三阴性乳腺癌的影像学研究进展

三阴性乳腺癌(triple-receptor negative breast cancer,TNBC)是指雌激素受体(estrogen receptor,ER)、孕激素受体( progesterone receptor,PR)及人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)均表达缺失的乳腺癌,具有特殊的生物学和临床痫理学特性,预后差.本文主要对三阴性乳腺癌的影像诊断进展(包括乳腺X线摄影、超声及磁共振影像)进行了综述.     

乳腺癌钼靶X线特征与ER、PR和HER-2的相关性研究

目的 初步探讨乳腺癌钼靶X线征象与雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone re-ceptor,PR)和人类表皮生长因子受体2(human epidermal receptor 2,HER-2)表达之间的关系.资料与方法 将49例乳腺癌患者钼靶X线表现特征与免疫组织化学测定的ER、PR和HER-2的表达进行对照研究.结果 49例乳腺癌中,肿块边缘"毛刺征"者ER、PR阳性表达率高,病变区有钙化者HER-2阳性表达率高.肿块大小与ER、PR表达均无关.结论 乳腺癌钼靶X线征象和ER、PR及HER-2的表达有密切关系,在一定程度上反映了ER、PR及HER-2的表达状态,能为乳腺癌的术前辅助内分泌治疗和预后提供有价值的信息.     

乳腺癌超声征象与分子标志物的相关性研究进展

乳腺癌是女性最常见的癌症,也是女性癌症死亡的主要原因[1].乳腺癌分子标志物雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor , PR )、人表皮生长因子受体-2 ( human epidermal growth factor receptor 2,HER-...     

乳腺癌钼靶X线表现与ER、PR和P53表达的相关性探讨

目的 探讨乳腺癌的钼靶X线表现与乳腺癌癌细胞中雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)及P53蛋白表达的相关性.方法 收集乳腺癌患者60例术前行钼靶X线检查,术后标本行免疫组织化学染色测定 ER、PR及P53蛋白表达情况,分析钼靶X线征象与ER、PR及P53蛋白表达的相关性.结果 在60例乳腺癌中,有肿块组ER、PR及P53阳性表达率均高于无肿块组,2组PR表达有统计学差异(χ2=6.213,P=0.013);其中有毛刺组ER、PR阳性表达率高于无毛刺组,且有统计学意义(χ2=6.673、3.873,P<0.05);钙化组ER、PR及P53阳性表达率高于无钙化组,均有统计学差异(χ2=7.330、5.984、4.671,P<0.05);有淋巴结转移组PR阳性表达率低于无淋巴结转移组,P53阳性表达率明显高于无淋巴结转移组,有统计学意义(χ2=6.213、5.978,P<0.05).结论 乳腺癌钼靶X线征象在一定程度上反映了ER、PR及P53的表达状况.     

乳腺癌动态增强MRI表现与病理、分子预后指标的相关性分析

目的:探讨乳腺癌磁共振动态增强表现与病理、分子预后指标之间的相关性。材料和方法:对104例原发性乳腺癌患者术前行乳腺MR扫描,根据MRI乳腺影像报告和数据系统(BI-RADS)描述乳腺癌的形态学和血流动力学表现。术后标本检测分析肿瘤大小、淋巴结状态和组织学分级并行免疫组化染色测定癌细胞雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、CerbB-2、Ki-67以及nm23的表达情况,采用Spearman等级相关和二元Logistic回归统计学方法分析与MRI表现的相关性。结果:形态不规则的肿瘤体积较大(P<0.001);肿瘤形态不规则形能预测ER阴性表达(P=0.035);环形强化是ER及PR阴性表达的预测因子(P=0.022,P=0.012);肿瘤信号增强率(SER)可以预测淋巴结状态(P=0.003),且SERmax值>133%易发生淋巴结转移。结论:乳腺癌MRI形态学和血流动力学表现与病理、分子预后指标之间存在一定相关性,可根据乳腺癌MRI表现对乳腺癌病灶的生物学行为和预后进行评估。肿瘤形态不规则、环形强化常提示患者预后不良。     

