真空辅助下11G空芯针穿刺活检预测乳腺癌病理及分子亚型的准确性研究  

Accuracy of preoperative 11G vacuum-assisted core needle biopsy in determining histological type and molecular subtype in breast cancer

作　　者：谢四梅[1] 张安秦[1] 张江宇[2] 朱彩霞[1] 韩旎[1] 

机构地区：[1]广东省妇幼保健院乳腺病中心,广州511400 [2]广东省妇幼保健院病理科,广州511400

出　　处：《国际外科学杂志》2016年第6期390-395,F0004,共7页International Journal of Surgery

摘　　要：目的评估真空辅助下11G空芯针穿刺活检预测乳腺癌病理及分子亚型的准确性。方法回顾性分析广东省妇幼保健院2014年3月1日-2015年3月31日术前接受真空辅助11G活检确诊为乳腺癌并随后行手术切除患者的临床资料。Kappa检验比较11G空芯针穿刺标本与相应手术切除标本的病理类型、雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体2（Her-2）、Ki．67、分子亚型的符合率。对免疫组化提示Her-2呈（＋＋）的标本，则需荧光原位杂交（FISH）进一步明确状态。乳腺癌分子亚型分成LuminalA、LuminalB、Her-2过表达型及三阴型。结果36例乳腺癌中（浸润性癌32例），穿刺标本与手术标本的病理类型、ER、PR、Her-2、Ki-67、分子亚型的符合率依次为94．4％（K=0．934）、96．9％（K：0．904）、87．5％（K=0．710）、100％（K=1．000）、84．4％（K=0．570）、78．1％（K=0．621）。配对t检验显示两者间ER、PR、Ki-67表达值差异均无统计学意义（P〉0．05）。两者间Her-2过表达型及LuminalB亚型符合率较好，分别为100％、94．1％。三阴型的符合率较差（33．3％），其次为LuminalA型（50％）。如将ER／PR的阳性标准从≥1％调整为≥10％，Ki-67的截断值调整为≥20％。ER、PR、Ki-67、分子亚型的符合率可高达100％、93．8％、87．5％、81．3％。结论术前真空辅助11G空芯针穿刺活检可准确预测乳腺癌病理类型及分子亚型。Objective To assess the accuracy of histological type and molecular subtype observed in preopera- tive ll-gauge vacuum-assisted core needle biopsy（VACNB） specimens in breast cancer. Methods Patients diag- nosed by preoperative 11- gauge VACNB and received subsequent open excisional biopsy （OEB） from Mar 1 st 2014 to Mar 31st 2015 were included. Kappa testing was used to test the concordance rate of histological type, estrogen re- ceptor （ ER）, progesterone receptor （ PR）, human epidermal growth factor 2 （ Her- 2）, Ki-67 and molecular subgroups between VACNB and paired OEB specimens. ER, PgR, Her-2, and Ki-67 were determined by immunohistochemistry （IHC）. Patients with Her-2 IHC （ ＋ ＋ ） were further examined by FISH. Molecular subtypes were classified as fol- lows： LuminalA, LuminalB, Triple Negative, and Her-2 positive. Results There were 36 patients analyzed（32 of them had invasive breast cancer）. Between VACNB and paired OEB specimens, concordance rate of histological type, ER, PR, Her-2, Ki-67 and molecular group were 94.4% （ K = 0. 934）, 96.9% （ st = 0. 904）, 87.5% （ st = 0.710）, 100% （ st = 1. 000）, 84.4% （ st = 0. 570）, 78.1% （ st = 0. 621 ）. No significant difference was detected in the expression of ER, PR and Ki-67 between VACNB and OEB specimens according to paired t-test results. Concord- anee rate of each molecular subtype between VACNB and OEB specimens were 100% for Her-2 positive subtype, 94.1% for LuminalB subtype, 50% for LuminalA, and 33.3% for TNBC. When the threshold for ER/PR positivity was upgraded from ≥1% to 1〉 10% and Ki-67 cutoff value to ≥20% , the concordance rate for ER, PR, Ki-67 and molecular subtype reached to 100%, 93.8%, 87.5%, 81.3%. Conclusions 11 G vacuum-assisted cole needle biopsy was accurate in determining histological type and molecular subtype in breast cancer.

关 键 词：乳腺肿瘤 真空辅助旋切手术 空芯针活检 分子分型 符合率 

分 类 号：R737.9[医药卫生—肿瘤]