中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
11期
819-823
,共5页
磁共振成像%乳腺肿瘤%受体,雌激素
磁共振成像%乳腺腫瘤%受體,雌激素
자공진성상%유선종류%수체,자격소
Magnetic resonance imaging%Breast neoplasms%Receptors,estrogen
目的 探讨基于雌激素受体(ER),孕激素受体(PR)和人类上皮因子受体2(Her2)表达的乳腺癌亚型的MRI特征表现,从影像学角度来预测癌基因的异常表达.方法 回顾性分析2007年2月至2011年1月杭州市中医院有完整MR资料,并经病理证实的267例乳腺癌患者的临床、病理和影像学资料.根据BI-RADS的标准,评价MRI表现,包括病灶类型、数目、形态、肿块边缘、肿块信号强度、肿块强化方式及时间-信号增强曲线类型.根据免疫组化中的ER、PR与Her2表达情况将乳腺癌分为4组:(1) ER/PR+、Her2+组；(2)ER/PR+、Her2-组；(3) ER/PR-、Her2+组；(4)ER/PR-、Her2-组,对比4组之间的差异.分类变量采用,检验和Fisher确切概率法分析.组间两两比较采用x2分割.结果 4组乳腺癌亚型病灶类型分布不同,组间差异有统计学意义(x2=41.267,P＜0.001),其中ER/PR+、Her2+组与ER/PR-、Her2+组中段样或线样强化方式所占比例较高[25.6％(11/43),36.1％ (13/36)],组间差异无统计学意义(x2=1.112,P=0.641),将两组合并与ER/PR+、Her2-组及ER/PR-、Her2-组比较,差异有统计学意义(x2=32.793,P＜0.001;x2=14.565,P＜0.001).ER/PR-、Her2-组占总病例数14.6％(39/267),以肿块型为主(92.3％,36/39),多为单发(91.7％,33/36).与其他组分别比较,ER/PR-、Her2-组肿块边缘多光滑[58.3％(21/36),P＜0.001]；在T2WI压脂像,肿块内部超高信号占33.3％ (12/36),肿块周边高信号占30.6％(11/36),均高于其他组,组间差异有统计学意义(P＜0.001)；增强以早期环形强化为主[80.6％ (29/36),P＜0.001].而肿块数目、肿块形态及肿块动态增强模式,组间差异均无统计学意义(x2=1.413,p=0.713;x2=8.423,P=0.204;x2=4.657,P=0.540).结论 段样或线样强化同时结合TIC曲线(呈Ⅱ型或Ⅲ型),有利于预测Her2+乳腺癌.早期环形强化的肿块为ER/PR-、Her2-乳腺癌最为重要的MRI特征,其余特征包括边缘光滑的乳腺肿块、在T2WI压脂像肿块内部存在超高信号及肿块周边高信号.
目的 探討基于雌激素受體(ER),孕激素受體(PR)和人類上皮因子受體2(Her2)錶達的乳腺癌亞型的MRI特徵錶現,從影像學角度來預測癌基因的異常錶達.方法 迴顧性分析2007年2月至2011年1月杭州市中醫院有完整MR資料,併經病理證實的267例乳腺癌患者的臨床、病理和影像學資料.根據BI-RADS的標準,評價MRI錶現,包括病竈類型、數目、形態、腫塊邊緣、腫塊信號彊度、腫塊彊化方式及時間-信號增彊麯線類型.根據免疫組化中的ER、PR與Her2錶達情況將乳腺癌分為4組:(1) ER/PR+、Her2+組；(2)ER/PR+、Her2-組；(3) ER/PR-、Her2+組；(4)ER/PR-、Her2-組,對比4組之間的差異.分類變量採用,檢驗和Fisher確切概率法分析.組間兩兩比較採用x2分割.結果 4組乳腺癌亞型病竈類型分佈不同,組間差異有統計學意義(x2=41.267,P＜0.001),其中ER/PR+、Her2+組與ER/PR-、Her2+組中段樣或線樣彊化方式所佔比例較高[25.6％(11/43),36.1％ (13/36)],組間差異無統計學意義(x2=1.112,P=0.641),將兩組閤併與ER/PR+、Her2-組及ER/PR-、Her2-組比較,差異有統計學意義(x2=32.793,P＜0.001;x2=14.565,P＜0.001).ER/PR-、Her2-組佔總病例數14.6％(39/267),以腫塊型為主(92.3％,36/39),多為單髮(91.7％,33/36).與其他組分彆比較,ER/PR-、Her2-組腫塊邊緣多光滑[58.3％(21/36),P＜0.001]；在T2WI壓脂像,腫塊內部超高信號佔33.3％ (12/36),腫塊週邊高信號佔30.6％(11/36),均高于其他組,組間差異有統計學意義(P＜0.001)；增彊以早期環形彊化為主[80.6％ (29/36),P＜0.001].而腫塊數目、腫塊形態及腫塊動態增彊模式,組間差異均無統計學意義(x2=1.413,p=0.713;x2=8.423,P=0.204;x2=4.657,P=0.540).結論 段樣或線樣彊化同時結閤TIC麯線(呈Ⅱ型或Ⅲ型),有利于預測Her2+乳腺癌.早期環形彊化的腫塊為ER/PR-、Her2-乳腺癌最為重要的MRI特徵,其餘特徵包括邊緣光滑的乳腺腫塊、在T2WI壓脂像腫塊內部存在超高信號及腫塊週邊高信號.
