目的：探讨不同分子亚型乳腺癌的MRI特征。材料与方法：回顾性分析139例病人的术前乳腺MRI图像，包括强化方式、肿块样病灶强化后形态、边缘、内部强化特征、时间-信号强度曲线（TIC）类型、伴随征象。同时记录免疫组化指标ER、PR、HER-2的受体表达情况及Ki-67水平，按照乳腺癌分子亚型分类，分成 Luminal A型、Luminal B型、HER-2阳性型和三阴性乳腺癌（TNBC）。以χ2检验比较各分子亚型间MRI表现的差异，采用交叉列联表方法分析二者的相关性。结果：Luminal A型32例（23.0%），Luminal B型76例（54.7%），HER-2阳性型14例（10.1%），TNBC 17例（12.2%）。肿块样强化病变119例，非肿块样病变20例。肿块样强化病变中，病变的边缘与分子亚型呈低度相关（C=0.360，P=0.008），内部强化特征与分子亚型呈中度相关（Ｃ=0.442，P=0.001），TIC类型与分子亚型呈低度相关（Ｃ=0.318，P=0.019），而病灶的形态及伴随征象与分子亚型无相关性（C=0.065，P=0.791）。结论：不同分子亚型乳腺癌的MRI变现各异，分子亚型与部分MRI征象之间存在一定的相关性，通过术前MRI检查有助于初步判定预后及初步确定治疗方案。
Abstract
Objective: To explore the MRI features of different molecular subtypes of breast cancer. Materials and Methods: Pre-operation breast MR images of 139 patients were retrospectively investigated concerning strengthen way, morphological, internal and marginal characteristics of mass like enhancement, time-signal intensity curve types and accompanied signs. Meanwhile, expression levels of immunohistochemistry indices including ER, PR, HER-2 and Ki-67 were recorded, and all subjects were assigned to different groups based on their molecular subtypes: Luminal A, Luminal B, HER-2 positive and TNBC. Differences in MRI characteristics were compared and tested with χ-square test, relevance between MRI characters and molecular subtyping was analyzed by crosstab analysis. Results: N of each group: Luminal A(32), Luminal B(76), HER-2 positive(14), TNBC(17). A total of 119 were mass like enhancement, whereas 20 were non-mass like enhancement. Among the mass like enhancement, the molecular subtype was slight correlated with margin(C=0.360, P=0.008) and time-signal intensity curve type(Ｃ=0.318, P=0.019）, moderately correlated with internal enhancement characteristics(C=0.442, P=0.001), whereas morphology and accompanied signs were not relevant to molecular subtype(C=0.065, P=0.791). Conclusions: Different subtypes of breast cancer showed distinct MRI manifestations, molecular subtyping was partially relevant to MRI characters. Thus, pre- operation MRI is helpful in preliminary determination of prognosis and preliminary preparation of therapeutic plans.
关键词
乳腺肿瘤 /
磁共振成像
Key words
Breast neoplasms /
Magnetic resonance imaging
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]Zheng G, Fang P, Ding R, et al. Identification of proteins responsible for the multiple drug resistance in 5-fluorouracil-induced breast cancer cell using proteomics analysis[J]. J Cancer Res Clin Oncol, 2010, 136(10): 1477-1488.
[2]Kim EJ, Kim SH, Park GE, et al. Histogram analysis of apparent diffusion coefficient at 3.0t: Correlation with prognostic factors and subtypes of invasive ductal carcinoma[J]. J Magn Reson Imaging, 2015, 39(7): 1616-1620.
[3]American College of Radiology. ACR practice guideline for the performance of contrast-enhanced magnetic resonance imaging(MRI) of the breast[C]. Reston, VA: American College of Radiology, 2013.
[4]Perou CM, Anne-Lise BD. Systems biology and genomics of breast cancer[J]. Cold Spring Harbor Perspect Biol, 2011, 3(2): 497-505.
[5]Sorlie T, Perou CM, Tibshirani R, et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications[J]. PNAS, 2001, 98(19): 10869-10874.
[6]Tamimi RM, Baer HJ, Marotti J, et al. Comparison of molecular phenotypes of ductal carcinoma in situ and invasive breast cancer[J]. Breast Cancer Res, 2008, 10(10): R67.
[7]Cheang MCU, Chia SK, David V, et al. Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer[J]. J Natl Cancer Inst, 2009, 101(10): 736-750.
[8]张少华，江泽飞. 2011年St.Gallen国际乳腺癌治疗专家共识相关问题解读[J]. 中国实用外科杂志，2011，31（10）：918-919.
[9]Lin NU, Vanderplas A, Hughes ME, et al. Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network[J]. Cancer, 2012, 118(22): 5463-5472.
[10]Munjal K, Ambaye A, Evans MF, et al. Immunohistochemical analysis of ER, PR, Her2 and CK5/6 in infiltrative breast carcinomas in Indian patients[J]. Asian Pac J Cancer Prev, 2009, 10(5): 773-778.
[11]Sun BM, Mirinae S, Kim KG, et al. Quantitative MRI morphology of invasive breast cancer: correlation with immunohistochemical biomarkers and subtypes[J]. Acta Radiol, 2014, 56(3): 269-275.
[12]郝亮，余日胜，崔凤，等. 雌激素受体、孕激素受体和人类上皮因子受体2表达的乳腺癌亚型的MRI表现特征分析对照研究[J]. 中华医学杂志，2013，93（11）：819-823.
[13]Yamaguchi K, Abe H, Newstead GM, et al. Intratumoral heterogeneity of the distribution of kinetic parameters in breast cancer: comparison based on the molecular subtypes of invasive breast cancer[J]. Breast Cancer, 2014, 1504(2-3): 1-7.
[14]皋岚湘，杨光之，丁华野. 基底细胞样型浸润性乳腺癌病理形态观察[J]. 中华病理学杂志，2008，37（2）：83-87.
[15]Kawashima H, Inokuchi M, Furukawa H, et al. Magnetic resonance imaging features of breast cancer according to intrinsic subtypes: correlations with neoadjuvant chemotherapy effects[J]. Springer Plus, 2014, 3(1): 240.
[16]于洋，霍天龙，赖云耀. 不同分子亚型乳腺癌的MRI和病理特征初探[J]. 中华放射学杂志，2014，48（3）：184-188.
[17]王盈盈，常晓丹，付娇慧. 乳腺浸润性导管癌3.0T MRI表现与预后因子相关性研究[J]. 磁共振成像，2014，5（2）：132-137.
[18]Lee SH, Cho N, Kim SJ, et al. Correlation between high resolution dynamic MR features and prognostic factors in breast cancer[J]. Korean J Radiol, 2008, 9(1): 10-18.
[19]徐慧，贾文霄，周梅. 乳腺癌动态增强MRI表现与病理，分子预后指标的相关性分析[J]. 中国医学影像学杂志，2011，19（2）：121-128.
[20]Jeh SK, Kim SH, Kim HS, et al. Correlation of the apparent diffusion coefficient value and dynamic magnetic resonance imaging findings with prognostic factors in invasive ductal carcinoma[J]. J Magn Reson Imaging, 2011, 33(1): 102-109.
基金
吉林省科技厅自然科学基金项目（20140101170JC）。
