常规超声及声辐射力脉冲成像技术在乳腺癌免疫组化分型中的应用研究
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摘要
目的探讨常规超声及声辐射力脉冲成像(Acoustic Radiation Force Impulse,ARFI)技术在乳腺癌免疫组化分型中的应用价值。方法综回顾性分析148例经手术或穿刺病理证实的乳腺癌患者常规超声征象及ARFI技术剪切波速度值。根据免疫组化中ER、PR、HerbB-2、Ki-67的表达强度,将乳腺癌患者分为4种类型,即管腔上皮A型、管腔上皮B型、HerbB-2过表达型及三阴性型,比较四组不同免疫组化分型乳腺癌常规超声征象及剪切波速度值是否有差异。结果三阴型乳腺癌多表现为肿块>2.0 cm(65.00%)、形态规则(30.00%)、边界清晰(45.00%),并且三阴型乳腺癌淋巴结转移率较高(40.00%);管腔上皮A型中边缘毛刺(40.43%)、纵横比>1(65.96%)征象显著高于其他各型;HerbB-2过表达型乳腺癌常伴微钙化(42.86%)及血流分级Ⅱ-Ⅲ级(36.67%);四组不同免疫组化分型乳腺癌的剪切波速度值结果显示,管腔上皮A型组的剪切波速度值最低,而HerbB-2过表达型组剪切波速度值高于管腔上皮A型、管腔上皮B型及三阴型,差异有统计学意义。结论不同免疫组化分型乳腺癌常规超声征象及ARFI技术剪切波速度值有差异,常规超声结合ARFI技术可初步预估乳腺癌的生物学行为,为新辅助化疗疗效的评估及指导穿刺活检提供帮助。
Objective To discuss the application value of conventional ultrasound and acoustic radiation force impulse(ARFI)technology in immunohistochemical typing of breast cancer. Methods Conventional ultrasonic images and shear wave velocity values by ARFI technology of 148 breast cancer patients were retrospectively analyzed, which were confirmed by surgery or puncture pathology. According to the expression of the ER, PR, HerbB-2 and Ki-67 in immunohistochemical, breast cancer patients were divided into four types, namely luminal epithelium type A, luminal epithelium type B, HerbB-2 overexpression type and triple-negative type. Then differences of conventional ultrasonic images and shear wave velocity values in different immunohistochemical types of breast cancer were evaluated. Results The triple-negative breast cancer were mainly manifested as tumor >2.0 cm(65.00%), regular shape(30.00%), clear boundary(45.00%), and high lymph node metastasis rate(40.00%). The images of middle edge burr(40.43%) and aspect ratio >1(65.96%)of luminal epithelium type A were significantly higher than those of other types. HerbB-2 overexpression type of breast cancer often performanced with microcalcification(42.86%)and blood ?ow class Ⅱ-Ⅲ grade(36.67%). The results of the shear wave velocity values of the four groups of differentiated immunohistochemical breast cancer showed that the shear wave velocity values of the luminal epithelium type A group were the lowest, while the shear wave velocity values of the Herbb-2 overexpression group were higher than those of the luminal epithelium type A, luminal epithelium type B and triple-negative types, with statistically significant differences. Conclusion There are differences between conventional ultrasonographic images and shear wave velocity values of different immunohistochemical breast cancer types in different groups. Conventional ultrasonography combined with ARFI technology can preliminarily predict the biological behavior of breast cancer and provide help for the evaluation of neoadjuvant chemotherapy efficacy and the guidance of puncture biopsy.
Objective To discuss the application value of conventional ultrasound and acoustic radiation force impulse(ARFI)technology in immunohistochemical typing of breast cancer. Methods Conventional ultrasonic images and shear wave velocity values by ARFI technology of 148 breast cancer patients were retrospectively analyzed, which were confirmed by surgery or puncture pathology. According to the expression of the ER, PR, HerbB-2 and Ki-67 in immunohistochemical, breast cancer patients were divided into four types, namely luminal epithelium type A, luminal epithelium type B, HerbB-2 overexpression type and triple-negative type. Then differences of conventional ultrasonic images and shear wave velocity values in different immunohistochemical types of breast cancer were evaluated. Results The triple-negative breast cancer were mainly manifested as tumor >2.0 cm(65.00%), regular shape(30.00%), clear boundary(45.00%), and high lymph node metastasis rate(40.00%). The images of middle edge burr(40.43%) and aspect ratio >1(65.96%)of luminal epithelium type A were significantly higher than those of other types. HerbB-2 overexpression type of breast cancer often performanced with microcalcification(42.86%)and blood ?ow class Ⅱ-Ⅲ grade(36.67%). The results of the shear wave velocity values of the four groups of differentiated immunohistochemical breast cancer showed that the shear wave velocity values of the luminal epithelium type A group were the lowest, while the shear wave velocity values of the Herbb-2 overexpression group were higher than those of the luminal epithelium type A, luminal epithelium type B and triple-negative types, with statistically significant differences. Conclusion There are differences between conventional ultrasonographic images and shear wave velocity values of different immunohistochemical breast cancer types in different groups. Conventional ultrasonography combined with ARFI technology can preliminarily predict the biological behavior of breast cancer and provide help for the evaluation of neoadjuvant chemotherapy efficacy and the guidance of puncture biopsy.
