基于术前钼靶影像及病理特征分析乳腺癌保乳术病理切缘阳性相关因素  

Analysis of Related Factors of Pathologically Positive Margin after Breast-conserving Surgery for Breast Cancer Based on Preoperative Mammography and Pathological Features

作　　者：刘美妍 王慧哲 徐静 王炳东 于玺 赵凯华 LIU Meiyan;WANG Huizhe;XU Jing;WANG Bingdong;YU Xi;ZHAO Kaihua(Qingdao University Qingdao Medical College,Qingdao,Shandong 266042,China;Department of Radiology,Qingdao Central Hospital,University of Health and Rehabilitation Sciences,Qingdao,Shandong 266042,China;Department of Pathology,Qingdao Central Hospital,University of Health and Rehabilitation Sciences,Qingdao,Shandong 266042,China;Department of Breast Surgery,Qingdao Central Hospital,University of Health and Rehabilitation Sciences,Qingdao,Shandong 266042,China)

机构地区：[1]青岛大学青岛医学院,山东青岛266042 [2]康复大学青岛中心医院放射科,山东青岛266042 [3]康复大学青岛中心医院病理科,山东青岛266042 [4]康复大学青岛中心医院乳腺外二科,山东青岛266042

出　　处：《临床误诊误治》2025年第1期40-44,共5页Clinical Misdiagnosis & Mistherapy

基　　金：吴阶平医学基金会临床科研专项(320.6750.2023-18-108)。

摘　　要：目的基于术前钼靶影像及病理特征分析乳腺癌保乳术病理切缘阳性的相关因素。方法选取2019年1月至2022年12月收治的乳腺癌保乳术患者202例,根据病理切缘情况分为切缘阳性组(n=65)和切缘阴性组(n=137)。比较2组的一般资料、病理特征、术前钼靶影像特点,多因素logistic回归分析乳腺癌保乳术病理切缘阳性的危险因素。结果2组是否伴有导管原位癌、组织学分期、人表皮生长因子受体-2(HER-2)表达情况以及肿块大小比较具有统计学差异(P<0.01)。多因素logistic回归分析显示,伴有导管原位癌、组织学分期高、HER-2表达阳性以及肿块较大均是乳腺癌保乳术病理切缘阳性的危险因素(P<0.05)。结论伴有导管原位癌、组织学分期高、HER-2表达阳性、肿块较大是乳腺癌保乳术病理切缘阳性的危险因素。对于有切缘阳性危险因素的患者,术前通过穿刺病理及钼靶影像评估肿瘤及周围组织切除的范围,保证切缘的安全边界,不额外增加切缘宽度,可以维持良好的乳房外观,提高患者术后生活质量,保障乳腺癌保乳术切除效果,降低二次手术率。Objective To analyze the factors related to pathologically positive resection margin after breast-conserving surgery(BCS)for breast cancer based on preoperative mammography and pathological features.Methods A total of 202 patients undergoing BCS from January 2019 to December 2022 were selected and divided into positive resection margin group(n=65)and negative resection margin group(n=137)according to pathological conditions.The general data,pathological features and preoperative molybdenum imaging characteristics of the two groups were compared,and the risk factors of pathologically positive margin after BCS for breast cancer were analyzed by multivariate logistic regression analysis.Results There were significant differences between the two groups with respect to the presence of ductal carcinoma in situ,histological stage,expression of human epidermal growth factor receptor-2(HER-2)and size of the mass(P<0.05).Multivariate logistic regression analysis showed that ductal carcinoma in situ,high histological stage,positive HER-2 expression and large mass were independent risk factors for pathologically positive margin after BCS for breast cancer(P<0.05).Conclusion Ductal carcinoma in situ,high histological stage,positive HER-2 expression and large mass are the risk factors for pathologically positive margin after BCS for breast cancer.For patients with risk factors of positive resection margin,the scope of resection of tumor and surrounding tissue could be evaluated by preoperative puncture pathology and molybdenum target imaging,which could ensure the safe boundary of resection margin without increasing the width of resection margin,maintain a good breast appearance,improve the postoperative quality of life of patients,ensure the resection effect of BCS for breast cancer,and reduce the rate of secondary surgery.

关 键 词：乳腺癌 保乳术 切缘阳性 钼靶影像 病理特征 危险因素 导管原位癌 人表皮生长因子受体-2 

分 类 号：R737.9[医药卫生—肿瘤]