Ultrasound Comparative Analysis Of Triple Negative Breast Cancer And Benign Lesions Of BIRADS4A

Objective:1.To analyze the ultrasound findings of triple-negative breast cancer(TNB C)and to improve diagnostic performance of the disease,compared it with BI RADS 4A benign lesions(fibroadenoma and adenosis).2.To screen out the main ultrasonographic features in early detection,to a void TNBC from missed diagnosis.3.To assess the consistency of ultrasonographic findings with pathological findings in axillary lymph node metastasis.Methods:The ultrasound findings of group A(TNBC,n=50)were compared with clas sified BIRADS 4A group B(fibroadenoma,n=34)and group C(adenosis,n=37)retrospectively,which were confirmed by core-needle biopsy or surgical biopsy pathology.Ultrasound examinations were available for all lesions.The ultrasound parameters included shape,margin,calcification,echo,orientation,boundary,peripher al duct change posterior acoustic features,halo,axillary adenopathy and elastogra phy.All masses were categoried by BI-RADS-US.The ultrasonographic parameters were under the single factor analysis first,by chi-square test,when P is less than 0.05,the difference is statistically signific ant.The variables which had statistical significance were analyzed by binary log istic regression analysis of Forward:LR method analysis,when P is less than 0.05,the difference is statistically significant.When primary differential diagnostic factors were obtained,draw ROC(receiver operating characteristic curve)and c alculate AUC(area under the curve)respectively and jointly.To analyze diagnostic value of ultrasonography in axillary lymph node me tastasis of TNBC patients,by Kappa test,use the histopathological diagnosis as gold standard.Results:1.There were statistical significance(P<0.05)differences in age,size,shape,margin,calcification,echo,vascular grade,BI-RADS category between TNBC an d fibroadenoma.There were statistical significance(P<0.05)for differences in age,size,margin,peripheral duct change,vascular grade between TNBC and adenos is.There were statistical significance(P<0.05)differences in shape,calcification,BI-RADS category between fibroadenoma and adenosis.There was no statistical significance(P>0.05)for difference in orientation,boundary,posterior acoustic feat ures,halo between three groups.2.Univariate logistic regression analyze showed,there were statistical signif icance(P<0.05)for differences in margin,calcification,echo,peripheral duct cha nge,vascular grade between TNBC and BIRADS 4A benign lesions.6 main p arameters for TNBC diagnosis were screened out for logistic regression analysi s,they were shape,margin,calcification,echo,peripheral duct change,vascular g rade.Multivariate logistic regression analyse showed,the main ultrasonographic features for TNBC were vascular grade,margin and echo,with odd rate(OR)val ue of 5.163,3.059,2.981,respectively.The receiver operating characteristic curve(ROC)confirmed that a mass combined with vascular grade Ⅱ-Ⅲ,irregular mar gin,heterogeneous echo can be characteristic in diagnosing TNBC(AUC 0.778).3.Postoperative pathological diagnosis showed,the rate of lymph node met astasis for TNBC was 22.0%,ultrasonography in axillary lymph node metastasis has a sensitivity of 54.5%,specificity of 87.2%,accuracy of 80.0%.Conclusion:1.TNBC often occur in women older than 50 years old,the lesions usuall y larger than 2 cm,heterogeneous echo,show irregular shape with distinct margi n,while the margin may be angular,micro-lobulated or spiculated.TNBC usual ly associated with posterior enhancement or no change,harder elastograghy featr ue,and categoried more than BIRADS 4B.With regard to fibroadenoma that w ere at least classified BI-RADS 4A,were most likely to be masses with lobulat ed or irregular shape,with distinct margin.For adenosis that were at least classif ied BI-RADS 4A,they often appear irregular and sometimes vertical orientation,may be confused with breast cancer.2.Multi variate logistic regression analysis showed that a mass combined wi th vascular grade Ⅱ-Ⅲ,irregular margin,heterogeneous echo can be characteri stic in diagnosing TNBC.3.Ultrasonography has a satisfying consistency in pathology when evaluatin g axillary lymph node metastasis for TNBC,while sensitivity is not high.