Multimodal Imaging Diagnosis Of Calcification In Breast Cancer And Its Correlation With Clinicopathological Features And Prognosis

As the largest cancer in the world,early diagnosis,effective monitoring and precise treatment of breast cancer are of great significance to improve the prognosis and living quality of patients.In the routine diagnosis of breast cancer,palpation examination is still one of the important methods of breast cancer screening,and tissue biopsy is the "gold standard" for breast cancer diagnosis.In recent years,with the rapid development of medical imaging technology,imaging examinations such as ultrasound,mammography and MRI have been widely used in breast cancer screening.However,in most cases,it is necessary to combine two or more imaging features(multimodal imaging)to make a combined diagnosis to improve the diagnosis rate of breast cancer.Microcalcification,as one of the main malignant signs of breast cancer,has attracted much attention in the imaging diagnosis of breast cancer recently.Previous studies have shown that most calcification in breast cancer imaging appears as microcalcification,which has different morphology and distribution,and may be related to the pathological type of breast cancer,clinical prognosis and other factors.Therefore,the images of calcification in breast cancer are acquired by multimodal imaging,and then comprehensive analysis is performed.Then the more accurate diagnosis will be obtained,which can provide the basis for determining the clinical prognosis of breast cancer patients and individualized precise treatment.Objectives:To explore the efficacy of multimodal imaging in the detection of calcification in breast cancer,and further to analyze the relationship between calcification in breast cancer and clinicopathological features and prognosis,so as to provide more reliable imaging basis for the clinical diagnosis,treatment and prognosis of breast cancer.Methods:From January 2018 to March 2019,87 patients with breast cancer were selected as the research objects.All patients underwent breast ultrasound,mammography,CT and MRI imaging examinations.Based on the postoperative histopathological results of breast cancer,the accuracy of breast ultrasound,mammography,CT,MRI and multimodal imaging in the detection of breast cancer calcification was analyzed.The diagnostic efficacy of different imaging methods including sensitivity,specificity,positive predictive value and negative predictive value were calculated by using the formula.Then the patients with breast cancer were further divided into calcified group and non-calcified group according to the results of multimodal imaging.Statistical software was used to analyze the relationship between calcification and clinicopathological characteristics(age,tumor size,TNM stage,pathological type,lymph node metastasis and expression of molecular markers)and prognosis of breast cancer patients.All patients were followed up for 36 months,the long-term prognosis of patients with calcification and non-calcification was analyzed,and the survival curve was plotted.All data were processed by SPSS24.0.Results:1.Among 87 patients with breast cancer,41 cases were diagnosed as calcification by postoperative pathological examination.Thirty-four cases of breast cancer calcification were diagnosed by breast ultrasound,and the examination accuracy was 75.86%,the diagnostic sensitivity was 65.85%,the specificity was84.78%,the positive predictive value was 79.41%,and the negative predictive value was 73.58%.Thirty-six cases of breast cancer calcification were diagnosed by mammography,and the accuracy was 87.36%,the diagnostic sensitivity was 80.49%,the specificity was 93.48%,the positive predictive value was 91.67%,and the negative predictive value was 84.31%.Thirty-three cases of breast cancer calcification were diagnosed by CT examination,with the accuracy of 81.61%,the sensitivity of 70.73%,the specificity of 91.30%,the positive predictive value of87.88% and the negative predictive value of 77.78%.Thirty-one cases of breast cancer calcification were diagnosed by MRI,and the examination accuracy was74.71%,the diagnostic sensitivity was 60.98%,the specificity was 86.96%,the positive predictive value was 80.65%,and the negative predictive value was 71.43%.2.Among 87 patients with breast cancer,40 cases were diagnosed as calcification by multimodal imaging examination,with the detection accuracy of94.25%,the diagnostic sensitivity of 92.68%,the specificity of 95.65%,the positive predictive value of 95.00% and negative predictive value of 93.62%.Compared with single breast ultrasound,mammography,CT and MRI,the diagnostic accuracy of multimodal imaging examination was significantly higher(P<0.05),and its diagnostic sensitivity and specificity,positive predictive value and negative predictive value were also higher than those of single imaging examination(P<0.05).3.The calcification in breast cancer was closely correlated with tumor TNM stage,pathological type and lymph node metastasis(P<0.05),but there was no relationship with age and tumor size(P>0.05).ER,HER2,Ki67 and PR in calcified group presented higher expression than those in non-calcified group,and the differences were statistically significant(P<0.05).4.The 36-month overall survival(OS)of calcified group was shorter than that of non-calcified group,but there was no significant difference between the two groups(P>0.05).The 36-month progression-free survival(PFS)of calcified group was shorter than that of non-calcified group,and the difference between the two groups was statistically significant(P<0.05).5.Univariate analysis showed that age and tumor size were not associated with poor prognosis of OS and PFS(P>0.05),while tumor TNM stage,ER expression,HER2 expression,Ki67 expression,PR expression,lymph node metastasis,as well as calcification were all concerned with poor prognosis of OS and PFS(P<0.05).6.multivariate analysis demonstrated that tumor TNM stage,HER2 expression,Ki67 expression,lymph node metastasis and calcification were independent adverse prognostic factors of OS and PFS in the patients with breast cancer(P<0.05).Conclusions:1.Multimodal imaging examination has a high detection rate for calcification in breast cancer,and the diagnostic sensitivity and specificity are high.For the diagnosis of breast cancer calcification,multimodal imaging is superior to single imaging method.2.The calcification in breast cancer is related to tumor TNM stage,pathological type,lymph node metastasis,and the expression of ER,HER2,Ki67 and PR.3.The breast cancer patients with calcification have worse clinical prognosis than those without calcification.Breast cancer calcification is an independent poor prognostic factor.