1. 广州医科大学附属广州市第一人民医院放射科,广东,广州,510180
2. 中山大学附属第三医院放射科,广东,广州,510180
3. 广东省人民医院//广东省医学科学院影像医学部,广东,广州,510180
网络首发:2017-03-16,
纸质出版:2017
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郭媛, 孔庆聪, 朱叶青, 等. 不同类型乳腺黏液样癌的MRI 征象及与生物学 预后因子的相关性[J]. 中山大学学报(医学科学版), 2017,38(2).
MRI Features of Mucinous Breast Carcinoma and the Correlation with Biological Prognostic Factors[J]. Journal of Sun Yat-sen University (Medical Sciences), 2017, 38(2).
:【目的】探讨不同类型乳腺黏液样癌的MRI表现及与生物学预后因子的相关性。【方法】回顾性分析经病理组 织学证实的35例乳腺单纯型黏液癌(PMBC)及15例混合型黏液癌(MMBC)的MRI资料,分析其形态学特征、T1WI及T2WI 信号特点、动态增强模式、DWI信号及ADC值,并与分子生物学指标(ER、PR、CerbB-2、Her-2、Ki-67等)相对照。【结果】PM? BC以椭圆形(16/35,45.7%)、圆形(10/35,28.6%)多见,且边界清晰(26/35,74.3%),多有分叶(31/35,88.6%);MMBC以不规 则形(9/15,60%)多见,且边界不清(13/15,86.7%),以毛刺状及不规则边缘多见。PMBC 与MMBC 的T2WI 信号不同,前者 T2WI为明显高信号(33/35,94.3%),后者主要呈高低混杂信号(11/15,73.3%)。PMBC与MMBC的早期强化率分别为(114.7 ± 9.1)%和(165.6 ± 14.3)%;前者时间-信号强度曲线(TIC曲线)Ⅰ型28例,Ⅱ型7例,后者Ⅱ、Ⅲ型均为7例,Ⅰ型1例。PM? BC的ADC值(1.91 ± 0.06)×10-3 mm2/s,MMBC约(1.13 ± 0.08)×10-3 mm2/s。两组间形态、边界、T2WI信号、早期强化率、TIC曲 线、ADC值均有统计学差异(P < 0.05)。PMBC、MMBC患者的ER、PR、CerbB-2阳性率无明显统计学差异,而Ki-67、Her-2阳 性率MMBC显著高于PMBC(P < 0.05)。【结论】MRI可从形态、信号、动态增强及ADC值等多个方面鉴别PMBC与MMBC,其 中PMBC影像征象更具特征性,分析其与生物学预后因子的相关性,间接提示MMBC较PMBC的预后较差。
Abstract:【Objective】To explore the MRI features of the mucinous breast carcinoma and the correlation with biological prognos? tic factors.【Methods】MRI features of 35 pure and 15 mixed mucinous carcinomas were retrospectively analyzed. MR images were reviewed for shape,margin,the signal intensity,enhancement patterns of tumors and DWI features. All the patients were detected by immunohistochemical staining with expression of ER,PR,CerbB-2,Ki-67 and Her-2. Correlations between the pure and mixed mucinous breast carcinoma and prognostic factors were analyzed.【Results】16 oval masses(16/35,45.7%)and 10 circular masses (10/35,28.6%)were found in 35 pure mucinous breast carcinomas with clear boundary(26/35,74.3%)and lobulated shape(31/ 35,88.6%);9 irregular masses(9/15,60%)were found in mixed mucinous breast carcinomas with unclear boundary(13/15, 86.7%). Very high signal intensity on T2-weighted images was found in 33 pure mucinous carcinomas(33/35,94.3%)and 11 mixedmucinous carcinomas showed mixed signal intensity(11/15,73.3%). Early enhancement rate was(114.7 ± 9.1)% for pure muci? nous carcinomas and(165.6 ± 14.3)% for mixed mucinous carcinomas. 28 pure mucinous tumors demonstrated persistent enhancing pattern on time-signal intensity curve,7 pure mucinous tumors demonstrated plateau pattern and 7 mixed mucinous carcinomas showed plateau pattern and washout pattern respectively. Mean ADC value was(1.91 ± 0.06)×10-3 mm2/s for pure mucinous carcino? mas and(1.13±0.08)×10-3mm2/s for mixed mucinous carcinomas. There was significant difference with morphology,boundary,T2WI signal,early enhancement rate,time-signal intensity curve,ADC value between pure and mixed mucinous breast carcinoma(P < 0.05). There was significant difference between pure and mixed mucinous breast carcinoma with Her-2 and Ki-67 expression(P < 0.05).【Conclusion】MRI could identify PMBC and MMBC from the shape,the signal intensity,dynamic enhancement and ADC val? ue,and PMBC had distinctive MRI features. The prognosis of MMBC is worse than that of PMBC form correlation between biological prognostic factors and mucinous breast carcinoma.
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