乳腺浸润性导管癌超声图像特征与分子亚型的关系

Correlation of ultrasonographic features with molecular subtypes of breast invasive ductal carcinoma

背景与目的:乳腺浸润性导管癌(breast invasive ductal carcinoma,IDC)属于乳腺癌中最常见的一种类型,其各分子亚型的超声图像特征具有重要的临床价值。该研究探讨了IDC超声图像特征与其分子亚型的关系。方法:该研究回顾性分析112例具有完整术前超声图像特征及术后病理结果的IDC病例资料。其中以雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人表皮生长因子受体2(human epidermal growth factor receptor-2,HER-2)及细胞核增值抗原(Ki-67)的免疫组织化学检测结果进行分子分型,即Luminal A型、Luminal B型、ERBB2阳性型和Basal-like型。结果:在112例IDC病例中,Luminal A型14例,占12.5%;Luminal B型62例,占55.4%;ERBB2阳性型21例,占18.7%;Basal-like型15例,占13.4%。4个亚型的超声图像特征在肿块长径、淋巴结数量、边界、形态和血流方面差异均有统计学意义(P<0.05);而在内部回声、微钙化、后方回声衰减及弹性成像方面差异无统计学意义(P>0.05)。在所统计的IDC病例中,Luminal A型和Luminal B型转移淋巴结数量相对少,边界多不清,形态不规则;ERBB2阳性型血供丰富,肿块较大,转移淋巴结较多;Basal-like型多边界清,形态规则,肿块大,转移淋巴结多。结论:IDC超声图像特征与其分子亚型存在一定相关性,为IDC的早期诊断、术前、术中及预后评估有重要的临床指导意义。

Background and purpose： Breast invasive ductal carcinoma （IDC） is the most common breast carcinoma, and the ultrasonographic features of its molecular subtypes has great clinical value. The purpose of this study was to discuss the correlation between uhrasonographic features of IDC and its molecular subtypes. Methods： Uhrasonographic features of 112 patients with preoperative integrated ultrasonographic information and pathologically confirmed IDC from Sep. 2012 to Feb. 2015 were retrospectively analyzed. Based on the immunohistoehemistry results of ER （estrogen receptor）, PR （progesterone receptor）, HER-2 （human epidermal growth factor receptor-2） and Ki-67, these cases were categorized into 4 molecular subtypes： Luminal A group, Luminal B group, ERBB2 positive group and Basal-like group. Results： There were 14 cases （12.5%） in Luminal A group, 62 cases （55.4%） in Luminal B group, 21 cases （18.7%） in ERBB2 positive group and 15 cases （13.4%） in Basal-like group. The 4 molecular subtypes differed in tumor length, lymph node involvement, tumor boundary, tumor shape and internal blood flow on ultrasonography （P〈0.05）. There were no significant differences in tumor internal echo, posterior echo, micro-calcification and elastrography between subtypes （P〉0.05）.Luminal A group and Luminal B group had less lymph node involvement, more obscure boundary and irregular shape. More internal blood flow, bigger tumor size and lymph node involvement were observed in ERBB2 positive group of this study. Patients in Basal-like group were more likely to have clear tumor boundary, regular tumor shape, bigger tumor size and lymph node involvement on ultrasonogram. Conclusion： Correlation exists between ultrasonographic features and molecular subtypes of IDC. This has tremendous clinical significance in the early diagnosis of IDC, preoperative, intraoperative and prognosis evaluation of IDC patients.