摘要
目的探讨多参数MRI图像特征及相关参数对人类表皮生长因子受体2(human epidermal growth factor receptor 2,HER-2)低表达乳腺癌的诊断价值,预测肿瘤组织内部预后因子表达状态,总结HER-2低表达乳腺癌MRI征象特点。材料与方法选取2014年1月1日至2022年4月12日接受治疗的52例HER-2低表达乳腺癌患者为受试对象进行回顾性分析。分析HER-2低表达乳腺癌的MRI征象特点。并以免疫组化染色检查结果作为金标准,根据预后因子[雌激素受体(estrogen recepto,ER)、孕激素受体(progesterone receptor,PR)、增殖标志物Ki-67(marker of proliferation Ki-67,Ki-67)以及HER-2]的阳性/阴性表达情况,进行四次分组。用组内相关系数(intra-class correlation coeficient,ICC)评价不同医师间对MRI图像基本特征分析结果的一致性。根据原始资料类型的不同,分别利用单因素分析(独立样本t检验、Fisher确切概率法、Mann-Whitney U检验等方法)对比分析组间各参数的差异,采用二分类logistic回归分析建立联合诊断模型,比较四组间的基本临床病理及MRI征象差异,得出HER-2低表达乳腺癌常见的MRI征象特点,探究临床影像特征与预后因子的相关性。结果不同医师之间对MRI图像基本特征分析结果一致性好(ICC范围0.883~0.972)。HER-2低表达乳腺癌临床病理及MRI上多表现为年龄29~74(51.10±10.67)岁,病理学类型:非特殊型浸润性乳腺癌占绝大多数(50/52,96.2%);组织学分级以Ⅱ~Ⅲ为主(47/54,87.0%);MRI征象多表现为单个病灶(41/52,78.8%),边缘毛刺(33/52,63.5%),肿块见分叶征(30/52,61.5%),内部不均匀强化(36/52,69.2%),时间-信号强度曲线(time-signal intensity curve,TIC)类型以Ⅲ型为主(46/52,88.5%),几乎无或少量背景实质强化(33/52,63.5%),表观弥散系数(apparent diffusion coefficient,ADC)值均值约为(0.767±0.143)×10^(-3)mm^(2)/s,取值范围为(0.512~1.200)×10^(-3)mm^(2)/s。临床病理及MRI特征对预后因子的预测价值:ER、PR阳性组,肿块边缘多见毛刺征(ER与PR阳性:72.1%,P=0.008),内部强化多不均匀(ER阳性:76.7%,P=0.030,PR阳性:79.1%,P=0.003),组织学分级较低(ER阳性:P=0.008,PR阳性:P=0.003)。ER、PR阴性组,多边缘模糊(ER与PR阴性:55.6%,P=0.008),内部强化以环形为主(ER阴性:66.7%,P=0.030,PR阴性:77.8%,P=0.003)。Ki-67阳性组与阴性组相比,肿块形态多呈分叶征(68.2%,P=0.034),组织学分级较高(P=0.003)。二分类logistic回归分析提示,组织学分级是预测HER-2低表达乳腺癌中ER、PR、Ki-67表达的独立相关因素(P=0.032、P=0.022、P=0.003),内部强化特征是预测HER-2低表达乳腺癌中ER、PR表达的独立相关因素(P=0.041,P=0.014)。结论HER-2低表达乳腺癌的临床病理与MRI特征具有一定的特异性,多参数MRI对于临床早期诊断HER-2低表达乳腺癌以及预测其相关预后因子表达状态存在一定的价值。
Objective:To investigate the diagnostic value of multiparametric MRI image features and related parameters for human epidermal growth factor receptor 2(HER-2)low expression breast cancer,to predict the expression status of prognostic factors within the tumor tissue,and to summarize the characteristics of MRI signs of HER-2 low expression breast cancer.Materials and Methods:Fifty-two patients with HER-2 low-expression breast cancer who received treatment from January 1,2014 to April 12,2022 were selected as subjects for retrospective study.The MRI sign characteristics of HER-2 low expression breast cancer were analyzed.The results of immunohistochemical staining examination were also used as the gold standard,and the results were analyzed according to the prognostic factors[estrogen receptor(ER),progesterone receptor(PR),marker of proliferation Ki-67(Ki-67),and the positive/positive ratio of HER-2]positive/negative expression were grouped four times.The intra-class correlation coefficient(ICC)was used to evaluate the consistency of the results of the basic characterization of MRI images between different physicians.Depending on the type of raw data,the differences of each parameter between the groups were compared and analyzed using one-way analysis(independent samples t-test,Fisher's exact probability method,Mann-Whitney U-test,etc.),respectively,and a joint diagnostic model was established by using biclassified logistic regression analysis to compare the differences of the basic