| Part 1:Correlation between characteristics of conventional ultrasound combined with contrast-enhanced ultrasound and the expression of Ki-67 in breast cancerObjectiveTo evaluate the correlation between conventional ultrasound combined with contrast-enhanced ultrasound(CEUS)and the expression of Ki-67 in breast cancer with different size.MethodsTwo hundred and thirty nine patients with 239 breast cancer lesions admitted to the First Affiliated Hospital of Soochow University from May 2018 to May 2020 were retrospectively selected.According to the maximum diameter of the lesions,they were divided into 2 groups(group A:maximum diameter≤2.0cm;Group B:maximum diameter>2.0 cm).Then 20%was taken as the cut-off value of Ki-67,and the lesions in 2 groups were divided into another 2:high expression group of Ki-67(Ki-67≥20%)and low expression group of Ki-67(Ki-67<20%).The differences in age,conventional ultrasound(including shape,orientation,margin,hyperechoic halo,posterior echo,microcalcification and blood flow),qualitative characteristics(including enhancement degree,enhancement direction,perfusion defect,radiating margin,penetrating vessels and enhancement range)and quantitative parameters(including transverse diameter,vertical diameter and their increscent ratio,and maximum intensity(IMAX),rise time(RT),time to peak(TTP),mean transit time(mTT)of the whole lesion)of CEUS between 2 groups with different expression of Ki-67 were analyzed.Results1.Conventional ultrasound:In group A,the posterior echo of the lesions were mostly unchanged when the expression of Ki-67 was high,while mostly unchanged or attenuation when the expression of Ki-67 was low,and the difference was statistically significant(P<0.05).In group B,microcalcifications mostly occurred in the lesions when the expression of Ki-67 was high,while they tended to have no microcalcifications when the expression of Ki-67 was low(P<0.05).2.Qualitative characteristics of CEUS:In group A,the enhancement range of lesions after CEUS were larger than that on gray-scale images when the expression of Ki-67 was high(P<0.05).In group B,the lesions tended to be high enhancement,radiating margin and lager enhancement range when the expression of Ki-67 was high,and the differences were statistically significant compared with the low-expression group(P<0.05).3.Quantitative parameters of CEUS:In group A,when the expression of Ki-67 was high,the vertical diameter and it’s increscent ratio after CEUS was bigger than that of the group with low expression of Ki-67,and the overall RT and TTP of the lesions were shorter than that of the group with low expression of Ki-67(P<0.05).In group B,when the expression of Ki-67 was high,the vertical diameter and it’s increscent ratio after CEUS was bigger than that of the group with low expression of Ki-67(P<0.05).4.Correlation analysis:In group A,the posterior echo,RT and TTP were negatively correlated with the expression of Ki-67(P<0.05),and the enhancement range,vertical diameter and it’s increscent ratio were positively correlated with the expression of Ki-67(P<0.05).In group B,microcalcification,the enhancement degree,radiating margin,enhancement range,vertical diameter and it’s increscent ratio were positively correlated with the expression of Ki-67(P<0.05).ConclusionConventional ultrasound,qualitative characteristics and quantitative parameters of CEUS are correlated with the expression level of Ki-67 in breast cancer with different sizes,which is of great significance for the evaluation of prognosis in breast cancer patients.Part 2:Predictive value of conventional ultrasound and contrast-enhanced ultrasound features in axillary lymph node metastasis of breast cancerObjectiveTo evaluate the predictive value of conventional ultrasound combined with contrast-enhanced ultrasound(CEUS)on axillary lymph node(ALN)metastasis in breast cancer with different age.MethodsTwo hundred and fifty patients with 250 breast cancer lesions admitted to the First Affiliated Hospital of Soochow University from May 2018 to December 2020 were retrospectively selected.According to the age of patients,the lesions were divided into 2 groups(young group:≤40 years old;elderly group:age>40 years old).Then the lesions in the two groups were also divided into ALN positive group and ALN negative group according to axillary lymph node pathology.The differences in molecular markers(including ER,PR,HER-2 and Ki-67),conventional ultrasound(including the maximum diameter,shape,orientation,margin,hyperechoic halo,posterior echo,microcalcification and blood flow),qualitative characteristics(including enhancement degree,enhancement direction,perfusion defect,radiating margin,penetrating vessels and enhancement range)and quantitative parameters(including transverse diameter,vertical diameter and their increscent ratio,and maximum intensity(IMAX),rise time(RT),time to peak(TTP),mean transit time(mTT)of the whole lesion)of CEUS between 2 groups with or without axillary lymph node metastasis(ALNM)were analyzed.Results1.Molecular markers:In the young group,the expressions of HER-2 were mostly negative when ALN was negative(P<0.05).In the elderly group,the expressions of Ki-67 were mostly high when ALN was positive,and the expressions of HER-2 were mostly negative when ALN was negative(P<0.05).2.Conventional ultrasound:In the young group,the maximum diameter of lesions in the ALN positive group were lager than that in the ALN negative group(P<0.05).In the elderly group,differences were found in the maximum diameter and blood situation between ALN positive and negative group(P<0.05).3.Qualitative characteristics of CEUS:In the young group,radiating margin of the lesions were mostly found in ALN positive group(P<0.05).In the elderly group,the lesions mostly showed radiating margin and perfusion defect when ALN was positive,and the differences were statistically significant compared with that in the ALN negative group(P<0.05).4.Quantitative parameters of CEUS:In the young group,there was no significant difference between ALN positive and negative group(P>0.05).In the elderly group,the transver diameter,vertical diameter and IMAX of lesions were higher than those in the ALN negative group(P<0.05).5.Logistic analysis:In the young group,ultrasonic characteristics were not the independent predictors of ALNM(P>0.05).In the elderly group,blood supply,perfusion defect and radiating margin were the independent predictors of ALNM(OR=4.290,4.028,5.571,all P<0.05).6.ROC curve:In the elderly group,the AUC of blood supply,perfusion defect,radiating margin and combined diagnosis of ALNM were 0.673,0.633,0.679 and 0.813,respectively.And there were statistically significant differences between the combined diagnosis and the single diagnosis(P<0.05).ConclusionConventional ultrasound and CEUS features of primary breast cancer lesions have low predictive value for ALNM in the young group.But blood supply,perfusion defect and radiating margin are independent predictors of ALNM in breast cancer of elderly group,which can provide more reliable information for preoperative evaluation. |
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