Angelini Giulia, Marini Carolina, Iacconi Chiara, Mazzotta Dionisia, Moretti Monica, Picano Eugenia, Morganti Riccardo
Department of Translational Research and New Technologies in Medicine and Surgery, Diagnostic and Interventional Radiology, 56124 Pisa, Italy.
Department of Radiology, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56100 Pisa, Italy.
Clin Imaging. 2018 May-Jun;49:12-16. doi: 10.1016/j.clinimag.2017.10.016. Epub 2017 Oct 27.
Few reports in literature describe triple negative breast cancer (TNBC) imaging findings. Aim of the study is to determine MR-features of TNBC compared to receptor positive cancer (nTNBC). From May 2014 to May 2015, we retrospectively enrolled 31 consecutive patients with histological diagnosis of TNBC and a control group of 31 consecutive nTNBC observed in the same period, out of 602 cancer, diagnosed in our department in the same year. Histopathological analysis and MR-features of TNBC (31 patients) were compared to nTNBC (31 patients). MR-features included dimension, fibroglandular tissue (FGT), background parenchimal enhancement (BPE), mass shape, margins, presence of rim, intratumoral signal intensity in T2w, uni-multifocality, kinetic curves. All patients were examined with MR 1,5T (Magnetom Simphony Tim, Siemens Healthcare) performing T2w fat-sat and contrast enhanced high temporal and spatial resolution T1w before and after injection of Gadolinium. 62 staging MR were reviewed. Median age was 50 (30-78ys) with a standard deviation of 10,9. TNBC showed 3 MR features in concordance with current literature: rim enhancement, hyperintensity in T2 sequence and unifocality. Rim enhancement was shown in 67.7% of TNBC (21/31) and 29% of nTNBC (9/31). Higher T2w values were shown in 83.9% of TNBC (26/31) and 58.1% of nTNBC (18/31). Cancer was multifocal in 7/31 (22.6%) of TNBC and 19/31 (61.3%) nTNBC. No correlation was found for dimension (p=0.12), FGT (p=0.959), BPE (p=0.596), homogeneity of enhancement (p=0.43), margins (p=0.671) and kinetic (p=0.37). Multivariate analysis demonstrated that rim enhancement and unifocality correlated independently with TNBC group. Area under ROC curve of our model is 0.835. Furthermore, we evaluated the clinical outcome of all 31 TNBC patients in a follow-up time ranging from 24months to 36months separating them in a free-survival group (23 women) and a recurrence group (8 women with local recurrence or distant metastasis): only kinetic curves resulted to be significantly higher in recurrence group (p=0.042).
文献中很少有报道描述三阴性乳腺癌（TNBC）的影像学表现。本研究的目的是确定TNBC与受体阳性乳腺癌（非TNBC）相比的磁共振成像（MR）特征。2014年5月至2015年5月，我们回顾性纳入了31例经组织学诊断为TNBC的连续患者，以及同期在我科诊断的602例癌症中观察到的31例非TNBC连续患者作为对照组。将TNBC（31例患者）的组织病理学分析和MR特征与非TNBC（31例患者）进行比较。MR特征包括大小、纤维腺组织（FGT）、背景实质强化（BPE）、肿块形状、边缘、边缘的存在、T2加权像上的瘤内信号强度、单灶性/多灶性、动态曲线。所有患者均使用1.5T磁共振成像（Magnetom Simphony Tim，西门子医疗）进行检查，在注射钆之前和之后进行T2加权脂肪抑制和对比增强的高时间和空间分辨率T1加权成像。回顾了62例分期MR图像。中位年龄为50岁（30 - 78岁），标准差为10.9。TNBC显示出与当前文献一致的3个MR特征：边缘强化、T2序列高信号和单灶性。67.7%的TNBC（21/31）和29%的非TNBC（9/31）显示边缘强化。83.9%的TNBC（26/31）和58.1%的非TNBC（18/31）显示T2加权值较高。7/31（22.6%）的TNBC和19/31（61.3%）的非TNBC为多灶性癌症。在大小（p = 0.12）、FGT（p = 0.959）、BPE（p = 0.596）、强化均匀性（p = 0.43）、边缘（p = 0.671）和动态（p = 0.37）方面未发现相关性。多变量分析表明，边缘强化和单灶性与TNBC组独立相关。我们模型的ROC曲线下面积为0.835。此外，我们评估了所有31例TNBC患者在24个月至36个月随访期内的临床结局，将他们分为无瘤生存组（23名女性）和复发组（8名有局部复发或远处转移的女性）：只有动态曲线在复发组中显著更高（p = 0.042）。
