CAJ | 학술논문

目的：探讨三阴乳腺癌（triple-negative breast cancer，TNBC）与基底细胞样乳腺癌（ basal-like breast cancer，BLBC）及非三阴乳腺癌（non triple-negative breast cancer，NTNBC）的关系及其形态、生物学特征。方法应用免疫组织化学（immunohistochemistry，IHC）方法对96例乳腺癌标本进行HER2、ER、PR蛋白的检查；应用FISH（fluorescent in situ hybridization）方法对3例HER2 IHC 3+及5例HER2 IHC 2+标本进行HER2基因扩增的检查；对22例TNBC进行了CK5/6或EGFR的检查。按照检查结果，将其分为TNBC、NTN?BC和BLBC，比较三者的病理形态及生物学特征。结果 NTNBC占72.92%（70/96），其组织学Ⅰ、Ⅱ及Ⅲ级的病例分别为28.57%（20/70）、57.14%（40/70）和14.29%（10/70），淋巴结转移率为44.44%（16/36）；TN?BC占乳腺癌的27.08%（26/96），无组织学Ⅰ级病例，组织学Ⅱ及Ⅲ级的病例分别为53.85%，（14/26）及46.15%，（12/26）例，淋巴结转移率为61.11%（11/18）；BLBC占TNBC的63.64%（14/22），同TNBC一样，无组织学Ⅰ级病例，Ⅱ、Ⅲ级的病例分别为57.14%（8/14）及42.86%（6/14），淋巴结转移率为55.56%（5/9）。TN?BC与BLBC低分化病例的比例以及淋巴结的转移率均高于NTNBC。3例HER2 IHC 3+的病例FISH检查结果同IHC，5例HER 2 IHC 2+标本FISH检查1例基因扩增，3例阴性，1例结果不确定。结论 TNBC与BLBC占乳腺癌1/4的比例，组织学多为中、低分化，浸润性生长，易发生淋巴结转移和复发，临床预后较差。虽然BLBC与TNBC大部分有重叠，但其具有独自的特异性，应成为独立的组织病理学类型。CK5/6或EGFR可用作从TNBC中筛选BLBC的指标。IHC 2+病例要做FISH检查，以正确指导治疗。
목적：탐토삼음유선암（triple-negative breast cancer，TNBC）여기저세포양유선암（ basal-like breast cancer，BLBC）급비삼음유선암（non triple-negative breast cancer，NTNBC）적관계급기형태、생물학특정。방법응용면역조직화학（immunohistochemistry，IHC）방법대96례유선암표본진행HER2、ER、PR단백적검사；응용FISH（fluorescent in situ hybridization）방법대3례HER2 IHC 3+급5례HER2 IHC 2+표본진행HER2기인확증적검사；대22례TNBC진행료CK5/6혹EGFR적검사。안조검사결과，장기분위TNBC、NTN?BC화BLBC，비교삼자적병리형태급생물학특정。결과 NTNBC점72.92%（70/96），기조직학Ⅰ、Ⅱ급Ⅲ급적병례분별위28.57%（20/70）、57.14%（40/70）화14.29%（10/70），림파결전이솔위44.44%（16/36）；TN?BC점유선암적27.08%（26/96），무조직학Ⅰ급병례，조직학Ⅱ급Ⅲ급적병례분별위53.85%，（14/26）급46.15%，（12/26）례，림파결전이솔위61.11%（11/18）；BLBC점TNBC적63.64%（14/22），동TNBC일양，무조직학Ⅰ급병례，Ⅱ、Ⅲ급적병례분별위57.14%（8/14）급42.86%（6/14），림파결전이솔위55.56%（5/9）。TN?BC여BLBC저분화병례적비례이급림파결적전이솔균고우NTNBC。3례HER2 IHC 3+적병례FISH검사결과동IHC，5례HER 2 IHC 2+표본FISH검사1례기인확증，3례음성，1례결과불학정。결론 TNBC여BLBC점유선암1/4적비례，조직학다위중、저분화，침윤성생장，역발생림파결전이화복발，림상예후교차。수연BLBC여TNBC대부분유중첩，단기구유독자적특이성，응성위독립적조직병이학류형。CK5/6혹EGFR가용작종TNBC중사선BLBC적지표。IHC 2+병례요주FISH검사，이정학지도치료。
Objective To investigate the pathomorphology,biologic characteristics and the relation?ships of triple-negative breast cancer (TNBC),non triple-negative breast cancer (NTNBC) and bas?al-like breast cancer (BLBC). Methods HER2,ER,PR,CK5/6 or EGFR protein were deter?mined with immunohistochemistry(IHC)in breast cancer, 3 cases of HER2 IHC 3+ and 5 cases of HER2 IHC 2+ were analysed for HER2 gene amplification with fluorescent in situ hybridization (FISH). CK5/6 or EGFR were checked in 22 cases of TNBC. The cases were divided into the TNBC,NTNBC and BLBC groups according to the examination results. The pathomorphology and bi?ologic characteristics of the three groups were compared. Results Of the 96 cases,27. 08%(26/96)were confirmed to be TNBC in which gradeⅡandⅢcases were 53. 85%(14/26)and 46. 15%(12/26)respectively,lymph nodes metastasis rate was 61. 11%(11/18);BLBC accounted for 63. 64%(14/22)of TNBC,in which gradeⅡ andⅢ cases were 57. 14%(8/14)and 42. 86%(6/14)respective?ly,lymph nodes metastasis rate was 55. 56%(5/9);There were no grade Ⅰcases in TNBC and BLBC. 72. 92%(70/96)were confirmed to be NTNBC in which gradeⅠ,ⅡandⅢcases were 28. 57%(20/70),57. 14%(40/70)and 14. 29%(10/70)respectively,lymph nodes metastasis rate was 44. 44%(16/36). The percentage of poorly differentiated cases and lymph nodes metastasis rate were higher in the TNBC and BLBC group than those in NTNBC,besides there was no gradeⅠcases in TNBC and BLBC group. Of the 5 HER2 IHC 2+ cases,one case there was gene amplification,one equivocal and three negative and of 3 HER2 IHC 3+ cases ,the FISH result was consistent with IHC. Conclu?sion More than 1/4 of breast cancer are TNBC or BLBC in our study. Compared with NTNBC,even though TNBC and BLBC share a great deal of overlap and have a poor differentiation with aggressive behavior and increased local recurrence or distant metastasis,indicating a poor prognosis,they may be independent histopathologic entity. CK5/6 or EGFR can be used to differentiate the BLBC from TNBC. IHC 2+cases should be examined with FISH in order to avoid misleading treatment.