乳腺浸润性导管癌剪切波弹性模量的病理研究

Pathologic analysis of supersonic shear elastography in breast invasive ductal carcinoma

目的探讨乳腺浸润性导管癌剪切波弹性模量值与瘤体胶原纤维形态和排列方式的关系。方法对术前经剪切波声弹性成像定量检测和病理证实的35例乳腺浸润性导管癌组织标本行病理苦味酸天狼猩红特殊染色,对所含胶原纤维的类型进行定量分析,对胶原纤维的形态特点和排列方式进行分析和归类,并将其不同的归类与肿瘤最大弹性模量值进行对照。结果苦味酸天狼猩红特殊染色切片镜检示35例乳腺浸润性导管癌肿块中Ⅰ型胶原纤维占胶原纤维总面积的83%(959 771.75/1156 351.51);胶原纤维均呈长直形态,其中29例乳腺癌病灶中长直细胶原纤维的弹性平均值(152.9±93.4)k Pa高于6例乳腺癌病灶中长直粗胶原纤维的弹性值(74.8±6.4)k Pa;35例乳腺癌病灶中6例胶原纤维表现为蜂窝状排列方式、10例表现为片状排列、11例表现为分层排列,8例表现为交错状排列方式;乳腺癌病灶中4种排列方式的胶原纤维弹性最大平均值分别为252.2 k Pa、152.4 k Pa、120.6 k Pa和65.0 k Pa,其中以蜂窝状排列的胶原纤维弹性值最大。结论乳腺癌病灶中不同形态和不同排列方式的胶原纤维是浸润性导管癌肿瘤硬度不同的重要原因。

Objective To investigate the correlation between the values of shear wave elastic modulus and collagen fibers morphology and arrangement of breast invasive ductal carcinomas.Methods Thirty-five breast invasive ductal carcinomas were performed conventional ultrasound and shear wave elastography(SWE)before operation.All specimens underwent special pathological staining.The morphological characteristics and arrangement of collagen fibers were analyzed and classified.And the classification and the maximum modulus of elasticity of the tumor were compared.Results In 35 cases of breast invasive ductal carcinoma,typeⅠcollagen fiber accounted for 83%of the total collagen area.All collagen fibers exhibited morphology of long and straight,and the average elasticity of 29 cases(152.9±93.4 kPa)with collagen fibers morphology of long,straight and thin was higher than the average elasticity of 6 cases(74.8±6.4 kPa)with collagen fibers morphology of of long,straight and thick.According to the classification of collagen arrangement,35 cases were classified to honeycomb,platelike,layered and interlaced arrangement.The average elasticity of collagen fibers with honeycomb(6 cases),platelike(10 cases),layered(11 cases),and interlaced arrangement(8 cases)was 252.2 kPa,152.4 kPa,120.6 kPa and 65.0 kPa respectively.The average elasticity modulus value of collagen fibers with honeycomb was the highest of other three kinds of them.Conclusion Different morphology and arrangement of collagen fibers are important causes with different stiffness in invasive ductal brseast carcinoma.