Correlation Study Of Breast Ultrasound Patterns And Risk Factors Of Breast Cancer

Objective Through the correlation study of breast ultrasound patterns and the risk factors of breast cancer, we analyzed the influence of risk factors of breast cancer on breast ultrasound patterns. To explore the possibility of breast ultrasound patterns to predict the breast cancer in high-risk population and provide a new research direction for the study of breast density assessment.Methods1.There were 1559 women who take the mammary physical examination in our hospital ultrasound department from March 2014 to May 2015, in which 214 cases were breast cancers. According to the different of breast constitution in the ultrasound images,the pattern were divided into four types(the catheter type, the mixed type, the dense type, the heterogeneous type). We used a questionnaire to collect the information of risk factors for breast cancer. Related risk factors for breast cancer included:(1)general situation: sex, age, birth weight, working property, marital status;(2)measurement index: height, weight, BMI;(3)hormone, fertility: menstruation status, menopausal status, childbearing history, history of breastfeeding, hormone replacement therapy;(4)history of breast diseases: history of breast surgery, history of breast hyperplasia;(5)genetic factors: family history of breast cancer;(6)other information: smoke, drink, psychologic status, etc. We analyzed the relationship between breast ultrasound patterns and risk factors of breast cancer.2. According to age( < 35 years, 35 ~ 54 yearsd and≥55years), menopausal status(premenopausal and postmenopausal) and breast health status(healthy, benign disease of breast and breast cancer), 1559 patients were divided into different groups, and the correlation between ultrasound patterns and risk factors of breast cancer were analyzed.3. There were 1688 healthy women who take the mammary physical examination in our hospital from December 2013 to October 2015, everyone has accepted the X-ray and ultrasound examination in a week. According to the BI-RADS classification criteria(almost entirely fat, fibroglandular densities, heterogeneously dense, extremely dense) proposed by ACR and the classification criteria of breast ultrasound(the catheter type, the mixed type, the dense type, the heterogeneous type) by Hou Xinyan. The breast typing of each subject were recorded by professional doctors and sonographers in double blind. Analyzed the correspondence between the breast ultrasound patterns and the molybdenum target classification.4. Two sonographers with 5 years working experience were selected to judge 404 breast ultrasound images into different breast ultrasound patterns after breast ultrasound knowledge training. The results were tested by Kappa, and the consistency of the evaluation of the breast ultrasound classification was evaluated.Results1. The consistency of different observers on the judgment of breast ultrasound: There were significant differences in the actual consensus rate and the random consensus rate of the two evaluators for the breast ultrasound classification results(P=0.000), that means the consistency of the samples is not due to random results. Two evaluators were highly consistent with the results of the same group of breast ultrasound patterns(K=0.813).2. Correlation between breast ultrasound patterns and molybdenum target typing: The corresponding analysis of the breast molybdenum target typing and ultrasound patterns showed that they were closely related. The extremely dense of mammary gland was correspondent with the catheter type of ultrasound patterns; heterogeneously dense was correspondent with the mixed type and the dense type; fibroglandular densities and almost entirely fat were correspondent with the heterogeneous type. In the population, the quantity of the heterogeneously dense of mammary gland was the majority, the mixed type of ultrasound was also majority, they were in good conformance.3. Risk of breast cancer in different types of breast ultrasound: The OR(odds ratio) values of catheter type was 0.466, [95%CI(0.213~0.919)], P<0.05; mixed type was 0.396, [95%CI(0.291 ~ 0.538)], P < 0.001; dense type was 1.774,[95%CI(1.338 ~2.351)],P<0.001; heterogeneous type was 1.765, [95%CI(1.204~2.587)], P<0.05. The dense type and heterogeneous type were high-risk of breast cancer, while mixed type and catheter type were low-risk type of breast cancer.4. Influence factors of breast ultrasound patterns: Univariate analysis showed that the factors such as age, BMI, menopausal status, childbearing history, history of breastfeeding, history of breast surgery, drink, psychological status, marital status and hormone replacement therapy were related with breast ultrasound patterns(P<0.05). Multivariant analysis showed that compared with the risk of breast cancer in low risk group, high risk group associated with menopausal status, psychological status, BMI and age(P<0.05).5. Distribution and influence factors of breast ultrasound in different age groups: The proportion of mixed type was highest in<35 years old group and 35~54 years old group, the proportion of dense type was highest in ≥55 years old group. There were significant differences in the distribution of different types of breast ultrasound in different age groups(χ2=247.023,P=0.000). Multivariant analysis showed that the influencing factors of different age groups are: <35 years old group includes drink, psychological status and BMI. 35~54 years old group includes menopausal status, history of breast surgery, psychological status and BMI. ≥55 years old group includes psychological status and BMI. The influence of the psychological state and the BMI are two strongest correlation of the breast ultrasound patterns. Compared with other age groups, 54~35 years old group was more affected by the risk factors of breast cancer.6. Distribution and influence factors of breast ultrasound in different menopausal status: There were statistical significance in the difference of the distribution of breast ultrasound between pre and post menopause(χ2=106.987,P=0.000). The mixed type was the dominant in the pre menopausal population(55.4%), and the density type was the dominant in the post menopausal population(41%). The common influencing factors of the pre and post menopause were history of breast surgery, psychological status and BMI. Pre and post menopause were also affected by different factors. Multivariant analysis showed that compared to the premenopausal group, the postmenopausal women were no longer affected by age.7. Distribution and influence factors of breast ultrasound in different breast health status: The mixed type was the dominant in healthy group and benign disease group(55.3%, 44.6%), and the density type was the dominant in breast cancer group(46.3%), the results were significant difference(χ2=62.520,P=0.000). Multivariant analysis showed that the influencing factors of different breast health status were: healthy group included drink, BMI and age. Benign disease group included menstruation status, psychological status, BMI and age. Breast cancer group included menopausal status, psychological status and BMI.Conclusion1. Two evaluators were highly consistent with the results of the breast ultrasound patterns. Ultrasonic classification had good reliability and clinical operability.2. There was a good correspondence between the breast ultrasound patterns and X-ray classification in terms of population distribution and assessment of breast density. Compared with X-ray classification, breast ultrasound patterns can reflect the proportion of the breast substance better.3.Breast ultrasound type distribution differences were statistically significant in different age groups, menopausal status, different health status of the breast. The dense and homogeneous breast showed higher rate in women who is over 55 years old, or postmenopausal, or breast cancer.4.These factors can affect the ultrasound classification of the female breast parenchyma, such as age, BMI, menopausal status, childbearing history, history of breastfeeding, history of breast surgery, drink, psychological status, marital status, hormone replacement therapy, etc. Older women, obese women or women with emotional depression were more likely to have a high risk of breast cancer, which is the dense and heterogeneous type of breast.5. Through hierarchical research, after controlling for age, psychological status and BMI were the strongest factors affecting the breast parenchymal pattern. In the age of 35 to 54 years old which was a high incidence age of breast cancer, breast ultrasound patterns was more affected by the risk factors of breast cancer. Different factors affected the breast ultrasound patterns between pre and post menopause. The most significant difference was the pre menopausal women were affected by age, and the relationship between the age and the post menopausal was not closely related. Negative psychological state had a significant impact on ultrasound patterns for women with breast disease.