Clinical value of ultrasonography combined with shear wave elastography for the assessment of molecular subtypes of breast cancer
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摘要:
目的 探讨超声造影联合剪切波弹性成像定性以及定量分析参数与乳腺癌不同分子分型之间的关系。 方法 收集2022年10月—2023年7月期间行乳房X光检查和/或常规超声检查中发现可疑恶性病变的患者并经蚌埠医学院第一附属医院病理科病理证实为浸润性乳腺癌并获取免疫组化结果的患者52例，依据病理结果分为3组乳腺癌分型：管腔型(26例)、HER-2型(17例)以及三阴型(9例)。观察这些患者的超声造影及弹性成像特征并采用超声造影软件对乳腺癌病灶进行时间-强度曲线分析，分析不同分子分型乳腺癌超声造影特征及弹性成像定量参数。 结果 不同亚型乳腺癌患者在组织学分级和淋巴结转移方面差异有统计学意义(均P < 0.05)。HER-2阳性表达的乳腺癌病灶更易出现快速增强的增强模式(n=15, 88.2%，P < 0.05)以及高增强的增强特征(n=14, 82.4%，P < 0.05)，HER-2亚型乳腺癌患者超声弹性成像Emax值及造影定量参数PI均明显高于管腔型及三阴型[(170.32±53.35)kPa vs.(119.26±36.95)kPa vs.(155.80±73.59)kPa，P=0.006；(25.22±5.79)dB vs.(20.82±4.80)dB vs.(24.51±6.75)dB，P=0.030]。 结论 超声造影增强特征及灌注参数联合剪切波弹性成像定量参数与不同分子亚型乳腺癌之间具有相关性，因此超声定性及定量分析参数可以作为较客观准确的检测手段，为乳腺癌临床诊断、个体化治疗以及预后分析等提供参考依据。 Abstract:Objective To investigate the relationship between qualitative and quantitative parameters of contrast ultrasound combined with shear wave elastography and different molecular staging of breast cancer. Methods Fifty-two patients with suspected malignant lesions detected by mammography and/or routine ultrasonography and confirmed as invasive breast cancer by the Department of Pathology of the First Affiliated Hospital of Bengbu Medical College from October 2022 to July 2023 were enrolled, and immunohistochemical results were collected, and were divided into three groups of breast cancer types based on the pathological results: luminal type (26 cases), HER-2 type (17 cases) and triple-negative (9 cases). Ultrasonographic and elastographic features of these patients were observed and time-intensity curves of breast cancer lesions were analyzed using ultrasonographic software, and ultrasonographic features of mass and quantitative parametric indicators of elastography were analyzed in relation to different molecular subtypes of breast cancer. Results There were significant differences in histological grading and lymph node metastasis between different breast cancer subtypes (P < 0.05), HER-2 positive breast cancer lesions were more likely to have a rapidly enhancing enhancement pattern(n=15, 88.2%, P < 0.05) as well as hyper-enhancing enhancement features(n=14, 82.4%, P < 0.05), and ultrasound elastography Emax values and the quantitative contrast parameter PI were significantly higher in patients with HER-2 subtype breast cancer than in luminal and triple-negative types [(170.32±53.35) kPa vs. (119.26±36.95) kPa vs. (155.80±73.59) kPa, P=0.006); (25.22±5.79) dB vs. (20.82±4.80) dB vs.(24.51±6.75) dB, P=0.030]. Conclusion There is a correlation between ultrasound enhancement features and perfusion parameters combined with quantitative parameters of shear wave elastography and different molecular subtypes of breast cancer, so ultrasound analysis and quantitative parameters can be used as a more objective and accurate means of detection, which can provide a reference basis for clinical diagnosis of breast cancer, individualized treatment and prognostic analysis. -
