乳腺癌超声表现与生物学指标的相关性及对临床治疗的指导意义

Relation between ultrasound and immune-histochemical findings of breast cancer

目的 探讨乳腺癌超声的边缘毛刺和微钙化灶与生物学指标雌激素受体（ER）、孕激素受体（PR）、c-erbB-2、p53的相关性,为乳腺癌术前辅助治疗及预后判断提供依据.方法 对45例手术后病理确诊为乳腺癌且测定ER、PR、c-erbB-2、突变型p53表达水平的病例进行超声图像回顾性观察,分析超声征象与分子生物学指标的关系,探讨其相关性.结果 ER、PR在具有边缘毛刺征肿块中的阳性表达率明显高于无边缘毛刺征的肿块,差异有统计学意义[85.3％（29/34）比36.4％ （4/11）,P=0.005;85.3％ （29/34）比45.4％ （5/11）,P=0.008];而c-erbB-2、p53在有边缘毛刺征肿块和无边缘毛刺征肿块中的阳性表达率差异无统计学意义[58.8％ （20/34）比27.3％ （3/11）,P=0.141;58.8％ （20/34）比18.2％ （2/11）,P=0.072].c-erbB-2、p53在有微钙化灶的肿块中阳性表达率明显高于无微钙化征的肿块,差异有统计学意义94.4％ （17/18）比22.2％（6/27）,P=0.005;88.9％（16/18）比22.2％（6/27）,P=0.000];而ER、PR有微钙化灶的肿块中阳性表达率与无微钙化征的肿块差异无统计学意义[72.2％ （13/18）比74.1％（20/27）,P =0.953;83.3％ （15/18）比70.4％（19/27）,P=0.534].结论 乳腺癌超声表现的边缘毛刺征和微钙化征可以从一定程度上预测某些免疫组织化学因子（ER、PR、c-erbB-2,p53）的表达水平;可以根据乳腺癌的超声表现预测其生物学行为,在免疫组织化学因子检测结果出来前早期指导临床治疗.

Objective To investigate the ultrasound burr on the edge of the breast cancer,tiny calcification and biological indicators such as estrogen receptor （ER）,progesterone receptor （PR）,c-erbB-2 and p53; to provide guidance for preoperative adjuvant therapy for breast cancer and prognosis judgments.Methods Totally 45 cases pathologically diagnosed of breast cancer after operation were enrolled; ER,PR,c-erbB-2 cases and p53 expression were detected ; the relation between the ultrasonic manifestations and molecular biological indicator were analyzed.Results Level of ER and PR was significantly higher in mass with edge burr of lump than that in mass without edge burr[85.3％ （29/34） vs 36.4％ （4/11）,P =0.005 ; 85.3％ （29/34） vs 45.4％ （5/11）,P =0.008] ; the positive rate of c-erbB-2 and p53 in mass with edge burr of lump and in mass without edge burr did not have statistically significant difference [58.8％ （20/34） vs 27.3％ （3/11）,P =0.141 ; 58.8％ （20/34） vs 18.2％ （2/11）,P =0.072].The level of c-erbB-2 and p53 was significantly higher in tumor with micro calcifications than that in tumor without micro calcifications [94.4％ （17/18） vs 22.2％ （6/27）,P =0.005 ; 88.9％ （16/18） vs 22.2％ （6/27）,P =0.000].The positive expression rate of ER and PR in tumors with and without micro calcifications had no statistically significant difference[72.2％ （13/18） vs 74.1％ （20/27）,P =0.953; 83.3％ （15/18）vs 70.4％ （19/27）,P =0.534].Conclusions Edge burr sign and micro calcification sign for breast cancer in ultrosound imaging can be used to predict the expression level of certain immunohistochemical factors （ER,PR,c-erbB-2,p53）.The biologic behavior of breast cancer can be predicted according to the ultrasonographic features,which can provide guide for early clinical treatment.