不同亚型乳腺导管原位癌与X线摄影和临床病理特征的相关性研究
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摘要
目的探讨不同亚型乳腺导管原位癌(DCIS)与X线摄影表现、临床病理特征的相关性。方法回顾性分析2015年2月至2016年9月经该院手术病理证实的DCIS患者79例,所有病例术前均进行X线摄影。应用美国放射学会(ACR)制定的乳腺影像报告数据系统(BI-RADS)对乳腺癌X线摄影表现进行规范化的描述分析。结果 79例单纯DCIS患者中ER阳性型44例(55.7%),HER-2阳性型32例(40.5%),三阴性型3例(3.8%)。X线病变类型:单纯钙化38例(48.1%);肿块、致密影或结构扭曲17例(21.5%);肿块、致密影或结构扭曲伴钙化24例(30.4%)。ER阳性型、HER-2阳性型、三阴性型患者的肿瘤直径分别为(1.7±1.6)、(2.1±1.6)、(3.2±1.6)cm(P=0.047)。HER-2阳性型、三阴性型患者更多表现为高核级、Ki-67高表达(P=0.000、0.000)。不同亚型间X线病变类型无明显差异(P=0.064)。钙化形态在不同亚型间存在差异(P=0.026),HER-2阳性型更多表现为线样或线样分支状钙化。钙化分布在不同亚型间无明显差异(P=0.272)。伴钙化DCIS其HER-2+及Ki-67高表达更为常见(P=0.030、0.016)。多变量Logistic回归显示:HER-2阳性型、三阴性型及Ki-67高表达更多表现为高核级(P<0.05)。结论 DCIS患者大部分为ER阳性型及HER-2阳性型,三阴型较少见。ER阳性型一般为低、中核级DCIS,而HER-2阳性型、三阴性型大多数为高核级DCIS,Ki-67呈高表达,预示其预后较差,发展为浸润性癌的风险及局部复发率较高。HER-2阳性型与X线摄影钙化明显相关,形态上多表现为线样或线样分支状钙化。
Objective To explore the correlation between different subtypes of breast ductal carcinoma in situ(DCIS)with mammographic and clinicopathologic features.Methods Seventy-nine patients with breast DCIS verified by operation and pathology in this hospital from February 2015 to September 2016 were retrospectively analyzed.The mammography was performed before operation in all cases.The X-ray features of breast cancer performed the normalized description according to BI-RADS formulated by ACR.Results Among 79 cases of simple DCIS,44 cases(55.7%)were ER-positive,32 cases(40.5%)were HER2-positive,and 3 cases(3.8%)were triple-negative.The X-ray lesion types:38 cases(48.1%)of simple calcifications,17 cases(21.5%)of mass,asymmetries or architectural distortion,24 cases(30.4%)of mass,asymmetries or architectural distortion complicating calcification.The mean tumor sizes distributions for ER-positive,HER2-positive,and triple-negative DCIS were(1.7±1.6),(2.1±1.6),(3.2±1.6)cm respectively(P=0.047).The HER2-positive type and triple-negative type were more manifested by high nuclear grade and Ki-67 high expression(P=0.000,0.000).The X-ray lesion types had no obvious difference among different subtypes(P=0.064).The calcification morphology had difference among different subtypes(P=0.026).HER-2 positive type was more manifested by the linear or linear branched calcification.The calci-cation distribution had no obvious difference among different subtypes(P=0.272).The HER-2 positive and Ki-67 high expression in DCIS complicating calcification were more common(P=0.030,0.016).The multivariate Logistic regression showed that the HER-2 positive type,triple negative type breast cancer and Ki-67 high expression were more manifested by high nuclear grade breast cancer(P<0.05).Conclusion The majority paltients with breast DCIS are ER-positive type and HER2-positive type.The triple-negative DCIS is uncommon.The ER-positive type is usually low,middle nuclear grade DICS,while the majority of HER-2 positive type and triple negative type breast cancer are high nuclear grade DCIS,Ki-67 shows high expression,which predicts its poor prognosis,the risk developing to infiltration cancer and local recurrence is high.The HER-2 positive breast cancer is significantly correlated with breast X-ray imaging calcification,its morphology is more manifested by linear of linear branched calcification.
