早期乳腺导管原位癌X线表现与预后生物学标记关系的研究

The X-ray features of breast ductal carcinoma in situ and its small invasive foci and correlation between mammographic features and prognostic biologic factors

目的评价乳腺导管原位癌（DCIS）及DCIS伴微浸润的X线片表现，分析X线表现与预后生物学标记的相关性。方法对50例乳腺DCIS及45例DCIS伴微浸润的患者行X线检查，共62例行预后生物学标记，分析影像表现与孕激素受体（PR）、癌基因（C—erbB-2）、抑癌基因（p53）的相关性。用卡方检验进行统计学处理，并对有意义者行优势比（OR值）分析。结果（1）单独1个X线征象表现者62例；合并2个征象26例；阴性7例。（2）各种X线征象单独分析显示，62例有钙化的病灶中恶性钙化占73％（45例），其余为中间性钙化；钙化以簇状分布最为常见（36例），其次为段样分布（18例）。22例有肿块的病灶中，以卵圆形肿块最为常见（13例）；肿块的边缘表现为浸润、小分叶、清晰和模糊各为15、1、4和2例；等密度肿块占的比例较高（55％，12例）。结构扭曲7例，除1例外多与其他征象伴行；局灶性不对称占16％（15／95），可单独发生或与其他征象伴发。（3）将病灶的X线表现分成恶性钙化、中间性钙化和非钙化3组，PR与C-erbB-2在3组中的分布有统计性意义，PR阳性表达者X线上非钙化征象发生率是中间性钙化的11．00倍[χ^2=8．571，P=0．003；95％可信区间（CI）为1．998～60．572]、恶性钙化的8．80倍（χ^2=9．748，P=0．002；95％CI为2．024～38．253）；而C—erbB-2高表达者，恶性钙化是非钙化发生的12．35倍（χ^2=7．353，P=0．007；95％CI为1．447—105．443），中间性钙化的5．74倍（χ^2=4．977，P=0．026；95％CI为1．110～29．645）。结论乳腺DCIS及DCIS伴微浸润X线征象有特征。X线征象可以作为早期乳腺DCIS的一个预后因子。

Objective To retrospectively evaluate the mammographic features of breast ductal carcinoma in situ （DCIS） and DCIS with small invasive foci, and to analyze the correlation between the mammographic findings and the prognostic biologic factors. Methods The mammographic examination was performed in 95 consecutive women with breast DCIS （n =50） and DCIS with invasive loci （ n =45）. The prognostic biologic factors including progesterone receptor （PR） , C-erhB-2, and 1353 were evaluated in 62 of 95 cases. Categorical data were expressed as percentages and analyzed by using the χ^2 test, and furthermore the odds ratio was measured. Results （ 1 ） Only one abnormality was seen on mammography in 62 patients. Combined two abnormalities on mammography were seen in 26 patients. Mammograms were normal in 7 patients. （2） Calcifications with or without other abnormality were noted in 62 cases. Of them, 73% （n=45） had higher probability of malignancy calcifications and the others we, re intermediate concern calcifications. Clustered calcifications （36 lesions ） was the most common distribution, which usually accompanied by another abnormality. And then were segmental （ 18 lesions） distributed pattern. As far as the shape of mass （n = 22） was concerned, the oval shaped lesion （13 cases） was the most common, and the margin of the mass appeared as ill-defined in 15 cases, microlobulated in 1, circumscribed in 4, and obscured in 2, respectively. Isodensity mass had a higher frequency in this group （ 12/22, 55% ）. Other non-calcification findings included architecture distortion （7 cases）, local asymmetry （15 cases）, global asymmetry （5 cases） ,and solitary dilated duct （3 cases）, and most of them accompanied with other signs. （3） For expression profile of the biological factors, significant differences were found among malignantcalcification group, intermediate concern calcification group, and non-calcification group. The odds of PR positive for the lesions noted as non-calcification were 11.00 times higher （χ^2 = 8.571 ,P = 0. 003 ;95 % CI, 1. 998-60. 572） than the lesions noted as intermediate concern calcifications, and 8. 80 times higher （χ^2 = 9. 748,P =0. 002;95% CI,2. 024-38. 253） than the lesions noted as malignant calcifications. The odds of C-erbB-2 positive for the lesions showed as malignant calcifications were 12. 35 times higher （ χ^2 = 7. 353, P =0. 007 ;95% CI, 1. 447-105. 443） than the lesions showed as non-calcification, and 5.74 times higher （χ^2 = 4. 977, P = 0. 026; 95% CI, 1. 110-29.645 ） than the lesions showed as intermediate concern calcifications. Conclusion The mammographic features of DCIS and DCIS with small invasive foci were characteristic. Mammographic findings could be a prognostic markers, which could provide a possibility for making a treatment plan.