非肿块型DCIS影像学特点与临床病理特征及分子分型的相关性分析  

Correlation Analysis Between Imaging Features Clinicopathological Characteristics and Molecular Subtypes of Non-Mass Ductal Carcinoma In Situ(DCIS)

作　　者：刘芳[1] 周梦红[1] 王海娟 袁博[1] 欧晓霞 李莉[1] LIU Fang;ZHOU Menghong;WANG Haijuan(The First Affiliated Hospital of Hunan University of Traditional Chinese Medicine,Hunan Changsha 410007,China)

机构地区：[1]湖南中医药大学第一附属医院,湖南长沙410007

出　　处：《河北医学》2024年第1期55-60,共6页Hebei Medicine

基　　金：湖南省教育厅医学科学研究项目,(编号:21C0236)。

摘　　要：目的:探讨非肿块型乳腺导管内原位癌(DCIS)影像学特点,并分析影像学特点与临床病理特征及分子分型关系。方法:选取2020年6月至2021年6月在我院接受手术治疗的100例非肿块型DCIS患者作为研究对象,进行超声影像分分型,分别为Ⅰ型31例,Ⅱ型15例、Ⅲ型43例及Ⅳ型11例。免疫组化检测病理组织雌激素受体(ER)、孕激素受体(PR)、人类表皮生长因子受体2(HER2)及Ki-67阳性表达;按照St.Gallen标准对患者进行Luminal A型及Luminal B型分子分型。结果:Ⅰ型:导管出现增粗,行走迂曲且管腔内出现低回声;Ⅱ型:乳腺内呈现片状的低回声区域,边界模糊;Ⅲ型:乳腺内呈现片状的低回声区域,可见分布不匀的点状强回声;Ⅳ型:乳腺内腺体及导管分布混乱,结构扭曲;Ⅰ型、Ⅱ型、Ⅲ型及Ⅳ型非肿块型DCIS患者临床病理资料年龄、肿瘤直径、月经状态、病灶部分、临床症状均无统计学差异(P>0.05),随着超声分型级别的升高细胞核分级也随之升高(P<0.05);Ⅰ型、Ⅱ型患者HER2阳性表达差异无统计学意义(P>0.05),与Ⅰ型相比,Ⅲ型及Ⅳ型的HER2阳性表达升高(P<0.05);与Ⅱ型相比,Ⅲ型的HER2阳性表达升高,但与Ⅳ型差异无统计学意义(P>0.05),Ⅲ型与Ⅳ型的HER2阳性表达组间比较差异无统计学意义(P>0.05);与Ⅰ型相比,Ⅲ型患者Luminal A型、Luminal B型分型分布升高(P<0.05),与Ⅰ型相比,Ⅳ型患者Luminal B型分型分布升高(P<0.05),Luminal A型差异无统计学意义(P>0.05)。结论:非肿块型DCIS患者超声主要为钙化型,认为结构紊乱型患者细胞核分级较高,且HER2阳性表达较多,Luminal A型占比降低,Luminal B型占比升高。Objective:To investigate the relationship between the imaging features and the clinicopathological characteristics of non-mass ductal carcinoma in situ(DCIS)and to analyze their correlation with molecular subtypes.Methods:This study selected 100 patients with non-mass DCIS who underwent surgical treatment at our hospital from June 2020 to June 2021.The patients were classified into four types(Type I:31 cases,TypeⅡ:15 cases,TypeⅢ:43 cases,and TypeⅣ:11 cases)based on ultrasound findings.Immunohistochemistry was used to evaluate the positive expression of estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor 2(HER2),and Ki-67.Patients were categorized into Luminal A and Luminal B molecular subtypes according to the St.Gallen standard.Results:Type I exhibited thickened and tortuous ducts with low echogenicity within the lumen.TypeⅡdisplayed patchy hypoechoic areas with indistinct boundaries in the breast.TypeⅡshowed lamellar hypoechoic areas with unevenly distributed punctate strong echoes in the breast.TypeⅣpresented disordered glandular structures with distorted architecture.There were no statistically significant differences in age,tumor diameter,menstrual status,lesion location,and clinical symptoms among patients with Type I,TypeⅡ,TypeⅢ,and TypeⅣnon-mass DCIS(P>0.05).However,as the ultrasound classification level increased,nuclear grade also increased(P<0.05).There were no significant differences in the positive expression of ER,PR,Ki-67 levels among Type I,TypeⅡ,TypeⅢand TypeⅣnon-mass DCIS patients(P>0.05).But,there was a significant difference in HER2 positive expression between Type I and TypeⅡ,with TypesⅢandⅣshowing a higher HER2 positive expression(P<0.05).There was no significant difference in HER2 positive expression between type I and type II patients(P>0.05).Compared to type I,type III and type IV showed higher HER2 positive expression(P<0.05).Type III had higher HER2 positive expression compared to type II,but the difference with type IV wa

关 键 词：非肿块型乳腺导管内原位癌 超声 分级 临床病理 

分 类 号：R737.9[医药卫生—肿瘤]