| Backgrond and ObjectiveBreast cancer has become the most common female malignant tumor around the world, and increasing at the rate of 2%-3% per year. With the development of our national economy, the change in the life style, the incidence rate of breast cancer in women is riseing significantly, especially in patients with a history of the benign mammary gland disease,and the age becomes younger. Now breast cancer was the second serious female tumor after cerical cancer, seriously endangers our country women’s life and health. So the prevention and control of the breast cancer have reached the point we should not ignore it.Breast ultrasound examination is one of the most important means of preoperative diagnosis of breast cancer, and in view of ultrasound examination is simple and convenient, economical and noninvasive and no radioactive damage, it has become the most commonly used and effective radiological examination method in preoperative diagnosis of breast cancer. Many studies have confirmed that there are certain correlation between the ultrasound performance of breast cancer and malignant behavior. Mass, the calcification, burr and high speed high resistance blood flow is the main ultrasound performance of breast cancer. In recent years, with the wide application and gradually mature of elastic imaging technology, mass hardness has also became the main reference breast factors of cancer diagnosis. Breast cancer is a kind of hormone dependence tumor, its main molecular marker:ER (estrogen receptor), PR (progesterone receptor), C-erbB-2 (former cancer gene), has a close relationship with the occurrence, development,transfer,and recurrence of breast cancer,can give a guide to the endocrine therapy for breast cancer. Different expression level of different molecular markers of breast cancer influence biological behaviour of breast cancer, and then influence the imaging appearances of breast cancer,make it possible to indirectly estimate the expression level of molecular markers through the imaging appearances of breast cancer, then to guide clinical treatment and prognosis assessment.The aim of the paper is to analysis and summarize the correlation between the ultrasound performance of breast cancer and the expression level of ER (estrogen receptor), PR (progesterone receptor), C-erbB-2(former cancer gene), and then to evaluate the value of evaluate the expression level of molecular marker through the sonographic findings of breast cancer.Material and MethodSelect 96 cases (97 masses in all) in in-and-out-patient department in our hospital from July 2010 to May 2011,all female, age from 24 to 81 years, mean age (49±11.) years old,were confirmed as cancer and with immunohistochemical(IHC) results. Ruled out the following cases:Failure to form clear the mass; cannot get satisfactory ultrasound elastography image; with atypical hyperplasia the focuses in the disease side;without complete athological and histological material. All cases were underwent sonography, record the size of the focuses, the edge is tidy or not and blood supply situation. Fixed probe don’t move, and then to adjust to Micropure imaging state, to dynamic observe if there are microcalcifications or not in focuses.And then, select the interface display clear focuses, and keep the probe position unchanged, adjust to Ultrasonic elastography state to press focuses by a constant pressure and constant speed several times,freeze and switch to analysis state,chose a displacement cycle in velocity curve in this state, chose the focuses with curve or selection box in displaying interface, placed a contrast box in its surrounding normal tissues,chose the selection box and will be offered the ratio of the normal tissues and focuses in the Ratio column, Repeat three times and record results. Immunohistochemical detection:take th focus of cancer,10% of formaldehyde fixed, paraffin embeded,4μm continuous slice, the rat against human ER and PR and C-erbB-2 monoclonal antibodies, s-p method detection kit, normal serum goats for sealing,all reagents were bought from Beijing Zhongshan Jinqiao Biotechnology Co., Ltd. Slice dewaxing hydration, natural cooling to room temperature, flush 3 times by distilled water,3 times by PBS,5 minutes each time, heat by the microwave and keep temperature between 92-98℃for 1-2 minutes. add goats serum, seal the specific antigen, add monoclonal antibodies of ER, PR and rat C-erbB-2.4℃refrigerator for the night. Rewarming for 30minutes,add second antibody, DAB show color 5-10 minutes at room temperature, add hematoxylin, flush 10 minutes by distilled water,observe the situation under a microscope.Group standard:with the maximum diameter line 2.0 mm as a border, the tumor size is divided to two group, big than the 2.0 mm for big mass group, equal to or less than 2.0 mm for the small mass group; blood flow situation is divided to four levels according to the Adler half quantitative classification method:0 level:not blood flow signal;Ⅰlevel:for a little blood flow, visible to 1～2 patch or fine short clavite vessels;Ⅱlevel:moderate blood flow, visible to 3～4 pointlike blood vessels or a long blood vessels, its length can be close to or more than mass radius; III level:which is quantity blood flow, visible in more than 5 pointlike blood vessels or two longer blood vessels.0-level I for lack of blood flow,Ⅱ-Ⅲlevel for rich blood group.strain ratio is devided by 15, greater than 15 for the high hardness group, less than or equal to 15 for the low hardness group. Molecular marker group:ER, PR to final score than 4 points for the negative group,> 4 points for the positive group; C-erbB-2 to (-) and (+) into negative group, (++) and (+++) into positive group.Result1.ER, PR, C-erbB-2 are all the high expression in breast cancer.2. Positive expression rate of ER with burr group is higC-erbB-2 than no burr group, and the difference was statistically significant (P< 0.05). Positive expression rate of ER of big mass group equal to small mass group, the difference was not statistically significant (P>0.05). Positive expression rate of ER of the microcalcification group is lower than without the microcalcification group, the difference was not statistically significant (P>0.05). Positive expression rate of ER of rich blood group, high hardness group is higC-erbB-2 than lack of blood flow, low hardness group, the difference was not statistically significant (P>0.05).3. Positive expression rate of PR with burr group is higC-erbB-2 than no burr group, and the difference was statistically significant (P<0.05). Positive expression rate of PR of big mass group lower than small mass group, the difference was statistically significant (P< 0.05). Positive expression rate of the microcalcification group of PR is lower than without the microcalcification group, the difference was statistically significant (P> 0.05). Positive expression rate of PR of rich blood group, high hardness group is higC-erbB-2 than lack of blood flow, low hardness group, the difference was not statistically significant (P> 0.05).4.Positive expression rate of C-erbB-2 of big mass group,high hardness group is higC-erbB-2 than small mass group, low hardness group.the difference was statistically significant (P< 0.05). Positive expression rate of C-erbB-2 of with burr group, the microcalcification group, rich blood group higC-erbB-2 than no burr group, without the microcalcification group, lack of blood group, the difference was not statistically significant (P> 0.05).Conclusion1.Burr and ER, PR expressions was positively associated,so how ER, PR expressions in lesions can be estimated according to with or without burr.2.The size of the masses was negative associated with PR expressions, positively associated with C-erbB-2 expressions,so how PR,C-erbB-2 expressions in lesions can be estimated according to the size of masses.3. Mass hardness was positively associated with C-erbB-2 expressions, so how C-erbB-2 expressions in lesions can be estimated according to hardness of masses. |
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