摘要
目的探究经超声引导下空心针活检术(CNB)诊断为乳腺导管原位癌(DCIS)的患者术后病理学升级的危险因素及与腋窝淋巴结转移情况。方法选择2013年3月至2019年10月南京医科大学第一附属医院乳腺病科收治的超声引导下CNB诊断的DCIS患者,分析术后病理升级为乳腺导管原位癌伴微浸润性(DCISM)、乳腺浸润性癌(IBC)的独立危险因素;进一步分析术后病理升级为IBC的独立危险因素。结果在348例患者中,61例(17.53%)和126例(36.21%)术后病理升级为DCISM和IBC。对DCIS术后病理学升级临床病理学特征进行分析,显示肿瘤大小,组织学分级,BI-RADS分类,病灶内有无钙化点是病理学升级的影响因素;Logistic回归分析结果显示,肿瘤大小、组织学分级、病灶内有无钙化是病理学升级的独立影响因素。术后DCIS组未发现有腋窝淋巴结阳性病例。术后病理升级的病例中,腋窝淋巴结转移率为14.97%(28/187),DCISM组腋窝淋巴结阳性率为3.28%(2/61),IBC组腋窝淋巴结转移率为20.63%(26/126);术后腋窝淋巴结阳性率DCISM组和DCIS组相比,差异无统计学意义(P=0.075),而IBC组的腋窝淋巴结阳性率高于DCIS组(P<0.001)和DCISM组(P=0.002)。对DCIS术后病理升级为IBC的临床病理学特征进行分析,显示肿瘤直径,组织分级,病灶内有无钙化以及乳腺密度是DCIS病理升级为IBC的独立危险因素。结论对于临床腋窝评估为阴性,术前CNB诊断为DCIS的患者,肿瘤较小(<2 cm),组织学分级低及病灶内无钙化的病例术后病理升级的风险较低,腋窝前哨淋巴结活检术可以豁免。
Objective To investigate the risk factors of pathological upstaging and the status of axillary lymph node in patients diagnosed as ductal carcinoma in situ(DCIS)by core needle biopsy(CNB).MethodsThe clinical data of breast cancer patients diagnosed as DCIS by ultrasound-guided CNB in Department of Breast Diseases of the First Affiliated Hospital of Nanjing Medical University from March 2013 to October 2019 were analyzed retrospectively.Independent risk factors of upstaging to DCIS with microinvasion(DCISM)and invasive breast cancer(IBC)confirmed bypathology were identified.And independent risk factors of pathological upstaging to IBC were further analyzed.Results Among the 348 patients,61 cases(17.53%)and 126 cases(36.21%)were upstaged to DCISM and IBC confirmed by pathology.Tumor size,histological grade,BI-RADS classification and calcification in the lesions were influencing factors of pathological upstaging.Logistic regression analysis showed that tumor size,histological grade and calcification in the lesion were independent factors for pathological upstaging.After surgery,no positive axillary lymph nodes were found in DCIS group.The axillary lymph node metastasis rate was 14.97%(28/187)in the patients with pathological upstaging.And the positive rates of axillary lymph nodes in the DCISM and IBC subgroups were 3.28%(2/61)and 20.63%(26/126),respectively.There was no significant difference in axillary lymph node positive rate between DCISM group and DCIS group(P=0.075).While the axillary lymph node positive rate in IBC group was higher than that in DCIS group(P<0.001)and DCISM group(P=0.002).The tumor size,tumor grade,calcification in the lesion and breast density were independent risk factors of pathological upstaging to IBC.Conclusions For patients diagnosed with DCIS by CNB,axillary sentinel lymph node biopsy may be omitted for breast cancer patients with cN0 with small tumor,low tumor grade and no calcification in the lesions because of little risk for upstaging.
作者
李严
王珏
陈锐
李硕
史晓青
徐迎港
张娓娓
查小明
LI Yan;WANG Jue;CHEN Rui;LI Shuo;SHI Xiaoqing;XU Yinggang;ZHANG Weiwei;ZHA Xiaoming(Department of Breast Disease, the First Affiliated Hospital with Nanjing Medical University /Jiangsu Province Hospital, Nanjing 210029, China)
出处
《中国肿瘤外科杂志》
CAS
2021年第3期220-224,共5页
Chinese Journal of Surgical Oncology
基金
国家自然科学基金青年基金项目(81302305)。
