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目的评价乳腺导管原位癌(DCIS)及 DCIS 伴微浸润的 X 线片表现,分析 X 线表现与预后生物学标记的相关性。方法对50例乳腺 DCIS 及45例 DCIS 伴微浸润的患者行 X 线检查,共62例行预后生物学标记,分析影像表现与孕激素受体(PR)、癌基因(C-erbB-2)、抑癌基因(p53)的相关性。用卡方检验进行统计学处理,并对有意义者行优势比(OR 值)分析。结果 (1)单独1个X线征象表现者62例;合并2个征象26例;阴性7例。(2)各种 X 线征象单独分析显示,62例有钙化的病灶中恶性钙化占73%(45例),其余为中间性钙化;钙化以簇状分布最为常见(36例),其次为段样分布(18例)。22例有肿块的病灶中,以卵圆形肿块最为常见(13例);肿块的边缘表现为浸润、小分叶、清晰和模糊各为15、1、4和2例;等密度肿块占的比例较高(55%,12例)。结构扭曲7例,除1例外多与其他征象伴行;局灶性不对称占16%(15/95),可单独发生或与其他征象伴发。(3)将病灶的 X 线表现分成恶性钙化、中间性钙化和非钙化3组,PR 与 C-erbB-2在3组中的分布有统计性意义,PR 阳性表达者 X 线上非钙化征象发生率是中间性钙化的11.00倍[χ~2=8.571,P=0.003;95%可信区间(CI)为1.998～60.572]、恶性钙化的8.80倍(χ~2=9.748,P=0.002;95% CI 为2.024～38.253);而 C-erbB-2高表达者,恶性钙化是非钙化发生的12.35倍(χ~2=7.353,P=0.007;95% CI 为1.447～105.443),中间性钙化的5.74倍(χ~2=4.977,P=0.026;95% CI 为1.110～29.645)。结论乳腺 DCIS 及 DCIS 伴微浸润 X 线征象有特征。X 线征象可以作为早期乳腺 DCIS 的一个预后因子。
Objective To evaluate the performance of ductal carcinoma in situ (DCIS) and DCIS with microinvasion in breast duct and to analyze the correlation between X-ray findings and prognostic biomarkers. Methods Fifty-two patients with DCIS and 45 patients with DCIS with microinvasion underwent X-ray examination. A total of 62 patients were enrolled in this study. Prognostic biomarkers were used to analyze the relationship between the imaging findings and the expression of progesterone receptor (PR), oncogene (C-erbB-2) , Tumor suppressor gene (p53) correlation. Chi-square test for statistical analysis, and meaningful line odds ratio (OR) analysis. Results (1) A single X-ray manifestations in 62 cases; merger two signs in 26 cases; negative in 7 cases. (2) Independent analysis of various X-ray findings showed that malignant calcification in 62 cases with calcification accounted for 73% (45 cases), and the rest were intermediate calcifications; the cluster with calcification was the most common (36 cases), followed by segment Like distribution (18 cases). Of the 22 cases with lumps, ovoid lumps were the most common (13 cases). The margins of the lumps showed infiltration, small lobes with 15, 1, 4 and 2 cases of clear and fuzzy lesions respectively. A higher proportion (55%, 12 cases). Structural distortions were found in 7 cases, with the exception of 1 case and more with other signs; focal asymmetry accounted for 16% (15/95), can occur alone or with other signs. (3) The X-ray findings of the lesions were divided into three groups: malignant calcification, intermediate calcification and non-calcification. The distribution of PR and C-erbB-2 in three groups was statistically significant. The positive expression of PR in non-calcification The incidence of intermediate calcification was 11.00-fold (χ ~ 2 = 8.571, P = 0.003; 95% CI was 1.998-60.572) and 8.80 times higher than malignant calcification (χ ~ 2 = 9.748, P = 0.002; 95% CI was 2.024-38.253). In patients with high expression of C-erbB-2, malignant calcification was 12.35 folds of non-calcification (χ ~ 2 = 7.353, P = 0.007; 95% CI 1.447 ~ 105.443) 5.74 fold (χ ~ 2 = 4.977, P = 0.026; 95% CI 1.110 ~ 29.645). Conclusion The characteristics of breast DCIS and DCIS with micro-infiltration X-ray findings. X-ray findings can be used as a prognostic factor for early breast DCIS.