目的 探讨不同分子亚型乳腺癌的MRI征象和病理特征.方法 回顾性分析202例经手术治疗的原发性乳腺癌患者资料,患者在术前均行乳腺MRI检查,癌组织标本采用免疫组织化学检查结果判断分子亚型,分为基底细胞样型、管腔型和人类表皮生长因子受体2(HER-2)过表达型3组.分析病灶的MRI征象,包括病灶呈肿块样或非肿块样强化及其中肿块型病灶的形状和边缘、单发或多发等,并分析肿块的强化特点和病理组织类型及病理分级.多发者记录最大病灶的征象.应用x2精确检验、Fisher确切概率法、Kruskal-Wallis H检验和Wilcoxon秩和检验进行统计分析.结果 202例中,基底细胞样型34例、管腔型144例、HER-2过表达型24例,其中呈肿块样强化者分别为29、133和19例,各组间差异无统计学意义(x2 =4.136,P=0.126).呈肿块样强化的患者中,29例基底细胞样型患者病灶呈圆形或类圆形、分叶状和不规则形者分别为8、19、2例,133例管腔型患者上述形状病灶分别为23、58、52例,19例HER-2过表达型患者上述形状病灶分别为1、11、7例,差异有统计学意义(x2=13.391,P＜0.05).基底细胞样型患者病灶边缘表现为光滑、有毛刺和不规则者分别为20、5、4例,管腔型分别为27、53、53例,HER-2过表达型分别为4、7、8例,差异有统计学意义(x2=28.515,P＜0.01).HER-2过表达型乳腺癌的多发病灶占52.6％ (10/19),而基底细胞样型和管腔型中多发病灶仅占6.9％(2/29)、8.0％ (24/133),差异有统计学意义(x2=16.140,P＜0.01).增强扫描后,基底细胞样型病灶呈均匀强化、不均匀强化和环形强化者分别为0、13、16例,管腔型分别为28、93、11例,HER-2过表达型分别为2、11、6例,差异有统计学意义(P＜0.01),而强化曲线类型在3组间差异无统计学意义(P =0.457).管腔型的组织学类型多样,混合型较常见(32.6％,47/144),而另2组主要为浸润性导管癌.浸润性导管癌的病理分级在3组间差异有统计学意义(Hc=30.014,P＜0.01),基底细胞样型以Ⅲ级为主(20/25),恶性程度高于另外2组.结论 乳腺癌的分子亚型能反映乳腺癌的生物学行为的差异,并表现出不同的MRI征象和病理特征,MRI有助于术前预测分子亚型.
目的 探討不同分子亞型乳腺癌的MRI徵象和病理特徵.方法 迴顧性分析202例經手術治療的原髮性乳腺癌患者資料,患者在術前均行乳腺MRI檢查,癌組織標本採用免疫組織化學檢查結果判斷分子亞型,分為基底細胞樣型、管腔型和人類錶皮生長因子受體2(HER-2)過錶達型3組.分析病竈的MRI徵象,包括病竈呈腫塊樣或非腫塊樣彊化及其中腫塊型病竈的形狀和邊緣、單髮或多髮等,併分析腫塊的彊化特點和病理組織類型及病理分級.多髮者記錄最大病竈的徵象.應用x2精確檢驗、Fisher確切概率法、Kruskal-Wallis H檢驗和Wilcoxon秩和檢驗進行統計分析.結果 202例中,基底細胞樣型34例、管腔型144例、HER-2過錶達型24例,其中呈腫塊樣彊化者分彆為29、133和19例,各組間差異無統計學意義(x2 =4.136,P=0.126).呈腫塊樣彊化的患者中,29例基底細胞樣型患者病竈呈圓形或類圓形、分葉狀和不規則形者分彆為8、19、2例,133例管腔型患者上述形狀病竈分彆為23、58、52例,19例HER-2過錶達型患者上述形狀病竈分彆為1、11、7例,差異有統計學意義(x2=13.391,P＜0.05).基底細胞樣型患者病竈邊緣錶現為光滑、有毛刺和不規則者分彆為20、5、4例,管腔型分彆為27、53、53例,HER-2過錶達型分彆為4、7、8例,差異有統計學意義(x2=28.515,P＜0.01).HER-2過錶達型乳腺癌的多髮病竈佔52.6％ (10/19),而基底細胞樣型和管腔型中多髮病竈僅佔6.9％(2/29)、8.0％ (24/133),差異有統計學意義(x2=16.140,P＜0.01).增彊掃描後,基底細胞樣型病竈呈均勻彊化、不均勻彊化和環形彊化者分彆為0、13、16例,管腔型分彆為28、93、11例,HER-2過錶達型分彆為2、11、6例,差異有統計學意義(P＜0.01),而彊化麯線類型在3組間差異無統計學意義(P =0.457).管腔型的組織學類型多樣,混閤型較常見(32.6％,47/144),而另2組主要為浸潤性導管癌.浸潤性導管癌的病理分級在3組間差異有統計學意義(Hc=30.014,P＜0.01),基底細胞樣型以Ⅲ級為主(20/25),噁性程度高于另外2組.結論 乳腺癌的分子亞型能反映乳腺癌的生物學行為的差異,併錶現齣不同的MRI徵象和病理特徵,MRI有助于術前預測分子亞型.
