Correlation of semi-quantitative parameters of 99mTc-3PRGD2 SPECT/CT imaging with molecular subtypes and pathology of breast cancer
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摘要:
目的 探讨99mTc-3PRGD2 SPECT/CT显像半定量参数对可疑乳腺病变的诊断价值，并根据乳腺癌分子分型进行分类比较，分析其与临床病理的相关性。 方法 收集2020年12月~2022年8月于我院接受检查的70例可疑乳腺病变患者病例资料。根据病理结果，分析乳腺癌Luminal阳性型、Her-2阳性型和三阴性型3种分子亚型与T/N值的相关性；分析雌激素受体、孕激素受体、Her-2及Ki67表达情况与影像学检查指标的关系。 结果 70例患者病理检查结果证实乳腺癌51例（72.86%），病理分型为Luminal阳性型22例，Her-2阳性型20例，三阴性型9例。乳腺良性病变24例（27.14%）。乳腺癌患者病变侧T/N值高于良性病变患者（3.96±0.82 vs 1.16±0.32），差异有统计学意义（t=14.426，P < 0.05）。诊断特异性为84.21%（16/19），敏感度为82.35%（42/51），准确率为82.86%（58/70），ROC曲线下面积为0.834（0.755~0.913），诊断临界值为1.56，即T/N值≥1.56时判定为恶性病变。Her-2阳性型的T/N值高于三阴性型（P < 0.05）。Her-2表达阳性患者的T/N值高于Her-2表达阴性的患者（P < 0.05）。雌激素受体、孕激素受体和Ki67表达阳性和表达阴性患者的T/N值相比，差异均无统计学意义（P>0.05）。 结论 99mTc-3PRGD2 SPECT/CT显像半定量指标在诊断乳腺病变良恶性方面有较高的敏感度，并且Her-2阳性型患者T/N值明显升高，有助于早期发现和诊断乳腺病变，为预测乳腺癌分子分型和治疗有相应的指导作用。 -
关键词:
- 乳腺癌 /
- 99mTc-3PRGD2 SPECT/CT /
- 分子分型 /
- 病理
Abstract:Objective To investigate the diagnostic value of semi-quantitative parameters of 99mTc-3PRGD2 SPECT/CT imaging in suspicious breast lesions, and to analyze its correlation with clinicopathology according to the molecular classification of breast cancer. Methods The case data of 70 patients with suspected breast lesions who were examined in our hospital from December 2020 to August 2022 were collected. According to the pathological results, the correlation between Luminal positive, Her-2 positive and triple negative molecular subtypes of breast cancer and T/N value was analyzed.The relationship between the expression of ER, PR, Her-2 and Ki67 and the imaging indexes were analyzed. Results The pathological examination results of 70 patients confirmed 51 cases (72.86%) of breast cancer. The pathological classification was 22 cases of Luminal positive type, 20 cases of Her-2 positive type and 9 cases of triple negative type.There were 24 cases (27.14%) of benign breast lesions.The T/N value of breast cancer patients was higher than that of benign lesions (3.96±0.82 vs 1.16±0.32), and the difference was statistically significant (t=14.426, P < 0.05). The diagnostic specificity was 84.21% (16/19), the sensitivity was 82.35% (42/51), the accuracy was 82.86 % (58/70), and the area under the ROC curve was 0.834 (0.755-0.913). The diagnostic threshold was 1.56, that is, when the T/N value was≥1.56, it was judged as malignant lesions. The T/N value of Her-2 positive type was higher than that of triple negative type (P < 0.05). The T/N value of Her-2 positive patients was higher than that of Her-2 negative patients (P < 0.05). There was no significant difference in T/N value between patients with positive and negative expression of ER, PR and Ki67 (P>0.05). Conclusion The semi-quantitative index of 99mTc-3PRGD2 SPECT/CT imaging has higher sensitivity in the diagnosis of benign and malignant breast lesions, and the T/N value of Her-2 positive patients is significantly increased. It is helpful for early detection and diagnosis of breast lesions, and can guid in predicting the molecular classification and treatment of breast cancer. -
Key words:
- breast cancer /
- 99mTc-3PRGD2 SPECT/CT /
- molecular typing /
- pathology
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图 1 乳腺局部影像学表现
A: 乳腺局部CT定位像, 左侧乳腺可见软组织密度影; B: 乳腺局部SPECT/CT显像, 病灶T/NT=4.61.
Figure 1. Local imaging findings of breast.
图 2 病理及免疫组化结果
A: 病理提示浸润性导管癌（HE染色, 10×10）; B~E: 免疫组化结果, 、ER（3+）, PR（2+）, Her-2（3+），Ki67（20%+）.
Figure 2. Pathology and immunohistochemical results.
图 3 99mTc-3PRGD2 SPECT/CT诊断乳腺良恶性的ROC曲线图
Figure 3. ROC curve of 99mTc-3PRGD2 SPECT/CT in diagnosis of benign and malignant breast.
表 1 70例患者病理检查结果
Table 1. Pathological examination results of 70 patients
病理类型 病灶数（n） 比例（%） 乳腺癌（n=51） 浸润性导管癌 38 74.51 导管内癌 7 13.73 浸润性小叶癌 4 7.84 粘液腺癌 2 3.92 良性病变（n=19） 乳腺增生 10 52.63 乳腺纤维瘤 6 31.58 导管内乳头状瘤 3 15.79 
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表 2 99mTc-3PRGD2 SPECT/CT诊断患者乳腺良恶性结果
Table 2. 99mTc-3PRGD2 SPECT/CT diagnosis of breast benign and malignant results (n)
99mTc-3PRGD2 SPECT/CT 病理检查 合计 恶性 良性 恶性 42 3 45 良性 9 16 25 合计 51 19 70 99mTc-3PRGD2：99mTc-联肼尼克酰胺-3聚乙二醇-精氨酸-甘氨酸-天冬氨酸环肽二聚体.
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表 3 乳腺癌不同分子分型的T/N值比较
Table 3. Comparison of T/N values of different molecular types of breast cancer
组别 例数（n） T/N值 Luminal阳性型 22 3.84±0.79 Her-2阳性型 20 4.29±1.02 三阴性型 9 3.52±0.63* F 3.821 P 0.047 *P < 0.05 vs Her-2阳性型. Her-2: 人表皮生长因子受体-2.
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表 4 乳腺癌临床病理与T/N值的关系
Table 4. Relationship between clinicopathology and T/N value of breast cancer(Mean±SD)
临床病理 T/N值 t P ER表达 1.716 0.093 阳性（n=37） 3.84±0.75 阴性（n=14） 4.27±0.92 PR表达 0.773 0.443 阳性（n=33） 3.89±0.84 阴性（n=18） 4.09±0.96 Her-2表达 4.994 < 0.001 阳性（n=16） 4.76±1.02 阴性（n=35） 3.59±0.64 Ki67表达 0.664 0.51 > 14%（n=32） 4.02±0.97 ≤14%（n=19） 3.85±0.71 ER: 雌激素受体; PR孕激素受体.
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