经麦默通活检诊断为乳腺导管内癌病例出现病理低估的影响因素研究
发布时间：2019-03-30 17:44
【摘要】：乳腺癌是女性常见恶性肿瘤之一,尽管通过多样的乳腺癌筛查手段越来越多的早期乳腺癌被发现,但伴随着逐年升高的发病率,乳腺癌仍严重威胁着女性的生命安全和生活质量。乳腺癌的术前诊断意义重大,关系到患者治疗方式的选择。麦默通因其诊断准确、损伤小、操作简单等优点广泛应用于乳腺疾病的诊断和治疗中。导管内癌(ductal carcinoma in situ,DCIS)是肿瘤未突破基底膜,有发展成为浸润性乳腺癌倾向的一种乳腺恶性疾病,临床诊断中容易出现病理低估。本研究回顾性分析了2009年至2015年间在吉林大学第一医院乳腺外科经麦默通穿刺活检病理证实为DCIS且进一步接受手术治疗的病例46例,研究影响DCIS病理低估的因素,从而在临床实践中实现更高的病理准确性。研究目的:探讨影响经麦默通穿刺活检病理证实为DCIS病理低估的因素,为临床个体化治疗提供理论依据。研究方法:回顾性分析了2009年1月至2015年12月间于吉林大学第一医院乳腺外科接受乳腺病灶麦默通穿刺活检证实DCIS的病例46例。所有的统计数据以SPSS 22.0软件进行分析。组间差异比较采用卡方检验或Fisher确切概率法,取P0.05为有统计学意义,并进行多因素Logistic回归分析,找到经麦默通穿刺活检诊断为DCIS病例出现病理低估的影响因素。研究结果:46例病例均为女性病例,平均年龄50.6岁。术后石蜡病理证实DCIS 31例、DCIS伴微小浸润10例、浸润性导管癌4例、浸润性筛状癌1例。15例病例出现病理低估。麦默通穿刺活检证实为DCIS的病理低估率为32.6%。对单因素分析具有统计学意义的3项因素(乳腺X线摄影是否伴有钙化、超声下肿物最大径、活检组织条数)进行多因素Logistic回归分析后,发现乳腺X线摄影是否伴有钙化、活检组织条数被证实为病理低估发生的独立预测因素,相对危险度OR值分别为:5.114和5.756。当肿物伴有钙化或穿刺条数较少时容易发生病理低估。结论:麦默通穿刺活检是公认的准确性较高的术前诊断方式,但经麦默通穿刺活检后仍有病理低估的发生,尤其当穿刺病理诊断为导管内癌时应引起注意。乳腺X线摄影发现病灶伴有钙化时可增加活检组织条数,会降低病理低估率,从而对手术方式的选择提供合理依据。
[Abstract]:Breast cancer is one of the most common malignant tumors in women. Although more and more early breast cancer has been detected by various breast cancer screening methods, the incidence of breast cancer is increasing year by year. Breast cancer continues to pose a serious threat to the safety and quality of life of women. Preoperative diagnosis of breast cancer is of great significance, which is related to the choice of treatment. It is widely used in the diagnosis and treatment of breast diseases because of its accurate diagnosis, small damage, simple operation and so on. Intraductal carcinoma (ductal carcinoma in situ,DCIS) is a malignant breast disease which does not break through the basement membrane and develops into invasive breast cancer. It is easy to appear pathological underestimation in clinical diagnosis. In this study, 46 cases of DCIS and further surgical treatment were analyzed retrospectively in the breast surgery department of the first Hospital of Jilin University from 2009 to 2015. The factors influencing the pathological underestimation of DCIS were studied. In order to achieve higher pathological accuracy in clinical practice. Objective: to explore the factors that influence the pathological underestimation of DCIS confirmed by biopsy and provide theoretical basis for clinical individualized treatment. Methods: from January 2009 to December 2015, 46 cases of DCIS confirmed by Mammerton biopsy in the breast surgery department of the first Hospital of Jilin University were retrospectively analyzed. All the statistics were analyzed with SPSS 22.0 software. The differences between groups were compared by chi-square test or Fisher exact probability method. P0.05 was statistically significant, and multivariate Logistic regression analysis was carried out to find out the influencing factors of pathological underestimation in DCIS cases diagnosed by McMurton puncture biopsy. Results: all 46 cases were female with an average age of 50.6 years. 31 cases of DCIS, 10 cases of DCIS with microinfiltration, 4 cases of invasive ductal carcinoma and 1 case of infiltrating sieve carcinoma were confirmed by paraffin-embedded pathology. The pathological underestimation rate of DCIS confirmed by biopsy was 32.6%. Univariate Logistic regression analysis of three factors (X-ray radiography of breast with calcification, maximum diameter of tumor under ultrasound, number of biopsy tissue) showed that mammography was accompanied with calcification or not, and it was found that there was no calcification in mammography, and that there was no calcification in breast X-ray radiography. The number of biopsy tissues was proved to be an independent predictor of pathological underestimation. The OR values of relative risk were 5.114 and 5.756, respectively. Pathological underestimation occurs when the tumor is accompanied by calcification or the number of puncture strips is small. Conclusion: Mymerton puncture biopsy is recognized as a highly accurate method for preoperative diagnosis, but there is still a pathological underestimation after the biopsy, especially when the biopsy is diagnosed as intraductal carcinoma. Mammography can increase the number of biopsy tissues with calcification, and reduce the rate of pathological underestimation, thus providing a reasonable basis for the choice of surgical methods.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9
