MR Imaging Findings in Molecular Subtypes of Breast Cancer According to BIRADS System

To evaluate magnetic resonance imaging (MRI) findings, according to Breast Imaging‐Reporting and Data System (BI‐RADS), and to relate them with molecular subtypes of breast cancer. The MRI findings were reviewed retrospectively in 201 women diagnosed of invasive breast cancer confirmed by surgery and were compared with the molecular subtypes. Following the BI‐RADS, MRI findings included disease type, size, enhancement, morphology and contrast kinetics. In mass‐like lesion types were studied shape, margin and enhancement, and in nonmass‐like lesion types, distribution modifiers and internal enhancement. Chi‐squared analysis showed significant association (p < 0.01) between molecular subtypes and lesion type on MRI and histologic grade. Shape, margin and mass enhancement (p < 0.05) also showed significant association among molecular subtypes. Triple negative were more frequently unifocal and mass‐like lesion, high histologic grade, round shape, smooth margin, and rim enhancement. Luminal‐A were more frequently low grade, mass‐like lesion, irregular shape and spiculated or irregular margin. Luminal‐B were more frequently moderate‐low grade, mass‐like lesion, nonirregular shape and spiculated margin. HER‐2‐enriched were more frequently moderate grade, nonmass‐like lesion and multicentric lesions were more present than in other subtypes. There are significantly different MRI features, according to BI‐RADS, between the molecular subtypes breast cancer.     

Molecular breast cancer subtypes in premenopausal and postmenopausal African-American women: age-specific prevalence and survival

BACKGROUND: Breast cancer is currently regarded as a heterogeneous disease classified into various molecular subtypes using gene expression analysis. These molecular subtypes include: basal cell-like, Her-2/neu, luminal A, and luminal B. OBJECTIVES: To analyze the prevalence and clinicopathologic associations for molecular breast cancer subtypes in premenopausal and postmenopausal African-American women. DESIGN: A retrospective analysis of all African-American women diagnosed with breast cancer from 1998 to 2005, who had assessable data for ER, PR, and Her-2/neu status. Molecular subtype classification was done based on immunohistochemical surrogates for ER, PR, and Her-2/neu status obtained from Howard University tumor registry for each patient. The molecular subtypes were defined as: luminal A (ER+ and/or PR+, HER2-), luminal B (ER+ and/or PR+, HER2+), basal-like (ER-, PR-, HER2-), and Her-2/neu (ER-, PR-, and HER2+). OUTCOME MEASURES: We analyzed the prevalence of molecular breast cancer subtypes in a population of African-American women and determined their associations with patient demographics and clinicopathologic variables: node status, tumor size, histological grade, p53 mutation status, and breast cancer-specific survival. RESULTS: The luminal A subtype was the most prevalent in our study sample (55.4%) compared with (11.8%) luminal B, (21.2%) basal cell-like, and (11.6%) Her-2/neu subtypes. The molecular subtypes did not differ by menopausal status. However, when stratified into age-specific groups, the basal cell-like subtype (57.1%) was the most prevalent in the age group <35 y compared with luminal A, luminal B, and Her-2/neu subtypes at 25.0%, 14.3%, and 3.6%, respectively. The basal cell-like subtype also showed an age-specific bimodal distribution with a peak in the <35 y and 51 to 65 y age groups. The basal cell-like and the Her-2/neu subtypes showed an increased association with clinicopathologic variables portending a more aggressive clinical course when compared with luminal A subtype. A paradoxical inverse relationship between the expression of p53 and Bcl-2 protooncoprotein was noted in the molecular subtypes. Breast cancer-specific survival differed significantly among the molecular subtypes (P < 0.04), with the basal cell-like and Her-2/neu subtypes having the poorest outcome. CONCLUSIONS: The high prevalence of the basal cell-like subtype in the young premenopausal African-American women aged <35 y could be a contributory factor to the poorer prognosis of breast cancer observed in this cohort of patients.     

