Study On The Contrast-enhanced Ultrasound Perfusion Patterns And Its Correlation With The Histopathological Grading Of Breast Cancer

Objective： To study the Contrast-Enhanced Ultrasound (CEUS) perfusionpatterns and its correlation with the histopathological grading of breast malignantlesions.Methods：One hundred and thirteen histopathologically confiemed breast lesions(75malignant lesions and38benign lesions) were included. We retrospectivelyreviewed the characteristics of US which include the lesions location, size, shape, L/T,boundary, margin, hyperechoic acoustic halo, angle, internal echo, micro-calcification,posterior acoustic and color Doppler flow imaging (CDFI) and the contrast-enhancedultrasonographic findings including the intensity, contrast agent distribution, size,boundary, margin, edge enhancement,peripheral vascular imaging and correlatedthem with histopathological grade.Results：1.In malignant lesions, there are59cases of invasive ductalcarcinoma(IDC),3cases of lobular carcinoma,1case of tubular carcinoma,10casesintraductal carcinoma,1case of invasive cribriform carcinoma,1case of mucousadenocarcinoma.48cases IDC with histological classification,6as class I,23as classII,19as class III.2.All the ultrasound features of the benign masses were brieflydisplayed as followings: regular shape, clear border, well-defined margin,homogeneous echo, Posterior acoustic enhancement or no change,CDFI:0~1gradeflow, whereas, irregular shape, obscure boundary, poorly-defined margin, inmalignant masses, hyperechoic acoustic halo,heterogeneous echo, micro-calcification,Posterior acoustic attenuation, CDFI:2~3grade flow with a significant difference (P＜0.05), but there were no statistical differences in masses L/T, angle and internalecho between in malignant and benign masses（P＞0.05）.3. The characteristic ofCEUS perfusion patterns in benign masses is that: regular shape, homogeneousenhancement, well-defined margin, where as irregular shape,heterogeneousenhanced,a greater size, tortuous surrounding vessels in malignant masses, with asignificant difference (P＜0.05）, but there were no statistical differences in intensity,edge enhancement between in malignant and benign masses （P＞0.05）.4. Comparison with in the diagnosis efficiency of the conventional ultrasound andCEUS in breast masses. The result shows that:the diagnosis coincidence rate inbreast masses by conventional ultrasound or CEUS or combined with the twoexaminations methods is75.2%,80.5%,88.5%.Conventional ultrasound combinedwith contrast-enhanced ultrasound is superior to conventional ultrasound or CEUSrespectively in diagnosis of breast masses, with a significant difference（P＜0.05）.5.Comparison with the characteristic of conventional ultrasound in differenthistological grade IDC. The result shows that: there was a significant difference inCDFI signal among the different histological grade IDC（P＜0.05）.There were nosignificant differences in the lesions location, size, shape, L/T, boundary, margin,hyperechoic acoustic halo, angle, internal echo, micro-calcification, posterior acousticamong the different histological grade IDC（P＞0.05）.6. Comparison with thecharacteristic of CEUS perfusion patterns in different histological grade IDC. Theresult shows that: there were significant differences in the masses shape, margin,contrast agent distribution, size in different histological grade IDC（P＜0.05）. Therewere no significant differences in the Lesions intensity, edge enhancement, peripheralvascular imaging in different histological grade IDC.7.The CDFI is well correlatedwith histopathological grade in IDC:2~3grade flow were higher in Ⅲ grade IDCthan that in Ⅱ or Ⅰ grade IDC, with a significant difference（P＜0.05）.8. TheCEUS perfusion patterns is well correlated with histopathological grade in IDC:Appearance rate of irregular shape, poorly-defined margin,heterogeneousenhanced,a greater size were higher in Ⅲ grade IDC than that in Ⅱ or Ⅰ gradeIDC, with a significant difference（P＜0.05）, but there were no statistical differencesin intensity， edge enhancement, peripheral vascular imaging among the erenthistological grade IDC（P＞0.05）.Conclusion：1.The characteristic of conventional ultrasound including lesionslocation, size, shape, L/T, boundary, margin, hyperechoic acoustic halo, angle,internal echo, micro-calcification, posterior acoustic and CDFI, et al have a highervalue for the diagnosis of breast masses.2.The masses shape, contrast agentdistribution, size, boundary, margin, peripheral vascular imaging after CEUS have agreater value for the diagnosis of breast masses.3. The breast masses diagnosis coincidence rate of Conventional ultrasound combined with contrast-enhancedultrasound is higher than that in conventional ultrasound or CEUS respectively,Conventional ultrasound combined with contrast-enhanced ultrasound is more usefulfor the diagnosis of breast masses.4.The color Dopper flood signal grade is wellcorrelated with histopathological grade. The flood flow signal of masses increasedwith raising of the histopathological grade level.5. The CEUS perfusion patterns iswell correlated with histopathological grade in IDC: Appearance rate of massesirregular shape, poorly-defined margin, heterogeneous enhanced, a greater sizeincreased with the raising of the histopathological grade level.