不同分子分型原发乳腺癌临床病理特征及X线、超声表现：140例23~35岁患者

曾辉; 陈卫国; 徐泽园; 马梦伟; 文婵娟; 徐维敏

doi:10.12122/j.issn.1674-4500.2020.03.05

不同分子分型原发乳腺癌临床病理特征及X线、超声表现：140例23~35岁患者

doi: 10.12122/j.issn.1674-4500.2020.03.05

南方医科大学南方医院放射科，广东广州 510515

基金项目:

南方医科大学科研启动计划创新驱动推进培育项目 PY2018N034

广东省医学科研基金 B2020095

南方医科大学南方医院院长基金 2017C040

详细信息

作者简介:
曾辉，硕士，医师，E-mail: zh491157591@163.com

通讯作者:
徐维敏，硕士，主治医师，E-mail: minmin6655@163.com

计量
- 文章访问数: 1089
- HTML全文浏览量: 467
- PDF下载量: 20
- 被引次数: 0
出版历程
- 收稿日期: 2020-06-21
- 刊出日期: 2020-07-15

Clinicopathological features, X-ray and ultrasound findings of primary young breast cancer with different molecular types

Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China

摘要

摘要: 目的探讨不同分子分型原发年轻乳腺癌的临床病理特征及X线、超声诊断要点。方法收集经病理确诊的140例原发年轻乳腺癌，回顾性分析其各亚型的临床病理资料以及X线、超声表现。采用免疫组织化学检测ER、PR、HER2及Ki-67，HER2（++）者行FISH检测。结果140例年轻乳腺癌的分子分型比例依次为Luminal B型>HER2过表达型>三阴性型>Luminal A型。各亚型年轻乳腺癌的X线表现差异具有统计学意义（P < 0.05）。Luminal A型主要表现为肿块伴钙化，呈不规则形，边缘毛刺；Luminal B型表现为肿块伴钙化，呈不规则形，边缘模糊；HER2过表达型表现为单纯钙化，呈细小多形性或/及细线样，段样分布；三阴性型表现为单纯肿块，呈不规则形，边缘模糊。不同亚型的超声均表现为不规则实性低回声团伴钙化，边缘模糊，但回声性质及血供情况存在差异。不同亚型年轻乳腺癌的病理学类型虽具有统计学意义，但均以IDC 2级多见，且以Luminal B型所占比例最高。各亚型年轻乳腺癌的淋巴结转移及远处转移以Luminal B型常见，但差异均不具有统计学意义（P>0.05）。结论本组病例超声主要征象虽不具特征性，但三阴性型较常出现混合回声，各分子亚型血供也有所区别，因此术前可根据X线及超声综合表现作出初步分子分型判定。
- 年轻 /
- 乳腺癌 /
- 乳腺X线摄影 /
- 超声 /
- 分子分型
Abstract: ObjectiveTo investigate the clinicopathological features and the main points of X-ray and ultrasound diagnosis of primary young breast cancer with different molecular types.MethodsA total of 140 cases of primary young breast cancer confirmed by pathology were collected. The clinicopathological data, X-ray and ultrasound findings of each subtype were analyzed retrospectively.ResultsThe molecular typing order of young breast cancer were Luminal B, HER2 overexpression, triple negative and Luminal A type. The mammography features was significantly different between different molecular phenotype in young breast cancer. Luminal A showed irregular mass with calcification and marginal burr and luminal B showed irregular mass with calcification and blurred margin. The overexpression of HER2 showed simple calcification, fine pleomorphism or/and thin line, segment-like distribution, and triple negative showed simple irregular mass with blurred edge. Different subtypes of ultrasound showed irregular solid hypoechoic masses with calcification and blurred edges. There were differences in echo properties and blood supply. Although the pathological types of different subtypes of young breast cancer were significant, most of them were IDC grade 2 and Luminal B type accounted for the highest proportion Luminal B type was the most common subtype of young breast cancer with lymph node metastasis and distant metastasis, but the difference was not statistically significant.ConclusionsThe main ultrasonographic signs of this group of cases are not characteristic, mixed echoes are more common in the triple negative type, and the blood supply of each molecular subtype is also different. Therefore, a preliminary molecular classification can be made according to the comprehensive manifestations of X-ray and ultrasound before operation.
- youth /
- breast cancer /
- mammography /
- ultrasound /
- molecular phenotype

