术前CEM联合病理特征对乳腺癌前哨淋巴结转移的预测价值

Predictive value of preoperative CEM combined with pathologic features in breast cancer sentinel lymph node metastasis

目的:探讨术前对比增强乳腺X线摄影(contrast-enhanced mammography,CEM)影像特征和病理特征与乳腺癌前哨淋巴结(sentinel lymph node,SLN)状态的关系。方法:回顾性分析该院诊治的57例乳腺癌患者资料,术前均行CEM检查,根据术后病理结果分为SLN转移组21例和未转移组36例。分析病灶CEM影像特征和病理特征与乳腺癌SLN状态的关系,多因素Logistic回归分析SLN转移的独立危险因素。结果:CEM影像特征:SLN是否转移与CEM肿块最大径、强化程度、强化模式、腋窝肿大淋巴结方面相关(P=0.018、0.023、0.021、0.037),而与乳腺腺体密度、病灶侧别、X线表现类型、肿块形态、毛刺征、微钙化、钙化形态、钙化分布、背景实质强化、强化方式方面无关(P均>0.05)。病理特征:SLN是否转移与病理类型、病理肿块最大径、组织学分级方面相关(P=0.038、0.033、0.036),而与年龄、ER、PR、HER-2、Ki-67、分子分型方面无关(P均>0.05)。多因素Logistic回归分析显示浸润性乳腺癌是乳腺癌SLN转移的独立危险因素(P=0.000)。结论:CEM影像特征肿瘤大小≥2 cm、强化程度重度、强化模式不均匀、有腋窝肿大淋巴结,提示乳腺癌发生SLN转移可能性大,浸润性乳腺癌是乳腺癌SLN转移的独立危险因素。

Objective:To investigate the relationship between preoperative contrast-enhanced mammography(CEM)image characteristics,pathologic features,and breast cancer sentinel lymph node(SLN)status.Methods:The data of 57 breast cancer patients treated in the hospital were retrospectively analyzed,and all of them underwent CEM examination before operation,and were divided into 21 cases of SLN metastasis group and 36 cases of non-metastasis group according to the postoperative pathological results.The relationship between the CEM imaging features of the lesions,pathological features and SLN status of breast cancer was analyzed,and the independent risk factors of SLN metastasis were analyzed by multifactorial Logistic regression.Results:CEM imaging features:SLN metastasis was related to the maximum diameter of CEM mass,enhancement degree,enhancement mode and axillary lymph nodes(P=0.018,0.023,0.021 and 0.037),while it was related to breast gland density,lesion side,X-ray manifestation type,mass shape,burr sign,microcalcification,calcification morphology,calcification distribution and background parenchyma enhancement.Pathological features:Whether SLN metastasized or not was related to pathological type,maximum diameter of pathological mass and histological grade(P=0.038,0.033 and 0.036),but not to age,ER,PR,HER-2,Ki-67 and molecular classification(P>0.05).Multivariate Logistic regression analysis showed that invasive breast cancer was an independent risk factor for breast cancer SLN metastasis(P=0.000).Conclusion:CEM imaging features tumor size≥2 cm,heavy enhancement,uneven enhancement pattern,and presence of axillary enlarged lymph nodes suggest a high likelihood of SLN metastasis in breast cancer,and invasive breast cancer is an independent risk factor for SLN metastasis in breast cancer.