Li Xiaokang, Li Yaqing, Zhu Ying, Fu Li, Liu Peifang
Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, P.R. China.
Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, P.R. China.
Oncol Lett. 2018 Apr;15(4):5643-5649. doi: 10.3892/ol.2018.8078. Epub 2018 Feb 16.
The aim of the present study was to evaluate the association between enhancement patterns and parameters in contrast-enhanced ultrasonography (CEUS) and microvessel distribution and histological prognostic tumor characteristics of breast cancer. Between September 2011 and April 2013, 109 breast lesions were prospectively analyzed, which were classified into Breast Imaging Reporting and Data System class 4-5 by conventional ultrasound. Before core-needle biopsy, CEUS examination was performed. Different enhancement patterns (homogeneous, peripheral and regional enhancement) were evaluated. Following CEUS, biopsies were performed at the same body positions under guidance of ultrasound. Parameters (wash-in time, peak intensity, time to peak, area under the time-intensity curve, ascending slope) of CEUS at corresponding puncture sites were recorded. Microvessel density (MVD) and pathological prognostic factors, including histological grade, lymph node status, tumor-node-metastasis stage, estrogen and progesterone receptor status, Ki-67 proliferative index and human epidermal growth factor receptor 2 overexpression, were determined. Mann-Whitney U test, Spearman's rank-correlation test and independent-samples t-tests were used for evaluation. Core-needle biopsy or surgical resection specimens of 99 malignant breast lesions were included in the present study. Of the 99 malignant lesions, 44 lesions exhibited homogeneous enhancement, 43 exhibited peripheral enhancement and 12 exhibited regional enhancement. Lesions with peripheral enhancement exhibited a higher peripheral/central ratio of MVD compared with lesions with homogeneous enhancement (P<0.001). Peak intensity and ascending slope ratios of tumor periphery/center were correlated with the corresponding MVD ratios (P=0.017 and P=0.016, respectively). MVD ratio was positively correlated with histological grade (P=0.003). In conclusion, the enhancement patterns and parameters of CEUS may not only reflect the microvessel distribution but also indirectly indicate the histological grade of breast cancer.
本研究的目的是评估超声造影（CEUS）中的增强模式和参数与乳腺癌微血管分布及组织学预后肿瘤特征之间的关联。在2011年9月至2013年4月期间，对109个乳腺病变进行了前瞻性分析，这些病变通过传统超声被分类为乳腺影像报告和数据系统4 - 5级。在粗针活检前，进行了CEUS检查。评估了不同的增强模式（均匀、周边和区域增强）。CEUS检查后，在超声引导下于相同体位进行活检。记录相应穿刺部位CEUS的参数（流入时间、峰值强度、达峰时间、时间 - 强度曲线下面积、上升斜率）。测定微血管密度（MVD）和病理预后因素，包括组织学分级、淋巴结状态、肿瘤 - 淋巴结 - 转移分期、雌激素和孕激素受体状态、Ki - 67增殖指数以及人表皮生长因子受体2过表达情况。采用曼 - 惠特尼U检验、斯皮尔曼等级相关检验和独立样本t检验进行评估。本研究纳入了99个乳腺恶性病变的粗针活检或手术切除标本。在这99个恶性病变中，44个病变表现为均匀增强，43个表现为周边增强，12个表现为区域增强。与均匀增强的病变相比，周边增强的病变MVD的周边/中心比值更高（P<0.001）。肿瘤周边/中心的峰值强度和上升斜率比值与相应的MVD比值相关（分别为P = 0.017和P = 0.016）。MVD比值与组织学分级呈正相关（P = 0.003）。总之，CEUS的增强模式和参数不仅可以反映微血管分布，还可以间接提示乳腺癌的组织学分级。
