乳腺癌钼靶X线表现与ER、PR和P53表达的相关性探讨

目的 探讨乳腺癌的钼靶X线表现与乳腺癌癌细胞中雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)及P53蛋白表达的相关性.方法 收集乳腺癌患者60例术前行钼靶X线检查,术后标本行免疫组织化学染色测定 ER、PR及P53蛋白表达情况,分析钼靶X线征象与ER、PR及P53蛋白表达的相关性.结果 在60例乳腺癌中,有肿块组ER、PR及P53阳性表达率均高于无肿块组,2组PR表达有统计学差异(χ2=6.213,P=0.013);其中有毛刺组ER、PR阳性表达率高于无毛刺组,且有统计学意义(χ2=6.673、3.873,P<0.05);钙化组ER、PR及P53阳性表达率高于无钙化组,均有统计学差异(χ2=7.330、5.984、4.671,P<0.05);有淋巴结转移组PR阳性表达率低于无淋巴结转移组,P53阳性表达率明显高于无淋巴结转移组,有统计学意义(χ2=6.213、5.978,P<0.05).结论 乳腺癌钼靶X线征象在一定程度上反映了ER、PR及P53的表达状况.     

乳腺癌新辅助化疗后钼靶下钙化的改变与临床病理特征和预后的关系

【摘要】目的：探讨乳腺癌新辅助化疗（NAC）后钙化的改变与临床病理特征和预后的关系。方法：回顾性分析我院2012年1月1日-2016年1月1日乳腺外科收治的经病理确诊为乳腺癌且行NAC的患者74例,根据NAC后钙化状态的改变将其分为钙化无变化组46例,钙化减少组23例,钙化增加组5例,对比不同钙化组患者的临床病理特征及无病生存期（DFS）及总生存期（OS）之间的差异。结果：NAC后74例患者中获得病理完全缓解（pCR）的患者共30例,pCR率为40.5%,其中Luminal A型为4例,Luminal B为4例,HER2-扩增型为15例,三阴型为7例。肿瘤大小、组织学分级、淋巴结状态、pCR率与钙化的状态密切相关（P均<0.05）。钙化状态的变化与HER-2扩增型（P=0.014）及三阴型乳腺癌（P=0.027）患者的pCR率相关。钙化减少组患者DFS明显优于钙化无变化组和增加组（P=0.001）,三组患者OS差异无统计学意义。结论：乳腺癌患者NAC后钙化状态会发生改变,该变化与多种临床病理因素相关,对预后评估有很大价值。     

肺癌肿瘤抑制因子1在雌激素受体、孕激素受体不同表达乳腺癌患者中的临床意义

目的分析肺癌肿瘤抑制因子1（tumor suppressor in lung cancer 1,TSLC1）与乳腺癌临床病理和预后关系。方法收集女性乳腺癌组织125例,采用免疫组织化学技术检测TSLC1表达。结果TSLC1主要表达在乳腺癌细胞质,其阳性率为38.4%（48/125）,与患者的年龄、肿瘤大小、淋巴结转移、临床分期、人类表皮生长因子受体 2（human epidermal growth factor receptor-2,HER-2）表达无关,而与雌激素受体（estrogen receptor,ER）、孕激素受体（progesterone receptor,PR）表达相关（P<0.001）。ER+（阳性）患者TSLC1阳性率低于ER-（阴性）患者[28.4%（25/88）与62.2%（23/37）];同样,PR+患者TSLC1阳性率低于PR-患者[24.3%（17/70）与56.4%（31/55）]。Z检验显示在ER+PR-的乳腺癌患者中TSLC1-和TSLC1+患者3年生存率差异有统计学意义（83.3%与14.3%,P=0.007）,总体生存曲线差异有统计学意义（P=0.003）。Cox多因素回归分析,TSLC1不是ER+PR-乳腺癌患者独立的危险预后因素（比值比10.696,95%可信区间0.988～115.843,P=0.051）。结论TSLC1在乳腺癌致病机制中与ER、PR相关,可作为临床ER+PR-乳腺癌患者新的预后指标。     

