摘要
目的 探究不同分子亚型浸润性乳腺癌的乳腺X线摄影、弹性模量和超声特征,并分析浸润性乳腺癌发病的危险因素.方法 回顾性选取2020年1月至2022年1月在深圳市龙岗区妇幼保健院进行诊治的123例浸润性乳腺癌患者纳入研究,作为病例组.根据患者病理学分子亚型结果分组:管腔A型33例(Luminal A组),管腔B型42例(Luminal B组),三阴型26例(三阴组),人类表皮生长因子受体2(HER-2)过表达型22例(HER-2过表达组).对各组的乳腺X线摄影(肿块形态、肿块边缘、肿块密度、微钙化及钙化分布情况)、弹性模量[面积比、应变率比值、最大弹性模量(Emax)、最小弹性模量(Emin)、平均弹性模量(Emean)、Eradio值]和超声特征(边界特点、回声类型、形态是否规则、有无钙化、后方回声表现、有无高回声晕、生长方向及血流信号方面)进行记录和对比分析,另选择同期在本院进行健康体检的50名志愿者作为对照组,探究浸润性乳腺癌的发病危险因素.结果 各组经乳腺X线摄影检查结果组间比较,差异无统计学意义(P＞0.05).对各组间患者的乳腺X线摄影特征进行比较,4组在肿块形态、肿块边缘、肿块密度、微钙化及钙化分布情况方面差异均有统计学意义(P＜0.05).Luminal A组与Luminal B组相比较,两组间面积比、应变率比值、Emax、Emin、Emean、Eradio值差异均无统计学意义(P＞0.05);HER-2 过表达组的上述指标均较Luminal A组、Luminal B组、三阴组高,三阴组较Luminal A组、Luminal B组低,差异均有统计学意义(P＜0.05).4组间多普勒超声特征在边界特点(毛刺状、清晰、微分叶)、回声类型、形态是否规则、有无钙化、后方回声表现、有无高回声晕、生长方向及血流信号方面比较,差异均有统计学意义(P＜0.05).单因素分析发现文化程度、绝经状态、职业、生育史及流产史等均可能会影响浸润性乳腺癌的发病(P＜0.05).多因素Logistic回归分析显示文化程度低及未生育为影响患者发生浸润性乳腺癌的危险因素.结论 不同分子亚型浸润性乳腺癌患者的乳腺X线摄影、弹性模量和超声特征表现均存在差异,患者文化程度低及存在生育史会增加患者发生浸润性乳腺癌概率,应予以重视.
Abstract
Objective To explore the differences of mammography,elastic modulus and ultrasonic characteristics of different molecular subtypes of invasive breast cancer and to analyzed the risk factors of invasive breast cancer.Methods A total of 123 patients with invasive breast cancer who were diagnosed and treated in Shenzhen Longgang District Maternal and Child Health Hospital from January 2020 to January 2022 were retrospectively selected into the study as a case group.Grouping based on molecular subtypes of patient pathology:33 cases of lumen A(Luminal A group),42 cases of lumen B(Luminal B group),26 cases of triyin(three negative group)and 22 cases of human epidermal growth factor re-ceptor 2(HER-2)overexpression(HER-2 overexpression group).The mammography(mass morphology,mass margin,mass density,micro-calcification,calcification distribution),elastic modulus[area ratio,strain rate ratio,maximum elastic modulu(Emax),minimum elastic modulus(Emin),mean elastic modulus(Emean),Eradio]and ultrasound features(boundary characteristics,echo type,morphology rule,presence of calcification,posterior echo performance,high echo halo,growth direction and blood flow signal)were recorded and compared.Another 50 volun-teers who underwent physical examination in our hospital during the same period were selected as the control group and the risk factors of invasive breast cancer were explore.Results There was no statistically significant difference in the results of breast X-ray examination between the groups(P＞0.05).The mammographic characteristics of patients between each group were compared,and there were statistical differences in tumor morphology,tumor edge,tumor density,microcalcification,and calcification distribution among the four groups,the differences were statistically significant(P＜0.05).There were no statistically significant differences in area ratio,strain rate ratio,Emax,Emin,Emean,and Eradio values between Luminal A group and Luminal B group(P＞0.05);the above indicators in the HER-2 overexpression group were significantly higher than those in the Luminal A group,Luminal B group and three negative group,while the above indicators in the three negative group were signifi-cantly lower than those in the Luminal A group and Luminal B group,the differences were statistically significant(P＜0.05).There were statis-tically significant differences among the four groups in terms of Doppler ultrasound features in boundary characteristics(burr like,clear,and lobu-lar),echo type,regular morphology,presence or absence of calcification,posterior echo manifestations,presence or absence of hyperechoic ha-los,growth direction,and blood flow signals(P＜0.05).Univariate analysis founded that education,menopause,occupation,reproductive his-tory and abortion history may affect the incidence of invasive breast cancer.Multivariate Logistic regression analysis showed that low education and nonfertility were considered as risk factors for the development of invasive breast cancer(P＜0.05).Conclusion There are differences in mam-mography,elastic modulus and ultrasonic characteristics in patients with different molecular subtypes of invasive breast cancer.Low education level and unborn of patients will increase the probability of invasive breast cancer,which should be paid attention to.
基金项目
广东省自然科学基金(2022A1515012468)
维普
万方数据