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乳腺癌已经成为全球女性癌症病死最主要的原因,其发病率居于女性恶性肿瘤首位[1]。乳腺癌是一种高度异质性的恶性肿瘤,在病理特征、临床表现和治疗疗效等方面均有明显的个体差异[2]。根据其免疫组织化学检查结果[如雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(human epidermal growth factor receptor-2,HER-2)、细胞增殖核抗原(Ki67)的水平],可将乳腺癌分子分型分为Luminal A型、Luminal B型、HER-2过表达型、三阴性乳腺癌(triple negative breast cancer,TNBC)及其他特殊类型[3]。不同分子分型的乳腺癌具有不同的生物学特点,不同的生物学特点决定了其组织病理学改变不同,这也是影像表现的基础;同时乳腺癌不同的生物学特点也影响临床治疗方案的制定及疗效的评估[4]。本研究旨在探讨不同分子分型的乳腺癌在超声、MRI及乳腺X射线摄影检查中影像特征的差异。
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由表1可知,不同分子分型乳腺癌患者的绝经情况、淋巴结转移情况差异均有统计学意义(均P<0.05),其中Luminal A型、Luminal B型及TNBC癌患者确诊时多处于未绝经时期;Luminal B型乳腺癌患者确诊时淋巴结转移阳性较高。
分型 年龄(岁, )$\bar x\pm s $ 绝经情况[例(%)] 淋巴结转移情况[例(%)] 已绝经 未绝经 阳性 阴性 Luminal A型(n=31) 49.2±10.8 9(29.0) 22(71.0) 12(38.7) 19(61.3) Luminal B型(n=104) 46.1±8.9 29(27.9) 75(72.1) 64(61.5) 40(38.5) HER-2过表达型(n=45) 49.6±10.1 24(53.3) 21(46.7) 18(40.0) 27(60.0) 三阴性乳腺癌(n=32) 48.5±8.5 14(43.8) 18(56.2) 13(40.6) 19(59.4) 检验值 t=0.113~1.037 χ2=10.345 χ2=10.026 P值 均>0.05 0.016 0.018 注:HER-2为人表皮生长因子受体2 表 1 不同分子分型女性乳腺癌患者的临床特征比较(n=212)
Table 1. Comparison of clinical characteristics of female breast cancer patients with different molecular types (n=212)
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由表2可知,不同分子分型的乳腺癌边缘、内部回声、肿瘤内血流Alder分级的差异均有统计学意义(均P<0.05)。Luminal A型乳腺癌肿瘤边缘多表现为模糊(图1A);Luminal B型和HER-2过表达型乳腺癌肿瘤边缘多表现为成角或毛刺(图1B、1C);TNBC肿瘤边缘多为分叶状(图1D)。Luminal A型、Luminal B型、HER-2过表达型及TNBC肿瘤内部回声多为不均匀回声,其中更多见于Luminal B型。Luminal A型和TNBC肿瘤内血流信号不丰富,Alder分级主要为0或Ⅰ级血流信号(图2A、2B);Luminal B型和HER-2过表达型乳腺癌肿瘤内多表现为丰富血流信号,即Alder分级主要为Ⅱ或Ⅲ级(图2C、2D)。乳腺癌肿瘤发生位置、长径、形态、纵横比值、后方回声差异均无统计学意义(均P>0.05,表2)。
分型 长径(mm) 位置[例(%)] 形态[例(%)] 边缘[例(%)] ≤20 >20~≤40 >40 左侧 右侧 不规则形 规则形 光滑 模糊 分叶 成角或毛刺 Luminal A型(n=31) 11(35.5) 11(35.5) 9(29.0) 18(58.0) 13(42.0) 31(100.0) 0(0.0) 5(16.1) 15(48.4) 6(19.4) 5(16.1) Luminal B型(n=104) 25(24.0) 58(55.8) 21(20.2) 51(49.0) 53(51.0) 95(91.3) 9(8.7) 8(7.7) 22(21.2) 30(28.8) 44(42.3) HER-2过表达型(n=45) 12(26.7) 21(46.7) 12(26.6) 23(51.1) 22(48.9) 44(97.8) 1(2.2) 1(2.2) 3(6.7) 18(40.0) 23(51.1) 三阴性乳腺癌(n=32) 11(34.4) 18(56.2) 3(9.4) 16(50.0) 16(50.0) 31(96.9) 1(3.1) 1(3.1) 4(12.5) 15(46.9) 12(37.5) χ2值 8.183 0.792 3.900 33.542 P值 0.225 0.851 0.272 <0.001 分型 纵横比值[例(%)] 内部回声[例(%)] 后方回声[例(%)] 