超声可疑的乳腺导管原位癌伴微浸润与乳腺导管原位癌的DBT影像及临床病理特征对比分析  

Comparative analysis of DBT imaging and clinicopathological features of ultrasonically suspected ductal carcinoma in situ with micro-invasion and ductal carcinoma in situ

作　　者：李鸿恩 唐大为 程佳玲 林兴[1] 曾益辉 王霞[1] LI Hongen;TANG Dawei;CHENG Jialing;LIN Xing;ZENG Yihui;WANG Xia(Department of Radiology,Guangdong Province Hospital for Women and Children Healthcare,Guangdong Guangzhou 510000,China.)

机构地区：[1]广东省妇幼保健院放射科,广东广州510000

出　　处：《现代肿瘤医学》2024年第14期2606-2614,共9页Journal of Modern Oncology

摘　　要：目的:在超声检查乳腺可疑病变的情况下,行数字化乳腺断层摄影(DBT)检查,研究乳腺导管原位癌伴微浸润(DCIS-Mi)与导管原位癌(DCIS)的DBT影像差异及其相关的临床病理学表现,探索DCIS-Mi的预测因子。方法:回顾性分析我院2019年01月至2022年11月经术后病理证实为DCIS的124例患者的临床、病理及DBT影像资料,其中纯DCIS患者79例(63.71%),DCIS-Mi患者45例(36.29%)。参照乳腺影像报告和数据系统(BI-RADS)标准,对两组患者的DBT影像进行了详细的特征分析。采用χ^(2)检验或Fisher确切概率法比较两组患者DBT影像特征与临床病理表现的差异性。采用多因素Logistic回归分析研究与DCIS-Mi相关的危险因素。结果:所以患者中,首发临床症状主要为触及肿块81例(65.32%)、乳头溢液31例(25.00%)、钙化灶12例(9.68%)。通过对两组病人的临床病理检查,我们可以看出它们的核异型性存在显著的差异(χ^(2)=7.967,P=0.005)。然而,对于两组病人的其他因素,如年龄、绝经情况、初次出现的临床症状、淋巴结的状态、免疫组化标记物(ER、PR、HER-2、Ki-67)及其病理分子物质的类别,这些原因的显著性并不显著(P>0.05)。DBT影像特征中,两者在病变最大径、形态及边缘毛刺征上差异具有统计学意义(χ^(2)分别为4.055、6.687、4.755,P<0.05);腺体类型、病变类型、微钙化、钙化形态及钙化分布上差异无统计学意义(P>0.05)。多因素Logistic回归分析肿块大小、肿块形态、边缘毛刺征未构成DCIS-Mi高危因素。结论:具有微侵袭性的DCIS-Mi与DCIS在临床病理学和DBT影像学方面有差异,DCIS-Mi病灶多呈肿块最大径≥2.5 cm,形态不规则,边缘不光整,有毛刺征。此外,DCIS-Mi的恶性程度也更高。在病理学方面,DCIS-Mi的肿瘤主要表现为HER-2过表达型,核异型性主要集中在中高级别,预后较差。Objective:In the case of ultrasonography for suspicious breast lesions,digital breast tomosynthesis(DBT)was performed to study the differences in DBT imaging between ductal carcinoma in situ with micro-invasion(DCIS-Mi)and ductal carcinoma in situ(DCIS),as well as the related clinicopathological manifestations,and to explore the predictors of DCIS-Mi.Methods:The clinical,pathological,and DBT imaging data of 124 patients with postoperative pathologically confirmed DCIS in our hospital from January 2019 to November 2022 were retrospectively analyzed,including 79 patients with pure DCIS(63.71%)and 45 patients with DCIS-Mi(36.29%).The DBT images of the two groups were analyzed in detail with reference to BI-RADS(breast imaging reporting and data system).χ^(2) test or Fisher exact probability method were used to compare the differences between DBT imaging features and clinicopathological findings between the two groups.Multivariate Logistic regression analysis was used to study the risk factors associated with DCIS-Mi.Results:Therefore,among the patients,the main initial clinical symptoms were touching mass in 81 cases(65.32%),nipple discharge in 31 cases(25.00%),and calcification in 12 cases(9.68%).Through the clinicopathological examination of the two groups of patients,we can see that there are significant differences in their nuclear atypia(χ^(2)=7.967,P=0.005).However,other factors,such as age,menopause,initial clinical symptoms,lymph node status,immunohistochemical markers(ER,PR,HER-2,Ki-67)and the category of pathological molecular substances,were not significant in the two groups(P>0.05).In the DBT image features,there were statistically significant differences in the maximum diameter,shape and marginal burr signs between the two lesions(χ^(2) were 4.055,6.687,4.755,P<0.05).There were no significant differences in gland type,lesion type,microcalcification,calcification morphology and calcification distribution(P>0.05).Multivariate Logistic regression analysis of tumor size,tumor shape and marginal burr sign

关 键 词：数字化乳腺断层摄影技术 导管原位癌 导管原位癌伴微浸润 临床病理表现 

分 类 号：R737.9[医药卫生—肿瘤]