X-ray Manifestations Of Breast Cancer And Molecular Classification Of Breast Cancer

Objective: To study the relationship between the mammographic features of breast cancer and the molecular classification of breast cancer(Luminal A type,Luminal B(HER-2 negative / HER-2 positive)type,ERBB2 + type,Basal-like type)expression and intraoperative lymph node metastasis correlation.Methods: We retrospectively reviewed preoperative mammography x-ray and pathologically confirmed breast cancer patients after surgery in 212 cases,all routine laboratory specimens immunohistochemical detection,through the ER,PR,HER-2 and Ki-67,molecular typing the expression,determine the breast cancer immunohistochemical staining of the situation,resulting in ER,PR,HER-2 positive and negative results.ER and PR criteria for reference to "ASCO / CAP breast cancer hormone receptor IHC test guidelines",are defined in the test specimen is greater than 1% of the tumor cell staining to determine the positive.Standards reference guidelines for HER-2 testing in breast cancer HER-2 interpretation,when the expression is(+++),identified as positive,(++)further when do FISH inspection judge of negative and positive,the expression as(-)or(+)were found to be negative 2013 St.Gallen international breast cancer Conference to define the molecular classification of breast cancer: Luminal A type(ER/PR+,PR > 20%,and HER-2,and Ki-67<14%);Lumial B:HER-2negative type:(ER/ PR+,and HER-2,and Ki-67>14% or PR<20%),HER-positive type :(ER/PR+,HER-2 positive,any state Ki-67);ERBB2+:(HER-2 posi tive,ER-,and PR-),basal-like/triple negative-type(special non-invasive d uctal carcinoma):(HER-2,and ER-and PR-)and other special types of breast cancer(Table1).To retrospectively analyze the X-ray findings of these breast cancer patients,to explore its relationship with the molecular classification ofbreast cancer,lymph node metastasis.The SPSS21.0 statistical package was used to perform χ2 test for multiple or two groups of counting data.P <0.05 was considered statistically significant,P <0.01 was considered significant difference.Results: 1 pathology results Among the 212 cases,17 cases of HER-2(+,+)no FISH results,the final group of 195 cases: 170 cases of invasive ductal carcinoma,invasive lobular carcinoma in 6 cases,7 cases of ductal carcinoma,degenerative invasive ductal carcinoma in 7 cases,Cancer in 1 case,invasive sigmoid carcinoma in 1 case,neuroendocrine cancer in 1 case,mucinous adenocarcinoma in 1 case,metaplastic carcinoma in 1 case.There were 68 cases of lymph node metastasis and 127 cases without lymph node metastasis.Age is less than 30 years old,2 cases;30-39,20 cases;40-49,55 cases;50-59,68 cases;60-69,39 cases;more than 70 years old,11 cases.2 by breast cancer X-ray performance is divided into 1)simple mass in 95 cases,68 cases of spit sign,lobulation in 26 cases,halo ring sign in 22 cases;2)simple calcification in 14 cases;3)mass with calcification in 53 cases;4)simple structural twist in 10 cases,Structural twist with calcification in 3 cases;5)simple asymmetric dense in 11 cases,asymmetric dense with calcification in 9 cases.3 Breast cancer molecular typing Luminal A type 15 cases,accounting for 7.7%;Luminal B(HER-2negative)type 96 cases,accounting for 49.2%;Luminal B(HER-2 positive)type 51 cases,accounting for 26.2% of the total;ERBB2 + type 22 cases,the total number of 11.3%;Basal-like 11 cases,accounting for 5.6% Among the 195 cases of breast cancer,157 cases(80.5%)were positive for ER expression,108 cases(55.4%)were positive for PR expression,73 cases(37.4%)were HER-2 positive expression,165 cases were positive for Ki-67,Accounting for 84.6%,68 cases of positive lymph node metastasis,accounting for 34.9%.4 The relationship between X-ray findings of breast cancer and Luminal A,Luminal B(HER-2negative),Luminal B(HER-2positive),ERBB2 +,Basal-like,and lymph node metastasis(Table2-5)4.1 There was no significant difference in pathological classification between the five groups(χ2 = 35.542,P = 0.305).The difference of lymph node metastasis between the five groups was statistically significant(P = 0.030).The proportion of Basal-like group(63.7%,7/11)in lymph node metastasis was higher than that in other