Prognostic Value of Breast Cancer Subtypes,Ki‐67 Proliferation Index,Age, and Pathologic Tumor Characteristics on Breast Cancer Survival in Caucasian Women

Estrogen receptor (ER), progesterone receptor (PR), and epidermal growth factor receptor 2 (HER2) status are well‐established prognostic markers in breast cancer management. The triple negative breast carcinoma subtype (ER‐/PR‐/HER2‐) has been associated with worse overall prognosis in comparison with other subtypes in study populations consisting of ethnic minorities and young women. We evaluated the prognostic value of breast cancer subtypes, Ki‐67 proliferation index (Ki‐67PI), and pathologic tumor characteristics on breast cancer survival in Caucasian women in our institution, where greater than 90% of the total patient population is white. From 628 new invasive breast cancer cases in our data base (2000‐late 2004), 593 (94%) were identified in Caucasian women. ER/PR/HER2 breast cancer subtypes were classified based on St. Gallen International Expert Consensus recommendations from 2011. ER/PR/HER2 status and its effect on survival were analyzed using a Kaplan–Meier curve. ER/PR/HER2 status, grade, tumor‐node‐metastasis status (TNM)/anatomic stage, and age were analyzed in terms of survival in a multivariate fashion using a Cox regression. Ki‐67PI was analyzed between ER/PR/HER2 groups using the Kruskal–Wallis, Mann–Whitney U‐tests, and 2 × 5 ANOVA. Our results showed that patients with stage IIB through stage IV breast carcinomas were 2.1–16 times more likely to die than patients with stages IA‐B and IIA disease, respectively (95% CI 1.17–3.81 through 9.68–28.03, respectively), irrespective of ER/PR/HER2 subtype. Similar effect was seen with T2, N2/N3, or M1 tumors in comparison with T1, N0/N1, and M0 tumors. Chances of dying increase approximately 5% for every year increase in age. There was a significant main effect of Ki‐67PI between ER/PR/HER2 subtypes, p < .001, but Ki‐67PI could not predict survival. In summary, TNM status/anatomic stage of breast carcinomas and age are predictive of survival in our patient population of Caucasian women, but breast carcinoma subtypes and Ki‐67 proliferation index are not.     

Magnetic resonance imaging patterns of tumor regression in breast cancer patients after neo‐adjuvant chemotherapy,and an analysis of the influencing factors

The objective of this study was to analyze the patterns of breast tumor shrinkage in patients after neo‐adjuvant chemotherapy (NAC) based on magnetic resonance imaging (MRI), and to evaluate the influential factors. Preoperative breast dynamic contrast‐enhanced MRI was performed on 88 patients before NAC, every 2 weeks during their chemotherapy treatment, and the week before their surgery. The MRI enhancement pattern of the primary tumors was classified into one of four categories based on BI‐RADS‐MRI: type I (postcontrast mass image), II (multiple small masses image), III (postcontrast mass image with peripheral non‐mass enhancement image), and IV (nonmass enhancement image). Multivariate regression and χ² test analyses were employed to establish significant associations. Two kinds of tumor regression patterns were observed: concentric shrinkage was observed in 39 lesions of 88 patients (44.3%), and nests or dendritic shrinkage was observed for the other 49 lesions (55.7%). ER+/HER2?, HER2+, and type I lesions were observed in 23 (62.2%), 21 (63.6%), and 29 (60.0%) patients, respectively, out of 49 nest or dendritic shrinkage pattern lesions. Triple negative breast cancer lesions, and type II, III, and IV lesions were observed in 13 (72.2%), 9 (81.8%), 10 (62.5%), and 10 (76.9%) patients, respectively, out of 39 lesions with a concentric shrinkage pattern. Molecular subtypes (χ²=7.171, P<.05) and the MRI schedule of enhancement (χ²=11.244, P<.05) were significantly associated with the tumor regression patterns. Multivariate analysis showed molecular subtypes (P<.05) and MRI pattern enhancement (P<.05) were significant predictive factors. Molecular subtypes and the MRI enhancement patterns of the primary tumors were significant predictive factors for tumor regression patterns of breast cancer after NAC.     

