【摘要】：目的 分析乳腺癌動(dòng)態(tài)增強(qiáng)MRI表現(xiàn)與分子生物學(xué)指標(biāo)雌激素受體(estrogen receptor, ER)、孕激素受體(progesterone receptor, PR)、人表皮生長(zhǎng)因子受體2(human epidermal growth factor receptor2, Her-2)、核增殖標(biāo)志物Ki-67表達(dá)的相關(guān)性。以期通過DCE-MRI表現(xiàn)揭示腫瘤的生物學(xué)行為,并為腫瘤的預(yù)后評(píng)估及臨床治療方案的選擇提供影像學(xué)參考。從而提高動(dòng)態(tài)增強(qiáng)磁共振檢查在臨床診療中的應(yīng)用價(jià)值。 方法 收集我院2011年04月～2013年08月術(shù)前行動(dòng)態(tài)增強(qiáng)磁共振檢查,并經(jīng)手術(shù)病理證實(shí)的乳腺癌53例共55個(gè)腫塊,檢查前、術(shù)前均未行放、化療治療。采用德國西門子3.0T超導(dǎo)磁共振掃描儀,常規(guī)行T1加權(quán)成像(T1weighted imaging, T1WI)、T2加權(quán)成像(T2weighted imaging, T2WI)及動(dòng)態(tài)增強(qiáng)掃描,觀察病變?cè)鰪?qiáng)后的形態(tài)學(xué)特征(腫塊大小、形態(tài)、邊緣)、時(shí)間信號(hào)強(qiáng)度曲線(time signal-intensity curve, TIC)類型、強(qiáng)化形式、早期增強(qiáng)率等。免疫組化染色測(cè)定分子生物學(xué)指標(biāo)ER、PR、Her-2、Ki-67的表達(dá)情況。分析乳腺癌動(dòng)態(tài)增強(qiáng)磁共振(dynamic contrast-enhanced magnetic resonance imaging, DCE-MRI)表現(xiàn)與分子生物學(xué)指標(biāo)的相關(guān)性。所有數(shù)據(jù)經(jīng)SPSS19.0軟件處理,采用非參數(shù)統(tǒng)計(jì)中Spearman等級(jí)相關(guān)檢驗(yàn),P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果 (1)腫塊大小與Ki-67陽性表達(dá)呈正相關(guān)(r=0.279,P0.05),與ER、PR、 Her-2無相關(guān)性(r值分別為-0.027、-0.119、0.046,P0.05),腫塊越大,其Ki-67陽性表達(dá)率越高。 (2)腫塊形態(tài)與Her-2陽性表達(dá)呈正相關(guān)(r=0.305,P0.05),與Ki-67陽性表達(dá)呈顯著正相關(guān)(r=0.427,P0.01),與ER、PR無相關(guān)性(r值分別為0.102、0.134,P0.05),在類圓形、分葉形及不規(guī)則形腫塊中,其Her-2、 Ki-67的陽性表達(dá)率是依次增高的,腫塊傾向于分葉形、不規(guī)則形時(shí),其Her-2、Ki-67陽性表達(dá)較高。 (3)腫塊邊緣與ER, PR陽性表達(dá)呈正相關(guān)(r值分別為0.288,、0.294,P0.05),與Her-2、Ki-67無相關(guān)性(r值分別為0.185、0.096,P0.05),即邊緣不規(guī)則、毛刺的腫塊其ER、PR陽性表達(dá)率較高。 (4)腫塊強(qiáng)化形式與PR陽性表達(dá)呈負(fù)相關(guān)(r=-0.282,P0.05),與ER、Her-2、Ki-67無相關(guān)性(r值分別為0.198、-0.211、0.202,P0.05),腫塊越傾向于環(huán)形強(qiáng)化,其PR陽性表達(dá)率越低。 (5)TIC類型與Ki-67陽性表達(dá)呈顯著正相關(guān)(r=0.358,P0.01),與ER、PR、Her-2無相關(guān)性(r值分別為0.182、0.067、0.229,P0.05),尤其是傾向于TIC-Ⅲ型時(shí),其Ki-67陽性表達(dá)率越高。 (6)早期增強(qiáng)率與Her-2陽性表達(dá)呈正相關(guān)(r=0.268,P0.05),與ER、PR、Ki-67無相關(guān)性(r值分別為0.137、0.223、0.101,P0.05),早期增強(qiáng)率越高,其Her-2陽性表達(dá)率越高。 結(jié)論 乳腺癌DCE-MRI表現(xiàn)中一些形態(tài)學(xué)特征(腫塊大小、形態(tài)、邊緣)、強(qiáng)化形式、TIC類型、早期增強(qiáng)率等與分子生物學(xué)指標(biāo)之間存在相關(guān)性。乳腺癌DCE-MRI表現(xiàn)可以反映腫瘤的生物學(xué)行為,能夠間接評(píng)估腫瘤預(yù)后并為指導(dǎo)臨床治療方案的選擇提供參考。
[Abstract]:Objective to analyze the dynamic enhanced MRI and molecular biological index of breast cancer, estrogen receptor (estrogen receptor, ER), progesterone receptor (progesterone receptor, PR), human epidermal growth factor receptor 2 (human epidermal growth factor receptor2, Her-2 (EGF 2 (human epidermal growth factor receptor2, Her-2). Correlation of nuclear proliferation marker Ki-67 expression. The purpose of this study was to reveal the biological behavior of tumor by DCE-MRI and to provide imaging reference for prognosis evaluation and clinical treatment. So as to improve the dynamic enhanced magnetic resonance examination in clinical diagnosis and treatment value. Methods from April 2011 to August 2013, 53 cases of breast cancer were examined with dynamic contrast-enhanced magnetic resonance imaging (Mr). 