肿瘤内血流Alder分级[例(%)] <1 ≥1 不均匀 均匀 衰减或增强 无改变 0或Ⅰ级 Ⅱ或Ⅲ级 Luminal A型(n=31) 20(64.5) 11(35.5) 26(83.9) 5(16.1) 18(58.1) 13(41.9) 19(61.3) 12(38.7) Luminal B型(n=104) 83(79.8) 21(20.2) 98(94.2) 6(5.8) 44(42.3) 60(57.7) 43(41.3) 61(58.7) HER-2过表达型(n=45) 37(82.2) 8(17.8) 37(82.2) 8(17.8) 16(35.6) 29(64.4) 16(35.6) 29(64.4) 三阴性乳腺癌(n=32) 27(84.4) 5(15.6) 23(71.9) 9(28.1) 13(40.6) 19(59.4) 21(65.6) 11(34.4) χ2值 4.756 12.283 3.983 10.699 P值 0.191 0.006 0.263 0.013 注:HER-2为人表皮生长因子受体2 表 2 不同分子分型女性乳腺癌患者的超声检查结果比较(n=212)
Table 2. Comparison of ultrasonographic results of female breast cancer patients with different molecular types (n=212)
图 1 不同分子分型乳腺癌的二维超声图 1A为Luminal A型乳腺癌的二维超声图,示肿瘤边缘模糊(白色箭头所示);1B为Luminal B型乳腺癌的二维超声图,示肿瘤边缘毛刺(白色箭头所示);1C为HER-2过表达型乳腺癌的二维超声图,示肿瘤边缘毛刺(白色箭头所示);1D为三阴性乳腺癌的二维超声图,示肿瘤边缘呈分叶状(白色箭头所示)。HER-2为人表皮生长因子受体2 图2 不同分子分型乳腺癌的彩色多普勒超声图 2A为Luminal A型乳腺癌的彩色多普勒超声图,示肿瘤内血流Alder分级为0级;2B为三阴性乳腺癌的彩色多普勒超声图,示肿瘤内血流Alder分级为Ⅰ级;2C为Luminal B型乳腺癌的彩色多普勒超声图,示肿瘤内血流Alder分级为Ⅲ级;2D为HER-2过表达型乳腺癌的彩色多普勒超声图,示肿瘤内血流Alder分级为Ⅲ级。图中,白色方框内表示彩色多普勒超声图中的病灶血流情况。HER-2为人表皮生长因子受体2 图3 不同分子分型乳腺癌的MRI增强图 3A为Luminal A型乳腺癌的MRI增强图,示肿瘤强化特征为不均匀强化(白色箭头所示);3B为Luminal B型乳腺癌的MRI增强图,示肿瘤强化特征为不均匀强化(白色箭头所示);3C为HER-2过表达型乳腺癌的MRI增强图,示肿瘤强化特征为不均匀强化(白色箭头所示);3D为三阴性乳腺癌的MRI增强图,示肿瘤强化特征为环形强化(白色箭头所示)。MRI为磁共振成像;HER-2为人表皮生长因子受体2 图4 不同分子分型乳腺癌的乳腺X射线摄影图 4A为Luminal B型乳腺癌的乳腺X射线摄影图,示肿瘤内多发点状钙化(白色箭头所示);4B为HER-2过表达型乳腺癌的乳腺X射线摄影图,示肿瘤内多发多形性钙化(白色箭头所示);4C为Luminal A型乳腺癌的乳腺X射线摄影图,示肿瘤内无钙化;4D为三阴性乳腺癌的乳腺X射线摄影图,示肿瘤内无明显钙化。HER-2为人表皮生长因子受体2 图1~图4中,Luminal A型患者为女性,42岁;Luminal B型患者为男性,31岁;HER-2过表达型患者为女性,55岁;三阴性乳腺癌患者为女性,37岁
Figure 1. 2-Dimensional ultrasound imagings of breast cancer with different molecular types Figure 2 Color doppler ultrasound imagings of breast cancer with different molecular types Figure 3 MRI enhanced images of breast cancer with different molecular typesFigure 4 Mammography images of breast cancer with different molecular types
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由表3可知,不同分子分型乳腺癌的肿瘤强化特征存在差异,且差异有统计学意义(P<0.001)。其中Luminal A型、Luminal B型及HER-2过表达型乳腺癌肿瘤强化特征以不均匀强化为主(图3A~C),而TNBC肿瘤环形强化的占比高于其他三者(图3D)。MRI乳腺实质背景强化、肿瘤强化形式、动态增强曲线、DWI弥散情况在不同分子分型乳腺癌中的差异均无统计学意义(均P>0.05,表3)。
分型 乳腺实质
背景强化强化形式 强化特征 动态增
强曲线DWI弥散
情况无或
轻度中度或
重度肿块型 非肿块型
或点状均匀
强化不均匀
强化环形
