乳腺癌免疫组化亚型的超声、临床和病理分析

目的探讨乳腺癌不同免疫组化亚型的超声表现和临床、病理特征,为其诊断和预后评估提供信息。方法将2013年2月~2015年2月216例病理证实的乳腺癌患者根据免疫组化结果分为三阴(TNBC)组(40例)、雌激素受体(ER)阳性组(119例)及人表皮生长因子受体2(HER-2)阳性组(57例)。对比分析各组的超声特征及临床、病理相关资料。结果(1)TNBC组和HER-2阳性组肿块最大径分别为(22.45±6.67)和(22.86±9.36)mm,均大于ER阳性组的(18.86±7.98)mm,差异有统计学意义(P0.05)。(2)TNBC组和HER-2阳性组边缘毛刺征者分别占57.5%、57.9%,均低于ER阳性组的76.5%;TNBC组内部微钙化者占30%,低于ER阳性组的50.4%和HER-2阳性组的56.1%;TNBC组后方回声增强者占40%,高于ER阳性组的5%和HER-2阳性组的12.3%,以上差异均有统计学意义(P0.05)。(3)TNBC组腋窝淋巴结转移率高达47.5%,显著高于ER阳性组的21.8%和HER-2阳性组的22.8%,差异有统计学意义(P0.05)。(4)三组乳腺癌的Ki67阳性指数表达的比较差异有统计学意义,TNBC组50%以上的高表达较多,ER阳性组5%~25%之间的表达较多,HER-2阳性组居于两者之间,以25%~50%的表达较多(P0.05)。(5)三组乳腺癌的发病年龄、肿块形态、纵横比、血流分级、p53阳性表达之间差异无统计学意义。结论乳腺癌不同免疫组化亚型有不同的超声声像图特征。TNBC在声像图上常表现为边缘少毛刺、内部缺乏微钙化、后方回声增强等良性特征,但是其淋巴结转移率高;ER阳性乳腺癌边缘毛刺征较多见;HER-2阳性乳腺癌肿块较大,内部微钙化多见;超声可为TNBC的早期诊断和预后评估提供信息。

Clinical,sonographic and histopathological characteristics of immunohistochemical subtypes in breast cancer

Objective To investigate the clinical,ultrasonographic (US) and histopathological characteristics of breast cancer for diagnosis and prognosis of immunohistochemical subtypes. Methods 216 patients with breast cancer confirmed by pathology were divided into triple-negative breast cancer (TNBC) group (40), estrogen receptor positive (ER+) group (119) and HER2+group (57). The US features, clinical and histopathological characteristics of the three groups were compared. Results The tumors and percentage of spiculation in the TNBC (22.45±6.67 mm, 57.5%) and HER2+(22.86±9.36 mm, 57.9%)groups were significantly (P<0.05)larger and lower than that in the ER+group (18.86±7.98 mm, 76.5%), respectively. The percentage of microcalcification and posterior acoustic enhancement in the TNBC (30.0%, 40.0%) was significantly (P<.05) lower and higher than that in the ER+(50.4%, 5.0%) and HER2+ (56.1%, 12.3%) cancer, respectively.Axillary lymph node metastasis and expression of Ki67 were significantly (P<0.05) more common in TNBC (47.5%, 50%) than ER+ (21.8%, 5-25%) and HER2+ (22.8%, 25-50%) cancer, respectively. There was no significant difference in age, tumor shape, cross-sectional diameter ratio, blood flow pattern and p53 expression among TNBC,.ER+and HER2+ groups. Conclusion The US characteristics of breast cancer correlate well with the immunohistochemical subtypes,.TNBC is less likely to have spiculatedmargins,.microcalcification,.and posterior acoustic enhancement but has higher lymph node metastasis rate. Spiculation is more common in ER+ breast cancer whereas HER2+ breast cancer often appears as a large mass with internal microcalcification. US appearance can provide important information for the diagnosis , treatment and prognosis assessment of TNBC.