病理性乳头溢液患者乳腺导管内癌及癌前病变危险因素和影像学特点分析

Analysis of risk factors and imaging characteristics of intraductal carcinoma and precancerous lesions of patients with pathological nipple discharge

目的探讨病理性乳头溢液(PND)患者导管内癌及癌前病变的危险因素及影像学特点。方法回顾性分析吉林大学中日联谊医院乳腺外科2016-06-01-2019-04-30接受手术治疗的PND患者临床病理资料。根据石蜡病理将患者分为导管内良性病变组(导管内乳头状瘤、导管扩张或上皮增生)和导管内癌及癌前病变组(筛状增生、不典型增生、导管原位癌、导管原位癌伴微浸润、导管内实性乳头状癌),收集临床、乳管镜及超声资料进行单因素、多因素Logistic回归及Spearman相关分析。评估PND患者导管内癌及癌前病变的危险因素及影像学特点。结果共纳入300例PND患者,包含355侧病变乳房,其中导管内良性病变患者211例(70.3%,病变乳房259侧),导管内癌及癌前病变患者89例(29.7%,病变乳房96侧)。单因素分析发现,年龄(χ^(2)=14.411,P=0.001)、身体质量指数(χ^(2)=8.045,P=0.018)、高血压病史(χ^(2)=4.514,P=0.034)和绝经状态(χ^(2)=5.627,P=0.018)在两组间具有统计学意义。多因素Logistic回归分析显示,年龄35~<50岁(OR=2.646,95%CI为1.092~6.415,P=0.031)、≥50岁(OR=4.359,95%CI为1.403~13.543,P=0.011)为导管内癌及癌前病变的独立危险因素。乳管镜及超声影像特征分析发现,溢液性质(χ^(2)=10.876,P=0.001)、乳管镜下肿物表面充血(χ^(2)=11.304,P=0.001)、肿物大小(χ^(2)=6.544,P=0.038)、形状(χ^(2)=15.974,P<0.001)、边界(χ^(2)=19.597,P<0.001)和乳腺影像报告和数据系统(BI-RADS)分级(χ^(2)=14.009,P<0.001)与PND患者是否发生导管内癌及癌前病变有统计学意义的关联,且导管内癌及癌前病变与血性溢液(rs=0.175,P=0.001)、乳管镜下肿物表面充血(rs=0.208,P<0.001)、病变形状(rs=0.249,P<0.001)、边界(rs=0.276,P<0.001)、BI-RADS分级(rs=0.199,P<0.001)存在低度正相关。结论对于年龄≥35岁,伴有血性溢液、乳管镜下肿物表面充血、超声提示病变形状不规则、边界不清、BI-RADS分级≥4类的PND患者,应警惕导管内癌及癌前病变的可能。

Objective To explore the risk factors and imaging characteristics of intraductal carcinoma and precancerous lesions in patients with pathological nipple discharge(PND).Methods This study retrospectively analyzed clinicopathologic data of patients with PND who received surgical treatment in the Department of Breast Surgery at China-Japan Union Hospital of Jilin University from June 1,2016to April 30,2019.Patients were divided into a group of benign intraductal lesions(including intraductal papilloma,ductal dilatation or epithelial hyperplasia),and a group of intraductal carcinoma and precancerous lesions(including cribriform hyperplasia,atypical ductal hyperplasia,ductal carcinoma in situ,ductal carcinoma in situ with microinvasion,and solid papillary carcinoma).Clinicopathological,ductoscopic and ultrasound data were collected,and the risk factors and imaging characteristics of intraductal carcinoma and precancerous lesions in patients with PND were analyzed by univariate analysis,multivariate Logistic regression analysis and Spearman correlation.Results A total of 300patients with PND were collected(including 355diseased breasts),which consisted of 211intraductal benign cases (70.3%,containing 259diseased breasts)and 89intraductal carcinoma and precancerous lesions(29.7%,containing 96diseased breasts).Univariate analysis showed statistically significant differences in age(χ^(2)=14.411,P=0.001),BMI(χ^(2)=8.045,P=0.018),history of hypertension(χ^(2)=4.514,P=0.034),and menopausal status(χ^(2)=5.627,P=0.018)between the two groups.Results of multivariate logistic regression analysis showed that age of 35-<50years(OR=2.646,95%CI:1.092-6.415,P=0.031),age≥50years (OR=4.359,95%CI:1.403-13.543,P=0.011)were independent risk factors for intraductal carcinoma and precancerous lesions in patients with PND.According to the analysis of ductoscopic and ultrasonic data,the property of discharge(χ^(2)=10.876,P=0.001),tumor with hyperemic surface(χ^(2)=11.304,P=0.001),size(χ^(2)=6.544,P=0.038),shape(χ^(2)=15.974,P<0.001),boundary(χ^(2)=19.597,P<0.001)and BI-RADS grade(χ^(2)=14.009,P<0.001)of the tumor showed statistically significant differences between the two groups,and there were low positive correlations between intraductal carcinoma or precancerous lesions and hemorrhagic discharge(rs=0.175,P=0.001),tumor with hyperemic surface(rs=0.208,P<0.001),shape(rs=0.249,P<0.001),boundary(rs=0.276,P<0.001)and BI-RADS grade(rs=0.199,P<0.001)of the tumor.Conclusion For patients who aged≥35,accompanying with hemorrhagic nipple discharge,tumor with hyperemic surface,unclear tumor boundary,irregular shape and BI-RADS≥4,clinicians should be overly concerned about the possibility of the intraductal carcinoma and precancerous lesions,and treat properly.