子宫肌瘤超声造影定量灌注特征预测超声消融的效果

目的探讨子宫肌瘤超声造影定量参数预测超声消融效果的价值。方法对63例子宫肌瘤患者术前行超声造影检查,采用JC型超声消融治疗系统内置灰度测量软件获得子宫肌瘤血流灌注定量参数。术后根据增强MRI分为消融满意组(消融率≥70%)和部分消融组(消融率70%),比较2组造影参数差异,分析造影参数与消融率的关系,并采用ROC曲线评价造影参数对消融效果的预测价值。结果 2组到达时间(AT)、达峰时间(TTP)、增强时间(ET)、增强强度(EI)、增强速率(ER)差异均有统计学意义(P均0.01);AT、TTP、ET与消融率呈正相关(P均0.01),EI、ER与消融率呈负相关(P均0.001)。AT、TTP、ET、EI、ER的ROC曲线下面积(AUC)均0.7,其中ER的预测价值最高(AUC=0.935)。以ER=5.23作为截点值,其预测消融效果的敏感度为80.0%、特异度为95.8%。结论子宫肌瘤的超声消融效果与超声造影定量参数存在一定相关性,ER可作为预测消融效果的较好指标。     

超声造影定量参数评价慢性肾脏病分期及与临床指标的相关性研究

目的探讨分析超声造影定量参数在评价慢性肾脏病(CKD)各分期肾皮质血流灌注情况的应用价值及其与临床指标间的相关性。方法共纳入研究80例CKD患者,根据CKD分期分为1、2、3、4～5期4组,每组各20例,另选取20例健康志愿者作为对照组,所有研究对象均行双肾超声造影检查,选择肾皮质区域建立时间强度曲线(TIC),获得血流灌注参数包括造影剂到达时间(AT)、达峰时间(TTP)、绝对增强强度(ΔI)及曲线下面积(AUC),比较各组超声造影定量参数的差异,并分析超声造影参数与临床指标间的相关性。结果超声造影显示对照组AUC明显高于CKD各组,差异有统计学意义(P0.05);随着CKD分期增高,双肾AUC减少,差异有统计学意义(P0.05);各组间双肾AT、TTP差异无统计学意义(P0.05)。双肾ΔI与肌酐、尿酸呈负相关(P0.05);双肾AUC与肌酐、尿酸、尿素氮呈负相关(P0.05);双肾AUC与血红蛋白呈正相关(P0.05);其余超声造影灌注参数与临床指标间无显著相关性(P0.05)。结论超声造影可以对CKD各分期肾皮质微循环血流灌注进行定量参数分析,能准确、敏感、有效地评价CKD患者的肾脏功能。超声造影定量参数还能反映不同分期CKD肾功能受损的严重程度,为临床早期诊治CKD提供可靠的客观指标。     

乳腺癌组织中HER2、ERα、ERβ、PR的表达及其相关性分析

目的探讨雌激素受体α（ERα）、雌激素受体β（ERβ）、孕激素受体（PR）、人类表皮生长因子受体2（HER2）在乳腺癌组织中的表达及其与TNM分期和腋窝淋巴结状况的关系。方法随机选择我院在2004年12月至2007年12月收治的HER2高表达（＋＋＋）51例与无表达（-）53例乳腺浸润性导管癌病例，分别检测乳腺癌组织的ERα、ERβ、PR的表达水平，分析其与TNM分期、腋窝淋巴结转移等临床指标的相关性。结果104例乳腺癌患者，TNM分期为I期的占14．42％，Ⅱ期占62．50％，Ⅲ期占19．23％，Ⅳ期占3．85％；HER2阳性的淋巴结转移率为41．18％，HER2阴性的转移率为47．5％；ERα、ERβ、PR的阳性表达率分别为52．88％、63．46％、73．08％。ERβ与ERα、PR的表达呈正相关（P〈0．01），与HER2的表达负相关（P〈0．01）；ERα与PR的表达正相关（P〈0．01），与HER2负相关（P〈0．01），PR与HER2的表达负相关（P〈0．05）；ERα、ERβ、PR、HER2的表达与淋巴结转移情况及TNM分期无显著相关性。结论HER2作为乳腺癌预后不良的重要指标与作为乳腺癌预后良好的重要指标ERα、ERβ、PR的表达呈负相关，与TNM分期及腋窝淋巴结转移状态未显示明显相关性。     

