乳腺乳头状癌分子亚型影像学特征及其临床意义

Imaging characteristics and clinical significance of molecular subtypes of papillary carcinoma of breast

目的:研究乳腺乳头状癌分子亚型的超声(ultrasonography,US)、乳房X线摄影(mammography,MG)和磁共振成像(magnetic resonance imaging,MRI)影像学特征及其临床意义。方法:回顾性分析47例(49个病灶)乳头状癌临床和影像资料,依据2022年CBCS乳腺癌分子分型标准,本研究未收集到HER-2阳性型和三阴型,47例分为3个亚组:Luminal A、Luminal B1和Luminal B2组。比较各亚型临床特征,超声(n=47)、MG(n=45)和MRI(n=14)影像特征的差异。分析3种影像学BI-RADS分类诊断的敏感性和误诊率。结果:(1)临床特征:各亚型触到包块比乳头溢液者多。(2)影像特征:US显示Luminal B2、Luminal A型病灶边界不清者远多于Luminal B1型(P<0.05);MG显示各亚型病灶的形态规则而边界不清;MRI显示Luminal B2型病灶边缘不清的比例为100%,而Luminal B1型病灶边缘清晰的比例为100%,Luminal B1型ADC值低于Luminal A型(P<0.05)。(3)影像学诊断:Luminal A、Luminal B1、Luminal B2型的敏感性分别为52.8%、16.7%、100%(US);57.1%、83.3%、75.0%(MG);80.0%、100%、100%(MRI)。US、MG及MRI的误诊率分别为46.8%、37.8%及14.3%,US的误诊率高于MRI(P=0.029)。结论:乳腺乳头状癌是一种ER、PR阳性表达为主的乳腺癌,US诊断Luminal B2型比较敏感,MRI、MG诊断Luminal A和Luminal B1型的敏感性更高。分子亚型的病理组成不同,影像特征亦存在差异,这种差异可为影像和临床诊疗提供参考。

Objective:To study the imaging characteristics and clinical significance of molecular subtypes of papillary carcinoma of the breast under ultrasonography(US),mammography(MG)and magnetic resonance imaging(MRI).Methods:Clinical and imaging data of 47 cases(49 lesions)of papillary carcinoma were retrospectively analyzed.According to the 2022 CBCS breast cancer molecular typing criteria,HER-2 positive and triple-negative types were not collected.47 cases were divided into three subgroups:Luminal A group,Luminal B1 group and Luminal B2 group.The clinical features(n=47),US(n=47),MG(n=45)and MRI(n=14)features of each subtype were compared.The sensitivity and misdiagnosis rate of three kinds of BI-RADS were analyzed.Results:In terms of clinical features,papillary carcinoma of breast is a luminal phenotype of breast cancer.There were more masses in each subtype than those in nipple discharge.Regarding to imaging features,US showed that Luminal B2 and Luminal A lesions had unclear boundaries far more than Luminal B1 lesions(P=0.015,P=0.027).MG showed that the morphology of each subtype was regular and the boundary was not clear.MRI showed that Luminal B2 lesions had unclear edges for 100%,while Luminal B1 lesions had clear edges for 100%,and ADC value of Luminal B1 was significantly lower than that of Luminal A(P=0.030).Imaging sensitivity of Luminal A,Luminal B1 and Luminal B2 were 52.8%,16.7%and 100%by US,57.1%,83.3%and 75.0%by MG,80.0%,100%and 100%by MRI respectively.The misdiagnosis rates of US,MG and MRI were 46.8%,37.8%and 14.3%respectively,and the misdiagnosis rate of US was much higher than that of MRI(P=0.029).Conclusion:Papillary carcinoma of breast is a type of breast cancer with positive expression ER and PR.Luminal B2 type is sensitive to US,but Luminal A and Luminal B1 types are more sensitive to MRI and MG.The molecular subtypes have different pathological compositions and imaging characteristics,which could provide reference for imaging diagnosis and clinical treatment.