Diagnosis Of Breast Cancer With Enhanced-contrast Ultrasound And Its Correlation With Biological Prognostic Factors

Objective:To screen the contrast-enhanced ultrasonic characteristics and quantitative parameters of breast tumor by single factor analysis and multifactor analysis method,establish the logistic regression model and evaluate its diagnostic efficiency.To evaluate the diagnostic value of malignant contrast imaging in the diagnosis of atypical breast lesions in BI-RADS-US4.To explore the correlation between the patterns of contrast-enhanced ultrasound and the quantitative parameters of the marginal of breast cancer and the biological prognostic factors.Methods:1)130 cases of breast tumors confirmed by postoperative pathology were examined by preoperative contrast-enhanced ultrasound.The single factor analysis and multifactor analysis methods were used to screen contrast-enhanced ultrasonic characteristics and quantitative parameters of breast tumors.To establish a logistic regression equation for diagnosis of breast cancer,and the ROC curve was used to evaluate the diagnostic efficiency of the equation.2)130BI-RADS-US Type 4 patients were examined by contrast-enhanced US?CEUS?and were classified again before surgery according to five contrast-enhanced malignancy imaging features:inhomogeneous enhancement,peripheral ring-like enhancement,expansive enhancement,internal filling defects and surrounding radioactive convergence.Lesions with no contrast-enhanced features of malignancy were categorized as Type 3;lesions with one,two or three features of malignancy were categorized as Type 4A,4B or4C,respectively;and lesions with four or more indices of malignancy were categorized as Type 5.The value of contrasted imaging features of malignancy in diagnosing BI-RADS-US type 4 atypical breast lesions was analyzed.3)60 patients with breast cancer confirmed by pathologically were examined by contrast-enhanced ultrasound before operation.The mode of contrast-enhanced ultrasound was observed,and the time intensity curve of breast cancer edge zone was analyzed by contrast-enhanced ultrasound QLAB software.The correlation between the characteristics of contrast-enhanced ultrasound and the quantitative parameter index of the marginal zone and the different biological prognostic factors of ER,PR,HER2 and Ki-67 were analyzed.Results:1)In the single analysis factor qualitative index and quantitative parameters,enhancement pattern,degree of enhancement,enhanced lesion enlargement,tumor peripheral convergence sign,the order of contrast agent enter tumor,inhomogeneous distribution of intratumoral contrast,the peak intensity,the peak time,the area under the curve and the grad between benign and malignant lesions had statistical differences?P<0.05?,The enhanced model and the enhancement of the lesion eventually entered the qualitative Logistic regression equation which was P=1/^{[1+e-?-1.277+0.992X2+0.957X5?]},the area under the ROC curve was 0.761.The peak intensity and peak time were finally entered the Logistic regression equation which was P=1/^{[1+e-?-0.333+0.09Y1-0.025Y3?]},the area under the ROC curve was 0.699.Combining qualitative and quantitative indexes with statistical significance for Logistic regression analysis,the indexes of entering the equation were enhanced mode and lesion enlargement,the Logistic regression equation was P=1/[1+e^{-?-1.479+0.985X2+0.988X5?}],the area under the ROC curve is 0.804 2)130 lesions were confirmed by surgery and pathology,BI-RADS-US4 A lesions were 61,41 lesions of 4B,28 lesions of 4C before CEUS,Grade BI-RADS-US3 lesions were 49,BI-RADS-US4lesions were 13,7 lesions of 4B,12 lesions of 4C,49 lesions of 5 grade after CEUS.The sensitivity,specificity,accuracy,positive and negative predictive value of contrast-enhanced ultrasound in the diagnosis of BI-RADS-US4 atypical breast lesions were90.4%,83.6%,86.9%,83.8%,90.3%,respectively,According to the characteristic of malignant tumor ultrasound contrast and contrast with pathology,the malignant features of contrast-enhanced ultrasound can reduce the biopsy rate of benign lesions by68.5%?46/67?,especially in dilatation of the adenosis,reduce the biopsy rate was 83.7%?31/37?,while improve about 73.0%?46/63?malignant diagnosis of confidence,especially for invasive ductal carcinoma increased about 82.69 43/52 diagnosis confidence.The theoretical risk of malignant breast lesions classified as grade 3 and 4A increased after CEUS,the rest of the theoretical risk values were within normal range.3)Breast cancer ER and PR negative expressions are more likely to be characterized by ultrasound of internal perfusion defects,and the two are negatively correlated?P<0.05?;Ki-67 positive expression is more likely to appear in high enhancement and fast-forward fast-back/slow retreat enhancement mode,and the two are positively correlated?P<0.05?;HER-2 positive expression of breast cancer lesions is more likely to appear in the enhancement mode of fast-forward fast-back/slow retreat,post-enhancement expansion,margin ambiguity,and internal filling defects such as ultrasound enhancement characteristics?P<0.05?;The expression of breast cancer ER,PR and HER-2 were correlated with TTP in the quantitative parameters of ultrasound,HER-2 expression was negatively correlated with TTP,ER and PR were positively correlated,and HER-2positive expression was positively correlated with Grad.The A and Area in the perfusion parameters were positively correlated with the positive expression of Ki-67?P<0.05?;The expression of miR-146a/u6 in breast cancer is lower than that in normal breast tissue next to breast cancer?P<0.05?;The high enhancement,Fast forward/slow retreat and central filling of breast cancer masses in the focus of miR-146a/u6 is more likely to appear low expression;TTP was positively related to miR-146a/u6 expression,and the shorter the peak time,the lower the expression of miR-146a/u6 in the lesion;The expression of miR-146a/u6 in breast cancer with lymph node metastasis showed low expression.Conclusion:1)The combined analysis of contrast-enhanced ultrasonic characteristics and quantitative indexes will help to improve the diagnostic efficiency of contrast-enhanced ultrasound in breast cancer.2)Breast malignant tumor imaging characteristics of BI-RADS-US4 atypical lesions with high accuracy,in reduce BI-RADS-US4 atypical lesions biopsy risk,also can improve malignant lesions diagnostic confidence at the same time,so as to further optimize the BI-RADS-US4atypical breast lesions classification,it can better provides reference basis for clinical diagnosis and treatment BI-RADS-US4 atypical breast lesions.3)The contrast enhancement pattern and the perfusion parameters of the marginal zone of the lesion are correlated with the biological prognostic factors of breast cancer.It can provide imaging reference as a predictor for clinical diagnosis and individualized treatment of breast cancer.