Relationship between contrast-enhanced ultrasound characteristics and clinicopathological features of breast cancer patients

doi:10.3877/cma.j.issn.1674-0807.2023.02.003

Abstract

Abstract:

Objective

To explore the relationship between the qualitative characteristics and quantitative parameters of contrast-enhanced ultrasound (CEUS) and clinicopathological features of breast cancer patients.

Methods

According to the inclusion and exclusion criteria, the clinical data of 89 patients who received the CEUS and were pathologically diagnosed with breast cancer in the First Affiliated Hospital of Army Medical University from May 2021 to August 2022 were retrospectively analyzed. The CEUS qualitative characteristics (enhancement speed, enhancement degree, enhancement order, internal homogeneity, enhancement margin, perforator vessel, perfusion defect, size after enhancement) and quantitative parameters [wash-in slope (WIS), time to peak (TTP), peak intensity(PI), rise time(RT) and wash-in area under the curve(WiAUC)] in 89 patients were analyzed to explore their relationship with clinicopathological features. The quantitative parameters of CEUS were analyzed by the Mann-Whitney U test, qualitative characteristics were expressed by absolute numbers and analyzed by Pearson’s χ² test or continuous correction χ² test. The qualitative characteristics and quantitative parameters of CEUS with a statistically significant difference in univariate analysis were used as independent variables for binary logistic regression, with clinicopathological features as the dependent variables.

Results

HER-2-positive breast cancer was more likely to show fast enhancement than HER-2-negative breast cancer (χ²=4.633, P=0.031). Compared with Ki-67 low expression breast cancer, Ki-67 high expression breast cancer was more likely to show hyperenhancement (χ²=4.355, P=0.037), and the size of lesions was usually larger after enhancement (χ²=4.355, P=0.037). Compared with histological grade 1/2 breast cancer, breast cancer of grade 3 was more likely to show perfusion defect (χ²=4.395, P=0.036). Breast cancer with a lesion diameter≥20 mm was more likely to show fast enhancement than the one < 20 mm (χ²=6.036, P=0.014). The WIS, PI and WiAUC of ER-negative breast cancer were significantly higher than those of ER-positive breast cancer (Z=-2.472, -2.870, -2.140; P=0.013, 0.004, 0.032). The WIS, PI and WiAUC of PR-negative breast cancer were significantly higher than those of PR-positive breast cancer (Z=-2.965, -3.361, -2.672; P=0.003, 0.001, 0.008). The WIS, PI and WiAUC of Ki-67 high expression breast cancer were significantly higher than those of Ki-67 low expression breast cancer (Z=-2.172, -2.713, -2.620; P=0.030, 0.007, 0.009). In addition, the WiAUC of HER-2-positive breast cancer was significantly higher than that of HER-2-negative breast cancer (Z=-2.161, P=0.031). The results of binary logistic regression analysis showed that PI was an independent predictor of ER expression (OR=0.907, 95%CI: 0.827-0.994, P=0.037); enhancement degree and WiAUC were independent predictors of Ki-67 expression(OR=5.082, 95%CI: 1.065-24.241, P=0.041; OR=1.030, 95%CI: 1.005-1.055, P=0.019).

Conclusions

The qualitative characteristics and quantitative parameters of CEUS are related to clinicopathological features of breast cancer patients to a certain degree, which provides a reference for evaluating the prognosis of breast cancer in a non-invasive way.

Key words: Breast neoplasms, Prognosis, Contrast-enhanced ultrasound

Xin Li, Jun Zhang, Chunlin Tang, Kaixuan Chen, Ying Tan, Ping Chen, Lin Tan, Yanli Guo. Relationship between contrast-enhanced ultrasound characteristics and clinicopathological features of breast cancer patients[J]. Chinese Journal of Breast Disease(Electronic Edition), 2023, 17(02): 80-87.

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References 32

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变量	变量类型	赋值
增强速度	X₁	同步＝0；快速＝1
增强程度	X₂	低/等增强＝0；高增强＝1
灌注缺损	X₃	无＝0；有＝1
增强后范围	X₄	无改变＝0；增大＝1
ER	Y₁	阴性＝0；阳性＝1
PR	Y₂	阴性＝0；阳性＝1
HER-2	Y₃	阴性＝0；阳性＝1
Ki-67	Y₄	低表达＝0；高表达＝1
组织学分级	Y₅	1/2级＝0；3级＝1
病灶直径	Y₆	<20 mm＝0；≥20 mm＝1

变量	变量类型	赋值
增强速度	X₁	同步＝0；快速＝1
增强程度	X₂	低/等增强＝0；高增强＝1
灌注缺损	X₃	无＝0；有＝1
增强后范围	X₄	无改变＝0；增大＝1
ER	Y₁	阴性＝0；阳性＝1
PR	Y₂	阴性＝0；阳性＝1
HER-2	Y₃	阴性＝0；阳性＝1
Ki-67	Y₄	低表达＝0；高表达＝1
组织学分级	Y₅	1/2级＝0；3级＝1
病灶直径	Y₆	<20 mm＝0；≥20 mm＝1