引文
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[14]Zhu X,Ying J,Wang F,et al.Estrogen receptor,progesterone receptor,and human epidermal growth factor receptor 2 status in invasive breast cancer:a 3,198 cases study at National Cancer Center,China[J].Breast Cancer Res Treat,2014,147(3):551-555
[15]Zeng L,Yang K.Exploring the pharmacological mechanism of yanghe decoction on HER2-positive breast cancer by a network pharmacology approach[J].J Ethnopharmacol,2017,199(5):68.
[16]Xu J,Guo X,Jing M,et al.Prediction of tumor mutation burden in breast cancer based on the expression of ER,PR,HER-2,and Ki-67[J].Onco Ther,2018,11:2269-2275.
[17]杨雅洁,孙艳花.乳腺癌组织中HER2的表达及其与临床病理特征的关系[J].南昌大学学报:医学版,2018,58(1):55-59.
[18]Dent R,Trudeau M,Pritchard KI,et al.Triple-negative breast cancer:clinical features and patterns of recurrence[J].Clin Cancer Res,2018,13(15 Pt 1):4429-4434.
[2]Turkoz FP,Solak M,Petekkaya I,et al.Association between common risk factors and molecular subtypes in breast cancer patients[J].Breast,2013,22(3):344-350.
[3]吴绍勇,谭月,官泳松.不同分子亚型乳腺癌首发肝转移患者的临床特征和预后[J].中华肝脏病杂志,2016,24(6):422-428.
[4]赵鹤楠,李紫瑶,俞卫东,等.剪切波弹性成像及超微血管显像在乳腺浸润性导管癌病理分级中的应用研究[J].中华超声影像学杂志,2017,26(2):146.
[5]Curigliano G,Burstein HJ,Winer EP,et al.De-escalating and escalating treatments for early-stage breast cancer:the St.Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017[J].Ann Oncol,2017,28(8):1700.
[6]Zhang L,Li J,Xiao Y,et al.Identifying ultrasound and clinical features of breast cancer molecular subtypes by ensemble decision[J].Sci Rep,2015,5:11085.
[7]樊智颖,王学梅,康姝,等.乳腺浸润癌剪切波弹性成像与临床病理、免疫组化特征相关性分析[J].中国医科大学学报,2014,43(4):344-350.
[8]刘军杰,陈圆圆,李智贤,等.乳腺浸润性导管癌超声BI-RADS分类与雌、孕激素受体及CerbB-2表达的相关性[J].中国医学影像学杂志,2014,22(4):244-248.
[9]李宏,李德华,胡波.乳腺癌超声征象与Ki67、p53表达的相关性及临床意义[J].中国临床医学影像杂志,2015,26(5):321-324
[10]刘海芳,高杨,姜楠,等.乳腺癌超声表现与生物学指标的相关性及对临床治疗的指导意义[J].中国医药,2015,10(1):1-4.
[11]Elebi F,Pilanc KN,Ordu E,et al.The role of ultrasonographic findings to predict molecular subtype,histologic grade,and hormone receptor status of breast cancer[J].Diagn Interv Radiol,2015,21(6):448-453.
[12]时兆婷,乐坚,陈雅玲,等.浸润性乳腺癌超声征象与腋下淋巴结转移的相关性研究[J].中华超声影像学杂志,2017,26(5):424
[13]Yang WT,Dryden M,Broglio K,et al.Mammographic features of triple receptor-negative primary breast cancers in young premenopausal women[J].Breast Cancer Res Treat,2008,111(3):405-410.
[14]Zhu X,Ying J,Wang F,et al.Estrogen receptor,progesterone receptor,and human epidermal growth factor receptor 2 status in invasive breast cancer:a 3,198 cases study at National Cancer Center,China[J].Breast Cancer Res Treat,2014,147(3):551-555
[15]Zeng L,Yang K.Exploring the pharmacological mechanism of yanghe decoction on HER2-positive breast cancer by a network pharmacology approach[J].J Ethnopharmacol,2017,199(5):68.
[16]Xu J,Guo X,Jing M,et al.Prediction of tumor mutation burden in breast cancer based on the expression of ER,PR,HER-2,and Ki-67[J].Onco Ther,2018,11:2269-2275.
[17]杨雅洁,孙艳花.乳腺癌组织中HER2的表达及其与临床病理特征的关系[J].南昌大学学报:医学版,2018,58(1):55-59.
[18]Dent R,Trudeau M,Pritchard KI,et al.Triple-negative breast cancer:clinical features and patterns of recurrence[J].Clin Cancer Res,2018,13(15 Pt 1):4429-4434.