clinicopathological and MRI signs among the four groups,which led to the conclusion that the differences of the basic clinicopathological and MRI signs between the four groups of HER-2 low The common MRI signs of HER-2 low expression breast cancer were characterized,and the correlation between clinical imaging features and prognostic factors was explored.Results:The results of basic characterization of MRI images were in good agreement between different physicians(ICC range 0.883-0.972).HER-2 low-expression breast cancer clinicopathologically and on MRI mostly showed age 29-74(51.10±10.67)years old,pathologic type:non-specific invasive breast cancer accounted for the majority(50/52,96.2%);histologic grading was predominantlyⅡ-Ⅲ(47/54,87.0%);MRI signs mostly showed a single lesion(41/52,78.8%),burr edges(33/52,63.5%),lobular signs(30/52,61.5%),internal inhomogeneous enhancement(36/52,69.2%),time intensity curve(TIC)typeⅢpredominantly(46/52,88.5%),and almost no or small amount of background parenchymal The mean value of apparent diffusion coefficient(ADC)was about(0.767±0.143)×10^(-3)mm^(2)/s,and the range of values was(0.512-1.200)×10^(-3)mm^(2)/s.The prognostic value of clinicopathological and MRI features on prognostic factors:ER,PR,and TIC.Predictive value:In the ER and PR positive group,burr sign was mostly seen at the edge of the mass(ER and PR positive:72.1%,P=0.008),internal enhancement was more heterogeneous(ER positive:76.7%,P=0.030,PR positive:79.1%,P=0.003),and histologic grading was lower(ER positive:P=0.008,PR positive:P=0.003).In the ER and PR negative group,there were more blurred margins(ER and PR negative:55.6%,P=0.008),and internal enhancement was predominantly circumferential(ER negative:66.7%,P=0.030,PR negative:77.8%,P=0.003).In the Ki-67 positive group,the morphology of the mass was more lobular(68.2%,P=0.034)compared to the negative group,with a higher histologic grading was higher(P=0.003).Two-category logistic regression analysis suggested that histologic grading was an independent correlate for predicting the expression of ER,PR,and Ki-67 in HER-2 low-expressing breast cancers(P=0.032,P=0.022,P=0.003),and internal enhancement features were an independent correlate for predicting the expression of ER and PR in HER-2 low-expressing breast cancers(P=0.041,P=0.014).Conclusions:The clinicopathologic and MRI features of HER-2 low-expression breast cancer have certain specificity,and multiparametric MRI is valuable for the early clinical diagnosis of HER-2 low-expression breast cancer and the prediction of the expression status of its related prognostic factors.
作者
邹紫勤
黄艳芳
杨宇
ZOU Ziqin;HUANG Yanfang;YANG Yu(Department of Radiology,the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine,Changsha 410021,China)
出处
《磁共振成像》
CAS
CSCD
北大核心
2023年第11期48-55,共8页
Chinese Journal of Magnetic Resonance Imaging
基金
湖南省自然科学基金项目(编号:2022JJ70114)。
关键词
乳腺癌
HER-2低表达乳腺癌
人表皮生长因子受体2
预后因子
磁共振成像
breast cancer
HER-2 low expression breast cancer
human epidermal growth factor receptor-2
prognostic factors
magnetic resonance imaging