单激素受体阳性乳腺癌的临床特点及预后研究

目的探讨单激素受体阳性乳腺癌的临床病理及预后特点。方法选取2000年1月-2004年12月就诊的Ⅰ~Ⅲ期乳腺癌568例,其中雌激素受体（estrogen receptor,ER）单阳型乳腺癌80例和孕激素受体（progesterone receptor,PR）单阳型乳腺癌58例（共138例）,分析两组单激素受体乳腺癌的临床病理特征及预后特点。结果 PR单阳型组年龄≤50岁以及绝经前患者比例显著高于ER单阳型组（P〈0.05）;ER及PR单阳型乳腺癌的无病生存期（disease-free survival,DFS）、总生存期（oerall survival,OS）差异无统计学意义（P〉0.05）;ER单阳型组的DFS、OS明显优于双阴型乳腺癌（P〈0.05）,但PR单阳型组与其差异无统计学意义（P〉0.05）;PR单阳型组的DFS及OS较双阳型乳腺癌显著缩短（P〈0.05）,而ER单阳型组与其差异无统计学意义（P〉0.05）。结论 PR单阳型乳腺癌更多见于年轻、绝经前女性,与ER单阳型乳腺癌的生存期差异无统计学意义;PR单阳型乳腺癌的预后接近于双阴型乳腺癌,而ER单阳型乳腺癌则更接近于双阳型乳腺癌。     

乳腺癌组织中p27kip1和ER的表达及意义

目的：检测p27^kipl和ER在乳腺良性与恶性病变组织中的表达与分布情况，探讨p27^kipl和ER的表达水平在乳腺癌发病、预后评估方面的价值。方法：采用DAKO EnVision^TM Systems结合组织病理学观察，检测了32例良性乳腺腺病、35例乳腺纤维腺瘤、24例乳腺癌组织中的p27^kipl和ER的表达与分布情况。结果：在良性乳腺疾病、乳腺纤维腺瘤组织中，p27^kipl有强阳性表达，阳性检出率分别为65．6％、60．0％；而在乳腺癌组织中，p27^kipl阳性检出率为29．2％；说明在良性乳腺疾病与乳腺癌组织中，p27^kipl有不同水平的表达。ER在乳腺癌组织中阳性检出率为66．7％；明显高于良性乳腺腺病(34．4％)、乳腺纤维腺瘤(37．1％)的阳性检出率。结论：在乳腺癌发病过程中，p27^kipl和ER的表达水平有可能起着重要的作用；同时检测p27^kipl和ER的表达与分布情况,在乳腺癌病人预后判断中具有辅助诊断价值。     

乳腺癌X线钙化征象与ER、PR、CerbB-2表达的相关性研究

目的:探讨乳腺癌X线摄影钙化征象与雌激素受体(ER)、孕激素受体(PR)及人表皮生长因子相关基因(CerbB-2/HER-2/neu)表达的相关性。方法:回顾性分析87例术后病理诊断为乳腺癌患者的双乳腺X线轴位、斜位片,记录乳腺癌钙化情况,术后标本行免疫组织化学染色测定肿瘤细胞ER、PR及CerbB-2表达情况,分析乳腺癌钙化灶与上述因素的关系。结果:乳腺癌钙化灶与ER、PR表达无相关性,而乳腺癌钙化灶与CerbB-2的表达有相关性。结论:乳腺癌钙化征象与分子生物学指标CerbB-2之间存在一定的相关性。乳腺癌X线摄影从一定程度上反映了癌细胞的生物学行为和预后,为临床治疗方案的选择提供客观依据。     

乳腺癌组织中PTEN的表达及其临床意义

目的研究肿瘤抑制基因PTEN在乳腺癌组织中的表达及临床意义。方法采用免疫组化染色检测146例乳腺癌组织和10例乳腺癌癌旁正常组织PTEN蛋白的表达情况。结果10例乳腺癌癌旁正常组织均有PTEN表达,免疫组化染色较强,PTEN表达于乳腺小叶腺泡上皮细胞及导管上皮细胞的胞质和胞核。146例乳腺癌组织的PTEN阳性表达率为57．5％（84／146）,PTEN蛋白表达于癌细胞的胞质和胞核,PTEN表达与乳腺癌原发肿瘤的大小、病理分期以及雌激素受体（ER）、孕激素受体（PR）有关,PTEN高表达的乳腺癌患者2年生存情况明显优于低表达者（P〈0．05）,且ER、PTEN同时表达的乳腺癌患者2年无病生存率高于其中之一未表达或均未表达者（P〈0．05）。结论乳腺癌组织中存在肿瘤抑制基因PTEN的表达缺失或减弱,可能与乳腺癌的发生、发展及预后有关。     

