| Objective:Breast cancer is a type of tumor with a high degree of heterogeneity,from traditional histology to modern molecular biology,the classification of various subtypes of breast cancer is trying to understand breast cancer more fully and accurately,in order to to solve the problem of heterogeneity,and achieve the zero space for breast cancer treatment and prevention.Muscular epithelium was previously thought to have a role in preventingtumor invasion,with the rapid development of modern molecular biology technology,medical scientists begin to revist the complex role played by myoepithelium in the development of breast cancer,its role as a hub switch for two-way adjustment of breast cancer has also been more in-depth understanding.Studies have shown that myoepithelium can promote the progression of ducta carcinoma in situ to invasive carcinoma,pathological morphology is characterized by expansive infiltration and glandular fusion,solid papillary carcinoma and encapsulated papillary carcinoma are typical examples of such tumors.In the latest edition of the 2012 edition of the WHO on Breast Cancer,The classification of solid papillary carcinoma and encapsulated papillary carcinoma that pathological manifestation is special into a special type of invasive breast cancer,both have the biological characteristics of "indolent tumors",At the age of onset,most of them met the definition of the elderly by the World Health Organization.The age of onset is mostly consistent with the definition of the elderly by the World Health Organization,so this type of breast cancer is called the elderly indolent special type of breast cancer.Due to the low incidence of this type of cancer and the specificity of the age of onset,tumor biological behavior,so that there is insufficient understanding of the imaging findings of this type of breast cancer,can not meet the needs of clinical diagnosis and treatment,the emergence of multi-modality imaging methods has greatly improved the diagnostic efficiency of tumors,making it possible to accurately diagnose and treat breast cancer.The multimodality imaging method uses different imaging principles and equipment to obtain different images and comprehensive analysis,which can provide a more objective imaging basis for the diagnosis and treatment of diseases.The traditional pathological tissue slices are combined with multi-modality imaging methods.It can better reflect the relationship between pathological changes and imaging multimodality characteristics,and help to grasp the heterogeneity of tumors and other factors that affect the overall assessment of tumors.there is no multimodality videography analysis and understanding of the elderly inert special type of breast cancer yet,This project aims at the establishment of different videography techniques,their pathological features,molecular typing,and other multi-modality analysis for elderly indolent special type breast cancer.In order to increase awareness of the disease,to provide a theoretical basis for clinical precise treatment and further analysis of tumor heterogeneity in combination with imageomics.Method:This study collected a total of 39 patients with pathologically confirmed EPC and SPC between December 2013 and December 2016,35 cases of routine pathological sections were collected.Among them,16 cases of EPC and 19 cases of SPC,collected 2 cases each of EPC and SPC,Making large sections of pathological tissue.Analyze the clinical pathological features and X-ray,ultrasound and MRI findings.Intraductal papilloma,intraductal carcinoma,and I,II and III invasive carcinomas of the same period were selected as control subjects for multimodality analysis of videograghy and histopathology and molecular typing characteristics.Result:The average age of EPC and SPC was 65.34(P<0.001),compared with the control group,the age difference was statistically significant,conforms to the clinical features of older people.All 39 cases were Luminal A and no lymph node metastasis(P < 0.001),Compared with control group,type II and III infiltrating carcinomas of Luminal A are rare,EPC and SPC are also mainly located behind the areola,Among them,the length of the EPC is statistically significant compared with the control group,mainly as a large cystic solid mass.There is no statistical difference between the length of SPC and the control group,and its volume is small,especially the mammogram is difficult to find.EPC showed round shape in 12 cases(66.67%)in MRI;13 cases(72.22%)were cystic solid masses(P value < 0.001).In DCE-MRI,16 cases(88.89%)showed annular inhomogeneous enhancement of cystic areas or cystic areas with solid enhancement protrusions.On MRI,the ADC value was 0.98±0.026×10-3 mm2/s(P value < 0.001).16 cases(76.19%)were single lesions in SPC and 5 cases(23.81%)were multifocal lesions.In DCE-MRI,13 cases(61.91%)showed annular inhomogeneous enhancement.This annular enhancement manifested as thick-walled ring enhancement with clearer borders.Another 5 cases showed non-mass-like enhancement with cluster-like enhancement and pebble-like enhancement.The TIC enhancement curve was type II in 11 cases(52.38%)and type III in 10 cases(47.62%).On MRI,the ADC value was 1.0±0.11×10-3 mm2/s(P value < 0.001).A telephone follow-up survey was conducted on the patients.The last follow-up time was August 20,2017.All patients survived without recurrence or metastasis.Conclusion:1.The multimodal analysis of imaging with pathology is helpful to better understand the videography features of elderly and indolent special breast cancer;which can improve diagnostic performance.2.EPC and SPC have more characteristics in DCE-MRI,mostly with special type of annular inhomogeneous enhancement.3.The molecular classification of EPC and SPC is Luminal A,which was consistent with ER and PR(+),which was no correlation between the two ring enhancement characteristics and the phenotype of ER and PR.4.Videography and pathological tissue biopsy analysis,MRI,US and traditional pathological tissue large-section contrast analysis can be better for showing the location,size,and histopathological correspondence of the lesions;MRI is a better response to peritumoral swelling infiltration changes and intratumoral heterogeneity.5.Multimodality videography with pathology analysis showed that EPC and SPC were characterized by a dilated swollen infiltrate with low malignancy. |
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