| Background:Breast cancer is a high incidence of malignant female disease which causes great influence and damage to the physical and mental health of women. Epidemiological survey show that incidence of breast cancer has always been on the top of female malignant disease since the early 1970’s worldwide, and gradually increasing by 0.2%-8% each year, the age of onset gradually present younger trend. Related studies also confirmed that the first incidence of malignant diseases of women in China is also breast cancer which has currently become a major public health problem, and needs urgent public attention.Current methods of imaging detection for breast tissue are:computer tomography scan (Computed tomography, CT), mammography X-ray examination, MRI (Magnetic resonance imaging, MRI) enhancement, ECT, Doppler ultrasound, and the primary application for clinical detection methods are mammography X-ray examination and Doppler ultrasound. In recent years, MRI, CT and other imaging technology has been increasingly used in examination of breast tissue, and its unique checking advantages also been recognized by medical staff, but because of the high purchase price, the popularity of primary hospital and breast cancer patients and their families unable to afford higher inspection charge, etc., so the application of MRI, CT and other imaging methods are far less than that of Doppler ultrasound. The gradual improvement of diagnostic technology and detection equipment for Color Doppler ultrasound and CEUS (Contrast-enhanced ultrasound, CEUS), it has become the preferred method of breast tissue examination, and currently it is not limited to a single examination of breast mass lesions presence as well as differential diagnosis of physical properties of cystic mass lesion tissue. Thus, detection rate of smaller size of breast lesions by ultrasound has also been significantly improved. At present, researchers have done researches on diagnostic value of MRI and CEUS on breast tumor tissue lesions, and come to a conclusion that the typical enhancement pattern of breast tissue lesions by CEUS can help medical personnel to differentially diagnose benign or malignant of breast tumor tissue after value assessment of two diagnostic methods.MVD (Microvessel density, MVD) is a method to diagnose neovascularization lesion in tumor tissue, and also a reliable laboratory parameter currently recognized by all researchers to assess tumor angiogenesis. Tumor MVD can quantitatively reflect state of tumor vascular lesion tissue generation; it is also important laboratory parameters to determine disease progression and potentiality of tumor metastasis to distant organs as an independent factor influencing patient’s survival time. MVD currently has been regarded as a "gold standard" by majority of researchers to evaluate tumor angiogenesis in tumor tissue. Not only can Check real-time CEUS technology accurately reflect the morphology and microcirculation perfusion of breast cancer, but also to some extent evaluate the state of tumor angiogenesis in tumor tissue, so it is worth wide application in the clinical practice.There are obvious differences among different diagnostic imaging technology in terms of accuracy and precision. CEUS and dynamic contrast-enhanced MRI assessments are noninvasive method for detecting vascularization in tumor lesion tissue, and relevant studies have also confirmed that the diagnosis of breast cancer pathology by the two methods show higher consistency. However, due to essentially difference between the both principles of contrast enhancement effect, there are less related research reports on direct comparison between the two methods. X-ray mammography imaging diagnostic method can be used to distinguish anatomical structures within breast soft tissue with clear images data during the inspection, which can provide effective reference for clinical diagnosis of breast cancer disease. Compared with conventional X-ray examination, Doppler ultrasound, MRI and other tests, X-ray mammography has higher sensitivity for calcification pathological signs with up to 95% specificity. On the other hand, because the compressor and stand of X-ray mammography machine lack operative flexibility which impose certain restrictions on patient’s position, it is difficult to carry out deep projection of breast region, so the diagnostic capacity at rear mammary glands or lesions at chest wall are limited significantly. In addition, impose restrictions on breasts are needed when mammography X-ray examination are going on, thus, overlapping glandular tissue may cover part of signs of disease, which led to missed diagnosis and misdiagnosis etc.Neoadjuvant chemotherapy, known as Preoperative chemotherapy or induction chemotherapy, refers to systematic adjuvant cytotoxic therapy for tumor lesions without distant organs and tissues metastasis before local surgical treatment. Compared with previous surgical treatment, its biggest advantage is that it tries to keep the patient’s breast and effectively control the primary tumor, so that the lesion volume and error are significantly reduced, and stimulate the immune functional activity, and ultimately prolonging lifetime significantly. Neoadjuvant chemotherapy has been gradually used in clinical