The Diagnostic Value Of Ultrasound Elastography Technique In Breast Cancer And Its Correlation With Biological Characteristics

Objective:1.To investigate the diagnostic value of ultrasound shear wave elastography techniques?virtual touch tissue quantification and virtual touch tissue imaging quantification?for breast masses;2.To investigate the correlation between shear wave elastic parameters and breast cancer size,patient's age,estrogen receptor?ER?,progesterone receptor?PR?,human epidermal growth factor receptor-2?HER-2?,Ki-67,molecular types,histological grade,pathological type and axillary lymph node status,seeking non-invasive imaging indicators that reflect the biological characteristics of breast cancer before surgery,which is the choice of breast cancer treatment strategy and prognostic judgment provides a certain reference value.Methods:1.A total of 195 patients?total 229 masses?of breast tumors that were surgically removed and confirmed by pathology were collected.Conventional ultrasound,virtual touch tissue quantification?VTQ?and virtual touch tissue imaging quantification?VTIQ?were performed before surgery.The size of the mass is obtained by conventional ultrasound,and is divided into 3 groups according to the maximum diameter of the mass:5mm¹0mm?S1?,11mm²0mm?S2?,21mm³9mm?S3?,the shear wave velocity?SWV?value(SWV_VTQ)of the mass was obtained by VTQ technology,the maximum SWV value?SWVmax?and the ratio of SWVmax to the surrounding gland SWV?SWVratio?were obtained by VTIQ technology.Using the pathological results as the gold standard,the diagnostic value of shear wave elastography for benign and malignant breast masses was explored,and the diagnostic value of the two techniques for benign and malignant breast masses of different sizes was compared;2.110 cases?114 masses?of breast cancer confirmed by pathology were selected.Conventional ultrasound and VTIQ were performed before operation.The size of the masses was obtained by conventional ultrasound,and the maximum value of SWV?SWVmax?was obtained by VTIQ.The expression of immunohistochemi-cal indexes ER,PR,HER-2,Ki-67,molecular types,pathological type,histological grade and axillary lymph node status were obtained according to the pathological results.Pearson correlation analysis was used to analyze the correlation between the mass size,patient's age and SWVmax value of breast cancer mass.T-test was used to compare the SWVmax value of breast cancer mass among different ER,PR,HER-2,Ki-67 expression and axillary lymph node status.The univariate analysis of variance was used to analyze the differences in SWVmax values of breast cancer masses between different histological grades,pathological types,and molecular types.Multiple linear regression analysis was used to include the above-mentioned related and different variables,and the factors affecting the SWVmax value were evaluated.Results:1.The cut off values of SWV_VTQ,SWVmax,and SWVratio in the diagnosis of benign and malignant breast masses were 4.52m/s,3.70m/s and 2.37 respectively.The area under the curve was 0.813[95%CI?0.756,0.861?],0.887[95%CI?0.839,0.925?],0.852[95%CI?0.799,0.895?]respectively;2.For breast masses with a maximum diameter of 5 mm¹0 mm,the area under the curve for the diagnosis of benign and malignant breast masses by SWVmax is greater than SWV_VTQTQ and SWVratio?0.931 vs 0.748 and 0.782?,and the difference is statistically significant?P<0.05?;For breast masses with a maximum diameter of 11mm²0mm and 21mm³9mm,there was no significant difference in the area under the curve between SWV_VTQ,SWVmax,and SWVratio in the diagnosis of benign and malignant breast masses?P>0.05?;3.The SWVmax value was positively correlated with the size of the masses?r=0.636,P<0.05?,the SWVmax value was not related to the patient's age?r=0.008,P>0.05?;4.There was a significant difference in SWVmax of breast cancer masses between different histological grades?F=10.778,P<0.05?,as the histological grades of breast cancer masses increased,the SWVmax value gradually increased;5.There was a significant difference in SWVmax of breast cancer masses between different pathological types?F=6.192,P<0.05?.Among them,the hardness of invasive lobular carcinoma was the highest and that of ductal carcinoma in situ was the lowest;6.There was a significant difference in SWVmax of breast cancer masses between HER-2 negative expression group and positive expression group,Ki-67 low expression group and high expression group,axillary lymph node metastasis group and non metastasis group?t=5.750,5.186,3.264,P<0.05?.There was no significant difference in SWVmax between ER,PR positive group and negative group?t=0.608,1.746,P>0.05?;7.There was a significant difference in SWVmax of breast cancer masses between different molecular types?F=10.208,P<0.05?,The SWVmax values of different molecular subtypes are ranked as Luminal B?HER 2+?type,HER-2 overexpression type>Luminal B?HER 2-?type,TNBC type>Luminal A type;8.Including the statistically significant parameters in the above univariate analysis into multivariate linear regression analysis.The results showed that the mass size,Ki-67 and HER-2 expression had the greatest impact on the SWVmax value?the standardized regression coefficients were 0.496,0.258,0.213,P<0.05?.Conclusions:1.Shear wave elastography technique?VTQ,VTIQ?has good diagnostic value for benign and malignant breast masses.For breast masses with 10mm<a maximum diameter of<40mm,VTQ and VTIQ have the same diagnostic value.For breast masses with 5mm<a maximum diameter of?10mm,VTIQ has higher diagnostic value than VTQ;2.Shear wave elastography parameter SWVmax has certain relationship with breast cancer lesion size,histological grade,pathological type,HER-2 expression,Ki-67 expression,axillary lymph node metastasis,and molecular types.Among them,breast cancer lesion size,the expression of HER-2 and Ki-67 had the greatest influence on the SWVmax value;3.Shear wave elastography parameter SWVmax value can be used as a non-invasive imaging index to reflect the biological characteristics of breast cancer to a certain extent.Shear wave elastography technology may provide some reference for the choice of treatment strategy and prognosis of breast cancer.