乳腺乳头状癌分子亚型影像学特征及其临床意义

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。

The molecular basis for ethnic variation and histological subtype differences in prostate cancer

Prostate cancer is a common malignancy among men in Western countries. Recently the morbidity and mortality of prostate cancer increase dramatically in several oriental countries including China. Rapidly evolving technology in molecular biology such as high-throughput sequencing and integrative analysis of genomic and transcriptomic landscapes have enabled the identification of key oncogenic events for prostate cancer initiation, progression and resistance to hormonal therapy. These surging data of prostate cancer genome also provide insights on ethnic variation and the differences in histological subtype of this disease. In this review, differences in the incidence of prostate cancer and the prevalence of main genetic alterations between Asian and Western populations are discussed. We also review the recent findings on the mechanisms underlying neuroendocrine differentiation of prostate cancer and the development of small cell neuroendocrine carcinoma after androgen deprivation therapy.