Prognosis of Japanese Breast Cancer Based on Hormone Receptor and HER2 Expression Determined by Immunohistochemical Staining

BACKGROUND: We classified Japanese breast cancer patients based on estrogen receptor (ER), progesterone receptor (PR), and HER2 protein expression and compared their prognoses. METHODS: We compared the background and prognostic factors of 600 patients with breast cancer who were assigned to the following groups: luminal A (ER + and/or PR + and HER2-; n = 431; 71.8%), luminal B (ER + and/or PR + and HER2 + ; n = 27; 4.5%), HER2 (ER-, PR-, and HER2 + ; n = 39; 6.5%) and basal-like (BBC; ER-, PR-, and HER2-; n = 103; 17.2%). RESULTS: Background factors did not significantly differ among the groups. Disease-free survival rates were significantly lower for the luminal B, HER2, and BBC subtypes than for the luminal A subtype. Cancer tended to recur earlier and overall survival was significantly lower for the BBC than for the luminal A and HER2 subtypes. Overall survival rates for the luminal B, HER2, and luminal A subtypes were comparable. CONCLUSIONS: The subtype distribution for Japanese and Caucasian patients was comparable. The prognosis for the BBC subtype was poorest among all subtypes. Breast cancer tended to recur earlier for the luminal B and HER2 subtypes than for the luminal A subtype; however, overall survival did not significantly differ among them.     

Breast Cancer Subtypes as Defined by the Estrogen Receptor (ER), Progesterone Receptor (PR), and the Human Epidermal Growth Factor Receptor 2 (HER2) among Women with Invasive Breast Cancer in California, 1999–2004

Abstract: Breast cancer research examining either molecular profiles or biomarker subtypes has focused on the estrogen receptor negative/progesterone receptor negative/human epidermal growth factor receptor 2 negative (ER−/PR−/HER2−) and ER−/PR−/HER2+ subtypes. Less is known about the epidemiology or clinical outcome of the other subtypes. This study examines the eight combinations of ER/PR/HER2 in patients with invasive breast cancer. The 5‐year relative survival and the distribution among demographic, socioeconomic, and tumor characteristics of each of the subtypes are examined. Using the California Cancer Registry, 61,309 women with primary invasive breast cancer were classified according to ER/PR/HER2 status. Five‐year relative survival was computed for the eight subtypes. Bivariate analyses were used to assess the distribution of cases across all subtypes. Multivariate logistic regression was used to compute the adjusted odds of having one of the five subtypes with the best and worst survival. Survival varied from 96% (ER+/PR+/HER2−) to 76% (ER−/PR−/HER2+ and ER−/PR−/HER2−). The four subtypes with the poorest survival were all ER negative. Women who were younger than age 50, non‐Hispanic black or Hispanic, of the lowest SES groups, and had stage IV tumors that were undifferentiated were overrepresented in ER−/PR−/HER2+ and triple negative (ER−/PR−/HER2−) subtypes. Asian Pacific Islanders had increased odds (OR = 1.41; 95% confidence interval [CI] = 1.26–1.57) of having the ER−/PR−/HER2+ subtype. Stage III tumors (OR = 1.25; 95% CI = 1.08–1.44) and stage IV tumors (OR = 1.58; 95% CI = 1.27–1.98) had higher odds than stage I tumors of being ER−/PR−/HER2+. Stage IV tumors (OR = 0.54; 95% CI = 0.44–0.67) strongly decreased the odds of the ER−/PR−/HER2− subtype. Poorly differentiated and undifferentiated tumors were over 20 times as likely as well‐differentiated tumors of being ER−/PR−/HER2− or ER−/PR−/HER2+. There are considerable differences in survival, demographics, and tumor characteristics among the eight subtypes. We recommend reporting breast cancer as an ER/PR/HER2 subtype and precisely documenting demographic and tumor characteristics.     

Features of Occult Invasion in Biopsy‐Proven DCIS at Breast MRI

The purpose of this study is to determine if MRI BI‐RADS criteria or radiologist perception correlate with presence of invasive cancer after initial core biopsy of ductal carcinoma in situ (DCIS). Retrospective search spanning 2000–2007 identified all core‐biopsy diagnoses of pure DCIS that coincided with preoperative MRI. Two radiologists fellowship‐trained in breast imaging categorized lesions according to ACR MRI BI‐RADS lexicon and estimated likelihood of occult invasion. Semiquantitative signal enhancement ratio (SER) kinetic analysis was also performed. Results were compared with histopathology. 51 consecutive patients with primary core biopsy‐proven DCIS and concurrent MRI were identified. Of these, 13 patients (25%) had invasion at excision. Invasion correlated significantly with presence of a mass for both readers (p = 0.012 and 0.001), rapid initial enhancement for Reader 1 (p = 0.001), and washout kinetics for Reader 2 (p = 0.012). Significant correlation between washout and invasion was confirmed by SER (p = 0.006) when threshold percent enhancement was sufficiently high (130%), corresponding to rapidly enhancing portions of the lesion. Radiologist perception of occult invasion was strongly correlated with true presence of invasion. These results provide evidence that certain BI‐RADS MRI criteria, as well as radiologist perception, correlate with occult invasion after an initial core biopsy of DCIS.     

