超声引导空芯针穿刺活检诊断乳腺癌激素受体状态的价值

Diagnostic Value of Ultrasound-guided Core Needle Biopsy for Hormone Receptor States of Breast Cancer

目的探讨超声引导空芯针穿刺活检(ultrasound-guided core needle biopsy,US-CNB)检测乳腺癌激素受体状态的准确性。方法回顾性分析2016年9月~2019年4月127例未经过新辅助治疗的131个乳腺癌病灶。US-CNB后7~46 d行乳腺癌手术。对比US-CNB和手术切除组织的病理结果,包括雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)。结果US-CNB均顺利完成。US-CNB标本中ER阳性、阴性病灶分别为121个(121/131,92.4%)和10个(10/131,7.6%),术后标本中分别为120个(120/131,91.6%)和11个(11/131,8.4%)(McNemar检验P=1.000),两者诊断一致率为99.2%(130/131)(κ=0.948,P=0.000)。US-CNB标本中PR阳性、阴性病灶分别为106个(80.9%,106/131)和25个(19.1%,25/131),术后标本中分别为106个(80.9%,106/131)和25个(19.1%,25/131)(McNemar检验P=1.000),两者诊断一致率为95.4%(125/131)(κ=0.852,P=0.000)。US-CNB与手术标本ER、PR表达性质均无统计学差异(McNemar检验P=1.000)。在表达比例方面,US-CNB与手术标本ER阳性细胞所占比例差异无统计学意义[中位数90%(70%~90%)vs.90%(80%~90%),Wilcoxon检验,Z=-1.804,P=0.071]。US-CNB与手术标本PR阳性细胞所占比例差异无统计学意义[中位数60%(5%~90%)vs.60%(5%~90%),Wilcoxon检验,Z=-0.592,P=0.554]。US-CNB与手术标本ER、PR表达强弱差异无统计学意义(Wilcoxon检验,Z=-0.786、P=0.432;Z=-1.792,P=0.073)。结论US-CNB可准确评价乳腺癌雌、孕激素受体表达状态,是术前评估乳腺癌激素受体表达的可靠方法。

Objective To discuss the accuracy of ultrasound-guided core needle biopsy(US-CNB)in detecting the states of hormone receptors for breast cancer patients.Methods We retrospectively analyzed 127 patients with 131 breast cancer lesions without any neoadjuvant treatment between September 2016 and April 2019.Surgery was performed at 7-46 d after US-CNB.The expression of estrogen receptor(ER)and progesterone receptor(PR)in US-CNB was compared with that of surgical excision.Results US-CNB was successfully completed.ER positive lesions of US-CNB were found in 121 lesions(121/131,92.4%),while ER negative lesions were found in 10 lesions(10/131,7.6%).For surgical specimen,there were 120 lesions(120/131,91.6%)and 11 lesions(11/131,8.4%),respectively.The McNemar test showed no significant difference(P=1.000)and the consistent rate was 99.2%(130/131)(κ=0.948,P=0.000).PR positive lesions of US-CNB were found in 106 lesions(106/131,80.9%),while PR negative lesions were found in 25 lesions(25/131,19.1%).For surgical specimen,there were 106 lesions(106/131,80.9%)and 25 lesions(25/131,19.1%),respectively.The McNemar test showed no significant difference(P=1.000),and the consistent rate was 95.4%(125/131)(κ=0.852,P=0.000).There were no significant differences in the qualitative expression of ER and PR between US-CNB and surgical specimens.In the aspect of proportion,there was no significant difference for the proportion of ER positive cells between US-CNB and surgical specimens[median,90%(70%-90%)vs.90%(80%-90%),Wilcoxon test,Z=-1.804,P=0.071].Neither was for the proportion of PR positive cells[median,60%(5%-90%)vs.60%(5%-90%),Wilcoxon test,Z=-0.592,P=0.554].For the comparison of intensity of ER and PR,the results showed no significant differences(Wilcoxon test,ER:Z=-0.786,P=0.432;PR:Z=-1.792,P=0.073).Conclusions US-CNB can accurately evaluate the expression characteristics of estrogen and progesterone receptors in breast cancer.It is a reliable method for preoperative evaluation of the expression status of hormone receptors.