强化流入型 平台型 流出型 高信号 等信号 Luminal A型(n=31) 23(74.2) 8(25.8) 27(87.1) 4(12.9) 1(3.2) 27(87.1) 3(9.7) 1(3.2) 8(25.8) 22(71.0) 29(93.5) 2(6.5) Luminal B型(n=104) 69(66.3) 35(33.7) 80(76.9) 24(23.1) 19(18.3) 72(69.2) 13(12.5) 11(10.6) 18(17.3) 75(72.1) 99(95.2) 5(4.8) HER-2过表达型(n=45) 30(66.7) 15(33.3) 35(77.8) 10(22.2) 13(28.9) 27(60.0) 5(11.1) 0(0.0) 14(31.1) 31(68.9) 45(100.0) 0(0.0) 三阴性乳腺癌(n=32) 23(71.9) 9(28.1) 28(87.5) 4(12.5) 6(18.8) 12(37.5) 14(43.7) 0(0.0) 8(25.0) 24(75.0) 32(100.0) 0(0.0) χ2值 0.926 2.871 30.142 12.176 2.709 P值 0.819 0.412 <0.001 0.058 0.439 注:MRI为磁共振成像;DWI为弥散加权成像;HER-2为人表皮生长因子受体2 表 3 不同分子分型女性乳腺癌患者的MRI检查结果比较[n=212,例(%)]
Table 3. Comparison of MRI results of female breast cancer patients with different molecular types (n=212, cases (%))
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由表4可知,不同分子分型的乳腺癌肿瘤内钙化情况的表现差异有统计学意义(P=0.022),其中Luminal B型及HER-2过表达型乳腺癌肿瘤内多伴有钙化(图4A、4B),而Luminal A型及TNBC肿瘤内多无钙化(图4C、4D)。Luminal A型与Luminal B型乳腺癌肿瘤内钙化形态以点状钙化为主,HER-2过表达型及TNBC肿瘤内钙化形态以多形性或线样为主,差异有统计学意义(P=0.008);乳腺腺体量在不同分子分型的乳腺癌中差异无统计学意义(P=0.096,表4)。
分型 腺体量 肿瘤内钙化情况 钙化形态 致密型 非致密型 有钙化 无钙化 点状 多形性或线样 Luminal A型(n=31) 25(80.6) 6(19.4) 12(38.7) 19(61.3) 10(83.3) 2(16.7) Luminal B型(n=104) 88(84.6) 16(15.4) 63(60.6) 41(39.4) 44(69.8) 19(30.2) HER-2过表达型(n=45) 30(66.7) 15(33.3) 31(68.9) 14(31.1) 14(45.2) 17(54.8) 三阴性乳腺癌(n=32) 26(81.3) 6(18.7) 14(43.8) 18(56.2) 5(35.7) 9(64.3) χ2值 6.346 9.627 11.792 P值 0.096 0.022 0.008 注:HER-2为人表皮生长因子受体2 表 4 不同分子分型女性乳腺癌患者的乳腺X射线摄影检查结果比较[n=212,例(%)]
Table 4. Comparison of mammography results of female breast cancer patients with different molecular types (n=212, cases (%))
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将单因素Logistic回归分析中差异有统计学意义的变量进一步纳入多分类有序Logistic回归分析,结果显示,患者绝经情况与乳腺癌肿瘤边缘可作为乳腺癌分子分型的独立预测因子(B=0.729、0.775,OR=7.053、23.696,95%CI:0.193~1.267、0.463~1.087,P=0.008、<0.001),AUC为0.635(95%CI:0.528~0.742),这表明患者绝经情况与乳腺癌肿瘤边缘情况对乳腺癌分子分型具有一定的诊断效能(图5)。
不同分子分型乳腺癌的超声、MRI及乳腺X射线摄影特征的诊断价值
Diagnostic value of ultrasonography, MRI and mammography features of breast cancer with different molecular types
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摘要:
