钼靶影像下乳腺癌生物学特征对保乳术切缘状态的影响

目的 探讨钼靶影像下乳腺癌生物学特征对保乳术切缘状态的影响。方法120例Ⅰ～Ⅱ期可扪及肿块的乳腺癌患者根据钼靶影像学表现分为肿块组、钙化组、肿块伴钙化组、不对称致密组和结构扭曲组。手术切除病灶范围采用距离肿物边缘1 cm，术中快速病理确定初始切缘状态，石蜡病理证实切缘状态及肿瘤分型，分析乳腺癌钼靶影像特征与保乳术切缘状态的关系。结果 保乳术的初始切缘状态与肿瘤大小、病理类型、组织学分级、淋巴结转移、雌激素受体状态、孕激素受体状态及HER-2表达等临床病理特征无关，而与脉管内有无癌栓有关（P＜0.05）；脉管内有癌栓者的切缘阳性率为26.3％（5／19），高于脉管内无癌栓的6.9％（7／101）。5组患者保乳术初始切缘状态的差异无统计学意义（P=0.241），但当包含两种及以上肿瘤类型时，乳腺癌钼靶影像特征与切缘状态的差异有统计学意义（P=0.005）。结论 行保乳术的乳腺癌患者术前应用钼靶影像评估手术切缘状态时，需要根据肿瘤影像学特征判断可能存在的病理类型，以便降低切缘阳性的概率。

Influence of biological characteristics of breast cancer in mammography on surgical margin status of breast-conserving surgery

Objective To explore the influence of biological characteristics of breast cancer in mammography on surgical mar-gin status of breast-conserving surgery. Methods One hundred and twenty patients diagnosed with stage Ⅰ or Ⅱ primary breast canc-er received breast-conserving surgery were enrolled in this study. According to the mammography images, the breast cancer patients were divided into five groups, including masses type group, mass associated with calcification type group, calcification type group, a-symmetries type group and architectural distortion type group. Total excision of breast lumps and surrounding tissue were performed a-bout 1 cm. Intraoperative rapid pathological was employed to determine the initical state of cutting edge, which was confirmed by paraf-fin pathology. The relationship between biological characteristics of breast cancer in mammography and surgical margin status was ana-lyzed. Results Pathologic features including age, tumor size, grade, nodal metastases, estrogen receptor status, progesterone receptor status and HER-2 expression were not associated with margin status of breast cancer patients. The positive rate of patients with tumor thrombus in vascular was 26. 3% (5/ 19), higher than 6. 9% (7/ 101) of patients without tumor thrombus in vascular with statistical significance (P<0. 05). No statistically significant difference was observed on the initial surgical margin status among five groups ac-cording to mammography classification. As for isolated malignant carcinoma, surgical margin status was not correlated with imaging characteristics of the tumor. However, mixed malignant carcinoma was significantly correlated with the margin status (P = 0. 005). Conclusion For breast-conserving surgery, we may need to consider characteristics of the tumor mammography classification and esti-mate pathological type in order to reduce the probability of positive margin.