多模态超声特征与乳腺癌分子亚型的关系研究

doi:10.12114/j.issn.1007-9572.2020.00.321

摘要/Abstract

摘要： 背景　乳腺癌的高度异质性决定了其生物学行为、预后及个体化治疗方案的不同。针对不同乳腺癌分子亚型采用个体化治疗的方式已在临床上广泛应用。目前已有研究表明乳腺癌的超声特征与其分子亚型有相关性，而如何在众多超声征象中甄选出预测乳腺癌分子亚型的敏感指标是目前研究的难点。目的　探讨多模态超声特征与乳腺癌分子亚型之间的关系。方法　前瞻性选取2017年1月—2019年2月在石河子大学医学院第一附属医院就诊的经病理检查确诊的女性乳腺癌患者91例为研究对象。观察患者多模态超声特征，包括二维超声、超声造影及声触诊组织量化技术（VTIQ）检查，术后依据免疫组化结果分为两组：管腔上皮型组，包括Luminal A型和Luminal B型患者；非管腔上皮型组，包括人表皮生长因子受体（HER）2过表达型和三阴型患者。分析管腔上皮型组和非管腔上皮型组多模态超声特征的差异。采用单因素和多因素Logistic回归分析探讨多模态超声特征与乳腺癌分子亚型的关系。结果　管腔上皮型组含Luminal A型11例、Luminal B型49例，非管腔上皮型组含HER2过表达型18例、三阴型13例。管腔上皮型组和非管腔上皮型组二维超声指标中肿块边界、边缘特征，超声造影指标中增强边界、增强范围、周围放射状增强特征及VTIQ中边缘弹性特征比较差异有统计学意义（P<0.05）。多因素Logistic回归分析显示，二维超声指标中肿块边界、边缘特征（肿块毛刺、肿块分叶），超声造影指标中肿块周围呈放射状，肿块边缘区VTIQ值是乳腺癌分子亚型为管腔上皮型的独立超声特征（P<0.05）。结论　不同分子亚型乳腺癌形态、血供特点及弹性特征不同，二维超声边缘毛刺、分叶征象，超声造影中周围放射状增强及VTIQ中边缘区硬度优势的超声特征与乳腺癌分子亚型关系密切，可用来初步预测管腔上皮型乳腺癌，为乳腺癌预后评估及个体化治疗方案的制定提供依据。

关键词: 乳腺肿瘤；超声；免疫组织化学；病理学, 分子

Abstract: Background　 High heterogeneity in breast cancer distinguishes individual biological behavior，prognosis and treatment.Individualized molecular subtype-specific therapy has been widely used clinically.Studies have shown that some ultrasound features are associated with molecular subtyping，but it is difficult to screen relevant predictors out of various ultrasound parameters.Objective　To identify the multimodal ultrasound characteristics associated with molecular subtypes of breast cancer.Methods　 This prospective study was conducted in 91 women with pathology-confirmed breast cancer from the First Affiliated Hospital，School of Medicine，Shihezi University during January 2017 to February 2019.Postoperative immunohistochemical results，including Luminal（Luminal A and Luminal B subtypes） and non-Luminal（HER2-enriched and triple-negative subtypes） breast cancer，were collected and compared in terms of multimodal ultrasound characteristics〔including findings of two-dimensional ultrasound，virtual touch tissue imaging quantification（VTIQ） and contrast-enhanced ultrasonography〕．Univariate and multivariate Logistic regression were used to identify the ultrasound characteristics associated with molecular subtypes of breast cancer.Results　 The Luminal A，Luminal B，HER2-enriched and triple-negative subtypes numbered 11，49，18，and 13，respectively.Luminal and non-Luminal breast cancer patients showed significant differences in two-dimensional ultrasonic border（degree of clearness） and marginal features（spiculated or lobulated），contrast-enhanced ultrasonic margin，range and peripheral radial enhancement，and VTIQ-generated shear-wave elastographic features（P<0.05）.Multivariate Logistic regression analysis showed that two-dimensional ultrasonic spiculated or lobulated border and margin，contrast-enhanced ultrasonic peripheral radial enhancement，and increased VTIQ-measured shear-wave elastographic value of the marginal zone were independently associated with luminal breast cancer（P<0.05）.Conclusion　Different molecular subtypes of breast cancer have different ultrasound morphological，blood supply and elastographic characteristics.The two-dimensional ultrasonic spiculated or lobulated margin，contrast-enhanced ultrasonic peripheral radial enhancement，and increased VTIQ-measured shear-wave elastographic value of the marginal zone are closely associated with luminal breast cancer，which may be used as auxiliary indicators in diagnosing，prognosis evaluating and developing individualized treatment regimen.

Key words: Breast neoplasms；Ultrason；Immunohistochemistry；Pathology, molecular

吴芳,成静,曹春丽,等. 多模态超声特征与乳腺癌分子亚型的关系研究[J]. 中国全科医学, 2020, 23(30): 3878-3883. DOI: 10.12114/j.issn.1007-9572.2020.00.321.
WU Fang,CHENG Jing,CAO Chunli, et al. Multimodal Ultrasound Characteristics Associated with Molecular Subtypes of Breast Cancer　[J]. Chinese General Practice, 2020, 23(30): 3878-3883. DOI: 10.12114/j.issn.1007-9572.2020.00.321.

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