目的 探讨超声、MRI及乳腺X射线摄影对不同分子分型乳腺癌的诊断价值。 方法 回顾性分析2018年1月至2022年4月在惠州市中心人民医院就诊的212例女性乳腺癌患者的临床资料和影像资料,年龄(47.6±9.3)岁。根据其组织病理学和免疫组织化学检查结果分为4组:Luminal A型31例,年龄(49.2±10.8)岁;Luminal B型104例,年龄(46.1±8.9)岁;人表皮生长因子受体2(HER-2)过表达型45例,年龄(49.6±10.1)岁;三阴性乳腺癌(TNBC)32例,年龄(48.5±8.5)岁。分析患者的临床特征、超声、MRI及乳腺X射线摄影的影像特征。计量资料的组间比较采用两独立样本t检验;计数资料的组间比较采用χ2检验或Fisher确切概率法;具有统计学意义的特征进一步采用有序Logistic回归分析及曲线下面积(AUC)对诊断效能的准确性进行评估。 结果 在临床特征中,不同分子分型乳腺癌患者的绝经情况、淋巴结转移情况差异均有统计学意义(χ2=10.345、10.026,P=0.016、0.018)。超声检查结果显示,Luminal A型乳腺癌肿瘤边缘多表现为模糊,Luminal B型和HER-2过表达型乳腺癌肿瘤边缘多表现为成角或毛刺,TNBC肿瘤边缘多为分叶状;四者肿瘤内部回声多为不均匀回声,更多见于Luminal B型;Luminal A型和TNBC肿瘤内血流Alder分级多为0或Ⅰ级血流信号,Luminal B型和HER-2过表达型乳腺癌肿瘤内血流Alder分级多为Ⅱ或Ⅲ级,差异均有统计学意义(χ2=33.542、12.283、10.699,均P<0.05)。MRI检查结果显示,Luminal A型、Luminal B型及HER-2过表达型乳腺癌肿瘤强化特征以不均匀强化为主,TNBC肿瘤环形强化的占比高于其他三者,差异有统计学意义(χ2=30.142,P<0.001)。乳腺X射线摄影检查结果显示,Luminal B型及HER-2过表达型乳腺癌肿瘤内多伴有钙化,Luminal A型及TNBC肿瘤内多无钙化;Luminal A型与Luminal B型乳腺癌肿瘤内钙化形态以点状钙化为主,HER-2过表达型及TNBC肿瘤内钙化形态以多形性或线样为主,差异均有统计学意义(χ2=9.627、11.792,均P<0.05)。乳腺癌患者绝经情况与肿瘤边缘可作为乳腺癌分子分型的独立预测因子(B=0.729、0.775,OR=7.053、23.696,95%CI:0.193~1.267、0.463~1.087,均P<0.05),AUC为0.635(95%CI:0.528~0.742)。 结论 不同分子分型乳腺癌的超声、MRI及乳腺X射线摄影特征存在差异,均对其具有一定的诊断价值。 Abstract:Objective To explore the diagnostic value of ultrasound, MRI, and mammography in different molecular subtypes of breast cancer. Methods A cohort of 212 female patients, aged (47.6±9.3) years old and with confirmed breast cancer, from Huizhou Municipal Central Hospital from January 2018, to April 2022, was retrospectively analyzed. In accordance with the results of pathology and immunohistochemistry, the patients were grouped into four groups: 31 cases of Luminal A, aged (49.2±10.8) years; 104 cases of Luminal B, aged (46.1±8.9) years; 45 cases of human epidermal growth factor receptor-2 (HER-2) overexpression, aged (49.6±10.1) years; and 32 cases of triple-negative breast cancer (TNBC), aged (48.5±8.5) years. The clinical characteristics of the patients and the imaging features of ultrasound, MRI, and mammography were analyzed. Intergroup comparisons of metric data conforming to normal distribution were performed using independent sample t-test (equal variance). Intergroup comparisons of count data were performed using chi-square test or Fisher’s exact probability method. Statistically significant features were evaluated for accuracy of the diagnostic efficacy by using ordered logistic regression analysis and area under the curve (AUC). Results Among the clinical features, the differences