| Objective To investigate the ultrasonographic characteristics of invasive lobular carcinoma(ILC)and its correlation with pathologic histology and molecular classification. Simultaneously the value of ultrasound in the TNM staging was analyzed.Methods A total of 102 patients with surgically confirmed ILC and 291 cases of invasive ductal carcinoma(IDC) between October 2006 and June 2015,who had undergone preoperative ultrasound examination, were included in the study. Both breasts and lymph nodes in axillary ? subclavian and superclavical were examined. US images were reviewed for site, size, orientation, shape, boundary, margin, echogenicity, posterior acoustic features, and microcalcifications. Immunohistochemistry was used to analyse Ki-67, estrogen receptor(ER), progesterone receptor(PR) and human epidermal growth factor receptor 2(HER2) expression in breast cancer tissue from above tumors, and correlation analysis was carried out. Subsequently, the differences of ultrasonic image characteristics between ILC group and IDC group, Luminal type and non-Luminal type in ILC group were analysised and contrasted. The preoperative ultrasonic TNM staging and postoperative pathological TNM staging in ILC group were also compared so that to evaluate the value of ultrasonography in preoperative TNM staging of ILC.Results1.Compared to the IDC group, the ILC group had higher proportions with multifocal lesions, echogenic halo, microcalcifications, posterior acoustic features, color Doppler flow signal degree(P<0.05). However there were no significant differences in the largest diameters of lesions, orientation, shape, boundary, margin, echogenicity and axillary nodes enlargement between two groups. The coincidence rate of the US and pathology diagnoses was 97.1%. 2.Molecular classification of ILC group predominated in Luminal A type(47.1%),for that Luminal A type(47.1%)> Luminal B type(38.2%)> HER2-enriched type(4.9%) > basal-like type(3.9%).Molecular classification of IDC group was given priority to Luminal B type(63.6%),for that Luminal B type(63.6%)>HER2-enriched type(12.7%)>Luminal type Atype(12.0%)>basal-like type(11.7%).The difference in molecular classification between the two groups had statistical significance(P<0.05). 3.There were significant differences in posterior acoustic features, color Doppler flow signal degree(P<0.05)between Luminal type and non-Luminal type of ILC group. However there were no significant differences in multifocal lesions, the largest diameters of lesions, orientation, shape, boundary, margin, echogenicity microcalcifications, echogenic halo, and axillary nodes enlargement between two groups. 4.For T stages in ILC, the coincidence rates of T1, T2, T3, T4 and the whole stage diagnosed by US and pathology was seperately 83.0%, 71.1%, 100.0%, 0%, 75.5%. The whole coincidence rates of N stages diagnosed by US and pathology was 79.4%, The sensitivity diagnosed by US was 84.6%, while the specificity was 85.7%, positive predictive value 80.5% and negative predictive value of 90.0%.Conclusions1. Compared with IDC group, older average age, multifocal lesions, echogenic halo,posterior attenuation, decreased flow signal degree were often found in ILC group, but microcalcifications were less observed. US had a higher accuracy in the diagnosis of ILC. 2.Referring to molecular classification, compared with the IDC group, the ILC group was given priority to Luminal A type, meanwhile Luminal B type took second place and HER2-enriched type and basal-like type were less found. Molecular classification of IDC group predominated in Luminal B type and other three types were few. 3.When compared to non-Luminal type of ILC group, older average age, smaller lesions,the largee aspect ratio, irregular shape, spiculated margin, acoustic halo,posterior attenuation and decreased flow signal were more often found in Luminal type group, while microcalcifications was less observed. 4.US had important application value in evaluation of preoperative TNM stages for ILC. |
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