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乳腺癌是女性较常见的恶性肿瘤之一,也是女性因癌症死亡的主要原因[1-2]。目前有研究结果表明,雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人表皮生长因子受体2(human epidermal growth factor receptor 2,HER-2)和细胞增殖核抗原Ki-67(简称Ki-67)的表达与肿瘤最大径和腋窝淋巴结受累程度相结合可用于评估乳腺癌预后并预测术后辅助治疗的疗效[3]。而根据4种分子生物标志物的不同表达产生的Luminal A、Luminal B、HER-2过表达型及基底细胞样型不同分子亚型可以更全面地评估乳腺癌预后的异质性[4]。动态对比增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging, DCE-MRI)及表观扩散系数(apparent diffusion coefficient,ADC)可以提供乳腺癌的形态学信息及血流动力学情况,并可区分不同的组织病理学和生物学特征[5],在乳腺癌的诊断及分期中发挥着重要作用。本研究回顾性分析不同分子亚型乳腺癌患者的DCE-MRI影像学表现及ADC特点,从而为术前预测乳腺癌不同分子亚型提供可靠的影像学依据。
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138例乳腺癌患者中,左侧乳腺癌59例、右侧乳腺癌79例;其中浸润性导管癌71例、浸润性小叶癌42例、导管原位癌17例、髓样癌4例、单纯癌3例、黏液腺癌1例。免疫组织化学染色法检测结果显示,Luminal A型14例、Luminal B型62例、HER-2过表达型33例、基底细胞样型29例。
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乳腺癌不同分子亚型的DCE-MRI特征表现见表1。4种乳腺癌分子亚型中,基底细胞样型乳腺癌较其他3种类型体积大(χ2=0.70、15.21、6.87,均P<0.01);Luminal A型多边缘光滑,其他3种类型边缘多不规则(χ2=26.41、7.23、7.88,均P<0.01);基底细胞样型乳腺癌多呈边缘强化,而Luminal A型乳腺癌多呈均匀强化,且其TIC类型以Ⅱ型居多,其他3种类型TIC类型以Ⅲ型为主(χ2=12.325,P<0.01)。4种乳腺癌分子亚型的DCE-MRI特征表现的典型病例见图1。
分子亚型 肿瘤最大径 边缘轮廓 分布 强化方式 TIC类型 ≤2(cm) >2(cm) 光滑 毛刺 不规则 多区域或
弥漫性节段性 均匀 不均匀 边缘强化 Ⅰ Ⅱ Ⅲ Luminal A型
[14 (10.2)]9
(64.3)5
(35.7)8
(57.1)5
(35.7)1
(7.2)0
0
9
(64.3)5
(36.7)0
3
(21.4)6
(42.9)5
(35.7)Luminal B型
[62 (44.9)]24
(38.7)38
(61.3)7
(11.3)16
(25.8)34
(54.8)5
(8.1)0
6
(9.7)45
(72.6)11
(17.7)5
(8.1)10
(16.1)47
(75.8)HER-2过表达型
[33 (23.9)]12
(36.4)21
(63.6)5
(15.2)18
(54.5)10
(30.3)0
0
5
(15.2)16
(48.5)12
(36.3)0
6
(18.2)27
(81.8)基底细胞样型
[29 (21.0)]7
(24.1)22
(75.9)3
(10.3)15
(51.7)7
(24.1)0
4
(13.9)2
(6.9)8
(27.6)19
(65.5)1
(3.5)5
(17.2)23
(79.3)χ2值 15.656 23.512 − 17.983 14.978 P值 0.001 <0.001 − <0.001 0.009 注:DCE-MRI为动态对比增强磁共振成像;TIC为时间-信号强度曲线;HER-2为人表皮生长因子受体2。−表示无此项数据 表 1 138例乳腺癌患者不同分子亚型的DCE-MRI的影像学特征[例(%)]
Table 1. Imaging features of dynamic contrast-enhanced MRI in 138 breast cancer patients with different molecular subtypes [case(%)]
图 1 4种不同分子亚型乳腺癌患者的DCE-MRI图及免疫组织化学染色图
Figure 1. The dynamic contrast-enhanced MRI image and immunohistochemical image of breast cancer patients with four different molecular subtypes
138例患者病灶的ADC为(0.497×10−3~1.367×10−3)mm2/s [(0.865±0.021)×10−3 mm2/s],其中,HER-2过表达型乳腺癌的ADC最高[( 1.023±0.027)×10−3 mm2/s],基底细胞样型和Luminal A型乳腺癌次之[(0.957±0.025)×10−3 mm2/s和(0.902±0.033)×10−3 mm2/s],Luminal B型乳腺癌最低[(0.852±0.013)×10−3 mm2/s]。HER-2过表达型乳腺癌的ADC与基底细胞样型及Luminal B型之间的差异均有统计学意义(F=11.80、12.40,均P<0.01),Luminal B型与Luminal A型之间的差异有统计学意义(F=25.50,P<0.01)。
乳腺癌不同分子亚型的动态对比增强MRI影像学特征分析及ADC特点研究
