Features of mammographic mass edge in digital X-ray three dimensional tomography and their correlations with pathological parameters in breast cancer / 肿瘤研究与临床

ABSTRACT

Objective To analyze the diagnostic value of features of mammographic mass edge in digital three dimensional tomography, and to discuss the correlations between the mammographic mass edge features and pathological features and molecular biological indicators, in order to provide evidence for early and accurate diagnosis and treatment of breast cancer and prognosis evaluation. Methods A retrospective analysis was made in 392 cases of breast cancer confirmed by operation and pathology in the People ' s Hospital of Shanxi Province from August 2017 to June 2018. These patients were examined by digital breast tomography (DBT) and full-field digital mammography (FFDM) before operation. Postoperative specimens were stained by immunohistochemical SP method to measure the expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and Ki-67. The correlation between the mammographic mass edge features and pathological features and molecular biological indicators were analyzed by usingχ2 test and Fisher exact probability method. Results In 392 patients, 352 cases (89.80％) were invasive ductal carcinoma, 6 cases (1.53％) were ductal carcinoma in situ with microinvasion, 7 cases (1.79％) were invasive lobular carcinoma, 17 cases (4.34％) were papillary carcinoma, 8 cases (2.04％) were mucinous carcinoma, 1 case (0.26％) was medullary carcinoma, and 1 case (0.26％) was metaplastic carcinoma. DBT were significantly better than FFDM in the detection rate [93.6％ (367/392) vs. 77.8％ (305/392)] and the diagnostic coincidence rate [88.2％(345/392) vs. 76.8％(278/392)] for breast cancer and judging the marginal features of tumor. The DBT imaging features of mucinous carcinomas were mostly regular in shape and clear in margin. The DBT imaging features of invasive ductal carcinomas were marginal burr sign or burr with lobulation sign. Immunohistochemical detection displayed the positive expression rates of ER and PR were highest, the positive expression rates of HER2 and Ki-67 were the lowest in marginal burr masses;the positive expression rates of ER and PR were high, the positive expression rates of HER2 and Ki-67 were low in marginal lobulated masses; the positive expression rate of HER2 was highest in borderline masses or partial borderline masses; the positive expression rates of HER2 and Ki-67 were highest in clear margin masses. Conclusions Breast DBT can reduce or eliminate the tissue overlap in FFDM examination, and improve the detection rate, the diagnostic coincidence rate and the specificity of breast cancer. It can also indirectly provide evidence for preoperative judgment of biological behavior of tumors, guide clinical treatment and assess the prognosis through the morphological and marginal features of breast masses. Breast DBT is worthy of a wide clinical application in breast examination.