血流彩色编码成像技术评估颈动脉植入支架前后血流动力学变化

目的探讨彩色血流编码DSA(CC-DSA)评估颈动脉支架植入术(CAS)前后血流动力学变化的可行性。方法回顾性分析接受CAS治疗的颈内动脉起始段重度狭窄患者16例。将CAS前后颈动脉造影图像经CC-DSA后处理得到相应的彩色血流编码图像,分别于颈总动脉、颈内动脉C1段、大脑中动脉M1段及横窦处设置感兴趣点(POI),分别检测达峰时间(TTP)及相对达峰时间(rTTP)。同时收集CAS前后颈动脉狭窄段及颈内动脉C1段远端(管腔正常处)收缩期峰值流速(PSV)及舒张末期流速(EDV)。结果 CAS治疗后颈内动脉C1段及大脑中动脉M1段TTP及rTTP均较术前降低(P均0.05),CAS治疗前后颈总动脉、横窦TTP及横窦rTTP差异均无统计学意义(P均0.05)。CAS治疗后颈动脉狭窄段PSV及EDV均较术前降低,颈内动脉C1段远端PSV较术前升高(P均0.05)。CAS治疗前后颈内动脉C1段TTP变化值与其远端(管腔正常处)超声参数PSV、EDV变化值均呈正相关(r_s=0.500、0.522,P=0.049、0.038)。结论 CC-DSA可量化评估颈内动脉狭窄患者CAS治疗后血流动力学变化。     

急性闭合性大白兔阴囊损伤模型的建立及常规超声和超声造影评价

目的:建立一种阴囊急性闭合性损伤动物模型的实验方法,并利用常规超声和超声造影技术评价该损伤类型。方法:健康新西兰雄性大白兔21只,随机选择一侧阴囊,用0.5 kg铁球从30 cm处自由落体打击被选一侧阴囊,打击次数3~12次。利用常规超声及超声造影技术评价实验动物造模结果,并用病理结果分析验证该技术评价的准确性。结果:21例阴囊损伤造模均成功,其中挫伤10例、血肿6例、破裂5例,所有类型均经病理结果证实。常规超声能观察睾丸形态、回声改变及血流状态,但对6 h以上睾丸挫伤诊断率较低,对复杂损伤不能进行准确甄别。超声造影在挫伤组表现为造影剂快速进入,各时间点造影参数到达时间(AT)、达峰时间(TTP)与健侧比较均有统计学意义(P均0.05),但峰值减半时间(HT)无统计学差异(P0.05);血肿组造影能清楚勾勒出血肿的轮廓,血肿周围形成延迟低增强带,造影参数AT、TTP与健侧比较均有统计学意义;严重的睾丸破裂可以观察到睾丸内无造影剂充盈,偶可发现造影剂外溢现象。结论:铁球作多次自由落体运动打击大白兔阴囊可以建立阴囊闭合性损伤模型,6次的打击造成单纯挫伤型损伤的可能性较大,10次的打击多造成复杂多样的损伤。联合使用常规超声及超声造影技术可以提高对损伤类型的判断。     

超声造影定量分析体外冲击波碎石后肾皮质血流灌注

目的探讨超声造影（CEUS）结合时间-强度曲线分析体外冲击波碎石术（ESWL）前后肾皮质血流灌注的改变及其临床意义。方法对30例诊断为肾结石患者行ESWL,于ESWL前、ESWL后即时分别行CEUS检查。用ACQ软件定量测量碎石靶区肾皮质血流灌注参数值,观察指标为造影剂到达时间（AT）、达峰时间（TTP）、达峰强度（PI）及速度参数（β）。结果AT、TTP、β值ESWL前后差异无统计学意义（P〉0.05）,PI值ESWL前后差异有统计学意义（P〈0.05）,ESWL后PI值小于ESWL前PI值。结论CEUS定量分析技术能显示ESWL前后肾皮质血流灌注的变化,反映肾的微小损伤,可以成为监测ESWL肾损伤的新手段。     