Analysis of dynamic contrast-enhanced MRI image and apparent diffusion coefficient features of different molecular subtypes of breast cancer
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摘要:
目的 探讨乳腺癌不同分子亚型的动态对比增强磁共振成像(DCE-MRI)影像学征象及表观扩散系数(ADC)特点。 方法 回顾性分析2018年1月至2020年1月于内蒙古医科大学附属人民医院就诊并经免疫组织化学染色法检查证实的138例乳腺癌女性患者的临床资料,患者年龄27~71(56.1±5.6)岁。所有患者均于术前行乳腺常规MRI扫描,根据乳腺影像报告和数据系统分析乳腺癌不同分子亚型的DCE-MRI特征;测量 ADC并分析其特点。术后采用免疫组织化学染色法将乳腺癌分为不同分子亚型。采用卡方检验或 Fisher确切概率法分析DCE-MRI特征与乳腺癌分子亚型的关系。采用单因素方差分析比较各分子亚型的ADC。 结果 138 例乳腺癌患者的免疫组织化学染色法检测结果显示, Luminal A 型 14 例 、 Luminal B 型 62 例、HER-2 过表达型 33 例、基底细胞样型 29 例。4种乳腺癌分子亚型中,基底细胞样型较其他3种类型体积大( χ2=0.70、15.21、6.87,均P<0.01);Luminal A型多边缘光滑,其他3种类型边缘多不规则( χ2=26.41、7.23、7.88,均P<0.01);基底细胞样型乳腺癌多呈边缘强化,而Luminal A型乳腺癌多呈均匀强化,且其动态增强扫描时间-信号曲线(TIC)类型以Ⅱ型居多,其他3种类型的TIC类型以Ⅲ型为主( χ2=12.325,P<0.01)。所有患者病灶的ADC为(0.497×10−3~1.367×10−3)mm2/s[(0.865±0.021)×10−3 mm2/s]。HER-2过表达型乳腺癌的ADC最高[(1.023±0.027)×10−3 mm2/s],基底细胞样型和Luminal A型乳腺癌次之[(0.957±0.025)×10−3 mm2/s和(0.902±0.033)×10−3 mm2/s],Luminal B型乳腺癌最低[(0.852±0.013)×10−3 mm2/s]。HER-2过表达型乳腺癌的ADC与基底细胞样型及Luminal B型之间的差异均有统计学意义( F=11.80、12.40,均P<0.01),Luminal B型与Luminal A型之间的差异有统计学意义( F=25.50,P<0.01)。 结论 乳腺癌各分子亚型的DCE-MRI影像学征象及ADC具有一定的特征性,可为乳腺癌患者术前预测、治疗方案的制定及预后评估提供参考依据。 Abstract:Objective To explore the characteristics of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and apparent diffusion coefficient (ADC) of different molecular subtypes of breast cancer. Methods The clinical data of one hundred thirty-eight women aged 27–71 (56.1±5.6) years and diagnosed with breast cancer, which was confirmed via immunohistochemical examination, at the Affiliated People's Hospital of Inner Mongolia Medical University were retrospectively analyzed from January 2018 to January 2020. All patients underwent routine breast MRI scanning before operation. DCE-MRI features of different molecular subtypes of breast cancer were analyzed using the breast imaging report and data system. ADC was measured and its characteristics were analyzed. The breast cancer was divided into non molecular subtypes via immunohistochemical staining after operation. Chi-square test and Fisher test was used to analyze the relationship between DCE-MRI features and molecular subtypes of breast cancer. The ADC of each molecular subtype was compared using one-way ANOVA. Results The immunohistochemical results showed that 138 cases of breast cancer are composed of 14 cases of Luminal A, 62 cases of Luminal B, 33 cases of HER-2 overexpression, and 29 cases of Basal-like