| BackgroundAt present breast cancer has become one of major diseases which endanger the women health. Especially for the young women, the incidence of breast cancer is increasing year by year. There is not a very valid method to prevent the incidence of breast cancer. The most common way to improve the effectiveness of treatment and reduce mortality of breast cancer is imaging examination which can achieve early diagnosis of breast cancer. This is also the key step of determining the prognosis of patients. Because most Chinese women’s breasts are small and its glands are relatively dense, the traditional breast X-ray is difficult to identify the breast neoplasms clearly, especially some women with the dense breast. Thus, conventional color Doppler ultrasound of breast neoplasms has become one of the main methods for Chinese women due to its non-invasiveness, high resolution, real-time dynamic observation of the tumor blood supply, and played an important role in differential diagnosis of breast cancer. However, conventional ultrasound has a certain limitation on low-velocity blood flow and microvascular structure, especially in the breast neoplasms with the maximum diameter less than 2.0cm. In recent years, contrast-enhanced ultrasound(CEUS) has developed rapidly. It has been now used for the differential diagnosis in the diseases of the liver, thyroid, kidney, breast and other organs. Because the diameter of microbubble is smaller than that of red blood cells, microbubbles can reach the inner of tissues or organs via the pulmonary circulation after intravenous injection. It can enhance scattering of tumor areas with blood supply. Additionally, microbubbles can even display vessels with 70μm diameter. As a result, it shows intratumoral microvascular structure, greatly improving the sensitivity of the detection rate of low-velocity blood flow in small vessels of breast cancers. It helps to improve the accuracy in diagnosis of breast cancer through clearly displaying blood supply of tumors.So far, the main method of treatment of breast cancer is still surgical resection [1]. However, some patients may relapse and have a poor prognosis. Therefore, the early diagnosis and treatment of breast cancer may contribute to improve the survival rate and the quality of life. Previous clinical studies have confirmed that neoadjuvant chemotherapy(NAC) of breast cancer is an important adjuvant therapy before surgery, namely preoperative chemotherapy and postoperative chemotherapy. Some clinical studies have already showed that neither preoperative chemotherapy nor postoperative chemotherapy has any significant effects on the improvement the survival rate of patients [2-3]. Preoperative chemotherapy can decrease the range of focal lesion of breast cancers and narrow the scope of the operation. So NAC has been a standard treatment of locally advanced breast cancer. But how to exactly evaluate the treatment response of NAC needs to be further studied.Objective1. To investigate the blood perfusion characteristics of real-time contrast-enhanced ultrasound(RT-CEUS) of early breast cancer, and the difference between time-intensity curve(TIC) analysis in the benign and malignant breast tumor.2. To explore the value of CEUS in the evaluation of NAC treatment with breast cancer.Methods1. Application of Contrast-enhanced Ultrasound in Differential Diagnosis of Early Breast CancerFrom September 2012 to December 2013 in Southwest Hospital, 63 patients, including 30 cases with benign tumors and 33 cases with malignant tumors, were collected. The tumor diameters were ≤2.0cm [(1.44 ± 0.45) cm]. First of all, we tried to determine location of breast neoplasms, check its shape, size, and the blood supply by conventional color Doppler ultrasound. Then ultrasound contrast agent, Sono Vue, was injected intravenously. The ultrasound contrast mode was taken to observe contrast-enhanced features of the benign and malignant breast tumors, including perfusion pattern, perfusion level and perfusion type. Finally, the parameters of benign and malignant neoplasms from time-intensity curve(TIC) using image analysis software were analyzed. All neoplasms have been pathologically diagnosed by biopsy and surgery.2. Application of Contrast-enhanced Ultrasound in Evaluating the Effect of Neoadjuvant Chemotherapy of Breast CancerThe relative information of patients, who were diagnosed with breast cancer via aspiration biopsy and then accepted TE schemes of neoadjuvant chemotherapy(specifically the 75mg/m2 Taxotere and 60mg/m2 epirubicin intravenously at the first day, a total of four cycles of treatment, every 21 days as one cycle) and finally had a surgery, were collected from October 2014 to March 2015 in our hospital. Ten patients participated in this study, and signed on the written informed consent after having been told the purpose, the potential risks and the benefits of our study. All patients are female with the average age of 51.6 years old(35-64 years old). Before undergoing neoadjuvant chemotherapy, the average diameter of breast neoplasms is 20.56 mm(raging from 10 to 36 mm). First of all, we tried to determine the location and the maximal diameter of breast tumors using conventional color Doppler ultrasound. Then the method of contrast-enhanced ultrasound is the same with the first part.Results1. In this study, 75.76%(23/30) of breast benign tumors were centrifugal perfusion, 73.33%(22/30) of breast benign tumors were low enhancement, and 78.79%(26/30) of benign tumors were homogeneous perfusion. On the other hand, 75.76%(25/33) of malignant tumors were centripetal enhancement, 87.88%(29/33) were high enhancement, and 90.91%(30/33) were homogeneous enhancement. Analyzed by image analysis software, time of peak in region of interest among breast tumor have no statistically significant, while peak intensity and ascending slope of the curve were statistically significant. The accuracy rate of diagnosis breast cancer by color Doppler ultrasound was 73.02%,specificity was 73.33%, sensibility was 72.73%. When combined with real-time CEUS, the accuracy rate was 81.82%, specificity was 83.33%, and sensibility was 82.54%.2. In this study, seven patients’ lesions reduced more than 50%, 3 patients reduced less than 50% among 10 patients after NAC, while no one disappeared or expended. Since the maximum diameter measured by CEUS was significantly greater than conventional ultrasound. Compared with postoperative pathological specimens, the data measured by CEUS had no statistical significance. Compared with conventional ultrasound, the data were statistically significant.after analysis by image analysis software, the peak time in regions of interest of breast cancer had no statistical significance.However, the peak intensity and ascending slope of the curves after NAC is significantly lower than before NAC.Conclusion1. RT-CEUS can clearly show microvascular features of benign and malignant breast tumors, effectively evaluate microvascular structure inside the tumor, and can improve the accuracy rate of diagnosis breast cancer.2. CEUS is more dominant than conventional ultrasound in the evaluation of NAC in breast cancer,.mainly reflected in clearly showing the condition of microvascular inside the tumor after NAC. |
PDF Full Text Request