乳腺癌病理生物学指标、术前数字化乳腺断层摄影表现与脉管侵犯的相关性研究

Study on the correlation between pathobiological indexes of breast cancer,preoperative digital breast tomographic findings and lymphovascular invasion

目的:探讨乳腺癌病理生物学指标、术前数字化乳腺断层摄影(DBT)表现与脉管侵犯(LVI)的相关性,旨在对乳腺癌的治疗及预后提供帮助。方法:回顾性分析2019年3月至2022年8月在我院经病理确诊为乳腺癌的406例患者的临床影像资料,所有患者术前均行DBT检查。以术后病理为金标准,按脉管内有无癌栓分为LVI阳性组(216例)与LVI阴性组(190例)。采用独立样本t检验、χ2检验或Fisher确切概率法及Mann-Whitney U检验比较两组在临床病理特征组间的差异。结果:单因素分析结果显示:临床病理特征方面:有无脉管侵犯在病理类型、病理肿瘤大小、组织学分级、前哨淋巴结转移、腋窝淋巴结转移、Ki-67、分子分型方面有显著差异,具有统计学意义(P值分别为0.007、0.000、0.016、0.000、0.000、0.002、0.023),而在患者年龄、ER、PR、Her-2状态比较,差异均无统计学意义(P均>0.05)。DBT影像特征方面:有无脉管侵犯在DBT肿瘤大小、钙化形态方面有差异,具有统计学意义(P值分别为0.025、0.013),而在乳腺密度、X线表现类型、肿块形态、毛刺征、微钙化、钙化分布方面比较,差异均无统计学意义(P均>0.05)。结论:乳腺癌脉管浸润与病理类型、肿瘤大小、组织学分级、前哨淋巴结、腋窝淋巴结、Ki-67、分子分型、钙化形态有关,术前DBT影像特征及临床病理特征有助于预测乳腺癌脉管侵犯状态。

Objective:To investigate the correlation between pathobiological indexes,preoperative digital breast tomographic(DBT)findings and lymphovascular invasion(LVI),in order to provide help for the treatment and prognosis of breast cancer.Methods:Clinical imaging data of 406 patients who were pathologically diagnosed with breast cancer in our hospital from March 2019 to August 2022 were retrospectively analyzed.All patients underwent DBT examination before surgery.According to the postoperative pathology as the gold standard,the patients were divided into LVI positive group(216 cases)and LVI negative group(190 cases).Independent sample t test,χ^(2)test,Fisher exact probability method and Mann-Whitney U test were used to compare the differences between the two groups in clinicopathological features.Results:The results of single factor analysis showed that there were significant differences in pathological type,pathological tumor size,histological grade,sentinel lymph node metastasis,axillary lymph node metastasis,Ki-67 and molecular classification(P values were 0.007,0.000,0.016,0.000,0.000,0.002,0.023,respectively).There was no significant difference in age,ER,PR and Her-2 status(all P>0.05).In terms of DBT imaging features,there were statistically significant differences in DBT tumor size and calcification morphology(P values were 0.025 and 0.013,respectively),while there were no statistically significant differences in breast density,X-ray manifestations,mass morphology,burr signs,microcalcification and calcification distribution(all P>0.05).Conclusion:Lymphovascular invasion of breast cancer is related to pathological type,tumor size,histological grade,sentinel lymph node,axillary lymph node,Ki-67,molecular classification,and calcification morphology.Preoperative DBT imaging features and clinicopathological features are helpful to predict the status of lymphovascular invasion of breast cancer.