乳腺癌多模态超声边缘带征象与预后因素关系的研究  

Study on the Relationship between Multimodal Ultrasound Marginal Zone Signs and Prognostic Factors in Breast Cancer

作　　者：郝如意 陈武[2] 刘晓芳[2] 沈倩倩 任志翔 贺红霞[1] HAO Ruyi;CHEN Wu;LIU Xiaofang(Department of Medical Imaging,Shanxi Medical University,Shanxi 030001,China)

机构地区：[1]山西医科大学医学影像学院,太原030001 [2]山西医科大学第一医院,太原030001

出　　处：《医学研究杂志》2022年第12期84-88,136,共6页Journal of Medical Research

基　　金：山西省卫生健康委员会科研课题(2019037)。

摘　　要：目的探讨乳腺癌多模态超声边缘带征象与癌灶直径、淋巴结转移状态以及免疫组化标志物雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人类表皮生长因子受体-2(human epidermal growth factor receptor-2,HER-2)、ki-67表达之间的关系。方法回顾性分析笔者医院腺体外科经手术病理检查证实为乳腺癌的女性患者67例,共69个癌灶,术前均行常规超声、超声造影、剪切波弹性成像(share wave elastography,SWE)检查,记录以上各超声模式下癌灶的边缘带征象。以病理结果为金标准,记录癌灶直径、淋巴结转移状态以及免疫组化标志物等预后指标数据。结果常规超声中仅乳腺癌边缘毛刺征与癌灶直径有相关性,且呈正相关(r=0.270,P<0.05)。SWE中乳腺癌“硬环征”、边缘带弹性最大值(Emax)、边缘带弹性比值(Eratio)与ki-67阳性表达、淋巴结转移、癌灶直径均呈正相关(r分别为0.270、0.345、0.253,0.301、0.376、0.426,0.291、0.303、0.273,P均<0.05);同时,边缘带Eratio与Her-2阳性表达呈正相关,与PR阳性表达呈负相关(r分别为0.313、-0.275,P均<0.05)。超声造影中放射状增强、增强后边缘模糊与ER阳性表达、PR阳性表达均呈正相关(r分别为0.274、0.382,0.288、0.372,P均<0.05);边缘带达峰时间与ER阳性表达、PR阳性表达均呈负相关(r分别为-0.414、-0.355,P均<0.05),曲线下面积与Ki-67阳性表达、癌灶直径均呈正相关(r分别为0.364、0.299,P均<0.05),峰值强度与癌灶直径呈正相关(r=0.419,P<0.05)。结论乳腺癌多模态超声边缘带征象与癌灶直径、淋巴结转移及免疫组化标志物呈现一定相关性,对于准确诊断乳腺癌及指导个体化治疗具有重要的影像学意义。Objective To explore the relationship between the signs of breast cancer marginal zone in multimodal ultrasound and tumor size,lymph node status and the expressions of estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor 2(Her-2)and ki-67.Methods Ultrasound,contrast-enhanced ultrasound and ultrasound shear wave elastography(SWE)were performed in 69 cases of breast cancer before operation.The signs of the tumor marginal zone under various imaging techniques were recorded.The pathological results were used as the gold standard to record the data of prognostic indicators such as tumor size,lymph node status and immunohistochemical markers.Results In ultrasound,only marginal spiculation of breast cancer was correlated with the size of the tumor,and was positively correlated.(r=0.270,P<0.05).In SWE,“stiffness rim sign”,Emax of marginal zone and Eratio of marginal zone were positively correlated with ki-67 positively expression,lymph node metastasis and tumor size(r were 0.270,0.345,0.253,0.301,0.376,0.426,0.291,0.303,0.273,all P<0.05).At the same time,the marginal zone Eratio was positively correlated with the positive expression of Her-2,and negatively correlated with the positive expression of PR.(r were 0.313,-0.275,all P<0.05).In contrast-enhanced ultrasond,the radiative enhancement and fog margins after enhancement were positively correlated with the expression of ER and PR(r were 0.274,0.382,0.288,0.372,all P<0.05).The expression of ER and PR was negatively correlated with the peak time of marginal zone(r were-0.414,-0.355,all P<0.05).The positive expression of ki-67 and tumor size were positively correlated with the area under the curve(r were 0.364,0.299,all P<0.05).The tumor size was positively correlated with the peak intensity(r=0.419,P<0.05).Conclusion The signs of breast cancer marginal zone in multimodal ultrasound have certain correlation with tumor size,lymph node status and immunohistochemical markers,which has important imaging significance for accurate diagnosis

关 键 词：多模态超声 乳腺癌 边缘带 免疫组化 

分 类 号：R445.1[医药卫生—影像医学与核医学]