两种不同剂量米非司酮治疗子宫肌瘤临床观察

目的探讨不同剂量米非司酮治疗子宫肌瘤对子宫肌瘤体积的影响以及对肌瘤组织中雌、孕激素受体（ER、PR）的影响,进一步了解米非司酮治疗子宫肌瘤的临床效果及可能的治疗机制。方法将90例临床诊断为子宫肌瘤、有手术指征、无内科合并症的患者随机分为对照组、短期大剂量组（A组）、长期小剂量组（B组）。于服药前后B超测量子宫肌瘤的体积,用免疫组织化学方法检测切除的子宫肌瘤标本中雌激素受体（ER）、孕激素受体（PR）水平。结果①两服药组服药后肌瘤体积较服药前明显缩小,肌瘤体积变化有统计学意义,B组体积变化更明显 ②对照组肌瘤组织中ER、PR均呈高表达,A组肌瘤组织中PR、ER表达均下降,与对照组比较差异有统计学意义（P〈0.05） B组肌瘤组织中PR、ER表达下降,与对照组比较差异有统计学意义（P〈0.01）,两服药组间比较,PR、ER表达差异有统计学意义（P〈0.05）。结论①短期大剂量及长期小剂量米非司酮均可使子宫肌瘤明显缩小,但长期小剂量效果更明显。②降低肌瘤组织中PR、ER表达是米非司酮治疗子宫肌瘤的重要机制之一。     

P53蛋白雌孕激素受体在乳腺癌中的表达及相关性研究

目的：探讨乳腺癌中P53蛋白，雌激素受体（ER），孕激素受体（PR）的表达及相关性研究。方法：采用免疫组化技术（S-P法）检测40例乳腺癌中P53突变蛋白、ER、PR的表达。结果：在ER、PR阳性者中PTE突变蛋白明显增多为30%。结论：P53突变蛋白、ER、PR表达与乳腺癌有关，是有价值的预后因子。     

不同化疗方案辅助化疗对乳腺癌患者术后月经影响的观察

目的：观察TEC（多西他赛＋表柔比星＋环磷酰胺）和CEF（环磷酰胺＋表柔比星＋氟尿嘧啶）两种不同化疗方案对乳腺癌患者术后月经的影响。方法：绝经前乳腺癌患者88例,随机分为TEC方案40例,CEF方案48例。观察不同化疗方案对月经的影响,并分析发生闭经（CIA）及CIA恢复独立影响因素。结果：采用TEC化疗方案患者CIA发生率为70.0%,CEF为61.0%,两者比较,差异不显著（P〉0.05）;年龄〉40岁患者CIA发生率显著高于≤40岁患者（P〈0.05）;雌激素受体（ER）及孕激素受体（PR）阳性患者CIA发生率显著高于ER及PR阴性患者（P〈0.05）。Logistic多元逐步回归分析结果显示,年龄是发生CIA和CIA恢复的独立影响因素,而化疗方案和ER及PR尚不是独立危险因素。结论：乳腺癌患者术后辅助化疗时应考虑患者的年龄。     

乳腺癌组织学分级与ER、PR、CerbB-2、Ki-67表达的关系

目的探讨乳腺癌组织学分级与雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体-2（CerbB-2）、Ki-67表达的相关性。方法用免疫组织化学法测定169例乳腺癌组织中ER、PR、CerbB-2、Ki-67的表达;Bloom-Richardson系统Nottingham改良方案测定组织学分级。结果169例患者ER、PR、CerbB-2和Ki-67表达的阳性率分别为56.21%、63.91%、54.44%和75.15%;Ⅰ、Ⅱ、Ⅲ级乳腺癌组织中ER、PR的阳性表达率间差异无显著性意义（P〉0.05）;随着组织学分级的递增CerbB-2、Ki-67的阳性表达率随之增加（P〈0.05）;ER的表达与CerbB-2、Ki-67的表达间有相关关系（P〈0.05）。结论乳腺癌组织中ER、PR的表达不随组织学分级的增加而增加;CerbB-2、Ki-67的表达随组织学分级的增加而增加;ER的表达与CerbB-2呈负相关,而与Ki-67呈正相关。     

