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中华乳腺病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (02) : 80 -87. doi: 10.3877/cma.j.issn.1674-0807.2023.02.003

论著

乳腺癌超声造影特征与临床病理特征的关系
李欣, 张君, 唐春霖, 陈凯旋, 谭鹰, 陈萍, 谭琳, 郭燕丽†()   
  1. 400038　重庆，陆军军医大学第一附属医院超声科
  • 收稿日期:2023-01-18 出版日期:2023-04-01
  • 通信作者: 郭燕丽

Relationship between contrast-enhanced ultrasound characteristics and clinicopathological features of breast cancer patients

Xin Li, Jun Zhang, Chunlin Tang, Kaixuan Chen, Ying Tan, Ping Chen, Lin Tan, Yanli Guo†()   

  1. Department of Ultrasound, First Affiliated Hospital of Army Medical University, Chongqing 400038, China
  • Received:2023-01-18 Published:2023-04-01
  • Corresponding author: Yanli Guo
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引用本文：

李欣, 张君, 唐春霖, 陈凯旋, 谭鹰, 陈萍, 谭琳, 郭燕丽. 乳腺癌超声造影特征与临床病理特征的关系[J/OL]. 中华乳腺病杂志(电子版), 2023, 17(02): 80-87.

Xin Li, Jun Zhang, Chunlin Tang, Kaixuan Chen, Ying Tan, Ping Chen, Lin Tan, Yanli Guo. Relationship between contrast-enhanced ultrasound characteristics and clinicopathological features of breast cancer patients[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2023, 17(02): 80-87.

目的

分析乳腺癌超声造影定性特征及定量参数与患者临床病理特征的关系。

方法

根据纳入、排除标准，收集在2021年5月至2022年8月于陆军军医大学第一附属医院进行了超声造影检查并确诊为乳腺癌的89例患者临床资料进行回顾性分析。分析患者的超声造影定性特征(增强速度、增强程度、增强顺序、增强均匀性、增强后边界、穿支血管、灌注缺损、增强后范围)及定量参数[上升斜率(WIS)、达峰时间(TTP)、峰值强度(PI)、上升时间(RT)及灌注曲线下面积(WiAUC)]，探讨其与乳腺癌患者临床病理特征的关系。超声造影的定量参数分析采用Mann-Whitney U检验，定性特征用绝对数表示，采用Pearson’s χ2检验或连续性校正χ2检验。对单因素分析中差异具有统计学意义的超声造影定性特征及定量参数进行以临床病理特征为因变量的二元Logistic回归分析。

结果

HER-2阳性乳腺癌相较于HER-2阴性乳腺癌更易表现为快速增强(χ2＝4.633，P＝0.031)。Ki-67高表达乳腺癌相较于Ki-67低表达乳腺癌更常表现为高增强(χ2＝4.355，P＝0.037)，且常在增强后出现病灶范围增大(χ2＝4.355，P＝0.037)。相较于组织学1/2级的乳腺癌，组织学3级的乳腺癌更易出现灌注缺损(χ2＝4.395，P＝0.036)。病灶直径≥20 mm的乳腺癌相较于病灶直径<20 mm的乳腺癌更易表现为快速增强(χ2＝6.036，P＝0.014)。ER阴性乳腺癌的WIS、PI、WiAUC大于ER阳性乳腺癌(Z＝－2.472、－2.870、－2.140，P＝0.013、0.004、0.032)。PR阴性乳腺癌的WIS、PI、WiAUC大于PR阳性乳腺癌(Z＝－2.965、－3.361、－2.672，P＝0.003、0.001、0.008)。Ki-67高表达乳腺癌的WIS、PI、WiAUC大于Ki-67低表达乳腺癌(Z＝－2.172、－2.713、－2.620，P＝0.030、0.007、0.009)。此外，HER-2阳性乳腺癌的WiAUC大于HER-2阴性乳腺癌(Z＝－2.161，P＝0.031)。二元Logistic回归分析结果显示：PI是ER状态的独立预测因素(OR＝0.907，95%CI：0.827~0.994，P＝0.037)；增强程度和WiAUC是Ki-67表达的独立预测因素(OR＝5.082，95%CI：1.065~24.241，P＝0.041；OR＝1.030，95%CI：1.005~1.055, P＝0.019)。

结论

乳腺癌患者的超声造影特征与其临床病理特征存在一定的关联性，这为临床无创性评估乳腺癌预后提供了依据。

关键词: 乳腺肿瘤, 预后, 超声造影
Objective

To explore the relationship between the qualitative characteristics and quantitative parameters of contrast-enhanced ultrasound (CEUS) and clinicopathological features of breast cancer patients.