MR Imaging Features of Triple‐Negative Breast Cancers

Triple‐negative (TN) breast cancers, which are associated with a more aggressive clinical course and poorer prognosis, often present with benign imaging features on mammography and ultrasound. The purpose of this study was to compare the magnetic resonance imaging features of TN breast cancers with estrogen (ER) and progesterone (PR) positive, human epidermal growth factor receptor (HER2) negative cancers. Retrospective review identified 140 patients with TN breast cancer who underwent a preoperative breast MRI between 2003 and 2008. Comparison was made to 181 patients with ER+/PR+/HER2? cancer. Breast MRIs were independently reviewed by two radiologists blinded to the pathology. Discrepancies were resolved by a third radiologist. TN cancers presented with a larger tumor size (p = 0.002), higher histologic grade (<0.001), and were more likely to be unifocal (p = 0.018) compared with ER+/PR+/HER2? tumors. MRI features associated with TN tumors included mass enhancement (p = 0.026), areas of intratumoral high T2 signal intensity (p < 0.001), lobulated shape (p < 0.001), rim enhancement (p < 0.001), and smooth margins (p = 0.005). Among the TN tumors with marked necrosis, 26% showed a large central acellular zone of necrosis.     

Is There a Correlation Between Breast Cancer Molecular Subtype Using Receptors as Surrogates and Mammographic Appearance?

Background

The identification of distinct molecular subtypes has changed breast cancer management. The correlation between mammographic appearance and molecular subtype for invasive breast cancer has not been extensively studied.

Methods

A retrospective review of our prospectively collected database was performed to evaluate the mammographic appearance and molecular subtypes of all cases of invasive breast cancers diagnosed between 2003 and 2010.

Results

There were 985 cases of invasive breast cancer with complete data on receptor status and mammographic appearance. The most common mammographic finding was a mass (61 %), and the most common molecular subtype was ER/PR positive, HER2 negative (71 %). On univariate analysis, race, stage, and histology were all significantly associated with molecular subtype. On multivariate analysis, the luminal molecular type was associated with architectural distortion [odds ratio (OR) 4.3, 95 % CI 1.3–14.1]; HER2 positive cancers, either with or without ER/PR expression, were more likely to be associated with mammographic calcifications (OR 2.8 and 3.1, respectively; 95 % CI 1.7–4.8 and 1.7–5.5); and triple negative cancers were most likely to be associated with a mammographic mass (OR 2.5; 95 % CI 1.4–4.4).

Conclusions

We observed several characteristic associations between molecular subtype and mammographic appearance. Improved understanding of these associations may help guide clinical decision making and provide information about underlying tumor biology.     

Follow‐up of Probably Benign Lesions (BI‐RADS 3 category) in Breast MR Imaging

Abstract: The purpose of our study was to determine the frequency of BI‐RADS 3 lesions in breast MR imaging in a clinical patient population and their frequency of malignancy in follow‐up breast MR imaging. In 44/698 (6.3%) patients with breast MR imaging, 56 lesions were categorized to BI‐RADS 3. These lesions were all not palpable and not detectable at conventional mammography or ultrasound. In follow‐up, lesions were score in complete resolved (CRL), partial resolved (PRL), stable lesions (SL), and progressive lesions (PL). Initial signal enhancement of lesions was coded by color intensity (bright for high, medium for medium, dark for low), the postinitial signal enhancement by color hue (blue for increase, green for plateau, red for wash‐out). In first follow‐up breast MR imaging 23/56 (41%) lesions were PRL, 14/56 (25%) lesions were CRL, 14/56 (25%) lesions remained SL. In one of five PL lesions, histopathology revealed a malignant tumor. In initial breast MR imaging, CRL showed significant fewer high pixels (p = 0.002), medium pixels (p = 0.006) significant more low pixels (p = 0.005) and significant more increase pixels (p = 0.037) than PRL. In a clinical patient population the frequency of malignancy of BI‐RADS 3 lesions in breast MR imaging and their frequency of malignancy are similar to that in conventional mammography. In initial breast MR imaging, complete resolved lesions showed less suspicious contrast kinetics than other lesions. In follow‐up, the increase of lesion size should warrant histopathological diagnosis.     

