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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (02) : 104 -108. doi: 10.3877/cma.j.issn.1674-0807.2020.02.008

所属专题： 文献；

论著

乳腺专用伽马显像中99Tcm-甲氧基异丁基异腈的摄取与乳腺浸润性导管癌患者临床病理特征的关系
杨冬竹1, 龙再颖1,†(), 于立明1, 赵艳霞1, 赵旭龙1, 单英丽1, 孟庆菊1, 张永臣1   
  1. 1. 064200　山东省威海市立医院核医学科
  • 收稿日期:2019-09-22 出版日期:2020-04-01
  • 通信作者: 龙再颖

Correlation of 99Tcm-methoxyisobutylisonitrile uptake on breast-specific gamma imaging with clinicopathological characteristics of invasive breast ductal carcinoma patients

Dongzhu Yang1, Zaiying Long1,†(), Liming Yu1, Yanxia Zhao1, Xulong Zhao1, Yingli Shan1, Qingju Meng1, Yongchen Zhang1   

  1. 1. Department of Nuclear Medicine, Weihai Municipal Hospital, Weihai 064200, Shandong Province, China
  • Received:2019-09-22 Published:2020-04-01
  • Corresponding author: Zaiying Long
  • About author:
    Corresponding author: Long Zaiying, Email:
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杨冬竹, 龙再颖, 于立明, 赵艳霞, 赵旭龙, 单英丽, 孟庆菊, 张永臣. 乳腺专用伽马显像中99Tcm-甲氧基异丁基异腈的摄取与乳腺浸润性导管癌患者临床病理特征的关系[J]. 中华乳腺病杂志(电子版), 2020, 14(02): 104-108.

Dongzhu Yang, Zaiying Long, Liming Yu, Yanxia Zhao, Xulong Zhao, Yingli Shan, Qingju Meng, Yongchen Zhang. Correlation of 99Tcm-methoxyisobutylisonitrile uptake on breast-specific gamma imaging with clinicopathological characteristics of invasive breast ductal carcinoma patients[J]. Chinese Journal of Breast Disease(Electronic Edition), 2020, 14(02): 104-108.

目的

分析乳腺浸润性导管癌患者的临床病理特征与乳腺专用伽玛显像(BSGI)中99Tcm-甲氧基异丁基异腈(MIBI)摄取之间的关系。

方法

回顾性分析2014年3月至2018年3月就诊于威海市立医院行BSGI检查、未接受新辅助治疗及穿刺活组织检查及术前无肿瘤远处转移的浸润性导管癌患者244例的临床资料。分析患者的BSGI数据，计算病灶的放射性计数与正常组织的比值(T/N)，从而评估肿瘤对99Tcm-MIBI的摄取量。T/N为偏态分布数据，用M(P25～P75)表示。用Wilcoxon秩和检验分析患者临床病理特征与T/N之间的关系，用多元线性回归模型分析患者临床病理特征对T/N的影响。

结果

全部244例患者BSGI中的T/N范围为1.0～7.5。Wilcoxon秩和检验结果显示T/N与T分期、N分期、组织学分级及Ki67表达有关(Z＝－6.852、5.198、－3.931，P均<0.001；Z＝－3.059, P＝0.002)，而与ER、PR、HER-2、P53、EGFR表达及三阴性乳腺癌无关(Z＝ －0.730、－1.526、－1.137、－1.175、－1.224、－1.556, P均>0.050)。多元线性回归分析表明T分期及N分期是T/N的影响因素(t＝5.100, 95%CI：0.414～0.935, P<0.001；t＝ 2.819, 95%CI：0.118～0.668, P＝0.005)。

结论

乳腺浸润性导管癌的T分期和N分期可能影响BSGI中肿瘤对99Tcm-MIBI的摄取，因此，可以通过术前测定BSGI的T/N，对肿瘤的恶性程度进行初步评估。

关键词: 乳腺肿瘤, 诊断显像, 99m锝甲氧基异丁基异腈
Objective

To analyze the relationship between the clinicopathological characteristics of invasive breast ductal carcinoma patients and the uptake of 99Tcm-methoxyisobutylisonitrile (MIBI) on breast-specific gamma imaging (BSGI).

