發(fā)布時間：2018-06-17 13:40

  本文選題：乳腺癌 + 空芯針活組織檢查　； 參考：《中國人民解放軍軍事醫(yī)學(xué)科學(xué)院》2016年碩士論文

【摘要】：目 的乳腺癌在我國近十幾年總體發(fā)病率呈現(xiàn)上升趨勢,位居城鄉(xiāng)女性首位,是危害生命健康的最主要的惡性腫瘤之一。1980年Fisher醫(yī)生提出乳腺癌是一個全身性疾病的新生物學(xué)觀點。隨著對乳腺癌研究的不斷深入,Fisher的觀點被越來越廣泛的接受。目前根據(jù)2015年NCCN指南,中晚期乳腺癌推薦行新輔助化療(neoadjuvant chemotherapy,NAC),新輔助化療可提高乳腺手術(shù)的保乳率,使越來越多的患者避免切除乳房的困擾,已逐漸成為診療常規(guī)。新輔助化療方案選擇和制定必須依據(jù)空芯針穿刺活檢所取得的腫瘤組織病理及免疫組化結(jié)果,在不能獲得全部腫瘤組織的情況下,空芯針穿刺病理的準(zhǔn)確性就顯得十分重要,雖然已有文獻(xiàn)證實空芯針穿刺病理的準(zhǔn)確性,但是在臨床診治過程中,乳腺癌穿刺活檢與術(shù)后病理之間,病理類型和免疫組化結(jié)果存在一定的不一致,文獻(xiàn)報道雌激素受體(estrogen receptor,ER)、孕激素受體(progesterone receptor,PR)、表皮生長因子受體2(human epidermal growthfactor receptor 2,HER2)受體的不一致比例3%-18%不等。受體狀態(tài)的變化是否會對患者新輔助的治療效果產(chǎn)生影響少有文獻(xiàn)報道。本項研究應(yīng)用大樣本量的回顧性分析對穿刺活檢和術(shù)后病理、新輔助治療前后的病理和免疫組化的一致性進(jìn)行研究,并分析病理和免疫組化的一致性對新輔助化療的影響。探索腫瘤穿刺后和新輔助化療后病理、ER、PR、HER2受體和Ki67值的變化規(guī)律,給臨床治療提供一些有效的指導(dǎo),給術(shù)后輔助化療提供一些參考的依據(jù)。材料與方法選取統(tǒng)計軍事醫(yī)學(xué)科學(xué)院附屬醫(yī)院從2011年11月到2015年6月行乳腺腫物穿刺活檢的乳腺癌病例,患者在穿刺前未行任何與腫瘤相關(guān)的治療,根據(jù)病人穿刺后行手術(shù)還是新輔助化療,將病人分為穿刺-手術(shù)組和穿刺-化療-手術(shù)組兩組。共收集穿刺-手術(shù)組病例205例,穿刺-化療-手術(shù)組病例439例。第一部分：穿刺-手術(shù)組病例的病理一致性分析1.配對同一名患者的穿刺活檢與術(shù)后病理標(biāo)本。補(bǔ)充和完善穿刺-手術(shù)組病例的臨床信息及穿刺活檢與術(shù)后的病理及免疫組化(ER、PR、HER2、Ki67)結(jié)果。205例患者中有2例穿刺沒有診斷而術(shù)后病理確診惡性,有5例為不典型、3例不能排除惡性建議均建議手術(shù)確診。共有188例病例穿刺與手術(shù)標(biāo)本均診斷為乳腺癌并有完善的病理資料。2.病理醫(yī)生復(fù)核病理及免疫組化結(jié)果。3.Ki67以14%為界,≤14%為低表達(dá),14%為高表達(dá)。對ER、PR、HER2、Ki67和分子分型共5個項目進(jìn)行一致性檢驗,計算一致率并記錄其變化(如ER的上調(diào)或下降等)。第二部分：穿刺-化療-手術(shù)組的病理一致性分析1.配對同一名患者的新輔助治療前后的病理標(biāo)本。補(bǔ)充和完善穿刺-化療-手術(shù)組病例的臨床信息及新輔助化療前后病理及免疫組化(ER、PR、HER2、Ki67)結(jié)果,439例中行蒽環(huán)類聯(lián)合紫衫類(AT)方案205例,蒽環(huán)類聯(lián)合紫衫類序貫長春瑞賓聯(lián)合順鉑(AT-NP)方案54例,蒽環(huán)類聯(lián)合紫衫類加曲妥珠單抗(ATH)方案62例,多西他賽聯(lián)合卡鉑加曲妥珠單抗(TCH)方案12例,多西他賽聯(lián)合聯(lián)合卡培他濱(TX)方案4例,其他方案102例。行AT方案205個病例中,共有165例病例有完善的病理資料,病理完全緩解(pathologic complete response,PCR)28例。2.病理醫(yī)生復(fù)核病理及免疫組化結(jié)果。3.Ki67以14%為界, 莖14%為低表達(dá),14%為高表達(dá)。對ER、PR、HER2、KI67和分子分型共5個項目進(jìn)行一致性檢驗,計算一致率并記錄其變化(如ER的上調(diào)或下降等)。第三部分：判斷ER、PR、HER2受體狀態(tài)的變化對新輔助化療療效的影響。1.根據(jù)穿刺-化療-手術(shù)組病例穿刺活檢與術(shù)后的病理及免疫組化中ER、PR、HER2的表達(dá)是否相同,有一個項目不同為不一致,將穿刺-化療-手術(shù)組病例分為一致組和不一致組兩組。2.統(tǒng)計兩組患者NAC后腫瘤的緩解率。緩解率=[(治療前最大徑-治療后最大徑)/治療前最大徑]×100%。3.使用t檢驗統(tǒng)計分析兩組病人的緩解率是否存在差異。所有數(shù)據(jù)均使用SAS9.1版軟件進(jìn)行統(tǒng)計分析,以P0.05有統(tǒng)計學(xué)意義。結(jié)果1.穿刺活檢診斷乳腺癌的敏感度和特異度分別99.02%和95.12%。穿刺-手術(shù)組的188例乳腺癌患者CNB和OEB標(biāo)本的病理類型一致,P=0.9955,分子亞型時一致率為72.34%,k=0.6064。ER,PR,HER2的一致率分別為94.68%,k=0.862、93.62%,k=0.8658和94.68%,k=0.8539,一致率均在93%以上,kappa檢驗的結(jié)果k值均大于0.75,顯示具有很好的一致性。開放切除活檢(open excision biopsy,OEB)樣本中Ki67的表達(dá)高于CNB樣本,一致率為73.40%,k=0.1492,提示一致性差,兩者的平均數(shù)分別為21.649%和25.899%,對兩組Ki67值進(jìn)行了配對設(shè)計定量資料的符號秩和檢驗,結(jié)果S=617,P=0.0013,差異具有統(tǒng)計學(xué)意義。2.穿刺-化療-手術(shù)組中行AT新輔助治療的137名患者的治療前后乳腺癌分子分型的一致率為56.64%,k=0.3778。ER、PR、HER2的一致率分別為87.61%,k=0.6678、80.53%,k=0.5959和93.81%,k=0.4305。Kappa值位于0.45-0.75之間,只有較好的一致性。對比穿刺-手術(shù)組的一致性檢驗結(jié)果,NAC對ER、PR、HER2的一致性存在影響。其中ER、HER2受體的陽性率無明顯變化,PR受體更易受到化療的影響導(dǎo)致陽性率下降。HR受體的狀態(tài)沒有受到NAC的影響,一致率為92.7%,k=0.796。Ki67的表達(dá)在NAC后明顯降低(P0.001),平均數(shù)分別是35.75%和19.12%。137例患者中有44例出現(xiàn)了ER、PR、HER2的受體狀態(tài)的改變,占總例數(shù)的32.11%。根據(jù)AT新輔助化療的周期數(shù)將病例分為4周期組,6周期組和8周期組,則ER、PR、HER2的受體狀態(tài)的改變率分別為27.08%,39.22%,38.46%。3.根據(jù)新輔助化療前后ER、PR、HER2的受體狀態(tài)是否一致,將137個病人分為一致組和差異組。計算兩組患者的腫瘤臨床緩解率(clinical response rate,cRR),均數(shù)分別為48.51%和48.20%,P=0.0957,差異沒有統(tǒng)計學(xué)意義。結(jié)論1.CNB可以準(zhǔn)確確定乳腺癌的ER、PR和HER2狀態(tài)以及Ki67值。對于non-Luminal型的腫瘤,術(shù)前CNB即可準(zhǔn)確確定分子亞型。對于性激素受體(HR)+/HER2-標(biāo)本,由于CNB后Ki67值會上升,在制定NAC方案時應(yīng)考慮此因素。2.NAC會使乳腺癌Ki67的表達(dá)下降,并在一定程度上引起雌激素受體(ER)、孕激素受體(PR)、HER2的表達(dá)下調(diào),但差異均沒有統(tǒng)計學(xué)意義,也不會對HR受體產(chǎn)生影響。3. ER、PR、HER2的改變率與NAC的周期數(shù)成正比,在6周期后達(dá)到高峰。4. ER、PR、HER2受體狀態(tài)的變化并不會引起NAC療效上的差異。CNB可作為選擇NAC方案的可靠依據(jù)。
