顾海玉 龚良庚 徐新红 王小英

【摘要】 目的：探討乳腺导管原位癌（DCIS）分子分型与影像特征和病理特征的相关性，比较其差异。方法：选取2018年1月-2020年6月经术后病理确诊为乳腺单纯DCIS患者90例。应用乳腺影像报告数据系统（BI-RADS）对乳腺癌X线摄影表现进行规范化的描述分析，根据超声BI-RADS分级标准对超声图像进行分类，采用免疫组织化学法（IHC）检测ER、PR、HER-2、Ki-67、p53的表达。结果：ER阳性型发病年龄大于HER-2阳性型;HER-2阳性型患者中中-高核级、Ki-67高表达、p53阳性常见，而ER阳性型反之;ER阳性型中肿块（或腺体结构紊乱）较常见，导管扩张并充盈缺损常见;而HER-2阳性型中肿块（或腺体结构紊乱）伴钙化较常见，导管扩张少见;伴钙化DCIS中HER-2阳性型、Ki-67高表达及中、高核级更为常见，差异均有统计学意义（P<0.05）。影响DCIS病理核分级的因素中，低核级多表现ER阳性型，Ki-67低表达，肿块（或腺体结构紊乱），少伴钙化，多伴有导管扩张并充盈缺损;而中、高核级多表现为HER-2阳性型，Ki-67高表达，肿块（或腺体结构紊乱）伴钙化，少伴导管扩张。二元logistic回归显示，Ki-67表达是DCIS分子分型的影响因素，Ki-67低表达更表现为ER阳性型。结论：HER-2阳性型患者发病年龄较ER阳性型者小，且中-高核级、Ki-67高表达、p53阳性常见，肿块（或腺体结构紊乱）常伴有钙化，导管扩张较少见，预示其预后较差，发展为浸润性癌的风险及局部复发率较高，ER阳性型则反之。

【关键词】 导管原位癌 分子分型 影像特征 病理核分级

Correlation between Molecular Typing and Imaging and Pathological Features of Ductal Carcinoma in Situ/GU Haiyu， GONG Lianggeng， XU Xinhong， WANG Xiaoying. //Medical Innovation of China， 2021， 18（07）： 0-028

[Abstract] Objective： To investigate the correlation between molecular classification of ductal carcinoma in situ （DCIS） and imaging and pathological features of the breast， and to compare the differences. Method： From January 2018 to June 2020， 90 patients with simple breast DCIS were selected pathologically after menstruation. The breast imaging report data system （BI-RADS） was used to standardize the description and analysis of breast cancer X-ray photographs. The ultrasound images were classified according to the ultrasound BI-RADS classification standards. The expression of ER， PR， HER-2， Ki-67 and p53 were detected by immunohistochemistry （IHC）.Result： The age of onset of the ER-positive type was greater than that of the HER-2 positive type; Here-2 positive patients had intermediate and high pathological grading， Ki-67 high expression， and p53 positive were common， while the ER-positive type was the opposite; in the ER-positive type， mass （or gland structure disorder） was more common， and the duct dilation and filling defect were common， while the HER-2 positive type mass （or gland structure disorder） with calcification is more common， and duct dilation was rare; HER-2 positive type， with calcification DCIS， Ki-67 high expression and intermediate and high pathological grading were more common，the differences were statistically significant（P<0.05）. Among the factors affect the pathological grading of DCIS， low pathological grades were mostly ER-positive， Ki-67 low expression， masses （or glandular structural disorders）， less accompanied by calcification， and more accompanied by ductal dilation and filling defects; high pathological grade was mostly HER-2 positive， Ki-67 was highly expressed， masses （or glandular structural disorders） were accompanied bycalcification， and rarely accompanied by duct dilation. Binary Logistic regression showed that Ki-67

expression was an imaging factor of DCIS molecular typing， and low Ki-67 expression was more ER-positive. Conclusion： The age of onset of HER-2 positive patients is younger than that of ER-positive patients， and it is common to have intermediate and high pathological grading， high Ki-67 expression， and p53 positive. Masses （or structural disorders of glands） are often accompanied by calcification， and duct dilation is rare.It indicates a poor prognosis， a higher risk of developing invasive cancer and a higher rate of local recurrence. The opposite is true for ER positive type.

[Key words] Ductal carcinoma in situ Molecular typing Imaging features Pathological grading

First-authors address： The Second Affiliated Hospital of Nanchang University， Nanchang 330006， China

doi：10.3969/j.issn.1674-4985.2021.07.006

導管原位癌（ductal carcinoma in situ，DCIS）是指肿瘤组织局限于乳腺导管内，未突破基底膜，但低核级和高核级DCIS可能源自两个完全不同的发生途径。基因表达微阵列技术证实DCIS是一种异质性病变，并且根据其分子特征提出了新的分型，即非典型导管增生（atypical ductal hyperplasia，ADH）、DCIS、低核级IDC有相同的基因表达谱，为雌激素受体（estrogen receptor，ER）表达型，而高核级DCIS和高核级的IDC具有相同的基因表达谱，与核分裂活性和细胞周期相关。买志福等[1]认为，低核级DCIS经过一个很长的潜伏期后可发展为分化良好的浸润性导管癌（invasive ductal carcinoma，IDC），而高核级DCIS病变经过一个比较短的时间则进展为分化差的IDC。本研究主要探讨不同分子分型DCIS与影像特征及病理特征的相关性，为临床治疗DCIS患者提供一定的参考依据，现报道如下。……