数字乳腺断层摄影及病理学特征与早期乳腺癌保乳手术结果的相关性研究  

Correlation of digital breast tomosynthesis and pathological features with the outcome of breast-conserving surgery in early-stage breast cancer

作　　者：刘梁生 马文娟 张宇 李艳博 王嘉慧 路红 Liangsheng Liu;Wenjuan Ma;Yu Zhang;Yanbo Li;Jiahui Wang;Hong Lu(Department of Breast Imaging,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Tianjin’s Clinical Research Center for Cancer,Key Laboratory of Breast Cancer Prevention and Therapy(Ministry of Education),Tianjin Key Laboratory of Cancer Prevention and Therapy,Tianjin 300060,China)

机构地区：[1]天津医科大学肿瘤医院乳腺影像诊断科,国家恶性肿瘤临床医学研究中心,天津市恶性肿瘤临床医学研究中心,乳腺癌防治教育部重点实验室,天津市"肿瘤防治"重点实验室,天津市300060

出　　处：《中国肿瘤临床》2024年第12期611-615,共5页Chinese Journal of Clinical Oncology

基　　金：国家自然科学基金项目(编号:82072004、82172025);天津市医学重点学科(专科)建设项目基金项目(编号:TJYXZDXK-009A);天津医科大学肿瘤医院院级课题项目(编号:Y1802)资助。

摘　　要：目的:研究数字乳腺断层摄影(digital breast tomosynthesis,DBT)影像特征及病理学特征与早期乳腺癌保乳手术(breastconserving surgery,BCS)结果的相关性。方法:回顾性分析2019年1月至2023年12月天津医科大学肿瘤医院行BCS成功保留乳房422例和术中改行乳房全切术(mastectomy)211例的早期乳腺癌患者术前临床资料。收集两组病例的术前DBT影像及临床病理学特征,采用单因素Logistic回归分析筛选出与BCS手术结果相关的特征,随后进行多因素Logistic回归分析。结果:单因素Logistic回归分析结果显示年龄(P=0.020)、结构扭曲(P<0.001)、乳腺构成类型(极致密型,P=0.001)和分子分型(Her2过表达型,P=0.001)在保留乳房组及乳房全切组间比较差异具有统计学意义;多因素Logistic回归分析结果显示结构扭曲(P<0.001)、乳腺构成类型(极致密型,P=0.003)和分子分型(Her2过表达型,P<0.001)在两组比较差异具有统计学意义。结论:乳腺构成类型、结构扭曲以及分子分型与BCS结果具有一定相关性,乳腺构成类型为极致密型、病变表现有结构扭曲以及分子分型为Her2过表达型的患者提示更大的改行乳房全切术可能性,可作为术前评估乳腺癌BCS结果的有效指标,从而制定准确的手术策略。Objective:To investigate the correlation between digital breast tomosynthesis(DBT)image features,pathological features,and the results of breast-conserving surgery(BCS)in early stage breast cancer.Methods:We retrospectively analyzed 422 cases of BCS resulting in successful breast preservation and 211 BCS cases that were followed by mastectomy.All of the patients underwent surgery at Tianjin Medical University Cancer Institute&Hospital between January 2019 and December 2023.Preoperative DBT images and clinicopathological features were assessed.A univariate Logistic regression analysis was performed to screen out the characteristics associated with BCS surgical results,after which multivariate Logistic regression analysis was performed to screen out the characteristics.Results:Univariate Logistic regression analysis showed that age(P=0.020),architectural distortion(P<0.001),breast composition(extremely dense,P=0.001),and molecular subtype(Her2,P=0.001)were statistically different between the two groups.Multivariate Logistic regression analysis showed that architectural distortion(P<0.001),breast composition(extremely dense breast,P=0.003),and molecular subtype(Her2,P<0.001)differed significantly between the two groups.Conclusions:Breast composition,architectural distortion,and molecular subtype correlated with BCS results.Extremely dense breast composition,architectural distortion,and Her2 subtype are associated with a higher possibility of conversion to mastectomy.These factors serve as effective predictive indicators of BCS results and thus aid clinicians in deciding the appropriate surgical strategies in the treatment of breast cancer.

关 键 词：乳腺癌 保乳手术 数字乳腺断层摄影 影像特征 分子分型 

分 类 号：R737.9[医药卫生—肿瘤]