超声引导穿刺活检检测乳腺癌ER、PR和CerbB-2表达的临床意义

目的:评价超声引导下穿刺活检检测乳腺癌患者雌激素受体(ER)、孕激素受体(PR)、CerbB-2表达的价值.方法:对58例乳腺肿块行超声引导下穿刺活检,病理诊断为乳腺癌同时检测ER、PR、CerbB-2的表达,并与手术切除标本检测结果相对照.结果:58例患者中,穿刺活检检测ER、PR、CerbB-2的阳性率分别为55.17％(32/58)、43.10％(25/58)、46.55％(27/58).术后标本ER、PR、CerbB-2的阳性率分别为56.90％ (33/58)、44.82％ (26/58)、48.27％ (28/58).二者间无显著差异(P＞0.05).结论:超声引导穿刺活检可准确检测乳腺癌ER、PR、CerbB-2的表达,为临床治疗方案的制定提供了可靠的依据.     

绝经后乳腺浸润性导管癌超声表现与雌激素受体、孕激素受体表达的关系

目的探讨绝经后乳腺浸润性导管癌二维及彩色多普勒超声表现与雌激素受体(ER)、孕激素受体(PR)表达的关系,评价超声表现术前预测ER、PR表达的可行性。方法对空军总医院2002年6月-2007年6月收治的经手术病理最终证实的96例绝经后乳腺浸润性导管癌临床资料进行分析,比较超声声像图特征与术后标本免疫组织化学染色的ER、PR表达水平。结果ER、PR阳性表达率分别为54.17%(52/96)、50%(48/96)。ER、PR双阳性、双阴性表达率分别为41.67%(40/96)、37.5%(36/96),超声表现为蟹足状或毛刺状乳癌中,ER有较高的阳性表达率(P<0.05),内部回声不均质及后方有声衰减组乳癌中,ER、PR单阳性及共同阳性均有较高的表达(P<0.05)。当ER、PR共同阴性表达时,肿块内血流信号增多(P<0.05)。结论绝经后乳腺浸润性导管癌二维及彩色多普勒超声表现可大致反映ER、PR的表达水平,联合ER、PR的表达检测对判断预后及指导治疗具有临床价值。     

PS_2基因在乳腺癌中表达的临床意义

目的　探讨雌激素调节蛋白PS2 在乳腺癌中的表达及其临床意义。方法　应用免疫组化S P法 ,对 4 8例人乳腺浸润性导管癌中PS2 进行检测 ,分析其与ER ,PR以及预后的关系。结果　PS2 与ER呈显著正相关。在ER(+)PR(+)的病人中 ,PS2 阳性率达 6 7 9% ,而在ER(- )PR(- )的病人中PS2 阳性率仅为 12 5 % ,二者相比有显著性差异 (P <0 .0 1)。PS2 阳性表达与病人长生存期呈正相关 ,与腋窝淋巴结转移无相关性。结论　在预测乳腺癌抗雌激素治疗的效果时 ,PS2 要优于ER ,PR。同时PS2 阳性的乳腺癌患者预后较好 ,PS2 可作为预测乳腺癌患者生物学行为的指标之一     

乳腺珠蛋白在乳腺癌、良性病变及正常乳腺组织中的表达及其临床意义

目的检测乳腺癌、良性乳腺病变及正常乳腺组织中人乳腺珠蛋白（human mammaglobin,hMAM）的表达,探讨乳腺珠蛋白在乳腺各种病变中的临床应用价值,并与传统乳腺癌标志物进行比较。方法选取48例乳腺癌、26例良性乳腺疾病及10例正常乳腺组织标本,其石蜡切片进行免疫组化染色。结果乳腺癌、良性乳腺疾病及正常组织中,hMAM表达阳性率分别为72.9%、88.3%和40%。其表达与患者年龄、病理分型及肿瘤大小、分级、淋巴结转移等无关,而与孕激素受体（PR）呈负相关。结论乳腺珠蛋白在乳腺癌、良性病变及乳腺正常组织中均存在高表达,未发现其表达与乳腺癌预后等相关。     

