Diagnostic Efficacy Of Contrast-enhanced Ultrasound In Focal Lesions Of The Breast

Objective:This study is to investigate the differences in the diagnosis of breast lesions by qualitative and semi-quantitative parameters of the breast lesions by ultrasound(US)and contrast-enhanced ultrasonography(CEUS).At the same time,CEUS characteristics in BI-RADS category 4 breast lesions grouped with different sizes are analyzed,and malignant risk assessment is conducted to explore the CEUS characteristics and malignant risk indicators of benign and malignant lesions.In addition,by correlating the characteristics of CEUS in breast cancer with its immunohistochemical indicators,the predictive value of CEUS for breast cancer prognosis and its guiding role in clinical diagnosis and treatment are also explored.Methods:US and CEUS characteristics of 253 cases of solid breast lesions are analyzed,including 170 benign lesions and 83 malignant lesions.US characteristics(including:shape,orientation,margin,homogeneity,echo pattern,posterior features,microcalcification and vascularity)and CEUS characteristics(including:degree of enhancement,enhanced morphology,enhanced boundary,enhanced homogeneity,perfusion mode,vasa vasorum,enhanced range,initial enhancement rate and regression rate)are observed,SPSS 23.0 statistical software was used to analyze the difference of CEUS characteristics between benign and malignant lesions is analyzed by X~2 test or Fisher's exact probability statistical method.Among them,183 cases(115 benign cases and 68 malignant cases)in BI-RADS category 4 breast lesions are grouped according to the size of the lesions(diameter?2cm group and diameter>2cm group),and the differences in CEUS characteristics between benign and malignant lesions are also observed as well as the CEUS indicator for predicting the malignant risk of malignant lesions by binary Logistic regression analysis.In addition,the CEUS characteristics of 96 breast cancer lesions are correlated with the expression of immunohistochemical indicators(ER,PR,c-erbB-2,ki-67)by Spearman correlation statistical method.Results:The US characteristics of 253 cases of benign and malignant breast lesions:shape,orientation,margin,homogeneity,calcification,vascularity and posterior features are statistically significant(P<0.05);there are no significant difference in echo pattern and orientation(P>0.05).Binary logistic regression analysis screens four indicators independently associated with breast malignant lesions,and their relative risk:irregular shape>margin not circumscribed>vascularity rich>microcalcification.The CEUS characteristics of 253 cases of benign and malignant breast lesions:enhancement degree,enhancement morphology,perfusion pattern,drainage vessels,enhancement range,initial enhancement rate,and regression velocity are statistically significant(P<0.05);there is no significant difference in enhancement boundary and enhanced homogeneity(P>0.05).183 cases in BI-RADS category 4 breast lesions with a diameter?2cm in the breast group:enhanced morphology,enhancement,enhancement homogeneity,perfusion pattern,vasa vasorum,expansion range,initial enhancement speed and regression rate of benign and malignant lesions are all statistically significant(P<0.05);and the enhancement boundary is not statistically significant(P>0.05).Binary logistic regression analysis screens two indicators independently associated with BI-RADS category 4 breast malignant lesions,and their relative risk:enhanced range expansion>vasa vasorum visible;diameter>2 cm in BI-RADS category 4 breast lesion group:enhanced morphology of the benign and malignant lesions,perfusion pattern,vasa vasorum,enhancement range expansion and initial enhancement rate is statistically significant(P<0.05).There is no significant difference in enhancement boundary,enhancement degree,enhancement homogeneity and regression rate(P>0.05).Binary logistic regression analysis screens out three indicators of independent malignant lesions diameter?2 cm in BI-RADS category 4 breast lesion group,the relative risk:vasa vasorum visible>perfusion mode centripetal>enhanced range expansion.In the CEUS characteristics of 96 cases of breast cancer,the enhanced border unclear of lesions is positively correlated with the expression of ER and PR(P<0.05).The enhanced heterogeneous of lesion enhancement is positively correlated with the expression of c-erbB-2(P<0.05).There is a positive correlation with the enhanced range expanded of c-erbB-2 and Ki-67(P<0.05).The transverse diameter of the lesions is significantly higher than that of the longitudinal diameter(t=12.20,P<0.05).Conclusion:US and CEUS both have differential diagnostic value for benign and malignant breast lesions,especially CEUS can further differential diagnosis and malignant risk assessment in BI-RADS category 4 lesions.The expression of immunohistochemical indicators in combined with CEUS characteristics can be predictive for the prognosis of breast malignant lesions and provide guidance for the clinical diagnosis and treatment of breast lesions.