乳腺癌钼靶X线特征与ER、PR和HER-2的相关性研究

目的 初步探讨乳腺癌钼靶X线征象与雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone re-ceptor,PR)和人类表皮生长因子受体2(human epidermal receptor 2,HER-2)表达之间的关系.资料与方法 将49例乳腺癌患者钼靶X线表现特征与免疫组织化学测定的ER、PR和HER-2的表达进行对照研究.结果 49例乳腺癌中,肿块边缘"毛刺征"者ER、PR阳性表达率高,病变区有钙化者HER-2阳性表达率高.肿块大小与ER、PR表达均无关.结论 乳腺癌钼靶X线征象和ER、PR及HER-2的表达有密切关系,在一定程度上反映了ER、PR及HER-2的表达状态,能为乳腺癌的术前辅助内分泌治疗和预后提供有价值的信息.     

三阴乳腺癌受体表型转化情况对乳腺癌患者临床预后的影响

目的 评价乳腺癌患者雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2(HER-2)的表达及复发前后受体表型的转化情况对解救治疗疗效及临床预后的影响.方法 纳入解放军307医院1994年9月-2011年11月收治乳腺癌患者211例,根据ER、PR和HER-2受体表型转化情况分为3组.A组(n=20):原发肿瘤灶为三阴乳腺癌(ER、PR和HER-2表达均为阴性,TNBC),复发转移后转化为非TNBC;B组(n=73):原发肿瘤灶为非TNBC,复发转移后转化为TNBC;C组(n=118):原发肿瘤及复发转移灶均为TNBC.对患者的一般资料进行总结,分析复发转移情况、解救治疗疗效及临床预后.结果 全组211例患者复发转移时中位年龄52(22 ～ 78)岁,以单发转移为主,首发转移最常见的部位依次为淋巴结、骨和皮肤.A、B、C三组患者的中位无病生存期分别为34.0、25.0、20.0个月.B、C组一、二、三线解救治疗的临床有效率显著高于A组(P=0.030、0.003、0.001),但A组在解救内分泌治疗中的临床获益率显著高于B、C组.211例患者的中位随访时间为68(20～127)个月.A、B、C三组复发后中位生存期分别为63.1、33.7、25.8个月(P=0.000),中位总生存期分别为156.7、67.8、47.4个月(P=0.000).结论 乳腺癌患者复发前后ER、PR和HER-2受体表型转化可影响临床预后,在制定解救治疗方案时应对ER、PR和HER-2受体的表达情况进行检测.     

新辅助化疗对乳腺癌孕激素受体等标志物水平影响的观察

目的：观察多西他赛联合吡柔比星化疗（新辅助化疗）对雌激素受体（ER）、孕激素受体（PR）、人类表皮生长因子受体2（HER-2）的影响。方法：选择确诊乳腺癌76例,采用新辅助化疗方案,21天为1个周期,疗程结束后15～20天手术;术中切标本行常规病理检查及免疫组织化学检查,观察新辅助化疗前后ER、PR、HER-2表达水平的变化。结果：76例中,术后病理学完全缓解3例;未达到病理完全缓解的73例中,化疗后ER表达水平较化疗前变化不显著（P〉0.05）;PR、HER-2表达水平较化疗前显著下调（P〈0.05）。结论：新辅助化疗后PR、HER-2水平下调,可能会对部分患者的预后产生影响。     

Patterns of disease spread in metastatic breast carcinoma: influence of estrogen and progesterone receptor status

