Analysis Of Ultrasonographic Characteristics Of Triple-negative Breast Cancer With Lymphovascular Invasion

Objective: The objective of this study is to compare the difference in sonographic characteristics between triple negative breast cancer(TNBC)and non-triple negative breast cancer(n-TNBC),and to research the preoperative ultrasound features of TNBC with lymphovascular invasion,which provides imaging evidence for the early diagnosis of TNBC and lymphovascular invasion.Methods: A retrospective cohort of 80 breast cancer patients following operation was recruited between January 2016 and December 2017 at the Qingdao Municipal Hospital.The patients had preoperative breast ultrasound examination,complete pathological data,using immunohistochemistry to detect the expression of breast cancer thrombus in breast cancer.All cases were divided into TNBC group and n-TNBC group according to the expression of ER,PR and Her2.The clinical pathological data were compared between the two groups,including age,size of tumor,pathological type,histological grade,axillary lymph node,and vascular tumor thrombus.Compare the difference in ultrasound performance between the two groups,including BI-RADS grade,mass status,shape,margin,internal and posterior echo,and blood flow status.According to the expression of vascular tumor thrombus,TNBC was divided into lymphovascular invasion(+)and lymphovascular invasion(-),and the difference in ultrasound performance between the two groups was compared.Differences between groups were compared using chi-square test or Fisher’s exact test.These analyses were performed using SPSS software(version 22.0,SPSS Inc,Chicago,IL,USA).A P value less than 0.05 was considered to be statistically significant.Results:(1)The minimum age of all patients was 29 years old,the oldest was 88 years old,and the median age was 53 years old.There were 16 patients(61.5%)in the TNBC group who were older than 53 years old and 10 patients were less than or equal to 53 years old(38.5%)of the patients in the n-TNBC group were older than 53 years(73.7%),and 80 or less(53.3%)were 53 years old.There was no statistical difference between the two groups(P=0.192).The proportion of postmenopausal status in the TNBC group was higher than that in the n-TNBC group(73.1% vs 53.6%),but there was no statistical difference(P=0.064).Whether in the TNBC group or the n-TNBC group,the longest diameter of the tumor was less than or equal to 2.5 cm,but there was no statistical difference between the two groups(P=0.781).Infiltrative ductal carcinoma was more common in the two groups,and the proportion of other pathological types in the TNBC group was higher than that in the nTNBC group(19.2% vs 9.8%),but the difference was not statistically significant(P=0.158).The proportion of grade III in the TNBC group was higher than that in the n-TNBC group(80.8% vs 52.9%),and the TNBC tumor had a higher histological grade(P=0.008).The positive rate of axillary lymph node in TNBC group was higher than that in n-TNBC group(53.8% vs 42.5%),but the difference was not statistically significant(P=0.281).There was no difference in lymphovascular invasion with TNBC and n-TNBC(P=0.519).(2)Comparing TNBC and n-TNBC ultrasound findings,the results showed that TNBC showed simple masses(88.5%),n-TNBC mostly showed masses with calcifications(52.9%)(P<0.001),TNBC masses were mostly round Shape or ellipse(53.8%),n-TNBC shape is irregular(84.3%)(P<0.001),TNBC rim is clear(11.5%),leaf(19.2%)is more common,n-TNBC lumps are blurred(60.7%),angulation(20.3%),and burrs(8.5%)were more common(P=0.006).There was no significant difference between the two groups of internal echoes,and the posterior echo of TNBC was mostly enhanced(42.3%,11 cases)or unchanged(46.2%,12 cases),and the posterior echo attenuation was reduced(11.5%,3 cases)(P=0.020).Most of the TNBC ultrasound gradings were 0-I(50%),and most of the n-TNBC patients were II-III(73.2%)(P=0.017).(3)There was no significant difference in the state,shape,margin,internal echo,and posterior echo of BI-RADS grade TNBC patients with lymphovascular invasion(+)and lymphovascular invasion(-)groups.The proportion of IIIII in the blood flow grading of suppository group was much higher than that of lymphovascular invasion(-)group(80% VS 31.3%),and the difference was statistically significant(P=0.044).Conclusions:(1)The TNBC histological grade is high,mainly showed a round or oval mass,calcification is rare,the edge is clear or sub-leaf,posterior echo enhancement or no changes,ultrasonic blood flowmeter was mostly classified as grade 0 and grade I,It tends to behave like a benign tumor in the ultrasound.(2)The n-TNBC histological grade is low.In the ultrasound,the main manifestations were irregular masses,calcifications were more common,the edges were more blurred,angled or burrs,and the posterior echo was attenuated.ultrasonic blood flowmeter was mostly classified as grade II and grade III.(3)Ultrasonic blood flowmeter of TNBC combined with lymphovascular invasion was mostly classified as grade II and grade III.Ultrasonic blood flowmeter of TNBC combined without lymphovascular invasion was mostly classified as grade 0 and grade I.