乳腺导管原位癌MRI表现与p53表达及临床病理的关系

The Relationship between MRI Findings,p53 Expression,and Clinical Pathology of Ductal Carcinoma in Situ of the Breast

目的:探讨分析乳腺导管原位癌(DCIS)磁共振成像(MRI)表现与p53蛋白(p53)表达及临床病理的关系。方法:回顾性研究60例2018年1月—2021年12月在南昌市人民医院经手术病理证实的DCIS患者的乳腺MRI平扫+增强的资料,观察记录患者病理分级和MRI表现[动态增强曲线、早期强化率、表观弥散系数(ADC)、病灶形态学],采用免疫组化法检测癌组织p53表达情况,分析MRI表现与p53表达及临床病理的关系。结果:DCIS患者MRI表现主要为非肿块强化37例(61.67%,37/60),以节段性强化(19例,51.35%)和簇环强化(17例,45.95%)为主。动态增强曲线主要以Ⅰ型为主(25例,41.67%),早期强化率以早期快速强化为主(22例,36.67%)。ADC值<1.0×10^(-3)mm^(2)/s较多,占65.00%(39/60)。p53阳性、高核级别中TIC类型为Ⅲ型和早期快速强化占比均显著高于p53阴性、非高核级别,差异均有统计学意义(P<0.05);p53(阳性、阴性)和病理分级(高核级别、非高核级别)在形态学、非肿块强化分布形式和内部强化及ADC比较,差异均无统计学意义(P>0.05)。p53表达与病理分级有关。高核级别的DCIS患者p53阳性表达发生率更高,差异有统计学意义(P<0.05)。结论:DCIS患者MRI表现具有特异性,主要表现为节段性分布和簇环强化的非肿块强化,以早期快速强化和I型TIC曲线多为常见。MRI表现与p53表达和临床病理分级有关,通过分析MRI表现可为DCIS患者的治疗和预后提供参考。

Objective:To explore and analyze the relationship between magnetic resonance imaging(MRI)findings,p53 protein(p53)expression and clinicopathology in ductal carcinoma in situ of breast(DCIS).Method:A retrospective study was conducted on MRI plain scan+enhancement data of 60 patients with surgically and pathologically confirmed DCIS in Nanchang People's Hospital between January 2018 and December 2021,the pathological grading and MRI findings[dynamic enhancement curve,early enhancement rate,apparent diffusion coefficient(ADC),focal morphology]of patients were observed and recorded,the expression of p53 in carcinoma tissues was detected by immunohistochemistry,the relationship between MRI findings,p53 expression and clinicopathology was analyzed.Result:The main MRI findings in DCIS patients were non-mass enhancement[37 cases(61.67%,37/60)],which was mainly on segmental enhancement(19 cases,51.35%)and cluster-ring enhancement(17 cases,45.95%).The dynamic enhancement curves were mainly on typeⅠ(25 cases,41.67%),and early enhancement rate was mainly on fast enhancement(22 cases,36.67%).The proportion of cases with ADC value<1.0×10^(-3)mm^(2)/s was high[65.00%(39/60)].The proportions of typeⅢTIC and early fast enhancement in p53 positive and high nuclear grading were significantly higher than those in p53 negative and non-high nuclear grading,the differences were statistically significant(P<0.05);but there were not significant differences in morphology,distribution of non-mass enhancement,internal enhancement or ADC among patients with different p53 expression(positive,negative)and pathological grading(high nuclear grade,non-high nuclear grade)(P>0.05).The expression of p53 was related to pathological grading.The incidence of p53 positive was higher in patients with high nuclear grade of DCIS,the difference was statistically significantly(P<0.05).Conclusion:MRI findings are specific in DCIS patients,which are mainly characterized by non-mass enhancement with segmental distribution and cluster-ring enhancement,and early fast enhancement and typeⅠTIC curves are common.MRI findings are related to p53 expression and pathological grade.The analysis of MRI findings can provide reference for the treatment and prognosis of DCIS patients.