数字乳腺三维断层摄影征象与分子分型及组织学分级的关系研究

Study on the relationship between three dimensional mammary gland tomographysigns and molecular classification and histological grade

目的:探讨数字乳腺三维断层摄影(DBT)征象与分子分型及组织学分级的关系。方法:选取2020年02月至2023年02月在我院诊治的乳腺癌女性患者118例,并行DBT检查。比较乳腺癌不同分子分型及组织学分级的DBT征象患者占比,并用受试者工作特征曲线(ROC)分析DBT征象对乳腺癌不同分子分型及组织学分级的诊断价值。结果:118例乳腺癌患者中Luminal A型12例、Luminal B型72例、HER2过表达型15例、三阴型19例。不同病理分型的病灶是否为单纯肿块、肿块有无伴钙化、边缘是否清晰、病灶大小、是否结构扭曲、有无不对称高密度影在乳腺癌分子分型之间比较,差异无统计学意义(P>0.05),不同病理分型之间有无恶性钙化、有无毛刺在乳腺癌中比较,差异有统计学意义(P<0.05)。三阴型单纯肿块占比高于Luminal A、B型及HER2过表达型(P<0.05),其余三种分型之间比较,差异无统计学意义(P>0.05),三阴型结构扭曲占比高于Luminal A型(P<0.05);HER2过表达型有恶性钙化占比高于Luminal A、B型及三阴型(P<0.05),Luminal A、B型及三阴型之间比较,差异无统计学意义(P>0.05),HER2过表达型结构扭曲占比高于Luminal A型(P<0.05);Luminal A、B型有毛刺占比高于HER2过表达型、三阴型(P<0.05),HER2过表达型与三阴型之间比较,差异无统计学意义(P>0.05)。118例乳腺癌患者中Ⅰ级13例、Ⅱ级70例、Ⅲ级35例。Ⅲ级毛刺征、淋巴结阳性、腺体密度≥50%占比高于Ⅰ级、Ⅱ级(P<0.05)。DBT征象中的毛刺、恶性钙化、单纯肿块分别诊断乳腺癌Luminal A、B型、HER2过表达型及三阴型的AUC(95%CI)分别为0.742(0.653~0.818)、0.799(0.715~0.867)、0.815(0.733~0.881)(P<0.05),毛刺征、淋巴结、腺体密度诊断乳腺癌Ⅲ级的AUC(95%CI)分别为0.667(0.575~0.751)、 0.802(0.719~0.870)、0.780(0.694~0.851)(P<0.05)。结论:乳腺癌的分子分型及组织学分级分别与DBT征象中的单纯肿块、恶性钙化、毛刺及毛刺征、淋巴结、腺体密度有关,DBT征象对乳腺癌的分子分型及组织学分级具有较高的诊断价值。

Objective:To investigate the relationship between the signs of digital breast three dimensional tomography(DBT)and molecular classification and histological grade.Methods:118 female patients with breast cancer diagnosed and treated in our hospital from February 2020 to February 2023 were selected for DBT examination.The proportion of patients with DBT signs in different molecular types and histological grades of breast cancer was compared,and the diagnostic value of DBT signs in different molecular classification and histological grades of breast cancer was analyzed by receiver operating characteristic curve ( ROC) . Results: Among the 118 patients with breastcancer, 12 were Luminal A, 72 were Luminal B, 15 were HER2 overexpression, and 19 were triple -negative. There wasno statistical significance in the comparison between different pathological types of breast cancer molecular types as towhether the lesions were simple masses,whether the masses were accompanied by calcification,whether the edgeswere clear, lesion size,whether the structure was distorted, and whether there was unsymmetrical high - density shadow( P > 0. 05) . The difference was statistically significant in the comparison between different pathological types as towhether there were malignant calcification and burrs in breast cancer ( P < 0. 05) . The proportion of simple mass inthree negative types was higher than that in Luminal A,B and HER2 overexpression types ( P < 0. 05) ,while the otherthree types had no statistical significance ( P > 0. 05) ,and the proportion of structural distortion in three negativetypes was higher than that in Luminal A type ( P < 0. 05) . The proportion of malignant calcification in HER2 overexpressiontype was higher than that in Luminal A,B and three negative types ( P < 0. 05) ,while the difference was notstatistically significant between Luminal A,B and three negative types ( P > 0. 05) , and the proportion of structural distortionin HER2 overexpression type was higher than that in Luminal A type ( P < 0. 05) . Luminal A and B had ahigher percentage of burrs than HER2 overexpression type and triple - negative type ( P < 0. 05) ,and there was nostatistical significance between HER2 overexpression type and triple - negative type ( P > 0. 05) . Among the 118 patientswith breast cancer, 13 cases were grade Ⅰ, 70 cases were grade Ⅱ, and 35 cases were grade Ⅲ. The percentagesof burr sign, lymph node positive and gland density ≥50% in grade Ⅲ were higher than those in grade Ⅰ andgrade Ⅱ ( P < 0. 05) . The AUC ( 95%CI) of DBT signs such as burr,malignant calcification and simple mass in diagnosisof Luminal A,B and HER2 overexpression type and triple - negative type were 0. 742 ( 0. 653 ~ 0. 818) ,0. 799 ( 0. 715 ~ 0. 867) and 0. 815 ( 0. 733 ~ 0. 881) , respectively ( P < 0. 05) . The AUC ( 95% CI) of burr sign,lymph node and gland density in the diagnosis of grade Ⅲ breast cancer were 0 . 667 ( 0. 575 ~ 0. 751) ,0. 802( 0. 719 ~ 0. 870) and 0. 780 ( 0. 694 ~ 0. 851) , respectively ( P < 0. 05) . Conclusion: The molecular classificationand histological grade of breast cancer are related to simple mass,malignant calcification,burr and burr sign, lymphnode and gland density in DBT sign, respectively. DBT sign has high diagnostic value in molecular classification andhistological grade of breast cancer.