.Methods In this retrospective case-control study,clinicopathological data of 69 cases,which had been evaluated as BI-RADS 3 lesions by ultrasound(4151 cases)diagnosed with breast cancer by minimally invasive excision pathology,were analyzed between May 2012 and June 2016 at the Department of Breast Surgery of the Second Hospital of Shandong University and Linyi People′s Hospital.All patients were female,aged(43.4±8.2)years(range:22 to 70 years).Based on residual tumor after minimally invasive excision,patients were classified into two subgroups:tumor residual group(n=39)and non-tumor residual group(n=30).The clinicopathological features between the two groups were compared.The differences in clinicopathological characteristics were compared in different groups using theχ^(2) test and the t test.Potential variables identified in the univariate analysis and other relevant variables will be analyzed multivarially using Logistic regression models.The Kaplan-Meier method was applied for survival analysis and survival curves.Results The breast cancer detection rate of ultrasound BI-RADS 3 lesions was 1.66%(69/4151),and their maximum diameter of the masses was(1.27±0.45)cm(range:0.5 to 2.3 cm).Among them,the maximum diameter were≤1 cm in 28 cases and>1 cm in 41 cases.Histopathological results showed carcinoma in situ in 24 cases and invasive carcinoma in 41 cases,positive expression of the estrogen receptor in 47 cases,positive expression of the progesterone receptor in 43 cases,Ki-67 proliferation index elevated in 26 cases.Axillary metastasis positive rate was 10.1%(7/69).Residual tumor after minimally invasive surgery was found in 39 cases(56.5%).Univariate analysis showed that the tumour residual group showed a significantly increased rate of positive expression of

关 键 词：乳腺肿瘤 活组织检查 微创旋切术 肿瘤残留 预后 

分 类 号：R73[医药卫生—肿瘤]