摘要
目的分析钼靶X线假阴性乳腺癌的临床病理特点以及分子生物学特性,为合理治疗提供理论依据。方法将2006年1月至4月间收治的183例女性乳腺癌按照钼靶X线结果分成阳性和假阴性两组,采用免疫组化S-P法检测其ER、PR、C-erbB-2和VEGF,并结合临床指标进行相关分析。结果钼靶X线假阴性组中,绝经后患者仅占28.57%(10/35),低于绝经前患者(χ2=7.748,P=0.008);髓样癌和黏液腺癌占27.27%(10/35),明显高于阳性组4.11%(6/148),且差异有统计学意义(P=0.000);TNM分期I期比率低于阳性组(82.56%vs14.30%,P=0.000);组织学分级Ⅲ级比率为23.08%(8/35),明显高于阳性组的3.26%(χ2=4.952,P=0.024);ER阳性比率低于阳性组(40%vs67.57%,P=0.003);而两组在发病年龄、肿块大小、腋淋巴结转移状况和PR状态表达方面的差异无统计学意义(P>0.05)。在肿瘤分子生物学特性分析方面,假阴性组患者中C-erbB-2强阳性表达率低于阳性组(25.71%vs51.35%,P=0.008);但两组VEGF表达率差异无统计学意义(P>0.05)。结论与钼靶X线阳性患者相比,钼靶X线假阴性患者多见于绝经前患者,黏液腺癌和髓样癌占一定比例,早期癌发生率低,提示:绝经前患者的致密型乳房和常常表现为良性临床特征的病理学类型是造成乳腺癌钼靶X线假阴性、不能早期发现的重要原因;而组织分化不良,ER阳性表达率低,C-erbB-2强阳性表达率低,则提示为术后辅助性化疗的适应症。
Objective To analyze the clinical-pathological and biological features of breast cancer patients with false-negative mammograms so as to study its prognosis and provide an evidence for the treatment. Methods One hundred eighty - nine female patients with breast cancer, which was confirmed pathologically in No. 4 Hospital of Hebei Medical University and Cangzhou Central Hospital from January to April in 2006, were divided into two groups： a positive group and a false negative group according to their mammogram results. The immunohistochemistry method （Streptavidin -Peroxidase （S-P） method） was used to determine ER, PR, C-erbB-2 and VEGF of the patients. And the related analyses were made in combination with the clinical indexes. Results In the false-negative group, the menopause patients only accounted for 28.57% （10/35）, which was lower than that of the non-menopause patients（Х^2 = 7. 748 ,P = 0. 008 ） ; the patients suffering from medullary carcinama and mucinous adenocarcinima accounted for 27.27% （10/35）, which was higher than that 4.11% （6/148） of the positive group, with statistical difference （ P = 0. 000）. According to TNM stages, the stage I rate of the false negative group was lower than that of the positive group （ 14.30% vs82.56% , P = 0. 000 ）. For histological grade, the rate of grade III was 23.08% （8/35） in the false-negative group, which was obviously higher compared with 3.26% （Х^2 = 4. 952, P = 0. 024） in the positive group. The ER positive rate was lower in the false-negative group than in the positive group （40%vs67.57%, P = 0. 003 ）. But there were no differences in age, tumor size, axillary lymphatic metastasis and PR between the two groups （P 〉 0. 05）. The biological feature analysis of the tumor showed the strong positive expression rate of C-erbB-2 in the false negative group was lower than that of the positive group （25.71% vs 51.35% ,P =0. 008 ）. But there was no difference in the VEGF expression rate between the two groups （P 〉 0. 05）. Conclusion Breast cancer with false-negative has higher incidence in non-menopause patients. Patients with medullary carcinoma and mucinous adenoeareinoma account for a certain proportion, with low incidence of early breast cancer. It is suggested that breast cancer with false-negative grams results from the dense breasts and pathological types showing frequently benign clinical features in non-menopause patients. However, poor differentiation of tissues, lower positive expression rate of ER and lower strong positive rate of C-erbB- 2 show that the patients are suited tO auxiliary chemotherapy after operation.
出处
《中华乳腺病杂志（电子版）》
CAS
2007年第4期87-91,共5页
Chinese Journal of Breast Disease(Electronic Edition)
基金
河北省普通高校强势特色学科支持项目
关键词
乳腺癌
钼靶X线假阴性
免疫组化
临床病理
分子生物学行为
Breast neoplasms
False-negative mammograms
Immunohistochemistry
Clinical pathology
Molecbiological behavior