临床病理特征	增强速度		增强程度		增强顺序		增强均匀性		增强后边界		穿支血管		灌注缺损		增强后范围
临床病理特征	同步	快速	低/等增强	高增强	离心/弥漫性	向心性	均匀	不均匀	清晰	不清	有	无	有	无	增大	无改变
ER
阴性	1	37	2	36	3	35	6	32	9	29	30	8	23	15	37	1
阳性	6	45	7	44	3	48	11	40	8	43	41	10	26	25	43	8
χ²值	1.405		0.911		0.000		0.471		0.901		0.028		0.802		2.773
P值	0.236^a		0.340^a		1.000^a		0.493		0.342		0.867		0.371		0.096^a
PR
阴性	1	48	2	47	4	45	10	39	10	39	41	8	28	21	47	2
阳性	6	34	7	33	2	38	7	33	7	33	30	10	21	19	33	7
χ²值	3.472		3.011		0.028		0.121		0.121		1.027		0.192		3.011
P值	0.062^a		0.083^a		0.867^a		0.728		0.728		0.311		0.661		0.083^a
HER-2
阴性	7	41	6	42	2	46	8	40	8	40	36	12	28	20	40	8
阳性	0	41	3	38	4	37	9	32	9	32	35	6	21	20	40	1
χ²值	4.633		0.208		0.390		0.400		0.400		1.473		0.452		3.483
P值	0.031^a		0.649^a		0.533^a		0.527		0.527		0.225		0.501		0.062^a
Ki-67
低表达	4	16	5	15	1	19	3	17	1	19	16	4	11	9	15	5
高表达	3	66	4	65	5	64	14	55	16	53	55	14	38	31	65	4
χ²值	3.305		4.355		0.000		0.043		2.247		0.000		0.000		4.355
P值	0.069^a		0.037^a		1.000^a		0.836^a		0.134^a		1.000^a		0.995		0.037^a
组织学分级^b
1/2级	5	49	8	46	2	52	13	41	10	44	43	11	25	29	48	6
3级	1	21	1	21	4	18	4	18	6	16	17	5	16	6	20	2
χ²值	0.049		0.749		2.735		0.065		0.290		0.000		4.395		0.000
P值	0.824^a		0.387^a		0.098^a		0.798^a		0.590^a		1.000^a		0.036		1.000^a
淋巴结状态
阴性	6	38	4	40	1	43	8	36	10	34	36	8	25	19	40	4
阳性	1	44	5	40	5	40	9	36	7	38	35	10	24	21	40	5
χ²值	2.580		0.000		1.537		0.048		0.740		0.225		0.109		0.000
P值	0.108^a		1.000^a		0.215^a		0.827		0.390		0.635		0.741		1.000^a
病灶直径
<20 mm	7	36	7	36	2	41	7	36	4	39	33	10	26	17	38	5
≥20 mm	0	46	2	44	4	42	10	36	11	35	38	8	23	23	42	4
χ²值	6.036		2.292		0.114		0.429		3.386		0.474		0.984		0.011
P值	0.014^a		0.130^a		0.736^a		0.513		0.066		0.491		0.321		0.915^a

临床病理特征	增强速度		增强程度		增强顺序		增强均匀性		增强后边界		穿支血管		灌注缺损		增强后范围
临床病理特征	同步	快速	低/等增强	高增强	离心/弥漫性	向心性	均匀	不均匀	清晰	不清	有	无	有	无	增大	无改变
ER
阴性	1	37	2	36	3	35	6	32	9	29	30	8	23	15	37	1
阳性	6	45	7	44	3	48	11	40	8	43	41	10	26	25	43	8
χ²值	1.405		0.911		0.000		0.471		0.901		0.028		0.802		2.773
P值	0.236^a		0.340^a		1.000^a		0.493		0.342		0.867		0.371		0.096^a
PR
阴性	1	48	2	47	4	45	10	39	10	39	41	8	28	21	47	2
阳性	6	34	7	33	2	38	7	33	7	33	30	10	21	19	33	7
χ²值	3.472		3.011		0.028		0.121		0.121		1.027		0.192		3.011
P值	0.062^a		0.083^a		0.867^a		0.728		0.728		0.311		0.661		0.083^a
HER-2
阴性	7	41	6	42	2	46	8	40	8	40	36	12	28	20	40	8
阳性	0	41	3	38	4	37	9	32	9	32	35	6	21	20	40	1
χ²值	4.633		0.208		0.390		0.400		0.400		1.473		0.452		3.483
P值	0.031^a		0.649^a		0.533^a		0.527		0.527		0.225		0.501		0.062^a
Ki-67
低表达	4	16	5	15	1	19	3	17	1	19	16	4	11	9	15	5
高表达	3	66	4	65	5	64	14	55	16	53	55	14	38	31	65	4
χ²值	3.305		4.355		0.000		0.043		2.247		0.000		0.000		4.355
P值	0.069^a		0.037^a		1.000^a		0.836^a		0.134^a		1.000^a		0.995		0.037^a
组织学分级^b
1/2级	5	49	8	46	2	52	13	41	10	44	43	11	25	29	48	6
3级	1	21	1	21	4	18	4	18	6	16	17	5	16	6	20	2
χ²值	0.049		0.749		2.735		0.065		0.290		0.000		4.395		0.000
P值	0.824^a		0.387^a		0.098^a		0.798^a		0.590^a		1.000^a		0.036		1.000^a
淋巴结状态
阴性	6	38	4	40	1	43	8	36	10	34	36	8	25	19	40	4
阳性	1	44	5	40	5	40	9	36	7	38	35	10	24	21	40	5
χ²值	2.580		0.000		1.537		0.048		0.740		0.225		0.109		0.000
P值	0.108^a		1.000^a		0.215^a		0.827		0.390		0.635		0.741		1.000^a
病灶直径
<20 mm	7	36	7	36	2	41	7	36	4	39	33	10	26	17	38	5
≥20 mm	0	46	2	44	4	42	10	36	11	35	38	8	23	23	42	4
χ²值	6.036		2.292		0.114		0.429		3.386		0.474		0.984		0.011
P值	0.014^a		0.130^a		0.736^a		0.513		0.066		0.491		0.321		0.915^a

