乳腺导管原位癌X线表现与病理学免疫组织化学分型关系的分析

目的:探讨乳腺导管原位癌(DCIS)X线摄影表现与病理学免疫组织化学分型的关系。方法:回顾性分析2016年1月至2019年10月在青岛大学附属医院经手术病理证实的505例DCIS患者共514个病灶的资料。根据免疫组织化学结果将全部DCIS病灶分为雌激素受体(ER)阳性型(215个病灶)、人表皮生长因子受体2(HER2)阳性型(282个病灶)和三阴性型(17个病灶)。患者术前均接受X线摄影检查,参照乳腺影像报告及数据系统(BI-RADS)标准分析不同分子分型患者的影像学表现,如病变类型,钙化性病变的钙化形态、分布,乳腺构成及BI-RADS分类情况。采用χ^2检验或Fisher确切概率法分析不同分子分型DCIS患者影像表现分布的差异,两两比较时检验水准α采用Bonferroni校正法。结果:ER阳性型44.7%(96/215)表现为阴性或非钙化性病变;HER2阳性型41.1%(116/282)表现为钙化伴肿块/非对称致密/结构扭曲;三阴性型82.4%(14/17)为钙化性病变,包括单纯钙化(7/17)和钙化伴肿块/非对称致密/结构扭曲(7/17)。DCIS HER2阳性型与ER阳性型在病变类型方面差异有统计学意义(χ^2=13.747,P=0.003)。细线样/细小分支状钙化(34/201)多见于HER2阳性型,无定形钙化(67/119)多见于ER阳性型,差异有统计学意义(χ^2=27.498,P<0.001)。团簇状分布钙化(59/119)多见于ER阳性型,线样/段样分布(76/201)多见于HER2阳性型,差异有统计学意义(χ^2=13.123,P=0.004)。结论:DCIS的X线表现与其病理学免疫组化不同分型有一定关系,认识其X线表现有助于为临床个性化治疗和预后提供更多依据。

Relationship between mammographic findings and pathological molecular subtypes of ductal carcinoma in situ

Objective To explore the relationship between mammographic features and pathological molecular subtypes of ductal carcinoma in situ(DCIS).Methods Imaging data of 514 ductal carcinoma in situ in 505 patients confirmed by surgical pathology in Affiliated Hospital of Qingdao University from Jan 2016 to Oct 2019 were analyzed retrospectively.According to the immunohistochemical results,the tumors were classified as estrogen receptor(ER)positive type(215 lesions),human epidermal growth factor receptor 2(HER2)positive type(282 lesions)and triple negative type(17 lesions).All patients underwent X-ray mammography before operation.According to the standard of breast imaging report and data system(BI-RADS),the imaging manifestations of lesions with different molecular types were analyzed,such as lesion types,calcification morphology and distribution of calcified lesions,breast composition and BI-RADS classification.The differences in imaging manifestations among pathological molecular subtypes of DCIS were analyzed byχ2 test or Fisher exact test,and Bonferroni correction method was used for test levelαin pairwise comparison.Results Totally 44.7%(96/215)lesions with ER positive type were negative or non-calcified,41.1%(116/282)lesions with HER2 positive type showed calcification with mass,asymmetric density and structural distortion,and 82.4%(14/17)lesions with triple negative type were calcified,including only calcification(7/17),and calcification with mass,asymmetric density and structural distortion(7/17).There was significant difference in lesion types between DCIS HER2 positive type and ER positive type(χ²=13.747,P=0.003).Thin line/fine branching calcification(34/201)was more common in HER2 positive type,while amorphous calcification(67/119)was more in ER positive type,which had a statistically significant difference(χ²=27.498,P<0.001).Clustered distributed calcification(59/119)was more common in ER positive type,and the linear/segment distribution(76/201)was more in HER2 positive type,and the difference was statistically significant(χ2=13.123,P=0.004).Conclusion The mammographic features of DCIS are related to different molecular subtypes,which will help to provide more evidence for clinical personalized treatment and prognosis.