浸润性乳腺癌术前FNA近似分子分型的临床意义

目的探讨浸润性乳腺癌术前细针吸取细胞学(fine needle aspiration,FNA)近似分子分型的可行性及临床意义。方法对42例女性原发性乳腺癌患者术前行细针穿刺术,涂片后进行细胞学诊断。利用免疫细胞化学技术检测ER、PR、HER2、CK5/6和EGFR表达情况,将乳腺癌近似分为腺腔A型(Luminal A)、腺腔B型(Luminal B)、纯HER2过表达型(pure HER2-overexpressing)、基底样型(basal-like)、HER2过表达基底样型(basal-HER2)及正常乳腺型(null)6个分子亚型。将其与术后对应标本的病理学及免疫组化结果进行比较。结果术前穿刺涂片诊断为"高度可疑乳腺癌"及"乳腺癌"的42例女性患者,经术后病理组织学证实均为浸润性乳腺癌,细胞学诊断准确率为100%。在42例乳腺癌细针吸取细胞涂片上利用免疫细胞化学进行术前各分子标记的检测,其中ER/PR阳性率为52.38%(22/42),HER2阳性率为42.86%(18/42),EGFR/CK5/6阳性率为19.04%(8/42)。相对应的石蜡切片经免疫组化检测,ER/PR阳性率分别为52.38%(22/42),HER2阳性率为40.48%(17/42),EGFR/CK5/6阳性率为23.81%(10/42)。其中,1例细胞涂片HER-2为阳性,而对应的石蜡切片为阴性;2例石蜡切片EGFR为阳性,而对应的细胞涂片为阴性,两种方法差异无统计学意义(P>0.05)。结论 FNA是术前诊断乳腺癌准确、易行的方法之一。浸润性乳腺癌术前FNA近似分子分型简单明了,切实可行。其有助于术前掌握乳腺癌的生物学特征,可能成为指导术前新辅助化疗、术式选择的有用指标。

Clinical significance of approximated molecular subtypes of preoperative breast carcinoma on FNA specimens

Purpose To investigate the clinical significance of approximated molecular subtypes of preoperative breast carcinoma on fine needle aspiration(FNA) cytology specimens.Methods The 42 female patients with primary breast carcinoma were aspirated by fine needle before operative.Six different subtypes,such as Luminal A,Luminal B,pure HER2-overexpressing,basal-like,basal-HER2 and null,were defined by five immunocytochemical markers,including estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor 2(HER2),epidermal growth factor receptor(EGFR) and Cytokeratin5/6(CK5/6) on cytology specimens.Corresponding tissue sections were detected for the same items with HE staining and immunohistochemical staining.The chi-square test was undertaken to establish the association between two methods.Results All 42 female patients with primary breast carcinoma were correctly diagnosed by FNA before operative if the histopathology results were regarded as gold standard.The sensitivity is 100%.Among the 42 cases,the positive rate of ER/PR,HER2,EGFR/CK5/6 were 52.38%(22/42),42.86%(18/42),19.04%(8/42),respectively in FNA smears,while 52.38%(22/42),40.48%(17/42),23.81%(10/42),respectively in tissue sections.There is no statistically significant difference between them(P>0.05).Conclusions FNA is one of accurate and feasible measures to diagnose breast carcinoma before operation.Approximated molecular subtypes on FNA specimens before operation should be useful for preoperatively realizing the tumor biological characters,guiding neoadjuvant chemotherapy and operation treatment.