[Abstract]:Objective the overall incidence of breast cancer in China has increased in the past decade, ranking first in urban and rural women. It is one of the most important malignant tumors that endanger life and health. Dr. Fisher proposed that breast cancer is a new biological view of a systemic disease in.1980. With the deepening of research on breast cancer, the view of Fisher is becoming more and more important. Widely accepted. According to the 2015 NCCN guide, new adjuvant chemotherapy (neoadjuvant chemotherapy, NAC) is recommended for middle and late stage breast cancer. Neoadjuvant chemotherapy can improve breast conserving rate of breast surgery and make more and more patients avoid the problem of breast resection. The results of histopathology and immunohistochemistry obtained by needle aspiration biopsy are very important for the accuracy of the pathology of the puncture needle puncture, although the accuracy of hollow needle puncture pathology has been proved in the literature, but during the clinical diagnosis, the biopsy of the breast cancer and the postoperative pathology There was a certain disagreement between the pathological and immunohistochemical results. The literature reported that the estrogen receptor (estrogen receptor, ER), progestin receptor (progesterone receptor, PR), epidermal growth factor receptor 2 (human epidermal growthfactor receptor 2, HER2) were different proportions of 3%-18%. The effect of new adjuvant therapy was rarely reported. This study used a retrospective analysis of a large sample of biopsy and postoperative pathology, the consistency of pathology and immunohistochemistry before and after neoadjuvant therapy, and analyzed the effect of the consistency of pathology and immunohistochemistry on neoadjuvant chemotherapy. And the changes of ER, PR, HER2 receptor and Ki67 value after neoadjuvant chemotherapy, provide some effective guidance for clinical treatment, provide some reference basis for postoperative adjuvant chemotherapy. Materials and methods selected statistics of breast cancer cases from November 2011 to June 2015 of the Affiliated Hospital of Military Medical Science Academy of the PLA, The patient was not treated with any tumor related treatment before the puncture. According to the patient's puncture operation or neoadjuvant chemotherapy, the patients were divided into two groups: puncture operation group and puncture chemotherapy operation group. A total of 205 cases of puncture operation group, 439 cases of puncture chemotherapy operation group were collected. Part 1: pathological agreement in the puncture operation group. Paracentesis and postoperative pathological specimens of 1. matched patients. Supplementary and perfected the clinical information of the cases of the puncture and operation group and the results of biopsy and postoperative pathology and immunohistochemistry (ER, PR, HER2, Ki67). There