| Objective: To explore the characteristics of mammographic density in breast cancer patients with different pathological characteristics and explore the diagnostic value of mammographic characteristics combined with mammographic density and risk factors for breast cancer.Methods: A retrospective analysis of 330 patients(aged 45-70 years old,benign 114 cases,and malignant 216 cases)who were treated in our hospital with unilateral breast mass from October 2018 to November 2019.All patients used the American Hologic Selenia Dimensions machine to take DBT and observe the image characteristics,including mass size,shape,margin,density and calcification;the computer-aided diagnostic system Quantra software of the American Hologic company was used to measure breast density values and record density value of the healthy side breast of the patients;data on breast cancer risk factors were collected including menstrual time,family history of breast cancer,and fertility history.Malignant patients were collected for pathological features,including immunohistochemical results,size,and presence or absence of lymph node metastasis.All patients were divided into two groups according to age,which are ≤55-years-old group and> 55-years-old group,and each group was compared separately.SPSS 21.0 and Med Calc were used to analyze and process the data.The chi-square test/Fisher exact probability method was used for the count data,and the rank sum test was used for the quantitative data.The ROC curve was drawn to evaluate the diagnostic efficacy of each image feature,risk factor,and mammographic density.Logistic regression was used to calculate the efficacy of image features,image features combined with breast density and risk factors for the benign and malignant identification of breast mass.Compare diagnostic value with Z test.Results: 1.Pathological features and mammography density of breast cancer patientsIn the ≤55-year-old group,there was no significant difference in mammography density between patients with negative and positive ER,PR,Ki-67,and HER-2 expression(P values were 0.462,0.983,0.928,0.236,P> 0.05);In the > 55-years-old group,there was no significant difference in mammography density between patients with negative and positive ER,PR,and Ki-67 expression(P values were 0.556,0.187,0.459,P> 0.05).The interquartile range of mammographic density was 8.00(5.50,10.50)in patients with HER-2 negative expression,and 10.00(7.50,12.50)in patients with positive HER-2 expression.The difference was statistically significant(P = 0.023,P <0.05).There was no significant difference in mammographic density between patients with a breast mass of ≤ 2 cm and≥ 2 cm in the ≤ 55-year-old group and the> 55-year-old group(P values were 0.219,0.295,P> 0.05).There was no significant difference in mammographic density between patients with and without lymph node metastasis in the ≤55-year-old group and the> 55-year-old group(P values were 0.867,0.072,P> 0.05).2.Mammography densityIn the>55-year-old group,the interquartile range of breast density was 8.00(7.00,11.75)in malignant patients,which was higher than 8.00(6.00,10.75)in benign patients,the difference was statistically significant(P=0.034,P<0.05);In the≤55-yearold group,there was no significant difference in breast density between benign and malignant patients.3.Breast cancer risk factors and imaging features of breast massesThere was no significant difference in the family history of breast cancer and the history of atypical hyperplasia in benign and malignant patients.In the ≤55-year-old group,the interquartile range of menstrual time was 35.00(33.50,36.50),which was higher than that of benign patients 34.00(32.10,35.90),and the difference was statistically significant P=0.028(P<0.05).In the >55-year-old group,the interquartile range of menstrual time was 36.50(34.00,39.00),which was higher than that of benign patients 36.00(34.50,37.50).The difference was statistically significant P=0.045(P <0.05).In the ≤55-year-old group and the> 55-year-old group,the differences in image size,shape,margin,density,and calcification of breast masses in benign and malignant patients were statistically significant(P<0.05).4.Analysis of image characteristics,risk factors and breast density of benign and malignant patients by ROC curve analysisIn the ≤55-year-old group,the AUC of mass size,shape,margin,density,calcification,and transit time were 0.746(95% CI 0.665-0.837),0.754(95% CI 0.661-0.841),0.851(95% CI 0.781-0.922)),0.724(95% CI 0.629-0.818),0.679(95% CI 0.581-0.776),0.617(95% CI 0.515-0.718).The cut-off value for menstrual time is 35.5 years.In the>55-year-old group,the AUC of mass size,shape,margin,density,calcification,menstrual time,and breast density were 0.726(95% CI 0.648-0.804),0.718(95% CI 0.642-0.794),and 0.854(95% CI 0.804-0.905),0.712(95% CI 0.626-0.798),0.616(95% CI 0.536-0.696),0.589(95% CI 0.509-0.669),0.611(95% CI 0.509-0.680).The diagnostic cut-off value of menstrual time was 36.5 years,and the diagnostic cut-off value of breast density was 12.5.Establish regression model of image features and total combined model of image features combined density and risk factors.In the ≤55-year-old group(excluding calcification features),the AUC of the image features model is 0.932(95% CI 0.891-0.974),the sensitivity is 0.768,and the specificity is 0.935;The AUC of the total combined model was 0.958(95% CI 0.929-0.988),the sensitivity was 0.821,and the specificity was 0.935,and the difference was not statistically significant(P = 0.058).In the > 55-year-old group(excluding the calcification and menstrual time characteristics),the AUC of the image features model is 0.915(95% CI 0.878-0.953),the sensitivity is 0.766,and the specificity is 0.931;the AUC of the total combined model is 0.943(95% CI 0.913-0.973),and the sensitivity It was 0.864 and the specificity was 0.897.The difference was statistically significant(P = 0.03,P<0.05).Conclusion: 1.For patients more than 55 years,mammographic density was relatively high in patients with HER-2 expression.2.Malignant patients have a longer menstrual period than benign patients,but combined imaging features cannot significantly improve the diagnostic efficacy of benign and malignant breast lesions.3.The mammographic density in malignant patients is higher than that in benign patients.For patients more than 55 years,the diagnostic efficacy of mammographic density combined with imaging features is better than that of imaging features.4.Mammographic density has certain diagnostic value for HER-2 expression status and benign and malignant differentiation of breast masses,and it is significant in patients more than 55 years. |
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