乳腺癌多模态影像诊断及其相关生物学指标的分析研究

发布时间：2017-12-31 12:19

本文关键词：乳腺癌多模态影像诊断及其相关生物学指标的分析研究　出处：《新疆医科大学》2017年博士论文　论文类型：学位论文

【摘要】：目的:综合应用多模态影像手段分析乳腺癌的表现及其相关生物学指标,用常规影像手段及新型手段分别评价对乳腺癌的诊断价值及和常见相关生物学指标的意义,然后探讨去甲基化组蛋白酶这种基因与常见生物学指标ER、PR、HER2之间的关系及临床表达意义,旨在为乳腺癌的预后及治疗提供新的参考依据。方法:1)通过对243例乳腺癌的钼靶影像表现相关特点及相关生物学指标ER、PR、HER-2的表达进行回顾性分析,探讨乳腺癌X线征象与ER/PR/HER2表达之间的相关性;2)共46例乳腺癌患者的标本经实验室设计的锥体束乳腺CT扫描,每例患者均在六个月内进行乳腺钼靶检查,观察指标为:乳腺肿瘤的边界,形态,钙化,周围浸润的情况。对相关指标与金标准进行对照比较;3)应用免疫组织化学的方法,从组织水平统计分析在浸润性乳腺癌中KDM3A与临床病理参数、雌激素受体、孕激素受体、人类表皮生长因子受体2的相关性以及分析KDM3A对浸润性乳腺癌患者生存率的影响。结果:1)X线钼靶表现:单纯肿块多见于Luminal A型;单纯钙化多见于Luminal B型和Her-2过表达型;局部致密伴钙化及结构扭曲伴钙化病变多见于Her-2过表达型。Her-2过表达型、LuminalB型乳腺癌单纯钙化比例较多,Her-2过表达型乳腺癌钙化多呈细小多型性,区域性分布,Luminal A型乳腺癌钙化以不定型和细小多型性多见;2)钼靶和锥体束乳腺CT两种检查方式在钙化、毛刺及形态的检出方面无显著统计学差异。在观察乳腺癌侵袭性的指标时有统计学差异;3)KDM3A蛋白在乳腺癌中高表达,KDM3A在乳腺癌组织中的表达与患者的年龄、临床分期、病理分级、淋巴结转移个数、肿瘤大小关系无统计学意义(P0.05)。KDM3A蛋白在乳腺癌中的表达与HER2的表达成正相关,与ER、PR蛋白表达呈负相关。综合多因素分析,临床分期、PR、KDM3A可以作为乳腺癌生存的综合因素考虑。结论:1)乳腺癌的数字化X线表现可一定程度上预测其分子亚型,为临床治疗及判断其预后提供影像学方面的根据,具备潜在的临床推广应用价值;2)在现有的参数条件下,锥体束乳腺CT(CBCT)在观察乳腺癌侵袭性是有一定的优势,对于乳腺癌边界和钙化的显示并没有呈现出明显优势,但是其空间定位的优势是明显的,这是我们需要进一步研究的突破点,锥体束乳腺CT应用于临床还需要更多的实践;3)在浸润性乳腺癌中KDM3A的表达水平与ER、PR、HER2表达水平无关,检测其蛋白表达情况对判断患者预后具有一定意义,为临床提供一个判断预后的新指标。
[Abstract]:Objective: to analyze the manifestation of breast cancer and its related biological indexes by multimodal imaging. The diagnostic value and the significance of common biological indexes of breast cancer were evaluated by conventional imaging and new methods, and then the gene of demethylated cathepsin and ERP PR, a common biological index, were discussed. The relationship between HER2 and clinical expression. Objective to provide a new reference for the prognosis and treatment of breast cancer. Methods the features of molybdenum target imaging and the relative biological index ERP PR were studied in 243 cases of breast cancer. The expression of HER-2 was analyzed retrospectively to explore the correlation between X-ray signs and ER/PR/HER2 expression in breast cancer. 2) A total of 46 samples of breast cancer were scanned by CT of pyramidal tract designed by laboratory. Mammography was performed in each patient within six months. The observed indexes were: the boundary, morphology and calcification of breast tumor. The relative indexes were compared with the gold standard. 3) KDM3A and clinicopathological parameters, estrogen receptor and progesterone receptor in invasive breast cancer were analyzed by immunohistochemical method. The correlation of human epidermal growth factor receptor 2 and the effect of KDM3A on the survival rate of invasive breast cancer patients were analyzed. Simple calcification was found in Luminal B type and Her-2 overexpression type. Local dense lesions with calcification and structural distortion with calcification were more common in Her-2 overexpression type. Her-2 overexpression type B breast cancer than in Luminal B type breast cancer. The calcification of Her-2 overexpression type breast cancer was mostly small polymorphic, and the regional distribution of luminal A type of breast cancer calcification was not stereotyped and small polymorphic. 2) there was no significant difference in calcification, burr and morphology between molybdenum target and pyramidal beam mammary CT. 3The high expression of KDM3A protein in breast cancer. The expression of KDM3A protein in breast cancer tissues and the age, clinical stage, pathological grade and number of lymph node metastasis. There was no significant difference in the relationship between tumor size and tumor size. The expression of P0.05N. KDM3A protein in breast cancer was positively correlated with the expression of HER2, and correlated with ER. The expression of PR protein was negatively correlated. KDM3A can be considered as a comprehensive factor for survival of breast cancer. Conclusion the digital X-ray findings of breast cancer can predict its molecular subtype to some extent. It provides imaging basis for clinical treatment and judgment of prognosis, and has potential clinical application value. 2) under the existing parameter condition, the cone bundle mammary CTB CT has the certain superiority in observing the breast cancer invasiveness, but has not shown the obvious superiority to the breast cancer boundary and the calcification display. However, the advantages of spatial localization are obvious, which is the breakthrough point that we need to further study. The application of cone-bundle mammary CT in clinic still needs more practice. 3) in invasive breast cancer, the expression of KDM3A was not related to the expression of ERP / HER2. Detection of the expression of HER2 protein was of significance in judging the prognosis of patients with invasive breast cancer. To provide a new prognostic index for clinical.
【学位授予单位】：新疆医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R737.9;R730.44

【相似文献】