乳腺浸润性导管癌肿块大小与多模态超声及免疫指标的相关性分析  

Correlation analysis between tumor size and multimodal ultrasound and immune markers in breast invasive ductal carcinoma

作　　者：李文肖 曹春莉 马婷 石丽楠 王子静 李军[2] LI Wen-xiao;CAO Chun-li;MA Ting(Department of Ultrasound,the First Affiliated Hospital of Medical College of Shihezi University,NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases Shihezi 832008,Xinjiang,China)

机构地区：[1]石河子大学第一附属医院超声医学科,新疆石河子832008 [2]石河子大学第一附属医院国家卫健委中亚高发病防治重点实验室

出　　处：《放射学实践》2024年第4期540-546,共7页Radiologic Practice

基　　金：国家自然科学基金(82060318,81860498,81560433);中国医学科学院中央级公益性科研院所基本科研业务费专项资金(2020-PT330-003);兵团科技计划项目(2022CB002-04);石河子大学自然科学基金(ZZZC2023035);石河子大学医学院第一附属医院青年基金(QN202126);石河子大学医学院第一附属医院青年基金(QN202107)。

摘　　要：目的:探讨不同大小乳腺浸润性导管癌(IDC)的常规超声、声触诊组织成像和定量分析(VTIQ)、超声造影超声特征及免疫指标的差异。方法:回顾性分析2017年-2022年5月在本院经病理证实的106例IDC患者的多模态超声和临床资料。根据肿块大小,将患者分为>2 cm组(55例)和≤2 cm组(51例)。分析两组之间肿瘤的常规超声特征(位置、纵横比、后方回声衰减、边缘毛刺征、Adler血流分级)、VTIQ指标[剪切波速度最大值(SWV_(max))、最小值(SWV_(min))、周边平均值(SWV_(周边AVG))、肿瘤与同切面正常腺体SWV最大值的比值(maxSWVR_(肿瘤/正常乳腺))、最大值与最小值的比值SWVR_(max/min))]和超声造影特征(增强程度、增强速度、增强顺序、病灶边缘放射状汇聚、灌注缺损和增强后病灶范围有无增大)的差异,及其与肿瘤免疫组化指标(ER、PR、Her-2、Ki-67)的相关性。结果:两组之间病变位置(χ^(2)=6.937,P=0.031)、Adler血流分级(χ^(2)=9.456,P=0.002)、SWV周边AVG(Z=-2.504,P=0.012)、maxSWVR肿瘤/正常乳腺(Z=-2.545,P=0.011)、SWVR_(max/min)(Z=-2.469,P=0.014)、增强强度(χ^(2)=3.918,P=0.048)、增强后放射状汇聚(χ^(2)=10.403,P=0.001)、增强后病灶面积增大与否(χ^(2)=8.289,P=0.004)及Ki-67水平(χ^(2)=5.213,P=0.022)的差异均具有统计学意义。Adler血流分级Ⅱ~Ⅲ级、增强后病灶边缘放射状汇聚、增强后病灶面积增大、高SWV周边AVG、高SWVR_(max/min)、高maxSWVR_(肿瘤/正常乳腺)乳腺IDC肿块大小呈正相关。结论:不同直径的乳腺浸润性导管癌(以2 cm为阈值时)的多模态超声特征存在一定差异,可以为临床及超声医师的术前诊断提供参考依据。Objective:The aim of this study was to explore the differences of immune parameters and multimodal ultrasound characteristics including conventional ultrasound,virtual touch tissue imaging and quantification(VTIQ)and contrast-enhanced ultrasound(CEUS)between different sizes of invasive breast ductal carcinoma(IDC).Methods:Multimodal ultrasound and clinical data of 106 patients with pathologically confirmed IDC in our hospital from 2017 to May 2022 were retrospectively analyzed.According to the tumor size,the patients were divided into>2cm group(55 cases)and≤2cm group(51 cases).Conventional ultrasound features(location,aspect ratio,rear echo attenuation,edge burr sign,Adler blood flow grading),VTIQ parameters[(maximum and minimum of shear wave velocity(SWV_(max),SWV_(min)),average SWV at peripheral area of tumor(SWV per-AVG),ratio of tumor SWV_(max)to SWV_(max)of normal breast tissue at the same plane(maxSWVR_(tumor/breast)),ratio of SWV_(max)to SWV_(min)(SWVR_(max/min))],and contrast-enhanced ultrasound features(enhancement intensity,enhancement speed,enhancement sequence,radial convergence,perfusion defect,area increase or not after enhancement),and their correlation with immunohistochemical indices of tumor(ER,PR,Her-2 and Ki-67).Results:There were significant differences between>2cm group and≤2cm group in the tumor location(χ^(2)=6.937,P=0.031),Adler blood flow classification(χ^(2)=9.456,P=0.002),SWV per-AVG(Z=-2.504,P=0.012),maxSWVR_(tumor/breast)(Z=-2.545,P=0.011),SWV_(max)/min(Z=-2.469,P=0.014),reinforcement strength(χ^(2)=3.918,P=0.048),radial convergence after enhancement(χ^(2)=10.403,P=0.001),range change after enhancement(χ^(2)=8.289,P=0.004)and Ki-67(χ^(2)=5.213,P=0.022).The Adler blood flow classification of gradeⅡ~Ⅲ,marginal radiation convergence after enhancement,increased lesion area after enhancement high SWV per-AVG,high SWVR_(max/min)and high maxSWVR_(tumor/breast)were positively correlated with size of IDC,respectively.Conclusion:This research highlights the differences in multimo

关 键 词：乳腺肿瘤 浸润性导管癌 超声造影 声触诊组织量化成像 免疫组化 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]