青年人乳腺癌的数字乳腺X线表现及病理特点  

Digital X-ray Mammography Manifestations and Pathological Features of Breast Cancers in Young Females

作　　者：欧阳晨雨[1] 秦广生[2] 廖昕[1] 秦耿耿[1] 徐维敏[1] 文婵娟[1] 陈卫国[1] 

机构地区：[1]南方医科大学南方医院放射科,广州510515 [2]普宁华侨医院设备科

出　　处：《临床放射学杂志》2015年第3期364-368,共5页Journal of Clinical Radiology

基　　金：广东省产学研结合重点项目课题(编号:2011A090200056);广东省科技计划项目(编号:2012A032200011)

摘　　要：目的探讨青年人乳腺癌的数字乳腺X线与病理表现特点。方法回顾性对比分析105例青年乳腺癌患者和300例中老年乳腺癌患者的数字X线表现及病理结果。结果青年组与中老年组乳腺癌均以Ⅱ级浸润性导管癌为主,外上象限好发。青年组60.95%乳腺癌为肿块型,以〈3 cm的肿块为主,36.19%呈非对称致密影,2.86%为单纯钙化;20.95%乳腺癌呈浸润性生长,21.90%可见毛刺,32.38%可见分叶,22.86%结构扭曲,毛刺发生率低于中老年组（χ2=8.331,P=0.004）,两组间分叶发生率无明显差别（χ2=2.255,P=0.133）。青年组72.38%乳腺癌可见钙化,以细小多形性钙化、成簇分布为主。肿块型与非肿块型钙化形态及分布差异均有统计学意义（χ2=17.513,P=0.002;χ2=17.965,P=0.000）。乳腺癌雌激素受体（ER）与孕激素受体（PR）、人类表皮生长因子受体-2（HER-2）表达有相关性（r=0.940,P=0.000;r=0.261,P=0.007）,ER阳性率低于中老年组,Her-2阳性率高于中老年组。两组间Ⅱ级浸润性导管癌ER、PR阳性率均高于III级浸润性导管癌。青年组Ki-67增殖指数3%~90%,≤5%4例,5%~30%27例,≥30%74例,Ki-67增殖指数大于30%的病例数百分比高于中老年组。两组分子分型均以Luminal B型为主,青年组HER-2过表达型及三阴型乳腺癌发病率均高于中老年组,淋巴结转移率高于中老年组。结论青年人乳腺癌特点为肿块直径多〈3 cm,钙化发生率高,组织学分级以Ⅱ级浸润性导管癌为主,病理分子分型以Luminal B型为主,数字乳腺X线摄影检查仍是青年人乳腺癌较佳的检查方法。Objective To investigate digital X-ray mammography manifestations and pathological characteristics of breast cancers in young females.Methods A total of 105 young females with breast cancer（ young group） and 300 middle-age and elderly females（ elderly group） with breast cancer were included in this study.The imaging manifestations and the pathological findings were retrospectively analyzed,and the results were compared between the two groups.Results In both groups,the lesion was predominantly grade II infiltrating ductal carcinoma,mostly located in the upper outer quadrant.In young group,60.95% of the lesions presented as a mass with a size less than 3 cm in most cases; 36.19% of lesions were characterized by an asymmetric dense shadow and calcification was observed in 2.86% of the lesions; 20.95%of the lesions showed an infiltrative growth pattern; marginal burrs,lobulation and distorted structures were seen in21.90%,32.38% and 22.86% of the lesions respectively; the occurrence of marginal burr in young group was significantly lower than that in elderly group（ χ2= 8.331,P = 0.004）,while no significant difference in the occurrence of marginal lobulation existed between the two groups（ χ2= 2.255,P = 0.133）.In young group,calcification was detected in72.38% of the breast carcinoma,and most of them were fine pleomorphic calcification,being distributed in a clustered pattern.The differences in the calcification morphology and distribution were statistically significant between the mass type and non-mass type（ χ2= 17.513,P = 0.002 and χ2= 17.965,P = 0.000,respectively）.ER expression level bore a definite correlation with PR and Her-2 expression level（ r = 0.940,P = 0.000 and r = 0.261,P = 0.007,respectively）; in young group the positive rate of ER was lower than that in elderly group,while the positive rate of Her-2 was higher than that in elderly group.In both groups the positive rate of ER and PR of grade II infiltrating ductal carcinoma was higher than that of grade Ⅲ infiltrating duct

关 键 词：乳腺癌 乳腺X线摄影术 青年 病理 

分 类 号：R737.9[医药卫生—肿瘤]