The Ultrasound And Magnetic Resonance Imaging Study Of Triple-negative Breast Cancers

Part Ⅰ The General Ultrasound Imaging of Triple-negative Breast Cancers Purpose To explore the general ultrasound(US)imaging features of triple-negative breast cancers.Methods From January 2014 to October 2016,936 breast cancers histologically diagnosed by operation were enrolled in this study,including 134 cases of triple-negative breast cancer(TNBC)and 802 cases of non-triple-negative breast cancer(Non-TNBC),numbers were given to the 802 cases of Non-TNBC according to time visiting doctors,were randomly selected as the control group.The original ultrasound images of each case were evaluated according to American College of Radiology Breast Imaging Reporting and Data System(ACR BI-RADS).Results TNBC seemed to be diagnosed at a younger age,with higher indicence of invasive ductal carcinoma,lower indicence of ductal carcinoma in situ,higher histological tumor grade and higher expression of Ki67.On ultrasound,TNBC have a relatively larger proportion to present as oval or round mass shape(29/134,21.6%),circumscribed margins(23/134,17.2%),enhancement posterior features or no posterior features(93/134,69.4%),without calcifcations in mass(88/134,65.7%).Additionally,TNBC was more likely to be masses with rich vascularities(82/134,61.2%),with a larger trendency to present as vessels in rim(44/130,33.8%).Features above had significant differences between TNBC and Non-TNBC(P 0.05).Conclusions TNBC have some special clinical and pathological characteristics,and some features on general ultrasound may may provide clues for its early diagnosis.Part Ⅱ The Contrast-enhanced Ultrasound Imaging of Triple-negative Breast Cancers Purpose To explore the contrast-enhanced ultrasound(CEUS)imaging features of triple-negative breast cancers through qualitative and quantitative analyses.Methods 67 cases of TNBC and 86 cases of Non-TNBC with contrast-enhanced ultrasound examination and intact imaging datas were selected for qualitative and quantitative analyses in this part.Qualitative analyses included enhancement distribution,enhancement degree,enhancement margin,perfusion defect and penetrating vessels,the shape of the enhancement and the size of the perfusion defects were evaluated.The time intensity curve(TIC)of the whole mass was acquired for quantitative analyses,parameters including peak intensity(Peak),time to peak(TP),the maximum rate for microbubbles of contrast agent to enter into tumor(Sharpness)and area under the curve(AUC)were provided for quantitative analyses.Results On qualitative analyses,TNBC have a relatively larger proportion to present as high enhancement(49/67,73.1%)and circumscribed margins(44/67,65.7%),and more likely to show as rim enhancement patterns(37/48,77.1%)for those with perfusion defects,features above were significantly different from that of Non-TNBC(P 0.05).On quantitative analyses,for the TIC of the whole mass,the average value of Peak(24.60±10.76)and AUC(3.07±1.40)for TNBC subtypes were higher than that of Non-TNBC,significant difference were found with that of Non-TNBC(P 0.05).Conclusions TNBC have some features on qualitative and quantitative analyses of contrast-enhanced ultrasound imaging,and these features may provide clues for the early diagnosis of TNBC.Part Ⅲ The Ultrasound and Magnetic Resonance Imaging Diagnosis of Triple-negative Breast Cancers Purpose To explore the magnetic resonance imaging(MRI)features of triple-negative breast cancers,investigating the diagnostic value of US,CEUS,MRI and its combinations for triple-negative breast cancers.Methods The MRI images of cases in part II were described according to BI-RADS in this part.The the diagnostic value of US,CEUS,MRI and US+CEUS+MRI were evaluated.Results On MRI,TNBC most presented as mass enhancement(56/74,75.7%),no significant difference were found with Non-TNBC(P 0.05).And for those presented as mass enhancement,TNBC have a relatively larger proportion to present as circumscribed margins(19/65,29.2% vs 5/80,6.3%)and rim enhancement(36/65,55.4% vs 11/80,13.8% than that of non-TNBC,significant difference were found between two groups(P0.05).MRI was better than US and CEUS for the diagnostic of TNBC,The diagnostic value of US+CEUS can match that of MRI,and US+CEUS+MRI have the highest diagnostic value for TNBC.Conclusions Some features on MRI may be unique for the diagnosis of TNBC,and combined diagnosis with US,CEUS and MRI may provide more confidence for the diagnosis of TNBC.