Methods

According to the inclusion and exclusion criteria, the clinical data of 89 patients who received the CEUS and were pathologically diagnosed with breast cancer in the First Affiliated Hospital of Army Medical University from May 2021 to August 2022 were retrospectively analyzed. The CEUS qualitative characteristics (enhancement speed, enhancement degree, enhancement order, internal homogeneity, enhancement margin, perforator vessel, perfusion defect, size after enhancement) and quantitative parameters [wash-in slope (WIS), time to peak (TTP), peak intensity(PI), rise time(RT) and wash-in area under the curve(WiAUC)] in 89 patients were analyzed to explore their relationship with clinicopathological features. The quantitative parameters of CEUS were analyzed by the Mann-Whitney U test, qualitative characteristics were expressed by absolute numbers and analyzed by Pearson’s χ2 test or continuous correction χ2 test. The qualitative characteristics and quantitative parameters of CEUS with a statistically significant difference in univariate analysis were used as independent variables for binary logistic regression, with clinicopathological features as the dependent variables.

Results

HER-2-positive breast cancer was more likely to show fast enhancement than HER-2-negative breast cancer (χ2=4.633, P=0.031). Compared with Ki-67 low expression breast cancer, Ki-67 high expression breast cancer was more likely to show hyperenhancement (χ2=4.355, P=0.037), and the size of lesions was usually larger after enhancement (χ2=4.355, P=0.037). Compared with histological grade 1/2 breast cancer, breast cancer of grade 3 was more likely to show perfusion defect (χ2=4.395, P=0.036). Breast cancer with a lesion diameter≥20 mm was more likely to show fast enhancement than the one < 20 mm (χ2=6.036, P=0.014). The WIS, PI and WiAUC of ER-negative breast cancer were significantly higher than those of ER-positive breast cancer (Z=-2.472, -2.870, -2.140; P=0.013, 0.004, 0.032). The WIS, PI and WiAUC of PR-negative breast cancer were significantly higher than those of PR-positive breast cancer (Z=-2.965, -3.361, -2.672; P=0.003, 0.001, 0.008). The WIS, PI and WiAUC of Ki-67 high expression breast cancer were significantly higher than those of Ki-67 low expression breast cancer (Z=-2.172, -2.713, -2.620; P=0.030, 0.007, 0.009). In addition, the WiAUC of HER-2-positive breast cancer was significantly higher than that of HER-2-negative breast cancer (Z=-2.161, P=0.031). The results of binary logistic regression analysis showed that PI was an independent predictor of ER expression (OR=0.907, 95%CI: 0.827-0.994, P=0.037); enhancement degree and WiAUC were independent predictors of Ki-67 expression(OR=5.082, 95%CI: 1.065-24.241, P=0.041; OR=1.030, 95%CI: 1.005-1.055, P=0.019).

Conclusions

The qualitative characteristics and quantitative parameters of CEUS are related to clinicopathological features of breast cancer patients to a certain degree, which provides a reference for evaluating the prognosis of breast cancer in a non-invasive way.

