Virtual Touch Tissue Imaging Quantification And Routine Ultrasound Features Of Triple Negative Breast Cancer

ObjectiveTo compare the findings of routine ultrasound and virtual touch tissue imaging quantification(VTIQ)in triple-negative breast carcinoma(TNBC)and non-TNBC,and to evaluate the sonographic features and shear-wave elasticity(SWE)features of TNBC.MethodsSonographic and SWE features of 36 TNBC in 36 female patients,in whom shear-wave elastographic examination was performed in the course of the diagnostic process,were reviewed and diagnosed at Qianfoshan Hospital Affiliated to Shandong University from November 2016 to March 2018.In addition,36 female patients,who had breast cancers with hormone receptor(HR)-positive(+)or human epidermal growth factor receptor 2(HER2)-positive(+)were also examined in the same period of time by shear-wave elastography and selected as a control groups(non-TNBC)after every TNBC,in order to compare sonography and SWE findings between two groups of patients.The final diagnosis was obtained in all cases by histopathology of the surgical specimen.The routine sonographic characteristics of all lesions were observed and recorded,then inthe VTIQ condition,the shear wave velocity(SWV)in the range of effective focus was measured under the condition of good quality control.Average values of repeated measurements(group 3?7)was obtained.The receiver operating characteristic(ROC)curve analysis was expressed as area under curve(AUC)with its 95%confidence intervals(CI)and used to determine the efficacy of analysed elastographic values to discriminate between the TNBC and non-TNBC groups.The size of the masses in the TNBC group was divided into two groups with the boundary of 20mm,and the average hardness between the two groups was compared.TNBC were divided into two groups according to whether the axillary lymph node metastases,the average hardness values of the two groups were calculated and compared respectively.ResultAll patients were female,the average age of TNBC group was(53.4±8.3)years old(interquartile 32?67),the average age of non-TNBC group was(51.1 ±9.6)years old(interquartile 31?76),and no statistically significant differences were found between these two groups.According to the pathology,there were 30 cases of nonspecific invasive breast cancer in TNBC group,in which histological tumor grade was mainly grade ?;while there were 27 cases of nonspecific invasive breast cancer in non-TNBC,in which histological tumor grade was mainly grade II.TNBC was more frequently had lymph node metastasis than non-TNBC,although no statistically significant differences were found.TNBC was larger than that in non-TNBC group,and the maximum diameter was about 27.0±12.5mm and 21.3± 10.0mm,and the difference was statistically significant(P=0.036).On ultrasound,it was more likely to have an oval shape in TNBC(36.1%:8.3%,P=0.006).Analysis of the posterior acoustic features revealed that there was a significant difference between the two groups(P<0.001).The rate of posterior enhancement was thigher in the TNBC group than that in the non-TNBC group(45.5%:15%).Moreover,TNBC less often showed posterior shadowing significantly than non-TNBC(2.8%:27.8%).Additionally,compared with non-TNBC,TNBC was less likely to have calcification on ultrasonography(52.8%:22.2%,P=0.007).There was no statistical difference between the two groups in the margin,the azimuth and the internal echo.According to the BI-RADS category,17 cases belonged to category 5 and above in TNBC and were significantly lower than non-TNBC(29 cases).Contrary,19 cases belonged to category 4 and below in TNBC and were significantly higher than non-TNBC(7 cases).Moreover,3 cases with category 3 of the preoperative diagnosis of BI-RADS were TNBC.The difference was statistically significant(P=0.02)in the BI-RADS between these two groups.The average SWV values in group TNBC and non-TNBC group were 3.68± 1.20m/s and 5.31 ± 1.20m/s respectively,and the difference was statistically significant(P<0.001).The sensitivity,specificity,accuracy,positive predictive value,negative predictive value of SWV in differentiating between TNBC and non-TNBC were 91.7%,80.6%,86.1%,82.5%,90.6%respectively based on the cut-off point as 3.98m/s.The date of ROC by using SWV were 0.869(95%CI:0.778?0960,P<0.001).In TNBC group,average SWV values in larger than 20mm and less than 20mm were 3.94±1.33m/s,3.08±0.44m/s respectively,the difference was statistically significant(P=0.007);moreover,the SWV values of tumor with or without axillary lymph node metastasis were 4.36± 1.44m/s and 3.077±0.34m/s respectively,the difference was statistically significant(P=0.002).Conclusion Compared with non-TNBC,routine ultrasound of TNBC is more prone to benign characteristics in shape,posterior feature and calcification.In VTIQ,the average SWV of TNBC was lower than that of non-TNBC.The hardness of the mass in the TNBC group with axillary lymph node metastasis and larger size(more than 20mm)was higher.