| ObjectiveBased on anatomy histology and acoustics of breast ultrasounic patterns, the differences of ultrasonic patterns between breast density and breast cancer were analyzed, so as to explore breast ultrasonic patterns as the possibility of a predictor of breast cancer risk.Methods1. Collected 4649 cases of breast examination of women in in Beijing military general hospital from October 2012 to November 2013, including 685 cases of ultrasonic examination revealed breast lumps, which undergone an operationand diagnosed by pathological examination, there are 500 cases of breast benign lesions and 185 cases of breast cancer.3964 cases of normal women as control group,185 cases of patients with breast cancer as cancer group,500 cases of patients with breast benign lesions as benign group. The ultrasonic patterns were classified into four categories: ①duct type; ②mixture type; ③density type; ④inhomogeneous type, according to proportion of glandular duct, fibrous and fatty of the breast ultrasonic ultrasonographic displays with all subject, breast thickness and duct diameter of bilateral sides were measured and recorded for a statistical analysis. The odds risk of breast cancer with different breast ultrasonic patterns was analyzed.2. Collected 100 cases of normal breast tissue surrounding the mammary tumor surgery pathology slice, each anatomical histological structure of mammary gland was observed in optical microscope. The number of mammary gland and ducts, lobular average area, average diameter ducts of different ultrasonic patterns were measured by the image analysis software in low-power field, calculated the mammary gland tissue, fibrous connective tissue and adipose tissue component percentages. Quantitative analysis of anatomical histological structure in different breast ultrasonic patterns was recorded.3. Collected 207 cases of breast checkup from October to December 2014 in Beijing military general hospital, the differences of SWV value with ultrasonic patterns, ages and thickness of mammary glands were investigated through the VTQ technology.Results1. Breast ultrasonic patterns distribution in control group:in 3964 cases of normal female breast examination, duct type 339 cases (8.55%), mixture type 2276 cases (57.42%), density type 1251 cases (31.56%), inhomogeneous type 98 cases (2.47%). Duct type was mainly distributed in the< 30 years old age group (21.78%), as the growth of the age, the proportion was gradually reduced, almost 60 and older were rare. Mixture type was mainly distributed in under the age of 50 age group (56.73%-64.64%), density type was mainly distributed in more than 50 years old age group (48.02%-58.86%), and the proportion of desity type was gradually rising with age. There had no obvious difference of inhomogeneous type in the distribution of all ages. There was statistically significant of breast ultrasonic patterns distribution in different age groups (P= 0.000).2. Breast ultrasonic patterns distribution in breast cancer group:density type 110 cases (59.46%), the proportion was the largest, followed by mixture type 58 cases (31.35%), duct type 5 cases (2.70%), inhomogeneous type 12 cases (6.49%). The proportion of density type and inhomogeneous type was 65.95% in cancer group as 34.03% in control group. The difference of breast cancer group and control group and benign group in the same patterns comparison was statistically significant (P< 0.05).3. Breast ultrasonic patterns distribution in breast benign group:mixture type 265 cases (53%), the proportion was the largest, followed by density type 110 cases (22%), inhomogeneous type 71 cases (14.2%), duct type 54 cases (10.8%).4. The correlation between ultrasonic patterns and breast cancer:the OR values of density type and inhomogeneous respectively was 3.181 [95%CI (2.354～4.298)], P< 0.001,2.736 [95% CI (1.474～5.079)], P< 0.001; mixture type was 0.339 [95% CI (0.247～0.465)], P< 0.001; duct type was 0.297 [95%CI(0.121～0.727)], P= 0.005). The density type and inhomogeneous type had the greatest impact on breast cancer risk, while mixture type and duct type was low-risk type.5. Breast thickness and duct diameter of different breast ultrasounic patterns:the duct diameter of bilateral breast was the largest in duct type, while the density type was the smallest. The difference of duct diameter between mixture type and inhomogeneous type was not statistically significant (P>0.05). The comparison between the other groups had significant difference (P<0.01). The thickness of bilateral breast of inhomogeneous type was the largest and that of dense type was the smallest. The difference of thickness between each groups was statistically significant (P<0.05).6. Anatomical tissue composition of different ultrasonic patterns:at low magnification, the glandular tissue proportion of duct type was the largest (54.72%), the followed by mixture type (43.76%), the fibrous connective tissue proportion of density type was the largest(71.36%) and the adipose tissue proportion of inhomogeneous type was the largest (67.94%). The number of mammary gland and ducts, lobular average area, average diameter ducts with density type and inhomogeneous type were lower than mixture type and duct type at low magnification, the differences had statistically significant (P< 0.05).7. SWV value of different breast ultrasonic patterns:Mammary gland parenchyma SWV value of different ultrasonic patterns had statistically significant difference (P < 0.001), the SWV value of density type was the largest, followed by mixture type, duct type and inhomogeneous type. SWV value had statistically significant difference (P< 0.001) between different age groups, with the increase of age, SWV value increased gradually, and SWV value was the largest between 40～49 years, while began to decrease after the age of 50 years. The thickness of mammary glands and SWV value had no statistical significant difference (P> 0.05).Conclutions1. There was significant difference of ultrasonic patterns distribution in control group and breast cancer groups, the proportion of density type and inhomogeneous type in breast cancer group was 65.95%, which was larger than the control group(34.03%). The density type and inhomogeneous type had higher risk of breast cancer, should be screened and followed up as the key object. While mixture type and duct type were low-risk types.2. Breast ultrasonic patterns and histological composition had high consistency. The histological feature of density type and inhomogeneous type were degradation of lobular glands and ducts, density type with fibrous connective tissue hyperplasia, breast density was the largest, and inhomogeneous type with a large amount of adipose tissue, breast density was the lowest. Mammary gland tissue composition ratio may be the important or the main factors influencing breast density, ultrasonic patterns reflects the change of the mammary gland parenchyma each composition proportion, can be used as an evaluation method of breast density, may become an indicator of screening high-risk group of breast cancer. |
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