乳腺导管原位癌、微浸润癌及浸润性癌临床病理指标表达差异分析

目的：比较乳腺导管原位癌（DCIS）、导管原位癌伴微浸润（DCIS-MI）及浸润性乳腺癌（IDC）临床病理及免疫组化特征。方法回顾性分析2008至2013年的214例乳腺癌患者的临床病理资料,其中DCIS 66例,DCIS-MI 48例,IDC 100例。根据免疫组化结果分为4组：Luminal-A [ER（＋）和／或 PR（＋）,HER2（－）],Luminal-B [ER（＋）和／或 PR（＋）,HER2（＋）],HER2（＋）型[ER（－）,PR（－）,HER2（＋）],和三阴型[ER（－）,PR（－）,HER2（－）]。结果从DCIS、DCIS-MI到IDC,肿瘤大小逐渐增加（P＜0．001）。IDC腋窝淋巴结阳性率高于DCIS和DCIS-MI（P＜0．001）。ER、PR、HER2阳性表达在纯DCIS、DCIS-MI与IDC之间的表达显著差异,P值均小于0．05。随着浸润的发展,Luminal-like 型比例下降,而HER2＋型和三阴型的比例增加（P＝0．016）。Ki-67指数分别为DCIS（10．4±12．9）％,DCIS-MI（13．9±16．3）％,IDC（43．9±26．4）％（P＜0．001）。结论在DCIS、DCIS-MI、IDC中不同亚型的分布以及各自的临床病理特点表明它们之间存在很大不同。     

ER+/HER2-乳腺癌多基因阵列检测应用：ASCO指南解读与瑞金医院临床实践

<正>雌激素受体（estrogen receptor, ER）阳性/人表皮生长因子受体2 (human epidermal growth factor receptor 2, HER2)阴性乳腺癌在内分泌治疗基础上,是否需辅助化疗,存在较大争议。既往研究发现,基于多基因阵列表达谱,如21基因复发分数（recurrence score,RS）和70基因预后分型,     

维生素D受体在乳腺肿瘤中的表达及其临床意义

目的 探讨维生素D受体(VDR)在乳腺肿瘤中的分布及其与乳腺癌临床病理因素的关系.方法 采用免疫组织化学SP法对51例乳腺癌组织及20例乳腺良性肿瘤组织进行ER,PR,HER2和VDR检测,分析VDR与乳腺癌患者年龄、绝经状况、肿瘤大小、有无腋窝淋巴结转移、临床分期、病理类犁及组织学分级的关系.对VDR与ER,PR及HER2 3种受体在乳腺癌中的表达率以及表达强度之间的关系进行等级相关性分析.结果 VDR在乳腺癌中的表达高于乳腺良性肿瘤(χ~2=4.23,P＜0.05),乳腺癌中VDR的表达强度与PR,HER2的表达强度呈正相关(r_(sPR)=0.295,P＜0.05;r_(sHER2)=0.296,P＜0.05).结论 VDR可能影响乳腺癌的发生;维生素D治疗可能提高PR阳性患者内分泌治疗的效果,改善HER2阳性患者的预后.     

肾癌与血管平滑肌脂肪瘤的谐波超声造影研究

目的 分析肾癌与血管平滑肌脂肪瘤谐波超声造影的强化形式和时间一强度曲线参数特征. 方法 前瞻性分析.肾癌47例(47个)、血管平滑肌脂肪瘤10例(11个)的谐波超声造影表现及时间强度曲线参数,比较2组强化形式及强化参数差异. 结果 ①27例(57.4%)肾癌高回声,39例(83.0%)彩色多普勒超声显示周边环绕血流或周边向内穿入血流与环绕血流混合;血管平滑肌脂肪瘤为高回声6例(54.5%),3例(27.3%)显示周边环绕血流或周边向内穿入血流与环绕血流混合.②39例(83.0%)肾癌谐波超声造影为高或等增强;血管半滑肌脂肪瘤9例(81.8%))为低增强,2组比较差异有统计学意义(P<0.01).③肾癌峰值强化时间(PT)、廓清时间(WT)、强化程度(△A,峰值强化与基础回声强度之差)、相对强化倍数(△AT/R,肿瘤强化程度与肾皮质强化程度之比)、时间一强度曲线的斜率(k)、相对血流最(△A·k,强化程度与斜率的乘积)分别为(22.65±8.78)s,(206.16±65.94)s,(14.94±6.14)dB,(1.28±0.64)dB,0.29±0.14,4.36±2.62;血管平滑肌脂肪瘤分别为(35.87±16.16)s,(150.03±61.08)s,(8.94±7.87)dB,(0.61±0.37)dB,0.17±0.07,2.06±1.02.2组参数比较差异均有统计学意义,P值均<0.05. 结论 谐波超声造影对肾癌与血管平滑肌脂肪瘤的鉴别有临床应用价值,前者以高或等增强为主,后者以低增强为主;时间一强度曲线参数也有助于二者的鉴别.     

