彩色多普勒超声对乳腺癌微钙化的诊断价值及微钙化与预后的关系

Diagnostic value of color Doppler ultrasonography for microcalcifications in breast cancer and the correlation between microcalcifications and patient prognosis

摘要:

目的 探讨彩色多普勒超声对乳腺癌微钙化的诊断价值并分析微钙化与预后的关系。方法 回顾性分析2017年6月—2018年6月天津医科大学肿瘤医院收治的乳腺癌患者420例临床资料。以术后病理诊断为金标准，评估彩色多普勒超声对微钙化的诊断效能。根据预后情况，将420例患者分为预后良好组（346例）和预后不良组（74例），采用单因素分析及多因素Logistics回归分析探究乳腺癌患者预后不良的危险因素。结果 超声微钙化影像学特点主要表现为肿块内部及其周边存在点状强回声，以及乳腺腺体内可见沿导管走形方向分布的点状强回声；伴钙化的肿块表现为边缘不光整，形态不规则，边缘毛刺，部分纵横比> 1。其中部分微钙化患者腺体内沿导管走形方向分布的强回声光点，该类钙化提示可能有导管内癌或原位癌，患者预后较好；超声诊断乳腺癌微钙化的准确率为71.4%（95% CI：0.672，0.845），敏感性为74.2%（95% CI：0.703，0.871），特异性为62.8%（95% CI：0.575，0.726），阳性预测值为86.1%（95% CI：0.744，0.943），阴性预测值为43.8%（95% CI：0.363，0.579）。多因素Logistic回归分析结果显示：肿瘤直径≥ 2 cm［O^R=2.401（95% CI：1.105，5.216）］、有淋巴结转移［O^R=2.583（95% CI：1.494，4.466）］、微钙化［O^R=5.376（95% CI：2.105，13.729）］是乳腺癌患者术后预后不良的危险因素（P <0.05）；TNM分期为Ⅰ、Ⅱ期［O^R=0.269（95% CI：0.160，0.452）］、术后放疗［O^R=0.345（95% CI：0.202，0.590）］、术后化疗［O^R=0.310（95% CI：0.179，0.537）］是乳腺癌患者术后预后不良的保护因素（P <0.05）。结论 彩色多普勒超声对乳腺癌微钙化具有一定诊断价值。乳腺癌手术患者预后受多种因素影响，微钙化是患者预后不良的独立影响因素。

Abstract:

Objective To investigate the diagnostic value of color Doppler ultrasonography for microcalcifications in breast cancer and to analyze the correlation between microcalcifications and patient prognosis.Methods The clinical data of 420 patients with breast cancer who underwent surgical treatments in our hospital from June 2017 to June 2018 were retrospectively analyzed. The diagnostic efficiency of color Doppler ultrasound for microcalcifications was evaluated, with postoperative pathological diagnosis as the gold standard. According to the prognosis, 420 patients were divided into good prognosis group (n = 346) and poor prognosis group (n = 74). Univariate and multivariate Logistic regression analyses were used to explore the risk factors for poor prognosis in breast cancer patients.Results The main imaging features of microcalcifications under the color Doppler ultrasonography were punctate hyperechoic foci within and around the masses, and those distributed along the breast ducts. The masses with calcifications were characterized by the ill-defined edge, irregular shape, spiculation, and the ratio of longitudinal to transverse diameter greater than 1 in some masses. The microcalcifications distributed along the breast ducts in some patients were indicative of the presence of ductal carcinoma or carcinoma in situ, and the prognosis of these patients was better. The diagnostic accuracy of color Doppler ultrasonography for the microcalcifications in breast cancer was 71.4% (95% CI: 0.672, 0.845), with a sensitivity of 74.2% (95% CI: 0.703, 0.871), a specificity of 62.8% (95% CI: 0.575, 0.726), a positive predictive value of 86.1% (95% CI: 0.744, 0.943), and a negative predictive value of 43.8% (95% CI: 0.363, 0.579). Multivariate Logistic regression analysis showed that tumor diameter greater than 2 cm [O^R = 2.401 (95% CI: 1.105, 5.216)], lymph node metastasis [O^R = 2.583 (95% CI: 1.494, 4.466)], and microcalcifications [O^R = 5.376 (95% CI: 2.105, 13.729)] were risk factors for poor prognosis of breast cancer patients (P < 0.05). However, stage Ⅰ and II tumors [O^R = 0.269 (95% CI: 0.160, 0.452)], postoperative radiotherapy [O^R = 0.345 (95% CI: 0.202, 0.590)] and postoperative chemotherapy [O^R = 0.310 (95% CI: 0.179, 0.537)] were protective factors for poor prognosis of breast cancer patients (P < 0.05).Conclusions Color Doppler ultrasonography is of certain diagnostic value for microcalcifications in breast cancer. The postoperative prognosis of breast cancer patients is influenced by multiple factors, and the presence of microcalcifications represents an independent influencing factor for poor patient prognosis.