目的:研究乳腺乳头状癌分子亚型的超声(ultrasonography,US)、乳房X线摄影(mammography,MG)和磁共振成像(magnetic resonance imaging,MRI)影像学特征及其临床意义。方法:回顾性分析47例(49个病灶)乳头状癌临床和影像资料,依据2022年CBCS乳腺癌分子分型标准,本研究未收集到HER-2阳性型和三阴型,47例分为3个亚组:Luminal A、Luminal B1和Luminal B2组。比较各亚型临床特征,超声(n=47)、MG(n=45)和MRI(n=14)影像特征的差异。分析3种影像学BI-RADS分类诊断的敏感性和误诊率。结果:(1)临床特征:各亚型触到包块比乳头溢液者多。(2)影像特征:US显示Luminal B2、Luminal A型病灶边界不清者远多于Luminal B1型(P＜0.05);MG显示各亚型病灶的形态规则而边界不清;MRI显示Luminal B2型病灶边缘不清的比例为100 %,而Luminal B1型病灶边缘清晰的比例为100 %,Luminal B1型ADC值低于Luminal A型(P＜0.05)。(3)影像学诊断:Luminal A、Luminal B1、Luminal B2型的敏感性分别为52.8 %、16.7 %、100 %(US);57.1 %、83.3 %、75.0 %(MG);80.0 %、100 %、100 %(MRI)。US、MG及MRI的误诊率分别为46.8 %、37.8 %及14.3 %,US的误诊率高于MRI(P=0.029)。结论:乳腺乳头状癌是一种ER、PR阳性表达为主的乳腺癌,US诊断Luminal B2型比较敏感,MRI、MG诊断Luminal A和Luminal B1型的敏感性更高。分子亚型的病理组成不同,影像特征亦存在差异,这种差异可为影像和临床诊疗提供参考。
Objective: To study the imaging characteristics and clinical significance of molecular subtypes of papillary carcinoma of the breast under ultrasonography(US), mammography(MG) and magnetic resonance imaging (MRI). Methods: Clinical and imaging data of 47 cases (49 lesions) of papillary carcinoma were retrospectively analyzed. According to the 2022 CBCS breast cancer molecular typing criteria, HER-2 positive and triple-negative types were not collected. 47 cases were divided into three subgroups: Luminal A group, Luminal B1 group and Luminal B2 group. The clinical features (n=47), US (n=47), MG (n=45) and MRI (n=14) features of each subtype were compared. The sensitivity and misdiagnosis rate of three kinds of BI-RADS were analyzed. Results: In terms of clinical features, papillary carcinoma of breast is a luminal phenotype of breast cancer. There were more masses in each subtype than those in nipple discharge. Regarding to imaging features, US showed that Luminal B2 and Luminal A lesions had unclear boundaries far more than Luminal B1 lesions (P= 0.015, P=0.027). MG showed that the morphology of each subtype was regular and the boundary was not clear. MRI showed that Luminal B2 lesions had unclear edges for 100 %, while Luminal B1 lesions had clear edges for 100 %, and ADC value of Luminal B1 was significantly lower than that of Luminal A (P=0.030). Imaging sensitivity of Luminal A, Luminal B1 and Luminal B2 were 52.8 %, 16.7 % and 100 % by US, 57.1 %, 83.3 % and 75.0 % by MG, 80.0 %, 100 % and 100 % by MRI respectively. The misdiagnosis rates of US, MG and MRI were 46.8 %, 37.8 % and 14.3 % respectively, and the misdiagnosis rate of US was much higher than that of MRI (P=0.029). Conclusion: Papillary carcinoma of breast is a type of breast cancer with positive expression ER and PR. Luminal B2 type is sensitive to US, but Luminal A and Luminal B1 types are more sensitive to MRI and MG. The molecular subtypes have different pathological compositions and imaging characteristics, which could provide reference for imaging diagnosis and clinical treatment.
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