18~30岁女性乳腺癌的4种分子亚型与影像学特征的相关性

Correlation between molecular subtypes and imaging features of breast cancer in women aged 18-30 years

目的探讨18~30岁女性乳腺癌的分子亚型与影像学特征的相关性。方法回顾性分析195例经术后病理确诊的原发年轻乳腺癌的影像及病理资料,用免疫组织化学检测ER、PR、HER2及Ki-67,HER2(++)者再行荧光原位杂交检测,分为Luminal A型(n=55)、Luminal B型(n=79)、HER2过表达型(n=41)和三阴性乳腺癌(n=20)。比较各亚型的临床病理特征、X线以及超声特点。结果195例年轻乳腺癌的分子分型比例依次为Luminal B型>LuminalA型>HER2过表达型>三阴性,LuminalA型乳腺癌患者更多为临床T1期和组织学Ⅰ级(P<0.05),Luminal B型更多为临床T2期和组织学Ⅱ级(P<0.05),三阴性乳腺癌更多为临床T3期和组织学Ⅲ级(P<0.05)。X线结果显示:LuminalA型以肿块伴钙化,细小多形性,边缘毛刺为多(P<0.05)。Luminal B型以肿块,细小多形性和线样,边缘模糊为多(P<0.05),HER2过表达型以钙化,线样或线样分枝状,边缘模糊为多(P<0.05),三阴性乳腺癌以肿块,细小多形性,边缘模糊为多(P<0.05)。超声结果显示:三阴性乳腺癌内部回声以均匀为多,其它三种类型以不均匀为多(P<0.05)。结论18~30岁青年女性乳腺癌的免疫组织化学分子亚型与部分影像学特征密切相关。术前可根据X线及超声综合表现预测乳腺癌分子分型。

Objective To investigate the correlation between molecular subtypes and imaging features of breast cancer in women aged 18-30 years.Methods The images and pathological data of 195 patients with primary breast cancer diagnosed by postoperative pathology were retrospectively analyzed.According to the expression levels of ER,PR HER2 and Ki-67 they were divided into Luminal A group(n=55),Luminal B group(n=79),HER2 overexpression group(n=41)and triple negative group(n=20).The clinical and pathological data of each subtype were analyzed retrospectively.Results The molecular typing proportion of 195 cases of young breast cancer was Luminal B type>Luminal A>HER2 overexpression>triple negative type.More patients with Luminal A breast cancer were in clinical T1 stage and histological gradeⅠ(P<0.05).More patients with Luminal B stage were in clinical T2 stage and biopsy grade(P<0.05).More patients with TNBC were in stage T3 stage and histological grade(P<0.05).TNBC had more clinical T3 and histological gradeⅢ(P<0.05).X-ray results showed that Luminal type A was characterized by Luminal mass with calcification,parvopleomorphism,and marginal burrs(P<0.05).Luminal B tumor,parvopleomorphism&line-like,with blurred margins were more common(P<0.05).HER2 overexpression tumor,with calcification,line-like or line-like branching,with blurred margins were more common(P<0.05).Triple negative tumor,parvopleomorphism,with blurred margins were more common(P<0.05).Ultrasonographic results showed that most of the three negative internal echoes were uniform,while the other three types were inhomogeneous(P<0.05).Conclusion The immunohistochemical subtypes of breast cancer in young women under 18 to 30 years old are closely related to some imaging features.Therefore,preoperative molecular typing could be preliminarily determined according to the comprehensive findings of X-ray and ultrasound.