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目的探讨新辅助化疗后乳腺癌残留灶分型与雌激素受体、孕激素受体及人表皮生长因子受体2的关系。方法 90例Ⅱ、Ⅲ期浸润性导管癌患者手术标本取半,制成全乳腺次连续大切片,显微镜下观察新辅助化疗后乳腺癌残留灶形态并分型;免疫组化检测乳腺癌化疗前后雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人表皮生长因子受体2(human epidermal growth factor receptor,HER-2)状态,并分析残留灶不同分型与新辅助化疗前、新辅助化疗后ER、PR、HER-2的表达水平及其变化情况的相关性。结果新辅助化疗后镜下残留灶可分为3型:Ⅰ型(向心性收缩的孤立性残留癌灶)、Ⅱ型(多灶性斑片状癌灶)、Ⅲ型(主残留病灶旁有卫星结节样残留),分别占61%(55/90)、33%(30/90)、6%(5/90)。残留灶不同分型与新辅助化疗前及新辅助化疗后ER、PR、HER-2表达水平无显著差异(P>0.05);残留灶不同分型与新辅助化疗后ER、PR、HER-2表达水平的变化无显著差异(P>0.05)。新辅助化疗后,ER、PR、HER-2表达水平降低,但无统计学差异(P>0.05)。结论 ER、PR及HER-2不能评估新辅助化疗后乳腺癌残留灶形态类型,应该进一步结合MRI与全乳大切片进行研究,便于术前了解残留癌灶的基本形态。
Objective To investigate the relationship between estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 in breast cancer after neoadjuvant chemotherapy. Methods Totally 90 cases of invasive ductal carcinoma of stage Ⅱ and Ⅲ were examined by semi-continuous sub-section of the whole breast. The shape and distribution of residual tumor in neoadjuvant chemotherapy were observed under microscope. Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor (HER-2) Neoadjuvant chemotherapy, neoadjuvant chemotherapy ER, PR, HER-2 expression levels and changes in the correlation. Results After neoadjuvant chemotherapy, the residual lesions can be divided into three types: type Ⅰ (centripetal contracted isolated residual cancer), type Ⅱ (multifocal patchy cancer), type Ⅲ Satellite nodules), accounting for 61% (55/90), 33% (30/90) and 6% (5/90), respectively. There were no significant differences in ER, PR and HER-2 expression levels between different types of residual tumor and those before neoadjuvant chemotherapy and neoadjuvant chemotherapy (P> 0.05). The differences of ER, PR, HER-2 There was no significant difference in the expression level (P> 0.05). Neoadjuvant chemotherapy, ER, PR, HER-2 expression decreased, but no significant difference (P> 0.05). Conclusion ER, PR and HER-2 can not assess the morphology of residual tumor after neoadjuvant chemotherapy, and should be further combined with MRI and whole-milk large sections to understand the basic morphology of residual tumor before surgery.