were 2 cases in.205 patients without diagnosis but 5 cases were atypical, 3 cases were not excluded. A total of 188 cases were diagnosed as breast cancer and 188 cases were diagnosed as breast cancer and had perfect pathological data. The pathological and pathological findings of the pathology and immunohistochemical results were 14%, low expression of less than 14%, and high expression of 14%. A total of 5 items of ER, PR, HER2, Ki67 and molecular typing were tested and calculated. The rate of consistency and records of changes (such as the up or down of ER). The second part: the pathological consistency analysis of the puncture, chemotherapy and operation group. 1. pairs of the pathological specimens of the same patient before and after the new adjuvant treatment. Supplement and improve the clinical information of the case of the puncture chemotherapy operation group and the pathological and immunohistochemical (ER, PR, HER2, Ki) before and after the neoadjuvant chemotherapy 67) 439 cases, 205 cases of anthracycline combined purple shirt (AT), 54 cases of anthracene ring combined with Changchun ribin combined with cisplatin (AT-NP), 62 cases of anthracycline combined with ATH, 12 cases of docetaxel combined with carboplatin plus trumpet (TCH), docetaxel combined with capecitabine (TX). Of the 4 cases and other 102 cases, of the 205 cases of AT scheme, 165 cases had perfect pathological data, pathological complete remission (pathologic complete response, PCR) 28 cases of.2. pathologists, pathological and immunohistochemical results,.3.Ki67 to 14%, low expression of stem 14%, and 14% high expression. ER, PR, HER2, KI67, and molecular typing were 5. The third part: determine the effect of ER, PR, HER2 receptor status on the effect of neoadjuvant chemotherapy..1. based on the same expression of ER, PR, HER2 in the biopsy and postoperative pathology and immunohistochemistry of the puncture chemotherapy operation group, and the same, there is one of the same. Different items were different, the cases of puncture chemotherapy and operation group were divided into two groups of unanimous group and unconforming group. Two groups of.2. statistics in two groups of patients were remission rate after NAC. The remission rate = [(the maximum diameter before treatment - the maximum diameter after treatment) / the maximum diameter before treatment] x 100%.3. by t test statistics analysis of the remission rates of two groups of patients. According to the statistical analysis of SAS9.1 software, the results of P0.05 were statistically significant. Results 1. the sensitivity and specificity of breast cancer diagnosis were 99.02% and 95.12%., respectively, and 188 cases of breast cancer patients with breast cancer were consistent with the pathological types of CNB and OEB, P=0.9955, the consistency rate of the molecular subtypes was 72.34%, k=0.6064.ER, PR, HER2. The rates were 94.68%, k=0.862,93.62%, k=0.8658, and 94.68%, and k=0.8539, all the conformance rates were above 93%. The k values of kappa test were all greater than 0.75, showing a good consistency. The expression of Ki67 in the samples of open excision biopsy (open excision biopsy, OEB) was higher than that of CNB sample, and the consensus rate was 73.40%. K=0.1492, suggesting that the consistency was poor, both were flat. The average numbers were 21.649% and 