Application Of Multimodal Ultrasound In Triple-negative Breast Cancer And HER-2 Overexpressing Breast Cancer

Part Ⅰ:Multimodal ultrasound identification of triple-negative breast cancer and HER-2 overexpressing breast cancerBackground and objectiveTriple-negative breast cancer(TNBC)is not expressed by estrogen receptor,progesterone receptor and human epidermal growth factor receptor 2(HER-2).So the conventional endocrine and trastuzumab-targeted treatments with better efficacy in non-TNBC are less sensitive.Therefore,treatment is more difficult and prone to recurrence and metastasis.However,the research shows that it is more sensitive to neoadjuvant chemotherapy.If the characteristics of TNBC can be predicted by some features of the ultrasound before surgery,it will provide greater help for the development of the entire treatment plan Most of the current research focuses on the identification of TNBC and non-TNBC ultrasound features.While human epidermal growth factor receptor 2(HER-2)overexpressing breast cancer is a small part of non-TNBC,its features are rarely noticed.But its characteristics may differ from most non-TNBC.Therefore,in order to improve the diagnostic level of TNBC,it is necessary to compare the ultrasound characteristics of TNBC and HER-2 overexpressing breast cancer.In this study,we compared the clinical and pathological features and multimodal ultrasound signs of TNBC with HER-2 overexpressing breast cancer and screened the main identification points to improve the diagnostic level of TNBC.Methods1.Clinical and pathological features and multimodal ultrasound findings of 127 patients with TNBC and 116 patients with HER-2 overexpressing breast cancer confirmed by postoperative pathology were retrospectively analyzed,including the conventional ultrasound,three-dime nsional ultrasound,ultrasound elastography(VTIQ)and ultrasound contrast findings.The conventional ultrasound findings of the mass refered to the size of the mass,shape,orientation,edge,boundary,internal echo,posterior echo,microcalcification,peripheral and internal blood supply of the mass;the three-dimensional ultrasound findings of the mass refered to the presence or absence of the mass,halo sign,and catheter change;the ultrasound elastography of the mass refered to the shear wave velocity mean and coefficient of variation in the mass;the contrast-enhanced angiography of the mass refered to the shape,boundary,enhancement intensity,filling defect,contrast agent distribution,enhancement sequence and the lesion size difference after angiography.2.Apply statistical analysis of spss 19.0 software,using mean ± standard deviation for measurement data((?)±s),the t-test was used to compare the measurement data of the two groups of patients,and the count data was expressed by n(%),using the chi-square test(χ2).The test was conducted to investigate the composition of the two groups.For the comparison of the theoretical data with the frequency less than 40,the accurate probability of Fish’s was used,and the difference was statistically significant at P<0.05.ResultsClinical and pathological features:There was a statistically significant difference in the axillary lymph node metastasis rate between the TNBC group and the HER-2 overexpression group(P=0.003).There were no significant differences in the age,family history,and mass fraction of the tumor(P>0.05)。Conventional ultrasound:The TNBC group and HER-2 overexpression group had statistically significant differences in the morphology,margin,border,microcalcification,and internal blood supply(P<0.05);while in the tumor size,orientation,internal echo,posterior echo,peripheral blood supply,there were no significant differences(P>0.05).Three-dimensional ultrasound:There was a statistically significant difference in the sign of convergence between the TNBC group and the HER-2 overexpression group(P=0.049).There were no significant differences in the halo sign and catheter change(P>0.05).Ultrasound elastography:There were significant differences in the shear wave velocity mean and coefficient of variation between the TNBC group and the HER-2 overexpression group(P<0.001).Contrast-enhanced ultrasonography:After angiography,the differences in the morphology,boundary,filling defect,and the lesion size difference after angiography were statistically significant(P<0.001);while in the enhancing intensity,contrast agent distribution characteristic and the order of enhancement,there were no significant differences(P>0.05).ConclusionsClinical and pathological features:The axillary lymph node metastasis rate of HER-2 overexpressing breast cancer is higher than that of TNBC.Conventional ultrasound:TNBC is characterized by a regular morphology,marginal