Methods

We retrospectively analyzed the clinical data of 244 patients with invasive breast ductal carcinoma who underwent BSGI in the Weihai Municipal Hospital from March 2014 to March 2018, with no neoadjuvant therapy and biopsy and no distant metastasis before surgery. The BSGI data of all patients were analyzed, and the ratio of radioactive count in tumor to radioactive count in normal tissue (T/N) was calculated to assess the uptake of 99Tcm-MIBI in tumor. With skewed distribution, T/N was expressed as M(P25-P75). Wilcoxon rank sum test was used to analyze the relationship between the clinicopathological characteristics and T/N, and the multiple linear regression model was used to analyze the effect of clinicopathological characteristics on T/N.

Results

In all 244 patients, T/N on BSGI ranged from 1.0 to 7.5. The results of Wilcoxon rank sum test showed that T/N was correlated with T stage, N stage, histological grade and Ki67 expression (Z=-6.852, 5.198, -3.931, P<0.001; Z=-3.059, P=0.002), but not correlated with ER, PR, HER-2, P53, EGFR expression and triple negative breast cancer (Z=-0.730, -1.526, -1.137, -1.175, -1.224, -1.556, P>0.050). The multiple linear regression analysis showed that T stage and N stage were influencing factors of T/N (t= 5.100, 95%CI: 0.414-0.935, P<0.001; t=2.819, 95%CI: 0.118-0.668, P=0.005).

Conclusions

The T stage and N stage of invasive breast ductal carcinoma may affect the uptake of 99Tcm-MIBI on BSGI. Therefore, using BSGI, T/N can be measured preoperatively to evaluate the malignancy of tumors.

