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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2013, Vol. 07 ›› Issue (05) : 338 -344. doi: 10.3877/cma.j.issn.1674-0807.2013.05.006

论著

三阴性乳腺癌与非三阴性乳腺癌的病理特征及X 线摄影征象比较
崔春晓1, 林青2,†(), 刘小庆1, 赵继平1, 唐晓燕1   
  1. 1.266000 青岛大学医学院附属医院放射科
    2.266000 青岛大学医学院附属医院乳腺影像科
  • 收稿日期:2012-12-05 出版日期:2013-10-01
  • 通信作者: 林青
  • 基金资助:
    青岛市公共领域科技支撑计划项目[2012-1-3-2-(8)-nsh]

Comparison of pathologic characteristics and mammographic findings between triple negative breast cancer and non-triple negative breast cancer

Chun-xiao CUI1, Qing LIN1,†(), Xiao-qing LIU1, Ji-ping ZHAO1, Xiao-yan TANG1   

  1. 1.Department of Radiology, Affiliated Hospital of Medical College of Qingdao University,Qingdao 266000, China
  • Received:2012-12-05 Published:2013-10-01
  • Corresponding author: Qing LIN
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引用本文：

崔春晓, 林青, 刘小庆, 赵继平, 唐晓燕. 三阴性乳腺癌与非三阴性乳腺癌的病理特征及X 线摄影征象比较[J/OL]. 中华乳腺病杂志(电子版), 2013, 07(05): 338-344.

Chun-xiao CUI, Qing LIN, Xiao-qing LIU, Ji-ping ZHAO, Xiao-yan TANG. Comparison of pathologic characteristics and mammographic findings between triple negative breast cancer and non-triple negative breast cancer[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2013, 07(05): 338-344.

目的

探讨三阴性乳腺癌(TNBC)的病理特征及X 线摄影征象。

方法

回顾性分析本院1102 例经病理检查证实为原发性乳腺癌的女性患者资料,其中包括:ER(-)/PR(-)/HER-2(-)组(TNBC 组)174 例,ER(-)/PR(-)/HER-2(+)组183 例,ER(+)/PR(-)/HER-2(-)组65 例,ER(+)/PR(+)/HER-2(-)组583 例,ER(+)/PR(+)/HER-2(+)组97 例。患者术前均完成双侧或单侧乳腺X 线常规摄影。采用χ2 检验比较TNBC 与其他组乳腺癌的X 线表现;采用方差分析比较肿块直径的差异,并用LSD检验进行两两比较;采用Dunnett t3 检验两两比较患者发病年龄的差异。

结果

(1)各组乳腺癌患者发病年龄的差异有统计学意义(F=3.877,P=0.004),其中TNBC 组的发病年龄较ER(+)/PR(+)/HER-2(+)组大[(51.9±9.2)岁比(48.3±8.9)岁,P=0.020]。各组乳腺癌的主要组织病理学类型均为浸润性导管癌。(2)TNBC 组较ER(-)/PR(-)/HER-2(+)组、ER(+)/PR(+)/HER-2(+)组更多表现为单纯肿块(χ2=24.808、13.628,P 均＜0.005),较少伴有钙化(χ2=28.392、10.609, P 均＜0.005)。TNBC 肿块多为圆形或卵圆形[与ER(-)/PR(-)/HER-2(+)组、ER(+)/PR(-)/HER-2(-)组及ER(+)/PR(+)/HER-2(+)组相比,χ2 =21.328、15.035、21.556,P 均＜0.005],边缘模糊。TNBC 肿块直径较ER(+)/PR(-)/HER-2(-)组和ER(+)/PR(+)/HER-2(-)组大[(23.93±11.59)mm 分别比(18.06±5.76)mm和(20.23±7.80)mm,P=0.003、0.030]。

结论

TNBC 的X 线摄影多表现为单纯肿块,呈圆形或卵圆形,多边界模糊,部分病变边界清楚,较少伴有钙化。此特点有助于此亚型乳腺癌的X 线诊断。

关键词: 乳腺肿瘤, 乳房X 线摄影术, 免疫组织化学

Objective

To evaluate the pathologic characteristics and mammographic findings of triple negative breast cancer (TNBC).

Methods

We retrospectively analyzed the clinical data of 1102 women who had been pathologically diagnosed with primary breast cancer in our hospital, including: TNBC group [n=174,ER(-)/PR(-)/HER2(-)], ER(-)/PR(-)/HER-2(+) group (n=183), ER(+)/PR(-)/HER-2(-)group (n=65), ER(+)/PR(+)/HER-2(-)group (n=583) and ER(+)/PR(+)/HER-2(+) group (n=97).All patients underwent bilateral or unilateral mammography before operation.χ2-test was used to compare the mammographic findings between TNBC group and other groups, one-way ANOVA to compare the tumor size among groups.LSD test was performed for pairwise comparison and Dunnett t3 test was conducted to compare the onset age among groups.

