术前穿刺病理联合MRI特征对浸润性乳腺癌保乳术中切缘阳性的预测价值

Prognostic Value of Preoperative Puncture Pathology Combined with MRI Features for Positive Incisal Margin During Breast Conserving Surgery for Invasive Breast Cancer

目的研究浸润性乳腺癌术前穿刺病理联合MRI特征对保乳术中切缘阳性的预测价值。方法回顾性分析本院2020年8月至2023年8月期间经病理证实为浸润性乳腺癌并行保乳手术患者的临床资料及病理信息。根据术中病理切缘情况分为切缘阳性组及切缘阴性组,分析每个病例的术前MRI图像,包括乳腺纤维腺体类型,同侧和对侧背景实质强化类型,病灶类型,病灶最长径,MIP病灶周围血管征象等MRI特征以及基本的临床病理特征。通过单因素比较两组间各种MRI特征和基本临床病理特征的差异,再将单因素分析有统计学意义的MRI特征与临床病理特征进行多因素Logistic回归分析,采用受试者操作特征(ROC)曲线评价回归模型对保乳术中切缘阳性的预测价值。结果本组研究最终纳入177例患者,其中切缘阳性组(27例),切缘阴性组(150例)。单因素分析结果显示:MRI特征中,病灶类型(χ^(2)=47.817,P<0.001)、病灶周围血管征象(χ^(2)=30.286,P<0.001),基本病理特征中术前穿刺病理浸润性癌伴导管原位癌(DCIS)(χ^(2)=3.865,P=0.049)及HER-2阳性表达(χ^(2)=4.096,P=0.043),是保乳术中切缘阳性的预测因素。多因素回归分析结果显示,对浸润性乳腺癌保乳术中切缘阳性预测最有价值的特征是:肿块型病灶周围存在其他病灶(OR=14.17(1.03-195.29),P=0.048)、非肿块型(OR=28.45(6.16-131.39),P<0.001)、MIP仅患侧多发点状征象(OR=27.13(3.66-201.14),P=0.001)、术前穿刺病理伴DCIS(OR=11.02(2.16-56.26),P=0.004);回归模型对预测切缘阳性的ROC曲线下面积为0.932(95%CI:0.883-0.982)。根据Logistic回归模型回归系数构建风险评分表,总分为8分,结果显示:当得分≥5分时浸润性乳腺癌保乳手术切缘阳性风险较高,得分<5分时保乳手术切缘阳性风险较低。结论MRI影像特征包括肿块型病灶周围存在其他病灶、非肿块型、MIP仅患侧多发点状血管征象,病理特征如术前穿刺病理伴DCIS,均与保乳手术切缘阳性密切相关。通过对危险因素进行赋值的方法,构建得到浸润性乳腺癌保乳手术切缘阳性风险评分表,可为临床手术提供更有价值的信息。浸润性乳腺癌术前穿刺病理联合MRI特征能提高对保乳术中切缘阳性评估的预测价值。

Objective To study the value of preoperative puncture pathology combined with MRI in predicting positive incisal margin of invasive breast cancer.Methods The clinical data and pathological information of patients with pathologically proven invasive breast cancer and breast conserving surgery in our hospital from August 2020 to August 2023 were retrospectively analyzed.Preoperative MRI images of each case were analyzed,including the types of breast fibroglandular glands,ipsilateral and contralateral background parenchymal enhancement,lesion type,lesion longest diameter,MIP lesion peripheral vascular signs and other MRI features as well as basic clinicopathological features.The difference of various MRI features and basic clinicopathological features between the two groups was compared by single factor analysis,and the MRI features and clinicopathological features with statistical significance were analyzed by multivariate Logistic regression analysis.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of regression model for positive incisal margin during breast preservation surgery.Results 177 patients were included in this study,including 27 patients in the positive margin group and 150 patients in the negative margin group.The results of single factor analysis showed that:MRI features included lesion type(χ^(2)=47.817,P<0.001),vascular signs around the lesion(χ^(2)=30.286,P<0.001),and basic pathological features including preoperative puncture pathological invasive carcinoma with ductal carcinoma in situ(DCIS)(χ^(2)=3.865,P=0.049)and positive expression of HER-2(χ^(2)=4.096,P=0.043)were predictive factors of positive margin during lactation.Multivariate regression analysis showed that the most valuable features for positive prediction of incisal margin during breast conserving surgery for invasive breast cancer were:There were other lesions surrounding the tumor type(OR=14.17(1.03-195.29),P=0.048)and non-tumor type(OR=28.45(6.16-131.39).P<0.001),MIP only on the affected side of multiple spot signs(OR=27.13(3.66-201.14),P=0.001),preoperative puncture pathology with DCIS(OR=11.02(2.16-56.26),P=0.004);The area under the ROC curve of the regression model for predicting positive incisal margins was 0.932(95%CI:0.883-0.982).According to the regression coefficient of Logistic regression model,a risk rating table was constructed with a total score of 8 points.The results showed that when the score was≥5,the risk of positive margin of invasive breast cancer surgery was higher,and when the score was<5,the risk of positive margin of breast cancer surgery was lower.Conclusion MRI imaging features include other lesions around the tumor lesion,non-tumor lesion,multiple punctural vascular signs only on the affected side of MIP,and pathological features such as preoperative puncture pathology with DCIS,all of which are closely related to the positive incision margin of breast preservation surgery.By assigning risk factors,a positive risk rating table was constructed for invasive breast cancer surgery,which can provide more valuable information for clinical surgery.Preoperative puncture pathology combined with MRI features can improve the predictive value of positive assessment of incisal margin during breast conserving surgery.