BACKGROUND AND PURPOSE: It is widely recognized that tumor hormone receptor status correlates with overall survival in metastatic breast carcinoma; however, the influence of hormone receptors on the pattern of disease spread is not well known. PURPOSE: We set out to determine the common distributions of metastatic disease spread in metastatic breast carcinoma, and to evaluate tumor hormone receptor status as predictor of disease spread. METHODS: Thirty-six patients being imaged for possible metastatic breast carcinoma between 1995 and 1998, in whom the presence or absence of tumor estrogen and progesterone receptors (ER+ or ER- / PR+ or PR-) was known, who underwent both contrast-enhanced MR of the brain and total body skeletal scintigraphy, were studied retrospectively. RESULTS: Of twelve patients with skeletal metastases but no brain metastases, 83% were ER+/PR+. Ten patients had brain metastases but no skeletal involvement, 80% of which were ER-/PR-. Seven patients had no brain or osseous metastases, but had metastatic disease in the chest or abdomen. Eighty-six percent of patients in this group were ER-/PR-. The tumor receptor status was statistically different between these three distribution groups (P = .01). A final group, consisting of seven patients, showed widespread disease, with diffuse metastases to the brain, viscera, and skeleton. In this group, no patients were ER+/PR+. CONCLUSION: There are two major patterns of disease spread in metastatic breast carcinoma, excluding patients with extensive diffuse metastases. Patients with ER+/PR+ tumors tend to develop osseous but not brain metastases. Patients with ER-/PR- tumors tend to develop brain but not osseous metastases. Appreciation of these distributions can aid the radiologist in detecting metastatic lesions, and will help the clinician to estimate the likelihood of metastases to various organ systems, as well as to potentially target therapy.     

Iodine-labeled tamoxifen uptake in primary human breast carcinoma.

Assessing tumor uptake and retention of (123)I-labeled tamoxifen (TX) could increase our understanding of TX's action and the mechanisms involved in resistance to the drug. METHODS: Nine untreated primary breast carcinoma patients underwent whole-body planar and tomographic (SPECT) imaging 30 min and 4-5 h after injection of 185 MBq (123)I-TX. Tumor-to-normal tissue uptake ratios (T/N) derived from SPECT images were related to estrogen receptor (ER) and progesterone receptor (PR) status. RESULTS: In 4 of 9 patients, all of whom were ER+/PR+, (123)I-TX tumor uptake was clearly depicted. In 2 of them, involved axillary lymph nodes were also visualized. T/N consistently increased over time. All ER+/PR- and ER-/PR- tumors as well as 2 ER+/PR+ tumors were (123)I-TX-. CONCLUSION: These preliminary findings suggest that (123)I-TX is preferentially taken up in alpha-ER+/PR+ breast tumors known to be more likely to respond to endocrine treatment.     

The effects of estrogen, progesterone, and C-erbB-2 receptor states on 18F-FDG uptake of primary breast cancer lesions.

The purpose of this prospective study was to investigate whether correlations exist between 18F-FDG uptake of primary breast cancer lesions and predictive and prognostic factors such as estrogen receptor (ER), progesterone receptor (PR), and C-erbB-2 receptor (C-erbB-2R) states. METHODS: Before undergoing partial or total mastectomy, 213 patients with newly diagnosed breast cancer underwent 18F-FDG PET (5.2 MBq/kg of body weight). The maximum standardized uptake value (SUV) of the primary lesion was measured in each patient. Standard immunohistochemistry was performed on a surgical specimen of the cancer lesion to characterize the receptor state of the tumor cells. Pearson chi2 tests were performed on the cross-tables of different receptor states to test any association that may exist among ER, PR, and C-erbB-2R. Maximum SUV measurements for different receptor states were compared using factorial ANOVA in a completely random design. RESULTS: After exclusion of certain lesions, 118 lesions were analyzed for this study. The mean maximum SUVs of ER-positive and ER-negative lesions were 3.03 +/- 0.26 and 5.64 +/- 0.75, whereas those of PR were 3.24 +/- 0.29 and 4.89 +/- 0.67, respectively, and those of C-erbB-2R were 4.64 +/- 0.70 and 3.70 +/- 0.35, respectively. Chi2 tests for ER and PR showed that if one is positive then the other tends to be positive as well (chi2 = 71.054, P < 0.01). For ER and C-erbB-2R states, if ER is positive, C-erbB-2R will more likely be negative (chi2 = 13.026, P < 0.01). No relationship was detected between PR and C-erbB-2R states (chi2 = 3.695, P > 0.05). ANOVAs showed that PR state alone (F = 0.095, P > 0.05) and C-erbB-2R state alone (F = 0.097, P > 0.05) had no effect on 18F-FDG uptake but ER state alone had an effect (F = 9.126, P < 0.01). ER and PR being together had no additional effect on 18F-FDG uptake. Our study also demonstrated that interactions exist between ER and C-erbB-2R state and between PR and C-erbB-2R state. CONCLUSION: SUV measurements may provide valuable information about the state of ER, PR, and C-erbB-2R and the associated glucose metabolism as measured by 18F-FDG uptake of the primary breast cancer lesions. Such an association may be of importance to treatment planning and outcome in these patients.     

