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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2023, Vol. 20 ›› Issue (06) : 631 -635. doi: 10.3877/cma.j.issn.1672-6448.2023.06.010

浅表器官超声影像学

超声联合乳腺X线摄影及PR、Her-2预测高级别与中低级别乳腺导管原位癌的价值
武壮壮, 张晓娟, 史泽洪, 史瑶, 原韶玲†()   
  1. 030001　太原，山西医科大学；030013　太原，山西医科大学附属山西省肿瘤医院超声科
    030013　太原，山西医科大学附属山西省肿瘤医院放射科
    030032　太原，山西白求恩医院
    030013　太原，山西医科大学附属山西省肿瘤医院超声科
  • 收稿日期:2021-12-15 出版日期:2023-06-01
  • 通信作者: 原韶玲

Prognostic value of ultrasound combined with mammography and PR and HER-2 status in high-grade and middle-low-grade ductal carcinoma in situ of the breast

Zhuangzhuang Wu, Xiaojuan Zhang, Zehong Shi, yao Shi, Shaoling Yuan†()   

  1. Shanxi Medical University, Taiyuan 030001,China; Department of Ultrasound, Affiliated Tumor Hospital of Shanxi Medical University, Taiyuan 030013, China
    Department of Radiology, Affiliated Tumor Hospital of Shanxi Medical University, Taiyuan 030013, China
    Shanxi Bethune Hospital, Taiyuan 030032, China
    Department of Ultrasound, Affiliated Tumor Hospital of Shanxi Medical University, Taiyuan 030013, China
  • Received:2021-12-15 Published:2023-06-01
  • Corresponding author: Shaoling Yuan
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武壮壮, 张晓娟, 史泽洪, 史瑶, 原韶玲. 超声联合乳腺X线摄影及PR、Her-2预测高级别与中低级别乳腺导管原位癌的价值[J/OL]. 中华医学超声杂志（电子版）, 2023, 20(06): 631-635.

Zhuangzhuang Wu, Xiaojuan Zhang, Zehong Shi, yao Shi, Shaoling Yuan. Prognostic value of ultrasound combined with mammography and PR and HER-2 status in high-grade and middle-low-grade ductal carcinoma in situ of the breast[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(06): 631-635.

目的

探讨超声、乳腺X线影像学特征及孕激素受体（PR）、人表皮生长因子-2（Her-2）对高级别与中低级别乳腺导管原位癌（DCIS）的预测价值。

方法

回顾性分析山西省肿瘤医院2015年1月至2020年12月经手术病理证实的196例DCIS患者，术前均行超声及乳腺X线检查且病理资料完整。根据术后病理结果将其分为高级别DCIS组80例和中低级别DCIS组116例。应用单因素分析方法比较2组患者影像表现及免疫组化的差异，将差异有统计学意义的因素纳入多因素Logistic回归分析，分析高级别与中低级别DCIS的独立预测因素。

结果

将单因素分析有统计学意义的超声表现为肿块、乳腺X线为微钙化、雌激素受体（ER）、PR及Her-2纳入二元 Logistic 回归进行多因素分析。结果表明，超声表现为肿块（OR=0.248，95％CI：0.109~0.562）、PR受体阳性（OR=0.230，95％CI：0.057~0.931）是中低级别DCIS的独立预测因素。乳腺X线表现为微钙化（OR=4.048，95％CI：1.736~9.440）、Her-2阳性（OR=6.160，95％CI：2.149~17.655）是高级别DCIS的独立预测因素。

结论

术前影像学检查及免疫组化PR、Her-2测定对DCIS的预测及DCIS患者的管理及治疗具有一定临床价值。

关键词: 乳腺导管原位癌, 超声检查, 乳腺X线摄影, 免疫组织化学
Objective

To assess the predictive value of ultrasonography, mammography, and progesterone receptor (PR) and human epidermal growth factor 2 (HER-2) status for high-grade and middle-low-grade ductal carcinoma in situ (DCIS) of the breast.

