乳腺钼靶联合血清ALP、ANXA2表达水平对乳腺浸润性导管癌的早期诊断价值

Early diagnostic value of breast molybdenum target combined with serum ALP and ANXA2 expression levels for invasive ductal carcinoma of the breast

目的探讨乳腺钼靶联合血清碱性磷酸酶(ALP)、膜联蛋白A2(ANXA2)表达水平对乳腺浸润性导管癌(IDC)的早期诊断价值。方法前瞻性选取2020年6月至2023年9月鄂州市中心医院收治的IDC患者380例为IDC组,选取同期本院收治的乳腺良性疾病患者256例为良性病变组,另选取同期来我院体检的健康女性215名为对照组。收集比较IDC组及良性病变组患者临床资料、乳腺钼靶特征;比较对照组、良性病变组、IDC组血清ALP、ANXA2、癌胚抗原(CEA)和糖类抗原(CA)153水平;采用多因素Logistic回归模型分析IDC发生的影响因素;采用受试者操作特征(ROC)曲线评估乳腺钼靶联合血清ALP、ANXA2水平诊断IDC的价值。结果IDC组患者肿块边缘模糊、边缘伴毛刺、泥沙样钙化、形态不规则、乳腺结构紊乱的比例分别为35.53%、24.21%、16.05%、23.16%、33.42%,均显著高于良性病变组(13.28%、8.98%、3.91%、7.42%、4.69%),差异均有统计学意义(P<0.05)。IDC组血清ALP、ANXA2、CEA及CA153水平分别为(91.63±12.39)U/L、(36.45±5.05)ng/mL、6.10(5.25,6.85)ng/mL、35.75(32.02,40.06)U/mL,良性病变组血清ALP、ANXA2、CEA及CA153水平分别为(81.26±11.95)U/L、(28.71±4.91)ng/mL、3.68(3.26,4.23)ng/mL、16.15(13.98,18.33)U/mL,均明显高于对照组[(73.47±11.71)U/L、(18.03±4.76)ng/mL、2.34(1.71,2.97)ng/mL、13.37(11.19,16.35)U/mL],且IDC组血清ALP、ANXA2水平均高于良性病变组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,ALP(OR=1.317)、ANXA2(OR=1.574)、CEA(OR=1.791)、CA153(OR=1.856),均为IDC发生的影响因素(P<0.05)。乳腺钼靶联合血清ALP和ANXA2与病理学诊断IDC的一致性(Kappa值=0.783)高于单独采用乳腺钼靶诊断(Kappa值=0.679)。ROC曲线显示,乳腺钼靶、血清ALP和ANXA2水平诊断IDC的敏感度分别为80.53%、66.58%、65.79%,特异度分别为89.45%、86.33%、85.55%,曲线下面积(AUC)分别为0.850、0.792、0.802,乳腺钼靶联合血清ALP、ANXA2水平诊断IDC的AUC为0.889,高于单独诊断(P<0.05),血清ALP和ANXA2诊断IDC的最佳截断值分别为86.83 U/L、32.17 ng/mL。结论IDC患者血清ALP和ANXA2水平较高,乳腺钼靶联合血清ALP和ANXA2对IDC具有较高的诊断价值。

Objective To explore the early diagnostic value of breast molybdenum target combined with serum alkaline phosphatase(ALP)and annexin A2(ANXA2)expression levels for invasive ductal carcinoma(IDC)of the breast.Methods From June 2020 to September 2023,380 IDC patients admitted to Ezhou Central Hospital were prospectively regarded as the IDC group,and 256 patients with benign breast diseases admitted to our hospital period were regarded as the benign lesion group.Another 215 women who underwent health examinations in our hospital at the same period were collected as the control group.The clinical data and mammographic characteristics of patients in the IDC group and the benign lesion group were collected and compared;the serum ALP,ANXA2,carcinoembryonic antigen(CEA)and carbohydrate antigen(CA)153 levels were compared among the control group,the benign lesion group and the IDC group;multivariate Logistic regression model was used to analyze the influencing factors of IDC;the value of breast mammography combined with serum ALP and ANXA2 levels in diagnosing IDC was evaluated by the receiver operator charactoristic(ROC)curve.Results The percentages of blurred edges,marginal burrs,sediment calcification,irregular shape and breast structure disorder in IDC group were 35.53%,24.21%,16.05%,23.16%and 33.42%,respectively,which were significantly higher than those in benign lesion group(13.28%,8.98%,3.91%,7.42%and 4.69%),the differences were statistically significant(P<0.05).The levels of serum ALP,ANXA2,CEA,CA153 in the IDC group were(91.63±12.39)U/L,(36.45±5.05)ng/mL,6.10(5.25,6.85)ng/mL,35.75(32.02,40.06)U/mL,respectively,the levels of serum ALP,ANXA2,CEA,CA153 in the benign lesion group were(81.26±11.95)U/L,(28.71±4.91)ng/mL,3.68(3.26,4.23)ng/mL,16.15(13.98,18.33)U/mL,respectively,which were higher than those in the control group[(73.47±11.71)U/L,(18.03±4.76)ng/mL,2.34(1.71,2.97)ng/mL,13.37(11.19,16.35)U/mL],respectively,the levels of serum ALP and ANXA2 in IDC group were higher than those in benign lesion group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that ALP(OR=1.317),ANXA2(OR=1.574),CEA(OR=1.791),and CA153(OR=1.856)were all influencing factors for the occurrence of IDC(P<0.05).The consistency between breast molybdenum target combined with serum ALP and ANXA2 and pathological diagnosis of IDC was higher(Kappa value=0.783)than using breast molybdenum target alone(Kappa value=0.679).The ROC curve showed that the sensitivity of breast molybdenum target,serum ALP,and ANXA2 levels in diagnosing IDC was 80.53%,66.58%,and 65.79%,respectively,with specificity of 89.45%,86.33%,and 85.55%,the area under the curve(AUC)were 0.850,0.792,and 0.802,respectively.The AUC of breast mammography combined with serum ALP and ANXA2 levels for diagnosing IDC was 0.889,which was higher than that of single diagnosis(P<0.05).The optimal cutoff values of serum ALP and ANXA2 for diagnosing IDC were 86.83 U/L and 32.17 ng/mL,respectively.Conclusion The serum levels of ALP and ANXA2 are high in IDC patients,and the combination of breast molybdenum target and serum ALP and ANXA2 has high diagnostic value for IDC.