| Objective: By analyzing the distribution of breast density in breast cancer patients and normal population,and conducting comparative study,more information and basis can be provided to further explore the relationship between breast density and breast cancer risk.Based on this study,the distribution of breast density among breast cancer patients with different molecular subtypes was analyzed,providing more information and basis for exploring the correlation between breast density and breast cancer molecular subtype.Methods: 1.Retrospective analysis of 1941 cases of female patients with breast cancer who received bilateral mammography(MG)and were pathologically diagnosed as breast cancer during the period from August 2015 to August 2016 in the Tianjin Medical University Cancer Hospital,as the experimental group.Age ranges from 24 to 88 years,with average age(52.7 ± 10.7)years.A total of 1503 outpatient physical examination patients who had no positive findings by bilateral mammography at the same time were analyzed,which was treated as the control group.Age range 18 to 85 years,median age was(45.7 ± 10.4)years.Under the optical microscope,normal tissue around the lesion was observed in all cases in the experimental group,the anatomical histological structure of the breast was observed and the breast was roughly classified.All mammography original images were fully automated to measure breast density by CAD system Quantra software.SPSS19.0 was used for statistical analysis.The experimental group calculated the density of the breast.In the control group,double breast density was calculated.Pearson test was used to assess whether the age of the experimental group and the control group were correlated with breast density.Using rank sum test was a significant difference in breast density between the experimental group and the control group at <45,45~54,55~64 and ≥65 years old.P < 0.05 was considered to be statistically significant.2.In the experimental group,1407 cases with complete postoperative immunohistochemical staining results were selected,all of them female,ranging in age from 25 to 87 years old,with the average age of(53.5 ± 10.41)years.The density in healthy side breast of each patient was recorded and classified according to immunohistochemical results.Immunohistochemical analysis criteria: positive expression of ER and PR indicated that the number of nuclear staining of invasive tumor was greater ≥1%,while negative expression indicated that the number of cells was < 1%.The positive expression of Ki-67 showed that brown-yellow granules appeared in tumor nuclei,the positive cells were greater ≥14%,and the positive cells were <14%.According to the expression level of HER2,the cells were divided into negative(--),weak positive(1+),positive(2+)and strong positive(3+),and further appropriate classification was conducted when fluorescence in situ hybridization(FISH)was used for unclear classification of positive(2+)patients.According to immunohistochemical results,1407 cases of breast cancer were divided into 186 cases of luminal A type breast cancer,895 cases of luminal B type breast cancer,189 cases of HER2-enriched type breast cancer and 137 cases of triple-negative type breast cancer.According to the age of < 45 years old,45 ~ 54 years old,55 ~ 64 years old or ≥65 years old,1407 patients were divided into 4 age groups.SPSS 19.0 was used for statistical analysis.Descriptive analysis was used to compare the distribution of breast density in different age groups and different molecular sub types of breast cancer.Kruskal-wallis test was used to analyze the differences in breast density between different molecular subtypes.P < 0.05 was statistically significant.Results:1.In the control group,there were a total of 1503 cases,with the density range from 2.5% to 50.5%,and the average density value(18.6 ± 7.9)%.There was a negative correlation between age and breast density(r=-0.39,P < 0.05).There were a total of 1941 cases in the experimental group,with the breast density ranging from 2.5% to 60% and an average density value(14.49 ± 7.62)%.Among the 113 cases with ductal carcinoma in situ,the breast density range was 5% to 34%,and the average density value(14.8% ± 6.59)%.In 1813 cases of invasive carcinoma,the breast density range was 2.5% to 60%,and the average density value(14.49 ± 7.68)%.After the rank-sum test,the difference was not statistically significant(P=0.29).In the experimental group,there was a negative correlation between age and breast density(r=-0.55,P < 0.05).After the rank-sum test,the breast density between the experimental group and the control group was statistically significant(P < 0.01).2.The experimental group and the control group were divided into < 45 years old,45 ~ 54 years old,55 ~ 64 years old,and ≥ 65 years old.In the control group,there were 701 cases in the < 45 years old group,and the breast