in menopausal status and lymph node metastasis among patients with breast cancer of different molecular subtypes were statistically significant (χ2=10.345, 10.026; P=0.016, 0.018). The results of ultrasonography showed that the margins of Luminal A breast cancer tumor were mostly blurred, the margins of Luminal B and HER-2 overexpression breast cancer tumors were mostly angular or hairy, and the margins of TNBC tumor were mostly lobulated. Moreover, the internal echoes in the tumors of the four subtypes were mostly heterogeneous echogenicity, which was more commonly seen in Luminal B. The blood flow Alder grade was mostly grade 0 or Ⅰ within Luminal A and TNBC, whereas the blood flow Alder grade within Luminal B and HER-2 overexpression breast cancer was mostly grade Ⅱ or Ⅲ. The differences were statistically significant (χ2=33.542, 12.283, 10.699; all P<0.05). The results of MRI showed that the tumor enhancement characteristics of Luminal A, Luminal B, and HER-2 overexpression breast cancer were mainly inhomogeneous enhancement, and the proportion of ring enhancement in TNBC tumors was higher than those in the other three, with a statistically significant difference (χ2=30.142, P<0.001). The results of mammography showed that calcification was mostly present in Luminal B and HER-2 overexpression breast cancer tumors, whereas no calcification was found in Luminal A and TNBC tumors. The calcification pattern in Luminal A and Luminal B breast cancer tumors was mainly punctate calcification, whereas that in HER-2 overexpression and TNBC tumors was mainly polypoidal or linear. The differences were all statistically significant (χ2=9.627, 11.792; both P<0.05). The patients' menopausal status and the tumor margins of breast cancer could be used as independent predictors of the molecular subtypes of breast cancer (B=0.729, 0.775; OR=7.053, 23.696; 95%CI: 0.193~1.267, 0.463~1.087; both P<0.05), with an AUC of 0.635 (95%CI: 0.528~0.742). Conclusion Differences were observed in the characteristics of ultrasound, MRI, and mammography in different molecular subtypes of breast cancer, indicating their certain diagnostic value. -
Key words:
- Breast neoplasms /
- Ultrasonography, mammary /
- Magnetic resonance imaging /
- Mammography
