三阴性乳腺癌与非三阴性乳腺癌的病理特征及X线摄影征象比较

目的 探讨三阴性乳腺癌（TNBC）的病理特征及X线摄影征象.方法 回顾性分析本院1102例经病理检查证实为原发性乳腺癌的女性患者资料,其中包括：ER（-）/PR（-）/HER-2（-）组（TNBC组）174例,ER（-）/PR（-）/HER-2（＋）组183例,ER（＋）/PR（-）/HER-2（-）组65例,ER（＋）/PR（＋）/HER-2（-）组583例,ER（＋）/PR（＋）/HER-2（＋）组97例.患者术前均完成双侧或单侧乳腺X线常规摄影.采用χ2检验比较TNBC与其他组乳腺癌的X线表现;采用方差分析比较肿块直径的差异,并用LSD检验进行两两比较;采用Dunnett t3检验两两比较患者发病年龄的差异.结果 （1）各组乳腺癌患者发病年龄的差异有统计学意义（F=3.877,P=0.004）,其中TNBC组的发病年龄较ER（＋）/PR（＋）/HER-2（＋）组大[（51.9±9.2）岁比（48.3±8.9）岁,P=0.020].各组乳腺癌的主要组织病理学类型均为浸润性导管癌.（2）TNBC组较ER（-）/PR（-）/HER-2（＋）组、ER（＋）/PR（＋）/HER-2（＋）组更多表现为单纯肿块（χ2=24.808、13.628,P均〈0.005）,较少伴有钙化（χ2=28.392、10.609,P均〈0.005）.TNBC肿块多为圆形或卵圆形[与ER（-）/PR（-）/HER-2（＋）组、ER（＋）/PR（-）/HER-2（-）组及ER（＋）/PR（＋）/HER-2（＋）组相比,χ2=21.328、15.035、21.556,P均＜0.005],边缘模糊.TNBC肿块直径较ER（＋）/PR（-）/HER-2（-）组和ER（＋）/PR（＋）/HER-2（-）组大[（23.93±11.59）mm分别比（18.06±5.76）mm和（20.23±7.80）mm,P=0.003、0.030].结论 TNBC的X线摄影多表现为单纯肿块,呈圆形或卵圆形,多边界模糊,部分病变边界清楚,较少伴有钙化.此特点有助于此亚型乳腺癌的X线诊断.

Comparison of pathologic characteristics and mammographic findings between triple negative breastcancer and non-triple negative breast cancer

Objective To evaluate the pathologic characteristics and mammographic findings of triple negative breast cancer （TNBC）. Methods We retrospectively analyzed the clinical data of 1102 women who had been pathologically diagnosed with primary breast cancer in our hospital, including： TNBC group [ n = 174, ER（-）/PR（-）/HER2（-） ], ER（ -）/PR（ -）/HER-2 （＋） group （ n= 183）, ER（ ＋）/PR（ -）/HER-2 （-） group （n=65）, ER（ ＋）/PR（ ＋）/HER-2 （-） group （ n= 583） and ER（ ＋）/PR（ ＋）/HER-2 （＋） group （ n = 97 ）. All patients underwent bilateral or unilateral mammography before operation. X2-test was used to compare the mammographic findings between TNBC group and other groups, one-way ANOVA to compare the tumor size among groups. LSD test was performed for pairwise comparison and Dunnett t3 test was conducted to compare the onset age among groups. Results （ 1 ） The mean onset age was significantly different among groups （ F= 3. 877 ,P=0. 004）, and the mean onset age of TNBC group was older than that of ER（ ＋）/PR（ ＋）/HER-2（＋） group [ （51.9 ± 9. 2 ） years vs （ 48.3± 8. 9 ） years, P = 0. 020 ]. Invasive ductal carcinoma was the mainhistopathological type of breast cancer in each group. （ 2 ） Compared with ER （ - ）/PR （ - ）/HER-2 （ ＋ ） group and ER （ ＋ ）/PR （ ＋ ）/HER-2 （ ＋ ） group, TNBC group more presented with single mass （ X2 = 24. 808,13. 628 ; all P〈0. 005） and less frequently associated with microcalcifications （X2 = 28. 392,10. 609 ;all P〈0. 005 ）. The masses were usually round or oval with indistinct margins in TNBC group [ compared with ER （-）/PR （-）/ HER-2（ ＋）, ER（ ＋）/PR（ -）/HER-2 （-） and ER（ ＋）/PR（ ＋）/HER-2 （＋） groups, X2 = 21. 328,15. 035, 21. 556, all P〈0. 005 ]. The mean diameter of the masses in TNBC group was significantly larger than that in ER（＋）/PR（-）/HER-2（-） group or ER（＋）/PR（＋）/HER-2（-） group [（23.93±11.59） mm, （18.06± 5.76） mm, （20. 23±7.80） mm; P=0. 003, 0. 030）. Conclusion The mammography of TNBC often shows single mass, round or oval, with indistinct margin, some lesions with clear margin, less associated with microcalcifications, which may be useful in mammographic diagnosis of TNBC.