三阴性乳腺癌的钼靶影像学表现和临床病理特征

Mammographic and pathological features of triple-negative breast cancer

目的比较三阴性乳腺癌[雌激素受体（ER）、孕激素受体（PR）和人类表皮生长因子受体2（HER-2）均表达阴性]、ER＋／PR＋／HER-2-型乳腺癌和ER-／PR-／HER-2＋型乳腺癌的钼靶影像学表现和临床病理特征，探讨钼靶影像学表现和临床病理特征诊断三阴性乳腺癌的价值。方法收集临床资料完整的乳腺癌患者500例，其中三阴性乳腺癌患者112例，ER＋／PR＋／ttER-2-型乳腺癌患者310例，ER＋／PR-／HER-2＋型乳腺癌患者78例。比较3组患者的钼靶影像学表现和临床病理特征。结果三阴性乳腺癌组与ER＋／PR＋／HER-2-组比较，具有较高的病理组织学分级（P〈0．001）。三阴性乳腺癌组钼靶X线检查多表现为肿物，其中单纯肿物占58．0％，肿物伴钙化占19．6％。三阴性乳腺癌组肿物边缘多表现为光滑（47．1％），高于ER＋／PR＋／HER-2-组（9．8％，P=0．032）和ER-／PR-／HER-2＋组（0，P=0．028）。三阴性乳腺癌组钼靶X线检查较少表现为钙化，其中单纯钙化占13．4％，肿物伴钙化占19．6％。三阴性乳腺癌组钙化多为良性钙化（70．3％），明显高于ER＋／PR＋／HER-2-组（23．1％，P=0．002）和ER-／PR-／HER-2＋组（10．2％，P〈0．001）。结论不吲类型的乳腺癌有不同的生物学特征，其钼靶影像学表现也不尽相同，乳腺癌的钼靶影像学特征町帮助临床医师预测乳腺癌类型和患者的预后，以及评估患者对各种治疗方法的敏感性，有利于制定最优的治疗方案。

Objective To retrospectively evaluate the mammographic imaging findings and pathologic changes of the so-called ＂triple-negative＂ breast cancer （ ER-/PR-/HER-2 - breast cancer）, and to compare them with the ER＋/PR＋/HER-2- and ER-/PR-/HER-2- breast cancer patients. Methods Five hundred cases of breast cancer treated in Cancer Institute and Hospital of Tianjin University from January to June of 2010 were included in this study. There were 112 cases of triple-negative breast cancer, 310 cases of ER＊/PR＊/HER-2- breast cancer, and 78 cases of ER-/PR-/HER-2 breast cancer. Their pathological and mammographic data were reviewed and analyzed. The pathological and manunographic features of the three groups were compared. Results Compared with the ER ＋/PR ＋/HER-2- breast cancer group, the triple-negative group had a higher histological grade （P 〈 0. 001 ）. Compared with the ER ＋/PR ＋/HER-2 - and ER-/PR-/HER-2 ＋groups, the triple-negative group was more likely to have a tumor mass （simple mass accounted for 58.0%, and tumor mass with calcification accounted for 19.6% ）. Moreover, compared with the ER＂/PR/HER-2 - group （47.1% vs. 9.8 %, P = 0. 032） and the ER-/PR-/HER-2＂ group（47.1% vs. 0. P =0.028） . the tumor mass of triple-negative cancer was more likely to have a smooth margin. Triple-negative breast cancer seldom represented as calcification （simple calcification only accounted for 13.4%, and a mass with calcification accounted for 19.6% ）, and most of them were benign calcification （70.3 % ）, significantly higher than that in the ER ＋/PR ＋/HER-2- group （23.1% ,P=0.002）and ER-/PR-/HER-2＋ group（10.2% ,P〈0.001）. Conclusions Different types of breast cancer have different biological characteristics and mammographic features. Analysis of thenlammographic features may help us to predict the type of breast cancer and its prognosis, and to select an optimal treatment plan for patients with different types of breast cancer.