单纯乳腺导管原位癌（DCIS）MRI 特征与 HER2表达及病理核分级的相关性研究

摘要

目的：探讨单纯乳腺导管原位癌动态增强 MR 影像特征与 HER2表达及病理核分级的相关性。方法：回顾2011年1月－2014年6月经手术病理证实的单纯 DCIS 28例，术前全部接受乳腺增强 MR 检查。系统描述病变的 MR形态特征、早期强化率及时间信号强度曲线，分析它们与 HER2表达及病理核分级的关系。结果：单纯 DCIS 动态增强MR 形态特征主要为非肿块样强化（22／28），以区段分布（13／28）为主。早期快速强化为主（25／28），时间信号强度曲线以平台型（18／28）和流出型（9／28）为主。HER2表达在高级别组和非高级别组分布差异有统计学意义（P ＝0．04），高级别组HER2阳性比例（11／18）较非高级别组（2／10）高；坏死成分在高级别组、非高级别组以及 HER2阳性组和 HER2阴性组分布差异有统计学意义（P ＝0．00、P ＝0．03），高级别组和 HER2阳性组易伴有坏死成分。单纯 DCIS MR 形态特征及时间信号强度曲线在各组差异无统计学意义。结论：单纯 DCIS 动态增强 MR 形态学表现具有相对特异性，主要表现为区段分布的非肿块样强化，早期快速强化为主，时间信号强度曲线以平台型和流出型为主。高级别 DCIS 更易表达 HER2，且更易出现坏死。%Objective:To investigate the correlation of MRI characteristics of pure DCIS of breast with HER2 expres-sion and pathology nuclear grade.Methods:28 patients with pure DCIS confirmed by surgery and pathology in our hospital from Jan 2011 to June 2014 were reviewed.All patients underwent dynamic contrast-enhanced MRI before operation.The MRI morphological characteristics,the early enhancement rate and the time-signal intensity curve of the lesion were de-scribed systematically and the correlation of above mentioned findings with HER2 expression and pathology nuclear grade was analyzed.Results:The most common morphological characteristics of pure DCIS were non-mass-like enhancement (22/28,78.6%),with mainly segmental distribution (13/28,46.4%).In early phase of there was a rapid enhancement (25/28, 89.3%),and in delayed phase the time-signal intensity curve showed mainly a plateau type (18/28,64.3%)and washout type (9/28,32.1%).There was statistical significant difference in HER2 expression between HNG group and non-HNG group (P =0.04),positive ratio of HER2 in HNG group (11/18)was higher than that in non-HNG group (2/10).There was statistical significant HNG group (11/18)and non-HNG group (P =0.00),and also between HER2 postive group and HER2 negative group (P =0.03).Necrox was more observed in HNG group and HER2 position group.There was no sta-tistical significant difference in the MRI morphcological characteristics and TIC between each group of pure DCIS.Conclu-sion:The morphological manifestations of dynamic enhancement MRI in pure DCIS have some characteristics.The main manifestation are non-mass-like enhancement with segmental distribution,and mainly enhancement in early phase and the plateau type and without type in time-signal intensity curve at delayed phase.HER2 expression and necrosis are more ob-served in HNG of pure DCIS.