The Application Of FMRI In Breast Cancer Diagnosis And Correlation Of Enhancement Features With Oncogene Expression And TCM Syndrome Type

Part I The Application of fMRI Diagnosis in Breast CancerObject i vesTo further explore breast enhancement scanning, DWI and dynamic MRS diagnostic value, and to improve breast cancer diagnosis specificity.Methods93 patients with 105 breast masses were performed with routine MR scan, dynamic enhance scan and DWI; 35 patients were underwent with MRS scan.Result1. Morphological manifestations and pathologic findings:105 masses of enhance forms can be divided into five types:(1) No strengthening (breast cyst 9); (2) The homogeneous enhancement 31 (fiber adenoma 9, breast cancer 11, mammary gland hyperplasia 10, leafy tumor 1); (3) The heterogeneous enhancement 42 (fiber adenoma 5, the hyperplasia 3, breast cancer 33, leafy tumor 1); (4) Ring enhancement 17 (breast cancer 15, fiber adenoma 1 and inflammation 1); (5) Reticular enhancement 2 (gigantic breast 1, inflammation 1). (6) duct shape enhancement4 (hyperplasia 1, duct carcinoma 3).2. Enhancement slope and pathology result:The maximum slope in 62 malignant masses was equally 19.19±8.13, maximum slopes in 43 benign masses was equally 9.46±6.64, the difference was very significant (p<0.01). In 42 Ⅱtype curves, the maximum slope of 24 malignant focuses were 17.52±6.39,18.while 18 benign focuses were 8.33±5.47, the difference was very significant (p<0.01). Use a test receiver operator characteristic (ROC) curve progress analysis, with 14.85 for critical point, sensibility was for 67%, specificity for 83%;With 17.10 for critical value, the specificity was 100%.3. Curve type and pathological results:According to general type standard, typeⅠof single-phase curve 20, typeⅡof platform type curve 42 andⅢtype curve type of washout 43. There were six kinds of forms:(1) Basic no increase signal strength curve (9 cyst); (2) The curve signal strength slowly increasing 6 (hyperplasia 2, fiber adenoma 2, chronic inflammation 1, duct carcinoma 1). (3) The intensity of curve after rapid increase early, continued to increase slowly 5 (hyperplasia 4, inflammatory breast cancer 1); (4) Curve early signal strength increasing rapidly formed the basic stop after middle-late platform (platform type) 42 (hyperplasia 9, fiber adenoma 8, leafy tumor 1, breast cancer 24); (5) Early signal strength rapid increase arrived the peak then rapid declined (washout type) 40 (hyperplasia 1, fiber adenoma 5, leafy tumor 1, breast 33); (6) Early signal strength increase quickly reached a peak, after platform period, then rising quickly again, all of 3 were breast cancers.3. Lesions ADC values:Average ADC values of 43 benign lesions in 37 cases was (1.37±0.36)×10-3 mm2/s, the different value between max and min were (0.63±0.19)×10-3s/mm2. Average ADC value of 62 malignant lesions in 58 patients was (0.90±0.53)×10-3 mm2/s, the different value between max and min were ((0.91±0.27))×10-3 mm2/s. By statistical analysis, both average ADC values and the max and the min ADC difference value were very significantly different (p < 0.01). Draw diagnosis benign and malignant lesions ROC curves, with ADC values 0.11 X 10-3 mm2/s as critical value to judge benign and malignant standard, sensitivity was 67%, specificity 72%; To 1.0 X 10-3 mm2 /s for critical value, specificity can raise to 84%, and sensitivity to 60% came. With the maximum and minimum ADC difference value 0.75×10-3s/mm2 for critical value, sensitivity was 67%, specificity 68%;If with 0.80 for critical value, sensitivity was 53% and specificity 82%.4.The spectrum analysis of 36 lesions in 35 patients were performed, including 11 benign lesions, with 5 chorine peak,6 no choline peak; Average SNR value were 1.39; 25 malignant lesions with 15 choline peak and 10 no choline peak, average SNR value were 2.51. Use a chi-square test, proportion of choline peak between benign or malignant lesions was no statistically significant difference t (p> 0.05). Using t-test, SNR value of benign and malignant lesion was significant difference (p< 0.05).5. Pathological type and classification:58 cases had gradeⅠ7 cases, gradeⅡ36 cases andⅢ15 cases (if with two or more lesions, according to the highest levels of types). Pathological types included 46 infiltrating duct carcinoma,6 infiltrating lobular carcinoma,3 duct carcinoma,2 mucous cancer and 1 inflammatory breast cancer.Conelusion1. Enhancement morphological characteristics of breast cancer such as duct or ring enhancement had diagnostic value. Maximum slope in benign or malignant lesions, particularly in the differential diagnosis of type II curve played an important role. With 14.85 for critical point, the sensitivity was 67%, the specificity 83%; With 17.10 for critical value, specificity was 100%. Formation