隐匿性乳腺癌的MRI表现及临床病理特征  

MRI findings and pathological features of occult breast cancer

作　　者：张俊杰 杨晓棠[1] 杜笑松[1] 张建新[1] 侯丽娜[1] 牛金亮[2] 

机构地区：[1]山西省肿瘤医院核磁CT室,太原030013 [2]山西医科大学第二医院影像科,太原030001

出　　处：《中华肿瘤杂志》2018年第1期40-45,共6页Chinese Journal of Oncology

摘　　要：目的探讨隐匿性乳腺癌原发癌灶的MRI表现及临床病理特征。方法依据2013年MRl乳腺影像报告和数据系统对隐匿性乳腺癌患者的乳腺内病灶进行分析，研究隐匿性乳腺癌患者MRI增强后形态学特征、时间-信号强度曲线（TIC）和临床病理特征。结果34例患者中，行乳腺癌改良根治术24例，其中18例在乳腺病理切片中可见原发癌灶。MRI检出原发癌灶17例，其中肿块型病变6例．直径0．6～1．2cm（平均0．9CITI）；非肿块样强化病变11例，其中线样分布4例，段样分布3例，局灶性分布3例，区域性分布I例。TIC类型I型5例，Ⅱ型10例，Ⅲ型2例。34例隐匿性乳腺癌中，有完整免疫组化结果23例，雌激素受体（ER）阳性11例（47．8％），孕激素受体（PR）阳性10例（43．5％），人表皮生长因子受体2（HER-2）阳性7例（30．4％），Ki-67高表达（〉14％）20例（87．0％）。LumiHalA型1例（4．3％）．LuminalB型10例（43．5％），三阴性乳腺癌7例（30．4％），HER-2过表达5例（21．7％）。结论隐匿性乳腺癌灶MRI常表现为体积较小的肿块型病变及局灶性分布、线样分布或段样分布的非肿块样强化病变，ER、PR阳性率低，而HER-2阳性率高，Ki-67指数较高，其分子亚型构成以LuminalB型最为多见。Objective To investigate the magnetic resonance imaging （MRI） findings and clinicopathological features of primary lesions in patients with occult breast cancer （OBC）. Methods The imaging reports from the Breast Imaging Reporting and Data System in 2013 were retrospectively analyzed to investigate the morphology and the time signal intensity curve （TIC） of breast lesions in patients with OBC. The clinical and pathological characteristics of these patients were also included. Results A total of 34 patients were enrolled. Among these patients, 24 patients underwent modified radical mastectomy and 18 of them had primary breast carcinoma in pathological sections. MRI detected 17 cases of primary lesions, including six masse lesions with a diameter of 0.6-1.2 cm （average 0.9 cm） , and 11 non-mass lesions with four linear distributions, three segmental distributions, three focal distributions, and one regions distribution. Five patients had TIC type I primary lesions, ten had TIC type 1I primary lesions, and two had TIC type llI primary lesions. Among all 34 cases, 23 of them had complete results of immunohistochemistry ： 11 estrogen receptor （ER） positive lesions （47.8%）, tenprogesterone receptor （PR） positive lesions （43.5%）, seven human epidermal growth factor receptor 2 （HER-2） positive lesions （30.4%）, and 20high expression （〉 14%） of Ki-67 （87.0%）. The proportion of type luminal A was 4.3%, type luminal B was 43.5%, triple negative breast cancer （TNBC） was 30.4%, and HER-2 over expression accounted for 21.7%. Conclusions The primary lesions of OBC usually manifested as small mass lesions, or focal, linear or segmental distribution of non-mass lesions. The positive rate of ER and PR was low, but the positive rate of HER-2 and the proliferation index of Ki-67 was high. Type luminal B is the most common molecular subtype.

关 键 词：乳腺肿瘤 肿瘤 未知原发灶 磁共振成像 病理学 临床 

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]