Study On The Value Of Real-time Shear Wave Elastography In Diagnosis Of Breast Cancer And Its Relationship With Pathology

ObjectiveTo analysethe value of shear wave elastrography(SWE)in differential of breast benign and malignant lesions andits correlation with Pathology.To investigate the relationship between the SWE parameters and the qualitative features of breast cancer andpathological type,histological grade,molecular marker and molecular typing of breast cancer.To investigate the value of SWE in evaluating the effect of chemotherapy.In order to improve the diagnosis value ofbreast tumor by ultrasonography further,and to predictinfiltration degree of invasive breast cancerby means of noninvasive and safe ultrasonography,to investigate the relationship between SWE and pathological changes of neoadjuvant chemotherapy in breast cancer,thus,to improve the value of ultrasonography in the diagnosis and treatment of breast cancer.MethodsAccording to inclusion and exclusion criteria of the study,select 499 cases breast patients(533 lesions)with conventional Ultrasonography and SWE in our hospital from January 2015 to September2016,and all the cases had lesion excision or tissue biopsy and got pathological results.According to the results of pathological diagnosis,499 cases were divided into 2 groups:Benign group: 87 cases(99 lesions)Malignant group: 412 cases(434 lesions)According to the neoadjuvant therapy of breast cancer,412 cases breast patients in the malignant group were subdivided into 2 groups:Chemotherapy group: 68 cases(76 lesions)Nonchemotherapy group: 344cases(358 lesions)The non chemotherapy group was divided into 2 groups according to whether or notheir age is 35 years old:Young group(< 35 years): 29 cases(29 lesions)Non young group(> 35 years old): 315 cases(329 lesions)The non chemotherapy group was divided into 2 groups according to the size of the lesion measured by ultrasound(2cm):<2cmgroup : 108 cases(115 lesions)≥2cm group: 228 cases(234 lesions)According to the degree of breast cancer infiltration,344 patients in the non chemotherapy group were divided into the following 3 groups:A group(ductal carcinoma in situ): 12 cases(12 lesions)B group(Microinvasive breast carcinoma,MBC):20 cases(20 lesions)C group(invasive ductal carcinoma): 210 cases(221 lesions)According to histopathological grading,196 patients from the C group with pathological diagnosis were divided into 3 groups:C1 group(grade 1 invasive ductal carcinoma):13 cases(13 lesions)C2 group(grade 2 invasive ductal carcinoma):98 cases(99 lesions)C3 group(grade 3 invasive ductal carcinoma):85 cases(89 lesions)In non chemotherapy group,242 cases had the completeinformation of the expression of ER,PR,HER2 and KI-67.According to the expression of ER,242 patients were divided into 2 groups:ER+group: 137 cases(138lesions)ER-group: 105cases(105 lesions)According to the expression of PR,242 patients were divided into 2 groups:PR+group: 123 cases(124lesions)PR-group: 119cases(119lesions)According to the expression of HER2,242 patients were divided into 2 groups:HER2+group: 204cases(205 lesions)HER2-group: 38cases(38 lesions)According to the expression of Ki-67,242 patients were divided into 2 groups:Ki-67Overexpressiongroup: 44cases(44 lesions)Ki-67Lowexpressiongroup: 198cases(199 lesions)According to the 2013 St.Gallen breast cancer consensus [18],242 patients were divided into 4 groups:Luminal A group : 8 cases(8 lesions)Luminal B group: 145 cases(146 lesions)HER2 over expressiongroup: 74 cases(74 lesions)Basal-likegroup: 15 cases(15 lesions)According to the pathological grading criteria of neoadjuvant chemotherapy,35 patients with final pathological results were divided into 2 group :(Pathological complete,pCR)group and non pCR group :pCR group: 8 cases(8 lesions)non PCR group: 27 cases(30 lesions)According to the sonographic findings,344 cases of non chemotherapy group were divided into 2type: mass type and non mass type.non chemotherapy group: mass type 335 cases(349 lesions)non mass type 9 cases(9 lesions)ROC curve was used to calculate the best diagnostic value of each parameter of SWE in benign and non chemotherapy group,and to compare the diagnostic efficacy of all parameters,and then compare the difference of SWE parameter elastic modulus value between the Benign group and Non chemotherapy groupand the detection rate of "changeable sign","hard ring sign" and "black hole sign".The elastic modulus values of SWE parameters and the detection rate of "changeable sign","hard ring sign" and "black hole sign" were compared between Young group and Non young group,so that to comparative analysis of the influence of age on SWE parameters and qualitative characteristics.The elastic modulus values of SWE parameters and the detection rate of "changeable sign","hard ring sign" and "black hole sign" were compared between<2cmgroup and ≥2cm group,so that to comparative analysis of the influence of the size on SWE parameters and qualitative characteristics.The elastic modulus values of SWE parameters and the detection rate of "changeable sign","hard ring sign" and "black hole sign" were compared between A group,B group and Cgroup,so that to analysis of the influence of the breast cancer infiltration on SWEparameters and qualitative characteristics.The elastic modulus values of SWE parameters and the detection rate of "changeable sign","hard ring sign" and "black hole sign" were compared between C1 group,C2 group and C3 group,so that to further analysis of SWE can reflect the histological grade of IDC.The elastic modulus values of SWE parameters were compared between ER+group and ER-group.The elastic modulus values of SWE parameters were compared