목적 탐토기우자격소수체(ER),잉격소수체(PR)화인류상피인자수체2(Her2)표체적유선암아형적MRI특정표현,종영상학각도래예측암기인적이상표체.방법 회고성분석2007년2월지2011년1월항주시중의원유완정MR자료,병경병리증실적267례유선암환자적림상、병리화영상학자료.근거BI-RADS적표준,평개MRI표현,포괄병조류형、수목、형태、종괴변연、종괴신호강도、종괴강화방식급시간-신호증강곡선류형.근거면역조화중적ER、PR여Her2표체정황장유선암분위4조:(1) ER/PR+、Her2+조；(2)ER/PR+、Her2-조；(3) ER/PR-、Her2+조；(4)ER/PR-、Her2-조,대비4조지간적차이.분류변량채용,검험화Fisher학절개솔법분석.조간량량비교채용x2분할.결과 4조유선암아형병조류형분포불동,조간차이유통계학의의(x2=41.267,P＜0.001),기중ER/PR+、Her2+조여ER/PR-、Her2+조중단양혹선양강화방식소점비례교고[25.6％(11/43),36.1％ (13/36)],조간차이무통계학의의(x2=1.112,P=0.641),장량조합병여ER/PR+、Her2-조급ER/PR-、Her2-조비교,차이유통계학의의(x2=32.793,P＜0.001;x2=14.565,P＜0.001).ER/PR-、Her2-조점총병례수14.6％(39/267),이종괴형위주(92.3％,36/39),다위단발(91.7％,33/36).여기타조분별비교,ER/PR-、Her2-조종괴변연다광활[58.3％(21/36),P＜0.001]；재T2WI압지상,종괴내부초고신호점33.3％ (12/36),종괴주변고신호점30.6％(11/36),균고우기타조,조간차이유통계학의의(P＜0.001)；증강이조기배형강화위주[80.6％ (29/36),P＜0.001].이종괴수목、종괴형태급종괴동태증강모식,조간차이균무통계학의의(x2=1.413,p=0.713;x2=8.423,P=0.204;x2=4.657,P=0.540).결론 단양혹선양강화동시결합TIC곡선(정Ⅱ형혹Ⅲ형),유리우예측Her2+유선암.조기배형강화적종괴위ER/PR-、Her2-유선암최위중요적MRI특정,기여특정포괄변연광활적유선종괴、재T2WI압지상종괴내부존재초고신호급종괴주변고신호.
Objective To evaluate the magnetic resonance (MR) imaging findings of breast cancer subtypes based on the profiles of ER/PR and Her2.Methods A retrospective study was conducted for 267 breast cancer subjects between February 2007 and January 2011.Clinicopathologic features and MR imaging findings of four subtypes were compared.The Chi-square(x2) test,Fisher's exact test and x2 section method were employed for categorical variables.Results MR imaging findings:Patients with segment or linear enhancement type accounted for 25.6％ in ER/PR +,Her2 + subtype group and 36.1％ in ER/PR-,Her2 +subtype,no significant difference existed between them (x2 =1.112,P =0.641).But they were significantly higher than ER/PR +,Her2-subtype group and ER/PR-,Her2-subtype group (x2 =32.793,P ＜0.001 ; x2 =14.565,P ＜ 0.001).ER/PR-,Her2-subtype patients accounted for 14.6％ of the total breast cancer patients (39/267).Subjects with ER/PR-,Her2-subtype were more likely to present unifocal (91.7％,33/36)and mass type lesion (92.3％,36/39).The mass type lesions in ER/PR-,Her2-subtype group were more likely to showed smooth margin [58.3％ (21/36),P ＜ 0.001],very high intratumoral signal and peripheral hyperintense pattern on fat suppression T2-weighted imaging(P ＜ 0.001)and early rim enhancement [81.5 ％ (29/36),P ＜ 0.001].No significantly difference of four subtypes were found on number of mass,mass shape and pattern at dynamic enhancement imaging(x2 =1.413,P =0.713 ;x2 =8.423,P =0.204 ; x2 =4.657,P =0.540).Conclusion Segment or linear enhancement type is characterized by MR imaging.Early rim enhanced mass is ER/PR-,Her2-breast cancer.The most important characteristics of MR imaging include a smooth edge of breast mass,very high intratumoral signal on fat suppression T2-weighted imaging and peripheral hyperintense pattern.