목적 탐토불동분자아형유선암적MRI정상화병리특정.방법 회고성분석202례경수술치료적원발성유선암환자자료,환자재술전균행유선MRI검사,암조직표본채용면역조직화학검사결과판단분자아형,분위기저세포양형、관강형화인류표피생장인자수체2(HER-2)과표체형3조.분석병조적MRI정상,포괄병조정종괴양혹비종괴양강화급기중종괴형병조적형상화변연、단발혹다발등,병분석종괴적강화특점화병리조직류형급병리분급.다발자기록최대병조적정상.응용x2정학검험、Fisher학절개솔법、Kruskal-Wallis H검험화Wilcoxon질화검험진행통계분석.결과 202례중,기저세포양형34례、관강형144례、HER-2과표체형24례,기중정종괴양강화자분별위29、133화19례,각조간차이무통계학의의(x2 =4.136,P=0.126).정종괴양강화적환자중,29례기저세포양형환자병조정원형혹류원형、분협상화불규칙형자분별위8、19、2례,133례관강형환자상술형상병조분별위23、58、52례,19례HER-2과표체형환자상술형상병조분별위1、11、7례,차이유통계학의의(x2=13.391,P＜0.05).기저세포양형환자병조변연표현위광활、유모자화불규칙자분별위20、5、4례,관강형분별위27、53、53례,HER-2과표체형분별위4、7、8례,차이유통계학의의(x2=28.515,P＜0.01).HER-2과표체형유선암적다발병조점52.6％ (10/19),이기저세포양형화관강형중다발병조부점6.9％(2/29)、8.0％ (24/133),차이유통계학의의(x2=16.140,P＜0.01).증강소묘후,기저세포양형병조정균균강화、불균균강화화배형강화자분별위0、13、16례,관강형분별위28、93、11례,HER-2과표체형분별위2、11、6례,차이유통계학의의(P＜0.01),이강화곡선류형재3조간차이무통계학의의(P =0.457).관강형적조직학류형다양,혼합형교상견(32.6％,47/144),이령2조주요위침윤성도관암.침윤성도관암적병리분급재3조간차이유통계학의의(Hc=30.014,P＜0.01),기저세포양형이Ⅲ급위주(20/25),악성정도고우령외2조.결론 유선암적분자아형능반영유선암적생물학행위적차이,병표현출불동적MRI정상화병리특정,MRI유조우술전예측분자아형.
Objective To investigate the MRI and pathological features of different molecular subtypes of breast cancer.Methods The data of 202 patients who underwent primary breast cancer resection were retrospectively reviewed.All of the patients had MRI preoperatively.The molecular subtypes of breast cancer defined by immunohistochemistry were classified as basal-like,luminal and HER-2 overexpression.Morphology (including mass or non-mass like enhancement,shape and margin of masses,unifocal or multifocal masses) and enhancement characteristics on MRI,histologic types and grades of tumors were analyzed with Chi-square test,exact test,Fisher exact test,Kruskal-Wallis H test,and Wilcoxon test.Results Among the 202 patients,34 were basal-like,144 were luminal and 24 were HER-2 overexpression.The number of mass cases in each subtype was 29,133 and 19 respectively,making no significant difference (x2 =4.136,P =0.126).As for the shape of basal-like lesions,8 were round,19 were lobular and 2 were irregular,while this distribution was 23,58,52 in luminal subtype and 1,11,7 in HER-2 overexpression subtype (x2 =13.391,P ＜ 0.05).The margin was also strikingly different among three groups (smooth,spiculated,irregular):20,5,4 respectively in basal-like,27,53,53 respectively in luminal,and 4,7,8 respectively in HER-2 overexpression (x2 =28.515,P ＜ 0.01).52.6％ (10/19) of HER-2 overexpression cases were multifocal,while only 6.9％ (2/29) of luminal and 8.0％ (24/133) of basal-like ones were multifocal (x2 =16.140,P ＜ 0.01).Characteristics in dynamic contrast-enhanced MRI were statistically different,with homogeneous,heterogeneous,and rim enhancement 0,13,16 respectively in basal-like cases,28,93,11 respectively in luminal cases and 2,11,6 respectively in HER-2 overexpression cases (P ＜ 0.01).However,the difference for enhancement curve did not reach significance (P =0.457).Histologic types were significantly different among molecular subtypes (P ＜ 0.01).Luminal breast cancer consisted of various histologic types,32.6％ (47/144) of which were mixed type.The majority of the other two molecular subtypes were invasive ductal carcinoma.Furthermore,invasive ductal carcinomas with different molecular subtypes showed different histologic grades (Hc =30.014,P ＜ 0.01).Basal-like breast cancer was more likely associated with a higher grade of malignancy.Conclusions Different molecular subtypes of breast showed distinct MRI features and pathologic characteristics.MRI might be a useful tool for preoperative prediction of molecular subtypes of breast cancer.
