不同分子分型乳腺癌的多模态超声特征和临床病理对照研究

目的:探究不同分子分型乳腺癌的多模态超声特征与临床病理的对照分析结果,提高不同分型乳腺癌的诊断准确性。方法:对2017年8月至2018年11月哈尔滨医科大学附属第二医院及附属肿瘤医院的112例浸润性乳腺癌患者进行回顾性分析,参照St.Gallen标准,按照免疫组化结果将其分为Luminal A(LA)型、Luminal B(LB)型、Her-2过表达型和三阴(triple negative,TN)型。术前均行二维、彩色多普勒血流显像、剪切波弹性成像以及超声造影检查,并收集完整的临床病理相关资料。分析不同分子分型乳腺癌多模态超声特征和临床病理特征方面的差异性。结果:①Luminal型乳腺癌多表现后方回声衰减,组织学分级、血流Alder分级、弹性模量Emax和Eratio较低。其中LA型多为毛刺或成角边缘,造影呈向心性增强;LB型多为模糊边缘,造影呈低增强,多无灌注缺损(均P<0.05)。②Her-2过表达型倾向于边缘模糊,后方回声增强,组织学分级、血流Alder分级、Emax和Eratio均较高,造影呈高增强模式以及灌注缺损表现,TTP值小于其他亚型(均P<0.05)。③TN型呈微分叶边缘、后方回声增强、低血流Alder分级;组织学分级、Emax、Eratio和Ki67表达水平较高;造影呈现向心性增强和灌注缺损(均P<0.05)。结论:不同分子分型乳腺癌在多模态超声特征和临床病理中表现不同,可为临床诊断、治疗和预后评估提供更加丰富的参考信息。

Comparative study of multimodal ultrasonographic features and clinicopathological appearances of breast cancer with different molecular subtypes

Objective To investigate the comparative analysis of multimodal ultrasound features and clinicopathology of different molecular types of breast cancer,so as to improve the diagnostic accuracy of different types of breast cancer.Methods A retrospective analysis of 112 patients with invasive breast cancer in the Second Affiliated Hospital and Affiliated Cancer Hospital of Harbin Medical Univeristy from August 2017 to November 2018 was carried out.With reference to St.Gallen standard,breast masses were divided into four subtypes,including Luminal A(LA),Luminal B(LB),Her-2 overexpression(Her-2+)and triple negative(TN).Two-dimensional greyscale,color Doppler flow imaging,shear wave elastography and contrast-enhanced ultrasound images were performed before operation.Complete clinicopathological data were collected.The differences between different subtypes of breast cancer in terms of multimodal ultrasound and clinicopathological features were analyzed.Results①Luminal breast cancer showed posterior echo attenuation,low Alder grade,low Emax and Eratio value.LA was more likely to show a speculated or angular margin and concentric enhancement;LB was more frequently to show a indistinct margin,low enhancement and no perfusion defect(all P<0.05).②Her-2+cancers were characterized with a indistinct margin,enhanced posterior echo,a high Alder grade,Emax and Eratio value,and a high contrast enhancement and perfusion defect.The TTP value was lower than other subtypes(all P<0.05).③TN cancers were associated with microlobulated margin,posterior echo enhancement,low Alder grade,high Emax and Eratio value and Ki67 expression,contrast concentric enhancement have and perfusion defect(all P<0.05).Conclusions Different molecular subtypes of breast cancer have different multimodal ultrasound features and clinicopathological appearances,which can provide more imaging information for clinical diagnosis,treatment,and prognosis.