探讨乳腺实性乳头状癌(SPC)的乳腺超声检查结果及组织病理学结果。

选择2014年1月至2022年5月在山西省肿瘤医院进行手术治疗并经手术切除组织病理学检查确诊的81例乳腺SPC患者为研究对象。根据患者病理学分型，将其分为原位型组(n＝34)与伴浸润型组(n＝47)。采用回顾性分析方法收集2组患者的病变位置、发病年龄、首发症状、乳腺超声检查结果及组织病理学检测结果，并采用χ²检验、连续性校正χ²检验、Fisher确切概率法进行统计学分析。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

①本研究乳腺SPC患者发病年龄较大，>60岁者为56例(69.1%)，61例(75.3%)首发症状为扪及乳腺肿块。2组患者病变位置、发病年龄、首发症状构成比分别比较，差异均无统计学意义(P>0.05)。②对这81例患者的乳腺超声检查结果显示，SPC肿块多表现为单发(65例，80.2%)，低回声(72例，88.9%)，形态不规则(50例，61.7%)，边界清晰(48例，59.3%)，平行位生长(68例，84%)，不伴钙化(75例，92.6%)，后方回声无变化(67例，82.7%)，Adler血流分级为Ⅱ~Ⅲ级(49例，60.5%)，淋巴结无转移(80例，98.8%)，不伴导管扩张(61例，75.3%)。原位型组与伴浸润型组患者上述指标分别比较，差异均无统计学意义(均为P>0.05)。伴浸润型组患者中，被乳腺超声辅助诊断为乳腺影像报告和数据系统(BI-RADS)4类者占比为89.4%(42/47)，显著高于原位型组的67.6%(23/34)，并且差异有统计学意义(χ²＝5.87，P＝0.015)。③这81例患者的手术切除组织免疫组化结果显示，SPC细胞雌激素受体(ER)、孕激素受体(PR)阳性率均为100.0%(81/81)，P63阳性率为39.5%(32/81)，Syn、CgA阳性率分别为63.0%(51/81)与51.8%(42/81)。原位型组患者P63阳性率显著高于伴浸润型组，并且差异有统计学意义(P<0.001)，而2组患者Syn、CgA阳性率比较，差异均无统计学意义(P>0.05)。

乳腺SPC患者的乳腺超声检查结果具有一定特征，其乳腺超声检查结果与组织病理学检查的SPC亚型密切相关。乳腺SPC细胞P63表达，有助于临床对原位型与伴浸润型乳腺SPC患者的区分。

To explore the breast ultrasound examination and histopathological findings of breast solid papillary carcinoma (SPC).

A total of 81 patients with breast SPC who underwent surgical treatment at Shanxi Provincial Cancer Hospital from January 2014 to May 2022 and were confirmed by pathological examination of surgically resected tissues were selected as the research subjects. According to pathological subtypes, they were divided into in situ group (n=34) and invasive group (n=47). Retrospective analysis methods were used to collect lesion location, onset age, initial symptoms, breast ultrasound results, and pathological results of the two groups. Statistical analysis was performed using chi-square test, continuity correction chi-square test, or Fisher′s exact probability method. This study followed the requirements of the 2013 revised World Medical Association Declaration of Helsinki.

① Patients with breast SPC were significantly older, with 56 cases (69.1%) aged ≥60 years. The first symptom of 61 cases (75.3%) was a palpable breast mass.There were no statistically significant differences in lesion location, onset age, and initial symptom composition between two groups (P>0.05). ② The results of breast ultrasound examination of these 81 patients showed SPC masses predominantly exhibited a single occurrence (65 cases, 80.2%), hypoechoic characteristics (72 cases, 88.9%), irregular morphology (50 cases, 61.7%), well-defined borders (48 cases, 59.3%), parallel growth orientation (68 cases, 84%), absence of calcification (75 cases, 92.6%), unchanged posterior echo (67 cases, 82.7%), Adler blood flow grade Ⅱ-Ⅲ (49 cases, 60.5%), no lymph node metastasis (80 cases, 98.8%), and no ductal ectasia (61 cases, 75.3%). However, no statistically significant differences were observed between in situ and invasive groups regarding these parameters (all P>0.05). In the invasive group, 89.4% (42/47) of those diagnosed with Breast Imaging Reporting and Data System (BI-RADS) category 4 by breast ultrasound were significantly higher than 67.6% (23/34) in the in situ group (χ²=5.87, P=0.015). ③The immunohistochemical results of surgically resected tissues from 81 patients showed that the estrogen receptor (ER) and progesterone receptor (PR) positive rates of SPC cells were 100.0% (81/81), the P63 positive rate was 39.5% (32/81), and the Syn and CgA positive rates were 63.0% (51/81) and 51.8% (42/81), respectively. The in situ group exhibited significantly higher P63 positive rate than the invasive group, with a statistically significant difference (P<0.001). However, no statistically significant differences were observed between the two groups in Syn and CgA positive rates (P>0.05).

The breast ultrasound examination results of patients with breast SPC have certain characteristics and are closely correlated with the SPC subtypes detected by histopathological examination. The expression of P63 in breast SPC cells is helpful for clinical differentiation of patients with in situ and invasive breast SPC.