| Objective 1.To investigate the correlation between the shear wave velocity(SWV)measured by virtual touch tissue imaging quantification(VTIQ)and the prognostic factors of breast cancer.2.To investigate the correlation between features of contrast-enhanced ultrasound as well as time curve analysis parameters and prognostic factors of breast cancer.3.To investigate the correlation between microcalcification and prognostic factors of breast cancer and the rate of shear wave velocity(SWV).Methods A total of 94 patients(97 lesions)diagnosed of suspected tumor(BI-RADS classification,class 4a or above)and confirmed by biopsy or postopetative pathological diagnosis in Zhejiang Cancer Hospital from January 2017 to August 2017 were selected.Simens Acuson S3000 Color Doppler ultrasonic diagnostic apparatus integrating with 9L4 linear array high frequency linear array probe equipped VTIQ technique and TOSHIBA Aplio 400 Color Doppler diagnostic apparatus integrating with 14L5 high frequency linear array probe equipped contrast and MicroPure Imaging were used respectively to examine the breast lesions and axillary lymph nodes of the patients thoroughly and carefully.The lesion size,microcalcification,maximum shear wave velocity(SWV max),mean shear wave velocity(SWV mean),ratio of the lesion to the surrounding gland tissue(SWV ratio),contrast features(enhancement degree,margin after enhancement,morphology,internal uniformity,enhancement direction,perfusion pattern,range increased or not after enhancement,perfusion defect,peripheral radial and penetrating vessels)and time curve analysis parameters(PI,TP,MTT,Slope,AUC,AUC-WI and AUC-WO)were collected.The biopsy or postoperative pathology were followed up to obtain clinicopathological prognostic factors(lymph node metastasis,pathological type,histological grade,clinical stage).Elastic parameter SWV value,contrast features,time curve analysis parameters and microcalcification were compared with the prognostic factors respectively and the correlations were analyzed.Results 1.Clinical pathological findings.Of the 152 breast masses in 145 patients,55 were benign(36.2%),and 97 were malignant(63.8%).Among the malignant tumor,there were 77 cases of invasive ductal carcinoma(79.4%),8 cases of ductal carcinoma in situ(8.2%),7 cases of micro-invasive carcinoma(7.2%),1 case of invasive papillary carcinoma(1%),1 case of invasive micropapillary carcinoma(1%),1 case of apocrine carcinoma(1%),1 case of mixed metaplastic carcinoma(1%)and 1 case of diffuse large B cell lymphoma(1%).There were 68 cases(70.1%)of microcalcification in 97 cases of breast cancer lesion,while another 29 cases(29.9%)without microcalcification.The maximum diameter of breast cancer lesions in 97 cases ranged from 8.8-120.0mm and median value was 24.2mm.According to the size,35 cases(36.1%)were in the group with diameter<20mm and 62 cases(63.9%)in the group with diameter>20mm.According to the lymph node metastasis,there were 57 cases(58.8%)in the metastasis group,and 40 cases in the non metastasis group(41.2%).According to clinical stage,there were 8 cases(8.2%)in stage 0,18 cases(18.6%)in stage I,45 cases(46.4%)in stage ?,24 cases(24.7%)in stage ? and another 2 cases(2.1%)in stage IV.Histological grading of 77 cases of invasive ductal carcinoma showed 3 cases(3.9%)in grade 1,49 cases(63.6%)in grade ? and 25 cases(32.5%)in grade ?.2.Correlation between SWV and prognostic factors.SWV mean and SWV max were correlated with the size of lesions,with the correlation coefficients of 0.423 and 0.345,respectively.The larger lesions were relatively higher in SWV than smaller lesions.Both SWV mean and SWV ratio were correlated with lymph node metastasis,and the lesions were higher in SWV with the existence of lymph node metastasis.The differences of SWV max,SWV mean and SWV ratio in different pathological types were statistically significant(P<0.05).The parameter in micro-invasive carcinoma were lower than in invasive ductal carcinoma and higher than in ductal carcinoma in situ.The differences of SWV max,SWV mean and SWV ratio were statistically significant in different clinical stages(P<0.05)with the following order that stage ?>stage ?>stage ?>stage ?>stage 0.There were significant differences in the parameters of SWV max,SWV mean and SWV ratio among the different histological grades of invasive ductal carcinoma(P<0.05),with the following order that stage ?>stage ?>stage ?.3.Features of contrast-enhanced ultrasound of breast cancer.Most of them showed high enhancement,inhomogeneous enhancement,perfusion defect,larger range than in two-dimensional ultrasound after enhancement,poorly defined margins and irregular shapes after enhancement.Centripetal enhancement was more common and some of them showed diffuse enhancement.Perfusion modes were more in rapid rise and down,or rapid rise and slow down.Radial or penetrating vessels were commonly seen in surrounding areas.4.Correlation between contrast features and prognostic factors.Inhomogeneous contrast enhancement,including peripheral annular enhancement and presence of perfusion defects,were more commonly seen in larger lesions.Radial or penetrating vessels were commonly seen in lesions with lymph node metastasis,invasive ductal carcinoma,and lesions with more advanced clinical stage.Ductal carcinoma in situ and invasive ductal carcinoma were mainly characterized by centripetal enhancement.5.Correlation of time curve analysis parameter with prognostic factors.Mean transit time(MTT)was correlated with lesion size,with the correlation coefficient of 0.234.The area under the curve(AUC)and wash-in area under the curve(AUC-WI)were notably different among different clinical stages(P<0.05).The time to peak(TP)of different histological grades in invasive ductal carcinoma were statistically significant(P<0.05),with the order as stage ?>stage ?>stage?.6.Comparison of microcalcification with prognostic factors and elastic shear wave velocity(SWV):no significant difference(P>0.05).Conclusion 1.The shear wave velocity(SWV)measured by elastic VTIQ technique is correlated with the prognostic factors of breast cancer,which is helpful for noninvasive evaluation of the prognosis of breast cancer.2.Some features of contrast-enhanced ultrasound and time curve analysis parameters are correlated with the prognostic factors,which is of some value for noninvasive evaluation of breast cancer prognosis,but further study is required.3.There is no obvious correlation between microcalcification and prognostic factors and elastic shear wave velocity in breast cancer. |
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