超声征象联合病理和生物学指标对乳腺浸润性导管癌脉管浸润的评估

Evaluation of ultrasound signs combined with pathological and biological indexes for vascular infiltration of breast invasive ductal carcinoma

目的探讨乳腺浸润性导管癌的超声征象、临床病理及生物学指标与乳腺浸润性导管癌脉管浸润的关系。方法回顾性选取2017年1月至2021年4月广东省第二中医院乳腺科收治的108例乳腺浸润性导管癌患者作为研究对象,按照术后病理结果,分为有脉管浸润组(63例)和无脉管浸润组(45例),分析肿块的超声声像图特征、临床病理及生物学指标与乳腺浸润性导管癌脉管浸润的关系,并分析超声腋窝异常淋巴结四个特征的诊断效能。结果超声声像图特征单因素分析结果显示,乳腺浸润性导管癌脉管浸润组更多表现为肿块形态不规则、非平行生长、内部有微钙化、后方回声衰减及有腋窝异常淋巴结,差异有统计学意义(P<0.05),进一步行logistic回归多因素分析,结果显示肿块形态不规则(β=1.706,OR=5.505,95%CI=1.006~30.142)和超声腋窝异常淋巴结(β=2.460,OR=11.704,95%CI=4.045~33.865)为乳腺浸润性导管癌脉管浸润的独立危险因素(P<0.05);临床病理和生物学指标单因素分析结果显示,乳腺浸润性导管癌脉管浸润组更多是增殖细胞核抗原-67(Ki-67)≥20%和TNM 3期,差异有统计学意义(P<0.05)。超声腋窝异常淋巴结四个特征之间及与联合诊断之间的ROC曲线下面积两两比较,差异均无统计学意义(P>0.05)。结论肿块形态不规则和腋窝异常淋巴结的超声表现是乳腺浸润性导管癌脉管浸润的独立危险因素,结合临床病理及生物学指标,对判断乳腺浸润性导管癌脉管浸润有意义,为乳腺癌的预后评估和辅助治疗提供有用的依据。

Objective To investigate the relationship between ultrasonic features,clinicopathological and biological indicators and lymphovascular invasion of invasive ductal breast carcinoma.Methods A total of 108 patients with invasive ductal breast carcinoma treated in the Department of Breast of Guangdong Second Traditional Chinese Medicine Hospital from January 2017 to April 2021 were selected retrospectively as the study subjects.They were divided into group with lymphovascular invasion(63 cases)and group without lymphovascular invasion(45 cases)according to the postoperative pathological results.The relationship between ultrasonic features,clinicopathological and biological indicators of invasive ductal breast carcinoma and lymphovascular invasion of invasive ductal breast carcinoma were analyzed.The value of four ultrasonic features of abnormal axillary lymph nodes in diagnosis of lymphovascular invasion in invasive ductal breast carcinom was also assessed.Results Univariate analysis of ultrasonic features showed that invasive ductal breast carcinomas showed more irregular shape,non-parallel orientation,internal microcalcification,posterior echo attenuation and abnormal axillary lymph nodes in the lymphovascular invasion group,with statistically significant differences(P<0.05).Multivariate logistic regression analysis showed that irregular morphology(β=2.093,OR=8.106,95%CI=1.634-40.207)and abnormal axillary lymph nodes(β=2.509,OR=12.287,95%CI=4.464-33.822)were independent risk factors for lymphovascular invasion in invasive ductal breast carcinoma respectively(P<0.05).Univariate analysis of clinicopathological and biological indicators showed that more proliferating cell nuclear antigen-67(Ki-67)≥20%and TNM stage 3 were found in the lymphovascular invasion group of invasive ductal breast carcinoma,with statistically significant differences(P<0.05).There were no statistically significant differences in the area under the ROC between the four features of ultrasonographic abnormal axillary lymph nodes and their combined diagnosis(P>0.05).Conclusion Irregular morphology of mass and abnormal axillary lymph nodes are independent risk factors for lymphovascular invasion in invasive ductal breast carcinoma respectively.Combined with clinicopathological and biological indicators,it is meaningful to assess lymphovascular invasion of invasive ductal breast carcinoma,and provides a useful basis for prognostic assessment and adjuvant treatment of breast cancer.