乳腺癌分子亚型的影像特征与保乳手术再切除率的相关性研究  

Correlation between image characteristics of intrinsic subtypes of breast cancer and resection rate of breast conserving surgery

作　　者：赵凯华[1] 李培莹[1] 谭政帅[1] 李振风[1] 方堃[1] 宫磊[1] 刘松岭[1] 王炳高[1] 颜政[1] 

机构地区：[1]青岛大学第二临床医学院青岛市中心医院乳腺病诊疗中心,山东青岛266042

出　　处：《临床肿瘤学杂志》2017年第7期628-632,共5页Chinese Clinical Oncology

摘　　要：目的探讨乳腺癌分子亚型的影像特征与保乳手术再切除率的相关性。方法 220例Ⅰ~Ⅱ期可扪及肿块、非特殊类型乳腺癌患者,术前采用空心针穿刺,根据病理组织学及免疫组化染色进行分子分型:Luminal A型32例,Luminal B型75例,Luminal-HER-2型38例,HER-2过表达型33例,三阴性乳腺癌(TNBC)42例。钼靶影像特征采用BI-RADS分类标准,分为肿块、钙化、结构扭曲、不对称致密和毛刺征。手术切除病灶范围采用距离肿物边缘1 cm,术中快速病理及石蜡病理证实切缘状态,结合分子亚型分析乳腺癌的影像特征与保乳手术再切除率的关系。结果乳腺癌单一影像征象在Luminal A组、Luminal B组、Luminal-HER-2组、HER-2过表达型组和TNBC组中的比例分别为37.5%(12/32)、29.3%(22/75)、28.9%(11/38)、15.2%(5/33)和61.9%(26/42);乳腺癌混合影像征象在Luminal A组、Luminal B组、Luminal-HER-2组、HER-2过表达型组和TNBC组中的比例分别为62.5%(20/32)、70.7%(53/75)、71.1%(27/38)、84.8%(28/33)和38.1%(16/42),差异有统计学意义(P<0.001)。乳腺癌边缘征象(毛刺征)在Luminal A组、Luminal B组、Luminal-HER-2组、HER-2过表达型组和TNBC组中的比例分别为50.0%(16/32)、42.7%(32/75)、50.0%(19/38)、18.2%(6/33)和7.1%(3/42),差异有统计学意义(P<0.001)。保乳手术的再切除率在Luminal A组、Luminal B组、Luminal-HER-2组、HER-2过表达型组和TNBC组分别为12.5%(4/32)、9.3%(7/75)、21.1%(8/38)、18.2%(6/33)和0(0/42),差异有统计学意义(P=0.01)。在乳腺癌的影像特征包含两种或两种以上影像学征象时,HER-2表达状态与保乳术再切除率有关,差异有统计学意义(P=0.001)。结论对非特殊型乳腺癌患者行保乳手术时,应结合分子分型、乳腺钼靶影像学征象及边缘征象来确定个体化的切除范围,以便降低再切除手术的概率。Objective To investigate the correlation between the image features associated with the intrinsic subtypes of breast cancer and resection rate of breast conserving surgery. Methods Two hundred and twenty cases with palpable mass and non specific breast cancer in stage Ⅰ-Ⅱ were divided into Luminal A（ n = 32）,Luminal B（ n = 75）,Luminal HER-2（ n = 38）,HER-2-enriched（ n = 33） and triple negative breast cancer（ TNBC,n = 42） according to the histopathology and immunohistochemistry examination,who were performed core needle biopsy before sugery. According to the mammography images with BI-RADS classification standard,mammogram features were divided into five groups,including masses types,calcification types,asymmetries types,architectural distortion types and spicule sign. The cutting edge was 1 cm apart from the mass. Frozen scection analysis was used to assess the margin status during the operation,which was confirmed by paraffin pathology diagnosis after surgery. Combining with intrinsic subtypes,we analyzed the correlation of imaging features of breast cancer and re-excision efficacy of breast-conserving surgery. Results Among the five groups,single imaging signs of breast cancer occupied 37. 5%（ 12/32）,29. 3%（ 22/75）,28. 9%（ 11/38）,15. 2%（ 5/33）and 61. 9%（ 26/42）,mixture imaging signs of breast cancer occupied 62. 5%（ 20/32）,70. 7%（ 53/75）,71. 1%（ 27/38）,84. 8%（ 28/33） and 38. 1%（ 16/42）,respectively,and the difference was statistically significant（ P〈0. 001）. The edge signs of breast cancer（ spiculated signs） occupied 50. 0%（ 16/32）,42. 7%（ 32/75）,50. 0%（ 19/38）,18. 2%（ 6/33） and 7. 1%（ 3/42） respectively.The difference was statistically significant（ P〈0. 001）. The re-excision rate after breast-conserving surgery were 12. 5%（ 4/32）,9. 3%（ 7/75）,21. 1%（ 8/38）,18. 2%（ 6/33） and 0（ 0/42） respectively. The difference was statistically significant（ P〈0. 001）. If the imaging features include two

关 键 词：乳腺癌 手术切缘 再切除术 钼靶 保乳手术 

分 类 号：R737.9[医药卫生—肿瘤]