Correlations Between Ultrasonographic Features And Pathologic Features And Molecular Subtypes Of Pure Ductal Carcinoma In Situ

Part ?:Ultrasound features of ductal carcinoma in situObjective:To analyze the ultrasound features of pure breast ductal carcinoma in situ(DCIS)retrospectively and percei?e the ultrasound features of DCIS.Methods:The images and records of 109 patients w ith pure DCIS confirmed by histopathology and immunohistochemistry in our hospital from January 2010 to April 2018 were reviewed.1 09 patients underwent lumpectomy with simple mastectomy or breast conserving therapy.The location,size,margin,internal texture,echogenic feathers,and relationship with peripheral ducts of the lesions were observed.The presence and distributions of echo foci were analyzed.The axillary lymph nodes were also investigated.All observed contents?were recorded and uploaded to the picture archiving and communication system(PACS)for analysis.The ultrasound features of lesions were analyzed under the guideline published by the Japan Association of Breast and Thyroid Sonology(JABTS)in 2003.Lesion features and size were compared between calcification group and non-calci fication group using the student t test or independent sample rank sum tests in SPSS 17.0.P-values of<0.05 were considered to be statistical significance.Results:From January 2010 to April 2018,a total of 109 cases with pure DCIS proved by mastectomy or lumpectomy were enrolled in the study.All patients had preoperative ultrasound examinations and histopathology and immunohistochemistry indicators records.There were 1 08 females and 1 male(mean 47.7 years,range 29 to 81 years).64 lesions were located in left breast.45 lesions were in right breast.Under the guidelines for breast DCIS ultrasound published by The Japan Association of Breast and Thyroid Sonology(JABTS),the ultrasound features of 109 cases were classified as four categories:? ducts dilation(5cases,4.6%).? Abnormal enlargement of the hypo-echoic area around the duct(16 cases,14.7%).?Local hypo-echoic area(42 cases,3 8.5 0%)? mass(46 cases,42.2%).The most common ultrasound features of DCIS were hypo-echoic area(42 cases)and mass(46 cases).Echo foci in ultrasound images represented the calcification in DCIS.DCIS with calcification was associated with le sion size(p=0.020),but not age(p=0.129),ultrasonic manifestations,such as duct dilation(p=0.630),abnormal enlargement of the hypo-echoic area around the duct(p=0.280).Local hypo-echoic area(p=0.464),and mass(p=0.197),when compared with lesions without calcification.Conclusions:The ultrasound features of pure DCIS are classified as four types:duct dilation,abnormal enlargement of the hypo-echoic area around the duct,local hypo-echoic area and mass.Local hypo-echoic area and mass are the most common ultrasonographic features.Calcification is an important feature of DCIS.Lesions with calcification are more frequently visible and larger than lesions without calcification.To analyze and perceive the features of DCIS will be helpful to improve the diagnosis of DCIS in ultrasound.Part ? Correlations between ultrasonographic features and pathologic features and molecular subtypes of pure ductal carcinoma in situObjective:To explore the correlations of ultrasonographic features of pure DCIS with histological grades,molecular subtypes and biological marker Ki67 index.Materials and methods:109 patients with pure DCIS in our hospital from January 2010 to April 2018 were enrolled for a retrospective study.108 were female and 1 was male.Ultrasound images and histopathological and immunohistochemical indicators of the DCIS were recorded.All cases with DCIS were classi fied to Lumina-A.Lumina-B and Her-2 over-expression subtypes.The relationships of molecular subtypes,ultrasonographic features,pathological features and Ki67 index were analyzed.Variance analysis or Kruskal Wallis test was used to analyze the correlations between the three groups.Independent sample student t test or the independent sample rank sum test was used to compare parameters between the two groups with SPSS 17.0 software package.P-values of<0.05 were considered to indicate statistical Significance.Results:Of 109 patients,71 cases were high nuclear grade pure DCIS.The age of the f-emale patients in different nuclear grade group had no significant statistical difference(p=0.194).Pure DCIS ultrasonographic features,such as hypo-echoic area in the mammary gland(p=0.046)and mass(p=0.016).lesion size(p<0.001).margin(p=0.016)and calcification(p=0.017)had significantly different statistically in histology grades.Accor-ding to the 2013 st.Gallen breast cancer consensus,109 cases of pure DCIS were classified to Luminal A(17 cases),Luminal B(50 cases),and Her-2 over-express(42 cases)subtypes.Basal-like subtype did not appear in the study.Lesion size(p<0.001),calcification(p=0.036).nuclear grade(p<0.001),and the Ki67 index(p<0.001)in each subtype were different statistically.Large lesion size(p<0.001),more calcification(p=0.006),and high grade(P<0.001)correlated with a high expression of Ki67>20%.Conclusions:1.Pure DCIS of high nuclear grade were more calcification and larger than those of low/medium grade in ultrasound.2.Pure DCIS of Luminal A subtype was smaller,less calcification and with low/intermediate nuclear grade,while DCIS of Her-2 over-expressed subtype was larger.more calcification and with higher nuclear grade.3.The classification of ultrasonographic features of pure DCIS could not predict the pathological nuclear grade of the tumor,guide classification of molecular subtype,nor predict the expression of Ki67 in tumors.But it could help the physicians understand the sonographic manifestations of DCIS.4.Small lesion size,less calcification and low/intermediate nuclear grade were correlated with an expression of Ki67<5%.Large lesion size,more calcification,and high nuclear grade were correlated with a high expression of Ki67>20%.