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目的了解乳腺癌组织类型分布,评价超声影像指标预测乳腺癌组织周围浸润的价值。方法入选经病理证实的135例(141个病灶)乳腺癌患者,将术前超声指标(肿瘤形态、边缘、钙化灶、回声、血流信号等)和术后病理检查结果进行对照。结果(1)组织学类型:浸润性导管癌116个(82.27%)病灶,导管内癌12个(8.51%),浸润性小叶癌7个(4.96%),髓样癌5个(3.35%),黏液腺癌1个(0.71%)。(2)单因素分析:肿瘤形态不规则、边缘不光整和周围强回声晕者癌周围组织浸润的发生率高于形态规则、边缘光整和无强回声晕者(P均<0.01)。(3)多因素Logistic回归:边缘(X2)、形态(X1)和周围强回声晕(X3)均可作为判断癌周围组织浸润的独立指标,周围组织浸润预报概率方程:Logit(P)=-6.322+4.251 X1+4.490 X2+2.205 X3。(4)超声指标判断癌周围组织浸润的ROC曲线下面积(95%CI)依次是:方程0.944(0.906～0.982)>边缘0.802(0.709～0.895)>形态0.698(0.590～0.807)>周围回声0.632(0.530～0.735),与随机面积0.5比较,P均<0.05。灵敏性和特异性分别是方程87.3%、89.7%,边缘91.2%、69.2%,形态96.1%、43.6%,周围回声59.8%、66.7%。结论乳腺癌病理组织类型以浸润性导管癌最常见。超声提示的肿块边缘、形态和周围回声情况均可作为判断癌周围组织浸润的独立指标,以该3项指标综合判断的价值优于任何单项指标。
Objective To investigate the distribution of breast cancer tissue types and to evaluate the value of ultrasound imaging in predicting the infiltration of breast cancer tissues. Methods A total of 135 patients (141 lesions) with breast cancer confirmed by pathology were enrolled in the study. The preoperative ultrasound indexes (tumor morphology, margins, calcifications, echo, blood flow signals, etc.) were compared with postoperative pathological findings. RESULTS: The histological types included 116 (82.27%) invasive ductal carcinomas, 12 (8.51%) intraductal carcinomas, 7 (4.96%) infiltrating lobular carcinomas and 5 (3.35%) medullary carcinomas , Mucinous adenocarcinoma 1 (0.71%). (2) Univariate analysis showed that the incidence of peri-invasive tissue infiltration was higher than that of morphological regularity, marginal radiofrequency and no-echo (all P <0.01). (3) Multivariate logistic regression analysis: Edge (X2), shape (X1) and surrounding hyperechoic (X3) can be used as independent indicators to determine the infiltration of peri-cancer tissue. Peripheral tissue infiltration prediction probability equation: Logit 6.322 + 4.251 X1 + 4.490 X2 + 2.205 X3. (4) The area under the ROC curve (95% CI) for determining the infiltrating of the surrounding tissue by ultrasound was: 0.944 (0.906-0.982)> 0.802 (0.709-0.895)> 0.698 (0.590-0.807)> 0.632 (0.530 ~ 0.735), P <0.05 compared with the random area of 0.5. The sensitivity and specificity were 87.3%, 89.7%, 91.2%, 69.2%, 96.1%, 43.6%, 59.8%, 66.7% respectively. Conclusion The pathological type of breast cancer is the most common type of invasive ductal carcinoma. Ultrasound tips of the tumor edge, shape and surrounding echo can be used as an indicator of tissue infiltration around the independent indicators to determine the value of these three indicators integrated better than any single indicator.