Objective To explore the correlation between different subtypes of breast ductal carcinoma in situ(DCIS)with mammographic and clinicopathologic features.Methods Seventy-nine patients with breast DCIS verified by operation and pathology in this hospital from February 2015 to September 2016 were retrospectively analyzed.The mammography was performed before operation in all cases.The X-ray features of breast cancer performed the normalized description according to BI-RADS formulated by ACR.Results Among 79 cases of simple DCIS,44 cases(55.7%)were ER-positive,32 cases(40.5%)were HER2-positive,and 3 cases(3.8%)were triple-negative.The X-ray lesion types:38 cases(48.1%)of simple calcifications,17 cases(21.5%)of mass,asymmetries or architectural distortion,24 cases(30.4%)of mass,asymmetries or architectural distortion complicating calcification.The mean tumor sizes distributions for ER-positive,HER2-positive,and triple-negative DCIS were(1.7±1.6),(2.1±1.6),(3.2±1.6)cm respectively(P=0.047).The HER2-positive type and triple-negative type were more manifested by high nuclear grade and Ki-67 high expression(P=0.000,0.000).The X-ray lesion types had no obvious difference among different subtypes(P=0.064).The calcification morphology had difference among different subtypes(P=0.026).HER-2 positive type was more manifested by the linear or linear branched calcification.The calci-cation distribution had no obvious difference among different subtypes(P=0.272).The HER-2 positive and Ki-67 high expression in DCIS complicating calcification were more common(P=0.030,0.016).The multivariate Logistic regression showed that the HER-2 positive type,triple negative type breast cancer and Ki-67 high expression were more manifested by high nuclear grade breast cancer(P<0.05).Conclusion The majority paltients with breast DCIS are ER-positive type and HER2-positive type.The triple-negative DCIS is uncommon.The ER-positive type is usually low,middle nuclear grade DICS,while the majority of HER-2 positive type and triple negative type breast cancer are high nuclear grade DCIS,Ki-67 shows high expression,which predicts its poor prognosis,the risk developing to infiltration cancer and local recurrence is high.The HER-2 positive breast cancer is significantly correlated with breast X-ray imaging calcification,its morphology is more manifested by linear of linear branched calcification.
引文
[1]RAUCH G M,HOBBS B P,KUERER H M,et al.Microcalcifications in 1657patients with pure ductal carcinoma in situ of the breast:correlation with clinical,histopathologic,biologic features,and local recurrence[J].Ann Surg Oncol,2016,23(2):482-489.
[2]KIM M Y,KIM H S,CHOI N,et al.Screening mammography-detected ductal carcinoma in situ:mammographic features based on breast cancer subtypes[J].Clin Imaging,2015,39(6):983-986.
[3]American College of Radiology.Illustrated breast imaging reporting and data system(BI-RADS)[M].Reston,VA:American College of Radiology,2013.
[4]《乳腺癌雌、孕激素受体免疫组织化学检测指南》编写组.乳腺癌雌、孕激素受体免疫组织化学检测指南[J].中华病理学杂志,2015,44(4):237-239.
[5]《乳腺癌HER2检测指南(2014版)》编写组.乳腺癌HER2检测指南(2014版)[J].中华病理学杂志,2014,43(4):262-266.
[6]邬万新,张怡,郭志琴,等.Ki67检测结果与乳腺癌临床病理指标的相关性分析[J].中华病理学杂志,2015,44(9):657-658.
[7]BAE M S,MOON W K,CHANG J M,et al.Mammographic features of calcifications in DCIS:correlation with oestrogen receptor and human epidermal growth factor receptor 2status[J].Eur Radiol,2013,23(8):2072-2078.
[8]SANTAMARíA G,BARGALLóX,FERNáNDEZ P L,et al.Neoadjuvant systemic therapy in breast cancer:association of contrast-enhanced MR imaging findings,diffusion-weighted imaging findings,and tumor subtype with tumor response[J].Radiology,2017,283(3):663-672.
