Preoperative Assessment Of The Accuracy Of Breast Cancer Size Measuring By Five Kinds Of Imaging Techniques And Its Influencing Factors

Objective:To evaluate the accuracy of two-dimensional ultrasound(2D-US),three-dimensional volume ultrasound(3D-US),strain ultrasounic elastography(SUE),full-feld digital mammography(FFDM)and digital breast tomosynthesis(DBT)on measurement of preoperative tumor size of breast cancer and its influencing factors.Methods and patients:During April 2016 to November 2016,101 breast cancer patients with 101 lesions in our hospital were recruited in the clinical measure study.The largest lesion diameters of 101 breast cancer patients were examined by five different imaging techniques(2D-US/3D-US/SUE/FFDM/DBT)before core needle biopsy.The pathological tumor size of breast cancer was selected as gold standard.The Linear regression models was used to compare the accuracy of the preoperative the five imaging techniques in predicting pathological tumor size,and the regression coefficients were estimated.The intraclass correlation coefficient(ICC)and Bland-Altman plots were used to test the agreement of tumor sizes determined by each imaging technique with histopathologic examination.Chi-square test(or Fischer's exact test)was used to analyze whether the accuracy of five imaging techniques to measure the size of breast cancer is affected by different clinical pathologic factors and imaging characteristics.Results:By the linear regression analysis,predictive strengths of tumor size from high to low followed by 3D-US/2D-US/SUE/DBT/FFDM(R2=0.80/0.65/0.61/0.47/0.32).The Bland-Altman plots and intraclass correlation coefficient revealed better size estimation with breast ultrasound(3D-US/2D-US/SUE)with low variation including a narrower range of 95%LOA,less outliers and more concentrated the numerical distribution,while mammography(DBT/FFDM)showed great variability.Among them,the agreement of 3D-US was the best,followed by 2D-US/SUE/DBT,while FFDM was the worst.The accuracy of the five imaging techniques for measuring the size of breast cancer was compared in terms of clinicopathological factors(age/menopause/Neoadjuvant chemotherapy/tumour size/histological grade/ER/PR/HER2/Ki-67/axillary lymph Node status/invasive ductal carcinoma present ductal carcinoma in situ/Histological type)and imaging features(breast density/microcalcifications/lesion type/the depth of lesions away from the skin/tumor shape/orientation/margin distinct)using the Chi-square test or Fischer's exact test.The accuracy rate of 3D-US was higher in the age of>40 years old group.The accuracy rate of 2D-US was higher in invasive ductal carcinoma(IDC)without presence of ductal carcinoma in situ(DCIS)/without microcalcifications/the size of lesion ?2cm/invasive ductal carcinoma/distinct margin group.The accuracy rate of SUE was higher in the IDC without presence DCIS/without microcalcifications/distinct margin of lesion group.The accuracy rate of DBT was higher in the HER2 negative/No lymph node metastasis/fat breast/the depth of lesions<2cm away from the skin/mass type/regular shape of lesion group.The accuracy rate of FFDM was higher in the ER positive/PR positive/HER2 negative/low histological grade/fat breast/mass type/the depth of lesions ?2cm away from the skin/distinct margin of lesion group.There were significant differences(P<0.05).While the expression of Ki-67,neoadjuvant chemotherapy,menopause and orientation of lesions had no significant effect on the accuracy of the five imaging techniques(P>0.05).Conclusions?For the measurement of breast cancer size,the accuracy of the five imaging techniques from high to low followed by 3D-US>2D-US>SUE>DBT>FFDM.Among them,3D-US was superior to the other imaging techniques,which was less affected by the clinicopathological factors and imaging features,whereas FFDM was the worst imaging technique for measuring the size of breast cancer and more affected by the clinicopathological factors and imaging features.?Breast ultrasonography was more effective than mammography in assessing lesions size of breast cancer when the patients with dense breast,the lesions showed non-mass type in the mammography,the lesions showed deeper(>2cm)in the ultrasonography and showed the clinicopathologic feature that HER2 expression was positive.?When the lesions of breast cancer patients with microcalcifications or DCIS,mammography more sensitive than ultrasound.It suggested that we can combined with mammography and ultrasound to increase the accuracy of the lesion size measurements.?Combined with the patient's clinicopathological factors and imaging features of lesions,The advantages of mammography and breast ultrasonography were used to evaluate the size of breast cancer.It is more conducive for the precise implementation of clinical individual therapy.