[Abstract]:Breast cancer is one of the most common malignant tumors in women. Although more and more early breast cancer has been detected by various breast cancer screening methods, the incidence of breast cancer is increasing year by year. Breast cancer continues to pose a serious threat to the safety and quality of life of women. Preoperative diagnosis of breast cancer is of great significance, which is related to the choice of treatment. It is widely used in the diagnosis and treatment of breast diseases because of its accurate diagnosis, small damage, simple operation and so on. Intraductal carcinoma (ductal carcinoma in situ,DCIS) is a malignant breast disease which does not break through the basement membrane and develops into invasive breast cancer. It is easy to appear pathological underestimation in clinical diagnosis. In this study, 46 cases of DCIS and further surgical treatment were analyzed retrospectively in the breast surgery department of the first Hospital of Jilin University from 2009 to 2015. The factors influencing the pathological underestimation of DCIS were studied. In order to achieve higher pathological accuracy in clinical practice. Objective: to explore the factors that influence the pathological underestimation of DCIS confirmed by biopsy and provide theoretical basis for clinical individualized treatment. Methods: from January 2009 to December 2015, 46 cases of DCIS confirmed by Mammerton biopsy in the breast surgery department of the first Hospital of Jilin University were retrospectively analyzed. All the statistics were analyzed with SPSS 22.0 software. The differences between groups were compared by chi-square test or Fisher exact probability method. P0.05 was statistically significant, and multivariate Logistic regression analysis was carried out to find out the influencing factors of pathological underestimation in DCIS cases diagnosed by McMurton puncture biopsy. Results: all 46 cases were female with an average age of 50.6 years. 31 cases of DCIS, 10 cases of DCIS with microinfiltration, 4 cases of invasive ductal carcinoma and 1 case of infiltrating sieve carcinoma were confirmed by paraffin-embedded pathology. The pathological underestimation rate of DCIS confirmed by biopsy was 32.6%. Univariate Logistic regression analysis of three factors (X-ray radiography of breast with calcification, maximum diameter of tumor under ultrasound, number of biopsy tissue) showed that mammography was accompanied with calcification or not, and it was found that there was no calcification in mammography, and that there was no calcification in breast X-ray radiography. The number of biopsy tissues was proved to be an independent predictor of pathological underestimation. The OR values of relative risk were 5.114 and 5.756, respectively. Pathological underestimation occurs when the tumor is accompanied by calcification or the number of puncture strips is small. Conclusion: Mymerton puncture biopsy is recognized as a highly accurate method for preoperative diagnosis, but there is still a pathological underestimation after the biopsy, especially when the biopsy is diagnosed as intraductal carcinoma. Mammography can increase the number of biopsy tissues with calcification, and reduce the rate of pathological underestimation, thus providing a reasonable basis for the choice of surgical methods.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9
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