三阴性乳腺癌临床病理及影像学征象分析

Clinical Analysis of the Pathological and Imaging Features of Triple Negative Breast Cancer

目的探讨雌激素受体、孕激素受体、人类表皮生长因子受体2(HER-2)表达均为阴性(三阴性)乳腺癌与Luminal型、HER-2型乳腺癌之间临床、病理及影像学特征的差异。方法搜集经病理证实且资料完整的乳腺癌患者186例,其中三阴性乳腺癌68例,Luminal型乳腺癌93例,HER-2型乳腺癌25例。比较不同类型乳腺癌的X线摄影及MRI动态增强的影像学表现及临床病理特征并进行统计学分析。结果三阴性乳腺癌与Luminal型、HER-2型乳腺癌相比较,平均发病年龄分别为(39.9±5.8)岁、(53.2±8.3)岁、(49.4±8.0)岁(t=-12.02、t=-5.47,P<0.01);有家族史者分别为66.2%、24.7%、40.0%(χ2=27.65,P<0.01;χ2=5.18,P<0.05);乳腺X线摄影肿块表现为单纯性肿物者分别为55.9%、18.3%、20.0%(χ2=24.69、χ2=9.47,P<0.01),呈类圆形者分别为49.0%、25.9%、0%(χ2=6.00、χ2=6.03,P<0.05),边缘光滑者分别为62.7%、20.4%、0%(χ2=19.48、χ2=9.80,P<0.01),良性钙化者分别为67.9%、21.7%、5.9%(χ2=17.60、χ2=16.45,P<0.01);MRI动态增强扫描,肿瘤呈环状强化者分别为61.8%、37.6%、32.0%(χ2=9.17、χ2=6.52,P<0.05),时间-信号强度曲线(TIC)呈平台型者分别为58.8%、40.9%、24.0%(χ2=5.08、χ2=8.87,P<0.05)。结论三阴性乳腺癌与Luminal型乳腺癌、HER-2型乳腺癌相比,在发病年龄、临床病史、乳腺X线摄影及MRI动态增强扫描的影像学表现上均具有明显差异。根据其表现特点可为临床制定合理的治疗方案提供依据。

Objective To investigate the differences in clinical, pathological and imaging features between the breast cancer with triple negative and the breast cancer of luminal type and HER 2 type. Triple negative breast cancer is meant that the expressions of estrogen receptor （ ER）, progesterone receptor （PR） and human epidermal growth factor receptor 2 （ HER 2） are all negative. Methods A total of 186 patients with pathologically-proved breast cancer and complete clini- cal materials were enrolled in this study. Among the 186 patients, breast cancer with triple negative was seen in 68, breast cancer of luminal type in 93 and breast cancer of HER 2 type in 25. Mammography and dynamic enhanced MRI findings as well as clinico-pathological manifestations were recorded, and the results were statistically analyzed. Results The mean age at the onset of disease of triple negative, luminal type and HER 2 type breast cancer was （39.9 ± 5.8 ） years, （53.2 ± 8.3 ） years and （49.4 ± 8.0） years respectively. The differences between triple negative and luminal type and between triple negative and HER 2 type were statistically significant （t = -12. 02, t = -5.47, P 〈 0. 01 ）. The percentage of patients with a positive family history in the three groups was 66.2%, 24.7% and 40.0% respectively （ x^2 = 27.65, P 〈 0. 01 ; x^2 = 5.18, P 〈 0.05）. On mammography, 55.9%, 18.3% and 20.0% of the lesions was manifested as a simple mass in the triple negative, luminal type and HER 2 type group respectively （ x^2 = 24.69, x^2 = 9.47, P 〈 0.01 ） ; and round or oval in shape was seen in 49.0% , 25.9% and 0% of cases respectively （ x^2 = 6.00, x^2 = 6.03, P 〈 0.05） ; smooth border was seen in 62.7% , 20.4% and 0% of cases respectively （ x^2 = 19.48, x^2 = 9.80, P 〈 0.01 ） ; benign calcification was detected in 67.9% , 21.7% and 5.9% of cases respectively （x^2 = 17.60,x^2 = 16.45, P 〈 0.01 ）. Dynamic enhanced MRI scanning demonstrated circular enhancement in 61.8% , 37.6% and 32.0% of cases in the three groups respectively （x^2 = 9.17, x^2 = 6.52, P 〈 0.05 ）. Time-signal intensity curve （TIC） took the form of platform pattern in 58.8%, 40.9% and 24.0% of cases in the three groups respectively （x^2 = 5.08, x^2 = 8.87, P 〈 0.05）. Con- clusion The triple negative breast cancer is quite different from luminal type and HER 2 type breast cancer in the onset age of the disease, in the clinical history and in mammography and dynamic enhanced MRI manifestations. Based on its im- aging features, the reasonable therapeutic scheme can be formulated.