乳腺导管内癌伴微浸润的病理、超声特征及其影响因素分析

Pathological and ultrasound features of breast intraductal carcinoma with microinvasion and factors associated with microinvasion

背景微浸润是乳腺导管内癌过渡为浸润性导管内癌的中间阶段,此阶段及其之前的诊治对改善患者预后具有重要意义,但目前关于乳腺导管内癌伴微浸润发生的影响因素缺乏大样本研究。目的研究乳腺导管内癌伴微浸润的病理、超声特征及其诊断影响因素。方法回顾性收集2018年7月-2021年7月中国中医科学院西苑医院收治的149例乳腺导管内癌患者临床资料,根据患者是否发生微浸润分为微浸润组(87例)和非微浸润组(62例),分析其病理、超声特征,采用多因素logistic回归分析乳腺导管内癌伴微浸润的相关影响因素,采用ROC分析探讨部分指标对乳腺导管内癌伴微浸润的诊断价值。结果单因素分析结果显示,微浸润组与非微浸润组触及肿块、绝经、组织学分级、形态、边缘、回声、导管改变、血流分级、明显钙化患者占比以及雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人表皮生长因子受体2(human epidermal growth factor receptor-2,HER-2)、细胞增殖核抗原(Ki-67)表达情况的差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,组织学分级为高/中级、ER阴性、PR阴性、HER-2高表达、Ki-67高表达、边缘不光整、回声低、血流分级2/3级、明显钙化均为乳腺导管内癌伴微浸润的独立危险因素(P<0.05)。ROC分析显示,ER、PR、HER-2、Ki-67表达这4个指标对乳腺导管内癌伴微浸润做联合诊断时,AUC(95%CI)、敏感度(n/N)、特异性(n/N)、准确度(n/N)分别为87.3%(79.1%~93.1%)、0.862(75/87)、0.839(52/62)、0.852(127/149),有较好的诊断价值。结论乳腺导管内癌伴微浸润的发生与组织学分级、边缘光整情况、回声情况、血流分级、钙化情况以及ER、PR、HER-2、Ki-67表达情况有关。

Background Microinvasion is the intermediate stage in the transition of breast intraductal carcinoma into invasive intraductal carcinoma,and the diagnosis and treatment of such patients before and during the stage is of great significance to improve the prognosis of patients,but at present,there is still a lack of large-sample studies on the influencing factors for breast intraductal carcinoma with microinvasion.Objective To investigate the pathological and ultrasound features of breast intraductal carcinoma with microinvasion and the influencing factors for diagnosis.Methods A retrospective analysis was performed for the clinical data about 149 patients with breast intraductal carcinoma who were admitted to Xiyuan Hospital from July 2018 to July 2021,and according to the presence or absence of microinvasion,the patients were divided into microinvasion group(n=87)and non-microinvasion group(n=62).Their pathological and ultrasound features were analyzed.Multivariate logistic regression analysis was used to identify the influencing factors for breast intraductal carcinoma with microinvasion,and receiver operating characteristic(ROC)curve analysis was used to investigate the value of several indicators in the diagnosis of breast intraductal carcinoma with microinvasion.Results Univariate analysis showed that there were significant differences between the microinvasion group and the non-microinvasion group in the proportion of patients with palpable mass or menopause,histological grade,the presence of estrogen receptor(ER)and progesterone receptor(PR),the expression of human epidermal growth factor receptor 2(HER-2)and Ki67,morphology,tumor boundary,echo,ductal changes,blood flow grade,and marked calcification(all P<0.05).Multivariate logistic regression analysis showed that high/intermediate histological grade,negative ER,negative PR,high HER-2 expression,high Ki67 expression,unclear tumor boundary,low echo,grade 2/3 blood flow,and marked calcification were independent risk factors for breast intraductal carcinoma with microinvasion(all P<0.05).ROC curve analysis showed that ER,PR,HER-2,and Ki67 showed good values in the diagnosis of breast intraductal carcinoma with microinvasion,with an area under the ROC curve of 87.3%(95%CI,79.1%-93.1%),a sensitivity of 0.862(75/87),a specificity of 0.839(52/62),and an accuracy of 0.852(127/149).Conclusion The development of breast intraductal carcinoma with microinvasion is associated with the histological grade of patients,tumor edge,echo,blood flow grade,calcification and the expression of ER,PR,HER-2,Ki67.