HTML全文

图 1 33岁女性，浸润性导管癌1级，Luminal A型

A-C: FFDM图示左乳外上象限后1/3不规则高密度肿块, 大小约20 mm×11 mm, 边缘毛刺, 内见细点状钙化; D:超声示不规则实性低回声团, 见点状边缘血流.

Figure 1. 33-year-old female, invasive ductal carcinoma grade 1, Luminal A type.

下载: 全尺寸图片幻灯片

图 2 35岁女性，浸润性导管癌2级，Luminal B型

A-B: FFDM图示左乳内下象限中1/3不规则高密度肿块，大小约48 mm×38 mm, 边缘模糊; C: FFDM物理放大图示肿块内及周围见细小多形性钙化.

Figure 2. 35-year-old female, invasive ductal carcinoma grade 2, Luminal B type.

下载: 全尺寸图片幻灯片

图 3 33岁女性，高级别导管内癌伴微浸润，HER2过表达型

A-C: FFDM图示左乳内下象限大量细小多形性、线样及线样分支状钙化, 呈段样分布.

Figure 3. 33-year-old female, high-grade intraductal carcinoma with microinvasion, HER2 overexpression type.

下载: 全尺寸图片幻灯片

图 4 30岁女性，浸润性导管癌2级，三阴性型

A-D: FFDM示左乳外上象限后1/3圆形高密度肿块, 大小约18 mm×18 mm, 边缘模糊, 内未见钙化, DBT显示更为清晰; E-F:超声示椭圆形实性低回声团, 内见点状血流信号.

Figure 4. 30-year-old female, invasive ductal carcinoma grade 2, triple negative type.

下载: 全尺寸图片幻灯片

表 1 不同分子分型年轻与非年轻乳腺癌的临床病理特征

Table 1. Clinicopathological features of young and non-young breast cancer with different molecular types

