影响乳腺癌穿刺活检与术后病理分子分型差异的自动乳腺全容积成像特征

Automated breast volume scanner imaging features affecting difference of molecular subtypes between core needle biopsy and surgery in breast cancer

目的:探讨影响乳腺癌粗针穿刺活检与术后病理分子分型差异的自动乳腺全容积成像(ABVS)特征。方法:回顾性分析2014年11月至2020年10月东部战区总医院收治的63例乳腺癌患者,共63个病灶。所有患者行改良根治术前均行粗针穿刺活检及ABVS检查。比较术前粗针穿刺活检与术后标本分子分型存在差异组(有差异组)与二者病理结果一致组(无差异组)ABVS特征的差异,并采用Logistic回归分析手术前后分子分型差异的独立影响因素。结果:手术病理结果显示,Luminal A型15个(23.8%),Luminal B型39个(61.9%),HER-2过表达型6个(9.5%),三阴型3个(4.8%)。其中14个病灶的粗针穿刺活检与术后分子分型之间存在差异。有差异组(n=14)与无差异组(n=49)的肿块最大径、边界、形态、边缘及汇聚征比较,差异具有统计学意义(P均<0.05)。Logistic回归分析结果表明,伴有汇聚征(OR=0.113,95%CI:0.015~0.865)、形态不规则(OR=0.117,95%CI:0.015~0.912)、边界模糊(OR=0.171,95%CI:0.029~0.992)以及边缘有毛刺(OR=12.576,95%CI:1.783~88.717)是粗针穿刺活检与术后分子分型差异的独立影响因素(P均<0.05)。结论:ABVS在一定程度能够指导粗针穿刺活检,减少穿刺活检病理与术后病理分子分型的差异,提高穿刺诊断准确性,为临床医师提供可靠的诊断依据和参考信息。

Objective To explore the characteristics of automatic breast volume scanner(ABVS)imaging that affect the difference of molecular subtypes between core needle biopsy and surgical specimens.Methods A retrospective analysis was performed on 63 breast cancer patients(63 lesions)who underwent core needle biopsy(CNB)and were examined by ABVS before surgery at the Jinling Hospital between November 2014 and October 2020.The differences in the ABVS imaging characteristics between the discrepancy group(molecular subtypes changed before and after surgery)and the consistency group(the pathological results were consistent before and after surgery)were compared.Logistic regression was used to analyze the independent factors affecting the difference in molecular subtypes between before and after surgery.Results According to the surgical pathology,there were 15(23.8%)luminal A,39(61.9%)luminal B,6(9.5%)HER-2,and 3(4.8%)triplenegative subtypes.Among the 63 cases,there were 14 lesions that had different pathological results between CNB and surgical specimens.Significant differences were found between the discrepancy group(n=14)and the consistency group(n=49)in the largest diameter,boundary,morphology,margin,and retraction phenomenon(P<0.05).The results of Logistic regression analysis showed that retraction phenomenon(odds ratio[OR]=0.113,95%confidence interval[CI]:0.015-0.86),indistinct boundary(OR=0.117,95%CI:0.015-0.912),and irregular morphology(OR=0.171,95%CI:0.029-0.992)were independent protective factors for the difference of molecular subtypes between before and after surgery,while spiculated margin(OR=12.576,95%CI:1.783-88.717)was the independent risk factor(P<0.05).Conclusion ABVS can help doctors to perform CNB better,reduce the difference with postoperative molecular typing,improve the accuracy of CNB,and provide reliable diagnostic basis and reference information for clinicians.