锥光束乳腺CT及超声引导乳腺穿刺标本与手术标本对比分析  

Comparative analysis of breast specimens acquired with cone-beam breast computed tomography-guided core needle biopsy,ultrasound-guided core needle biopsy and surgical resection

作　　者：蒙丽宇 苏丹柯[1] 康巍[1] 赖少侣[1] 韦苇[1] 于滢华[2] MENG Liyu;SU Danke;KANG Wei;LAI Shaolü;WEI Wei;YU Yinghua(Medical Imaging Center,Guangxi Medical University Cancer Hospital,Nanning 530021,China;Department of Breast Surgery,Guangxi Medical University Cancer Hospital,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院医学影像中心,广西南宁530021 [2]广西医科大学附属肿瘤医院乳腺外科,广西南宁530021

出　　处：《实用放射学杂志》2021年第6期940-944,共5页Journal of Practical Radiology

基　　金：国家重点研发项目(2017YFC0112600,2017YFC0112603);广西高校中青年教师科研基础能力提升项目(2019KY0140)。

摘　　要：目的比较锥光束乳腺CT(CBBCT)及超声引导核芯针穿刺(CNB)标本与手术标本免疫组化指标及分子亚型的一致性.方法回顾性分析先行CNB、后行手术切除的73例乳腺癌患者的资料,对CNB标本及手术标本免疫组化指标、分子亚型的结果行一致性检验.结果CNB标本与手术标本的免疫组化指标雌激素受体(ER)、孕激素受体(PR)、人类表皮生长因子受体2(HER-2)及Ki-67的一致率分别为98.63%、94.52%、97.26%和79.45%,对应的Kappa值分别为0.95、0.85、0.93和0.51(P<0.001).CNB标本与手术标本的分子亚型的一致率为84.93%,Kappa值为0.80(P<0.001).将73例患者分为CBBCT组及超声组,分别计算CBBCT及超声引导CNB标本与对应手术标本的免疫组化指标及分子亚型的一致率,结果显示差异无统计学意义.以手术标本免疫组化指标为金标准,CNB标本ER、PR、HER-2和Ki-67的敏感度及特异度分别为100%及92.31%、94.74%及93.75%、90%及100%、86.27%及63.64%.结论CBBCT及超声引导CNB标本能充分预测手术标本的免疫组化结果及分子亚型,能在术前提供较准确的肿瘤病理特征,为制订术前个体化新辅助治疗方案提供重要依据.Objective To compare the consistency of immunohistochemical indexes and molecular subtypes in the specimens acquired with cone-beam breast CT(CBBCT)-guided core needle biopsy(CNB),ultrasound-guided CNB and surgical resection.Methods In this retrospective study,73 patients underwent image-guided CNB and subsequent surgical resection were included,the consistency of immunohistochemical indexes and molecular subtypes between CNB specimens and surgical specimens were evaluated.Results The agreement rates of estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor-2(HER-2)and Ki-67 between CNB specimens and surgical specimens were 98.63%,94.52%,97.26%,79.45%jrespectively and the corresponding Kappa values were 0.95,0.85,0.93,0.51,respectively(P<0.001).The agreement rates of molecular subtypes between CNB specimens and surgical specimens were 84.93%,and Kappa value were 0.80(P<0.001).Then,73 patients were divided into the CBBCT group and the ultrasound group,the agreement rates of the immunohistochemical indexes and molecular subtypes of the CBBCT or ultrasound guided CNB specimens and the corresponding surgical specimens were calculated.The results showed no significant differences.Using the immunohistochemical indexes of the surgical specimens as the gold standard,the sensitivities and specificities of ER,PR,HER-2 and Ki-67 of the CNB specimens were 100%and 92.31%,94.74%and 93.75%,90%and 100%,86.27%and 63.64%respectively.Conclusion CBBCT and ultrasound guided CNB specimens can sufficiently predict the immunohistochemical indexes and molecular subtypes of surgical specimens,which can provide accurate tumor pathological characteristics,and an important basis to make personalized neoadjuvant treatment schemes before surgery.

关 键 词：锥光束乳腺CT 核芯针穿刺 免疫组化指标 分子亚型 

分 类 号：R816.4[医药卫生—放射医学] R446.8[医药卫生—临床医学]