Is Oncotype DX Recurrence Score (RS) of Prognostic Value Once HER2‐Positive and. Low‐ER Expression Patients are Removed?

Oncotype DX has been criticized for not providing significantly more prognostic information than histopathologic analysis. Oncotype DX was validated in cohorts that included poor prognostic factors (HER2‐positive, low‐estrogen receptor [ER] expression), raising the question: if patients with known high recurrence rates are excluded, is the Recurrence Score (RS) still valid? Our purpose was to determine if RS can be predicted with readily available measures. One hundred and twenty samples from August 2006 to November 2010 that underwent Oncotype DX testing were analyzed. Data included RS, ER, progesterone receptor (PR), HER2, and Ki67 status by immunohistochemistry (IHC). IHC data were used to create two linear regression models to predict RS. SAS's JMP‐7 was used for statistical analysis. When comparing Oncotype DX‐ and IHC‐derived ER and PR values, there were 21 discordant samples. The linear regression model PRS‐F created with IHC data (ER, PR, HER2, Ki67) from all samples (n = 120) had an adjusted R² = 0.60 indicating a good model for predicting RS. The PRS‐R model was built without low‐ER and HER2‐positive samples (n = 110). It had an adjusted R² = 0.38 indicating poor prediction of RS. Oncotype DX data showed good concordance with IHC for ER‐ and PR‐expression in this cohort. Low‐ER samples had high RS. After removing low‐ER and HER2‐positives, calculating RS with PRS‐R from remaining data showed poor predictive power for RS (adjusted R² = 0.38). This result questions whether RS is prognostic in this subgroup (who would most benefit from further clarification of recurrence risk) and independent of pathology, or is simply producing random RS values. Data bases available to Genomic Health can resolve this issue.     

胃癌组织中AEG-1、HER2的表达及临床意义

目的探讨胃癌组织中AEG-1、HER-2的表达及与胃癌临床病理特征的相关性。 方法收集2013年1月至2018年1月96例胃癌患者组织切片,采用免疫组织化学法检测AEG-1、HER-2表达情况。在以上胃癌患者中随机选取20例,取距肿瘤5 cm以上的癌旁胃组织作为对照组。使用SPSS16.0统计软件进行分析,依据不同分析目的分别采用χ²检验、线性趋势检验、Spearman等级相关分析及Kaplan-Meier生存分析,P<0.05为差异有统计学意义。 结果胃癌组织中AEG-1阳性表达率(76.0%)明显高于癌旁胃组织(0%),其阳性表达率与分化程度、TNM分期、淋巴结转移有关(P<0.05)。胃癌组织中HER2阳性表达率(41.7%)明显高于癌旁胃组织(0%),其阳性表达率与分化程度、浸润深度、TNM分期、淋巴结转移有关(P<0.05)。胃癌组织中AEG-1、HER2阳性表达呈正相关(r＝0.276,P＝0.007)。Kaplan-Meier生存分析提示胃癌中AEG-1及HER2双阴性表达患者的预后(平均生存期：31.1个月)优于AEG-1及HER2双阳性表达患者(平均生存期：48.3个月)。 结论胃癌组织中可能存在AEG-1、HER2信号通路。检测胃癌组织中AEG-1、HER2的表达,有利于判断胃癌的发生、发展、浸润、转移及预后。     

Is There a Role for Oncotype Dx Testing in Invasive Lobular Carcinoma?