Key words:
- Contrast ultrasonography /
- Shear wave elastography /
- Breast cancer /
- Molecular staging
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图 1 1例69岁组织学分级为Ⅰ~Ⅱ级的管腔型乳腺癌患者的超声图像
注：A示灰度超声图像；B示剪切波弹性成像图；C示超声造影增强程度图像(低增强或等增强)；D示超声造影时间强度曲线(同步增强)。
Figure 1. Ultrasound image of a 69-year-old patient with luminal breast cancer, histological grade Ⅰ to Ⅱ
图 2 1例66岁组织学分级为Ⅲ级的HER-2型乳腺癌患者的超声图像
注：A示灰度超声图像；B示剪切波弹性成像图；C示超声造影增强程度图像(高增强)；D示超声造影时间强度曲线(快速增强)。
Figure 2. Ultrasound image of a 66-year-old patient with HER2-positive breast cancer, histological grade Ⅲ
图 3 1例54岁组织学分级为Ⅲ级的三阴型乳腺癌患者的超声图像
注：A示灰度超声图像；B示剪切波弹性成像图；C示超声造影增强程度图像(高增强)；D示超声造影时间强度曲线(快速增强)。
Figure 3. Ultrasound image of a 54-year-old patient with grade Ⅲ triple-negative breast cancer
表 1 不同分子亚型原发性乳腺癌患者临床病理特征比较
Table 1. Comparing clinicopathological characteristics among primary breast cancer patients with different molecular subtypes
组别 例数 年龄
(x±s，岁)月经状态[例(%)] 肿块最大径[例(%)] 病理分级[例(%)] 淋巴结状态[例(%)] 无 有 ＜2 cm ≥2 cm Ⅰ/Ⅱ级 Ⅲ级 阳性 阴性 管腔型 26 55.88±9.58 22(84.6) 4(15.4) 6(23.1) 20(76.9) 25(96.2) 1(3.8) 10(38.5) 16(61.5) HER-2型 17 55.76±7.48 15(88.2) 2(11.8) 2(11.8) 15(88.2) 13(76.5) 4(23.5) 13(76.5) 4(23.5) 三阴型 9 54.33±8.76 7(77.8) 2(22.2) 1(11.1) 8(88.9) 5(55.6) 4(44.4) 4(44.4) 5(55.6) 统计量 0.109a 0.725b 1.014b 8.188b 6.169b P值 0.897 0.771 0.617 0.011 0.045 注：a为F值, b为χ2值。 
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表 2 3组原发性乳腺癌患者剪切波弹性成像定量参数比较(x±s，kPa)
Table 2. Quantitative parameter comparison of shear wave elastography in three groups of patients with primary breast cancer(x±s, kPa)
组别 例数 Emax Emean Esd 管腔型 26 119.26±36.95 38.32±11.44 16.66±5.30 HER-2型 17 170.32±53.35a 46.56±11.76 21.43±8.90 三阴型 9 155.80±73.59ab 43.20±11.25 20.47±5.64 F值 5.734 2.710 2.878 P值 0.006 0.077 0.066 注：与管腔型比较，aP < 0.05；与HER-2型比较, bP < 0.05。
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表 3 3组原发性乳腺癌患者超声造影定性参数比较[例(%)]
Table 3. Comparing qualitative parameters of ultrasonography among three groups of patients with primary breast cancer
组别 例数 增强速度 增强程度 快速 同步 低/等增强 高增强 管腔型 26 9(34.6) 17(65.4) 16(61.5) 10(38.5) HER-2型 17 15(88.2) 2(11.8) 3(17.6) 14(82.4) 三阴型 9 7(77.8) 2(22.2) 2(22.2) 7(77.8) χ2值 13.710 9.430 P值 0.001 0.009 组别 例数 增强范围 病灶边缘 扩大 无明显改变 清晰 模糊 管腔型 26 7(26.9) 19(73.1) 18(69.2) 8(30.8) HER-2型 17 8(47.1) 9(52.9) 11(64.7) 6(35.3) 三阴型 9 4(44.4) 5(55.6) 5(55.6) 4(44.4) χ2值 2.180 0.685 P值 0.346 0.799 组别 例数 灌注缺损 放射状或穿入性血管 无 有 无 有 管腔型 26 19(73.1) 7(26.9) 19(73.1) 7(26.9) HER-2型 17 13(76.5) 4(23.5) 12(70.6) 5(29.4) 三阴型 9 7(77.8) 2(22.2) 3(33.3) 6(66.7) χ2值 0.179 4.612 P值 0.999 0.105
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表 4 3组原发性乳腺癌患者超声造影定量参数比较(x±s)
Table 4. Quantitative parameter comparison of ultrasonography in three groups of patients with primary breast cancer(x±s)
组别 例数 TTP(s) PI(dB) 管腔型 26 16.72±3.84 20.82±4.80 HER-2型 17 17.91±5.82 25.22±5.79a 三阴型 9 14.08±2.51 24.51±6.75ab F值 2.213 3.775 P值 0.120 0.030 注：与管腔亚型比较, aP < 0.05；与HER-2亚型比较, bP < 0.05。
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