摘要
目的比较分析乳腺导管原位癌(ductal carcinoma in situ,DCIS)及导管原位癌伴微浸润(ductal carcinoma in situ with microinvasion,DCISM)的超声表现及临床病理特征。方法回顾性分析笔者医院2013年1月~2020年12月经手术病理证实的118例DCIS及31例DCISM患者的超声及临床病理资料。肿块型病变参照BI-RADS标准,分析病变大小、形态、纵横比、边缘、边界、回声类型、后方回声、微钙化及血流。非肿块型病变分为低回声区型、导管异常型、结构扭曲型及多发小囊肿型,同时记录微钙化及血流情况。组织病理分为低、中、高核级。免疫组化指标包括ER、PR、Her-2及Ki-67。结果DCIS发病年龄轻(P<0.05);两组主要症状均为乳头溢液或触及肿块,且既往乳腺癌病史无差别(P>0.05)。两组肿块型病变均以形态不规则、纵横比<1的实性低回声肿物为主,且多边缘不清晰(P>0.05);非肿块型病变均以低回声区型为主(P>0.05)。DCISM中高核级比例高(74.1%vs 89.3%,P<0.05),ER阳性率及Luminal-like型占比低(72.0%vs 51.6%,P<0.05),两组PR、Her-2及Ki-67表达比较,差异无统计学意义(P>0.05)。微钙化与ER阴性、PR阴性、Her-2阳性、Ki-67高表达及高核级相关(P<0.05)。结论DCIS与DCISM的超声表现相似,微钙化或可提示肿瘤预后不良。DCISM的核级高,ER阳性率低,Her-2过表达及三阴型比例高,说明DCISM具有更高的侵袭性。
Objective To compare the ultrasonographic and clinicopathological features of ductal carcinoma in situ(DCIS)and ductal carcinoma in situ with microinvasion(DCISM)of the breast.Methods 118 patients with DCIS and 31 patients with DCISM confirmed pathology in our hospital from January 2013 to December 2020 were retrospectively analyzed.The size,shape,orientation,margin,boundary,echo type,posterior echo,microcalcification and blood flow of mass lesions were analyzed according to BI-RADS.Non mass lesions were divided into hypoechoic area type,ductal abnormality type,structural distortion type and multiple cyst type,microcalcification and blood flow were recorded.Histopathology was divided into low,medium and high nuclear grade.Immunohistochemical markers included ER,PR,Her-2 and Ki-67 index.Results Onset of DCIS was younger(P<0.05).The main symptoms were nipple discharge or palpable mass,and there was no difference in past history of breast cancer in the two groups(P>0.05).The mass lesions in DCIS and DCISM were mainly solid hypoechoic masses with irregular shape and aspect ratio<1,and the boundaries were not clear(P>0.05).The main manifestation of non mass lesions in DCIS and DCISM was hypoechoic area(P>0.05).The proportion of DCISM with medium and high nuclear grade was higher(74.1%vs 89.3%,P<0.05),and the positive rate of ER and Luminal-like subtype were lower(72.0%vs 51.6%,P<0.05).The expression of PR,Her-2 and Ki-67 had no significant difference(P>0.05).Microcalcification was correlated with ER negative,PR negative,Her-2 positive,Ki-67 high expression and high nuclear grade(P<0.05).Conclusion The ultrasonographic features of DCIS and DCISM are similar.Microcalcification may indicate poor prognosis.DCISM has higher nuclear grade,lower positive rate of ER,and higher proportion of Her-2 enriched and triple-negative subtypes,which indicates that DCISM displays an aggressive biological behavior.
作者
张晓丽
张彦宁
邱兰燕
Zhang Xiaoli;Zhang Yanning;Qiu Lanyan(Department of Ultrasound,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《医学研究杂志》
2021年第6期140-144,共5页
Journal of Medical Research
关键词
乳腺导管原位癌
乳腺导管原位癌伴微浸润
超声
免疫组化
Ductal carcinoma in situ
Ductal carcinoma in situ with microinvasion
Ultrasonography
Biological markers