乳腺癌中ALDH1的表达与其分子亚型及ABCG2的关系

目的探讨乙醛脱氢酶1(ALDH1)表达在乳腺癌中的表达及与各分子亚型、ATP结合膜转运蛋白超家族G成员2(ABCG2)的关系。方法根据免疫学标志物(ER,PR,HER2,CK5/6)把179例乳腺癌标本分为5类分子亚型:管腔A型,管腔B型,HER2过表达型,基底样型和正常乳腺样型。应用免疫组织化学检测ALDH1及ABCG2表达情况,并分析两者之间的相互关系以及两者与乳腺癌各临床病理因素之间的关系。结果 179例乳腺癌中43例(24.0%)呈ALDH1阳性表达。ALDH1的表达率在乳腺癌各分子亚型有明显差异(P=0.003),在管腔A型,管腔B型,HER2过表达型,基底样型和正常乳腺样型中的阳性表达率分别为16.7%(17/102),21.4%(3/14),54.5%(13/22),33.3%(8/24)和17.6%(3/17)。ALDH1阳性表达与ABCG2的表达之间无明显关系(P=0.052)。ALDH1和ABCG2的表达均与术前化疗与否有关(P=0.027和P=0.033),ALDH1的表达与HER2表达有关(P=0.006)。结论小部分乳腺癌呈ALDH1阳性表达,且ALDH1表达率在乳腺癌各分子亚型中表...     

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目的探讨改良根治术后的乳腺癌免疫组化各分子亚型的预后特性和年复发变化。方法回顾性分析2003年1月至2008年8月常州市第一人民医院应用改良根治术治疗310例乳腺癌的临床资料。根据免疫组化雌激素受体(ER)、孕激素受体(PR)和人类表皮生长因子受体2(HER2)的检测结果分为luminal型、HER2阳性型、三阴性乳腺癌,对比分析不同亚型乳腺癌的临床复发风险。结果 310例乳腺癌总体年复发风险高峰在2年左右,5年有一个平稳的小高峰。免疫组化各分子亚型HER2阳性年复发风险最高,三阴性乳腺癌次之,Luminal型复发风险最低(P<0.05)。HER2阳性型年复发风险最高,但是复发高峰在2～3年,之后直线下降;三阴性乳腺癌复发高峰虽然较HER2阳性型低,但是维持在2～5年复发,延时较长。结论免疫组化的各分子亚型对乳腺癌临床复发起不同的预后指导作用。     

Survival and clinicopathological characteristics of breast cancer patient according to different tumour subtypes as determined by hormone receptor and Her2 immunohistochemistry. a single institution survey spanning 1998 to 2010

As far as recent breast cancer molecular subtype classification is concerned, much work has dealt with clinical outcomes for triple negative and Her2 patients. Less is known about the course of patients in the remaining subtypes. Molecular classification based on immunohistochemistry is widely available and correlates well with genetic microarray assessment, but at a lower cost. The aim of our investigation was to correlate immunohistochemical subtypes of breast cancer with clinical characteristics and patient outcomes. Since 1998, 1167 patients operated for 1191 invasive breast tumours were included in our database. Patients were regularly followed up until March 2010. Disease-free survival, overall mortality, and breast cancer-specific mortality at 5 years were calculated for the cohort. 72% of tumours were ER+PR±HER2- group, 13% triple negative (ER-PR-HER2-), 10% ER+PR±HER2+ group, and 5% Her2 (ER-PR-HER2+). Cancer-specific survival was 94.2% for the ER+PR+HER2- subtype, 84.8% for the Her2 subtype, 83.3% for the ER+PR-HER2- subtype, and 78.6% for triple negatives. Distant metastases prevalence ranged from 7% to 22% across subtypes, increasing stepwise from ER+PR+HER2-, ER+PR+HER2+, ER+PR-HER2-, ER+PR-HER2+, ER-PR-HER2+ through triple negative. Small, low-grade tumours with low axillary burden were more likely to belong to the ER+PR±HER2- group. Conversely, larger high-grade tumours with significant axillary burden were more likely to belong to Her2 or triple negative groups. ER+PR±HER2- group patients with negative PR receptors performed more like Her2 or triple negative than like the rest of ER+PR±HER2± groups patients. Molecular classification of breast tumours based only on immunohistochemistry is quite useful on practical clinical grounds, as expected. ER+PR±HER2- group patients with negative PR receptors seem to be at high risk and deserve further consideration.     