Oncotype Dx Breast Cancer Assay is a 21‐gene assay used in estrogen receptor (ER)‐positive breast cancer to predict benefit from chemotherapy (CT). Tumors are placed into one of three risk categories based on their recurrence score (RS). This paper explores the impact of tumor histopathologic features and Oncotype Dx RS on the treatment plan for invasive lobular carcinoma (ILC). Invasive lobular carcinoma cases submitted for Oncotype Dx testing were identified from a clinical data base. The histopathologic and immunohistochemical features and RS subcategory of each tumor, and treatment regimen and medical oncologic assessments of each patient were reviewed. A total of 135 cases of ILC had RS testing, which represented 15% of all ILC diagnosed at the institution over the time period. 80% of ILC was of the classical subtype and all tumors were ER positive and human epidermal growth factor receptor 2 (HER‐2) negative by immunohistochemistry. Sixty three percent of cases were low risk (LR), 35.5% were intermediate risk (IR) and 1.5% were high risk (HR). Both HR cases were pleomorphic ILC. Sixty eight percent of classical ILC had a LR score, while 70% of pleomorphic ILC had an IR score. Patients in the IR category were significantly more likely to undergo CT than patients in the LR category (54% versus 18%; p < 0.0001). In the LR category, those undergoing CT were significantly younger and more likely to have positive lymph nodes (p < 0.05). Qualitative analysis of medical oncologic assessments showed that RS played a role in decision‐making on CT in 74% of cases overall. At our institution, Oncotype Dx RS currently plays a role in the management of a proportion of ILC and impacts on treatment decisions.     

Is breast cancer from Sub Saharan Africa truly receptor poor? Prevalence of ER/PR/HER2 in breast cancer from Kenya

ObjectivesStudies on ER/PR/HER2 in breast cancer from Sub Saharan Africa (SSA) are fraught with inconsistencies in the prevalence of hormone receptor status. In Kenya, ER/PR/HER2 for breast cancers is not part of routine assessment and available in only three to four centers across the country. Variability in methodology and interpretation makes comparison between data difficult. Our aim was to accurately determine the prevalence of ER/PR/HER2 using standardized techniques and double reporting. Prognostic tumor parameters were also correlated with clinical features and receptor status.Materials and methodsConsecutive invasive breast cancers (IBC) accrued between September 2011 and December 2012 were analyzed at Aga Khan University Hospital, Nairobi (AKUHN). Tumor blocks were stained for ER/PR/HER2 on an automated platform. Double reporting of ER/PR/HER2 was done using the Allred system and the ASCO/CAP guidelines respectively.ResultsA total of 301 cases of IBC were analyzed for pathology and ER/PR/HER2. The age range of patients was 19–94 years with a median of 47.5 years. Invasive ductal carcinoma (NOS) was the most common histologic type (84.2%). ER positivity was seen in 72.8%, PR in 64.8% and HER2 in 17.6% of all cases. Triple negative breast cancers (TNBC) constituted 20.2% of the cases. There was a significant association between receptor status and histologic grade (p < 0.001) and statistically significant trend of increasing pathological stage of tumor (pT) associated with TNBC (p = 0.020).ConclusionsWe present a definitive prospective analysis of ER/PR/HER2 from a single center and demonstrate that prevalence of receptor status from SSA is comparable with that in the West.     

An Analysis of Oncotype DX Recurrence Scores and Clinicopathologic Characteristics in Invasive Lobular Breast Cancer

The Oncotype DX breast cancer assay (Genomic Health, Redwood City, CA) is increasingly being used to guide treatment decisions for patients with early stage, hormone‐positive, Her‐2‐negative breast cancer. The utility of the Oncotype DX in decision making for treatment of invasive lobular carcinoma (ILC) has not been investigated as the results reported by Genomic Health are largely in a population with invasive ductal carcinoma (IDC). The authors hypothesized that the Oncotype DX recurrence score (RS) distribution for ILC is different than that for IDC. We performed a retrospective analysis of early stage breast cancer patients treated at Penn State Cancer Institute from 2001 to 2011 and identified 102 patients with ILC. We also pulled RS data from our institution's prospective registry of consecutive patients with early stage IDC treated during the same time period. Median follow‐up was 55 months. We found that the RS distribution for ILC differed significantly from that of IDC (p = 0.024). We also found a statistically significant difference in the RS distribution between the pure ILC and pleomorphic ILC subtypes (p = 0.027). The Oncotype DX RS distribution in ILC is unique, differing significantly from that in ductal carcinoma. Consequently, the clinical usefulness and cost‐effectiveness of the Oncotype DX in guiding treatment for ILC should be further investigated.     