density range was 2.5% to 47%,and the average density value(20.13 ± 7.56)%;There were 524 cases in the 45~54 age group,and the density of the breast was 4.25% to 50.5%,and the average density value(19.02 ± 7.19)%.There were 227 cases in the 55~64 age group with a density range of 4% to 49.25%,and the average density value(12.2 ±5.81)%.There were 51 cases in the ≥65 years old group,and the density of breast density was 3.75% to 19%,and the average density value(8.78 ± 3.25)%.In the experimental group,there were 448 cases in the < 45 years old group,and the density range of the breast was 5.5% to 60%,and the average density value(21.08 ± 7.60)%.There were 660 cases in the group of 45~54 years,and the density range of breast was 3.5% to 53.5%,and the average density value(16.19 ± 7.12)%.There were 576 cases in the 55~64 years group,and the density range of the breast was 3.5% to 49.5%,and the average density value(10.99 ± 5.39)%.There were 257 cases in ≥ 65 years older group,and the density range of the breast was 2.5% to 24%,and the average density value(8.18 ± 3.48)%.Evaluate separately by the rank and inspection < 45 years old,45 ~ 54 years old,55 ~64 years old,or ≥65 years old people aged breast density,the experimental group and control group in which < 45 years old of breast density,experimental groups were higher than the control group,the difference was statistically significant(P < 0.05);45 ~ 54 years old,55 ~ 64 years old,and ≥ 65 years old groups,The breast density in the control group was higher than the experimental group,and the difference was statistically significant(P < 0.05).3.1407 cases in the experimental group extraction,different age groups of patients with breast cancer of breast density according to the descriptive analysis results showed that the < 45 years old group 298 examples,breast density range 4.5% to 43.5%,the average density value(20.14 ± 7.08)%.There were 469 cases in the 45~54 age group,with the breast density range of 3.5% to 53.5% and the average density value was(16.42 ± 7.82)%.There were 449 cases in the 55~64 age group,and the density of the breast was 3.5% to 49.5%,and the average density value(10.91 ± 5.41)%.A total of 191 patients were ≥65 years old,and the density of the breast was 2.5% to 21.5%,and the average density value(8.15 ± 3.36)%.4.The 1407 cases were classified according to the breast cancer molecular subtype : there were 186 cases of luminal A type,breast density rang of 2.5% to 49.5%,and average density value(14.04 ± 8.11)%.luminal B type of 895 cases,breast density range of 3% to 53.5%,average density value(14.48 ± 7.59)%.There were 189 cases with HER2-enriched type,the density range of the breast was 4% to 43.5%,and the average density value(14.78 ± 7.68)%.A total of 137 cases were triple-negative type,and the density of the breast was 3.5% to 37.5%,and the average density value(13.17 ± 7.3)%.The statistical analysis needed to balance the data of each group.The number of cases in luminal B was 378 randomly(the maximum number of cases in the other three groups was 2 times),and the total number of cases in the final study was 890.The molecular subtypes were grouped by age group,and Kruskal-wallis test was used to analyze the breast density in different age groups.Where <45 years old group between different molecular subtypes of breast density difference was statistically significant(P = 0.02,P < 0.05),the rest of the group in breast density differences between the various molecular subtypes has no statistical significance(P = 0.79;P = 0.78;P = 0.75).Conclusion:1.Correlation analysis showed that age was negatively correlated with breast density,and the density of the breast decreased with age.Among young people,the experimental group had higher breast density than the control group.As different age,however,the experimental group and control group of breast density distribution is also changed,this could herald a breast density and the relationship between breast cancer risk may vary among different with age,breast density and the relationship between breast cancer risk is still need further research are discussed.2.In breast density and the research of the relativity of breast cancer molecular subtypes,< 45 years of age group of patients with breast cancer of breast density in different has significant statistical differences between breast cancer molecular subtypes,the difference between HER2-enriched type and triple-negative type was most significantand,the rest of the group of breast density and significantly associated with breast cancer molecular subtypes has yet to see,show that breast density and has correlation between breast cancer molecular subtypes,but it is not clear whether affected by factors such as age,whether breast density can foresee the breast cancer molecular subtypes will need to be further explored. |
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