subtypes(Table2).4.2 There were significant differences in the signs of X-ray(P <0.05).There were significant differences in the simple mass,simple calcification,mass calcification,structural distortions,asymmetry and so on.There was no significant difference in the edge of the tumor between the five groups(χ2 = 3.829,P =0.962).ERBB2 + signs accounted for 13/22(59.1%),non-tumor signs accounted for 9/22(40.9),calcification accounted for 16/22(72.7%),non-calcified signs accounted for 6/22(27.3%),non-mass signs(Χ2 = 3.829,P=0.050)and calcification(χ 2=10.678,P=0.001)were not statistically significant compared with non-ERBB2 + type.Five cases of X-ray findings(Table3).4.3 There was no correlation between luteal sign,burr sign and halo sign and Luminal A type,Luminal B(HER-2 negative)type,Luminal B(HER-2 positive)type,ERBB2 + type,Basal-like type expression(Table4)4.4 mass size and shape: five subtypes of the tumor size(long diameter)was statistically significant,(χ2 =23.229,P=0.003),There was no statistically significant difference in the morphology of the five subtypes(χ2 =13.519,P=0.095).(Table5)4.5 Calcification distribution: cluster distribution,segment distribution,line-like distribution,regional distribution,scattered distribution,and calcification: irregular calcification,rough heterogeneity calcification,fine pleomorphic calcification,fine line or thin calcification.The relationship between branching calcification and breast cancer Luminal A type,Luminal B(HER-2 negative)type,Luminal B(HER-2 positive)type,ERBB2 + type,Basal-like subtype expression,Luminal B(HER-2 negative)Calcification for the 3 cases,which in the form of fine pleomorphic calcification in 3 cases;Luminal B(HER-2 positive)showed calcification in 6 cases,the morphological manifestations of small pleomorphic calcification of 5/6 There were 4/6 cases of cluster distribution in the distribution,5 cases of calcification in ERBB2 + type,5 cases of fine pleomorphic calcification in morphology.In this study,the total number of calcification into the group less,not using statistical methods.4.6 The distribution of Luminal A in the five groups was the largest in the 40-49 age range,accounting for 9/15(60%).The age of Luminal B(HER-2 negative)was the largest in the 50-59 years,About 33/96(34.4%),Luminal B(HER-2 positive)in the 50-59-year range up to about 18/51(35.3%),ERBB2 + type in the 50-59-year interval up to about 12 / 22(54.5%),Basal-like type in the 60-69 years old interval up to about 4/11,suggesting that the older age(36.4%).(Table6)Conclusion: Between the molecular classification of breast cancer Luminal A type,Luminal B(HER-2 negative)type,Luminal B(HER-2 positive)type,ERBB2 + type,Basal-like type and breast cancer X-ray imaging(simple mass,simple calcification,mass with calcification,Structural distortions,asymmetric and dense)have a certain correlation.Among them Luminal type showed mass 129/162(79.6%),non-mass 33/162(20.4%);and the expression of ERBB2 + was 16/22(72.7%),and non-calcified 6/22(27.3%),suggesting that it is associated with Her-2 positive and calcification signs.Luminal B(HER-2 negative and positive)type of the largest proportion of about 147/195(75.4%);Basal-like lymph node metastasis rate of the highest,about 7 / 11(63.6%),suggesting that the high rate of lymph node metastasis,the lower the degree of malignancy,poor prognosis,high risk of recurrence;five groups of age distribution Luminal A type in the 40-49 year interval,about 9/15(60%)suggest that the age of onset is small,Luminal B(HER-2 negative)in the 50-59-year interval up to about 33/96(34.4%),Luminal B(HER-2 positive)inthe 50-59 years The range is about 18/51(35.3%),ERBB2 + is in the range of 50-59 years old,about 12/22(54.5%),Basal-like is the largest in the 60-69 age range,about 4/11,Suggesting that the age of onset(36.4%).Breast cancer mammography performance and the molecular classification of breast cancer has a certain correlation between,can be used to roughly by observing the image performance to predict the molecular classification of breast cancer and lymph node metastasis for preoperative judgment of tumor biology behavior,assessment of prognosis,to guide the clinical treatment to provide some reference.