目的 探讨乳腺浸润性导管癌不同分子分型及病理组织学分级间常规超声征像的差异。方法 收集因乳腺肿物入保定市第一中心医院诊疗并最终手术确诊为乳腺浸润性导管癌的患者资料,回顾性分析术前常规超声典型征像及术后病理学资料,比较不同分子分型及病理组织学分级间的超声征像差异及相关性。结果 (1)五组分子分型病灶的超声征像均存在统计学差异(P<0.05),其中三阴型多表现为肿物回声均匀(47.2%,17/36),病灶后方回声增强(58.3%,21/36);少表现为回声衰减(5.6%,2/36),微钙化(27.8%,10/36)等。HER-2阳性(HR阳性)多表现为微钙化(77.8%,35/45)伴病灶后方回声衰减(48.9%,22/45)。Luminal A型多表现乏血供(62.2%,46/74)。(2)不同组织学分级病灶的超声征像存在统计学差异(P<0.05)。中高分化组病灶多表现为边缘毛刺征(70.0%,133/190),高回声晕(60.5%,115/190),病灶后方回声衰减(42.1%,80/190);低分化组病灶超声征像多表现为富血供(84.3%,43/51)。多变量logistic回归分析显示,血流分布及肿块后方回声特点是超声影像学辨别低分化组IDC病灶的独立危险因素(P<0.05)。结论 乳腺浸润性导管癌的超声检查在一定程度上有助于辨别分子分型及组织学分级程度,为乳腺癌患者个性化治疗方案的选择及预后提供影像学依据。
Abstract
Objective To explore the difference in conventional ultrasonographic features of breast invasive ductal carcinoma between different molecular subtypes and histopathological grades. Methods The complete clinical data on patients hospitalized due to breast mass bumps and eventually diagnosed with breast invasive ductal carcinoma was collected before the typical preoperative ultrasound features and postoperative pathological data were retrospectively analyzed. The difference and correlations between different molecular subtypes and histopathological grades were analyzed. Results (1) There was significant difference in the ultrasonic signs of molecular subtype lesions between the five groups (P<0.05). Most of the ultrasonic signs of the three-negative lesions showed uniform echo of the tumor (47.2%, 17/36), and enhanced echo behind the lesions (58.3%, 21/36).Echo attenuation (5.6%, 2/36)and microcalcification (27.8%, 10/36)were uncommon.Most of the ultrasonographic signs of HER-2 positive (HR positive) lesions were microcalcification (77.8%, 35/45) with posterior echo attenuation (48.9%, 22/45).Ultrasonographic signs of Luminal A type lesions showed a lack of blood supply among most of the patients (62.2%, 46/74).(2) The ultrasonographic signs of lesions of different histological grades were significantly different (P<0.05).Most of the lesions in the moderately and highly differentiated group showed edge spiculation signs (70.0%, 133/190), hyperechoic halo (60.5%, 115/190), and posterior echo attenuation (42.1%, 80/190).The dominating ultrasonographic manifestation of lesions in the poorly-differentiated group was abundant blood supply (84.3%, 43/51). Multivariate logistic regression analysis showed that the distribution of blood supply and the echo characteristics behind the tumors were independent risk factors for identifying IDC lesions via ultrasound imaging in the poorly-differentiated group (P<0.05). Conclusions Ultrasound examination of breast invasive ductal carcinoma can facilitate molecular classification and histological grading, and provide imaging data for personalized treatment and early prediction of therapeutic effect in patients with breast cancer.
关键词
乳腺浸润性导管癌 /
超声检查 /
分子分型 /
组织学分级
Key words
IDC /
ultrasonography /
molecular classification /
histological classification
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