differential leaf or smoothing,clear border,no microcalcification inside,and its blood flow often shows peripheral rich blood supply and scarce internal blood supply;HER-2 over expressing breast cancer is characterized by a irregular shape,marginal burr or horn,unclear border,internal micro calcific at ion and its blood flow often manifests as a whole rich blood supply.Three-dimensional ultrasound:HER-2 overexpressing breast cancer is more likely to exhibit the convergent sign than TNBC.Ultrasound elastography:TNBC has a lower shear wave velocity mean than HER-2 overexpressing breast cancer,and the coefficient of variation is smaller,that is,TNBC is softer and more homogeneous.Contrast-enhanced ultrasonography:TNBC is more likely to have a regular mo rpholo gy,clear boundary,visible filling defect and is less likely to have a obvious lesion size difference after angiography.HER-2 overexpressing breast cancer is more likely to have a irregular morphology,unclear border and less likely to have a filling defect.Besides,its lesion size increases significantly after angiography.Part Ⅱ:Multimodal ultrasound identification of androgen receptor-positive and negative triple-negative breast cancerBackground and objectiveAlthough TNBC patients have a better initial response to neoadjuvant chemotherapy,long-term drug resistance is still inevitable.Therefore,TNBC urgently needs to find new therapeutic targets and more effective targeted therapies based on this to effectively cooperate with neoadjuvant chemotherapy.In recent years,some studies have found that some TNBCs express androgen receptor(AR),and AR is expected to become a new target in the treatment of this type of TNBC.If ultrasound can predict whether TNBC expresses AR or not,it will provide a basis for the formulation of the programIn this study,we compared the clinical and pathological features and multimodal ultrasound signs of AR-positive TNBC with the negative one,the main identification points of the two were screened to improve the diagnostic level of AR-positive TNBC.MethodsThe 127 TNBC cases of the first part were divided into 32 cases of the AR-positive group and 95 cases of the AR-negative group by immunohistochemistry results.The other methods were the same as the first part.ResultsClinical and pathological features:There were significant differences in the age,breast cancer family history and tissue grading between the AR-positive group and AR-negative group(P<0.05).There was no significant difference in axillary lymph node metastasis(P=0.277).Conventional ultrasound:The AR-positive group and AR-negative group had statistically significant differences in the morphology,margin,boundary,microcalcification,and internal echo(P<0.05);but in the mass size,orientation,internal echo,posterior echo,blood supply,the differences were not statistically significant(P>0.05).Three-dimensional ultrasound:There was a statistically significant difference in the sign of convergence between the AR-positive group and the AR-negative group(P=0.016).There were no significant differences in the halo sign and catheter change(P>0.05).Ultrasound elastography:There was a statistically significant difference in the coefficient of variation of shear wave velocity between the AR-positive group and the AR-negative group(P<0.001);however,there was no significant difference in the mean shear wave velocity(P=0.095).Contrast-enhanced ultrasonography:After angiography,the AR-positive group and the AR-negative group had statistically significant differences in morphology and boundary(P<0.001).However,in the mass enhancement,filling defect,contrast agent distribution characteristics,enhancement sequence,and lesion size difference after angiography,there were no significant differences(P>0.05).ConclusionsClinical and pathological features:AR-positive TNBC is more common in older women than AR-negative TNBC,and is unlikely to have a family history of breast cancer,and its tumor tissue grade is lower than AR-negative one.Conventional ultrasound:AR-positive TNBC is more likely to have a irregular morphology,unclear border,marginal burr or angulation than AR-negative one.In addition,AR-positive TNBC is more likely to exhibit microcalcification and is less likely to be cystic and not homogeneous echo.Three-dimensional ultrasound:AR-positive TNBC is more likely to show the sign of convergence than AR-negative one.Ultrasound elastography:AR-positive TNBC has a coefficient of variation of shear wave velocity greater than that of AR-negative one,that is,AR-negative TNBC is more homogeneous.Contrast-enhanced ultrasonography:After angiography,AR-positive TNBC is more likely to have a irregular morphology and unclear boundary than AR-negative one.