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中华医学超声杂志(电子版) ›› 2022, Vol. 19 ›› Issue (04) : 337 -341. doi: 10.3877/cma.j.issn.1672-6448.2022.04.010

浅表器官超声影像学

影响乳腺癌穿刺活检与术后病理分子分型差异的自动乳腺全容积成像特征
王丹丹1, 李雅婷2, 徐超丽1, 杨斌1,()   
  1. 1. 210002 南京大学医学院附属金陵医院(东部战区总医院)超声诊断科
    2. 210002 南京医科大学附属金陵临床医学院(东部战区总医院)超声诊断科
  • 收稿日期:2021-06-09 出版日期:2022-04-01
  • 通信作者: 杨斌

Automated breast volume scanner imaging features affecting difference of molecular subtypes between core needle biopsy and surgery in breast cancer

Dandan Wang1, Yating Li2, Chaoli Xu1, Bin Yang1,()   

  1. 1. Department of Ultrasound, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
    2. Department of Ultrasound, Jinling Clinical Medical College, Nanjing Medical University, Nanjing 210002, China
  • Received:2021-06-09 Published:2022-04-01
  • Corresponding author: Bin Yang
引用本文:

王丹丹, 李雅婷, 徐超丽, 杨斌. 影响乳腺癌穿刺活检与术后病理分子分型差异的自动乳腺全容积成像特征[J/OL]. 中华医学超声杂志(电子版), 2022, 19(04): 337-341.

Dandan Wang, Yating Li, Chaoli Xu, Bin Yang. Automated breast volume scanner imaging features affecting difference of molecular subtypes between core needle biopsy and surgery in breast cancer[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(04): 337-341.

目的

探讨影响乳腺癌粗针穿刺活检与术后病理分子分型差异的自动乳腺全容积成像(ABVS)特征。

方法

回顾性分析2014年11月至2020年10月东部战区总医院收治的63例乳腺癌患者,共63个病灶。所有患者行改良根治术前均行粗针穿刺活检及ABVS检查。比较术前粗针穿刺活检与术后标本分子分型存在差异组(有差异组)与二者病理结果一致组(无差异组)ABVS特征的差异,并采用Logistic回归分析手术前后分子分型差异的独立影响因素。

结果

手术病理结果显示,Luminal A型15个(23.8%),Luminal B型39个(61.9%),HER-2过表达型6个(9.5%),三阴型3个(4.8%)。其中14个病灶的粗针穿刺活检与术后分子分型之间存在差异。有差异组(n=14)与无差异组(n=49)的肿块最大径、边界、形态、边缘及汇聚征比较,差异具有统计学意义(P均<0.05)。Logistic回归分析结果表明,伴有汇聚征(OR=0.113,95%CI:0.015~0.865)、形态不规则(OR=0.117,95%CI:0.015~0.912)、边界模糊(OR=0.171,95%CI:0.029~0.992)以及边缘有毛刺(OR=12.576,95%CI:1.783~88.717)是粗针穿刺活检与术后分子分型差异的独立影响因素(P均<0.05)。

结论

ABVS在一定程度能够指导粗针穿刺活检,减少穿刺活检病理与术后病理分子分型的差异,提高穿刺诊断准确性,为临床医师提供可靠的诊断依据和参考信息。

Objective

To explore the characteristics of automatic breast volume scanner (ABVS) imaging that affect the difference of molecular subtypes between core needle biopsy and surgical specimens.

Methods

A retrospective analysis was performed on 63 breast cancer patients (63 lesions) who underwent core needle biopsy (CNB) and were examined by ABVS before surgery at the Jinling Hospital between November 2014 and October 2020. The differences in the ABVS imaging characteristics between the discrepancy group (molecular subtypes changed before and after surgery) and the consistency group (the pathological results were consistent before and after surgery) were compared. Logistic regression was used to analyze the independent factors affecting the difference in molecular subtypes between before and after surgery.

Results

According to the surgical pathology, there were 15 (23.8%) luminal A, 39 (61.9%) luminal B, 6 (9.5%) HER-2, and 3 (4.8%) triple-negative subtypes. Among the 63 cases, there were 14 lesions that had different pathological results between CNB and surgical specimens. Significant differences were found between the discrepancy group(n=14) and the consistency group (n=49) in the largest diameter, boundary, morphology, margin, and retraction phenomenon (P<0.05). The results of Logistic regression analysis showed that retraction phenomenon (odds ratio [OR]=0.113, 95% confidence interval [CI]: 0.015-0.86), indistinct boundary (OR=0.117, 95%CI: 0.015-0.912), and irregular morphology (OR=0.171, 95%CI: 0.029-0.992) were independent protective factors for the difference of molecular subtypes between before and after surgery, while spiculated margin (OR=12.576, 95%CI: 1.783-88.717) was the independent risk factor (P<0.05).

Conclusion

ABVS can help doctors to perform CNB better, reduce the difference with postoperative molecular typing, improve the accuracy of CNB, and provide reliable diagnostic basis and reference information for clinicians.

图1 乳腺肿块自动乳腺全容积成像(ABVS)、粗针穿刺活检与术后病理图像(粗针穿刺活检与术后病理分子分型有差异)。图a为ABVS冠状面图像显示肿块内微钙化,周围组织纠集;图b为粗针穿刺活检病理结果提示为浸润性导管癌Luminal B型;图c为术后病理结果显示为浸润性导管癌Luminal A型
图2 乳腺肿块自动乳腺全容积成像(ABVS)、粗针穿刺活检与术后病理图像(粗针穿刺活检与术后病理分子分型一致)。图a为ABVS冠状面图像显示病灶尚规则,边缘有毛刺,可见成角,可见汇聚征;图b为粗针穿刺活检病理结果提示为浸润性导管癌Luminal A型;图c为术后病理结果显示为浸润性导管癌Luminal A型
表1 穿刺活检与术后病理分子分型有差异组与无差异组一般资料及ABVS图像特征比较[例(%)]
表2 粗针穿刺活检与术后病理分子分型差异的影响因素赋值表
表3 影响粗针穿刺活检与术后病理分子分型差异的多因素Logistic回归分析
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