雌激素受体阴性乳腺癌 HER －2过表达及与影像学和临床病理特征的关系

目的：探讨人类表皮生长因子受体 HER －2过表达在雌激素受体阴性（ER －）乳腺癌诊断中的价值及其与钼靶、超声影像学特征及临床病理特征的关系，并与 ER －／HER －2－乳腺癌进行比较。方法：收集临床资料完整的 ER －乳腺癌患者190例，其中 HER －2过表达（HER －2＋）乳腺癌患者78例，HER －2无过表达（HER －2－）型乳腺癌患者112例。比较两组患者的钼靶及超声影像学表现和临床病理特征。结果：在这190例 ER －乳腺癌患者中，HER －2＋乳腺癌组与 HER －2－组比较，年龄差异具有统计学意义（P ＝0．0049）；均具有较高的病理组织学分级，组间差异无统计学意义（P ＝0．296）。HER －2＋乳腺癌组更多表现为淋巴结阳性（P ＝0．003）。钼靶 X 线检查 HER －2＋与 HER －2－两组间比较，差异具有统计学意义（P ＜0．001）。单纯钙化 HER －2＋组（46．2％）较 HER －2－组（13．4％），差异具有统计学意义（P ＜0．001）；单纯肿物 HER －2－组（58．0％）较 HER －2＋组（34．6％），差异具有统计学意义（P ＝0．0038）；肿物特征 HER －2＋组与 HER －2－组比较，差异具有统计学意义（P ＝0．017）；HER －2＋组（42．5％）多表现为分叶状肿物，较 HER－2－组（14．9％），差异具统计学意义（P ＝0．0030）；HER －2－组（33．3％）多为圆形肿物，较 HER －2＋组（12．5％），差异具有统计学意义（P ＝0．013）；HER －2＋组与 HER －2－组肿物边缘组间比较，差异具有统计学意义（P ＜0．001）；HER －2＋组（57．5％）较多变现为毛刺，较 HER －2－组（14．9％），差异具有统计学意义（P ＜0．001）；HER －2－组较 HER －2＋组光滑程度，差异具有统计学意义（P ＜0．001）；HER －2＋组（89．8％）更多表现为恶性钙化，较 HER －2－组（29．7％），差异具有统计学意义。超声检查 HER －2＋组与 HER －2－组，差异具有统计学意义（P ＜0．005）；肿块边缘差异具有统计学意义（P ＜0．001）；内部回声差异具有统计学意义（P ＝0．014）。结论：不同类型的乳腺癌有不同的生物学特征，其钼靶影像学表现也不尽相同，了解 ER －HER －2＋型乳腺癌的钼靶及超声影像学特征，可帮助临床医师预测乳腺癌这一亚型及相关类型和患者的预后，以及评估患者对各种治疗方法的敏感性，有利于制定最优的治疗方案。

The relationship of imaging and clinicopathologic feature of tumors with human epider-mal growth factor receptor type 2 overexpression in estrogen receptor -negative breast carcinomas

Objective:To determine if estrogen receptor(ER)-negative human epidermal growth factor receptor type 2(HER -2)-positive and ER -negative HER -2 -negative breast cancers have distinguishing clinical and im-aging features.Methods:190 cases of ER -negative breast cancer included in this study.There were 78 cases of HER -2 overexpression(HER -2 +)breast cancer,112 cases without HER -2 overexpression(HER -2 -)breast cancer. Their pathological and mammographic data were analyzed.The pathological and mammographic features of the two groups were compared.Results:Without HER -2 overexpression(HER -2 -)with ER -negative breast cancer group and HER -2 overexpression(HER -2 +)with ER -negative breast cancer group all had a higher histological grade, but no significant difference(P =0.296).Compared with the without HER -2 overexpression(HER -2 -)breast cancer group,frequency of HER -2 /neu overexpression in each age group was evaluated and significant differences. HER -2 overexpression(HER -2 +)breast cancer group was more likely to have a lymphonodus positive (P =0.003),mammographic imaging appearances and were correlated with tumor HER -2 status(P <0.001).Compared with the without HER -2 overexpression(HER -2 -)breast cancer group,the HER -2 /neu overexpression(HER -2 +)breast cancer group more likely represented simple calcification(46.2% vs 13.4%,P <0.001).Compared with the HER -2 overexpression(HER -2 +)breast cancer group the without HER -2 overexpression(HER -2 -)breast cancer group more likely represented a simple mass(58.0% vs 34.6%,P =0.003 8).The characteristics of mass shape were correlated with tumor HER -2 status(P =0.017).HER -2 without overexpression(HER -2 -)breast cancer more likely shows round shape(33.3% vs 12.5%,P =0.013),the HER -2 overexpression(HER -2 +) breast cancer more likely shows lobulated shape(42.5% vs 14.9%,P =0.003 0).Moreover,the tumor mass of the HER -2 /neu overexpression (HER -2 +)breast cancer was more likely to have a spiculated margin (57.5% vs 14.9%,P <0.001),the overexpression(HER -2 +)breast cancer more likely shows malignancy calcification (P<0.001).Mammographic imaging were correlated with tumor HER -2 status.Mass margins(P <0.001)and echo pattern(P =0.014)shows a significant difference.Conclusion:Different types of breast cancer have different biologi-cal characteristics and mammographic features.Analysis of the mammographic features may help to predict the type of breast cancer and its prognosis,and to select an optimal treatment plan for patients with different types of breast cancer.