Key words: Breast neoplasms, Diagnostic imaging, Technetium Tc 99m sestamibi
表1 244例浸润性导管癌患者多元线性回归模型变量赋值表
因素 变量 变量赋值
T分期 X1 T1 ＝0，T2～T3＝1
N分期 X2 N0＝0，N1～N3＝1
组织学分级 X3 1～2级＝0，3级＝1
Ki67 X4 <10%＝0，≥10%＝1
ER X5 阴性＝0，阳性＝1
PR X6 阴性＝0，阳性＝1
HER-2 X7 阴性＝0，阳性＝1
P53 X8 野生型＝0，突变型＝1
EGFR X9 阴性＝0，阳性＝1
三阴性乳腺癌 X10 否＝0，是＝1
T/N Y 连续变量
表2 244例浸润性导管癌患者的临床病理学特征与T/N的关系
变量 例数(%) T/N[M(P25～P75)] Z值 P值
T分期 ? ? ? ?
? T1 133(54.5) 2.0(1.6～2.5) －6.852 <0.001
? T2～T3 111(45.5) 2.8(2.2～3.5)
N分期 ? ? ? ?
? N0 154(63.1) 2.1(1.7～2.6) －5.198 <0.001
? N1～N3 90(36.9) 2.8(2.2～3.5)
组织学分级 ? ? ? ?
? 1～2级 163(66.8) 2.2(1.7～2.8) －3.931 <0.001
? 3级 81(33.2) 2.6(2.0～3.7)
Ki67 ? ? ? ?
? <10% 22(9.0) 1.9(1.5～2.3) －3.059 0.002
? ≥10% 222(91.0) 2.4(1.9～3.1)
ER ? ? ? ?
? 阴性 55(22.5) 2.3(1.9～3.2) －0.730 0.465
? 阳性 189(77.5) 2.3(1.9～3.0)
PR ? ? ? ?
? 阴性 49(20.1) 2.5(2.0～3.3) －1.526 0.127
? 阳性 195(79.9) 2.3(1.8～3.0)
HER-2 ? ? ? ?
? 阴性 82(33.6) 2.4(1.9～3.0) －1.137 0.695
? 阳性 162(66.4) 2.2(1.8～3.0)
P53 ? ? ? ?
? 野生型 28(11.5) 2.5(2.0～3.3) －1.175 0.238
? 突变型 216(88.5) 2.3(1.9～3.0)
EGFR ? ? ? ?
? 阴性 170(69.7) 2.3(1.9～3.1) －1.224 0.221
? 阳性 74(30.3) 2.1(1.7～2.7)
三阴性乳腺癌 ? ? ? ?
? 是 9(3.7) 2.8(2.2～3.6) －1.556 0.120
? 否 235(96.3) 2.3(1.9～3.0)
表3 244例浸润性导管癌患者T/N影响因素的多元线性回归模型分析结果
变量 未标准化系数 标准误 标准化系数 t值 P值 95%置信区间
T分期 0.675 0.132 0.318 5.100 <0.001 0.414～0.935
N分期 0.393 0.139 0.171 2.819 0.005 0.118～0.668
组织学分级 0.129 0.071 0.115 1.824 0.069 －0.010～0.269
Ki67 0.020 0.102 0.013 0.201 0.841 －0.180～0.221
图1 1例61岁左侧乳腺浸润性导管癌患者的乳腺专用伽玛显像图　a图所示为头尾位；b图所示内外侧斜位
图2 1例51岁右侧乳腺浸润性导管癌患者的乳腺专用伽玛显像图　a图所示为头尾位；b图所示内外侧斜位
[1]
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials[J]. Lancet, 2005, 365(9472): 1687-1717.
[2]
Olsen AH, Njor SH, Vejborg I, et al. Breast cancer mortality in Copenhagen after introduction of mammography screening: cohort study[J]. BMJ, 2005，330(7485): 220.
[3]
谭辉，张一秋，石洪成. 核医学乳腺专用显像仪在乳腺癌诊疗中的应用[J]．中华核医学与分子影像杂志，2014，34(1): 73-75.
[4]
Lee A, Chang J, Lim W, et al. Effectiveness of breast-specific gamma imaging (BSGI) for breast cancer in Korea: a comparative study[J]. Breast J, 2012, 18(5): 453-458.
[5]
Sun Y, Wei W, Yang HW, et al. Clinical usefulness of breast-specific gamma imaging as an adjunct modality to mammography for diagnosis of breast cancer: a systemic review and meta-analysis[J]. Eur J Nucl Med Mol Imaging, 2013, 40(3): 450-463.
[6]
Cwikla JB, Buscombe JR, Kolasinska AD, et al. Correlation between uptake of Tc-99m sestaMIBI and prognostic factors of breast cancer[J]. Anticancer Res, 1999, 19(3B): 2299-2304.
[7]
Bonazzi G, Cistaro A, Bello M, et al. Breast cancer cellular proliferation indexes and 99mTc-sesta Mibi capture: what correlation？[J]. J Exp Clin Cancer Res, 2001, 20(1): 91-94.
[8]
Amin MB, Edge SB, Greene FL, et al. AJCC cancer staging manual[M]. 8th ed. New York: Springer, 2016: 589-628.
[9]
Hammond ME, Hayes DF, Wolff AC, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer[J]. J Oncol Pract, 2010, 6(4):195-197.
[10]
《乳腺癌HER2检测指南》编写组．乳腺癌HER2检测指南(2019版)[J]．中华病理学杂志，2019, 48(3):169-175.
[11]
许良中，杨文涛. 免疫组织化学反应结果的判断标准[J]．中国癌症杂志，1996，6(4):229-231.
[12]
Yoon HJ, Kim Y, Chang KT, et al. Prognostic value of semi-quantitative tumor uptake on Tc-99m sestamibi breast-specific gamma imaging in invasive ductal breast cancer[J]. Ann Nucl Med, 2015, 29(7): 553-560.
[13]
Tan H, Zhang H, Yang W, et al. Breast-specific gamma imaging with Tc-99m-sestamibi in the diagnosis of breast cancer and its semiquantitative index correlation with tumor biologic markers, subtypes, and clinicopathologic characteristics[J]. Nucl Med Commun, 2016, 37(8): 792-799.
[14]
Lee SJ, Choi YY, Kim C, et al. Correlations between tumor to background ratio on breast- specific gamma imaging and prognostic factors in breast cancer[J]. J Korean Med Sci, 2017, 32(6): 1031-1037.
[15]
Tadwalkar RV, Rapelyea JA, Torrente J, et al. Breast-specific gamma imaging as an adjunct modality for the diagnosis of invasive breast cancer with correlation to tumour size and grade[J]. Br J Radiol, 2012, 85(1014): e212-e216.
[16]
Papantoniou VJ, Souvatzoglou MA, Valotassiou VJ, et al. Relationship of cell proliferation (Ki-67) to 99mTc-(V)DMSA uptake in breast cancer[J]. Breast Cancer Res，2004, 6(2): R56-R62.
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