Methods

A retrospective analysis was performed on 196 patients with breast DCIS confirmed by surgical pathology from January 2015 to December 2020 at Shanxi Tumor Hospital. All patients were examined by ultrasonography and mammography before operation, and had complete pathological data. According to postoperative pathological results, the patients were divided into a high-grade DCIS group (n=80) and a middle-low-grade DCIS group (n=116). Univariate analysis was used to compare the differences in imaging and immunohistochemical features of patients in the two groups. Factors with statistically significant differences in the univariate analysis were included in multivariate Logistic regression analysis to analyze the independent predictors of high-grade and middle-low-grade DCIS.

Results

The statistically significant parameters identified in the univariate analysis, such as mass on ultrasound, microcalcification on mammography, and estrogen receptor (ER), PR, and HER-2 status, were included in binary logistic regression for multivariate analysis. The results showed that mass (odds ratio [OR]=0.248, 95% confidence interval [CI]:0.109～0.562) and PR positivity (OR=0.230, 95%CI:0.057~0.931) were independent predictor of middle-low-grade DCIS. Microcalcification (OR=4.048,95%CI:1.736~9.440) and HER-2 positivity (OR=6.160, 95%CI:2.149~17.655) were identified to be independent predictor of high-grade DCIS.

Conclusions

Preoperative imaging examination and immunohistochemical determination of PR and HER-2 status have appreciated clinical value for the prediction of DCIS and the management and treatment of DCIS patients.

Key words: Ductal carcinoma?in?situ of the breast, Ultrasonography, Mammography, Immunohistochemistry
表1 高级别与中低级别DCIS组单因素比较分析［例（%）］
因素 高级别组（n=80） 中低级别组（n=116） 统计值 P值
年龄（岁，
x¯
±s）		 51.33±9.679 51.43±11.660 t'=-0.069 0.945
临床表现 χ2=0.012 0.914
肿块 66（82.5） 95（81.9）
其他 14（17.5） 21（18.1）
ER χ2=47.569 ＜0.001
阳性 40（50.0） 108（93.1）
阴性 40（50.0） 8（6.9）
PR χ2=59.440 ＜0.001
阳性 29（36.3） 103（88.8）
阴性 51（63.7） 13（11.2）
Her-2 χ2=51.380 ＜0.001
阳性 43（53.8） 9（7.8）
阴性 37（46.3） 107（92.2）
超声表现 χ2=31.826 ＜0.001
肿块型 21（26.3） 78（67.2）
非肿块型 59（73.8） 38（32.8）
X线表现 χ2=23.818 ＜0.001
微钙化 60（75.0） 46（39.7）
无微钙化 20（25.0） 70（60.3）
图2 患者，女性，57岁，右乳高级别乳腺导管原位癌乳腺X线图像示多发微钙化
表2 高级别与中低级别DCIS预测因素赋值表
因素 变量名 变量赋值说明
ER X1 阳性=1，阴性=0
PR X2 阳性=1，阴性=0
Her-2 X3 阳性=1，阴性=0
肿块型 X4 肿块型=1，非肿块型=0
微钙化 X5 有微钙化=1，无微钙化=0
病理结果 Y 高级别=1，中低级别=0
表3 高级别与中低级别DCIS多因素Logistic回归分析
因素 β值 SE值 Waldχ2 P值 OR值 95%CI
ER -0.488 0.818 0.356 0.551 0.614 0.123~3.053
PR -1.468 0.713 4.427 0.039 0.230 0.057~0.931
Her-2 1.818 0.537 11.451 0.001 6.160 2.149~17.655
肿块型 -1.395 0.418 11.154 0.001 0.248 0.109~0.562
微钙化 1.398 0.432 10.473 0.001 4.048 1.736~9.440
常量 0.319 0.653 0.239 0.625 1.376
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