不同亚型乳腺导管原位癌与X线摄影和临床病理特征的相关性研究  

Study on correlation between different subtypes of breast ductal carcinoma in situ with mammographic and clinicopathologic features

作　　者：荣小翠[1] 康一鹤 吴勇超[1] 武中林[1] 赵俊京[1] RONG Xiaocui;KANG Yihe;WU Yongchao;WU Zhonglin;ZHAO Junjing(Department of Radiology,the Fourth Hospital of Hebei Medical University,Shijiazhuang, Hebei 050011,China)

机构地区：[1]河北医科大学第四医院放射科

出　　处：《重庆医学》2019年第13期2245-2249,共5页Chongqing medicine

摘　　要：目的探讨不同亚型乳腺导管原位癌(DCIS)与X线摄影表现、临床病理特征的相关性。方法回顾性分析2015年2月至2016年9月经该院手术病理证实的DCIS患者79例,所有病例术前均进行X线摄影。应用美国放射学会(ACR)制定的乳腺影像报告数据系统(BI-RADS)对乳腺癌X线摄影表现进行规范化的描述分析。结果 79例单纯DCIS患者中ER阳性型44例(55.7%),HER-2阳性型32例(40.5%),三阴性型3例(3.8%)。X线病变类型:单纯钙化38例(48.1%);肿块、致密影或结构扭曲17例(21.5%);肿块、致密影或结构扭曲伴钙化24例(30.4%)。ER阳性型、HER-2阳性型、三阴性型患者的肿瘤直径分别为(1.7±1.6)、(2.1±1.6)、(3.2±1.6)cm(P=0.047)。HER-2阳性型、三阴性型患者更多表现为高核级、Ki-67高表达(P=0.000、0.000)。不同亚型间X线病变类型无明显差异(P=0.064)。钙化形态在不同亚型间存在差异(P=0.026),HER-2阳性型更多表现为线样或线样分支状钙化。钙化分布在不同亚型间无明显差异(P=0.272)。伴钙化DCIS其HER-2+及Ki-67高表达更为常见(P=0.030、0.016)。多变量Logistic回归显示:HER-2阳性型、三阴性型及Ki-67高表达更多表现为高核级(P<0.05)。结论 DCIS患者大部分为ER阳性型及HER-2阳性型,三阴型较少见。ER阳性型一般为低、中核级DCIS,而HER-2阳性型、三阴性型大多数为高核级DCIS,Ki-67呈高表达,预示其预后较差,发展为浸润性癌的风险及局部复发率较高。HER-2阳性型与X线摄影钙化明显相关,形态上多表现为线样或线样分支状钙化。Objective To explore the correlation between different subtypes of breast ductal carcinoma in situ(DCIS)with mammographic and clinicopathologic features.Methods Seventy-nine patients with breast DCIS verified by operation and pathology in this hospital from February 2015 to September 2016 were retrospectively analyzed.The mammography was performed before operation in all cases.The X-ray features of breast cancer performed the normalized description according to BI-RADS formulated by ACR.Results Among 79 cases of simple DCIS,44 cases(55.7%)were ER-positive,32 cases(40.5%)were HER2-positive,and 3 cases(3.8%)were triple-negative.The X-ray lesion types:38 cases(48.1%)of simple calcifications,17 cases(21.5%)of mass,asymmetries or architectural distortion,24 cases(30.4%)of mass,asymmetries or architectural distortion complicating calcification.The mean tumor sizes distributions for ER-positive,HER2-positive,and triple-negative DCIS were(1.7±1.6),(2.1±1.6),(3.2±1.6)cm respectively(P=0.047).The HER2-positive type and triple-negative type were more manifested by high nuclear grade and Ki-67 high expression(P=0.000,0.000).The X-ray lesion types had no obvious difference among different subtypes(P=0.064).The calcification morphology had difference among different subtypes(P=0.026).HER-2 positive type was more manifested by the linear or linear branched calcification.The calci-cation distribution had no obvious difference among different subtypes(P=0.272).The HER-2 positive and Ki-67 high expression in DCIS complicating calcification were more common(P=0.030,0.016).The multivariate Logistic regression showed that the HER-2 positive type,triple negative type breast cancer and Ki-67 high expression were more manifested by high nuclear grade breast cancer(P<0.05).Conclusion The majority paltients with breast DCIS are ER-positive type and HER2-positive type.The triple-negative DCIS is uncommon.The ER-positive type is usually low,middle nuclear grade DICS,while the majority of HER-2 positive type and triple negative type breas

关 键 词：导管原位癌 放射摄影术 亚型 病理学 分子 

分 类 号：R445[医药卫生—影像医学与核医学]