Analysis Of BI-RADS 3 And 4A Breast Lesions Ultrasound Image Features:feasibility Study Of A New Clinical Classification Standard

Purpose:1.Breast cancer is the most common malignant tumor among Chinese women,and its incidence and mortality are increasing every year.As an economical,noninvasive and repeatable imaging technique,conventional ultrasound has become the most widely used examination in detecting or diagnosing breast lesions.However,which ultrasonic features are most strongly associated with malignancy in BI-RADS 3 and 4A lesions is not very clear.This study investigated the association of ultrasound features of BI-RADS 3 and 4A breast lesions with breast cancers,and proposed a new clinical classification standard that can more accurately guide the classification of BI-RADS category 3 and 4A breast lesions.2.With the progress of breast ultrasound technology and the in-depth study of breast cancer immunohistochemical indicators,it is found that the immunohistochemical indicators expression of breast cancer affected its ultrasound features.This study explored the correlation between the ultrasound features of BI-RADS 3 and 4A breast cancers and the immunohistochemical indicators,which may provide information for the diagnosis and treatment of breast cancers.Methods:1.The medical records of 652 BI-RADS 3 and 4A breast lesions in our institution were reviewed.Then the association between ultrasound features and breast cancers was analyzed retrospectively by univariate and multivariate regression analysis,and a new clinical classification standard was proposed to guide the classification of BI-RADS 3 and 4A breast lesions.In the research population within our institution,the diagnostic value of this classification standard was tested by comparing with several previous classification standards.2.The clinical data of 154 cases of BI-RADS 3 and 4A breast cancers were collected,then we performed univariate and multivariate regression analysis to retrospectively investigate the correlation between the ultrasonic features of BI-RADS 3 and 4A breast cancers and immunohistochemical indicators:ER,PR,HER-2 and Ki-67.Results:1.Multivariate logistic regression confirmed the following ultrasonic features were significantly associated with malignity:patient’s age≥45 years(OR 3.353;95%CI 2.081-5.403;P<0.001),round shape of mass(OR 1.947;95%CI 1.133-3.348;P=0.016),non-circumscribed,indistinct margin(OR 21.754;95%CI 1.257-376.503;P=0.034),non-circumscribed,spiculated margin(OR 27.846;95%CI 1.506-514.890;P=0.025),and internal vascularity(OR 3.836;95%CI 1.365-10.779;P=0.011).2.Based on multivariate logistic regression and ROC curve analysis,a new classification standard was constructed,that is a breast lesion should be classified as BI-RADS 4A if at least two of the following features are observed:the patient is≥45 years old,round shape of mass,non-circumscribed margin(indistinct or spiculated)and internal vascularity.The sensitivity of this new classification standard was 83.7%(41/49),specificity was 80.2%(134/167),and accuracy was 81.0%(175/216).3.Multivariate logistic regression showed that in BI-RADS 3 and 4A breast cancers,the expression levels of HER-2 and Ki-67 were correlated with ultrasonic features:the expression level of HER2 was positively correlated with the heterogeneous pattern of tumor(OR 2.761;95%CI 0.962-7.928;P=0,049);the expression level of Ki-67 was positively correlated with the internal vascularity signal of tumor(OR 4.426;95%CI 2.162-9.059;P<0.001).Conclusion:1.By evaluating the ultrasound features of BI-RADS 3 and 4A breast lesions,the ultrasonic features most strongly associated with malignancy were determined,and a new classification standard was constructed based on the results.The new classification standard states that patients should receive diagnostic puncture biopsy(BI-RADS 4A)instead of follow-up(BI-RADS 3)if at least two of the following features are observed:the patient is≥45 years old,round shape of mass,non-circumscribed margin(indistinct or spiculated)and internal vascularity.This classification standard shows relatively high sensitivity and specificity.Compared with previous classification standards,the diagnostic accuracy is significantly improved.2.It is confirmed that the ultrasound image features of breast cancer are correlated with its immunohistochemical indicators:HER-2 positive breast cancer is more often manifested as a heterogeneous echo pattern;the high expression of Ki-67 is related to the internal vascularity in breast cancer.The ultrasound image features can be used as a non-invasive way to reflect the biological characteristics of breast cancers to a certain extent,and has certain reference value in the selection of treatment strategies and prognosis of breast cancer.