本文選題：乳腺癌　切入點(diǎn)：動(dòng)態(tài)磁共振成像　出處：《廣州醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的:探討乳腺癌磁共振影像學(xué)特征與分子生物學(xué)指標(biāo)、分子亞型及WHO組織學(xué)分級(jí)之間的相關(guān)性。材料與方法:本研究回顧性分析了從2015年3月至2017年2月在廣州醫(yī)科大學(xué)附屬第二醫(yī)院通過穿刺或手術(shù)病理證明為乳腺癌的患者總共90例。全部病人均為單側(cè)乳腺發(fā)病,其中單發(fā)腫塊者75例,多發(fā)腫塊者15例,年齡區(qū)間為29~87歲,平均年齡為54歲。所有病人在術(shù)前未進(jìn)行任何相關(guān)治療且術(shù)前均成功行乳腺磁共振動(dòng)態(tài)增強(qiáng)檢查(DCE-MRI),術(shù)后病理切片以及免疫組化標(biāo)記物檢查。所有影像學(xué)相關(guān)參數(shù),是由兩位具有五年以上臨床工作經(jīng)驗(yàn)的放射科主治醫(yī)師依據(jù)MRI乳腺影像報(bào)告和數(shù)據(jù)系統(tǒng)(BI-RADS)來進(jìn)行判讀,影像內(nèi)容包括腫瘤的形態(tài)學(xué)特征:腫塊的直徑(2cm或≤2cm),腫塊形狀(類圓形,分葉狀,不規(guī)則狀),腫塊邊緣(光滑,毛刺,不光整),腫塊的強(qiáng)化方式(均勻,混雜,環(huán)形)。血流動(dòng)力學(xué)特征:時(shí)間信號(hào)曲線(time-signal intensity curve,TIC),即I型:呈緩慢持續(xù)上升;II型:早期上升迅速,而于中后期速度維持在平穩(wěn)水平;III型:注入對(duì)比劑后病灶早期即可明顯強(qiáng)化,而中后期病灶的信號(hào)強(qiáng)度呈逐步下降;腫瘤的信號(hào)增強(qiáng)率,達(dá)峰時(shí)間、流出率等指標(biāo)。將病人術(shù)后的病理資料進(jìn)行分析和記錄,其中包括腫瘤淋巴結(jié)轉(zhuǎn)移狀況,WHO分級(jí)情況;通過免疫組化所獲取的生物學(xué)因子表達(dá)情況和分子亞型分類,包括雌激素受體(ER),孕激素受體(PR),原癌基因人類表皮生長因子受體-2(C-erb B-2),抑癌基因P53,細(xì)胞增殖抗原標(biāo)記物(Ki-67),TopoⅡα同工酶等。數(shù)據(jù)分析方面,應(yīng)用SPSS 22.0軟件,計(jì)量資料采取均數(shù)±標(biāo)準(zhǔn)差(x±s)表述,行非參數(shù)Spearman相關(guān)性檢驗(yàn)和二分類Logistic回歸分析,檢驗(yàn)顯著性以α=0.05為水準(zhǔn),以P0.05認(rèn)為具有統(tǒng)計(jì)學(xué)差異。結(jié)果單發(fā)腫塊75例(83%),多發(fā)腫塊15(17%)例,形態(tài)學(xué)表現(xiàn)為類圓形33例(37%),分葉狀29例(32%),不規(guī)則者28例(31%);腫瘤邊緣光滑者占31例(34%),邊緣不光整約20例(22%),邊緣毛刺征者達(dá)39例(43%);腫瘤的強(qiáng)化方式,腫塊呈明顯均勻強(qiáng)化者48例(53%),混雜式強(qiáng)化者約29例(32%),環(huán)形強(qiáng)化者13例(14%)。時(shí)間-信號(hào)曲線類型:Ⅱ型47例(52.2%),Ⅲ型43例(47.8%)。最大強(qiáng)化率值為93.5%~494.53%,平均值為(271.92±62.30)%。病灶達(dá)峰時(shí)間值為58.21~414.89s,平均達(dá)峰時(shí)間值為(196.69±100.28)s,病理及免疫組化結(jié)果:其中80例乳腺浸潤性導(dǎo)管癌(89.0%),1例乳腺粘液腺癌(1.1%),3例乳腺高級(jí)別導(dǎo)管內(nèi)癌(3.3%),乳腺浸潤性小葉癌者4例(4.4%),乳腺浸潤性乳頭狀癌者2例(2.2%)。WHO組織分級(jí):Ⅰ級(jí)2例(2.6%),Ⅱ級(jí)33例(42.9%),Ⅲ級(jí)42例(54.5%);淋巴結(jié)轉(zhuǎn)移陽性者35例(48.9%),淋巴結(jié)轉(zhuǎn)移陰性者55例(61.1%)。ER陽性表達(dá)58例(64.4%),ER陰性表達(dá)32例(35.6%);PR陽性表達(dá)45例(50%),PR陰性表達(dá)45例(50%);C-erb B-2陽性表達(dá)29例(48.3%),C-erb B-2陰性表達(dá)61例(51.7%);p53陽性表達(dá)22例(24.4%),p53陰性表達(dá)68例(75.6%);TopoⅡα陽性表達(dá)59例(65.5%),TopoⅡα陰性表達(dá)31例(34.5%);Ki-67陽性表達(dá)67(74.4%),Ki-67陰性表達(dá)23例(25.6%)。(1)乳腺腫瘤的大小:腫塊的大小與ER的表達(dá)呈負(fù)相關(guān)(r=-0.264,p=0.012),與P53(r=0.22,p=0.03)及C-erb B-2(r=0.272,p=0.032)表達(dá)呈正相關(guān)。(2)腫瘤的形態(tài):腫瘤的形態(tài)與ER(r=-0.273,p=0.009)及PR(r=-0.226,p=0.032)表達(dá)呈負(fù)相關(guān),與C-erb B-2(r=0.220,p=0.037)表達(dá)呈正相關(guān)。(3)腫瘤的邊緣:腫瘤的邊緣與ER(r=0.320,p=0.002)及PR(r=0.209,p=0.048)表達(dá)呈正相關(guān)。(4)腫瘤的內(nèi)部強(qiáng)化方式及強(qiáng)化曲線類型與各生物因子間無明顯相關(guān)性。(5)淋巴結(jié)轉(zhuǎn)移與p53(r=0.275,p=0.014)及Ki-67(r=0.237,p=0.026)表達(dá)呈正相關(guān)。