不同分子分型乳腺癌肝转移癌灶多层螺旋CT特征比较

Comparison of multi-slice spiral CT features of liver metastases from breast cancer with different molecular types

目的 对比分析不同分子分型乳腺癌肝转移癌灶在多层螺旋CT(MSCT)下的特征,了解MSCT在区分不同分子分型乳腺癌肝转移中的效果。方法 回顾分析本院医院2018年12月至2023年8月乳腺癌肝转移患者资料,均行MSCT扫描,根据分子分型不同分为血管上皮A型组(A组)、血管上皮B型组(B组)、HER-2过表达组(C组)、Basal型组(D组)。对比4组转移灶平均数目、单发与多发占比、肝叶分布情况以及转移灶长径、形态、边界和强化程度、密度。结果 病灶数目比较:A组最低,其次为B组、C组,D组最多(P<0.05);单发与多发:4组患者均以多发为主,多发占比高于单发(P<0.05),4组多发占比比较差异无统计学意义(P>0.05);肝叶分布:4组患者均以全肝发病为主,与其他3组比较,D组右叶发病占比更高(P<0.05)。大小:4组均以长径≤2 cm的小转移灶为主,占比高于长径≥2 cm病灶(P<0.05),4组病灶大小比较,差异无统计学意义(P>0.05)。形态:4组均以圆形或类圆形病灶为主,占比高于不规则病灶(P<0.05),4组病灶形态比较,差异无统计学意义(P>0.05)。边界:A组、C组边界清晰和模糊的病灶占比相当,2组间比较,差异无统计学意义(P>0.05);B组边界模糊病灶占比高于清晰病灶(P<0.05);D组边界清晰病灶占比高于模糊病灶(P<0.05);B组与D组比较,B组、D组与A组和C组比较,均差异有统计学意义(P<0.05)。强化特征:4组均以结节样强化为主,其占比高于环状强化和不典型强化(P<0.05)。密度分布:A组、D组均以低密度为主,低密度占比高于等密度、高密度和囊变占比(P<0.05);B组和C组以低密度、等密度为主,低密度与等密度占比比较,差异无统计学意义(P>0.05);A组和D组低密度占比高于B组和C组,等密度占比低于B组和C组(P<0.05)。结论 通过MSCT观察不同分子分型乳腺癌肝转移病灶,能明确4种分型共同特点和区别,尤其在不同分型的肝叶分布、边界、密度上进行区分,为临床鉴别和精准治疗提供一定指导。

Objective To compare and analyze the characteristics of different molecular types of breast cancer liver metastases by multi-slice spiral CT(MSCT),and to understand the effect of MSCT in distinguishing different molecular types of breast cancer liver metastases.Methods A retrospective analysis of the data of patients with breast cancer liver metastases from December 2018 to August 2023 in the hospital was performed.MSCT scans were performed.According to different molecular types,they were divided into group A,group B,group C,and group D.The average number of metastases in the 4 groups,the proportion of single and multiple,the distribution of liver lobes,and the length,morphology,border,degree of enhancement,and density of metastases were compared.Results Comparison of the number of lesions:group A had the lowest number,followed by group B and group C,and group D had the highest number(P<0.05).Single and multiple:the majority of patients in the four groups were multiple,with a higher proportion of multiple cases than single cases(P<0.05).The proportion of multiple cases in the four groups was compared and there was no significant difference(P>0.05).Liver lobe distribution:all four groups of patients were mainly affected by whole liver disease.Compared with the other three groups,the proportion of right lobe disease in group D was higher(P<0.05).Size:the four groups were mainly composed of small metastases with a length diameter of≤2 cm,with a higher proportion than lesions with a length diameter of≥2 cm(P<0.05).The size of lesions in the four groups was compared and there was no significant difference(P>0.05).Morphology:The four groups were mainly composed of circular or quasi-circular lesions,with a higher proportion than irregular lesions(P<0.05).The morphology of the lesions in the four groups was compared(P>0.05).Boundary:The proportion of lesions with clear and blurred boundaries in group A and group C was equivalent,and the comparison between the two groups was significant(P>0.05).The proportion of blurred boundary lesions in group B was higher than that of clear lesions(P<0.05).The proportion of well-defined lesions in group D was higher than that of blurred lesions(P<0.05).The comparison between group B and group D,as well as between group B and group D and group A and group C,was significantly different(P<0.05).Enhanced features:The four groups were mainly characterized by nodular enhancement,with a higher proportion than circular enhancement and atypical enhancement(P<0.05).Density distribution:groups A and D are mainly low-density,with a higher proportion of low-density compared to isodensity,high-density,and cystic transformation(P<0.05).The B and C groups were mainly low-density and isodensity,and there was no statistically significant difference in the proportion of low-density and isodensity(P>0.05).The proportion of low-density in group A and group D was higher than that in group B and group C,while the proportion of isodensity was lower than that in group B and group C(P<0.05).Conclusion Observation of liver metastases from different molecular types of breast cancer by MSCT can clarify the common characteristics and differences of the four types,especially in the distribution,boundary,and density of liver lobes of different types,which can provide a certain degree for clinical identification and precise treatment.guide.