超声BI-RADS分级假阴性乳腺癌临床病理特征的回顾性分析

Retrospective Analysis of the Clinicopathological Features of False Negative Breast Cancer with Ultrasound BI-RADS Classification

【目的】回顾性分析乳腺癌超声假阴性与真阳性病例的临床病理参数和分子生物学特性之间的差异,总结该类病例的临床特点。【方法】选取广东省妇幼保健院2018年01月01日至2019年12月31日确诊为浸润性乳腺癌的女性患者414例,结合乳腺影像报告数据系统(BI-RADS)分级标准分为假阴性组和真阳性组,比较分析两组患者的发病年龄、肿瘤大小、组织学分级、淋巴结转移情况以及肿瘤细胞雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER2)、肿瘤增殖抗原(Ki-67)表达、组织纤维反应、血管增生、淋巴细胞浸润和坏死情况之间的差异,对差异有统计学意义的指标再行多因素二元Logistic回归分析。【结果】414例浸润性乳腺癌病例中有43例超声假阴性和371例真阳性,两组的病理组织学类型无统计学差异(P=0.250)。假阴性组中,管腔A型(32.6%)和基底样型(27.9%)比例分别高于真阳性组(17.8%和14.3%),HER2过表达型(6.9%)的比例低于真阳性组(32.1%),差异均有统计学意义(P<0.05);而管腔B型(32.6%)的比例和真阳性组(35.8%)无统计学差异(χ^2=0.182,P=0.669)。与真阳性组相比,超声假阴性组的肿瘤组织学分级(χ^2=5.129,P=0.077)、ER表达(χ^2=1.666,P=0.197)、PR表达(χ^2=0.290,P=0.590)、HER2表达(χ^2=3.378,P=0.066)、组织纤维反应(χ^2=5.353,P=0.069)、淋巴细胞浸润(χ^2=2.023,P=0.155)和坏死情况(χ^2=0.468,P=0.494)均无统计学差异;肿瘤大小(P<0.001)、淋巴结转移(χ^2=43.184,P<0.001)、Ki-67表达(χ^2=9.293,P=0.010)、年龄(χ^2=10.334,P=0.006)和血管增生情况(χ^2=5.937,P=0.015)的差异均有统计学意义。假阴性组中肿瘤大小≤2 cm(81.4%,35/43 vs.33.7%,125/371)、无淋巴结转移(97.7%,42/43 vs.44.7%、166/371)、Ki-67表达>70%(18.6%,8/43 vs.5.9%,22/371)、年龄≤45岁(65.1%,28/43 vs.41.2%,153/371)和血管增生数量≤3条的比例(74.4%,32/43 vs.55.0%,204/371)均高于真阳性组。多因素Logistic回归分析显示只有肿瘤大小≤2 cm(OR=6.791,P<0.001)和淋巴结无转移(OR=43.333,P<0.001)是影响超声结果为假阴性的独立危险因素。【结论】管腔A型和基底样型乳腺癌易被超声BI-RADS分级标准低估,且肿瘤大小≤2 cm、淋巴结无转移的患者易出现乳腺超声假阴性,应引起重视。

【Objective】To retrospectively analyze the differences of clinicopathological parameters and molecular bio⁃logical characteristics between ultrasound false negative and true positive breast cancer cases and summarize the clinical characteristics of these cases.【Methods】A total of 414 invasive breast cancer cases in Guangdong Women and Children Hospital between January 1st,2018 and December 31st,2019 were enrolled in this study.According to the BI-RADS classification standard of ultrasound,they were divided into false negative group and true positive group.The differences of onset age,tumor size,tumor histological grade,lymph node metastasis,estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor(HER2),Ki-67,fiber reaction,vascular hyperplasia,lymphocyte infil⁃tration and necrosis between the two groups were compared and analyzed.The differences with statistical significance were analyzed by multivariate logistic regression analysis.【Results】These 414 invasive breast cancer cases were composed of 43 false negative cases and 371 true positive cases.There was no significant difference in histopathological type between the two groups(P=0.250).In the false negative group,the rate of luminal A(32.6%)and basal-like(27.9%)cases was respectively higher than that of the true positive group(17.8%,14.3%),whereas the rate of HER2 overexpression(6.9%)cases was lower than that of the true positive group(32.1%),with statistical significance(P<0.05).The rate of luminal B cases in the false negative group(32.6%)was not significantly different from that in the true positive group(35.8%,χ^2=0.182,P=0.669).Compared with the true positive group,there was no significant difference in tumor his⁃tological grade(χ^2=5.129,P=0.077),ER expression(χ^2=1.666,P=0.197),PR expression(χ^2=0.290,P=0.590),HER2 expression(χ^2=3.378,P=0.066),fiber reaction(χ^2=5.353,P=0.069),lymphocyte infiltration(χ^2=2.023,P=0.155)and necrosis(χ^2=0.468,P=0.494),whereas the differences of the tumor size(P<0.001),lymph node metastasis(χ^2=43.184,P<0.001),Ki-67 expression(χ^2=9.293,P=0.010),age(χ^2=10.334,P=0.006)and vascular hyperplasia(χ^2=5.937,P=0.015)were statistically significant.In the false negative group,the rate of tumor size≤2 cm(81.4%,35/43 vs.33.7%,125/371),no lymph node metastasis(97.7%,42/43 vs.44.7%,166/371),Ki-67 expression>70%(18.6%,8/43 vs.5.9%,22/371),age≤45 years(65.1%,28/43 vs.41.2%,153/371)and vascular hyperplasia number≤3(74.4%,32/43 vs.55.0%,204/371)were higher than that in the true positive group,respectively.Multivariate logistic regression analysis showed that only tumor size≤2 cm(OR=6.791,P<0.001)and no lymph node metastasis(OR=43.333,P<0.001)were independent risk factors for the false negative ultrasound results.【Conclusions】Luminal A and HER2 overexpression breast cancer cases are easier to be underestimated by ultrasound BI-RADS classification.Patients with tumor size≤2 cm and no lymph node metastasis are prone to have false negative breast ultrasound results,which should be regarded with more care.