病理三维重建研究新辅助化疗后乳腺原发肿瘤的退缩模式

Shrinkage mode of the primary breast tumor after neoadjuvant chemotherapy analyzed with part-mount sub-serial sectioning and three-dimensional reconstruction technique

目的：探索新辅助化疗后乳腺原发肿瘤的退缩模式。方法将86例ⅡA～ⅢC期乳腺浸润性导管癌患者分别行半疗程（25例）和全疗程（61例）新辅助化疗。新辅助化疗后手术标本制作次连续病理大切片，显微镜下勾画残余肿瘤范围，Photoshop软件配准，3D-Doctor软件三维重建残余肿瘤，评价新辅助化疗后原发肿瘤病理退缩模式。结合病理退缩模式，将临床-病理退缩模式分为向心性退缩（相比新辅助化疗前原发肿瘤最长径，新辅助化疗后残余肿瘤最长径≤2 cm且退缩比率≥50％）和非向心性退缩。结果半疗程组患者中，外科病理完全缓解（ pCR）1例，孤立状退缩1例，弥散状退缩23例；全疗程组患者中，外科pCR 18例，孤立状退缩3例，结节状退缩12例，团块伴散在状退缩21例，弥散状退缩7例，差异有统计学意义（ P＜0．001）。 Logistic多因素分析显示，新辅助化疗前原发肿瘤分期、新辅助化疗后淋巴结降期、新辅助化疗前钼靶恶性钙化灶和孕激素受体（ PR）表达为预测临床-病理退缩模式的独立影响因素（均P＜0．05）。结论病理组织学三维重建能够全面、立体、直观地展示新辅助化疗后乳腺原发肿瘤的退缩模式。全疗程新辅助化疗前原发肿瘤分期、新辅助化疗后淋巴结降期、PR表达和新辅助化疗前钼靶恶性钙化灶为新辅助化疗后乳腺原发肿瘤临床-病理退缩模式的独立影响因素。

Objective The aim of this study is to evaluate the shrinkage mode of the primary tumor in women with breast cancer after neoadjuvant chemotherapy （ NAC ） determined by part-mount sub-serial section （ PMSS） and three-dimensional （ 3D） reconstruction technique. Methods Eighty-six women with pathologically proven solitary invasive ductal carcinoma （ⅡA-ⅢC） were recruited. They were divided into two groups. Group A （ n=25） received half cycles of NAC and Group B （ n=61） received whole cycles of NAC. Breast specimen was prepared with PMSS, and residual tumors were microscopically outlined, scanned and registered by Photoshop software. The 3D model of residual tumors was reconstructed with 3D-Doctor software to evaluate the shrinkage mode. Further, the clinicpathologic shrinkage modes were divided into 2 categories：concentric shrinkage mode （ CSM, the longest diameter of the pathological residual tumors was less than 50% and ≤2 cm in comparison with the primary tumor before NAC ） , and non-concentric shrinkage mode （ NCSM, the longest diameter of the pathological residual tumors was more than 50% and/or〉2 cm in comparison with the primary tumor before NAC） . Results Pathological shrinkage modes：Group＆amp;nbsp;A： modes Ⅰ,Ⅱ, andⅤwere observed in 1, 1, and 23 cases, respectively;Group B：modesⅠ,Ⅱ,Ⅲ,Ⅳ, and Ⅴwere observed in 18, 3, 12, 21, and 7 cases, respectively （ P〈0.001） . The multivariate analysis showed that patients with lower primary tumor stage, PR（-） or mammographic malignant calcification before NAC（-） and lymph nodes down-staging after NAC were more likely to present with CSM after NAC （ P〈0.05 for all）. Conclusions The pathologic reconstruction of breast residual tumors can fully and three-dimensionally reveal the shrinkage mode of the primary breast tumor in women with breast cancer after NAC. PMSS and 3D reconstruction of pathology provide a new platform in this area. Primary tumor stage, PR expression and mammographic malignant calcification before NAC and lymph node down-staging after NAC are independent predictors of the clinicopathologic shrinkage mode.