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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2015, Vol. 09 ›› Issue (01) : 39 -43. doi: 10.3877/cma. j. issn.1674-0807.2015.01.009

论著

空芯针穿刺活组织检查与开放性手术活组织检查对乳腺癌手术质量及预后的影响
莫永泮1, 韩晓蓉1, 吴坤河2, 郜红艺2, 杨剑敏1, 王颀1,†()   
  1. 1.511442 广州,广州医科大学附属广东省妇幼保健院乳腺病中心
    2.511442 广州,广州医科大学附属广东省妇幼保健院病理科
  • 收稿日期:2015-01-15 出版日期:2015-02-01
  • 通信作者: 王颀

Impact of biopsy by core needle biopsy or open surgical biopsy on surgical quality and prognosis of breast cancer patients

Yongpan Mo1, Xiaorong Han1, Kunhe Wu2, Hongyi Gao2, Jianmin Yang1, Qi Wang1,†()   

  1. 1.Breast Disease Center
    2.Department of Pathology, Guangdong Women and Children’ s Hospital of Guangzhou Medical University,Guangzhou 511442,China
  • Received:2015-01-15 Published:2015-02-01
  • Corresponding author: Qi Wang
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莫永泮, 韩晓蓉, 吴坤河, 郜红艺, 杨剑敏, 王颀. 空芯针穿刺活组织检查与开放性手术活组织检查对乳腺癌手术质量及预后的影响[J/OL]. 中华乳腺病杂志(电子版), 2015, 09(01): 39-43.

Yongpan Mo, Xiaorong Han, Kunhe Wu, Hongyi Gao, Jianmin Yang, Qi Wang. Impact of biopsy by core needle biopsy or open surgical biopsy on surgical quality and prognosis of breast cancer patients[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2015, 09(01): 39-43.

目的

探讨空芯针穿刺活组织检查(CNB)与传统的开放性手术活组织检查(OSB)对乳腺癌患者DFS 的影响,同时评估两种活组织检查(简称活检)方式对乳腺癌手术质量的影响。

方法

回顾性分析2007 年1 月至2009 年12 月在广东省妇幼保健院乳腺病中心经CNB 或OSB 证实为乳腺癌的306 例患者的临床资料,其中OSB 组155 例,CNB 组151 例。 采用Kaplan-meier 法对两组患者的DFS 情况进行分析,并运用Cox 回归模型探讨影响乳腺癌患者DFS 的因素。 同时以保留乳房率、保留乳房患者首次切缘阳性率、前哨淋巴结活检率及手术次数为指标,评价两种活检方式对乳腺癌手术质量的影响;计数资料比较采用χ2 检验,计量资料比较采用t 检验。

结果

全部患者的临床随访时间为29 ～83 个月,中位随访时间为59 个月。 OSB 组与CNB 组中出现复发或转移的患者为分别为32 例(20.6%,32/155)和29 例(19.2%,29/151)。并且,OSB 组局部复发率为4.5%(7/155),远处转移率为16.1%(25/155);CNB组局部复发率为2.6%(4/151),远处转移率为16.5%(25/151)。 两组患者间局部复发率及远处转移率的差异均无统计学意义(χ2 =0.769、0.010,P=0.380、0.919)。 Kaplan-meier 生存分析显示,OSB 组与CNB 组间DFS 差异无统计学意义(χ2=0.030,P=0.864)。 Cox 回归分析显示,淋巴结转移、ER 及HER-2表达是影响乳腺癌患者DFS 的主要因素(OR=2.458,95%CI: 1.883 ～3.209,P=0.000;OR=0.453,95%CI: 0.238 ～0.863,P=0.016;OR=2.086,95%CI: 1.110 ～3.920,P=0.022),不同的活检方式并不影响乳腺癌患者的DFS。 CNB 组的保留乳房率明显高于OSB 组[25. 2%(38/151)比9. 7%(15/155),χ2 =12.812,P=0.000],手术次数明显少于OSB 组(1.00±0.00 比1.35±0.48,t=9.090,P=0.000),但其前哨淋巴结活检率与OSB 组的相比,差异无统计学意义[31.8%(48/151)比32.9%(51/155),χ2=0.043,P =0.835]。 并且,CNB 组保留乳房患者的首次切缘阳性率与OSB 组的保留乳房患者相比,差异也无统计学意义[10.5%(4/38)比5/15,χ2=2.515,P =0.113]。

结论

术前空芯针穿刺活检对患者的DFS 无不良影响,并且可以明确诊断及分子分型,有利于手术方案及后续辅助治疗方案的制定,尽而提高乳腺癌的手术质量,不失为可扪及肿块乳腺癌的首选活检方法。

关键词: 乳腺肿瘤, 活组织检查, 预后

Objective

To investigate the impact of core needle biopsy (CNB) and traditional open surgical biopsy (OSB) on disease-free survival and surgical quality of breast cancer patients.

