摘要
目的 探讨多模态超声检查(常规超声、应变弹性、超声造影)特征与T1 期乳腺癌分子亚型之间的相关性.方法 选取我院就诊的 697 例乳腺病变患者中实际符合纳入标准的 99 例患者(99 个病灶),术前均接受常规超声检查、弹性超声检查和超声造影(CEUS)检查.通过病理和免疫组化确定乳腺癌分子亚型为:Luminal A、Luminal B、HER-2 过表达和Basal-Like型;采用非参数Kruskal-Wallis检验或Pearson's χ2 检验或Fisher精确概率法对不同分子亚型多模态超声特征进行对比分析,两两比较用Bonferroni法校正.结果 4 种亚型中,乳腺病灶方向(平行/非平行)、边缘(模糊/界清)、应变弹性评分、增强速度(同步增强/快速增强)、造影剂灌注方向(整体性/向心性/离心性)、增强后病灶范围有无增大 6 个超声检查特征比较,差异有统计学意义(P<0.05);各项指标两两比较,仅超声造影中增强速度、造影剂灌注方向、增强后病灶范围差异有统计学意义(P<0.05);其中luminal B型较luminal A型以快速高增强多见;HER-2 过表达型较Luminal B型多表现为向心性增强,Luminal A型与Luminal B型较HER-2 过表达型多表现为离心性增强;Luminal A型较HER-2过表达型增强后范围扩大多见.结论 在T1 期乳腺癌的不同分子亚型中,常规超声检查及应变弹性超声特征有一定差异,但价值有限,而超声造影模式差异显著,超声造影特征可能是预测乳腺癌不同分子亚型重要参数.
Abstract
Objective To investigate the correlation between multimodality ultrasound features(conventional ultrasound,strain elasticity,contrast-enhanced ultrasound)and molecular subtypes of T1 breast cancer.Methods A total of 697 consecu-tive breast patients in our hospital were selected,and 99 patients(99 lesions)were included after inclusion and exclusion crite-ria.All patients received conventional ultrasound,elastic ultrasound and CEUS examination before surgery.Breast cancer mo-lecular subtypes were identified by postoperative pathological and immune-histochemical analysis as Luminal A,Luminal B,HER-2 overexpression,and basal-like.The nonparametric Kruskal-Wallis test,Pearson's χ2 test,or Fisher's exact probability method were used to compare and analyze the multimode ultrasonic characteristics of different molecular subtypes,and the pair-to-pair comparison was corrected by Bonferroni method.Results Among the 4 subtypes,there were significant differences in the direction(parallel or non-parallel),edge(blurred or clear),strain elasticity score,enhancement speed(synchronous or rapid enhancement),contrast agent perfusion direction(global,concentric,or eccentric)and whether the lesion size increased after enhancement;Pairwise comparison of significant indicators showed that the enhancement speed,contrast agent perfusion di-rection and lesion range after enhancement had statistical significance in CEUS(P<0.05).Luminal B had a faster enhancement rate than luminal A.Compared with Luminal B,HER-2 overexpression showed more centripetal enhancement,Luminal A and Luminal B showed more centrifugal enhancement.Compared with HER-2 overexpression type,Luminal A had a higher propor-tion of range enlargement.Conclusion In different molecular subtypes of T1 breast cancer,the characteristics of conventional ultrasound and strain elastography are different,but their value is limited,while the contrast ultrasound mode is significantly dif-ferent.The characteristics of contrast ultrasound may be an important parameter for predicting different molecular subtypes of breast cancer.
基金项目
福建省卫生健康委员会科技计划项目(2020QNB047)
维普
万方数据