Contrast-enhanced Ultrasound Parameters And Patterns Of Malignant Breast Lesions: Preliminary Correlation With Molecular Subtypes

Objective: To investigate the preliminary correlations betweencontrast-enhanced ultrasound parameters and patterns with molecular subtypesin malignant breast lesions. High frequency image morphological characteristicswere observed, Contrast-enhanced ultrasound was underwent, molecularsubtypes of malignant breast lesions were determined byimmunohistochemistry. In order to provide the imaging basis for individualizedtreatment and prognosis of breast cancer.Methods: Surgical resection specimens of60malignant breast lesions in60women underwent conventional ultrasound and contrast-enhanced ultrasoundfrom January2012to August2013in Department of Hepatobiliary Surgery ofthe People’s Hospital of Guangxi Zhuang Autonomous Region. First of all,all the patients were examined detailly with conventional ultrasound technology.Secondly, observed the blood flow signals with Color Doppler. Finally, injected2.4ml SonoVue by the elbow vein, enhancement degree, enhancement direction(centripetal enhancement、centrifugal enhancement、diffuse enhancement), thecharacteristics of contrast agent distribution, the lesions range change afterCEUS were evaluated. Time-intensity curve analysis software and GammaVariate curve analysis software was used to measure parameters. Amplitude ofpeak intensity、arrive time、peak time、peak intensity、half time、gradient between start frame to peak frame、rising slope、descending slope、area under curve wereevaluated. Molecular subtypes of malignant breast lesions were determined byimmunohistochemistry after operation. Statistical analysis was performed toexplore the correlation between ultrasound characteristic and molecularsubtypes.Results:First, Contrast-enhanced ultrasound of malignant breast lesionswere observed as follow.Of the60breast cancer,(1)enhancement degree:50cases (83.3%) showedhigher enhancement.(2)enhancement direction:56cases (93.3%) showedcentripetal enhancement.(3) the characteristics of contrast agent distribution:51cases (85.0%) showed heterogeneous enhancement,9cases (15.0%) showedhomogeneous enhancement;23cases (38.3%) showed clear enhanced edge,37cases (61.6%) showed unclear enhanced edge. There were37cases (61.7%)lesions that showed speculated margins,39cases (65.0%) showed penetratingvessels and22cases (37.0%) showed perfusion defect.(4) the lesions rangechange after Contrast-enhanced ultrasound：there were56cases (93.3%) lesionsrange enlarged after Contrast-enhanced ultrasound.Second, Contrast-enhanced ultrasound of different molecular subtypes ofmalignant breast lesions has some characteristics.(1)Newspeak epithelial type: The appeared rate of speculated marginsincreased （P<0.05）.(2)HER2expression type: The appeared rate ofnon-uniform perfusion in malignant breast lesions defect increased（P<0.05）.(3)Basal-type: Contrast-enhanced edge is clear.Last, the correlations between contrast-enhanced ultrasound parameters andER、PR、Ki-67、HER2of breast cancer There was positive correlation between Grad（gradient between start frameto peak frame）、RS and Ki-67（γ=0.345、0.260，P<0.05）,while was notremarkable correlation among AT、PT、HT、PI、AUC、DS and Ki-67（P>0.05）.Conclusion:Firstly, Contrast-enhanced ultrasound patterns and parameters were relatedwith molecular subtypes of breast cancer, which may provide valuableinformation for clinical diagnosis and individualized treatment of breast cancer.Secondly, Contrast-enhanced ultrasound patterns and parameters of differentmolecular subtypes of malignant breast lesions had some significantcharacteristics. Thirdly, there was positive correlation between gradient betweenstart frame and peak frame, rising slope, as well as Ki-67, which can be used asa quantitative basis for evaluation of breast tumor angiogenesis. Lastly but notleast, it was possible that Contrast-enhanced ultrasound indirectly reflect theexistence of breast cancer genes and cytokines, as well as the histopathologicalchange caused by its express.