between PR+groupand PR-group;The elastic modulus values of SWE parameters were compared between HER2+group and HER2-group.The elastic modulus values of SWE parameters were compared between Ki-67 Overexpressiongroup and Ki-67 Lowexpression group.The elastic modulus values of SWE parameters were compared betweenLuminal A group,Luminal B group,HER2 over expressiongroup and Basal-likegroup.The elastic modulus values of SWE parameters were compared between pCR group and Non PCR group.Results1 The maximum diameter of 99 mass lesions in Benign group was 0.3cm to 10.0cm,with an average of(1.98 + 1.71)cm;The maximum diameter of 349 mass lesions in non chemotherapy group was 0.5cm to 20.0cm,with an average of(3.15 + 2.18)cm;The maximum diameter of 76 mass lesions in chemotherapy group was 0.6 cm to 15.0cm,with an average of(3.44+ 2.58)cm.2 Compare the AUC of 457 benign and malignant breast lesions by SWE parameters Emean,Emax,Emin,Eratio,SD,E range with that AUC was 0.5,P all<0.05.Among them,the AUC of Emax was 0.864,and the corresponding diagnostic value was 85.45 kPa.The accuracy of Emax 85.45 kPa as a criterion for benign and malignant breast lesions was higher than other SWE parameters.The sensitivity of SD was the highest for 86.0%and the specificity of Emin was the highest for 90.9%.3 The SWE parameters of the non chemotherapy group(Emean,Emin,Emax,SD,Eratio,E range)were significantly higher than those in benign group(P< 0.05)and its detection rate of "changeable sign","hard ring sign" and "black hole sign" was significantly higher than that of malignant group(P< 0.05).4 There was no significant difference in the SWE parameters and the qualitative findings of breast cancer between Young group and Non young group(P< 0.05).5 Emean,Emax and SD of < 2cm group were significantly higher than those of ≥2cm group,the differences were statistically significant(P < 0.05).6 From DCIS → MBC → IDC,the SWE parameters value increased gradually;Emean,Emin、Emax、SD of A group were smaller than those of B group and C group,the difference were statistically significant(P all< 0.05);Eratio of A group was smaller than thatof C group,the differences was statistically significant(P< 0.05);E range of A group and B group were smaller than thoseof C group,the differences werestatistically significant(Pall < 0.05);the detection rate of "changeable sign","hard ring sign" and "black hole sign" of A group,B group were lower than those of C group,the difference were statistically significant(Pall< 0.05).7 From C1 →C2 →C3,SWE parameters showed a gradual increasing trend;SD value of C3 group was bigger than that of C1 group and C2 group,the differences were statistically significant(Pall< 0.05);The detection rate of "changeable sign" in C1,C2 and C3 group were statistically significant(Pall < 0.05).8 The Eratio value of PR-group was significantly higher than that of PR+ group,the difference was statistically significant(P< 0.05);The Eratio value of HER2+group was significantly higher than that of HER2-group,the difference was statistically significant(P< 0.05);The Eratio value of Ki-67 Overexpression groupwas significantly higher than that of Ki-67 Lowexpression group,the difference was statistically significant(P< 0.05).The expression of Eratio was correlated with PR,HER2 and Ki-67,and the correlation coefficients with PR were-0.209 and P=0.001,the correlation coefficient with HER2 was 0.231,P=0.000,and the correlation coefficient with Ki-67 was,P=0.006,.9 The Eratio value of HER2 over expression group was higher than those of Luminal A group and Luminal B group,the difference were statistically significant(Pall< 0.05).10 The values of Emean,Emax,SD and Eratio of the non chemotherapy group were higher than those of the chemotherapy group(Pall< 0.05).The detection rate of the "changeable sign","hard ring sign" of the non chemotherapy group were higher than thoseof the chemotherapy group,and the difference were statistically significant(Pall< 0.05).The values of Emax,SD and E rangeof pCR groupwere lower than those of Non pCR group(Pall< 0.05).The detection rate of the,"hard ring sign","black hole sign" of pCR groupwerelower than thoseof Non pCR group,and the difference were statistically significant(Pall< 0.05).Conclusions1 SWE parameters(Emean value,Emin value,Emax value,SD value,Eratio value,E range)and qualitative performance of "hard ring sign" and "changeable sign","black hole" sign can provide a basis for differential diagnosis of benign and malignant breast lesions.2 From DCIS-MBC – IDC,SWE parameters value significantly and gradually increased,SWE has a certain value in reflecting the degree of infiltration of breast cancer.3 With the increase of IDC of the breast histological grade,the parameters of SWE values was increased gradually,and the detection rate of "hard ring sign","changeable sign" and "black hole" sign with histological grade were also increased.SWE has a certain value in reflecting the histological grading of breast cancer.4 PR positive breast cancer had lower Eratio value,while Herb-2 positive,Ki-67 high expression had higher Eratio value.Eratio value is correlated with PR,Herb-2 and Ki-67 expression.5 The Eratio expression of HER2 was higher than that of Luminal A and Luminal B.From Luminal→A Luminal B→HER2 over expression→Basal-like group,Emax,SD showed a gradual increase trend.SWE has some value in predicting the molecular classification of breast cancer.6 The SWE parameters of chemotherapy group were lower than those of non chemotherapy group,and "hard ring sign" and "changeable sign" were less than those in chemotherapy group.7 Emax,SD,E range of SWE is related to the pathological changes of neoadjuvant chemotherapy.