(6)達(dá)峰時(shí)間與TopoⅡα(r=-0.240,p=0.04)及Ki-67表達(dá)(r=-0.296,p=0.01)呈負(fù)相關(guān),而信號(hào)增強(qiáng)率及流出率與生物因子無統(tǒng)計(jì)學(xué)差異。(7)分子分型與腫瘤的大小顯著正相關(guān)(r=0.239,p=0.041),即Her-2過表達(dá)型乳腺腫瘤的直徑較其他類型大。(8)乳腺癌的WHO分級(jí)同腫塊內(nèi)部的強(qiáng)化方式呈顯著負(fù)相關(guān)(r=-0.235,p=0.043),即腫塊的組織學(xué)分級(jí)越高,腫瘤的強(qiáng)化方式越趨向于混雜式強(qiáng)化。(9)二分類Logistic回歸分析顯示HER-2陽性表達(dá)者腫塊為較大直徑的風(fēng)險(xiǎn)是HER-2表達(dá)陰性者的5.71倍,p53表達(dá)陽性者出現(xiàn)較大直徑的風(fēng)險(xiǎn)是p53表達(dá)陰性者的5.403倍,TopoⅡα表達(dá)陽性者出現(xiàn)較大直徑的風(fēng)險(xiǎn)是P53表達(dá)陰性者的3.565倍。結(jié)論:本研究認(rèn)為乳腺癌MRI影像學(xué)表現(xiàn)與分子生物學(xué)指標(biāo)、WHO分級(jí)及分子分型間存在一定的相關(guān)性,因此可進(jìn)一步應(yīng)用影像學(xué)檢查方法來間接反映乳腺癌的生物學(xué)行為,為乳腺癌患者制定合理的個(gè)體化診療方案提供更多參考依據(jù)。
[Abstract]:Objective: To investigate the characteristics and molecular biology of breast cancer magnetic resonance imaging, correlation between the classification of molecular subtypes and WHO. Materials and methods: This was a retrospective study from March 2015 to February 2017 through the puncture or surgical pathology proved breast cancer patients with a total of 90 patients in the Second Affiliated Hospital of Guangzhou Medical University. All patients were unilateral breast disease, including 75 cases of single tumor, 15 cases of multiple masses, age range 29~87 years old, the average age was 54 years. All patients in the preoperative without any treatment and before surgery were successfully performed breast dynamic enhanced magnetic resonance examination (DCE-MRI), postoperative pathology biopsy and immunohistochemical marker examination. All the parameters of imaging, by two with more than five years working experience in clinical radiology physician on the basis of MRI breast imaging reporting and data system (BI-RADS ) for interpretation, image content including morphological characteristics of tumor mass diameter (2cm or 2cm), mass shape (round, lobulated, irregular), mass margins (smooth, burr, not finishing), enhancement mass (uniform, hybrid, ring). Hemodynamic characteristics: time signal curve (time-signal intensity curve, TIC), namely I type: a slow rising; type II: early rising rapidly, and in the middle and late rate remained at a steady level; type III: early lesions after injection of contrast agent can obviously strengthen, and the signal intensity in the late lesions showed a gradual decline in tumor signal; enhanced rate, peak time, flow rate and other indicators. The pathological data of patients were analyzed and recorded, including tumor lymph node metastasis, WHO classification; expression and molecular subtype classification by biological factor Immunohistochemistry was taken, including female 嬋，

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