The Diagnostic Value Of Ultrasonic Elastography Combined With Conventional Ultrasonography In Triple-Negative Breast Cancer

Objective To explore the diagnostic value of ultrasonic elastography (UE) combined with conventional ultrasonography in triple-negative breast cancer (TNBC). And to analyze the characteristics of the ultrasonic image of TNBC comprehensively involved in the morphology, blood flow and hardness to avoid misdiagnosis of the TNBC, and to improve the diagnostic accuracy of ultrasound in breast cancer.Methods183cases of women with pathologically confirmed breast cancer were collected in First Affiliated Hospital of Guangxi Medical University from May2010to July2011.183patients were divided into TNBC group and non-TNBC group according to the expression of ER,PR and HER2in the postoperative specimens, which were34cases of TNBC (negativity for ER, PR and HER2) and149cases of non-TNBC (not all the three receptors are negative). All the patients were examined preoperatively with ultrasonography. Firstly, the two-dimensional ultrasonographic features of the lesions were detailedly recorded according to Breast Imaging Reporting and Data System (BI-RADS). Secondly, the Doppler color flow features of the lesions were recorded according to Adler’s criterion; and the masses were defined as malignant lesions when RI>0.70. Finally, the elasticity scores were recorded according to Luo baoming’s criterion. The conventional ultrasonography and UE image characteristics of TNBC patients were analyzed and compared with those of non-TNBC patients.ResuIts①In TNBC group and non-TNBC group, the percentage of spiculation, posterior shadowing and microcalcifications were26.47%,26.47%,50.00%and53.02%,47.65%,73.83%, respectively. There were significant differences (P<0.05).②In TNBC group and non-TNBC group, the percentage of blood stream grade2～3and RI≥0.70were76.47%,58.62%and59.06%,67.65%, respectively. The differences were not statistically significant (P>0.05). In TNBC group, the blood stream gave priority to grade2～3and RI>0.70.③In TNBC group and non-TNBC group, the percentage of elasticity score4～5were91.18%and93.29%, respectively. The difference was not statistically significant (P>0.05). In TNBC group, the elasticity score gave priority to4～5.④Most of the misdiagnosed cases in UE were scored as3. In UE,2out of3misdiagnosed TNBC cases and7out of10misdiagnosed non-TNBC cases were scored as3.Conclusions①TNBC lacks typical features of the malignant tumor in two-dimensional ultrasonography. So it is difficult to distinguish TNBC from benign tumor.②The Doppler imaging characteristics of the TNBC are hypervascular and high resistance. It can be served as one of the clues to suggest the malignancy in the lesions showed benign characteristics.③In UE imaging, TNBC appears as hard mass with elasticity scores as high as non-TNBC. It can be used to identify TNBC and benign lesions.④It is necessary to pay attention to the lesions scored as3to avoid misdiagnosis in UE. Comprehensively evaluating the ultrasonographic features combining with UE can avoid the misdiagnosis of TNBC. A biopsy is recommend when necessary.