| ObjectiveThe combination of ultrasound and mammography is the most common type of screening for breast cancer in China, and it can contribute to realize the complementary advantages and image fusion. We often implant the imaging marker after the percutaneous biopsy of breast lesions. Imaging marker placed within the target tissues can accurately identify the non-palpable breast lesions(diameter < 15 mm) with dual-modality images, which is important for the tumors resection, further therapy, observation and management of the lesions. It is of great significance for the early diagnosis and treatment of breast cancer. For the selecting of the ideal raw materials of implanted markers for breast lesions, we have retrieved the markers of three generations, six companies of 13 brands in the world, and do the test of hydroscopic property, thermosensitivity and the acoustic impedance for the component materials in vitro. We do this preclinical study for the exploration of domestic manufacturing and the expansion of application of dual- modality breast marker, which is suitable for Asian women, and it can be seen under both preoperative imaging and the naked eye intraoperatively.Methods(1)Grouping PEG of different molecular weight, testing the melting point and the acoustic impedance parameters in the condition of 24℃ and 37.5℃. Implanting the markers into the subcutaneous fat of living ducks, and the imaging of metal titanium silk with PEG or TPGS were monitored by ultrasound and mammography.(2)The handcrafted markers of metal titanium silk with dressing protein were implanted into the acoustics imitation and the excised breast of a cow, and the hydroscopic property and the dual- modality imaging were monitored by ultrasound and mammography.(3) By the real-time measurement of volume change of dressing protein marker after absorbing water and swelling in vivo on ultrasound images, evaluation the hydroscopic evolution law of protein marker in vivo and in vitro. The second batch of dressing protein markers made by cooperation manufacturer were implanted into the subcutaneous fat of living ducksand distilled water respectively, then do the tests of swelling volume- time in vivo and water absorption quality – time in vitro.(4) According to the preliminary design, the third batch breast markers made by cooperation manufacturer, which are modified with the crosslinking dressings protein and genipin composited with metal(single spiral structure), were implanted into the living muscle,fascia and fat tissue, ultilizing the characteristic of ultrasound’s sensitivity to anechoic and mammography’s sensitivity to metal high density, the dual-modality imaging of markers were observed and evaluated by ultrasound and mammography.Results(1)The melting point of PEG1000 is close to the normal temperature of the human body.The acoustic impedance of PEG1000 is close to the value of water in the condition of 37.5 ℃,and it can make a solid to liquid conversion when heated. After implanted into the duck, the PEG and TPGS showed no echo-free zone in ultrasound images. The metal titanium silk can be showed clearly on mammography images.(2)The handcrafted dressing protein have the property of expansion and hygroscopicity up to(4.63 ± 0.51)×100%, the imaging of dressing protein on ultrasound showed fixed echo-free zone. The markers of metal titanium silk with collagen showed well both in ultrasound and mammography.(3)After the implantation of the third batch breast markers, it have a good visibility on the images of ultrasound in the living muscle tissue, fascia and fat tissue. We observe that the thin anechoic changed over time around the markers on ultrasound images, and then the central characteristic of spiral strip metal shadow displayed gradually.The metal titanium silk of markers have a good visibility on the mammography. After the vivisection, we found that the swelling markers have stable color, and have no dispersion in the organizations.Conclusion(1)After the implantation of PEG monomer and TPGS, it failed to form the anechoic in the images of ultrasound. And after the dissection, we found that the implanted PEG and TPGS are deformed and have changed into transparent flow liquid from white solid. Therefore, it do not have the function of the marker of ultrasound.(2) The implanted dressing protein markers showed a good fixed anechoic zone on acoustic images. The markers of metal titanium silk with dressing protein have a good visibilityon the images of ultrasound and mammography, which have a great potential for application and research of dual-modality.(3)After the implantation of the third batch breast markers, it have a good visibility in the images of ultrasound for the living muscle tissue, fascia and fat tissue. We can observe that the thin anechoic changed over time around the markers on ultrasound images, and then the central characteristic of spiral strip metal shadow displayed gradually. At the same time, the characteristic of gardenia blue color can be formed after the genipin crosslinked with dressing protein, which have strong stability. After implantation of the composite metal breast markers,the markers can be seen under both preoperative imaging and the naked eye intraoperatively,which can help to guide the localization of lesions preoperatively and intraoperatively. |
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