treatment of breast cancer, providing a broad space for locally advanced breast cancer and conservative surgery treatment of breast cancer. Currently, clinical medical staffs assess the efficacy of neoadjuvant chemotherapy in breast cancer patients through palpation, physical condition of the patient, mammography X-ray photography and other methods. Among them, palpation and assessing the physical condition of the patient to a great extent depend on the experience of attending doctor, moreover, there is greater subjectivity with no strict and uniform quantitative indicators, so its reliability is relatively low [17]. X-ray Mammography imaging technology clearly show breast tissue lesions, but high density of glandular lesions has significant effects on determination of the focus scope, and also the persistence of microcalcifications are easily misdiagnosed as malignant tumor tissue, which result in a greater impact for the accuracy assessment for neoadjuvant chemotherapy.CEUS uses ultrasound contrast agent (gas as a main component) as contrast enhancement agents directly to breast tissue after injection of the body through vein, since there is a big difference in acoustic impedance between the gas and the blood, soft tissue, so that the echo of cancer lesion with rich neovascular tissue are significantly increased, thus, achieving the ultimate goal of detect ing lesions. In addition, because breast cancer microvascular have some relevance with tumor lesion tissue classification, distant organ metastasis, therefore CEUS can also predict prognosis for breast cancer patients, and to assess the efficacy of non-surgical treatment of breast cancer.Objective:This study aims to investigate value of differential diagnosis of CEUS (CEUS) on benign and malignant breast tumor, to provide a research foundation for diagnosis of breast cancer in clinical application; to study the relationship between breast cancer CEUS quantitative parameters and MVD, and to evaluate the value of angiogenesis in breast tissue lesions; to compare the value of CEUS, enhanced magnetic resonance and X-ray mammography in different clinical diagnosis, providing the early best diagnosis of breast cancer in the future, to analyse the clinical value of contrast-enhanced ultrasound in the assessment of neoadjuvant chemotherapy for patients with breast cancer. This study aims to investigate value of differential diagnosis of CEUS (CEUS) on benign and malignant breast tumor, to provide a research foundation for diagnosis of breast cancer in clinical application; to study the relationship between breast cancer CEUS quantitative parameters and MVD, and to evaluate the value of angiogenesis in breast tissue lesions; to compare the value of CEUS, enhanced magnetic resonance and X-ray mammography in different clinical diagnosis, providing the early best diagnosis of breast cancer in the future, to analyse the clinical value of contrast-enhanced ultrasound in the assessment of neoadjuvant chemotherapy for patients with breast cancer.Methods:70 cases of female patients with breast cancer hospitalized from January 2014 to July 2015 for surgical treatment were chosen as subjects, after all the breast tissue were diagnosed by postoperative pathology. All patients were through CEUS examination, and immunohistochemistry was applied to detect expression levels of CD34 in breast cancer tissue to determine the MVD. The perfusion parameters of breast tumor margin, the central region and the surrounding normal tissue were compared, in accordance with 48/HPF as standard,70 breast cancer samples were divided into high MVD and low MVD groups, breast cancer enhancement feature and perfusion parameters between the two groups were compared.152 cases of female patients with breast masses during hospital treatment of from January 2014 to July 2015 were chosen as subjects to accept postoperative pathologic examination, including 70 malignant cases and 82 benign cases. All the patients were through routine ultrasound and CEUS examinations, CEUS manifestations of breast lesion tissue were observed and benign and malignant lesions of time-intensity parameters of CEUS were compared, the results and analysis of CEUS were analyzed.152 patients with breast masses during hospital treatment from January 2014 to July 2015 were chosen as research subject, all patients were through CEUS, MRI, X-ray mammography examination and pathological examination. Internal enhancement feature and time-intensity curve of CEUS and MRI were compared, and diagnostic related parameters of contrast-enhanced ultrasound, X-ray mammography, MRI for breast cancer were also compared.50 cases of breast cancer patients during hospital treatment from January 2014 to July 2015 were chosen as subjects, all the patients were treated by neoadjuvant chemotherapy before surgical treatment. Conventional ultrasonic manifestations of all the patients were observed before and after the treatment of neoadjuvant chemotherapy, the perfusion area of ultrasound contrast agent in breast cancer primary tumor were compared before and after neoadjuvant chemotherapy treatment, and the acoustic quantitative time-intensity curve (TIC) were analysed by software.Results:breast malignant tumors showed heterogeneous enhancement and peripheral enhancement