摘要
目的研究乳腺良恶性肿瘤区域血流灌注的变化特点。方法乳腺良恶性肿瘤共60例,均为女性,年龄2270岁,平均年龄40岁。应用超声造影时间-强度曲线定量分析技术,检测其中乳腺恶性肿瘤30例（33个病灶）、乳腺纤维腺瘤30例（34个病灶）瘤灶边缘及中心部区域灌注参数峰值强度（PI）、曲线下面积（AUC）、达峰时间（TTP）、廓清时间（WOT）,用光学、透射电子显微镜观察瘤内新生血管显微结构及超微结构改变,免疫组织化学技术检测CD34、VEGF、Flk-1/KDR在两组肿瘤中的表达特性。结果恶性组病灶边缘各灌注参数与中心区域相比差异有统计学意义（P〈0.05）,良性组病灶边缘各灌注参数与中心区域相比差异无统计学意义（P〉0.05）。光学显微镜下恶性组90.91%（30/33）见坏死灶,血管异常丰富区位于癌巢边缘。良性组未见坏死灶,血管管径和分布均一。透射电子显微镜下恶性组新生血管内皮细胞超微结构具有不同于正常血管内皮细胞的分裂旺盛的瘤性特征,癌巢边缘可见扩张、迂曲的大血管,癌巢中心常见狭窄、闭塞的幼稚新生血管。恶性组瘤内微血管密度（MVD）显著高于良性组（P〈0.05）,尤其富集于癌巢边缘。VEGF及Flk-1/KDR在恶性组血管内皮细胞尤其是癌巢边缘呈强阳性表达,在良性组血管内皮细胞几乎不表达（P〈0.05）。结论实时超声造影区域灌注参数的差异为乳腺良恶性肿瘤的鉴别诊断提供了重要依据。针对VEGF或Flk-1/KDR为靶点进行新生血管特异性分子显像可能为乳腺癌的准确诊断提供新的思路,癌巢边缘可能是下一步进行乳腺癌分子影像观察的重点靶区。
Objective To compare blood perfusion differences of benign and malignant breast tumor.Methods A total of 60 female with benign and malignant breast tumors were enrolled,aged 22-70 years,mean age 40 years.Thirty cases with malignant breast carcinoma（33 lessions）and 30 cases with fibroadenoma（34 lessions）were performed by contrast-enhanced time-intensity curve quantitative analysis.Perfusion index including peak intensity（PI）,area under the curve（AUC）,time to peak（TTP）and wash-out time（WOT）were collected at tumor edge and tumor center.The samples of breast tumor,breast fibroadenoma were analysed routinely with microscope and transmission electron microscope.The expression of CD34,VEGF,Flk-1/KDR in 2 groups were measured with immunohistochemical technique.Results In malignant tumor group,PI,AUC and WOT in tumor edge were significantly higher than those in tumor center,while TTP was vice verse.However,there was no statistical differences between the perfusion parameters of tumor edge and center in benign group.The neovessels of breast tumors were composed of monolayer endothelial cells,the gap in endothelial cells became wide.The micro-vessels densely distributed and diffused around the edge of cancer nest.The MVD of malignant group（34.48 ± 8.34）was significantly higher than that in benign group（18.65 ± 4.69）.The high VEGF expression distributed diffusely or focally at the edge of cancer nest and necrotic tissue.The VEGF expression between malignant and benign group had significant difference.The Flk-1/KDR expressed diffusely or focally in breast carcinoma,especially high at the edge of cancer nest and necrotic tissue.The Flk-1/KDR expression between malignant and benign group had significant difference.Conclusion The variance of regional perfusion parameters are valuable diagnostic basis in differential diagnosis between benign and malignant breast tumor.The results showed that the molecular imaging which targeted to VEGF and Flk-1/KD may provide an new idea to explore the early dia
出处
《生物医学工程与临床》
CAS
2009年第5期431-435,共5页
Biomedical Engineering and Clinical Medicine
基金
国家自然科学基金资助面上项目(30670580)
关键词
乳腺癌
区域灌注
超声
breast cancer
regional perfusion
ultrasonography
