The Relationship Between The Charateristic Of Shear Wave Elastography And Pathology Of Breast Cancer

Part Ⅰ Role of shear wave elastography in the molecular markers of breastcancer Objectives The molecular markers ER,PR,HER-2 and Ki-67 are of great significance in the prognosis of breast cancer,so it is very important to distinguish the expression level of molecular markers.Ultrasound is an important examination method of breast cancer.Some studies show that the characteristics of conventional ultrasound are related to the expression level of molecular markers.As an important examination method in ultrasound,there is little research on the relationship between expression level of shear wave and molecular markers.This study is to investigate the relationship between the characteristics of shear wave elastography and the expression of molecular markers of breast cancer,and to evaluate the prediction value of shear wave elastography in molecular markers of breast cancer.Methods From August 2015 to February 2017,388 consecutive women with 392 solid lesions confirmed to be invasive breast cancer were included.The shear-wave elasticity modulus of the lesions were acquired.The comparison of these modulus in different expression of molecular markers was investigated by using the the Kruskal-Wallis test and logistic regression.The value of SWE on prediction in the expression of molecular markers was evaluate by using the analysis of receiver operating characteristics(ROC)curves.Results The lesions of breast cancers with ER negative,PR negative and Her-2 positive had higher elasticity modulus(all P < 0.05).The periphery areas of breast cancers with Her-2 positive and Ki-67 positive had higher elasticity modulus(all P <0.05),and most of the elasticity modulus(except total Emax at ROI-3mm for breast cancers with ER negative and Emax at ROI-3mm for breast cancers with PR negative and)in the periphery areas of breast cancers with ER negative,PR negative were significantly higher(all P < 0.05).Histological classification is an independent risk factor for the expression of all molecular markers.As for elasticity modulus,the independent risk factor for expression of ER was Emax-s(OR = 0.19)at ROI-2mm.The independent risk factors for expression of PR were Emean(or = 3.20)at ROI-M and total Emean(or = 0.11)at ROI-1mm.The independent risk factors for expression of HER-2 were Emax(or = 0.22)and ESD(or = 3.85)at ROI-M.The area under ROC curve of ER,PR and HER-2 were 0.847,0.771 and 0.760.Conclusion The elasticity modulus of shear wave elastography of the lesions and its periphery areas have significant influence on the prediction of expression level of molecular markers.The elasticity modulus of the lesions and the periphery areas in breast cancer with different expression of ER,PR,HER-2 had a certain predictive efficiency in the expression of molecular markers.Therefore,shear wave elastography has an important value in predicting the expression of molecular markers in breast cancer.Part Ⅱ Role of shear wave elastography in the molecular subtype of breast cancerObjectives The molecular subtypes of breast cancer are related to the choice of treatment plan and the evaluation of prognosis.There were some studies that showed that the charateristics of conventional ultrasound were related to the molecular subtype of breast cancer.As one of the most important techniques of ultrasound,the value of shear wave elastography in molecular typing of breast cancer has attracted more and more attention.This study is to investigate the relationship between the characteristics of shear wave elastography and different molecular subtypes of breast cancer,and to evaluate the value of shear wave elastography in molecular typing of breast cancer.Methods From August 2015 to February 2017,388 consecutive women with 392 solid lesions confirmed to be invasive breast cancer were included.The shear-wave elasticity modulus of the lesions were acquired.The comparison of these modulus in different molecular subtypes of breast cancer was investigated by using the Mann-Whitney U test and the Kruskal-Wallis test.The value of SWE on the differential diagnosis of immunohistochemical profiles in invasive breast cancer was evaluate by using the analysis of receiver operating characteristics(ROC)curves.At the same time,The comparison of ROC curves was investigated by using the Z test.Results Most of the elasticity modulus(except Emax at ROI-3mm)were significantly different among the molecular subtypes of breast cancer(all P < 0.05).The elasticity modulus of HER-2 overexpression breast cancer were significantly higher than those of non-HER-2 overexpression breast cancer(all P < 0.05).In HER-2 overexpression breast cancer,only the Esd at ROI-2mm and ROI-3mm was significantly higher than those of the lesion(P < 0.05).The elasticity modulus of the margin of non-HER-2 overexpression breast cancer were significantly higher than those of the lesion(P < 0.05).The area under the curve was 0.688 for all combined elasticity modulus in the lesions and the periphery areas,and 0.623 for all combined elasticity modulus in the lesions.At the same time,the former was significantly higher than that of the latter in diagnostic efficiency(P=0.028)Conclusion The elasticity modulus of shear wave elastography of the lesions and its areas were significantly different in different breast cancer molecular subtypes.The elasticity modulus in the periphery area is as important as those in the lesions,which is helpful to the molecular typing of breast cancer,and its combined index has certain diagnostic value for the molecular typing of breast cancer.