Tse Gary M K, Cheung Humairah S, Pang Lai-Man, Chu Winnie C W, Law Bonita K B, Kung Fred Y L, Yeung David K W
Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Ngan Shing St., Shatin, Hong Kong, SAR China.
AJR Am J Roentgenol. 2003 Nov;181(5):1267-72. doi: 10.2214/ajr.181.5.1811267.
Proton MR spectroscopy is a recently described technique with high sensitivity and specificity for differentiating breast carcinoma from benign lesions. We evaluated the possible relationship between spectroscopy results and the tumor proliferative index, angiogenesis, and HER2/neu oncogene overexpression. SUBJECTS AND METHODS. We prospectively evaluated 19 breast carcinomas, 21 benign breast lesions (including 18 fibroadenomas, one fibrocystic change, one hamartoma, and one papilloma), and six phyllodes tumors (four benign, two of borderline malignancy) using proton MR spectroscopy. All lesions were larger than 1.5 cm. Tumor Ki-67 proliferative index, tumor angiogenesis, and HER2/neu oncogene overexpression were evaluated by immunohistochemistry of the histologic material.
Spectroscopy findings were positive in 17 (89%) of 19 carcinomas but negative for all benign lesions and phyllodes tumors (sensitivity, 89%; specificity, 100%). Significantly higher levels were obtained for all biologic parameters in carcinomas compared with benign lesions and phyllodes tumors. HER2/neu oncogene overexpression was present in 37% of carcinomas but not in other lesions. The two false-negative findings of breast carcinoma showed similar Ki-67 proliferative index and microvessel density compared with the remaining carcinomas, but both cases were negative for HER2/neu overexpression.
Proton MR spectroscopy is useful in the in vivo characterization of breast masses when the lesion exceeds 1.5 cm in maximal dimension. Spectroscopy is unable to reveal benign breast lesions and phyllodes tumors of benign and borderline malignancy. We suggest that a false-negative spectroscopic result may be related to an absence of HER2/neu overexpression in carcinoma of the breast.
质子磁共振波谱是一种最近描述的技术，对鉴别乳腺癌与良性病变具有高灵敏度和特异性。我们评估了波谱结果与肿瘤增殖指数、血管生成以及HER2/neu癌基因过表达之间的可能关系。
我们前瞻性地使用质子磁共振波谱评估了19例乳腺癌、21例乳腺良性病变（包括18例纤维腺瘤、1例纤维囊性变、1例错构瘤和1例乳头状瘤）以及6例叶状肿瘤（4例良性，2例交界性恶性）。所有病变均大于1.5 cm。通过对组织学材料进行免疫组织化学评估肿瘤Ki-67增殖指数、肿瘤血管生成以及HER2/neu癌基因过表达。
19例癌中的17例（89%）波谱结果为阳性，但所有良性病变和叶状肿瘤的波谱结果均为阴性（灵敏度为89%；特异性为100%）。与良性病变和叶状肿瘤相比，癌的所有生物学参数水平均显著更高。37%的癌存在HER2/neu癌基因过表达，而其他病变中未出现。乳腺癌的2例假阴性结果与其余癌相比，Ki-67增殖指数和微血管密度相似，但这两例HER2/neu过表达均为阴性。
当病变最大径超过1.5 cm时，质子磁共振波谱有助于对乳腺肿块进行体内特征性诊断。波谱无法显示乳腺良性病变以及良性和交界性恶性叶状肿瘤。我们认为波谱假阴性结果可能与乳腺癌中HER2/neu过表达缺失有关。