Key words: Breast neoplasms, Prognosis, Contrast-enhanced ultrasound
表1 二元Logistic回归分析的变量赋值表
变量 变量类型 赋值
增强速度 X1 同步＝0；快速＝1
增强程度 X2 低/等增强＝0；高增强＝1
灌注缺损 X3 无＝0；有＝1
增强后范围 X4 无改变＝0；增大＝1
ER Y1 阴性＝0；阳性＝1
PR Y2 阴性＝0；阳性＝1
HER-2 Y3 阴性＝0；阳性＝1
Ki-67 Y4 低表达＝0；高表达＝1
组织学分级 Y5 1/2级＝0；3级＝1
病灶直径 Y6 <20 mm＝0；≥20 mm＝1
表2 89例乳腺癌患者临床病理特征与超声造影定性特征的关系(例)
临床病理特征 增强速度 增强程度 增强顺序 增强均匀性 增强后边界 穿支血管 灌注缺损 增强后范围
同步 快速 低/等增强 高增强 离心/弥漫性 向心性 均匀 不均匀 清晰 不清 有 无 有 无 增大 无改变
ER                                
阴性 1 37 2 36 3 35 6 32 9 29 30 8 23 15 37 1
阳性 6 45 7 44 3 48 11 40 8 43 41 10 26 25 43 8
χ2值 1.405 0.911 0.000 0.471 0.901 0.028 0.802 2.773
P值 0.236a 0.340a 1.000a 0.493 0.342 0.867 0.371 0.096a
PR                                
阴性 1 48 2 47 4 45 10 39 10 39 41 8 28 21 47 2
阳性 6 34 7 33 2 38 7 33 7 33 30 10 21 19 33 7
χ2值 3.472 3.011 0.028 0.121 0.121 1.027 0.192 3.011
P值 0.062a 0.083a 0.867a 0.728 0.728 0.311 0.661 0.083a
HER-2                                
阴性 7 41 6 42 2 46 8 40 8 40 36 12 28 20 40 8
阳性 0 41 3 38 4 37 9 32 9 32 35 6 21 20 40 1
χ2值 4.633 0.208 0.390 0.400 0.400 1.473 0.452 3.483
P值 0.031a 0.649a 0.533a 0.527 0.527 0.225 0.501 0.062a
Ki-67                                
低表达 4 16 5 15 1 19 3 17 1 19 16 4 11 9 15 5
高表达 3 66 4 65 5 64 14 55 16 53 55 14 38 31 65 4
χ2值 3.305 4.355 0.000 0.043 2.247 0.000 0.000 4.355
P值 0.069a 0.037a 1.000a 0.836a 0.134a 1.000a 0.995 0.037a
组织学分级b                                
1/2级 5 49 8 46 2 52 13 41 10 44 43 11 25 29 48 6
3级 1 21 1 21 4 18 4 18 6 16 17 5 16 6 20 2
χ2值 0.049 0.749 2.735 0.065 0.290 0.000 4.395 0.000
P值 0.824a 0.387a 0.098a 0.798a 0.590a 1.000a 0.036 1.000a
淋巴结状态                                
阴性 6 38 4 40 1 43 8 36 10 34 36 8 25 19 40 4
阳性 1 44 5 40 5 40 9 36 7 38 35 10 24 21 40 5
χ2值 2.580 0.000 1.537 0.048 0.740 0.225 0.109 0.000
P值 0.108a 1.000a 0.215a 0.827 0.390 0.635 0.741 1.000a
病灶直径                                
<20 mm 7 36 7 36 2 41 7 36 4 39 33 10 26 17 38 5
≥20 mm 0 46 2 44 4 42 10 36 11 35 38 8 23 23 42 4
χ2值 6.036 2.292 0.114 0.429 3.386 0.474 0.984 0.011
P值 0.014a 0.130a 0.736a 0.513 0.066 0.491 0.321 0.915a
图1 乳腺癌患者乳腺超声造影图像　a、c图为Ki-67高表达乳腺癌超声造影图像；b、d图为Ki-67低表达乳腺癌超声造影图像注：a、c图呈高增强，增强后病灶范围较常规超声增大，WIS＝2.19 dB/s，PI＝7.73 dB，WiAUC＝28.93 dB·s；b、d图呈低增强，增强后病灶范围较常规超声未见明显增大，WIS＝0.99 dB/s，PI＝4.82 dB，WiAUC＝24.34 dB·s；蓝色圆圈为勾画的感兴趣区；WIS为上升斜率；PI为峰值强度；WiAUC为灌注曲线下面积
