Contrast-enhanced Ultrasound Performances Of Breast Cancer: Correlation With Molecular Subtypes

Part I Correlation between Contrast-enhanced Ultrasound Enhancement Features and Different Breast Cancer Molecular SubtypesPurpose To explore different contrast-enhanced ultrasound(CEUS) enhancement features among breast cancer molecular subtypes.Methods 189 patients with histologically proved breast cancer were selected for retrospective analysis. Qualitative features included early phase vascular characteristics, enhancement order; peak phase enhancement margin, distribution, perfusion defect and its shape, size and position, peripheral enhancement and late phase enhancement. The molecular subtype were decided according to 2011 St. Gallen's consensus. The machine Esolate My Lab 90 and contrast agent Sono Vue were used. Each patient had no contradictions to CEUS and informed consent was obtained.Results There were 46,75, 37 and 31 cases of Luminal A, Luminal B, HER2+ and triple negative(TN) breast cancer respectively. Positive axillary lymph nodes rate were 26.08%, 40%, 56.76% and 38.71% for each subtype(P=0.006). Tumor diameters were significantly different among these four subtypes(P=0.012), the average diameters of HER2+ breast cancer was 1.32-fold higher than Luminal subtype(P=0.001). Besides, 84.35% of HER2+ and 89.66% of triple negative subtype were grade III, while 91.42% of Luminal A subtype were grade I/II with significant difference(P=0.000). However, CEUS enhancement features showed no significant difference among these subtypes(P>0.05). Conclusions Qualitative CEUS enhancement features showed no significance among different breast cancer molecular subtypes.Part II Correlation between Contrast-enhanced Ultrasound Parameters and Different Breast Cancer Molecular SubtypesPurpose To explore different contrast-enhanced ultrasound(CEUS) parameters among breast cancer molecular subtypes.Methods 189 patients with histologically proved breast cancer were selected for retrospective analysis. Quantitative parameters including ?Peak, ?TP, ?Sharpness and ?AUC were obtained from regions of interest, meaning differences between lesions and surrounding reference tissues. The machine Esolate My Lab 90 and contrast agent Sono Vue were used. Each patient had no contradictions to CEUS and informed consent was obtained.Results Quantitative parameters ?Peak and ?AUC value were significantly different among breast cancer subtypes(P=0.011, P=0.001). The average value of ?AUC for HER2+ subtypes were 13.33-fold higher than Luminal ones(P=0.000), and 6.72-fold higher than triple negative ones(P=0.030), while the value of ?Peak for HER2+ subtypes was also higher than Luminal(P=0.000) and triple negative ones(P=0.029). If the cutoff value of ?Peak was 2.3500, the sensitivity, specificity and area under the curve for prediction of HER2+ subtypes was 62.2%, 66.4%, and 0.675, and 89.2%, 46.1% and 0.748 for ?AUC, if the cutoff value was 0.1500.Conclusions Quantitative parameters ?Peak and ?AUC were significantly higher for HER2+ breast cancer subtype, and has the potential for prediction to some extent.Part III Contrast-enhanced Ultrasound Parameters in prediction of axillary lymph node metastasis for breast cancerPurpose To investigate the value of CEUS parameters in prediction of axillary lymph node metastasis for breast cancer.Methods 189 patients with histologically proved breast cancer were selected for retrospective analysis. Quantitative parameters including ?Peak, ?TP, ?Sharpness and?AUC were obtained from regions of interest, meaning differences between lesions and surrounding reference tissues. The machine Esolate My Lab 90 and contrast agent Sono Vue were used. Each patient had no contradictions to CEUS and informed consent was obtained.Results Univariate analysis demonstrated significant difference for tumor diameters(P=0.000), HER2expression(P=0.017), Ki67 expression(P=0.034) and quantitative parameters ?Peak(P=0.018) and ?TP(P=0.040) between breast cancers with positive and negative axillary lymph nodes. Binary Logistic analysis revealed tumor diameters(odds ratio: 2.700, P=0.002) and ?Peak(odds ratio: 1.959, P=0.038) were independent prognostic factors for axillary lymph node metastasis of breast cancer, and further subtype analysis showed these two factors were independent for Luminal subtype(odds ratio: 4.875, P=0.001; odds ratio: 2.417, P=0.043).Conclusions Quantitative parameters ?Peak of CEUS and tumor diameters were independent prognostic factors for axillary lymph node metastasis of breast cancer.