粗针穿刺活检在乳腺癌术前诊断中的应用及新辅助化疗前后分子生物学指标的变化  

Application of core needle biopsy to preoperative diagnosis of breast cancer and changes of molecular biology indices before and after neoadjuvant chemotherapy

作　　者：贾巍[1] 张红真[1] 王文娟[1] 赵光远[1] 姜玉荣[1] 尹长恒[1] 

机构地区：[1]河北省哈励逊国际和平医院,衡水市053000

出　　处：《广西医学》2016年第9期1235-1238,共4页Guangxi Medical Journal

基　　金：河北省衡水市科技局科研基金(14021A)

摘　　要：目的探讨超声引导下粗针穿刺活检(CNB)在乳腺癌患者术前诊断中的应用价值,以及新辅助化疗前后分子生物学指标的变化。方法选取142例疑诊乳腺癌患者均术前于超声引导下行CNB。47例患者CNB病理确诊后可直接行乳腺癌改良根治术,未经免疫组化检测,将其CNB的病理检查与术后病理检查结果进行对比分析;其余95例患者经CNB病理确诊及检测雌激素受体(ER)、孕激素受体(PR)、人类表皮生长因子受体2(Her-2)、细胞增殖抗原Ki-67等分子生物学指标后,采用TE方案(表柔吡星+紫杉醇)行新辅助化疗,化疗结束后再行手术治疗,比较化疗前后ER、PR、Her-2、Ki-67表达情况。结果 47例直接行乳腺癌根治术患者中,CNB病理诊断准确率为91.48%(43/47),假阴性率为0;95例术前行TE方案化疗的患者中,化疗后ER、PR、Her-2、Ki-67表达不同程度减弱,其中化疗后Ki-67的阳性转阴性比例及表达减弱比例均高于其他3个指标。结论超声引导下CNB可于术前明确乳腺癌病理诊断,对治疗方案的制定有重要指导意义。经TE方案新辅助化疗后,Ki-67表达阳性转阴性率显著升高。Objective To explore the application value of ultrasound-guided core needle biopsy（CNB） in preoperative diagnosis in patients with breast cancer, and the changes of molecular biology indices before and after neoadjuvant chemotherapy. Methods Ultrasound- guided CNB was performed before surgery in 142 patients suspected as breast cancer. Forty-seven patients were definitely diagnosed by CNB pathological examination and received the modified radical mastectomy without immunohistochemistry examination, and the pathological result of CBN was compared with the pathological result after surgery. The other 95 patients received neoadjuvant chemotherapy using TE plan（epirubicin ＋ paclitaxel） after definite diagnosis by CBN pathological examination and molecular biology indices detection including estrogen receptor（ER）, progesterone receptor （PR）, human epidermal growth factor receptor-2 （Her-2） and proliferating cell nuclear antigen Ki-67, and then received surgery following chemotherapy. The expressions of ER, PR, Her-2 and Ki-67 before and after chemotherapy were compared. Results Of 47 patients receiving directly radical mastectomy,the accuracy rate of CBN pathological diagnosis was 91.48% （43/47） and false negative rate was 0. Of 95 patients receiving TE chemotherapy before surgery, the expressions of ER, PR, Her-2 and Ki-67 decreased in vary degrees after chemotherapy, and the proportions of positive Ki-67 turned negative and Ki-67 with decreased expression were higher than those of the other 3 indices （P 〈 0.05 ）. Conclusion Ultrasound-guided CNB can obtain a definite pathological diagnosis of breast cancer before surgery and has important guiding significance for making a therapy plan. After TE neoadjuvant chemotherapy, the proportion of positive Ki-67 turned negative increases significantly.

关 键 词：乳腺癌 粗针穿刺活检 新辅助化疗 细胞增殖抗原Ki-67 雌激素受体 孕激素受体 人类表皮生长因子受体2 

分 类 号：R737.9[医药卫生—肿瘤]