指标	年轻乳腺癌组(n=140)					对照组(n=200)
指标	Luminal A	Luminal B	HER2过表达	三阴性	P	Luminal A	Luminal B	HER2过表达	三阴性	P	P_组间
年龄(岁, Mean±SD)	33.0±0.5	31.6±0.3	32.0±0.5	31.3±0.8	0.306	49.5±1.4	49.8±0.9	54.0±1.7	48.1±1.7	0.060
患侧[n (%)]					0.684					0.771	0.152
右	7(50.0)	39(47.6)	9(34.6)	8 (44.4)		25 (58.1)	53(54.6)	15(46.9)	14(50.0)
左	7(50.0)	43(52.4)	17(65.4)	10 (55.6)		18(41.9)	44 (45.4)	17 (53.1)	14(50.0)
触诊[n (%)]					0.085					0.001	0.018
无症状	0(0.0)	7(8.6)	1(3.8)	0(0.0)		8(18.6)	2(2.1)	2(6.3)	0(0.0)
可触及肿块	12(85.7)	74(90.2)	24 (92.4)	18(100.0)		35(81.4)	95(97.9)	29(90.6)	28(100.0)
乳头溢液	2(14.3)	1(1.2)	1(3.8)	0(0.0)		0(0.0)	0(0.0)	1(3.1)	0(0.0)
家族史[n (%)]					0.292					0.153	0.020
有	0(0.0)	5(6.1)	0(0.0)	2(11.1)		0(0.0)	0(0.0)	1(3.1)	0(0.0)
无	14(100.0)	77(93.9)	26(100.0)	16(88.9)		43(100.0)	97(100.0)	31(96.9)	28(100.0)
瘤径(cm)					0.032					0.531	0.012
≤2	5(35.7)	22(26.8)	2(7.7)	0(0.0)		20(46.5)	30(30.9)	10(31.2)	8(28.6)
2~5	5(35.7)	35(42.7)	12(46.2)	13(72.0)		21(48.8)	57(58.8)	17(53.1)	18(64.3)
> 5	4(28.6)	25(30.5)	12(46.2)	5(28.0)		2(4.7)	10(10.3)	5(15.6)	2(7.1)
淋巴结转移[n (%)]					0.473					0.005	0.000
-	8(57.1)	31(37.8)	12 (46.2)	9 (50.0)		34 (79.1)	56 (57.7)	24 (75.0)	12(42.9)
+	6(42.9)	51(62.2)	14 (53.8)	9 (50.0)		9 (22.9)	41 (42.3)	8 (25.0)	16(57.1)
远处转移[n (%)]					0.672					0.700	0.000
-	13 (92.9)	67(81.7)	23 (88.5)	15(83.3)		43 (100.0)	94(96.9)	31(96.9)	27(96.4)
+	1 (7.1)	15(18.3)	3(11.5)	3(16.7)		0 (0.0)	3(3.1)	1(3.1)	1(3.6)
病理[n (%)]					0.003					0.000
IDC 1级	1 (7.1)	1(1.2)	0 (0.0)	0 (0.0)		4(9.3)	0(0.0)	0(0.0)	0(0.0)
IDC 2级	4(28.6)	50(61.0)	13 (50.0)	10 (55.6)		15(34.9)	67(69.1)	18(56.3)	13(46.4)
IDC 3级	0(0.0)	7(8.5)	4(15.4)	7 (38.9)		0(0.0)	6(6.2)	5(15.6)	11(39.3)
IDC伴DCIS	5(35.7)	7(8.5)	1(3.8)	1 (5.6)		7(16.3)	10(10.3)	1(3.1)	1(3.6)
中低级别DCIS	0 (0.0)	3(3.7)	0(0.0)	0 (0.0)		6(14.0)	2(2.1)	0(0.0)	0(0.0)
高级别DCIS	2(14.3)	3(3.7)	4(15.4)	0 (0.0)		0(0.0)	4(4.1)	4(12.5)	2(7.1)
DCIS伴微浸润	0 (0.0)	6(7.3)	3 (11.5)	0 (0.0)		4(9.3)	1(1.0)	3(9.4)	0(0.0)
其他类型	2(14.3)	5(6.1)	1 (3.8)	0 (0.0)		7(16.3)	7(7.2)	1(3.1)	1(3.6)

下载: 导出CSV

表 2 不同分子分型年轻乳腺癌的X线及超声表现

Table 2. X-ray and ultrasonographic findings of young breast cancer with different molecular types [n(%)]

