Gu Li-Shuang, Zhang Rui, Wang Yong, Liu Xue-Mei, Ma Fei, Wang Jia-Yu, Sun Xiao-Ying, Liu Meng-Jia, Wang Bo, Zou Shuang-Mei
Department of Ultrasound, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China.
Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
J Thorac Dis. 2019 Dec;11(12):5274-5289. doi: 10.21037/jtd.2019.11.52.
Locally advanced breast cancer (LABC) is one of the subgroups of invasive breast cancer. The treatment of LABC is neoadjuvant chemotherapy (NAC) before surgery, which is different from the others. The study aimed to analyze and compare the characteristics of conventional ultrasound, contrast-enhanced ultrasonography (CEUS) and strain elastography (SE) in LABC patients who have different treatment outcomes, and to provide help for LABC in the imaging diagnosis and clinic treatment.
From May 2018 to April 2019, 36 patients (40 lesions) of LABC were enrolled, which diagnosed by puncture biopsy. According to the clinical evaluation, these patients were recommended to undergo pre-operative NAC followed by surgery. All patients underwent conventional ultrasound, CEUS and SE before puncture. According to postoperative pathological grading and follow-up, the patients were divided into effective and ineffective groups. We summarized and compared the features of conventional ultrasound, CEUS and SE of patients in two groups. The correlation between the imaging characteristics and the postoperative pathological grading was also analyzed.
Conventional ultrasonic features of LABC: the most lesions of LABC were mass type (32/40, 80.0%), and all lesions were irregular. Most of lesions showed unclear boundaries (39/40, 97.5%), heterogeneous echoes (38/40, 95.0%), and internal calcifications (24/40, 60.0%). Most of lesions had hyperechoic halos (31/40, 77.5%), aspect ratio less than or equal to 1 (34/40, 85.0%), and blood flow grading was III (36/40, 90.0%). CEUS features of LABC: compared with the surrounding normal tissues, all the lesions (40/40,100.0%) were highly enhanced. Most of lesions (35/40, 87.5%) were uneven enhanced. The main enhancement mode was "fast in and slow out" (39/40, 97.5%). There were totally 25 lesions which had "solar sign" (25/40, 62.5%). SE features of LABC: the average visual elastography score of the lesions was 4.28±0.67, the maximum strain rate (E1) of the lesions averaged 4.88±0.54, and the overall strain rate of the lesion averaged 4.14±0.72. There was no significant difference between effective and ineffective groups in the characteristics of conventional ultrasound, CEUS and SE. There was a correlation between the appearance of "solar sign" in CEUS and postoperative pathological grading, and the contingency coefficient was 0.564 (P<0.05). The pathological grading of patients without solar sign was higher. The other characteristics of conventional ultrasound, CEUS and SE in LABC patients had no correlation with postoperative pathological grading.
In LABC, the conventional ultrasound usually shows irregular shape and unclear boundaries. The aspect ratio is less than or equal to 1. CEUS showed uneven enhancement of "fast in and slow out", and "solar sign" was often seen. Elastography showed that the texture of the lesion was significantly stiffer than the surrounding normal tissue. Ultrasound imaging before NAC had no relationship with pathological complete response or not. However, "solar sign" in CEUS was an important feature and had correlation with postoperative pathological grading.
局部晚期乳腺癌（LABC）是浸润性乳腺癌的亚组之一。LABC的治疗是术前新辅助化疗（NAC），这与其他类型不同。本研究旨在分析和比较不同治疗结果的LABC患者的常规超声、超声造影（CEUS）和应变弹性成像（SE）的特征，为LABC的影像诊断和临床治疗提供帮助。
2018年5月至2019年4月，纳入36例（40个病灶）经穿刺活检确诊的LABC患者。根据临床评估，建议这些患者接受术前NAC然后手术。所有患者在穿刺前均接受常规超声、CEUS和SE检查。根据术后病理分级和随访情况，将患者分为有效组和无效组。总结并比较两组患者常规超声、CEUS和SE的特征。还分析了影像特征与术后病理分级之间的相关性。
LABC的常规超声特征：LABC的大多数病灶为肿块型（32/40，80.0%），且所有病灶均不规则。大多数病灶边界不清（39/40，97.5%），回声不均匀（38/40，95.0%），内部有钙化（24/40，60.0%）。大多数病灶有高回声晕（31/40，77.5%），纵横比小于或等于1（34/40，85.0%），血流分级为III级（36/40，90.0%）。LABC的CEUS特征：与周围正常组织相比，所有病灶（40/40，100.0%）均呈高增强。大多数病灶（35/40，87.5%）增强不均匀。主要增强模式为“快进慢出”（39/40，97.5%）。共有25个病灶有“太阳征”（25/40，62.5%）。LABC的SE特征：病灶的平均视觉弹性成像评分为4.28±0.67，病灶的最大应变率（E1）平均为4.88±0.54，病灶的整体应变率平均为4.14±0.72。有效组和无效组在常规超声、CEUS和SE特征方面无显著差异。CEUS中“太阳征”的出现与术后病理分级之间存在相关性，列联系数为0.564（P<0.05）。无太阳征患者的病理分级更高。LABC患者常规超声、CEUS和SE的其他特征与术后病理分级无关。
在LABC中，常规超声通常显示形状不规则、边界不清。纵横比小于或等于1。CEUS显示“快进慢出”的不均匀增强，且常可见“太阳征”。弹性成像显示病灶质地明显比周围正常组织硬。NAC前的超声成像与是否病理完全缓解无关。然而，CEUS中的“太阳征”是一个重要特征，与术后病理分级相关。
