三阴性乳腺癌的钼靶X线及超声征象分析

Imaging features of triple negative breast cancer in mammography and sonography

目的比较并探讨三阴性乳腺癌（triple negative breast cancer,TNBC）及其他亚型乳腺癌的钼靶X线、超声表现,以及两种影像学方法对诊断三阴性乳腺癌的价值.方法 对157例乳腺癌患者术前行钼靶X线及超声形态学分析,术后标本测定癌细胞的ER、PR、HER2表达情况,分析三组乳腺癌临床病理特征与钼靶X线及超声表现的关系.结果 三阴性乳腺癌在钼靶X线上的特征性表现为单纯肿块（P〈0.01）、类圆形（P=0.023）、边缘清晰（P=0.005）,超声的特征性表现为单纯肿块（P〈0.01）、类圆形（P=0.01）、边缘清晰（P=0.001）,32例三阴性乳腺癌中导管内癌2例（6%）,HER2、ER阳性乳腺癌的中导管内癌分别为21例（41%）、30例（40%）,差异有统计学意义（P=0.003）.32例三阴性乳腺癌中,12例在钼靶上无异常表现,而这12例乳腺癌在超声上有10例呈肿块表现.结论 三阴性乳腺癌影像学有特征性表现,超声对于筛查三阴性乳腺癌具有一定优势,能发现钼靶无法发现的病灶.

Objective To compare imaging features of breast cancers of different immunophenotypes. Methods We identified all women who had been diagnosed with primary breast cancer at a single institution and who had undergone mammography and ultrasound at initial diagnosis. Patient characteristics including clinical, histologic, mammographic and sonographic features of breast cancers were tabulated by immunophenotype. Results Lesion margins on nlammograms （P = 0. 005） and sonograms （P 〈0, 001 ）, lesion shapes on mammograms （P = 0. 023） and sonograms （ P = 0. 01 ）, calcifications on mammograms （ P 〈 0. 001 ） and sonograms （P 〈0. 001 ） were significantly associated with triple receptor- negative （TRN） cancers. Duetal carcinoma in situ was reported in 6% （2/32）, 41% （21/51）, and 40% （30/74） of TRN, HER2 （ ＋ ）, and ER（ ＋ ） patients, respectively （P = 0. 003 ）. Twelve （ 37% ） of thirty - two TRN breast cancers exhibited mammographically occult, whereas these 12 patients presented ten masses according to breast US. Conclusion Sonograms proves superior in visualizing more cases and is useful in detecting breast cancer not discovered with mammography.