Clinical Study Of Shear Wave Elastography Combined With Contrast-enhanced Ultrasound In The Diagnosis Of Breast Lesions And The Correlation Of Breast Cancer Different Molecular Subtyping

Part 1: Clinical study of Shear wave elastography combined with contrast-enhanced ultrasound in the diagnosis of breast lesionsObjective To evaluate the value of shear wave elastography combined with contrast-enhanced ultrasound in the diagnosis of breast lesions.Methods 219 patients with 237 breast lesions who were diagnosed breast lesions in our hospital from January 2016 to January 2019 were enrolled.The conventional ultrasound,shear wave elastography and contrast-enhanced ultrasound were performed before operation,and the observed indicators were recorded.The diagnostic threshold value of contrast-enhanced ultrasound were obtained by statistical methods.The multivariate Logistic regression model was used to analyze the significant indicators of the combined diagnosis of breast lesions.Taking the pathological results as the gold standard to construct the ROC curve,compare the diagnostic efficacy of conventional ultrasound,shear wave elastography,contrast-enhanced ultrasound and the combination in the diagnosis of breast lesions,and to analyze missed and misdiagnosed cases.Results According to the ROC curve,the diagnostic threshold value of contrast-enhanced ultrasound was 9.5 points,the results of the multivariate Logistic regression model were Emax(OR=9.103,95% CI :3.969-20.877),enhanced contrast agent distribution(OR=7.216,95% CI :2.238-23.264),lesion edge(OR=5.195,95% CI :1.893-14.255)and the area of enhanced lesions(OR=6.563,95% CI :2.812-15.314).The diagnostic sensitivity,specificity,accuracy and area under the ROC curve of shear wave elastography were 84.57%,72.00%,80.59%,0.783,contrast-enhanced ultrasound were 93.21%,70.67%,86.08%,0.819,and the combination were 90.74%,80.00%,87.34%,0.918,the combination had the maximum efficiency.Conclusion The combination of shear wave elastography and contrast-enhanced ultrasound was of great value in the diagnosis of breast lesions,and could improve the diagnostic accuracy.Part 2: The correlation between shear wave elastography and contrast-enhanced ultrasound features of breast cancer different molecular subtypingObjective To explore the correlation between shear wave elastography and contrast-enhanced ultrasound featuers of breast cancer different molecular subtyping,and whether it can be used as a predictor of breast cancer molecular classification.Methods 153 patients with 159 breast lesions who were diagnosed breast cancer in our hospital from January 2016 to January 2019 were enrolled.Shear wave elastography and contrast-enhanced ultrasound were performed before operation,and the observed indicators were recorded.Each lesion was analyzed by contrast-enhanced ultrasound for indicators with benign and malignant statistical differences.The molecular subtyping was confirmed by postoperative pathology and immunohistochemistry results,to explore the correlation between shear wave elastography and contrast-enhanced ultrasound features of immunohistochemical molecular characteristics of breast cancer.Results The shear wave elastography index Emax of 159 breast cancers was not significantly different from different molecular subtyping of breast cancer and its pathological features ER/PR,HER-2,Ki 67(F=0.885,P=0.450(29)0.05).There was a statistically significant difference between whether there was filling defect after enhancement and the change of lesion area after contrast-enhanced ultrasound of the different subtyping of breast cancer(P=0.01;P=0.007),which was positively correlated(OR=0.168,P=0.034;OR=0.156,P=0.049).There was a statistically significant difference between filling defect after enhancement and the positive expression of the pathological features Ki 67(P=0.022),which was positively correlated(OR=0.200,P=0.012).Conclusion There was no significantlydifference in the shear wave elastography index Emax of different molecular subtyping of breast cancer,and there was significantly difference between whether there was filling defect after contrast-enhanced ultrasound and the change of lesion area after contrast-enhanced ultrasound,which could provide valuable information for clinical diagnosis and personalized treatment of breast cancer.