不同分子分型乳腺癌的超声、MRI及乳腺X射线摄影特征的诊断价值

Diagnostic value of ultrasonography,MRI and mammography features of breast cancer with different molecular types

目的探讨超声、MRI及乳腺X射线摄影对不同分子分型乳腺癌的诊断价值。方法回顾性分析2018年1月至2022年4月在惠州市中心人民医院就诊的212例女性乳腺癌患者的临床资料和影像资料,年龄(47.6±9.3)岁。根据其组织病理学和免疫组织化学检查结果分为4组:Luminal A型31例,年龄(49.2±10.8)岁;Luminal B型104例,年龄(46.1±8.9)岁;人表皮生长因子受体2(HER-2)过表达型45例,年龄(49.6±10.1)岁;三阴性乳腺癌(TNBC)32例,年龄(48.5±8.5)岁。分析患者的临床特征、超声、MRI及乳腺X射线摄影的影像特征。计量资料的组间比较采用两独立样本t检验;计数资料的组间比较采用χ^(2)检验或Fisher确切概率法;具有统计学意义的特征进一步采用有序Logistic回归分析及曲线下面积(AUC)对诊断效能的准确性进行评估。结果在临床特征中,不同分子分型乳腺癌患者的绝经情况、淋巴结转移情况差异均有统计学意义(χ^(2)=10.345、10.026,P=0.016、0.018)。超声检查结果显示,Luminal A型乳腺癌肿瘤边缘多表现为模糊,Luminal B型和HER-2过表达型乳腺癌肿瘤边缘多表现为成角或毛刺,TNBC肿瘤边缘多为分叶状;四者肿瘤内部回声多为不均匀回声,更多见于Luminal B型;Luminal A型和TNBC肿瘤内血流Alder分级多为0或Ⅰ级血流信号,Luminal B型和HER-2过表达型乳腺癌肿瘤内血流Alder分级多为Ⅱ或Ⅲ级,差异均有统计学意义(χ^(2)=33.542、12.283、10.699,均P<0.05)。MRI检查结果显示,Luminal A型、Luminal B型及HER-2过表达型乳腺癌肿瘤强化特征以不均匀强化为主,TNBC肿瘤环形强化的占比高于其他三者,差异有统计学意义(χ^(2)=30.142,P<0.001)。乳腺X射线摄影检查结果显示,Luminal B型及HER-2过表达型乳腺癌肿瘤内多伴有钙化,Luminal A型及TNBC肿瘤内多无钙化;Luminal A型与Luminal B型乳腺癌肿瘤内钙化形态以点状钙化为主,HER-2过表达型及TNBC肿瘤内钙化形态以多形性或线样为主,差异均有统计学意义(χ^(2)=9.627、11.792,均P<0.05)。乳腺癌患者绝经情况与肿瘤边缘可作为乳腺癌分子分型的独立预测因子(B=0.729、0.775,OR=7.053、23.696,95%CI:0.193~1.267、0.463~1.087,均P<0.05),AUC为0.635(95%CI:0.528~0.742)。结论不同分子分型乳腺癌的超声、MRI及乳腺X射线摄影特征存在差异,均对其具有一定的诊断价值。

Objective To explore the diagnostic value of ultrasound,MRI,and mammography in different molecular subtypes of breast cancer.Methods A cohort of 212 female patients,aged(47.6±9.3)years old and with confirmed breast cancer,from Huizhou Municipal Central Hospital from January 2018,to April 2022,was retrospectively analyzed.In accordance with the results of pathology and immunohistochemistry,the patients were grouped into four groups:31 cases of Luminal A,aged(49.2±10.8)years;104 cases of Luminal B,aged(46.1±8.9)years;45 cases of human epidermal growth factor receptor-2(HER-2)overexpression,aged(49.6±10.1)years;and 32 cases of triple-negative breast cancer(TNBC),aged(48.5±8.5)years.The clinical characteristics of the patients and the imaging features of ultrasound,MRI,and mammography were analyzed.Intergroup comparisons of metric data conforming to normal distribution were performed using independent sample t-test(equal variance).Intergroup comparisons of count data were performed using chi-square test or Fisher’s exact probability method.Statistically significant features were evaluated for accuracy of the diagnostic efficacy by using ordered logistic regression analysis and area under the curve(AUC).Results Among the clinical features,the differences in menopausal status and lymph node metastasis among patients with breast cancer of different molecular subtypes were statistically significant(χ^(2)=10.345,10.026;P=0.016,0.018).The results of ultrasonography showed that the margins of Luminal A breast cancer tumor were mostly blurred,the margins of Luminal B and HER-2 overexpression breast cancer tumors were mostly angular or hairy,and the margins of TNBC tumor were mostly lobulated.Moreover,the internal echoes in the tumors of the four subtypes were mostly heterogeneous echogenicity,which was more commonly seen in Luminal B.The blood flow Alder grade was mostly grade 0 orⅠwithin Luminal A and TNBC,whereas the blood flow Alder grade within Luminal B and HER-2 overexpression breast cancer was mostly gradeⅡorⅢ.The differences were statistically significant(χ^(2)=33.542,12.283,10.699;all P<0.05).The results of MRI showed that the tumor enhancement characteristics of Luminal A,Luminal B,and HER-2 overexpression breast cancer were mainly inhomogeneous enhancement,and the proportion of ring enhancement in TNBC tumors was higher than those in the other three,with a statistically significant difference(χ^(2)=30.142,P<0.001).The results of mammography showed that calcification was mostly present in Luminal B and HER-2 overexpression breast cancer tumors,whereas no calcification was found in Luminal A and TNBC tumors.The calcification pattern in Luminal A and Luminal B breast cancer tumors was mainly punctate calcification,whereas that in HER-2 overexpression and TNBC tumors was mainly polypoidal or linear.The differences were all statistically significant(χ^(2)=9.627,11.792;both P<0.05).The patients'menopausal status and the tumor margins of breast cancer could be used as independent predictors of the molecular subtypes of breast cancer(B=0.729,0.775;OR=7.053,23.696;95%CI:0.193~1.267,0.463~1.087;both P<0.05),with an AUC of 0.635(95%CI:0.528~0.742).Conclusion Differences were observed in the characteristics of ultrasound,MRI,and mammography in different molecular subtypes of breast cancer,indicating their certain diagnostic value.