临床病理特征	WIS(dB/s)	TTP(s)	PI (dB)	RT(s)	WiUAC (dB·s)
ER
阴性	1.51(1.15，1.96)	15.37(13.64，18.12)	9.31(7.16，13.10)	5.57(4.39，6.56)	54.07(32.48，75.83)
阳性	1.10(0.80，1.82)	16.86(13.29，20.93)	6.66(5.13，9.62)	5.22(4.10，6.70)	38.48(26.55，63.50)
Z值	－2.472	－0.643	－2.870	－0.601	－2.140
P值	0.013	0.520	0.004	0.548	0.032
PR
阴性	1.49(1.14，1.98)	15.35(13.61，18.81)	9.53(7.20，11.87)	5.55(4.35，6.76)	53.78(33.52，76.02)
阳性	1.00(0.76，1.64)	17.24(13.07，20.87)	6.34(5.09，8.84)	5.33(4.20，6.60)	35.78(24.12，60.79)
Z值	－2.965	－0.499	－3.361	－0.466	－2.672
P值	0.003	0.618	0.001	0.641	0.008
HER-2
阴性	1.25(0.88，1.64)	15.80(13.65，20.35)	7.52(5.75，9.60)	5.15(4.07，6.44)	38.52(28.73，57.00)
阳性	1.43(0.99，1.99)	15.94(13.46，19.68)	8.56(6.15，12.85)	5.60(4.50，6.81)	55.72(30.04，79.12)
Z值	－1.436	－0.111	－1.897	－1.103	－2.161
P值	0.151	0.912	0.058	0.270	0.031
Ki-67
低表达	1.00(0.65，1.77)	16.77(12.70，21.61)	6.34(4.25，8.47)	5.09(3.78，6.84)	33.50(18.99，47.70)
高表达	1.43(1.00，1.94)	15.90(13.65，19.04)	8.42(6.20，11.75)	5.41(4.35，6.68)	50.38(31.64，75.75)
Z值	－2.172	－0.039	－2.713	－0.492	－2.620
P值	0.030	0.969	0.007	0.623	0.009
组织学分级^a
1/2级	1.41(0.92，1.92)	16.13(13.32，18.94)	8.12(5.86，11.57)	5.39(4.28，6.81)	47.44(29.20，76.56)
3级	1.40(0.97，1.60)	15.35(13.87，20.80)	8.32(6.20，11.02)	5.82(4.30，6.95)	42.73(32.45，69.68)
Z值	－0.493	－0.338	－0.126	－0.613	－0.069
P值	0.622	0.735	0.900	0.540	0.945
淋巴结状态
阴性	1.36(1.00，1.87)	15.69(13.34，19.30)	7.59(5.33，11.73)	4.97(4.34，6.03)	40.20(29.29，64.27)
阳性	1.35(0.86，1.92)	16.50(13.62，20.08)	7.78(6.15，10.72)	5.73(4.09，7.00)	46.77(31.84，72.39)
Z值	－0.382	－0.234	－0.238	－1.503	－0.866
P值	0.703	0.815	0.812	0.133	0.386
病灶直径
<20 mm	1.33(0.81，1.75)	17.75(13.64，20.93)	7.20(5.52，10.48)	5.36(4.35，6.43)	40.56(24.84，63.50)
≥20 mm	1.42(1.00，1.94)	15.35(13.33，19.15)	8.66(6.17，11.82)	5.42(4.22，6.92)	50.89(30.98，76.56)
Z值	－0.998	－0.895	－1.437	－0.316	－1.404
P值	0.318	0.371	0.151	0.752	0.160

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