项目	Luminal A	Luminal B	HER2 过表达	三阴性	P	项目	Luminal A	Luminal B	HER2 过表达	三阴性	P
X线					0.025	肿块形态					0.895
肿块	2(14.3)	16(19.5)	4(15.4)	8(44.4)		圆/椭圆	2(15.4)	7(9.2)	3(13.0)	2(11.1)
肿块伴钙化	7(50.0)	29(35.4)	6(23.1)	6(33.3)		不规则	11(84.6)	69(90.8)	20(87.0)	16(88.9)
钙化	3(21.4)	26(31.7)	15(57.7)	1(5.6)		边缘					0.297
其他	2(14.3)	11(13.4)	1(3.8)	3(16.7)		清晰	2(15.4)	9(11.8)	1(4.4)	0(0.0)
肿块形态					0.567	不清晰	11(84.6)	67(87.2)	22(95.6)	18(100.0)
圆/椭圆	2(22.2)	12(26.7)	2(20.0)	6(42.9)		模糊	4(30.8)	32(42.1)	10(43.5)	11(61.1)
不规则	7(77.8)	33(73.3)	8(80.0)	8(57.1)		成角	5(38.5)	23(30.3)	9(39.1)	6(33.3)
边缘					0.028	微分叶	0(0.0)	2(2.6)	0(0.0)	1(5.6)
清晰/遮蔽	1(11.1)	1(2.2)	0(0.0)	0(0.0)		毛刺	2(15.4)	10(13.2)	3(13.0)	0(0.0)
微分叶	1(11.1)	7(15.6)	0(0.0)	3(21.4)		回声					0.006
模糊	2(22.2)	23(51.1)	9(90.0)	11(78.6)		低	13(100.0)	73(96.1)	20(87.0)	13(72.2)
毛刺	5(55.6)	14(31.1)	1(10.0)	0(0.0)		混合	0(0.0)	3(3.9)	3(13.0)	5(27.8)
钙化形态					0.029	生长方向					0.627
细小多形性	3(100.0)	8(30.8)	1(6.7)	1(100.0)		平行	5(38.4)	33(43.4)	8(34.8)	5(27.8)
线样或线样分枝状	0(0.0)	8(30.8)	8(53.3)	0(0.0)		非平行	8(61.6)	43(56.6)	15(65.2)	13(72.2)
细小多形性 & 线样	0(0.0)	10(38.4)	6(40.0)	0(0.0)		钙化					0.408
分布					0.901	肿块内	8(61.6)	57(74.0)	16(64.0)	12(66.7)
成簇	0(0.0)	3(11.5)	2(16.7)	0(0.0)		无钙化	5(38.4)	19(24.7)	7(28.0)	6(32.3)
段样	3(100.0)	23(80.5)	13(83.3)	1(100.0)		导管内	0(0.0)	1(1.3)	2(8.0)	0(0.0)
超声					0.744	血流情况					0.047
肿块	5(35.7)	19(23.2)	7(26.9)	6(33.3)		内部血流	5(35.7)	30(36.6)	12(46.1)	10(55.5)
肿块伴钙化	8(57.1)	57(69.5)	16(61.5)	12(66.7)		边缘血流	1(7.1)	1(1.2)	0(0.0)	0(0.0)
肿块伴钙化	8(57.1)	57(69.5)	16(61.5)	12(66.7)		边缘血流	1(7.1)	1(1.2)	0(0.0)	0(0.0)
其他	1(7.1)	6(7.3)	3(11.5)	0(0.0)		内部、边缘血流	0(0.0)	13(15.9)	6(23.1)	6(33.3)
						无	8(57.1)	38(46.3)	8(30.8)	2(11.2)

下载: 导出CSV

参考文献(19)

