目的: 研究乳腺乳头状癌病理亚型病例的超声(US)、乳房X线摄影(MG)和磁共振成像(MRI)的影像学表现,分析乳腺乳头状癌亚型及影像学特征与常见免疫组化指标的关系。方法: 回顾性分析2012年2月16日至2021年12月20日收治的47例乳腺乳头状癌病例,其中,US检查47例(47病灶)、MG检查45例(45病灶)、MRI检查14例(16病灶),对比分析亚型病例及其影像特征与ER、PR、Her-2、Ki-67等免疫组化指标的关系。结果: US特征:在ER、PR表达中,各亚型的超声影像学特征比较差异无统计学意义(P＞0.05),42例肿块的ER、PR阳性表达率分别为97.6%(41/42)、88.1%(37/42)。在Her-2表达中,pDCIS亚型肿块后方回声改变存在统计学差异(P=0.039)。EPC亚型肿块直径、IPC亚型肿块后方回声改变在Ki-67表达中存在统计学差异(P=0.037,P=0.039)。MG特征:Ki-67表达中SPC亚型的钙化分布特征存在统计学差异(P=0.048),在ER、PR、Her-2表达中,各亚型的MG影像学特征比较差异无统计学意义(P＞0.05),26例肿块的ER、PR阳性表达率分别为96.2%(25/26)和80.8%(21/26)。MRI特征:ER、PR、Her-2及Ki-67表达中4个亚型的MRI影像学特征关系比较差异均无统计学意义(P＞0.05),13例肿块的ER、PR阳性表达率分别为100%(13/13)及84.6%(11/13);Her-2阴性表达率达76.9%(10/13)。结论: 乳腺乳头状癌是一种以ER、PR阳性表达为主的乳腺癌,US显示EPC亚型肿块直径≥2 cm及IPC亚型肿块后方回声衰减与Ki-67阳性表达存在关联。Ki-67阳性表达与SPC亚型钙化非良性分布的MG影像特征相关。这些影像特征有助于判断乳腺乳头状癌的生物学特性,可协助临床预测患者的预后。

Objective: To study the imaging findings of ultrasound (US), mammography (MG) and magnetic resonance imaging (MRI) in patients with pathological subtypes of breast papillary carcinoma, and to analyze the relationship between subtypes and imaging features of breast papillary carcinoma and common immunohistochemical indicators. Methods: A retrospective analysis of 47 cases of papillary breast cancer admitted from February 16, 2012 to December 20, 2021, including 47 cases of US examination (47 lesions), 45 cases of MG examination (45 lesions), and 14 cases of MRI examination (16 lesions). The relationship between subtype cases and their imaging features and immunohistochemical indicators such as ER, PR, Her-2 and Ki-67 was compared and analyzed. Results: US characteristics: In the expression of ER and PR, there was no significant difference in the ultrasound imaging characteristics of each subtype (P> 0.05), the positive expression rates of ER and PR in 42 cases were 97.6% (41/42) and 88.1% (37/42), respectively. In the expression of Her-2, there was a statistically significant difference in the posterior echo of pDCIS subtype tumor (P=0.039). The tumor diameter of EPC subtype and the posterior echo of IPC subtype showed significant differences in Ki-67 expression (P=0.037,P=0.039). MG characteristics: There were statistical differences in the calcification distribution of SPC subtype in Ki-67 expression (P=0.048), and there was no statistically significant difference in the imaging characteristics of MG in ER, PR and Her-2 expression (P> 0.05), the positive expression rates of ER and PR in 26 cases were 96.2% (25/26) and 80.8% (21/26), respectively. MRI features: There were no significant differences in MRI imaging features of ER, PR, Her-2 and Ki-67 expression subtypes (P> 0.05), the positive expression rates of ER and PR in 13 cases were 100.0% (13/13) and 84.6% (11/13), respectively. The negative expression rate of Her-2 was 76.9% (10/13). Conclusions: Papillary breast carcinoma is a kind of breast cancer with positive expression of ER and PR. Tumor diameter ≥2 cm in EPC subtype and posterior echo attenuation of mass in IPC subtype on US are associated with positive expression of Ki-67. The positive expression of Ki-67 is related to the imaging characteristics of MG with non-benign distribution of calcification of SPC subtype. These imaging features are helpful to determine the biological characteristics of papillary breast carcinoma and to predict the prognosis of patients.