Characteristics and outcomes according to molecular subtypes of breast cancer as classified by a panel of four biomarkers using immunohistochemistry

To investigate the significance of immunohistochemical molecular subtyping, we evaluated outcomes of subtypes based on estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67. Using tissue microarrays, 1006 breast cancer patients between November 1999 and August 2005 were categorized into four subtypes: luminal A (ER+ and/or PR+, HER2-, Ki-67 < 14%), luminal B (ER+ and/or PR+, HER2-, Ki-67 ≥ 14% or ER+ and/or PR+, HER2+), HER2-enriched (ER-, PR-, HER2+), and triple-negative breast cancer (TNBC) (ER-, PR-, HER2-). Demographics, recurrence patterns, and survival were retrospectively analyzed using uni-/multivariate analyses. Luminal A, luminal B, HER2-enriched, and TNBC accounted for 53.1%, 21.7%, 9.0%, and 16.2% of cases, respectively. Luminal A presented well-differentiation and more co-expression of hormone receptors comparing to luminal B. HER2-enriched showed larger size and higher nodal metastasis. TNBC demonstrated younger age at diagnosis, larger size, undifferentiation, higher proliferation, and frequent visceral metastases. The peak of recurrence for luminal A was at 36 months postoperatively, while that for HER2-enriched and TNBC peaked at 12 months. The relapse risk of luminal B was mixed. Luminal A showed the best survival, but no difference was observed between the other three subtypes. When matched by nodal status, however, TNBC showed the worst outcomes in node-positive patients. In multivariate analyses, luminal A remained a positive prognostic significance. Immunohistochemically-defined subtypes showed different features, recurrence patterns, and survival. Therefore, molecular subtypes using four biomarkers could provide clinically useful information of tumor biology and clinical behaviors, and could be used for determining treatment and surveillance strategies.     

ER和PR及HER-2表达与乳腺癌分子分型及临床特征和预后的关系

目的:利用雌激素受体(ER)、孕激素受体(PR)及人表皮生长因子受体2(HER-2)的免疫组织化学检测结果将乳腺癌简易分为4种分子亚型,并探讨这4种分子亚型的临床特征和影响预后的相关因素。方法:根据ER、PR及HER-2的免疫组织化学检测结果,采用回顾性方法将本院收治的175例乳腺癌患者简易分为类luminal A型、类luminal B型、类HER-2(+)型及类basal-like型4种类型。对各型的临床特征采用SPSS17.0统计软件进行分析,并用Kaplan-Meier法和Cox回归分析各型乳腺癌患者的生存情况及预后因素。结果:在175例乳腺癌患者中,类luminal A型、类luminal B型、类HER-2(+)型及类basal-like型分别占56.00%(98/175)、17.71%(31/175)、12.57%(22/175)和13.71%(24/175)。类basal-like型与类luminal A型相比,患者无瘤生存率较低(P0.05)。经Cox多因素预后分析,淋巴结阳性患者的预后较淋巴结阴性患者差;类luminal A型患者预后最好,而类basal-like型患者预后最差。结论:淋巴结状况及分子分型是影响乳腺癌预后的重要因素。依据ER、PR及HER-2行乳腺癌分子分型与国际公认分型的临床表现及预后基本一致,对指导基层医院的乳腺癌预后及治疗同样具有重要意义。     

