单灶性浸润性小叶癌：术前超声成像与术后病理的肿瘤大小一致性。
Unifocal Invasive Lobular Carcinoma: Tumor Size Concordance Between Preoperative Ultrasound Imaging and Postoperative Pathology.
机构信息
Department of Radiology, University of Massachusetts Medical School, Worcester, MA.
Department of Medical Imaging, University of Arizona, Tucson, AZ.
出版信息
Clin Breast Cancer. 2018 Dec;18(6):e1367-e1372. doi: 10.1016/j.clbc.2018.07.017. Epub 2018 Jul 27.
BACKGROUND
We systematically analyzed the extent of disease in unifocal invasive lobular carcinoma (ILC) using ultrasonography, with the histopathologic findings as the reference standard.
PATIENTS AND METHODS
In the present single-institution retrospective study, 128 cases of ILC were identified during a 5-year period. After exclusions, the analyzed cohort included 66 cases. Ultrasound measurements of the tumor extent along 3 axes were obtained. The tumor size was determined as the largest extent among the 3 axes and the tumor volume by ellipsoidal approximation. Pathology review provided the tumor size and volume. Correlation and regression analyses of tumor size and volume from the ultrasound and pathologic examinations were performed. The tumor stage from the ultrasound and pathologic examinations were used for the concordance analyses.
RESULTS
The median and quartiles (Q1, Q3) of tumor size from ultrasonography and pathology were 12.5 mm (Q1, 9 mm; Q3, 19 mm) and 17 mm (Q1, 12 mm; Q3, 25 mm), respectively. The corresponding data for tumor volume were 0.52 cm (Q1, 0.18 cm; Q3, 1.92 cm) and 1.04 cm (Q1, 0.45 cm; Q3, 2.49 cm). The ultrasound measurements correlated with the pathology-reported tumor size (Spearman ρ = 0.678; P < .0001) and volume (Spearman ρ = 0.699; P < .0001). The ultrasound-measured size and volume differed from the pathology-reported size and volume (P < .0001; Wilcoxon signed ranks test). Concordance between the clinical tumor size stage from ultrasound (cT) and pathology tumor size stage (pT) varied with the pT stage (P = .0003, Fisher's exact test), with the greatest concordance rate of 95.7% (95% confidence limit, 85.2%-99.5%) observed for pT1 tumors.
CONCLUSION
Ultrasonography underestimates the tumor size and volume, with the underestimation increasing for larger tumors. Hence, the concordance rate in tumor size stage between ultrasonography and pathology is tumor size dependent, with the greatest concordance rate observed for pT1 tumors.
背景
我们系统地分析了单发浸润性小叶癌（ILC）的超声病变范围，并以组织病理学发现为参考标准。
患者和方法
在这项为期 5 年的单机构回顾性研究中，确定了 128 例 ILC 病例。排除后，分析队列纳入 66 例患者。获取肿瘤在 3 个轴线上的超声测量结果。肿瘤大小定义为 3 个轴线上的最大范围，肿瘤体积通过椭球近似法确定。病理检查提供肿瘤大小和体积。对超声和病理检查的肿瘤大小和体积进行相关性和回归分析。超声和病理检查的肿瘤分期用于一致性分析。
结果
超声和病理检查的肿瘤大小中位数和四分位数（Q1、Q3）分别为 12.5mm（Q1，9mm；Q3，19mm）和 17mm（Q1，12mm；Q3，25mm）。肿瘤体积的相应数据分别为 0.52cm（Q1，0.18cm；Q3，1.92cm）和 1.04cm（Q1，0.45cm；Q3，2.49cm）。超声测量与病理报告的肿瘤大小（Spearman ρ=0.678；P<0.0001）和体积（Spearman ρ=0.699；P<0.0001）相关。超声测量的大小和体积与病理报告的大小和体积不同（P<0.0001；Wilcoxon 符号秩检验）。超声临床肿瘤大小分期（cT）与病理肿瘤大小分期（pT）的一致性随 pT 分期而变化（P=0.0003，Fisher 精确检验），pT1 肿瘤的一致性率最高，为 95.7%（95%置信区间，85.2%-99.5%）。
结论
超声低估了肿瘤的大小和体积，并且随着肿瘤的增大，低估程度也随之增加。因此，超声和病理检查的肿瘤大小分期之间的一致性率取决于肿瘤大小，pT1 肿瘤的一致性率最高。
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