mechanism of typeⅡcurve might be that vascular tumor had emboli or tumor compressed by blood vessels and blood backflow was obstacled.2. The benign and malignant lesions average ADC values had differences, but there were overlaps between benign and malignant lesions in diagnoses The different value between the max and min of benign and malignant lesions were statistically significant differences also. With 0.80 for critical value, sensitivity was 53%, specificity 82%. In the differential diagnosis for benign and malignant lesions,it provided a new method.3. Choline peak without qualitative analysis as a benign or malignant disease diagnosis standard was questionable; Benign or malignant lesion choline peak SNR played an important role in the differential diagnosis. Thus it was expected to become a new diagnostic method, but need a technical breakthrough.PartⅡStudies on Correlation between Breast Enhancement slope and Oncogene ExpressionObjectives To observe and analyze the relationship between the breast cancer enhancement slope and oncogene expression, to explore the molecular biology basis of enhancement slope and provide a new methods for clinical treatment and evaluating prognosis.MethodsER, PR, P53, CerbB-2, VEGFand MVD immunohistochemical detection were performed in 58 patients with breast cancer confirmed by surgical pathology.All of them had been done with MR dynamic enhance scanning. The correlation between maximum slope of enhancement and oncogene expression were analyzed.Result1. Enhance scan maximum slope negatively correlated with ER, PR, (r=-0.090, 0.169 respectively), and P53, Cerb-2 expression, positively correlated, respectively (r=0.099,0.074), but there were no statistically significant (p> 0.05).2. P53 expression and ER, PR was negative correlation (r=-0.257,-0.282) and had a statistically significant (p< 0.05), which showed P53 high expression predicted a poor prognosis.3. MVD positively correlated with VEGF expression (r=0.389, p<0.05) Dynamic enhance scanning was significantly related with VEGF maximum slope, and correlation coefficient was 0.632 (p< 0.01), but with no obvious MVD maximum slope relevant (correlation coefficient was 0.079, p > 0.05).Conelusion1. Maximum slope of enhance scanning related to VEGF significantly, but no obvious correlations with MVD, which illuminated that the malignant tumor of increased molecular biology slope is based on incomplete, vascular endothelial cells permeability increase, but no obvious relationship with vascular density.2. In clinic, according to the enhance slope of lesions, express degree of VEGF could be evaluated, which could be used to guide antiangiogenic drugs and obvious the therapy.3. There were some correlations between oncogene expressions.4. According to the maximum slope was able to evaluate ER, PR, P53, CerbB-2 expression. Whether to evaluate cancer gene expression by metabolites MRS is pending to further study. Part III Relationships on Breast cancer MR1 and TCM Syndrome TypeObject ivesTo investigate the correlation between MR enhance slope, curve types, size of breast cancer and TCM syndrome type.Methods58 patients with breast cancer confirmed by surgical pathology, all of whom had been performed with MR dynamic enhance scanning. According to TCM syndrome type standard, they were classified into three types:(1) type of liver depression and qi stagnation, (2)type of chong-ren disorders and(3)type of zhengxu duchi.ResultOf 37 patients with type of liver depression and qi stagnation, the average size and average slope were 2.95+1.73cm,17.95±8.27, respectively. Of them, there were 15 typeⅢcurve,22 typeⅡcurve and no typeⅠcurve. Of 15 patients with type of chong-ren disorders, the average size and average slope were 2.67+1.63cm,20.68+6.79. Of them there were 8 typeⅢcurve,6 typeⅡcurve and 1 typeⅠcurve. Of 15 patients with type of zhengxu duchi, the average size and average slope were 3.14±2.09cm,23.07±8.73. Of them there were 3 typeⅢcurve,3 typeⅡcurve and 1 type；Ⅰcurve.with SPSS13.0, maximum slope, curve type of three kinds of TCM syndrome type had no statistically significant difference (p= 0.303,0.394,> 0.05). In all three kinds of TCM syndrome type, there is some difference between the tumor size. There was no significant difference between type of liver and qi stagnation and type of chong-ren disorders (p=0.636> 0.05). However, there were very significant difference between type of zhengxu duchi and type of liver and qi stagnation or chong-ren disorders, (p= 0.005, p= 0.004, all< 0.01).Cone I us ion1. MR enhance slope, curve type and TCM syndrome type had no obvious correlation. 2. The tumor size and TCM syndrome type had obvious correlation, indicting that human resistance decrease in type of zhengxu duchi, in accord with Chinese medicine "poor virtual with poison ablaze"...