目的:探讨乳腺癌空芯针活检(core needle biopsy,CNB)与手术切除标本Ki67表达量的改变及其与分子分型的关系。方法:回顾性分析在瑞金医院乳腺疾病诊治中心接受CNB与手术切除治疗乳腺癌病人Ki67的表达量与改变情况。Ki67改变值定义为手术切除标本Ki67表达减去CNB标本的Ki67表达量,并分析乳腺癌临床病理指标和分子分型与Ki67表达量改变之间的关系。结果:共有298例乳腺癌病人的CNB和手术切除配对标本行激素受体、Her-2以及Ki67免疫组织化学检查。手术切除标本Ki67的表达量显著高于CNB标本:29.3%比26.8%,P=0.046;Ki67改变值的中位数和平均数分别为0(四分位距,-5.0%,10.0%)和2.5%±14.0%。单因素(P=0.024)和多因素(P=0.048)方差分析均显示Ki67改变值与分子分型状态显著相关:82例luminal A型的Ki67改变值为5.4%,显著高于112例luminal B型的-0.7%;而在38例luminal B-HER2+型、39例三阴性型以及27例Her-2+型乳腺癌病人中Ki67改变值无统计学差异。结论:手术切除标本的Ki67表达量较CNB标本显著上升,Ki67表达升高主要见于luminal A型病人,研究结果有助于设计新型临床研究。 Objective: To investigate the changes of Ki67 expression in breast cancer with core needle biopsy (CNB) and resection specimens and its relationship with molecular typing. Methods: The expression and alteration of Ki67 in patients with breast cancer treated with CNB and surgical resection in the Breast Disease Center of Ruijin Hospital were retrospectively analyzed. The Ki67 change was defined as the Ki67 expression in the resected specimens minus the Ki67 expression in CNB specimens, and the relationship between the clinicopathological parameters and molecular typing of breast cancer and Ki67 expression was analyzed. Results: A total of 298 cases of breast cancer patients with CNB and surgical resection specimens were performed hormone receptor, Her-2 and Ki67 immunohistochemistry. The expression of Ki67 in the resected specimens was significantly higher than that of CNB specimens (29.3% vs. 26.8%, P = 0.046). Median and mean Ki67 changes were 0 (quartile, -5.0%, 10.0%) and 2.5% ± 14.0%. The ANOVA of single factor (P = 0.024) and multiple factors (P = 0.048) showed that the change of Ki67 was significantly correlated with the molecular typing status: the Ki67 change of 82 luminal A types was 5.4%, which was significantly higher than that of 112 cases of luminal B -0.7%, while there was no significant difference in Ki67 between 38 patients with luminal B-HER2 +, 39 patients with triple negative and 27 patients with Her-2 + breast cancer. CONCLUSION: The Ki67 expression in surgically resected specimens is significantly higher than that in CNB specimens. Ki67 expression is mainly found in luminal A patients, and the results are helpful to the design of new clinical trials.