3.0T磁共振动态增强扫描联合超声检查对不同分子亚型乳腺癌的诊断价值  

The value of detecting breast cancer of different molecular subtypes combining ultrasound and dynamic contrast enhancement MRI

作　　者：郭媛[1] 魏新华[1] 丁汉军[1] 汪珍穗[1] 吴红珍[1] 江新青[1] 

机构地区：[1]广州市第一人民医院放射科,510180

出　　处：《中华临床医师杂志（电子版）》2014年第16期49-52,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：2013年广州市医药卫生科技项目:功能磁共振成像联合血清VEGF对乳腺癌治疗疗效的定量评估(20131A011024)

摘　　要：目的：研究3.0 T磁共振动态增强扫描联合超声检查对乳腺癌的诊断价值，探讨不同分子亚型乳腺癌的影像特征。方法回顾性分析24例经手术病理证实的乳腺癌患者（30个病灶）的超声和MRI资料，所有患者均为女性，年龄39～69岁，中位年龄55岁；根据雌激素受体、孕激素受体、人表皮生长因子受体-2（HER-2）的表达状态，将乳腺癌分为三阴性、HER-2过表达和Luminal三个亚型，分析不同分子类型乳腺癌的影像表现，如回声/信号、形态、边界、钙化、强化方式、周围组织是否受侵等，重点分析MRI的时间-信号强度曲线（TIC）及超声的Adler血供分型。结果根据乳腺癌分子亚型的标准，三阴性型占3.3%（1/30）；Her-2过表达型占20.0%（6/30），Luminal型占76.7%（23/30）。术前超声单独诊断乳腺癌的准确率为76.7%（23/30），MRI单独诊断乳腺癌的准确率为86.7%（26/30），联合超声、MRI诊断乳腺癌的准确率为96.7%（29/30）。MRI的TIC以Ⅱ型、Ⅲ型居多，分别为18/30（60%）、12/30（40%），超声 Adler 血供以Ⅱ型居多（18/30，60%）；MRI的TIC对Her-2过表达及Luminal乳腺癌两种分子分型有统计学意义（P＜0.05）。结论不同分子类型乳腺癌的影像学征象各具特点；联合磁共振动态增强扫描与超声检查对乳腺癌的检出准确率均高于单独任一检查方法。Objective To evaluate the diagnostic capability of detecting breast cancer combining ultrasound and dynamic contrast enhancement MRI and to investigate the ultrasonic and MRI features of breast cancers of different molecular subtypes.MethodsUltrasonic and MRI data of 24 patients （30 lesions） with breast cancer confirmed by pathology were retrospectively analyzed. All patients were female, aged 39-69 years, with a median age of 55 years. According to the expression of estrogen receptors, progesterone receptor and human epidermal growth factor receptor-2 （HER-2）, the tumors were classified into triple-negative, HER-2 over expressed and luminal subtypes. The imaging features of different molecular subtypes breast cancers, such as the echo/signal, border, calcification, blood supply of tumor and the changes of surrounding tissue of tumors, were analyzed, especially time-signal intensity curve type in MRI and Alder blood supply type.Results There were one case of triple-negative （1/30）, 6 cases of HER-2 over expressed （6/30） and 23 cases of Luminal subtypes （23/30）. Diagnostic accuracy rate of breast cancer by ultrasound was 76.7%, and 86.7% by MRI, and both of them were 96.7%. There were statistical differences in TIC curve between HER-2 and Luminal subtypes （P〈0.05）.Conclusion Ultrasonic and MRI imaging features of different molecular subtypes breast cancers have some characteristics. Diagnostic accuracy rate of breast cancer combined ultrasound with MRI is higher than either one.

关 键 词：乳腺肿瘤 超声 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]