Diagnosis Of Breast Cancer In CDFI And Research For Prognosis Of Breast Cancer With Grale-Scale US

The diagnosis of breast cancer in CDFI and the research for prognosis of breast cancer with grale-scale USIntroductionNowadays, one of the most common uses of ultrasound is to help distinguish benign from malignant breast mass. US the initial imaging investigation for the women 45 years or younger with breast symptoms. The sensitivity of breast cancer diagnosis according to combination of US and mammography is 91.5%.Recently, using Color Doppler Flow Imaging(CDFI) to observe thepattons of morphology and distribution of blood vessels in solid breast mass is one of the heat tops in breast mass diagnosis. But their investigation of breast mass vascularity only indicated the intratumoral blood vessels, and the diagnostic accuracy is low. The intratumoral blood vessels is derived from normal vascular endothelial cells. So is there any relationship between the intratumoral blood vessels with abnormal morphology and distribution and the normal mammary arteries? How is. their relationship? And the difference of the mammary arteries feeding pattern between benign and malignant breast mass. About this option, nowadays, nobody internal or abroad have reported. US is not only used in the field of breast cancer diagnosis, but also Gray-scale US have been reported using in prognosis of breast cancer abroad. Malignant halo of breast cancer is the significant features of breast cancer on ultrasound. Nakajima using halo ratio (halo area/total tumor area) to investigate the prognosis of breast cancer, concluded that halo ratio was a independent prognostic indicator for overall or disease-free survival. Thus, the purpose of our study was to investigate the pathologic basement of malignant halo and its relationship with prognosis of breast cancer. Nowadays, correlated investigation has not been reported internal and external.MethodsBetween July 2004 and November 2005, 248 patients with breast mass were confirmed by operation and pathology in our hospital. The patients who were confirmed with breast cancer were not given chemotherapy before operation. Before operation, all the patients were examined by Gray-scale US and CDFI prospectively. CDFI detect the mammary arteries and their relationship with the breast mass location, observe the mammary arteries and their branches feeding pattern to breast mass. Compare the characteristics and differences of vascular distribution between benign and malignant breast mass in CDFI. Build the diagnostic standards of breast cancer with CDFI. Combined with Gray-scale US manifestations to diagnose and evaluate the effect of US diagnosing. Prospectively using Gray-scale US to examine 83 patients who were confirmed with nonspecific infiltrative breast cancer according to pathology. According to the margin status of the mass in sonographic imaging, we divided the 83 patients into three groups, including well defined(Group 1), ill defined(Group 2) and with halo(Group 3), and taking three experiments independently. (a) using immunohistochemistry to observe the expressions of estrogen receptor(ER), progesterone receptor(PR), human epidermal growth factor receptor(CerbB-2), vascular endothelial growth factor(VEGF), CD34, Ki-67. Using light microscope to observe tumor tissue grades, count mitotic figures and the lymph nodes metastasis. (b) selecting 31 patients from the above three groups, comparing with mammarygraphy and pathology to observe the breast cancer margin status, then selected 11 patients from the 31 patients, using 3D(3-diamension) in comparison of mammarygraphy to observe breast cancer spicule. (c) locating and drawing halo tissue from 4 postoperative specimens with halo by ultrasonic guidance, and observing the tissue structure under HE staining.Results 1,CDFI detect the relationship between mammary arteries and breast cancer as well as their branches feeding pattern. Among the 248 patients with breast tumor, 146 were confirmed to be breast cancer by pathology. CDFI indicating the character breast cancer vascular distribution pattern included penetrating vessels, branches of penetrating vessels, branches of directed vessels and central large vessels.â‘ mammary artery main shunt or its branches crossing through the mass, and the vessels were pressed by the mass tissues, the main shunt and its branches were called penetrating vessels, 35 cases (24%).â‘¡there is some distance between mammary artery main shunt or its branches and breast mass, their branches spanning this distance and penetrating into the mass, this pattern is called branches of penetrating vessels, 21 cases (14%).â‘¢mammary artery or its branches directly contact with the surface of the mass, their branches directly distribute inside the mass, called branches of directed vessels, 45 cases (31%).â‘¡,â‘¢pattern of breast distribution of blood vessels followed the principle of "three mostly and one center" which is referred to that the branches of penetrating vessels and branches of directed vessels were mostly arising vertically from the affiliated artery main shunt, mostly penetrating into the mass in linear pattern and coursing toward the center of the mass, and mostly have more branches to meet the different directions of blood feedings.â‘£central large vessels, referred to the large tubular vessels detected in the center of the mass, not extending to the margins and without branches, or the central vessels arising from the extratumoral arteries, penetrating into and almost cross the mass, and sending branches around, the two large vessels above were called central large vessels, 5 cases (3%). Using the four vascular distribution patterns as the standards of diagnosing breast cancer with CDFI, combined with Gray-scale US to diagnose 146 breast cancer and 102 breast benign masses, under curve area of ROC A_Z=0.989, indicating CDFI vascular distribution can promote the accuracy of breast cancer diagnosis.2,â‘ Ki-67 expression, number of gradeâ…¢tissue grading and mitotic count in Group 1 were significantly higher than those in Group 2 and Group 3, their individual P value were 0.009,0.007,0.026. Patients ages in Group 3 were significantly elder than those in Group 1 and Group 2, its P value is 0.01. There was no statistically significant in the differences of other immunohistochemical indicator, tumor size and lymph nodes metastasis among the three groups.â‘¡the observing results of the margin status from US, mammarygraphy and pathology were similar. Breast cancer with malignant halo often appeared masses with spicule in mammarygraphy. The spicule displayed in 3D sonography was similar with that in mammarygraphy. But the spicule in 3D sonography was not related to halo.â‘¢under macroscopic observation, halo tissue was similar with yellow fatty tissue, and tightly contacted to the edge of the cancerous tissue. Under light microscope, halo tissue was mainly composed of fatty tissue and scattered clumps of cancerous tissue, fibrous tissue, normal lobular and tubular, atypical hyperplasia lobular and tubular, and inflammatory cells.ConclusionUsing CDFI to investigate the relationship of mammary arteries and breast cancer as well as their branches feeding pattern, compare the differences of the benign and malignant breast tumors, conclude the characteristics of breast cancer vascular distribution in CDFI, including penetrating vessels, branches of penetrating vessels, branches of directed vessels and central large vessels, compensate the shortage of only depicting the morphology and distribution of intratumoral blood vessels, improve the diagnostic index of breast cancer with CDFI, and when combined with Gray-scale US can significantly promote the diagnostic accuracy of breast cancer.Malignant halo is a special manifestation in sonography of breast cancer. Latest investigation and our experiment have indicated that the prognosis of nonspecific infiltrative breast cancer with well defined boundary were very poor, but that of breast cancer with spicule and almost breast cancer with malignant halo were better.