subtypes. Among the four molecular subtypes of breast cancer, Basal-like subtype is the largest type of tumor (χ2=0.70, 15.21, 6.87; all P<0.01). Edges of Luminal A type are smooth, and those of the other types are irregular (χ2=26.41, 7.23, 7.88; all P<0.01). Basal-like subtype breast cancer showed ring enhancement, while Luminal A type breast cancer presented homogeneous enhancement. The dynamic enhanced scan time signal intensity curve (TIC) was mostly type Ⅱ, while the three other types of TIC were mainly type Ⅲ (χ2=12.325, P<0.01). The ADC range of lesions in all patients was (0.497×10−3–1.367×10−3) mm2/s [(0.865±0.021)×10−3 mm2/s]. HER-2 overexpressing breast cancer presented the highest ADC at (1.023±0.027)×10−3 mm2/s, followed by Basal-like subtype breast cancer at (0.957±0.025)×10−3 mm2/s) and Luminal A type breast cancer at (0.902±0.033)×10−3 mm2/s, Luminal B type breast cancer had the lowest at (0.852±0.013)×10−3 mm2/s. ADC demonstrated a significant difference between HER-2 overexpressing and Basal-like subtype and Luminal B type breast cancers (F=11.80,12.40; both P<0.01). A significant difference was also observed between Luminal B and Luminal A type breast cancers (F=25.50, P<0.01). Conclusion DCE-MRI imaging signs and ADC of each molecular subtype of breast cancer have certain characteristics, which can provide reference basis for preoperative prediction, treatment plan formulation and prognosis evaluation of breast cancer patients. -
Key words:
- Breast neoplasms /
- Magnetic resonance imaging /
- Molecular subtypes /
- Biological factors
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表 1 138例乳腺癌患者不同分子亚型的DCE-MRI的影像学特征[例(%)]
Table 1. Imaging features of dynamic contrast-enhanced MRI in 138 breast cancer patients with different molecular subtypes [case(%)]
分子亚型 肿瘤最大径 边缘轮廓 分布 强化方式 TIC类型 ≤2(cm) >2(cm) 光滑 毛刺 不规则 多区域或
弥漫性节段性 均匀 不均匀 边缘强化 Ⅰ Ⅱ Ⅲ Luminal A型
[14 (10.2)]9
(64.3)5
(35.7)8
(57.1)5
(35.7)1
(7.2)0
0
9
(64.3)5
(36.7)0
3
(21.4)6
(42.9)5
(35.7)Luminal B型
[62 (44.9)]24
(38.7)38
(61.3)7
(11.3)16
(25.8)34
(54.8)5
(8.1)0
6
(9.7)45
(72.6)11
(17.7)5
(8.1)10
(16.1)47
(75.8)HER-2过表达型
[33 (23.9)]12
(36.4)21
(63.6)5
(15.2)18
(54.5)10
(30.3)0
0
5
(15.2)16
(48.5)12
(36.3)0
6
(18.2)27
(81.8)基底细胞样型
[29 (21.0)]7
(24.1)22
(75.9)3
(10.3)15
(51.7)7
(24.1)0
4
(13.9)2
(6.9)8
(27.6)19
(65.5)1
(3.5)5
(17.2)23
(79.3)χ2值 15.656 23.512 − 17.983 14.978 P值 0.001 <0.001 − <0.001 0.009 注:DCE-MRI为动态对比增强磁共振成像;TIC为时间-信号强度曲线;HER-2为人表皮生长因子受体2。−表示无此项数据 -
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