| ObjectiveTo investigate the different characteristics of conventional ultrasound and contrast-enhanced ultrasound in breast cancer with different sizes.MethodsThe image characteristics of conventional ultrasound and contrast-enhanced ultrasound of 107 cases of breast cancer tumors confirmed by pathology were retrospectively analyzed.According to the maximum diameter of the tumour,breast cancer was divided into two groups:one group was≦2.0cm(50.5%,54/107),the other was>2.0cm(49.5%,53/107).The features of conventional ultrasound and contrast-enhanced ultrasound were analyzed and compared between the two groups.ResultsThere were statistically significant differences in the orientation and CDFI characteristics between two groups in conventional ultrasound(P=0.004,P=0.002).The breast cancer group with a maximum diameter of ≤2.0cm was more likely to show the non-parallel orientation in the conventional image.At the same time,Alder grade of blood flow is often 0-I,while the maximum diameter of breast cancer mass>2.0 cm is more likely to have parallel tumor orientations on conventional ultrasound images,and Alder grade of blood flow is often Ⅱ-Ⅲ.In CEUS,there are differences between the two groups in the characteristics of the enhanced intensity of breast cancer tumors,the filling defect in the tumor,the perforating blood vessels around the tumor as well as the clearance time after the enhancement(P=0.000,0.000,0.009 and 0.038 in proper order).The group of maximum diameter ≤2.0cm presented hypo-or iso-enhancement,usually without perforating vessels or perfusion defects,and the clearance time was often pre-out or syn-out,while the group of maximum diameter>2.0cm usually presented hyper-enhancement,accompanied with perforating vessels and perfusion defects,and the clearance time was often post-out.ConclusionsThere are differences in the characteristics of conventional ultrasound and contrast-enhanced ultrasound images of breast cancers of different sizes.The size of the foci should be considered in the analysis of contrast-enhanced ultrasound.ObjectiveTo analyze and compare the characteristics of different molecular subtypes of breast cancer(luminal and non-luminal epithelial types,HER-2 overexpression and non-HER-2 overexpression type,TNBC and non-TNBC types)on conventional ultrasonography and contrast-enhanced ultrasonography,and then build three predictive models according to their characteristics to evaluate their respective predictive values.MethodsThe first part of 107 breast cancer cases were used as the model to construct the samples.The above cases were all treated by surgery,confirmed by pathology and had complete immunohistochemical data.Routine ultrasonography and contrast-enhanced ultrasonography were performed before surgery to observe their characteristics.According to the results of immunohistochemistry after the operation,107 model-constructed samples were divided into three groups to construct three models,namely,the first group of models was the luminal epithelial type(73 cases)and non-luminal epithelial type group(34 cases),the second group included 21 cases with overexpression of human epidermal growth factor receptor 2(Her-2)and 86 cases without overexpression of Her-2,the third group was triple-negative breast cancer(TNBC)(13 cases)and non-TNBC group(94 cases).Three corresponding prediction models were constructed according to conventional ultrasound and contrast-enhanced ultrasound characteristics in univariate and multivariate Logistic regression analyses.In addition,30 cases of breast cancer from March 2021 to November 2021 were selected as the model validation samples.The above cases were not only all confirmed pathologically with complete immunohistochemical data after surgical treatment,but also performed by conventional ultrasound and contrast-enhanced ultrasound to observe the characteristics.Model validation samples were used to draw receiver operating curves(ROC)to analyze the respective predictive values of the above three models(luminal and non-luminal epithelial types,HER-2 overexpression and non-HER-2 overexpression type,TNBC and non-TNBC types).Results:1.Univariate analysis1.1 The first group of luminal and non-luminal epithelial types:univariate analysis showed that 6 characteristics of conventional ultrasound and contrast-enhanced ultrasound had statistical significance in luminal type and non-luminal type of the first group(all P<0.05),including the size(≤ 2 cm and>2 cm),the margin of conventional ultrasound,crab-foot sign after enhancement,filling defect in enhanced mass,enlargement of enhanced mass and clearance time.1.2 The second group of HER-2 overexpression and non-HER-2 overexpression type:the margin of conventional ultrasound and the crab-foot sign after the contrast-enhanced ultrasound,the filling defect in the enhanced mass,the enlargement of the enhanced mass,and the clearance time,totally 5 characteristics were statistically significant(all P<0.05).1.3 The third group of TNBC and non-TNBC types:the third group of TNBC and non-TNBC had significant differences in the size and margin of conventional ultrasound and the margin of contrast-enhanced ultrasound(all P<0.05).2.Multivariate analysis2.1 The first group of luminal and non-luminal epithelial types:multivariate Logistic regression analysis screened the independent influencing factors composed of angulation(OR=10.945,P=0.013)and spiculation(OR=7.113,P=0.044)of the lesion margin on conventional ultrasound and filling defect in the enhanced mass(OR=4.3 86,P=0.043).2.2 The second group of HER-2 overexpression and non-HER-2 overexpression type:logistic regression analysis showed the blurring of the lesion margin(OR=68.924,P=0.016)and the filling defect in the enhanced mass(OR=13.212,P=0.003)were included in the regression equation.2.3 The third group of TNBC and non-TNBC types:logistics regression analysis showed that the angular(OR=0.111,P=0.026)and spiculated(OR=0.075,P=0.026).P=0.035)in the margin of the conventional ultrasound entered the regression equation,and no characteristic of contrast-enhanced ultrasound pattern entered the equation.3.Prediction model3.1 The first group of luminal and non-luminal epithelial types:the Logistic regression risk prediction model was Y=-2.721+2.393X21+1.962X22+1.478X4.3.2 The second group of HER-2 overexpression and non-HER-2 overexpression type:the Logistic regression risk prediction model was Y=-3.944+4.233X1+2.581X3.3.3 The third group of TNBC and non-TNBC types:the Logistic regression risk prediction model was Y=-0.462-2.195X21-2.594X22.4.Model Validation Sample Predicted Value4.1 The first group of luminal and non-luminal epithelial types:The area under the ROC curve of the model validation sample was 0.738(95%CI 0.530-0.946).The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy were 80.95%,66.67%,85.00%,60.00%,and 76.67%,respectively.4.2 The second group of HER-2 overexpression and non-HER-2 overexpression type:The area under the ROC curve of the model validation sample was 0.792(95%CI 0.553-1.00).The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy were 66.67%,91.67%,66.67%,91.67%,and 86.67%,respectively.4.3 The third group of TNBC and non-TNBC types:The area under the ROC curve of the model validation sample was 0.560(95%CI 0.265-0.855),and the calculated sensitivity,specificity,positive predictive value,negative predictive value,and accuracy were 20.00%,92.00%,33.00%,85.19%,and 80.00%respectively.ConclusionThere are differences in the characteristics of conventional ultrasound and contrast-enhanced ultrasound in different molecular subtypes of breast cancer.The conventional ultrasound and contrast-enhanced ultrasound prediction model has a certain value in risk assessment of luminal epithelial and non-luminal epithelial breast cancer type and HER-2 overexpression and non-HER-2 overexpression breast cancer groups.However,the predictive value of breast cancer in TNBC and non-TNBC breast cancer groups is poor,and further studies are needed to expand the sample. |
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