53 cases of breast cancer proved by operation and pathology were treated with chemotherapy and radiotherapy before examination. Siemens 3.0T superconducting magnetic resonance scanner was used in Germany. T1-weighted imaging (T1weighted imaging, T1WI), T2-weighted imaging (T2weighted imaging, T2WI) and dynamic enhancement were used to observe the morphologic features (size and shape of mass) after enhancement. Edge), time signal intensity curve (time signal-intensity curve, TIC) type, enhancement form, early enhancement rate, etc.). The expression of ER,PR,Her-2,Ki-67 was detected by immunohistochemical staining. To analyze the correlation between dynamic enhanced magnetic resonance (dynamic contrast-enhanced magnetic resonance imaging, DCE-MRI) and molecular biological indexes in breast cancer. All the data were processed by SPSS19.0 software, using non-parametric statistics Spearman grade correlation test, P0.05 for the difference was statistically significant. Results (1) there was a positive correlation between tumor size and Ki-67 positive expression (P 0.05), but no correlation with ER,PR, Her-2 (r = -0.027 ~ -0.119 ~ 0.046). The higher the positive expression rate of Ki-67 was. (2) there was a positive correlation between tumor morphology and Her-2 positive expression (P 0.05), a significant positive correlation with Ki-67 expression (r = 0.427, P0.01), and no correlation with ER,PR (r = 0.102, 0.134, respectively). P0.05), in round, lobular and irregular tumors, the positive expression rate of Her-2, Ki-67 was increased in turn, and the positive expression rate of Her-2,Ki-67 was higher when the mass tended to lobular shape and irregular shape. (3) the positive expression of ER, PR was positively correlated with the margin of the tumor (r = 0.288%, P < 0.05), but not correlated with the expression of Her-2,Ki-67 (r = 0.185%, 0.096%, respectively). The positive expression rate of ER,PR was higher in the tumor of Spurs. (4) the positive expression of PR was negatively correlated with the enhancement of tumor (r = 0.198 ~ 0.211), but not with ER,Her-2,Ki-67 (r = 0.198 ~ (-0.211) ~ (0.202). The more inclined the tumor was to circular enhancement, the lower the positive expression rate of PR was. (5) there was a significant positive correlation between TIC type and Ki-67 positive expression (r = 0.358P 0.01), but no correlation with ER,PR,Her-2 (r = 0.182P 0.067 0. 229P 0.05), especially when TIC- type 鈪，

本文編號(hào)：2302928