Methods

We retrospectively analyzed the clinical data of 306 patients with breast cancer diagnosed by CNB or OSB in Breast Disease Center,Guangdong Women and Children’s Hospital from January 2007 to December 2009,including 155 cases in OSB group and 151 cases in CNB group. Kaplan-meier method was used to analyze disease-free survival in the two groups and Cox regression model was used to discuss the factors influencing the prognosis of the patients. Meanwhile the impact of different biopsy methods on the quality of breast cancer surgery was evaluated by the following parameters: breast-conserving rate,rate of positive margin in first breast-conserving surgery,rate of sentinel lymph node biopsy and times of surgeries.Count data were analyzed by Chi-square test,measurement data by t test.

Results

All the patients were followed up for 29 to 83 months (median 59 months).Overall 32 cases(20.6%,32/155) in OSB group and 29 cases(19.2%,29/151) in CNB group had recurrence or metastasis.The local recurrence rate and distant metastasis rate was 4.5% (7/155) and 16.1%(25/155) in OSB group,2.6% (4/151) and 16.5% (25/151) in CNB group,which indicated no significant difference between the two groups (χ2 =0. 769,0. 010,P=0. 380,0. 919). Kaplan-meier survival analysis showed that there was no significant difference in disease-free survival between the two groups (χ2=0.030,P=0.864).Cox regression analysis showed that lymph node metastasis,ER and HER-2 expression were the major influencing factors in the prognosis of breast cancer patients (OR=2.458, 95%CI: 1.883-3.209,P=0.000;OR=0.453,95%CI: 0. 238-0. 863,P=0. 016;OR=2. 086,95%CI: 1. 110-3. 920,P=0.022),and the different methods of biopsy did not affect the disease-free survival.The breast-conserving rate was significantly higher in CNB group than that in OSB group [25.2%(38/151) vs 9.7%(15/155),χ2=12.812,P =0.000],and the patients in CNB group had fewer operations compared with OSB group (1.00±0.00 vs 1.35±0.48,t=9.090,P=0.000),but there was no significant difference in the rate of sentinel lymph node biopsy between the two groups [31.8%(48/151) vs 32.9%(51/155), χ2=0.043,P=0.835].The rate of positive margin in first breast-conserving surgery showed no significant difference between CNB group and OSB group [10.5% (4/38)vs 5/15, χ2=2.515,P =0.113].

Conclusion

Preoperative CNB can provide guidance for the diagnosis,molecular typing and the selection of surgical and subsequent adjuvant treatment plans so as to improve the quality of breast cancer surgery,without adverse effects on disease-free survival of breast cancer patients,which can be regarded as the first choice for the patients with palpable breast mass.

Key words: Breast neoplasms, Biopsy, Prognosis
表1 OSB 组和CNB 组乳腺癌患者的临床病理资料比较(例)
组别 例数 年龄 肿瘤直径 组织学分级 淋巴结转移 ER HER-2
＜45岁 ≥45岁 ＜2 cm 2～5 cm ＞5 cm 1级 2级 3级 0枚 1～3枚 4～10枚 ＞10枚 + - + -
OSB组 155 87 68 90 62 3 52 80 23 103 37 7 8 96 59 32 123
CNB组 151 72 79 48 87 16 26 106 19 70 51 15 15 79 72 27 124
检验值 χ2=2.186 Z=-4.994 Z=-2.158 Z=3.648 χ2=2.890 >χ2=0.376
P值 0.139 0.000 0.031 0.000 0.089 0.540
表2 COX 回归模型中各变量的赋值情况
变量 变量的分类及赋值
活检方式 OSB=1,CNB=2
年龄 ＜45=1,≥45=2
肿瘤直径 ＜2 cm=1,2 ～5 cm=2,＞5 cm=3
淋巴结转移 0枚=0,1 ～3枚=1,4 ～10枚=2,＞10枚=3
TNM分期 Ⅰ期=1,Ⅱ期=2,Ⅲ期=3
ER -=0,+=1
PR -=0,+=1
HER-2 -=0,+=1,++=2,+++=3
组织学分级 1级=1,2级=2,3级=3
手术次数 1次=1,2次=2
图1 开放性手术活组织检查(OSB)组与空心针穿刺活组织检查(CNB)组乳腺癌患者的无瘤生存曲线比较 注: OSB 组与CNB 组比较, χ2=0.030,P=0.864
表3 乳腺癌患者无瘤生存影响因素的COX 回归结果
因素 回归系数 标准误 Wald值 P值 OR值 OR值95%CI
淋巴结转移 0.899 0.136 43.730 0.000 2.458 1.883～3.209
ER -0.791 0.329 5.795 0.016 0.453 0.238～0.863
HER-2 0.735 0.322 5.217 0.022 2.086 1.110～3.920
表4 OSB 组与CNB 组乳腺癌患者的手术质量比较
组别 例数 保留乳房率[例(%)] 前哨淋巴结活检率[例(%)] 手术次数(次)
OSB组 155 15(9.7) 51(32.9) 1.35±0.48
CNB组 151 38(25.2) 48(31.8) 1.00±0.00
检验值 χ2=12.812 χ2=0.043 t=9.090
P值 0.000 0.835 0.000
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