[1]	Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020[J]. CA: A Cancer J Clin, 2020, 70(1): 7-30. http://d.old.wanfangdata.com.cn/Periodical/zhzl201210017
[2]	叶欣, 周晓云, 杨莉, 等.不同年龄范围界定下的年轻乳腺癌患者的临床病理特征及预后分析[J].上海交通大学学报:医学版, 2020, 40(3): 351-7. http://d.old.wanfangdata.com.cn/Periodical/shdeykdxxb202003013
[3]	Fu JF, Wu LP, Fu W, et al. How young is too young in breast cancer?: young breast cancer is not a unique biological subtype[J].Clin Breast Cancer, 2018, 18(1): e25-39. https://www.ncbi.nlm.nih.gov/pubmed/28802528
[4]	Erić I, Petek Erić A, Kristek J, et al. Breast cancer in young women:pathologic and immunohistochemical features[J]. Acta Clin Croat, 2018, 57(3): 497-502. https://www.ncbi.nlm.nih.gov/pubmed/31168183
[5]	Fabiano V, Mandó P, Rizzo M, et al. Breast cancer in young women presents with more aggressive pathologic characteristics:retrospective analysis from an Argentine national database[J]. JCO Glob Oncol, 2020, 6: 639-46. https://pubmed.ncbi.nlm.nih.gov/32315233/
[6]	Huang JL, Lin Q, Cui CX, et al. Correlation between imaging features and molecular subtypes of breast cancer in young women(≤30 years old)[J]. Jpn J Radiol, 2020. DOI: 10.1007/s11604-020-01001-8.
[7]	Sabiani L, Houvenaeghel G, Heinemann M, et al. Breast cancer in young women: Pathologic features and molecular phenotype[J].Breast, 2016, 29: 109-16. http://d.old.wanfangdata.com.cn/OAPaper/oai_doaj-articles_93ecdcc97e1d567ea1b81528da00023b
[8]	吕琪, 吴军刚, 贾春梅, 等.年轻女性乳腺浸润性导管癌及其不同分子亚型的超声声像图特征分析[J].中国全科医学, 2020, 23(3):358-62. http://d.old.wanfangdata.com.cn/Periodical/zgqkyx202003021
[9]	Magny SJ, Shikhman R, Keppke AL. Breast Imaging Reporting and Data System (BI RADS). In StatPearls[EB/OL].[2020-02-17].https://www.ncbi.nlm.nih.gov/books/NBK459169.
[10]	Kirova YM, Carroll S, Fourquet A, et al. The st Gallen international expert consensus on the primary therapy of early breast cancer 2017: the point of view of an international panel of experts in radiation oncology[J]. Ann Oncol, 2018, 29(1): 280-1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6246427/
[11]	Metelková A, Skálová A, Fínek J, et al. Breast Cancer in Young Women-Correlation of Clinical Histomorphological, and Moleculargenetic Features of Breast Carcinoma in Women Younger than 35 Years of Age[J]. Klin Onkol, 2017, 30(3): 202-9. https://www.ncbi.nlm.nih.gov/pubmed/28612617
[12]	Xiong Q, Valero V, Kau V, et al. Female patients with breast carcinoma age 30 years and younger have a poor prognosis: the M.D.Anderson Cancer Center experience[J]. Cancer, 2015, 92(10):2523-8. https://www.ncbi.nlm.nih.gov/pubmed/11745185
[13]	Darwish AD, Helal AM, Aly El-Din NH, et al. Breast cancer in women aging 35 years old and younger: The Egyptian National Cancer Institute (NCI) experience[J]. Breast, 2017, 31: 1-8.
[14]	Wu MX, Ma J. Association between imaging characteristics and different molecular subtypes of breast cancer[J]. Acad Radiol, 2017, 24(4): 426-34. http://d.old.wanfangdata.com.cn/Periodical/yxzdyjrfsx202001010
[15]	Sun SS, Zhang B, Zhao HM, et al. Association between mammographic features and clinicopathological characteristics in invasive ductal carcinoma of breast cancer [J]. Mol Clin Oncol, 2014, 2(4): 623-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4051570/
[16]	An YY, Kim SH, Kang BJ, et al. Breast cancer in very young women (< 30 years): Correlation of imaging features with clinicopathological features and immunohistochemical subtypes [J]. Eur J Radiol, 2015, 84(10): 1894-902. http://www.tandfonline.com/servlet/linkout?suffix=CIT0003&dbid=8&doi=10.1080%2F0284186X.2017.1404635&key=21937191
[17]	Çelebi F, Pilancı KN, Ordu Ç, 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): 448-53.
[18]	Zeng Z, Hou CJ, Hu QH, et al. Mammography and ultrasound effective features in differentiating basal-like and normal-like subtypes of triple negative breast cancer[J]. Oncotarget, 2017, 8 (45): 79670-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5668080/
[19]	Han W, Kim SW, Park IA, et al. Young age: an independent risk factor for disease-free survival in women with operable breast cancer [J]. BMC Cancer, 2004, 4: 82-9. http://d.old.wanfangdata.com.cn/OAPaper/oai_doaj-articles_36942bc20a3a98a4d777f54ede0aac27