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图 1 不同分子分型乳腺癌的二维超声图 1A为Luminal A型乳腺癌的二维超声图,示肿瘤边缘模糊(白色箭头所示);1B为Luminal B型乳腺癌的二维超声图,示肿瘤边缘毛刺(白色箭头所示);1C为HER-2过表达型乳腺癌的二维超声图,示肿瘤边缘毛刺(白色箭头所示);1D为三阴性乳腺癌的二维超声图,示肿瘤边缘呈分叶状(白色箭头所示)。HER-2为人表皮生长因子受体2 图2 不同分子分型乳腺癌的彩色多普勒超声图 2A为Luminal A型乳腺癌的彩色多普勒超声图,示肿瘤内血流Alder分级为0级;2B为三阴性乳腺癌的彩色多普勒超声图,示肿瘤内血流Alder分级为Ⅰ级;2C为Luminal B型乳腺癌的彩色多普勒超声图,示肿瘤内血流Alder分级为Ⅲ级;2D为HER-2过表达型乳腺癌的彩色多普勒超声图,示肿瘤内血流Alder分级为Ⅲ级。图中,白色方框内表示彩色多普勒超声图中的病灶血流情况。HER-2为人表皮生长因子受体2 图3 不同分子分型乳腺癌的MRI增强图 3A为Luminal A型乳腺癌的MRI增强图,示肿瘤强化特征为不均匀强化(白色箭头所示);3B为Luminal B型乳腺癌的MRI增强图,示肿瘤强化特征为不均匀强化(白色箭头所示);3C为HER-2过表达型乳腺癌的MRI增强图,示肿瘤强化特征为不均匀强化(白色箭头所示);3D为三阴性乳腺癌的MRI增强图,示肿瘤强化特征为环形强化(白色箭头所示)。MRI为磁共振成像;HER-2为人表皮生长因子受体2 图4 不同分子分型乳腺癌的乳腺X射线摄影图 4A为Luminal B型乳腺癌的乳腺X射线摄影图,示肿瘤内多发点状钙化(白色箭头所示);4B为HER-2过表达型乳腺癌的乳腺X射线摄影图,示肿瘤内多发多形性钙化(白色箭头所示);4C为Luminal A型乳腺癌的乳腺X射线摄影图,示肿瘤内无钙化;4D为三阴性乳腺癌的乳腺X射线摄影图,示肿瘤内无明显钙化。HER-2为人表皮生长因子受体2 图1~图4中,Luminal A型患者为女性,42岁;Luminal B型患者为男性,31岁;HER-2过表达型患者为女性,55岁;三阴性乳腺癌患者为女性,37岁
Figure 1. 2-Dimensional ultrasound imagings of breast cancer with different molecular types Figure 2 Color doppler ultrasound imagings of breast cancer with different molecular types Figure 3 MRI enhanced images of breast cancer with different molecular typesFigure 4 Mammography images of breast cancer with different molecular types
表 1 不同分子分型女性乳腺癌患者的临床特征比较(n=212)
Table 1. Comparison of clinical characteristics of female breast cancer patients with different molecular types (n=212)
分型 年龄(岁, )$\bar x\pm s $ 绝经情况[例(%)] 淋巴结转移情况[例(%)] 已绝经 未绝经 阳性 阴性 Luminal A型(n=31) 49.2±10.8 9(29.0) 22(71.0) 12(38.7) 19(61.3) Luminal B型(n=104) 46.1±8.9 29(27.9) 75(72.1) 64(61.5) 40(38.5) HER-2过表达型(n=45) 49.6±10.1 24(53.3) 21(46.7) 18(40.0) 27(60.0) 三阴性乳腺癌(n=32) 48.5±8.5 14(43.8) 18(56.2) 13(40.6) 19(59.4) 检验值 t=0.113~1.037 χ2=10.345 χ2=10.026 P值 均>0.05 0.016 0.018 注:HER-2为人表皮生长因子受体2 表 2 不同分子分型女性乳腺癌患者的超声检查结果比较(n=212)
Table 2. Comparison of ultrasonographic results of female breast cancer patients with different molecular types (n=212)