Results

(1)The mean onset age was significantly different among groups (F=3.877,P=0.004), and the mean onset age of TNBC group was older than that of ER(+)/PR(+)/HER-2(+)group[(51.9±9.2) years vs (48.3±8.9)years, P = 0.020].Invasive ductal carcinoma was the main histopathological type of breast cancer in each group.(2)Compared with ER(-)/PR(-)/HER-2(+) group and ER(+)/PR(+)/HER-2(+) group, TNBC group more presented with single mass (χ2=24.808,13.628;all P＜0.005) and less frequently associated with microcalcifications (χ2=28.392,10.609;all P＜0.005).The masses were usually round or oval with indistinct margins in TNBC group [compared with ER(-)/PR(-)/HER-2(+), ER(+)/PR(-)/HER-2(-) and ER(+)/PR(+)/HER-2 (+) groups, χ2 =21.328,15.035,21.556, all P＜0.005 ].The mean diameter of the masses in TNBC group was significantly larger than that in ER(+)/PR(-)/HER-2(-) group or ER(+)/PR(+)/HER-2(-) group [(23.93±11.59) mm, (18.06±5.76) mm, (20.23±7.80) mm; P=0.003,0.030).

Conclusion

The mammography of TNBC often shows single mass, round or oval, with indistinct margin, some lesions with clear margin, less associated with microcalcifications, which may be useful in mammographic diagnosis of TNBC.

