动态磁共振成像在乳腺癌保乳术中的术前评估作用

[目的]评价动态增强磁共振成像（MRI）在乳腺癌保乳根治术的术前评估作用.[方法]平均年龄35.8岁的65 例女性乳腺癌患者,术前均行钼靶及MRI检查,对钼靶、MRI评估是否可行保乳手术进行分析,通过病理诊断来评价MRI在评估乳腺癌多中心病灶以及切缘范围上的准确性.[结果]65例患者中,钼靶术前评估认为可保乳术患者64.6%,低于MRI评估的83.1%,且两者相比差异有显著性（P＜0.05）.对癌块切缘判断准确率MRI为80%,显著高于钼靶的53.8%（P＜0.05）.[结论]在中青年女性的I~IIb期乳腺癌保乳术的术前评估方法中,动态增强MRI成像较钼靶更能准确判断有无多中心病灶及肿块切缘范围,更有利于决定是否采取保乳手术和更准确地判断手术切缘.     

VEGF在三阴性乳腺癌中的表达及意义

【目的】探讨血管内皮生长因子（VEGF）在三阴性乳腺癌（TNBC）中的表达及意义。【方法】采用SP免疫组织化学法检测 VEGF蛋白在50例 TNBC组织石蜡标本（TNBC组）和50例非三阴性乳腺癌组织石蜡标本（非TNBC组）中的表达,并分析其与 TNBC临床病理因素的关系及对预后的影响。【结果】TNBC组VEGF阳性表达率50．0％（25/50）显著高于非TNBC组阳性表达率（30．0％,15/50）,其差异有统计学意义（χ2＝4．92,P＜0．05）;VEGF在 TNBC 组织中的表达与腋窝淋巴结转移、脉管内有癌栓密切相关（P ＜0．05）;TNBC组 VEGF阳性表达组的5年无病生存率（DFS）和5年总生存率（OS）分别为16．0％（4/25）和76．0％（19/25）,阴性表达组的5年无病生存率和5年总生存率分别为48．0％（12/25）和96．0％（24/25）,两组比较有统计学意义（P＜0．05）。【结论】VEGF在 TNBC发生发展过程中,具有提高肿瘤细胞殖能力和转移潜力的作用,且其表达异常增高者可能预后不良。     

高频超声与核磁共振诊断乳腺癌的比较研究

目的比较高频超声、核磁共振（MRI）以及二者并用对乳腺癌的诊断价值。方法回顾性分析62例经病理确诊的68个乳腺癌病灶的高频超声及MRI的影像资料,比较两者独立诊断及并用诊断乳腺癌的敏感性。结果高频超声及MRI诊断乳腺癌的敏感性分别为89.7%（61/68）和95.6%（65/68）,差异无统计学意义（P〉0.05）;两者并用诊断的敏感性为97.1%（66/68）,并不优于单一高频超声或MRI（P〉0.05）;高频超声显示微小钙化灶优于MRI（P〈0.01）,MRI显示多灶性乳腺癌及病灶范围优于高频超声。结论高频超声诊断乳腺癌方便、经济且较敏感,可作为首选检查方法;MRI更有利于病理分期及制定治疗方案。     

In Vivo HER2-Targeted Magnetic Resonance Tumor Imaging Using Iron Oxide Nanoparticles Conjugated with Anti-HER2 Fragment Antibody

Purpose

The feasibility of iron oxide nanoparticles (IONPs) conjugated with anti-epidermal growth factor receptor 2 (HER2) single-chain antibody (scFv-IONPs) as novel HER2-targeted magnetic resonance (MR) contrast agents was investigated.

Procedures

The scFv-IONPs were prepared and identified. For in vitro MRI, NCI-N87 (HER2 high expression) and SUIT2 (low expression) cells were incubated with scFv-IONPs. For in vivo MRI, NCI-N87 and SUIT2 tumor-bearing mice were intravenously injected with scFv-IONPs and imaged before and 24 h post-injection.

