The Study Of Correlation Between Automated Breast Volume Scanner And Breast Cancer Diagnosis And Expression Of Molecular Biological Factors

Part?Comparative Study of Diagnostic Value of Automated Breast Volume Scanner and Dynamic Contrast-Enhanced Magnetic Resonance Imaging in breast lesions of BI-RADS 4Objective To compare the value of automated breast volume scanner(ABVS)and dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in the diagnosis of breast lesions of BI-RADS 4.Method1.From January 2017 to June 2018,230 patients(a total of 237 lesions)with breast lesions classified as BI-RADS 4 by conventional ultrasound(US)were recruited in this study,including 76 BI-RADS 4A,65 BI-RADS 4B,96 BI-RADS 4C.2.The procedure was as follows:firstly,all patients underwent US.Patients with breast lesions of BI-RADS 4 were reevaluated by ABVS and DCE-MRI,respectively.BI-RADS 4A and 4B breast lesions were regarded as benign and malignancy,respectively.Pathological results were used as the gold standard to compare the reevaluated value of ABVS and DCE-MRI for breast lesions of BI-RADS 4.3.US examination: US mainly observes the maximum diameter,shape,azimuth,edge condition,internal echo,posterior characteristics,peripheral echo halo,blood flow,microcalcification,etc.Breast lesions were evaluated according to the American College of Radiology Association(ACR)breast imaging report and data system(BI-RADS,2013).The lesions of BI-RADS 4 were reevaluated by ABVS and DCE-MRI.4.ABVS examination: The standard of ABVS reevaluation was based on the following criteria: Solid masses with one of the three suspicious findings(no circumscribed margin,no parallel orientation,and microcalcifications)were defined as category 4A,and masses with two or more suspicious findings were defined as category 4B.For non-mass lesions,localized hypoechoic areas with one of the three suspicious findings(segmental distribution,ductal change,and microcalcifications)were defined as category 4A.Localized hypoechoic areas with two or three suspicious findings were defined as category 4B.Regardless of the solid masses or the non-mass lesions,lesions with convergence sign of the coronal plane were defined as category 4C.5.DCE-MRI examination: observe the shape of the lesion(circular or elliptical,lobulated,irregular),the edge of the lesion(clear,innocent,spiculated margin),the way the lesion was strengthened(not strengthened,evenly strengthened and internal separation without strengthened,uneven strengtheninged,edge strengthened),early strengthening rate(<50%,50% to 100%,>100%),Time-signal intensity curve type(type I,type II,type III).According to the improvement Fischer scoring method,0 to 1points were defined as BI-RADS category 1;2 points were defined as BI-RADS category 2;3 points were defined as BI-RADS category 3;4 points were defined as BI-RADS category 4A,5 points were defined as BI-RADS category 4B,6 points were defined as BI-RADS category 4C;7 to 11 points were defined as BI-RADS category 5.The pathological results were used as the gold standard,and the sensitivity,specificity and accuracy of US,ABVS and DCE-MRI in the diagnosis of breast BI-RADS 4 masses were calculated.The statistical software SPSS22.0 was used for statistical description and inference.The count data was expressed by frequency and percentage.The comparison between the groups of count data was performed by chi-square test.When P<0.05,the difference was considered statistically significant.Results Pathological results: A total of 237 lesions,84 benign lesions and 153 malignant lesions.Benign lesions include 46 fibroadenomas,15 adenosis,7 chronic granulomatous inflammation,10 intraductal papilloma,4 breast abscess,2 fat necrosis;malignant lesions include 143 invasive ductal carcinoma,2 invasive lobular carcinoma,3intraductal carcinoma in situ,2 mucinous carcinoma,1 neuroendocrine carcinoma,1carcinosarcoma,1 medullary carcinoma.The evaluation of US was 76 BI-RADS 4A,65 BI-RADS 4B,and 96 BI-RADS 4C,with BI-RADS 4A and 4B breast lesions being regarded as benign and malignancy,respectively,the diagnosis of US was 76 benign lesions and 161 malignant lesions.The sensitivity,specificity and accuracy of US diagnosis were 81.70%(125/153),57.14%(48/84)and 