Vascular characterisation of triple negative breast carcinomas using dynamic MRI

Objectives  

Triple-negative (ER-/PR-/HER2-) breast carcinomas (TNBC) are aggressive tumours with underexplored imaging features. This study investigates whether their vascular characteristics as assessed by dynamic contrast-enhanced (DCE) and dynamic susceptibility contrast-enhanced (DSC) MRI are distinct from the prognostically more favourable ER+/PR+/HER2- cancers.     

乳腺浸润性导管癌钼靶X线表现与激素受体表达的关系

目的 探讨乳腺浸润性导管癌(infiltrating ductal cancer,IDC)钼靶X线征象与雌激素受体(ER)和孕激素受体(PR)之间的关系.资料与方法 回顾性分析65例经乳腺钼靶X线摄影及手术病理证实的IDC的X线表现,术后标本经免疫组织化学染色判断ER、PR表达情况,并分析其与钼靶X线征象之间的关系.结果 65例IDC中,癌肿毛刺征与癌细胞ER阳性表达之间呈正相关(P<0.05);乳腺癌钙化与癌细胞ER和PR阳性表达水平之间呈负相关(P<0.05);乳腺癌结构紊乱与癌细胞ER阳性表达水平之间呈负相关(P<0.05).结论 乳腺IDC钼靶X线表现在一定程度上反映了ER、PR表达状态.     

Breast cancer models to study the expression of estrogen receptors with small animal PET imaging

Different animal models of estrogen positive tumors (ER+) were evaluated for their suitability to follow tumor response after various treatment protocols, using small animal positron emission tomography (PET). ER+ human breast cancer cell lines MCF-7 and T-47D, using MDA-MB-231 as ER-; control, and murine mammary ductal carcinomas MC4-L2, MC4-L3, and MC7-L1, were compared for their in vivo growth rate and retention of ER+ status. Tumor metabolic activity was estimated from the relative uptake (% injected dose/g) of [18F]fluorodeoxyglucose (FDG) uptake, whereas ER content was determined from 16alpha-[18F]fluoroestradiol (FES) retention. F-18 activity values were obtained by small animal PET imaging and confirmed by tissue sampling and radioactivity counting. Reliable uptake measurements could be obtained for tumors of 200 microl or over. The human cell lines grew at a slower rate in vivo and failed to accumulate FES; in contrast, the Balb/c MC7-L1 and MC4-L2 grew well and showed good uptake of both FDG and FES. Chemotherapy and hormone therapy delayed the growth of MC7-L1 and MC4-L2 tumors, confirming their suitability as an ER+ model for therapeutic interventions. MC4-L3 tumors also showed promising results but required the presence of progestative pellets to grow. These data demonstrate that murine MC7-L1 and MC4-L2 tumors are suitable models for the monitoring of ER+ breast cancer therapy using small animal PET imaging.     

Biodistribution and breast tumor uptake of 16α-[18F]-fluoro-17β-estradiol in rat

To evaluate the usefulness of 16alpha-[18F]-fluoro-17beta-estradiol (FES) for the assessment of estrogen receptor (ER), we examined the tissue distribution and kinetics of FES in immature female Sprague-Dawley rats and then examined FES uptake in rat breast tumors induced by 7,12-dimethylbenz(a) anthracene (DMBA). The FES uptake by the uterus, an ER-rich tissue, was highly selective and it was 3.34 +/- 0.79%ID/g at 60 minutes and 1.57 +/- 0.57%ID/g at 120 minutes after injection. The FES uptakes in ER-negative tissues were 0.12 +/- 0.05%ID/g or less and 0.05 +/- 0.03%ID/g or less, respectively. Coadministration of unlabeled beta-estradiol showed marked depression of uterine FES uptake. The FES uptake by rat breast tumors was 0.14 +/- 0.06%ID/g at 60 min and 0.12 +/- 0.09%ID/g at 120 min. The FES uptake by rat breast tumors correlated with the ER concentration (r = 0.45, p < 0.05). In conclusion, these results suggest that the FES uptake by tissue is mainly ER mediated and FES is thus useful for detecting ER positive breast tumors.     