分型 长径(mm) 位置[例(%)] 形态[例(%)] 边缘[例(%)] ≤20 >20~≤40 >40 左侧 右侧 不规则形 规则形 光滑 模糊 分叶 成角或毛刺 Luminal A型(n=31) 11(35.5) 11(35.5) 9(29.0) 18(58.0) 13(42.0) 31(100.0) 0(0.0) 5(16.1) 15(48.4) 6(19.4) 5(16.1) Luminal B型(n=104) 25(24.0) 58(55.8) 21(20.2) 51(49.0) 53(51.0) 95(91.3) 9(8.7) 8(7.7) 22(21.2) 30(28.8) 44(42.3) HER-2过表达型(n=45) 12(26.7) 21(46.7) 12(26.6) 23(51.1) 22(48.9) 44(97.8) 1(2.2) 1(2.2) 3(6.7) 18(40.0) 23(51.1) 三阴性乳腺癌(n=32) 11(34.4) 18(56.2) 3(9.4) 16(50.0) 16(50.0) 31(96.9) 1(3.1) 1(3.1) 4(12.5) 15(46.9) 12(37.5) χ2值 8.183 0.792 3.900 33.542 P值 0.225 0.851 0.272 <0.001 分型 纵横比值[例(%)] 内部回声[例(%)] 后方回声[例(%)] 肿瘤内血流Alder分级[例(%)] <1 ≥1 不均匀 均匀 衰减或增强 无改变 0或Ⅰ级 Ⅱ或Ⅲ级 Luminal A型(n=31) 20(64.5) 11(35.5) 26(83.9) 5(16.1) 18(58.1) 13(41.9) 19(61.3) 12(38.7) Luminal B型(n=104) 83(79.8) 21(20.2) 98(94.2) 6(5.8) 44(42.3) 60(57.7) 43(41.3) 61(58.7) HER-2过表达型(n=45) 37(82.2) 8(17.8) 37(82.2) 8(17.8) 16(35.6) 29(64.4) 16(35.6) 29(64.4) 三阴性乳腺癌(n=32) 27(84.4) 5(15.6) 23(71.9) 9(28.1) 13(40.6) 19(59.4) 21(65.6) 11(34.4) χ2值 4.756 12.283 3.983 10.699 P值 0.191 0.006 0.263 0.013 注:HER-2为人表皮生长因子受体2 表 3 不同分子分型女性乳腺癌患者的MRI检查结果比较[n=212,例(%)]
Table 3. Comparison of MRI results of female breast cancer patients with different molecular types (n=212, cases (%))
分型 乳腺实质
背景强化强化形式 强化特征 动态增
强曲线DWI弥散
情况无或
轻度中度或
重度肿块型 非肿块型
或点状均匀
强化不均匀
强化环形
强化流入型 平台型 流出型 高信号 等信号 Luminal A型(n=31) 23(74.2) 8(25.8) 27(87.1) 4(12.9) 1(3.2) 27(87.1) 3(9.7) 1(3.2) 8(25.8) 22(71.0) 29(93.5) 2(6.5) Luminal B型(n=104) 69(66.3) 35(33.7) 80(76.9) 24(23.1) 19(18.3) 72(69.2) 13(12.5) 11(10.6) 18(17.3) 75(72.1) 99(95.2) 5(4.8) HER-2过表达型(n=45) 30(66.7) 15(33.3) 35(77.8) 10(22.2) 13(28.9) 27(60.0) 5(11.1) 0(0.0) 14(31.1) 31(68.9) 45(100.0) 0(0.0) 三阴性乳腺癌(n=32) 23(71.9) 9(28.1) 28(87.5) 4(12.5) 6(18.8) 12(37.5) 14(43.7) 0(0.0) 8(25.0) 24(75.0) 32(100.0) 0(0.0) χ2值 0.926 2.871 30.142 12.176 2.709 P值 0.819 0.412 <0.001 0.058 0.439 注:MRI为磁共振成像;DWI为弥散加权成像;HER-2为人表皮生长因子受体2 表 4 不同分子分型女性乳腺癌患者的乳腺X射线摄影检查结果比较[n=212,例(%)]
Table 4. Comparison of mammography results of female breast cancer patients with different molecular types (n=212, cases (%))
分型 腺体量 肿瘤内钙化情况 钙化形态 致密型 非致密型 有钙化 无钙化 点状 多形性或线样 Luminal A型(n=31) 25(80.6) 6(19.4) 12(38.7) 19(61.3) 10(83.3) 2(16.7) Luminal B型(n=104) 88(84.6) 16(15.4) 63(60.6) 41(39.4) 44(69.8) 19(30.2) HER-2过表达型(n=45) 30(66.7) 15(33.3) 31(68.9) 14(31.1) 14(45.2) 17(54.8) 三阴性乳腺癌(n=32) 26(81.3) 6(18.7) 14(43.8) 18(56.2) 5(35.7) 9(64.3) χ2值 6.346 9.627 11.792 P值 0.096 0.022 0.008 注:HER-2为人表皮生长因子受体2 -
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