乳腺MRI 背景实质强化程度与乳腺癌分子分型的关系

目的： 观察乳腺背景实质强化(background parenchymal enhancement，BPE)在不同分子分型的乳腺癌患 者中的分布情况，并分析其与乳腺癌分子分型的关系。方法： 回顾性分析150 例乳腺癌患者的MRI动态增强扫描图 像，根据雌激素受体(estrogen receptor，ER)、孕激素受体(progesterone receptor，PR)、人类表皮生长因子受体-2 (human epidermal growth factor receptor 2，HER-2)和细胞增殖的相关抗原Ki-67 的表达状态，将乳腺癌分为管腔A型 (Luminal-A 型)、管腔B 型(Luminal-B 型)、HER-2 型和三阴型，并根据乳腺影像报告和数据系统(breast imaging and reporting data system，BI-RADS)标准，将BPE分为4 型，即轻微强化、轻度强化、中度强化和显著强化。分析BPE 分布与乳腺癌分子分型的关系。结果： 在轻度强化的BPE 患者中，Luminal-B 型乳腺癌发生率明显升高，且与 Luminal-A 型、HER-2 型和三阴型乳腺癌之间差异存在统计学意义(均P<0.01)。在显著强化的BPE患者中，三阴性型 乳腺癌所占比例最高，且与Luminal-A 型、Luminal-B 型、HER-2 型乳腺癌之间差异存在统计学意义(均P<0.05)。结 论： BPE可作为乳腺MRI靶向筛查中一种额外的风险分层指标，对临床诊断和个体化治疗有参考价值。

Relationship between degree of breast MRI background parenchymal enhancement and breast cancer subtype

Objective: To observe the distribution of magnetic resonance imaging (MRI) breast parenchymal enhancement (BPE) among different breast cancer subtypes and to explore the relationship between the BPE and the breast cancer tumor type. Methods: A total of 150 consecutive patients with breast cancer underwent breast dynamic enhanced scanning image. According to the expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2) and Ki-67,the molecular subtypes were classified into Luminal-A, Luminal-B, HER-2 overexpression, and triple-negative breast cancer. The BPE of the whole breast was evaluated and categorized as minimal, mild, moderate, or marked according to the breast imaging reporting and data system (BI-RADS). The relationship between the distribution of BPE and the breast cancer subtypes was analyzed. Results: In patients with mild BPE, the incidence of Luminal-B breast cancer was significantly increased, and there were statistical differences among the Luminal-B and the luminal-A, the HER-2 over-expressed type, and the triple-negative type (all P<0.01). In the marked BPE patients, the proportion of triple negative breast cancer was the highest, and there was statistical difference among the triple-negative type and the Luminal-A, the Luminal-B, and the HER-2 over-expression types (all P<0.05). Conclusion: The BPE can be served as an additional risk stratification index in the targeted screening of breast cancer type, which can offer reference value in the clinical diagnose and individualized treatment.