Estrogen receptor and breast MR imaging features: a correlation study

PURPOSE: To compare the MRI features between estrogen receptor (ER) positive and negative breast cancers. MATERIALS AND METHODS: Breast MRI of 90 consecutive patients confirmed with invasive ductal carcinoma (IDC), 51 ER positive and 39 ER negative, were analyzed. The tumor morphology and dynamic contrast-enhanced (DCE) kinetics were evaluated based on the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) MRI lexicon and compared. Enlarged axillary lymph nodes on MRI and choline (Cho) detection using MR spectroscopy (MRS) were also analyzed and compared. For patients receiving axillary node dissection the pathological nodal status was also compared. RESULTS: ER negative breast cancer had bigger tumors compared to ER positive cancer (3.6 +/- 2.0 cm vs. 1.8 +/- 1.3 cm, P < 0.00005). ER negative cancer was more likely to exhibit nonmass type enhancements compared to ER positive cancer (P < 0.005). Enlarged axillary lymph nodes were more frequently identified on MRI in ER negative compared to ER positive patients (P < 0.05). After excluding patients undergoing neoadjuvant chemotherapy, auxiliary lymph node status did not show significant difference between ER positive and ER negative cancer on MRI and pathology. ER negative cancer was more likely to show the malignant type enhancement kinetics (P = 0.15), rim enhancement (P = 0.15), and Cho detection on MRS (P = 0.23) compared to ER positive cancer, but it did not reach a level of statistical significance. CONCLUSION: ER negative breast cancer was more aggressive, with larger tumor size, more non-mass-type enhancement lesions, and a higher percentage showing enlarged axillary nodes on MRI. These features might be related to its poorer cellular differentiation and/or a higher angiogenesis.     

PS_2基因在乳腺癌中表达的临床意义

目的　探讨雌激素调节蛋白PS2 在乳腺癌中的表达及其临床意义。方法　应用免疫组化S P法 ,对 4 8例人乳腺浸润性导管癌中PS2 进行检测 ,分析其与ER ,PR以及预后的关系。结果　PS2 与ER呈显著正相关。在ER(+)PR(+)的病人中 ,PS2 阳性率达 6 7 9% ,而在ER(- )PR(- )的病人中PS2 阳性率仅为 12 5 % ,二者相比有显著性差异 (P <0 .0 1)。PS2 阳性表达与病人长生存期呈正相关 ,与腋窝淋巴结转移无相关性。结论　在预测乳腺癌抗雌激素治疗的效果时 ,PS2 要优于ER ,PR。同时PS2 阳性的乳腺癌患者预后较好 ,PS2 可作为预测乳腺癌患者生物学行为的指标之一     

乳腺癌钼靶X线微钙化与癌细胞ER、PR表达关系的研究

目的分析钼靶片中乳腺癌微钙化与ER、PR表达及临床病理关系,评价微钙化征象预测ER、PR表达的可行性。方法乳腺癌病例115例,钼靶X线片由3位有经验的影像诊断医师阅片,明确钙化并根据钙化及相关表现分组。免疫组化采用SP法,根据癌细胞核内染色判断ER、PR表达情况。各钙化组分别与ER、PR表达情况进行比较分析。结果乳腺癌钼靶片中微钙化的有无、微钙化数目、钙化类型与肿瘤细胞ER、PR表达无明显相关性(P>0.05)。乳腺癌微钙化多见于导管癌,占53.33%,是钼靶片中无肿块表现乳腺癌的主要X线征象。微钙化表现与乳腺癌临床TNM分期无关(P>0.05)。乳腺癌钼靶片微钙化表现常伴腋下淋巴结转移(24/47例),而钙化数目较少(<20枚)的乳腺癌更易伴有腋下淋巴结转移(16/24例)。结论微钙化在钼靶片乳腺癌诊断中,特别是在早期癌以及无肿块表现的乳腺癌诊断中具有重要意义。但是,微钙化表现与ER、PR表达无明显相关性,尚不能作为乳腺癌ER、PR表达的预测指标。