乳腺X线特征在不同Luminal型乳腺癌诊断中的价值

Diagnostic Value of Breast X-ray Features in Different Luminal Typing of Breast Cancer

目的探讨乳腺X线特征与不同Luminal型乳腺癌的相关性。方法回顾性分析371例Luminal型乳腺癌的临床病理及乳腺X线特征,根据Luminal型乳腺癌的分型标准,将患者分成Luminal A型和Luminal B型两组。分析两组患者中的临床病理、乳腺X线特征的差异,用二元logistic回归分析Luminal B型乳腺癌的独立影响因素,用受试者工作特征曲线的曲线下面积(AUC)评价其诊断效能。结果371例乳腺癌患者中73例(19.7%)Luminal A型,298例(80.3%)Luminal B型;病理SBR分级高、合并脉管侵犯者多出现在Luminal B型乳腺癌中(P<0.05)。征象类别、腋窝淋巴结肿大在不同Luminal型乳腺癌中的差异有统计学意义(P<0.001);肿块、钙化及肿块合并钙化的病灶多出现在Luminal B型乳腺中(P=0.028、0.034、0.007),结构扭曲的病灶多出现在Luminal A型乳腺癌中(P=0.005)。logistic回归表明病理SBR 2级、SBR 3级、伴钙化及腋窝淋巴结肿大是Luminal B型乳腺癌的独立影响因素(OR=3.912、31.687、2.498、4.210),而结构扭曲征象则是Luminal B型乳腺癌的保护因素(OR=0.155);临床病理特征、乳腺X线征象及两者联合预测Luminal B型乳腺癌的AUC为0.661、0.691和0.758。结论不同Luminal型乳腺癌与乳腺癌的临床病理、X线特征有一定的相关性,有助于Luminal型乳腺癌的分型诊断。

Objective To investigate the correlation of breast X-ray features with different Luminal typing in breast cancer.Methods The data of clinicopathology and mammographic characteristics of 371 cases of Luminal breast cancer patients were retrospectively analyzed,according to the classification criteria of Luminal breast cancer,the patients were divided into Luminal A group and Luminal B group.The differences in clinicopathology and mammographic findings between the two groups were analyzed,and the independent factors of Luminal B breast cancer were analyzed by logistic regression,and diagnostic efficiency was evaluated by area under the curve(AUC)for the receiver operating characteristic curve.Results Among 371 Luminal breast cancer patients,73(19.7%)patients were Luminal A type and 298(80.3%)patients showed Luminal B type,and patients with high pathological grade and vascular invasion were more likely to be the Luminal B typing breast cancer(P<0.05).There were statistical differences in the types of signs and axillary lymph node enlargement in different Luminal typing breast cancers(P<0.001).Lesions presenting as mass,calcifications,or mass complicated with calcifications were more likely to be Luminal B typing breast cancer(P=0.028,0.034 and 0.007,respectively),while lesions with structural distortion were more likely to be Luminal A typing breast cancer(P=0.005).Logistic regression results showed that pathological SBR grade 2,SBR grade 3,with calcifications and axillary lymph node enlargement on mammograms were independent influencing factors for Luminal B typing breast cancer(OR=3.912,31.687,2.498 and 4.210,respectively),while structural distortion sign was a protective factor for Luminal B typing breast cancer(OR=0.155).The AUC values of clinicopathologic characteristics,breast X-ray features findings and the combined two methods in typing diagnosis of Luminal B breast cancer were 0.661,0.691 and 0.758,respectively.Conclusion The clinicopathologic characteristics and breast X-ray features are related to different Luminal types of breast cancer,which is helpful for the typing diagnosis of Luminal breast cancer.