25.899% respectively. The symbol rank and test of the paired design quantitative data were carried out for the Ki67 values of the two groups. The results were S=617, P=0.0013, and the difference was statistically significant in 137 patients with AT neoadjuvant therapy in the.2. puncture chemotherapy operation group. The consistency of the molecular classification of breast cancer before and after treatment was 56.64%, k=0.3778.ER, PR, HER2. The rates were 87.61%, k=0.6678,80.53%, k=0.5959 and 93.81%, and the k=0.4305.Kappa value was between 0.45-0.75, only good consistency. Compared with the consistency test of the puncture operation group, NAC had an effect on the consistency of ER, PR, HER2. The positive rate of ER, HER2 receptor was not obviously changed, and PR receptor was more susceptible to the effect of chemotherapy. The state of.HR receptor was not affected by NAC, the consistency rate was 92.7%, the expression of k=0.796.Ki67 decreased significantly after NAC (P0.001). The average number of 35.75% and 19.12%.137 patients had 44 cases of ER, PR, and HER2 receptor state changes, and the 32.11%. of the total number of cases divided the cases into 4 according to the cycle number of AT neoadjuvant chemotherapy. In the periodic group, the 6 cycle group and the 8 cycle group, the changes of the receptor status of ER, PR, and HER2 were 27.08%, 39.22%, and 38.46%.3. were based on the consistent receptor status of ER, PR and HER2 before and after the neoadjuvant chemotherapy. The 137 patients were divided into the same group and the difference group. The clinical remission rate (clinical response rate, cRR) of the two groups of patients was calculated, respectively. For 48.51% and 48.20%, P=0.0957, the difference is not statistically significant. Conclusion 1.CNB can accurately determine the ER, PR and HER2 status of breast cancer and the Ki67 value. For the non-Luminal type tumor, the preoperative CNB can accurately determine the molecular subtype. For the sex hormone receptor (HR) +/HER2- specimens, the Ki67 value will rise after CNB, and should be considered in the formulation of the scheme. This factor.2.NAC can decrease the expression of Ki67 in breast cancer, and to some extent cause the estrogen receptor (ER), progesterone receptor (PR) and HER2 expression down, but the difference is not statistically significant, and does not affect the HR receptor of.3. ER, PR, HER2 is proportional to the cycle number of NAC, reaching the peak after the 6 cycle. Changes in body status will not cause differences in the efficacy of NAC..CNB can be used as a reliable basis for selecting NAC protocols.
【學(xué)位授予單位】：中國人民解放軍軍事醫(yī)學(xué)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R737.9

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7 唐美潔;;老年晚期乳腺癌新輔助化療的臨床護(hù)理與探討[A];2011年老年護(hù)理安全管理學(xué)術(shù)交流會暨高級研修班論文集[C];2011年

8 張文瑩;孫曉文;;1例乳腺癌新輔助化療誘發(fā)糖尿病的術(shù)后護(hù)理體會[A];“河南省腫瘤�？谱o(hù)士職業(yè)安全防護(hù)及新技術(shù)交流”學(xué)術(shù)會論文集[C];2011年

9 莫慶玉;;乳腺癌新輔助化療100例的觀察及護(hù)理[A];中華護(hù)理學(xué)會全國腫瘤護(hù)理學(xué)術(shù)交流暨專題講座會議論文匯編[C];2010年

10 彭忠民;劉奇;;耐藥相關(guān)基因表達(dá)對Ⅲ期非小細(xì)胞肺癌新輔助化療的臨床預(yù)測[A];第四屆中國腫瘤學(xué)術(shù)大會暨第五屆海峽兩岸腫瘤學(xué)術(shù)會議論文集[C];2006年

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7 李新萍;新輔助化療為晚期乳腺癌患者帶來手術(shù)機(jī)會[N];中國醫(yī)藥報;2009年

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