Ki-67与乳腺癌临床、病理及钼靶BI-RADS分级的关系

目的探究Ki-67与乳腺癌患者临床、病理及钼靶BI-RADS分级的关系。方法回顾性分析2015年1月~2016年12月孝感市中心医院甲乳外科收治的199例女性乳腺癌患者的临床、病理及钼靶BI-RADS分级资料。结果 Ki-67指数与肿瘤直径、淋巴结转移情况、钼靶BIRADS分级、ER、PR、HER-2及浸润性导管癌WHO分级均有关(均P0.05),与年龄无关(P0.05)。髓样癌Ki-67指数平均值(61.47%)大于浸润性导管癌(36.26%)、粘液癌(15.10%)、浸润性小叶癌(20.62%)及导管内癌(12.53%)(均P0.05)。浸润性导管癌Ki-67指数平均值大于粘液癌及导管内癌(均P0.05)。Luminal B型(35.43%)、HER-2阳性型(39.58%)及三阴性型(57.26%)Ki-67平均值均大于Luminal A型(7.23%)(均P0.05),Luminal B型Ki-67平均值小于HER-2阳性型(P0.05)。三阴性型Ki-67平均值大于非三阴性型(30.20%)(P0.05)。结论 Ki-67指数与乳腺癌患者临床、病理及钼靶BI-RADS分级均有关,对乳腺癌的治疗和判断预后具有指导意义。     

Molecular Subtypes of Breast Cancer in South Asian Population by Immunohistochemical Profile and Her2neu Gene Amplification by FISH Technique: Association with other Clinicopathologic Parameters

Molecular breast cancer subtypes were defined by gene expression prolife; however, immunohistochemical (IHC) expression can categorize breast cancers analogous to gene expression profiling. We aimed to evaluate distribution of these molecular breast cancer subtypes in our population and their association with clinocopathologic parameters. We retrospectively analyzed 1,104 cases of primary breast cancers over 3 years duration. ER, PR, Her2neu IHC staining, and subsequent fluorescent in situ hybridization studies (Her2neu gene amplification in cases with 2+ IHC staining) were performed to categorize breast cancer subtypes. Luminal A breast cancers were most frequent (45.8%) followed by triple negative (18.6%), luminal B (17.8%) and Her2neu (17.8%) subtypes. We found a strong association of breast cancer subtypes with tumor grade and Ki67 proliferation index with triple negative cancers being associated with higher grade and proliferation index. Significant association was seen with age groups, luminal A subtype occurring at a slightly older age, whereas triple negative and Her2neu cancers were more frequent in younger age group. We found a higher proportion of triple negative cancers in our set up, and they were found to have high‐tumor grade and proliferation index along with presentation at younger age. As these cancers are associated with BRCA 1 mutations and abnormal BRCA 1 pathways, we suggest that large scale studies should be done to evaluate BRCA 1 mutations and abnormal BRCA 1 pathways in our population to establish risk factors for this highly aggressive tumor subtype.     

Breast Nonmass Enhancement Detected with MRI: Uility and Lesion Characterization with Second‐Look Ultrasonography

The purpose of this study was to verify the utility of second‐look ultrasonography (US) in evaluating nonmass enhancement (NME) lesions detected on breast magnetic resonance imaging (MRI) by analysing its correlation and imaging features. From July 2008 to June 2012, 102 consecutive MRI‐detected NME lesions were subsequently evaluated with US. Lesions were evaluated according to the established Breast Imaging Reporting and Data System (BI‐RADS) lexicon. The correlation between MRI‐detected NME lesion characteristics, lesion size, histopathological findings and features at second‐look US were analysed. Second‐look US identified 44/102 (43%) of the NME lesions revealed by MRI. A US correlate was seen in 34/45 (76%) malignant lesions compared with 10/57 (18%) benign lesions (p < 0.0001). The likelihood of malignancy was significantly higher for NME lesions with a US correlate than lesions without: 34/44 (77%) versus 11/58 (19%) (p < 0.0001). The malignancy of the 44 (43%) MRI‐detected NME lesions with a US correlate was significantly associated with US lesion margins and BI‐RADS categories (p = 0.001 and 0.002 respectively). Second‐look US of MRI‐detected NME lesions is useful for decision‐making as part of the diagnostic workup. Familiarity with the US features associated with malignancy improves the utility of US in the workup of these NME abnormalities.