乳腺导管原位癌伴微浸润与导管原位癌的临床病理及X线表现对比分析

目的对比分析乳腺导管原位癌伴微浸润(DCISM)与导管原位癌(DCIS)的X线及临床病理表现及DCISM的预测因子。方法收集2016年1月至2020年7月在青岛大学附属医院经手术病理证实的DCISM及DCIS患者626例,患者术前均接受乳腺X摄影检查。参照乳腺影像报告和数据系统(BI-RADS)标准对DCISM与DCIS患者X线表现进行分类诊断。采用χ²检验或Fisher确切概率法分析DCISM与DCIS患者临床病理及X线表现的差异性,应用单因素和多因素二元logistic回归分析探讨与DCISM相关的危险因素。结果626例患者中,DCISM患者171例,DCIS患者455例。单因素回归分析表明,肿瘤直径≥2.7cm、高核级别、粉刺性坏死、淋巴结阳性、Ki67高表达、雌激素受体及孕激素受体阴性是DCISM的预测因子(P<0.05)。多因素回归分析显示,肿瘤直径≥2.7cm(OR 2.229,95%CI 1.505~3.301,P<0.001)、高核级别(OR 1.711,95%CI 1.018~2.875,P=0.043)、淋巴结阳性(OR 4.140,95%CI 1.342~12.773,P=0.013)是DCISM的独立预测因子(P<0.05)。乳腺X线摄影中,DCIS与DCISM患者的病变类型、有无钙化及钙化分布差异具有统计学意义(χ²分别为17.42、9.65、9.10,P<0.05),17.6%(80/455)的DCIS患者表现为隐匿性病变,49.1%(84/171)的DCISM表现为钙化伴肿块、非对称致密、结构扭曲。团簇状钙化多见于DCIS(41.5%,120/289),而区域性钙化在DCISM中更普遍(35.9%,47/131)。结论乳腺X线摄影表现为钙化性病变及区域性钙化在DCISM中更常见。肿瘤直径≥2.7cm、高核级别、淋巴结阳性是DCISM的独立预测因子。

Comparative analysis of clinicopathological and mammographic findings between ductal carcinoma in situ with microinvasion and ductal carcinoma in situ

Objective To comparative analyze mammographic and clinicopathological findings of ductal carcinoma in situ(DCIS)and DCIS with microinvasion(DCISM),and to investigate the predictive factors for DCISM.Methods A total of 626 patients with DCISM and DCIS confirmed by surgery and pathology in the Affiliated Hospital of Qingdao University from January 2016 to July 2020 were collected and underwent preoperative mammography.The X-ray findings of DCISM and DCIS patients were classified and diagnosed according to the Breast Imaging Reporting and Data System(BI-RADS)criteria.The differences in clinicopathological and radiographic findings between DCISM and DCIS patients were analyzed usingχ² test or Fisher exact test.The risk factors of DCISM were evaluated by using univariate and multivariate binary logistic regression analysis.Results Among the 626 cases,171 were diagnosed as DCISM,455 were diagnosed as DCIS.Large diameter(≥2.7 cm),high nuclear grade,comedo type,axillary lymph node metastasis,high Ki67 proliferation index,negativity of estrogen receptor and progesterone receptor were found to be predictors of DCISM in the univariate analysis(all P<0.05).And large diameter(≥2.7 cm)(OR 2.229,95%CI 1.505-3.301,P<0.001),high nuclear grade(OR 1.711,95%CI 1.018-2.875,P=0.043)and axillary lymph node metastasis(OR 4.140,95%CI 1.342-12.773,P=0.013)were found to be independent predictors of DCISM in the multivariate analysis(all P<0.05).Mammographically,the lesion types,the presence and distribution of calcification were statistically significant between DCIS and DCISM patients(χ²=17.42,9.65,9.10,P<0.05).Up to 17.6%(80/455)of DCIS were occult leisions,and DCISM showed more lesions with calcification in mass,asymmetry,and architectural distortion(49.1%,84/171).Grouped calcifications were usually associated with DCIS(41.5%,120/289),while regional calcification were commonly found in DCISM(35.9%,47/131).Conclusions Lesions with calcification and regional calcification were more likely associated with DCISM on mammography.Large diameter(≥2.7 cm),high nuclear grade and axillary lymph node metastasis were found to be independent predictors of DCISM.