73.00%(173/237),respectively.The reevaluation of ABVS was 90BI-RADS 4A,45 BI-RADS 4B,102 BI-RADS 4C,so the diagnosis of ABVS was 90 benign lesions,and 147 malignant lesions.The sensitivity,specificity,and accuracy of ABVS were 90.20%(138/153),89.29%(75/84),89.87%(213/237).The reevaluation of DCE-MRI was 81 BI-RADS 4A,47 BI-RADS 4B,109BI-RADS 4C,so the diagnosis of DCE-MRI was 81 benign lesions and 156 malignant lesions.The sensitivity,specificity and accuracy of DCE-MRI were 91.50%(140/153),80.95%(68/84),and87.76%(208/237).The sensitivity,specificity,accuracy of ABVS and DCE-MRI in the diagnosis of breast lesions of BI-RADS 4 were higher than those of US,the difference is statistically significant(P<0.05).However,when ABVS compared with DCE-MRI,there was no significant difference in sensitivity,specificity,accuracy in the diagnosis of breast lesions of BI-RADS 4(P>0.05).Conclusion ABVS and DCE-MRI had higher sensitivity,specificity and accuracy than US in diagnosing BI-RADS 4 breast lesions.Compared with DCE-MRI,ABVS had the similar sensitivity,specificity and accuracy.Both of them are an effective supplement to US,which can improve the accuracy of benign and malignant identification of BI-RADS 4breast lesions.Part?Correlation between breast cancer signs and expression of biological factors in conventional ultrasound and ABVSObjective To investigate the correlation between breast cancer signs and theexpression of molecularbiological factors in conventional ultrasound combined with ABVS,including estrogen receptor(ER),progesterone receptor(PR),human epidermalgrowth factor receptor 2(HER-2).Trying to use ultrasound to assist in evaluating theexpression of molecular biological factors in breast cancer,and to provide morereference information for developing individualized neoadjuvant chemotherapy and monitoring efficacy.Methods From January 2017 to June 2018,153 patients(153 lesions)admitted to ourhospital proven to be breast cancers by pathology were included.All of themunderwent conventional ultrasound and Automated Breast Volume Scanner(ABVS)examinations before surgery.Conventional ultrasound signs and ABVS coronal planesigns of breast cancer were evaluated respectively.Conventional ultrasound signsmainly include the maximum diameter,shape,azimuth,edge condition,internal echo,posterior characteristics,blood flow,microcalcification,etc.ABVS coronal signs mainly include convergence sign.Molecular biological factors of breast cancer,including ER,PR,HER-2,were determined through immunohistochemistry.The correlation between the conventional ultrasound signs and ABVS coronal plane signs and breast cancer molecularbiological factors was analyzed.Results The expressions of ER,PR and HER-2 were not significantly different from the maximum diameter,shape,azimuth,internal echo,posterior features and blood flow of conventional ultrasound(P>0.05).The positive expression rate of ER and PR in the tumors having spiculated margin was higher than that having no-spiculated margin(75.00% vs 49.52%,70.83% vs 43.81%),the difference is statistically significant(P<0.05).The positive expression rate of ER and PR in the tumors having convergence sign was higher than that without the above sign(80.00% vs 38.55%,72.86% vs 34.94%),the difference is statistically significant(P<0.05);The positive expression rate of ER and PR in the tumors having spiculated margin combined with convergence sign was higher than that only having spiculated marginorthe convergence sign(97.22% vs 75.00% ? 80.00%,94.12% vs70.83% ? 72.86%),and the positive expression rate of HER-2 was lower(2.50% vs 16.67% ? 21.43%);the positive expression rate of HER-2 in the tumors with microcalcification was higher than that without microcalcification(38.57%vs 10.84%),the difference is statistically significant(P < 0.05).Conclusion Conventional ultrasound and ABVS coronal plane signs had a certain reference value for predicting the expression of molecular biological factors in breast cancer.Conventional ultrasound combined with ABVS can better predict the expression of ER,PR and HER-2,which can provide morereference information for precise treatment,individualized treatment,efficacy monitoring and early assessment of prognosis of breast cancer.