while benign breast tumors showed mainly non enhancement and homogeneous enhancement; time-intensity curve of benign tumor was mainly type of fast-in fast-out and slow in fast out while time-intensity curve of breast malignant tumors was mainly fast-in slow-out type, but there was overlapping phenomenon for the time-intensity curve of two benign and malignant tumors; starting time of enhancement for breast malignant tumors was faster than that of benign breast tumor, but there was no significant difference between the two groups (P> 0.05), but the peaking time of malignant tumors was significantly faster than that of benign breast tumor (P<0.05), and the peak intensity of malignant tumors was significantly higher than that of benign breast tumor (P<0.05), and obvious slowing time of malignant tumors were significantly slower than that of benign breast tumor (P<0.05); the sensitivity, specificity and accuracy rate of breast malignant tumors which was diagnosed by pathological diagnosis of breast tumor tissue as gold standard, were 79.01%, (64/81),91.55%(65/71) and 84.87%(64+65/152) respectively. Compared with the surrounding normal tissue, RI and TTP in tumor center became significantly shorter (P<0.05), PI was significantly higher (P<0.05), WIS increased significantly (P<0.05), both of MTT showed no significant difference (P> 0.05); compared with the center of the tumor, the PI of tumor edge significantly increased (P<0.05) while TTP became significantly shorter (P<0.05), WIS increased significantly (P<0.05), both of RT and MTT showed no significant difference (P> 0.05); incidence rate of uneven enhancement, perfusion defect in high MVD group were significantly higher than those in low MVD group (P<0.05), while there were no significant difference between the two groups in terms of enhancement patterns, enhance ment border and perforating vessels (P<0.05); breast cancer PI in high MVD group was significantly higher than that in low MVD group (P<0.05), while the RT, TTP, WIS and other perfusion parameters showed no significant difference (P<0.05). CEUS and MRI showed good consistency on assessment of enhanced area in 152 patients with breast lumps (r=0.876, P=0.000), there was no significant difference by paired t-test between the two (t=0.152, P=0.794). CEUS and MRI showed inconsistent on evaluation of enhanced homogeneity in 72 cases of breast lesions (Kappa=-0.176, P =0.057); among 152 cases,130 cases (85.5%) showed consistent results while 22 cases (14.5%) showed inconsistent results (see Table 7), CEUS showed more inhomogeneous enhancement than MRI. The perfusion defect area of homogeneous enhancement was set as 0 cm2, perfusion defect area of CEUS was significantly larger than the same section perfusion defect area of MRI (P<0.01); CEUS time-intensity curve showed 72 cases of slow type,80 cases of fast type, MRI time-intensity curves showed 57 cases of increasing type,23 cases of platform,72 cases of outflow type, there was no significant correlation between CEUS and MRI time- intensity curve; diagnostic sensitivity, accuracy and negative predictive values of contrast-enhanced ultrasound and MRI for breast cancer were significantly higher than those of X-ray mammography (P<0.05), while there were no significant difference between contrast-enhanced ultrasound and MRI in terms of diagnostic sensitivity, specificity, accuracy and positive predictive value (P> 0.05). The conventional two-dimensional ultrasound examination revealed that primary tumor volume in 50 cases of patients with breast cancer after treatment by neoadjuvant chemotherapy were decreased significantly than that before neoadjuvant chemotherapy treatment (t=9.675, P<0.05); before and after neoadjuvant chemotherapy treatment, the CEUS examination on 50 cases of breast cancer patients showed thatultrasound contrast agent perfusion area (length to diameter x transverse diameter) in breast cancer primary tumor after neoadjuvant chemotherapy treatment significantly reduced compared with that before neoadjuvant chemotherapy (t=6.324, P<0.05); enhanced intensity of contrast agent in breast cancer primary tumor after neoadjuvant chemotherapy significantly reduced compared with that before neoadjuvant chemotherapy, and the difference was statistically significant (t=15.392, P<0.05).Conclusion:CEUS has a high clinical value on the differential diagnosis of breast benign and malignant tumors. The breast cancer CEUS ultrasound contrast has typical enhancement, to a certain extent, can reflect the distribution characteristics of tumor microvessels, and may be a basis for evaluation of tumor angiogenesis. the diagnostic value of contrast-enhanced ultrasound, MRI of breast cancer were significantly better than that of X-ray mammography, although diagnostic capabilities of MRI for all types of breast cancer are stronger, but on account of its radiation damage, high cost of testing, contrast-enhanced ultrasound would be a more feasible for preliminary diagnosis in diagnosis of breast cancer. Not only can CEUS technology reflect the effect of neoadjuvant chemotherapy, but also visually evaluate tumor angiogenesis network features safely and in a non-invasive way, its parameters may have a certain value of predicting the curative effect. |
PDF Full Text Request