Key words: Breast neoplasms, Mammography, Immunohistochemistry
表1 各组乳腺癌患者的发病年龄比较
组别 例数 发病年龄(岁,x¯±s)
TNBC组 174 51.9±9.2a
ER(-)/PR(-)/HER-2(+)组 183 52.3±9.1
ER(+)/PR(-)/HER-2(-)组 65 54.0±11.5
ER(+)/PR(+)/HER-2(-)组 583 51.2±10.5
ER(+)/PR(+)/HER-2(+)组 97 48.3±8.9
F值 3.877
P值 0.004
表2 各组乳腺癌的组织病理类型比较
组别 例数 原位癌[例(%)] 浸润性导管癌[例(%)] 其他[例(%)]
三阴性乳腺癌组 174 19(10.92)a 136(78.16) 19(10.92)
ER(-)/PR(-)/HER-2(+)组 183 33(18.03)b 149(81.42) 1(0.55)
ER(+)/PR(-)/HER-2(-)组 65 5(7.69) 60(92.31) 0(0.00)
ER(+)/PR(+)/HER-2(-)组 583 61(10.46) 476(81.65) 46(7.89)
ER(+)/PR(+)/HER-2(+)组 97 3(3.09) 87(89.69) 7(7.22)
χ 2值 16.365c
P值 0.003c
图1 三阴性乳腺癌X 线摄影[头尾位(CC 位)] 患者为女性,59 岁,发现右侧乳腺肿块1 d。乳腺X 线摄影显示:右侧乳腺外上象限类圆形肿块,边界清楚,后方见斑片状浸润,未见钙化(此种类型病变约占TNBC 的63.3%);病理学诊断:浸润性导管癌(基底细胞样型,Ⅲ级,大小为3.0 cm×3.0 cm×1.5 cm);免疫组织化学:ER-/PR-/HER-2-
图2 ER(-)/PR(-)/HER-2 (+)乳腺癌X 线摄影[内外侧斜位(MLO 位)] 患者为女性,49 岁,发现右侧乳腺肿物7 d。乳腺X 线摄影显示:左侧乳腺外上象限分叶状肿块,边缘模糊有毛刺,向周围浸润,伴棒状、分枝状钙化; 病理学诊断:左侧乳腺浸润性导管癌(Ⅲ级,大小为2.5 cm×2.0 cm×1.5 cm); 免疫组织化学:ER-/PR-/HER-2 3+
图3 ER(+)/PR(+)/HER-2(+)乳腺癌X 线摄影[头尾位(CC 位)] 患者为女性,79 岁,发现右侧乳腺肿块半年。乳腺X 线摄影示:右侧乳腺上象限分叶状肿块,边界模糊,见毛刺征,内部见成簇分布多形性钙化灶,密度不均质; 病理学诊断:右侧乳腺浸润性导管癌(Ⅱ级,直径3.5 cm);免疫组织化学:ER 2+/PR 3+/HER-2+
表3 各组乳腺癌的X 线征象比较
组别 例数 X线征象[例(%)]
阴性 阳性
三阴性乳腺癌组 174 24(13.79) 150(86.21)
ER(-)/PR(-)/HER-2(+)组 183 16(8.74) 167(91.26)
ER(+)/PR(-)/HER-2(-)组 65 4(6.15) 61(93.85)
ER(+)/PR(+)/HER-2(-)组 583 88(15.09) 495(84.91)
ER(+)/PR(+)/HER-2(+)组 97 9(9.28) 88(90.72)
χ 2值 9.255
P值 0.055
表4 阳性病例的乳腺癌X 线特征
组别 例数 X线征象[例(%)]
单纯肿块 单纯钙化 肿块合并钙化 局限性致密并钙化 局限性致密 结构扭曲
三阴性乳腺癌组 150 95(63.33)ab 9(6.00) 21(14.00) 6(4.00) 18(12.00) 1(0.67)
ER(-)/PR(-)/HER-2(+)组 167 59(35.33) 36(21.56) 48(27.74) 5(2.99) 18(10.78) 1(0.60)
ER(+)/PR(-)/HER-2(-)组 61 27(44.26) 5(8.20) 14(22.95) 0(0.00) 12(19.67) 3(4.92)
ER(+)/PR(+)/HER-2(-)组 495 287(57.98) 48(9.70) 69(13.94) 8(1.62) 60(12.12) 23(4.65)
ER(+)/PR(+)/HER-2(+)组 88 34(38.64) 14(15.91) 24(27.27) 1(1.14) 12(13.64) 3(3.41)
χ 2值 41.159c
P值 0.000c
表5 阳性病例的肿块及钙化情况
组别 例数 肿块类型[例(%)] 钙化情况[例(%)]
肿块型a 非肿块型 钙化型b 非钙化型
三阴性乳腺癌组 150 116(77.33) 34(22.67) 36(24.00)c 114(76.00)
ER(-)/PR(-)/HER-2(+)组 167 107(64.07) 60(35.93) 89(53.29) 78(46.71)
ER(+)/PR(-)/HER-2(-)组 61 41(67.21) 20(32.79) 19(31.15) 42(68.85)
ER(+)/PR(+)/HER-2(-)组 495 356(71.92) 139(28.08) 125(25.25) 370(74.75)
ER(+)/PR(+)/HER-2(+)组 88 58(65.91) 30(34.09) 39(44.32) 49(55.68)
χ 2值 8.381 55.676
P值 0.079 0.000
图4 ER(+)/PR(-)/HER2(-)乳腺癌X 线摄影[头尾位(CC 位)] 患者为女性,53 岁,发现右侧乳腺肿块10 余天。乳腺X 线摄影显示:右侧乳腺深部不规则形高密度肿块,边缘模糊、分叶,可见毛刺。病理学诊断:右侧乳腺浸润性导管癌(Ⅱ级,大小4.0 cm×2.5 cm×2.0 cm);免疫组织化学:ER 3+/PR-/HER-2-
图5 ER(+)/PR(+)/HER-2(-)乳腺癌X 线摄影[内外侧斜位(MLO 位)] 患者为女性,44 岁,发现右侧乳腺肿物15 d。乳腺X 线摄影显示:右侧乳腺内上象限不规则形肿块,伴成簇分布细小钙化,边缘模糊;病理学诊断:右侧乳腺浸润性导管癌(Ⅱ～Ⅲ级,大小2.2 cm×2.0 cm×2.0 cm),免疫组织化学:ER 3+/PR 2+/HER-2-
表6 各组乳腺癌肿块的特征比较
组别 肿块数 肿块形态[例(%)] 肿块边缘[例(%)] 肿块直径(mm)
类圆形a 分叶状和不规则形 清楚 模糊 浅分叶 毛刺
三阴性乳腺癌组 116 89(76.72)bc 27(23.28) 14(12.07)d 63(54.31) 23(19.83) 16(13.79) 23.93±11.59f
ER(-)/PR(-)/HER-2(+)组 107 50(46.73) 57(53.27) 4(3.74) 67(62.62) 13(12.15) 23(21.50) 21.65±7.21
ER(+)/PR(-)/HER-2(-)组 41 18(43.90) 23(56.10) 4(10.00) 21(52.50) 1(2.44) 15(37.50) 18.06±5.76
ER(+)/PR(+)/HER-2(-)组 356 186(52.24) 170(47.76) 14(3.93) 181(50.84) 40(11.24) 121(33.99) 20.23±7.80
ER(+)/PR(+)/HER-2(+)组 58 39(67.24) 19(32.76) 1(1.72) 34(58.62) 10(17.24) 13(22.41) 21.81±7.11
检验值 χ 2=31.418 χ 2=15.080e F=4.619
P值 0.000 0.005e 0.001
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