| purpose:The purpose of this study is to investigate the clinical value of multimodal imaging in breast ductal carcinoma(DCIS),and to analyze the correlation between the imaging features,pathological classification and the expression of biomarkers.method:120 female patients with DCIS were collected from January 2018 to December2020,and all patients were improved mammography and ultrasound examination before operation,among which 30 cases were MRI.Mammography was used to check whether there were local structural disorders,masses and calcification.Breast ultrasound examination recorded the masses(with / without calcification),and the structural disorder of glands,blood flow enhancement,catheter expansion and the shape and echo of the lesions.The main contents of MRI were the morphological characteristics,tic curve and ADC value of the lesions.According to the histological classification,DCIS was divided into low,medium and high nuclear grades.The expression of Er,PR,HER-2,Ki-67 and p53 was detected by immunohistochemistry.All imaging methods were classified according to the 5th edition of breast imaging report and data system(BI RADS)developed by the American Society of Radiology(ACR)in 2013.The coincidence rate of the methods was evaluated by the gold standard of postoperative pathological diagnosis,and the correlation between some imaging signs and pathological nucleus classification and biomarkers was analyzed.Spss23.0 statistical software was used to analyze the data.result:1.Molybdenum target examination: 43 cases(35.83%)were simple calcification,8 cases(6.67%),13 cases(10.83%)of gland structure disorder,10 cases(8.33%)with calcification,26 cases(21.67%)and 20 cases(16.67%)with no abnormality.2.ultrasonography: 82 cases(68.33%)with or without calcification,13 cases(10.83%)with and without obvious abnormality were found in 25 cases(20.83%).Some lesions showed catheter expansion(which could be existed alone or accompanied by other lesions)in 19 cases(5.83%),and no catheter expansion occurred in 101 cases(84.17%).The blood flow of mass type and gland disorder type can be divided into three types: I,II and III.The proportion of cases with blood flow of Ⅰ is 51.58%(49/95),the ratio of cases with blood flow as Ⅱ is 36.84%(35/95),and the proportion of cases with blood flow as Ⅲ is 11.58%(11/95).3.MRI: the morphological features of the lesions were mass type and non mass type.The results showed that 14 cases(46.67%)were mass type,13 cases were irregular,1 case was round;the enhanced tic curve showed 7 cases,5 cases and 2cases of type II and I type respectively;the average ADC value was(0.92 ± 0.11)×10-3mm m2 / s.The results showed that the average ADC value was(1.11 ± 0.14)×10-3mm m2 / s.The difference of Ti C curve and average ADC value between the masses and non mass DCIS lesions was statistically significant(P < 0.05).4.Take pathology as the gold standard,the diagnostic accuracy of breast ultrasound,molybdenum palladium and MRI was 71.67%,70.00%,and 96.67%respectively.5.among the calcified lesions,59 cases were high pathological grading,18 cases were intermediate pathological grading and 2 cases were low pathological grading,56 cases were HER-2 positive and 23 cases were negative for HER-2,48 cases of Ki-67 high expression and 31 cases of Ki-67 low expression,32 cases were positive for p53 and 47 cases were negative for p53.Among the lesions without calcification,16 cases were high pathological grading,14 cases were intermediate pathological grading and 11 cases were low pathological grading,14 cases were HER-2 positive and 27 cases were negative for HER-2,10 cases of Ki-67 high expression and 31 cases of Ki-67 low expression,9 cases of p53 positive and 32 cases of p53 negative.The difference between the nuclear classification and immunohistochemistry was statistically significant between calcification and non calcified lesions(P < 0.05).6.ER positive lesions: 18 cases were tumor type,8 calcified lesions,15 cases with calcified lesions and 9 cases without calcification or mass,11 cases were low,intermediate and high pathological grading,23 cases and 16 cases were respectively,43 cases of Ki-67 low expression and 7 cases were high expression,6 cases were positive for p53 and 44 cases were negative.Among the positive lesions of HER-2,11 cases were tumor type,18 calcified lesions,38 cases with calcified lesions and 3cases without calcification or mass,2 cases were low,intermediate and high pathological grading,9 cases and 59 cases were respectively,19 cases of Ki-67 low expression and 51 cases were high expression,35 cases were positive and negative for p53.The difference between ER positive type and HER-2 positive focus,imaging and pathological features was statistically significant(P < 0.05).7.Among the low pathological grading cases,6 cases were tumor,1 calcification,1 mass with calcification,5 without tumor or calcification,7 cases of catheter expansion,6 cases without catheter expansion,11 ER positive and 2 Er negative cases,2 positive and 11 negative cases of HER-2,12 cases of Ki-67 low expression,1 case with high expression,3 cases of p53 positive and 10 negative cases.Among the cases of intermediate pathological grading,12 cases were mass,6 calcified,12 with calcification,2 without mass or calcification,2 cases of catheter expansion,30 cases without catheter expansion,28 ER positive and 4 Er negative cases,9 cases with positive HER-2 and 23 negative cases,24 cases with low Ki-67 expression,8 cases with high expression,4 cases of p53 positive and 28 negative cases.Among the high pathological grading cases,11 cases were tumor,19 calcified,40 cases with calcification,5 cases without tumor or calcification,10 cases of catheter expansion,65 cases without catheter expansion,41 ER positive and 34 Er negative cases,59 cases and 16 negative cases with positive HER-2,26 cases with low Ki-67 expression,49 cases with high expression,34 cases of p53 positive and 41 negative cases.The difference of imaging characteristics and immunohistochemistry was statistically significant in different pathological nuclei classification(P < 0.05).ConclusionMolybdenum target X-ray is more sensitive to calcified ductal carcinoma,and ultrasound is more likely to find tumor type breast duct carcinoma.MRI multi-dimensional analysis of lesions is the most accurate rate in diagnosis of breast duct carcinoma.Moreover,the imaging features were correlated with the pathological classification and the expression Level of biomarkers. |
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