不同分子分型原发乳腺癌临床病理特征及X线、超声表现:140例23~35岁患者

目的探讨不同分子分型原发年轻乳腺癌的临床病理特征及X线、超声诊断要点。方法收集经病理确诊的140例原发年轻乳腺癌，回顾性分析其各亚型的临床病理资料以及X线、超声表现。采用免疫组织化学检测ER、PR、HER2及Ki-67，HER2（++）者行FISH检测。结果140例年轻乳腺癌的分子分型比例依次为Luminal B型>HER2过表达型>三阴性型>Luminal A型。各亚型年轻乳腺癌的X线表现差异具有统计学意义（P < 0.05）。Luminal A型主要表现为肿块伴钙化，呈不规则形，边缘毛刺；Luminal B型表现为肿块伴钙化，呈不规则形，边缘模糊；HER2过表达型表现为单纯钙化，呈细小多形性或/及细线样，段样分布；三阴性型表现为单纯肿块，呈不规则形，边缘模糊。不同亚型的超声均表现为不规则实性低回声团伴钙化，边缘模糊，但回声性质及血供情况存在差异。不同亚型年轻乳腺癌的病理学类型虽具有统计学意义，但均以IDC 2级多见，且以Luminal B型所占比例最高。各亚型年轻乳腺癌的淋巴结转移及远处转移以Luminal B型常见，但差异均不具有统计学意义（P>0.05）。结论本组病例超声主要征象虽不具特征性，但三阴性型较常出现混合回声，各分子亚型血供也有所区别，因此术前可根据X线及超声综合表现作出初步分子分型判定。 

Clinicopathological features,X-ray and ultrasound findings of primary young breast cancer with different molecular types

ObjectiveTo investigate the clinicopathological features and the main points of X-ray and ultrasound diagnosis of primary young breast cancer with different molecular types.MethodsA total of 140 cases of primary young breast cancer confirmed by pathology were collected. The clinicopathological data, X-ray and ultrasound findings of each subtype were analyzed retrospectively.ResultsThe molecular typing order of young breast cancer were Luminal B, HER2 overexpression, triple negative and Luminal A type. The mammography features was significantly different between different molecular phenotype in young breast cancer. Luminal A showed irregular mass with calcification and marginal burr and luminal B showed irregular mass with calcification and blurred margin. The overexpression of HER2 showed simple calcification, fine pleomorphism or/and thin line, segment-like distribution, and triple negative showed simple irregular mass with blurred edge. Different subtypes of ultrasound showed irregular solid hypoechoic masses with calcification and blurred edges. There were differences in echo properties and blood supply. Although the pathological types of different subtypes of young breast cancer were significant, most of them were IDC grade 2 and Luminal B type accounted for the highest proportion Luminal B type was the most common subtype of young breast cancer with lymph node metastasis and distant metastasis, but the difference was not statistically significant.ConclusionsThe main ultrasonographic signs of this group of cases are not characteristic, mixed echoes are more common in the triple negative type, and the blood supply of each molecular subtype is also different. Therefore, a preliminary molecular classification can be made according to the comprehensive manifestations of X-ray and ultrasound before operation.