表3 89例乳腺癌患者临床病理特征与超声造影定量参数的关系[M(P25，P75)]
临床病理特征 WIS(dB/s) TTP(s) PI (dB) RT(s) WiUAC (dB·s)
ER          
阴性 1.51(1.15，1.96) 15.37(13.64，18.12) 9.31(7.16，13.10) 5.57(4.39，6.56) 54.07(32.48，75.83)
阳性 1.10(0.80，1.82) 16.86(13.29，20.93) 6.66(5.13，9.62) 5.22(4.10，6.70) 38.48(26.55，63.50)
Z值 －2.472 －0.643 －2.870 －0.601 －2.140
P值 0.013 0.520 0.004 0.548 0.032
PR          
阴性 1.49(1.14，1.98) 15.35(13.61，18.81) 9.53(7.20，11.87) 5.55(4.35，6.76) 53.78(33.52，76.02)
阳性 1.00(0.76，1.64) 17.24(13.07，20.87) 6.34(5.09，8.84) 5.33(4.20，6.60) 35.78(24.12，60.79)
Z值 －2.965 －0.499 －3.361 －0.466 －2.672
P值 0.003 0.618 0.001 0.641 0.008
HER-2          
阴性 1.25(0.88，1.64) 15.80(13.65，20.35) 7.52(5.75，9.60) 5.15(4.07，6.44) 38.52(28.73，57.00)
阳性 1.43(0.99，1.99) 15.94(13.46，19.68) 8.56(6.15，12.85) 5.60(4.50，6.81) 55.72(30.04，79.12)
Z值 －1.436 －0.111 －1.897 －1.103 －2.161
P值 0.151 0.912 0.058 0.270 0.031
Ki-67          
低表达 1.00(0.65，1.77) 16.77(12.70，21.61) 6.34(4.25，8.47) 5.09(3.78，6.84) 33.50(18.99，47.70)
高表达 1.43(1.00，1.94) 15.90(13.65，19.04) 8.42(6.20，11.75) 5.41(4.35，6.68) 50.38(31.64，75.75)
Z值 －2.172 －0.039 －2.713 －0.492 －2.620
P值 0.030 0.969 0.007 0.623 0.009
组织学分级a          
1/2级 1.41(0.92，1.92) 16.13(13.32，18.94) 8.12(5.86，11.57) 5.39(4.28，6.81) 47.44(29.20，76.56)
3级 1.40(0.97，1.60) 15.35(13.87，20.80) 8.32(6.20，11.02) 5.82(4.30，6.95) 42.73(32.45，69.68)
Z值 －0.493 －0.338 －0.126 －0.613 －0.069
P值 0.622 0.735 0.900 0.540 0.945
淋巴结状态          
阴性 1.36(1.00，1.87) 15.69(13.34，19.30) 7.59(5.33，11.73) 4.97(4.34，6.03) 40.20(29.29，64.27)
阳性 1.35(0.86，1.92) 16.50(13.62，20.08) 7.78(6.15，10.72) 5.73(4.09，7.00) 46.77(31.84，72.39)
Z值 －0.382 －0.234 －0.238 －1.503 －0.866
P值 0.703 0.815 0.812 0.133 0.386
病灶直径          
<20 mm 1.33(0.81，1.75) 17.75(13.64，20.93) 7.20(5.52，10.48) 5.36(4.35，6.43) 40.56(24.84，63.50)
≥20 mm 1.42(1.00，1.94) 15.35(13.33，19.15) 8.66(6.17，11.82) 5.42(4.22，6.92) 50.89(30.98，76.56)
Z值 －0.998 －0.895 －1.437 －0.316 －1.404
P值 0.318 0.371 0.151 0.752 0.160
表4 89例乳腺癌患者临床病理特征与超声造影特征的关系二元Logistic回归分析结果
因变量自变量 回归系数 标准误 Wald值 P值 OR值 95%置信区间
ER            
PI －0.098 0.047 4.337 0.037 0.907 0.827~0.994
Ki-67            
增强程度 1.626 0.797 4.159 0.041 5.082 1.065~24.241
WiAUC 0.029 0.013 5.464 0.019 1.030 1.005~1.055
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