乳腺浸润性导管癌各分子亚型X线表现及临床特征

Mammographic features and clinical characteristics of different molecular subtypes of infiltrative ductal carcinoma

目的探讨乳腺浸润性导管癌WHOⅡ型分子亚型的X线表现与临床特征。方法 110例经手术病理证实的乳腺浸润性导管癌(WHOⅡ级)患者,术前均行乳腺X线摄影,术后依据免疫组化雌激素受体(ER)、孕激素受体(PR)、人类表皮生长因子受体2(HER-2)水平将其划分为Luminal A型、Luminal B型、Basal-like型和HER-2+型4个分子亚型,对比分析该4型患者的影像学表现及分布比例、发病年龄、绝经状态等临床特征。结果 110例患者,不同分子亚型间X线表现差异显著,Luminal A型和Luminal B型表现为肿块影、毛刺征者比例较高;Basal-like型则常表现为非蠕虫样钙化及边缘清晰肿块影;HER-2+型表现为无明确肿块影、蠕虫样钙化者比例高;淋巴结阳性病例中,HER-2+型多枚淋巴结转移比例更高;HER-2+型和Basal-like型病例肿瘤最大径>2 cm的比例较高,而Luminal A型和Luminal B型的肿瘤最大径多≤2 cm。结论乳腺浸润性导管癌各分子亚型的X线表现及临床特征显著相关。乳腺癌的X线表现在一定程度上反映着乳腺癌的分子亚型及癌细胞的生物学行为和预后,对早期诊断及治疗有重要意义。

Objective To observe the mammographic features and clinical characteristics with the molecular subtypes of WHO Grade Ⅱ infiltrative ductal carcinoma.Methods Totally 110 patients with WHO Grade Ⅱ infiltrative ductal carcinoma proved pathologically who underwent digital mammography examination before operation were enrolled.They were classified into 4 different subtypes： Luminal A,Luminal B,Basal-like and HER-2＋ tumors according to immunohistochemical（IHC） markers as estrogen receptor（ER）,progesterone receptor（PR） and HER-2.Mammographic appearances and clinical characteristics such as distribution,age of onset and menopausal status among different subtype were analyzed.Results High proportion of mass and spicular sign were found in Luminal A and Luminal B tumors.Basal-like tumor manifested as nonwormlike calcification and mass with clear edge.High proportion of wormlike calcification were observed in HER-2＋ tumors without clear mass.There were more lymph nodes metastasis in HER-2＋ tumors.The proportion of the maximum diameter of the tumor was 2 cm was higher in HER-2＋ and Basal-like subtype,while tumor diameters in most cases of Luminal A and Luminal B subtypes were ≤2 cm.Conclusion The mammographic features and clinical characteristics of different molecular subtypes of WHO Grade Ⅱ infiltrative ductal carcinoma have significant correlation.To some extent,the biologic behavior and prognosis can be assessed according to mammographic features enhance the reliability of early diagnosis and treatment.