乳腺珠蛋白在乳腺癌、良性病变及正常乳腺组织中的表达及其临床意义

目的检测乳腺癌、良性乳腺病变及正常乳腺组织中人乳腺珠蛋白(human mammaglobin,hMAM)的表达,探讨乳腺珠蛋白在乳腺各种病变中的临床应用价值,并与传统乳腺癌标志物进行比较。方法选取48例乳腺癌、26例良性乳腺疾病及10例正常乳腺组织标本,其石蜡切片进行免疫组化染色。结果乳腺癌、良性乳腺疾病及正常组织中,hMAM表达阳性率分别为72.9%、88.3%和40%。其表达与患者年龄、病理分型及肿瘤大小、分级、淋巴结转移等无关,而与孕激素受体(PR)呈负相关。结论乳腺珠蛋白在乳腺癌、良性病变及乳腺正常组织中均存在高表达,未发现其表达与乳腺癌预后等相关。     

MRI of occult breast carcinoma in a high-risk population

OBJECTIVE: The purpose of this study was to determine the frequency of cancer and the positive predictive value of biopsy in the first screening round of breast MRI in women at high risk of developing breast cancer. MATERIALS AND METHODS: Retrospective review was performed of the records of 367 consecutive women at high risk of developing breast cancer who had normal findings on mammography and their first breast MRI screening examination during a 2-year period. The frequency of recommending biopsy at the first screening MRI study and the biopsy results were reviewed. RESULTS: Biopsy was recommended in 64 women (17%). Biopsy revealed cancer that was occult on mammography and physical examination in 14 (24%) of 59 women who had biopsy and in 14 (4%) of 367 women who underwent breast MRI screening. Histologic findings in 14 women with cancer were ductal carcinoma in situ in eight (57%) and infiltrating carcinoma in six (43%). The median size of infiltrating carcinoma was 0.4 cm (range, 0.1-1.2 cm). Two patients had nodes that were positive for cancer. Biopsy revealed high-risk lesions (atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, or radial scar) in 13 (4%) of 367 women and other benign findings in 32 (9%) of 367 women who had MRI screening. CONCLUSION: Among women at high risk of developing breast cancer, breast MRI led to a recommendation of biopsy in 17%. Cancer was found in 24% of women who underwent biopsy and in 4% of women who had breast MRI screening. More than half the MRI-detected cancers were ductal carcinoma in situ.     

乳腺癌的ER、PR、C-erbB-2和P53表达与钼靶X线表现相关性研究

目的 探讨乳腺癌的ER、PR、C-erbB-2和P53表达与钼靶X线表现之间的相关性.方法 对66例原发性乳腺癌患者术前行乳腺钼靶X线形态学分析,术后标本行免疫组织化学染色测定癌细胞ER、PR、C-erbB-2和P53表达情况,并分析与钼靶X线表现之间的关系.结果 66例乳腺癌中,癌肿毛刺状边缘与癌细胞ER阳性表达之间呈正相关关系（P＜0.01）;乳腺癌钙化与癌细胞C-erbB-2和P53阳性表达之间呈正相关关系（P＜0.01）,而与癌细胞ER和PR阳性表达水平之间呈负相关（P＜0.01）;乳腺癌结构紊乱与癌细胞ER阳性表达水平之间呈负相关（P＜0.01）,而与PR、C-erbB-2和P53阳性表达水平之间均无明显相关性;淋巴结转移与癌细胞ER和PR阳性表达之间呈正相关关系（P＜0.01）.结论 乳腺癌的钼靶X线表现与ER、PR、C-erbB-2和P53表达之间存在一定相关性,可根据乳腺癌钼靶X线表现对癌灶的生物学行为和预后进行评估.     

