人表皮生长因子受体2阳性乳腺癌在激素受体不同表达状态下超声多模态特征分析

Analysis of multimodal ultrasonic characteristics in breast cancer with human epidermal growth factor receptor 2 positive under different expression status of hormone receptor

目的分析人表皮生长因子受体2(HER-2)阳性乳腺癌患者在激素受体(HR)不同表达状态下的超声多模态特征,为HER-2阳性乳腺癌的早期诊断、治疗提供参考。方法回顾性收集2017年1月至2023年12月南京医科大学第一附属医院和句容市人民医院收治的160例HER-2阳性乳腺癌患者的临床资料,依据免疫组化结果分为HR阳性组(n=89)和HR阴性组(n=71)。比较两组一般资料、病理特征及超声多模态特征,logistic回归分析HER-2阳性乳腺癌超声多模态特征与HR表达状态的关系,受试者工作特征曲线(ROC)分析超声多模态特征对HER-2阳性乳腺癌患者HR表达状态的预测价值。结果与HR阴性组比较,HR阳性组常规超声征象中,形态不规则、边缘毛刺或不清晰、微钙化和内部不均质回声占比显著降低;超声造影征象中,增强后形态不规则、增强后边界模糊和无充盈缺损占比显著降低,差异均有统计学意义(P<0.05)。与HR阴性组比较,HR阳性组超声造影征象中增强后病灶直径差值显著缩小[(3.29±0.36)mm vs(4.30±0.44)mm,t=15.971,P<0.01],弹性成像征象中弹性评分[(3.15±0.33)分vs(4.56±0.47)分,t=21.416,P<0.01]及硬度比值[(0.24±0.04)分vs(0.33±0.05)分,t=12.340,P<0.01]显著降低。Logistic回归分析示,HER-2阳性乳腺癌患者增强后病灶直径差值、弹性评分、硬度比值与HR表达状态密切相关(P<0.05)。ROC曲线分析示,超声多模态三项特征联合预测HER-2阳性乳腺癌患者HR表达状态的曲线下面积(0.895)大于病灶直径差值(0.641)、弹性评分(0.833)、硬度比值(0.783)各单项检测(Z=7.524、3.405、4.420,P<0.05),且联合预测的特异度、约登指数也最高。结论HER-2阳性乳腺癌HR阳性表达与超声多模态特征密切关联,超声多模态特征对HER-2阳性患者HR阳性表达的预测价值较高。

Objective To analyze multimodal ultrasonic characteristics of human epidermal growth factor receptor 2(HER-2)positive breast cancer patients in different hormone receptor(HR)expression states,so as to provide a reference for the early diagnosis and treatment of HER-2 positive breast cancer.Methods The clinical data of 160 patients with HER-2 positive breast cancer who were diagnosed and treated in the First Affiliated Hospital with Nanjing Medical University and Jurong People s Hospital from January 2017 to December 2023 were collected retrospectively.According to immunohistochemical results,patients were divided into HR positive group(n=89)and HR negative group(n=71).General data,pathological characteristics and multimodal ultrasonic characteristics of the two groups were compared.Logistic regression analysis was performed to analyze the relationship between multimodal ultrasonic characteristics and HR expression in HER-2 positive breast cancer.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of multimodal ultrasonic characteristics for HR expression in HER-2 positive breast cancer patients.Results Compared with HR negative group,proportions of routine ultrasound signs(irregular shape,edge anomaly or fuzziness,microcalcification,internal uneven echo)significantly decreased in HR positive group,and proportions of contrast-enhanced ultrasound signs(irregular shape,fuzzy boundary and non-filling defect after enhancement)significantly decreased(P<0.05).Compared with HR negative group,difference value of lesion diameter in contrast-enhanced ultrasound sign[(3.29±0.36)mm vs(4.30±0.44)mm,t=15.971,P<0.01],elasticity score[(3.15±0.33)points vs(4.56±0.47)points,t=21.416,P<0.01]and hardness ratio[(0.24±0.04)points vs(0.33±0.05)points,t=12.340,P<0.01]in elastography signs significantly decreased in HR positive group.Logistic regression analysis showed that difference value of lesion diameter,elasticity score and hardness ratio after enhancement were closely related to HR expression(P<0.05).ROC curve analysis showed that the area under the curve of three characteristics of ultrasoud multimodality combined to predict the HR expression status in patients with HER-2 positive breast cancer(0.895)was larger than that of the lesion diameter difference(0.641),elasticity score(0.833)and hardness ratio(0.783)(Z=7.524,3.405,4.420,P<0.05),and the specificity and Youden index of combined prediction were also the highest.Conclusion HR positive expression in patients with HER-2 positive breast cancer is closely related to multimodal ultrasonic characteristics.Multimodal ultrasonic characteristics have a high predictive value for HR positive expression in HER-2 positive patients.