乳腺浸润性导管/小叶混合癌与浸润性小叶癌、导管癌的临床病理特征及预后差异

目的 研究乳腺浸润性导管/小叶混合癌(infiltrative ductal/lobular mixed carcinoma,IDC-L)与浸润性小叶癌(infiltrative lobular carcinoma,ILC)及浸润性导管癌(infiltrative ductal carcinoma,IDC)病理特征及预...     

Impact of biomarkers and genetic profiling on breast cancer prognostication: A comparative analysis of the 8th edition of breast cancer staging system

The 8th edition of the American Joint Committee on Cancer (AJCC) staging guidelines combine traditional TNM system with biomarkers to reflect our current understanding of tumor biology and targeted therapy. In this study, we investigated the impact of the TNM + Biomarkers staging system and the additive value of Oncotype Dx? genomic profile recurrence score (RS) (TNM + Biomarkers+RS <11) for the staging of breast cancer (BC) using data from two tertiary referral cancer centers. Compared to TNM alone, the TNM + Biomarkers system changed the stage group in 32.7% of BCs (27% downstage, 5.7% upstage). Most (98.3%) of the downstaged BCs were estrogen receptor (ER)+/progesterone receptor (PR)+, whereas 78% of the upstaged BCs were ER?/PR?/human epidermal growth factor receptor 2 (HER2)?. Compared to TNM + Biomarkers staging, the addition of genetic profile data (TNM + Biomarker+RS <11) downstaged only <1% BCs. Our analysis suggests that for T1‐T2N0 ER+/HER2? BCs, Oncotype Dx? RS <11 provides added value as a staging parameter only in a very small group of cases compared to TNM + Biomarkers alone.     

Different Distribution of Breast Cancer Subtypes in Breast Ductal Carcinoma in situ (DCIS), DCIS with Microinvasion, and DCIS with Invasion Component

Background

Breast ductal carcinoma in situ with microinvasion (DCIS-Mi) is considered to be the interim stage in the progression from DCIS to invasive breast cancer (IDC). Cases that exceed DCIS-Mi but still do not fulfill the diagnostic criteria of IDC often are observed. We define those cases as DCIS with invasion component (DCIS-I), and attempt to study the differences of clinicopathological features and immunohistochemical-based subtypes among DCIS, DCIS-Mi, and DCIS-I.

Methods

In this retrospective study, 550 consecutive DCIS patients were recruited, 271 (49.3%) cases were diagnosed as pure-DCIS, 67 as DCIS-Mi, and 212 as DCIS-I. They were categorized into four groups: luminal-A (ER+ and/or PR+, HER2?), luminal-B (ER+ and/or PR+, HER2+), ERBB2+ (ER?, PR?, HER2+), and basal-like (ER?, PR?, HER2?).

Results

DCIS-Mi and DCIS-I patients tended to have larger tumors with highly graded nuclear (P = 0.011 for size; P < 0.0001 for nuclear grade). The proportion of luminal-like tumors decreased, whereas ERBB2+ and basal-like tumors increased in DCIS-I/DCIS-Mi compared with pure-DCIS (P = 0.039). Although the HER2-positive tumors displayed a stable proportion among DCIS subgroups, the essences of them were varying. In pure-DCIS, luminal-B was the major subtype of HER2-positive tumors (luminal-B vs. ERBB2+, 19% vs. 14.6%), whereas in DCIS-I, the proportion of luminal-B decreased vastly (luminal-B vs. ERBB2+, 12.8% vs. 23.5%). DCIS-I had a worse relapse-free survival outcome compared with pure-DCIS.

Conclusions

Different distribution of subtypes and distinctive characteristics among DCIS, DCIS-Mi, and DCIS-I indicate that they are distinct entities. Further studies with larger sample size are needed to replicate our observations.