Ductal enhancement on MR imaging of the breast

OBJECTIVE: The purpose of this study was to determine the prevalence and positive predictive value of ductal enhancement among MR imaging-detected breast lesions that had biopsy and to assess the histologic findings associated with ductal enhancement. MATERIALS AND METHODS: Retrospective review was performed of 427 nonpalpable, mammographically occult lesions that had MR imaging-guided needle localization and surgical biopsy. Lesions were reviewed by one radiologist who was unaware of the histologic outcomes and were classified according to a standardized lexicon. MR imaging and histologic findings of ductal enhancing lesions were reviewed. RESULTS: Ductal enhancement accounted for 88 (21%) of 427 lesions and 88 (59%) of 150 nonmass lesions. Histologic finding in these 88 lesions were ductal carcinoma in situ (DCIS) in 18 (20%); infiltrating carcinoma in five (6%), including three with DCIS; lobular carcinoma in situ (LCIS) in nine (10%); atypical ductal hyperplasia in eight (9%); and benign in 48 (55%). Among the 48 benign lesions, the dominant histologic findings were fibrocystic change (n = 16); ductal hyperplasia (n = 8); fibrosis (n = 8); postbiopsy change (n = 5); benign breast tissue (n = 3); sclerosing adenosis (n = 2); and single cases of fibroadenoma, fibroadenomatoid change, lymph node, mastitis, papilloma, and radial scar. Factors associated with a trend toward a higher frequency of carcinoma included clumped enhancement (p = 0.05) and synchronous ipsilateral cancer (p = 0.07). CONCLUSION: Ductal enhancement accounted for 21% of MR imaging-detected lesions that had biopsy and had a positive predictive value of 26%. Differential diagnosis of ductal enhancement includes carcinoma (usually DCIS); atypical ductal hyperplasia; LCIS; and benign findings such as fibrocystic change, ductal hyperplasia, and fibrosis.     

乳腺浸润性导管癌胶质细胞瘤转录因子1表达及其临床意义

 目的 研究胶质细胞瘤转录因子1（glioma-associated oncogene homolog 1, Gli1）在乳腺浸润性导管癌中的表达情况和临床意义。方法 通过免疫组化Envision法检测Gli1在乳腺浸润性导管癌及癌旁组织的表达情况,分析乳腺浸润性导管癌中Gli1表达与年龄、肿瘤大小、临床TNM分期、淋巴转移、雌激素受体（ER）、孕激素受体（PR）、P53、人类表皮生长因子受体-2（HER-2）表达的关系。 结果 乳腺浸润性导管癌中Gli1的表达明显高于癌旁组织（χ²=10.996,P <0.01)。Gli1的表达与肿瘤大小、TNM分期、P53表达正相关,差异有统计学意义（分别χ²=4.621, χ²=4.332, χ²=4.601,P<0.05）;与年龄、淋巴结转移、ER、PR、HER-2表达无明显相关,差异无统计学意义。 结论 Gli1的表达是辅助诊断乳腺癌的新指标,Gli1表达促进乳腺浸润性导管癌肿瘤生长、分期进展,Gli1表达可能与P53的调控有关。     

MR imaging screening of the contralateral breast in patients with newly diagnosed breast cancer: preliminary results

PURPOSE: To investigate the role of screening magnetic resonance (MR) imaging in the detection of synchronous contralateral breast cancer in patients with newly diagnosed breast cancer. MATERIALS AND METHODS: Between January 1999 and July 2001, 182 patients with newly diagnosed breast cancer (after either core or excisional biopsy with positive or close margins of resection) underwent bilateral contrast material-enhanced MR imaging at 1.5 T with a dedicated bilateral breast multicoil array. The contralateral breast was imaged for cancer screening. Family history of breast cancer, index cancer histology, breast density, and age at diagnosis of first breast cancer were assessed as potential risk factors for synchronous contralateral breast cancer. RESULTS: Fifteen patients (8.2%) had a suspicious enhancing lesion depicted in the contralateral breast. Seven patients (3.8%) had malignant results: ductal carcinoma in situ (DCIS) in four, invasive ductal carcinoma with DCIS in two, and invasive ductal carcinoma in one. Eight patients (4.4%) had benign results: fibrocystic changes in four, atypical ductal hyperplasia in two, atypical lobular hyperplasia and focal lobular carcinoma in situ in one, and ductal hyperplasia in one. Six patients with negative MR findings underwent prophylactic mastectomy; no malignancy was found. No significant differences were noted among patients with true-positive (n = 7), false-positive (n = 8), or negative (n = 167) MR findings with regard to family history of breast cancer (P <.27), index cancer histology (P <.19), breast density (P <.34), or age at diagnosis of first breast cancer (P <.10). CONCLUSION: The preliminary results demonstrate the feasibility of using MR imaging of the breast in a screening role, specifically to evaluate the contralateral breast in patients with newly diagnosed breast cancer to detect mammographically and clinically occult synchronous breast cancer.