乳腺导管内乳头状肿瘤的免疫表型分析

Immunohistochemical Study of Intraductal Papilloma Neoplasms of the Breast

目的:研究乳腺导管内乳头状肿瘤免疫表型及其临床意义。方法:采用免疫组织化学方法检测665例乳腺导管内乳头状肿瘤患者肿瘤组织中钙调蛋白(calponin)、平滑肌肌球蛋白重链(smooth muscle myosin heavy chain,SMMHC)、p63和cerbB-2的表达水平,并将患者分为导管内乳头状瘤组、不典型乳头状瘤组及导管内乳头状癌组,并随访其预后。结果:3组患者的发病年龄差异有统计学意义,但发病部位差异无统计学意义。肿瘤直径:导管内乳头状瘤组平均(0.56±0.12)cm,不典型乳头状瘤组平均(0.75±0.26)cm,乳头状癌组平均(1.92±0.67)cm;后者明显大于前两组(P<0.01)。SMMHC、calponin及p63抗体在乳头状癌中的表达明显低于乳头状瘤和不典型乳头状瘤,cerbB-2表达明显高于乳头状瘤和不典型乳头状瘤,差异均有统计学意义(P<0.05);但乳头状瘤与不典型乳头状瘤相比,3种抗体的表达差异均无统计学意义(P>0.05)。564例患者获得5年生存随访,乳头状瘤患者随访407例,其中3例(0.7%)复发;不典型乳头状瘤患者随访88例,其中2例(2.3%)复发;乳头状癌患者随访69例,无复发患者。但3组间5年的无病生存率差异无统计学意义。结论:SMMHC、calponin、p63和cerbB-2标记物在鉴别乳腺乳头状肿瘤的良恶性时具有较高的临床价值;行扩大切除术后的乳腺导管内乳头状癌患者的预后与另两组相似。

Objective： To study the characteristics of the immunophenotypes in different types of intraductal papilloma neoplasms（IDPN） of the breast. Methods： The expression of calponin,SMMHC, p63 and cerbB-2 were detected by immunohisto-chemistry in breast intraductal papilloma,atypical papilloma and intraductal papillary carcinoma, and clinical pathological characteristics were analyzed. Results： The positive rates of calponin, smooth muscle myosin heavy chain （SMMHC） and p63 in intraductal papillary carcinoma were significantly lower than those in breast intraductal papilloma and atypical papilloma （P〈0.05）. The expression level of cerbB-2 in intraductal papillary carcinoma was significantly higher than those in breast intraductal papilloma and atypical papilloma （P〈0. 05）. The follow-up results showed that the five year disease-free survival rates a mong the three groups had no significant differences. Conclusions： The four immunophenotypes are of great value in the differentitation of benign and malignant intraductal papilloma neoplasms of the breast. After extended mastectomy, the prognosis of patients with intraductal papillary carcinoma of breast has no significant differences with the other groups.