Chu A Jung, Chang Jung Min, Cho Nariya, Moon Woo Kyung
Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Breast Cancer. 2017 Jun;20(2):192-197. doi: 10.4048/jbc.2017.20.2.192. Epub 2017 Jun 26.
The aim of our study was to investigate the characteristics of primary and recurrent breast cancers and the correlation between cancer subtypes and detection modes.
Between 2003 and 2013, 147 cases of recurrent breast cancer in 137 women (mean age, 45.30±10.78 years) were identified via an annual clinical examination using radiological studies among 6,169 patients with a breast cancer history (mean follow-up period, 13.26±1.78 years). Clinical, radiological, and pathological findings including immunohistochemistry findings of primary and recurrent cancers were reviewed. The size of the tumor in primary and recurrent cancers, disease-free survival, methods of surgery, and the recurrence detection modalities were analyzed with respect to the breast cancer subtype.
Ipsilateral and contralateral in-breast recurrence occurred in 105, 21 had axillary lymph node recurrence, and 21 had chest wall recurrences. The subtypes of the primary cancers were hormone receptor (HR) positive and human epidermal growth factor receptor 2 (HER2) negative (HR+HER2-) in 57, HER2 positive (HER2+) in 39, and triple-negative type in 51, and the recurrent cancers in each subtype showed the same type as the primary cancer in 84.3% of cases. In the in-breast recurrent cancers, the HR+HER2- cancers were most frequently detected using ultrasonography (15/43) followed by mammography (MG) (11/43). The HER2+ recurrent cancers were most commonly detected using MG (14/31, 45.2%), whereas triple-negative type recurrent cancers most commonly presented as symptomatic masses (15/31) (=0.028).
Most recurrent breast cancers showed the same cancer subtype as the primary tumor, and recurrent breast cancer subtypes correlated with the detection modality. Imaging surveillance of survivors of breast cancer might be more beneficial in cases of HR+HER2- type breast cancer or HER2+ type breast cancer than in cases of triple-negative type breast cancer.
本研究旨在调查原发性和复发性乳腺癌的特征以及癌症亚型与检测方式之间的相关性。
2003年至2013年期间，在6169例有乳腺癌病史的患者（平均随访期为13.26±1.78年）中，通过年度临床检查及放射学研究，确定了137名女性（平均年龄45.30±10.78岁）中的147例复发性乳腺癌病例。回顾了原发性和复发性癌症的临床、放射学及病理学检查结果，包括免疫组化结果。分析了原发性和复发性癌症的肿瘤大小、无病生存期、手术方法以及复发检测方式与乳腺癌亚型的关系。
同侧乳腺内复发105例，腋窝淋巴结复发21例，胸壁复发21例。原发性癌症的亚型中，激素受体（HR）阳性且人表皮生长因子受体2（HER2）阴性（HR+HER2-）57例，HER2阳性（HER2+）39例，三阴性类型51例，各亚型复发性癌症中84.3%与原发性癌症类型相同。在乳腺内复发性癌症中，HR+HER2-癌症最常通过超声检查发现（15/43），其次是乳腺钼靶检查（MG）（11/43）。HER2+复发性癌症最常通过MG检查发现（14/31，45.2%），而三阴性类型复发性癌症最常表现为有症状的肿块（15/31）（P=0.028）。
大多数复发性乳腺癌与原发性肿瘤具有相同的癌症亚型，且复发性乳腺癌亚型与检测方式相关。对于HR+HER2-型乳腺癌或HER2+型乳腺癌患者，乳腺癌幸存者的影像学监测可能比三阴性型乳腺癌患者更有益。
