Study On Contrast-enhanced Ultrasonography Assess Pathologic Grade And Correlation With Tumor Angiogenesis In Bladder Cancer

Objective:1.To explore the application value of conventional ultrasound combined with contrast-enhanced ultrasound(CEUS)in identification of inverted papilloma of the bladder(IPB)and papillary urothelial carcinoma(PUC).2.To investigate the correlation between time-intensity curve(TIC)parameters of CEUS and microvessel density(MVD)of low-grade papillary urothelial carcinoma(LGPUC)and high-grade papillary urothelial carcinoma(HGPUC).Methods:1.Conventional ultrasound and CEUS characteristic of 32 patients with IPB and 57 patients of PUC confirmed by pathology between September 2014 and November 2016 in our hospital,was analyzed retrospectively.CEUS TIC parameters included rise time(RT),mean transit time(MTT),peak intensiy(PI),time from peak to one half(TPH),wash in slope(WIS),time to peak(TP),semi-descending slope(DS)were acquired by QLAB software and statistical analysis was carried out in order to obtain the CEUS feature of IPB and PUC.2.55 patients with LGPUC and 50 patients with HGPUC confirmed by pathology between February 2013 and November 2016 in our hospital,were retrospectively analyzed.Lesions were examined before surgery using CEUS with TIC analysis by QLAB software.The MVD of the resectioned tissue specimens were quantified via immunohistochemistry for CD34 and the correlation with CEUS TIC parameters was investigated.Results:1.Based on conventional ultrasound,the IPB and PUC groups were similar in the location,morphology,longitudinal/transverse diame-terratio(L/T)and colordoppler(all P > 0.05)in the study.In the two groups of CEUS quantitative parameters,PI,TPH,TP and DS had statistical significance(all P < 0.05).The two groups were statistically similar with regard to RT,MTT,and WIS(all P > 0.05).2.For the 105 patients studied,mean MVD per high power field of LGPUC(41.39 ± 16.65)was significantly lower than that of HGPUC groups(51.03 ± 20.16)(P < 0.05).The correlation analysis showed that tumor MVD positively and linearly correlated with the TPH(r = 0.86,P < 0.05),and negatively linearly correlated with the DS(r =-0.76,P < 0.05).Conclusion:1.TIC parameters of CEUS can reflect the perfusion of the contrast agent inside IPB and PUC tumors.Conventional ultrasound associating with CEUS has certain clinical value in identification of IPB and PUC.2.CEUS can be used to differentiate LGPUC from HGPUC.There is a good correlation between CEUS quantitative parameters and MVD,which means that CEUS can reflect the MVD of PUC to some extent.And CEUS may be used as a preoperatively repeatable,noninvasive and efficient tool to evaluate quantitatively tumor microvasculature,which may provide efficient information for clinical diagnosis,personalized treatment and the prognosis of PUC patients.