Results

The scFv-IONPs demonstrated high transverse relaxivity (296.3 s^?1 mM^?1) and affinity toward HER2 (K_D?=?11.7 nM). In the in vitro MRI, NCI-N87 cells treated with scFv-IONPs exhibited significant MR signal reduction (44.6 %) than SUIT2 cells (6.8 %). In the in vivo MRI, decrease of MR signals in NCI-N87 tumors (19.3 %) was more notable than that in SUIT2 tumors (6.2 %).

Conclusions

The scFv-IONPs enabled HER2-specific tumor MR imaging, suggesting the potential of scFv-IONPs as a robust HER2-targeted MR contrast agent.

     

基于雄激素受体构建三阴性乳腺癌预后模型

目的三阴性乳腺癌(TNBC)属于异质性疾病,TNM分期难以准确预测其预后。通过对雄激素受体(AR)在TNBC中的表达分析,构建了一种新的预后模型。方法回顾性纳入176例TNBC患者的肿瘤标本,免疫组化检测AR染色强度和AR阳性细胞占比,以两者评分的乘积(简称:AR乘积)作为AR结果。对患者进行随访,分析AR与预后的关系,根据COX回归分析结果构建预后指数(PI):PI=风险系数1X变量1+风险系数2×变量2+……+风险系数n×变量n,绘制生存风险的列线图。结果AR乘积:0分103例、1分15例、2分17例、3分1例、4分9例、6分10例、9分21例。AR乘积与年龄、病理学类型、组织学分级、Ki-67、TNM有关。TNM和AR乘积是无病生存率(DFS)的独立影响因素。PI=-0.535XAR乘积+BTNM。计算每个患者的PI并分组:低风险组(PI<-3,45例)、中风险组(-3≤PI<0、114例)、高风险组(PI≥0、17例)。三组间DFS、总生存率(OS)差异均有统计学意义。绘制列线图预测3年、5年DFS,其C指数为0.719,校正曲线捉示预测值和实际结果间基本重合,提示该列线图有较好的预测能力。结论AR阳性表达预示TNBC患者更好的预后。利用AR和TNM可以构建TNBC患者的预后模型,能更:准确地预测其预后。     

磁共振成像诊断乳腺癌的研究进展

乳腺癌是女性最常见的恶性肿瘤之一,早期诊断对其治疗与预后十分重要,而磁共振成像(MRI)在乳腺癌的早期诊断中发挥着越来越重要的作用。MRI主要包括:动态增强扫描、弥散加权成像、灌注成像、磁共振波谱分析及磁共振引导下穿刺活检术。MRI以其本身所特有的优点成为乳腺癌早期诊断的一种十分重要的手段。     

Tumour-Targeted Treatment Intensification for Prostate Cancer Using Magnetic Resonance Imaging Guidance

IntroductionLocal control in prostate cancer may be improved with targeted dose escalation to regions with high tumour burden. Multiparametric magnetic resonance imaging (mpMRI) combined with MRI-guided biopsies may aid in defining tumour-dense regions before radiation therapy. Deformable registration techniques may be used to map these tumour regions onto the radiotherapy planning MRI. Radiation therapy delivery techniques such as volumetric modulated arc therapy and high-dose-rate brachytherapy may allow for highly conformal dose escalation, and when coupled with image-guided radiation delivery (ie, cone beam computed technology and fiducial markers), may allow high-precision dose-escalated treatment.MethodsEligible prostate cancer patients were enrolled on a prospective trial of tumour dose escalation. Two strategies were investigated: (1) an integrated boost to external beam radiation for a total tumour dose of 95 Gy in 38 fractions or (2) a focal high-dose-rate boost of 10 Gy before 76 Gy in 38 fractions external beam radiation. Patients underwent MRI-guided biopsy with fiducial marker placement before therapy. mpMRI was acquired and used in conjunction with a non-endorectal coil T2 MRI and computed technology simulation images to define the gross tumour volume via a deformable registration approach for intraprostatic tumour dose escalation.ResultsA case example for each dose escalation strategy illustrates the tumour-targeted approach using MRI guidance.ConclusionsCombining mpMRI sequences with a deformable registration approach may aid in more accurate and reproducible definition of tumour-dense regions. This novel process coupled with daily image guidance may allow high-precision dose-escalated tumour-targeted radiotherapy for prostate cancer.