摘要目的 探讨空心针穿刺活检(core needle biopsy,CNB)是否能够确定乳腺癌的雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、HER2状态、Ki67值并进行准确的分子分型.方法 回顾性分析2012年11月至2015年6月在军事医学科学院附属医院既行CNB又行开放切除活检(open excision biopsy,OEB)的188例乳腺癌患者.标本均通过免疫组织化学方法测定ER、PR、HER2和Ki67,并分为Luminal A、Luminal B、三阴性和HER2阳性四种分子亚型.用Kappa检验对CNB和OEB免疫组化结果进行一致性分析.结果 CNB和OEB评估ER、PR、HER2受体状态和Ki67表达的一致率分别为94.68％、93.62％、94.68％和73.40％.两者对于non-Luminal肿瘤的分型一致(P=0.774).OEB样本中Ki67的表达高于CNB样本(P＜0.05),分子亚型一致率为72.34％ (K=0.6064).结论 CNB可以确定乳腺癌的ER、PR、HER2状态以及Ki67值,CNB可对non-Luminal肿瘤准确分型.

abstractsObjective To evaluate core needle biopsy (CNB) in detecting estrogen receptor (ER) and progesterone receptor (PR) of HER2,Ki67,and molecular classification of breast cancer.Methods Clinical data of 188 breast cancer patients admitted from Nov 2012 to Jun 2015,were retrospectively analyzed.All patients received both CNB and open excision biopsy (OEB).Immunohistochemistry (IHC) was used to evaluate the expression of ER,PR,HER2 and Ki67.All cases were categorized into four molecular subtypes:Luminal A,Luminal B,triple negative breast canccr and HER2 over-expression breast cancer.Kappa test was used to evaluate the consistency of CNB and OEB.Results Concordance rate of ER,PR,HER2 receptor status and Ki67 value were 94.68％,93.62％,94.68％ and 73.40％.There was no difference between CNB and OEB for non-Luminal tumors (P =0.774).Ki67 expression in OEB samples was higher than in CNB samples (25.90％ vs.21.65％,P ＜ 0.001).Concordance rate between CNB and OEB for molecular subtypes was 72.34％ (K =0.606 4).Conclusions CNB is accurate in evaluating ER,PR,HER2 and Ki67 in breast cancer.CNB is accurate in diagnosing non-Luminal molecular subtypes of breast cancer.