乳腺X线摄影背景实质强化水平与乳腺癌不同分子分型及临床因素的相关性分析

Correlation analysis between background parenchymal enhancement level in mammography and different molecular types and clinical factors of breast cancer

目的:探讨对比增强能谱乳腺X线摄影(CESM)检查背景实质强化(background parenchymal enhancement,BPE)水平与乳腺癌不同分子分型间及常见预后相关标志物的相关性。方法:回顾性分析2019年06月至2022年10月我院经术后病理及免疫组化确诊的乳腺癌61例,术前均行CESM检查。将健侧乳腺CESM低能图BPE强化的范围分为四类:极少、轻度、中度、重度,统计分析分为两组:BPE极少和轻度为低BPE组,BPE中度和重度为高BPE组。BPE强化的强度分为对称和非对称。采用Spearman相关性检验分析BPE强化的范围和强度与患者临床特征(年龄、初潮年龄、绝经状态)的相关性;采用单因素方差分析比较BPE强化的范围和强度与淋巴结转移、乳腺癌家族史、纤维腺体含量、TNM期、免疫组化标记物、分子分型间的差异。结果:61例乳腺癌患者中,病理分型:浸润性乳腺癌为47例(77.05%),导管原位癌为10例(16.39%),乳头状恶性肿瘤为2例(3.28%),小叶原位癌为2例(3.28%)。分子分型:Luminal A型15例(24.59%),Luminal B型27例(44.26%),Her-2过表达型12例(19.67%),TNBC 7例(11.48%)。BPE强度的范围:低BPE组34例(55.74%)、高BPE组27例(44.26%)。临床特征分析:BPE强度的范围与患者年龄、绝经状态呈负相关(r=-0.378、-0.353,P=0.003、0.005),卡方检验显示BPE强化的范围与患者年龄、绝经状态差异均具有统计学意义(χ^(2)=9.669、7.592,P=0.008、0.006)。BPE强化的范围和强度与初潮年龄间不存在相关性(P>0.05),BPE强化的范围和强度与淋巴结转移、乳腺癌家族史、组织学分类、TNM期、免疫组化标记物、分子分型间差异无统计学意义(P均>0.05)。结论:CESM检查中,BPE强化的范围与患者年龄、绝经与否具有相关性,BPE水平与乳腺癌分子分型间差异无统计学意义。

Objective:To explore the correlation between background parenchymal enhancement(BPE) level in contrast-enhanced energy spectrum mammography(CESM) examination and different molecular types of breast cancer and common prognostic markers.Methods:A retrospective analysis was performed on 61 cases of breast cancer diagnosed by postoperative pathology and immunohistochemistry in our hospital from June 2019 to October 2022.CESM examination was performed before surgery.The scope of BPE enhancement on CESM low-energy map of healthy breast was divided into four categories:minimal,mild,moderate,and severe.Statistical analysis was divided into two groups:low BPE group with minimal and mild BPE,and high BPE group with moderate and severe BPE.The strength of BPE strengthening can be divided into symmetric and asymmetric.Spearman correlation test was used to analyze the correlation between the scope and intensity of BPE enhancement and clinical characteristics(age,age of menarche,menopausal status).Univariate ANOVA was used to compare the extent and intensity of BPE enhancement with lymph node metastasis,family history of breast cancer,fibroglandular content,TNM stage,immunohistochemical markers,and molecular typing.Results:Among the 61 patients with breast cancer,the pathological types were as follows:invasive breast cancer in 47 cases(77.05%),ductal carcinoma in situ in 10 cases(16.39%),papillary malignant tumor in 2 cases(3.28%),lobular carcinoma in situ in 2 cases(3.28%).Molecular types:Luminal A type 15 cases(24.59%),Luminal B type 27 cases(44.26%),Her-2 overexpression type 12 cases(19.67%),TNBC type 7 cases(11.48%).The range of BPE intensity was 34 cases(55.74%) in low BPE group and 27 cases(44.26%) in high BPE group.Analysis of clinical characteristics:The range of BPE intensity was negatively correlated with the age and menopausal status of the patients(r=-0.378,-0.353,P=0.003,0.005).Chi-square test showed that the range of BPE intensity was significantly different from the age and menopausal status of the patients(χ^(2)=9.669,7.592,P=0.008,0.006).There was no correlation between the extent and intensity of BPE enhancement and the age of menarche(P>0.05).There was no significant difference between the extent and intensity of BPE enhancement and lymph node metastasis,family history of breast cancer,histological classification,TNM stage,immunohistochemical markers and molecular typing(all P>0.05).Conclusion:In CESM examination,the extent of BPE enhancement was correlated with patient age and menopause,and there was no statistically significant difference between BPE level and molecular classification of breast cancer.