[9]RAUCH G M,KUERER H M,SCOGGINS M E,et al.Clinicopathologic,mammographic,and sonographic features in 1,187patients with pure ductal carcinoma in situ of the breast by estrogen receptor status[J].Breast Cancer Res Treat,2013,139(3):639-647.
[10]梁晓燕,黄颖,许建林,等.乳腺导管原位癌与浸润性导管癌X线征象对比分析[J].实用放射学杂志,2015,31(8):1266-1268,1277.
[11]MUN H S,SHIN H J,KIM H H,et al.Screening-detected calcified and non-calcified ductal carcinoma in situ:differences in the imaging and histopathological features[J].Clin Radiol,2013,68(1):e27-35.
[12]WANG S Y,SHAMLIYAN T,VIRNIG B A,et al.Tumor characteristics as predictors of local recurrence after treatment of ductal carcinoma in situ:a meta-analysis[J].Breast Cancer Res Treat,2011,127(1):1-14.
[13]YUAN P,XU B L,WANG C Z,et al.Ki-67expression in luminal type breast cancer and its association with the clinicopathology of the cancer[J].Oncol Lett,2016,11(3):2101-2105.
[14]姜婷婷,顾雅佳,彭卫军,等.乳腺导管原位癌的MRI表现及与病理分级的关系[J].中国癌症杂志,2013,23(8):631-636.
[2]KIM M Y,KIM H S,CHOI N,et al.Screening mammography-detected ductal carcinoma in situ:mammographic features based on breast cancer subtypes[J].Clin Imaging,2015,39(6):983-986.
[3]American College of Radiology.Illustrated breast imaging reporting and data system(BI-RADS)[M].Reston,VA:American College of Radiology,2013.
[4]《乳腺癌雌、孕激素受体免疫组织化学检测指南》编写组.乳腺癌雌、孕激素受体免疫组织化学检测指南[J].中华病理学杂志,2015,44(4):237-239.
[5]《乳腺癌HER2检测指南(2014版)》编写组.乳腺癌HER2检测指南(2014版)[J].中华病理学杂志,2014,43(4):262-266.
[6]邬万新,张怡,郭志琴,等.Ki67检测结果与乳腺癌临床病理指标的相关性分析[J].中华病理学杂志,2015,44(9):657-658.
[7]BAE M S,MOON W K,CHANG J M,et al.Mammographic features of calcifications in DCIS:correlation with oestrogen receptor and human epidermal growth factor receptor 2status[J].Eur Radiol,2013,23(8):2072-2078.
[8]SANTAMARíA G,BARGALLóX,FERNáNDEZ P L,et al.Neoadjuvant systemic therapy in breast cancer:association of contrast-enhanced MR imaging findings,diffusion-weighted imaging findings,and tumor subtype with tumor response[J].Radiology,2017,283(3):663-672.
[9]RAUCH G M,KUERER H M,SCOGGINS M E,et al.Clinicopathologic,mammographic,and sonographic features in 1,187patients with pure ductal carcinoma in situ of the breast by estrogen receptor status[J].Breast Cancer Res Treat,2013,139(3):639-647.
[10]梁晓燕,黄颖,许建林,等.乳腺导管原位癌与浸润性导管癌X线征象对比分析[J].实用放射学杂志,2015,31(8):1266-1268,1277.
[11]MUN H S,SHIN H J,KIM H H,et al.Screening-detected calcified and non-calcified ductal carcinoma in situ:differences in the imaging and histopathological features[J].Clin Radiol,2013,68(1):e27-35.
[12]WANG S Y,SHAMLIYAN T,VIRNIG B A,et al.Tumor characteristics as predictors of local recurrence after treatment of ductal carcinoma in situ:a meta-analysis[J].Breast Cancer Res Treat,2011,127(1):1-14.
[13]YUAN P,XU B L,WANG C Z,et al.Ki-67expression in luminal type breast cancer and its association with the clinicopathology of the cancer[J].Oncol Lett,2016,11(3):2101-2105.
[14]姜婷婷,顾雅佳,彭卫军,等.乳腺导管原位癌的MRI表现及与病理分级的关系[J].中国癌症杂志,2013,23(8):631-636.