超声造影时间-强度曲线与乳腺癌血管生成拟态生成及区域分布的相关性分析

The relationship between contrast enhanced ultrasound and vasculogenic mimicry genesis and distribution

目的:探讨超声造影(contrast enhanced ultrasound,CEUS)时间-强度曲线(time intensity curve,TIC)与乳腺癌血管生成拟态(vasculogenic mimicry,VM)生成及区域分布的相关性。方法:选取2016年1月—2018年12月经手术病理证实为乳腺浸润性导管癌患者167例。所有患者手术前均行常规超声及CEUS检查,记录患者临床病理特征、CD34/PAS双染色结果、乳腺肿瘤边缘区、中央区和乳腺病灶旁正常组织的始增时间(initial time,IT)、峰值强度(peak intensity,PI)、达峰时间(peak time,PT)、上升斜率(rising slope,RS)、消除斜率(descending slope,DS)、平均渡越时间(mean transit time,MTT)、曲线下面积(area under curve,AUC)。t检验或χ^2分析比较VM阳性组和阴性组特征的差异,ANOVA方差分析乳腺病灶边缘区、中央区和乳腺病灶旁正常组织的差异。结果:VM阳性组患者病理分级以Ⅱ、Ⅲ级为主,发生淋巴结转移更为常见(P<0.05)。TIC结果显示VM阳性组患者PI明显增高、PT显著缩短、AUC明显增大(P<0.05)。此外,VM阳性组患者肿瘤边缘区、中心区和乳腺病灶旁正常组织IT、PT、AUC差异具有统计学意义(P<0.05),而VM阴性组患者仅PI、AUC具有统计学差异(P<0.05)。结论:VM阳性乳腺癌恶性程度更高,发生淋巴结转移更为常见。VM阳性乳腺病灶及其边缘区CEUS TIC显示PT显著缩短、AUC明显增大。CEUS可作为VM生成和分布的有效评估方法。

Objective To investigate the relationship between contrast enhanced ultrasound(CEUS)with time intensity curve(TIC)and vasculogenic mimicry(VM)genesis and distribution.Methods 167 patients confirmed as breast invasive cancer were enrolled between January 2016 and December 2018.The B mode ultrasound and CEUS were performed.The clinicopathological characters,CD34/PAS staining results,the TIC parameters of initial time(IT),peak intensity(PI),peak time(PT),rising slope(RS),descending slope(DS),mean transit time(MTT)and area under curve(AUC)of marginal zone,central zone and normal tissue adjacent to breast lesions were recorded.t test or χ^2 test were used to analyze the difference between VM positive and VM negative lesions.The ANOVA analysis was used for evaluating the differences among marginal zone,central zone and normal tissue adjacent to breast lesions.Results The majority of VM positive lesions showed the higher histopathological grade and lymph node metastasis(P<0.05).The TIC parameters of IT,PT and AUC were significantly different among marginal zone,central zone and normal tissue adjacent to breast lesions in VM positive group(P<0.05),while the PI and AUC were significantly different in VM negative group(P<0.05).Conclusions The VM positive breast cancer showed higher aggressive character and more lymph node metastasis.VM positive cancer and the marginal zone of VM positive cancer showed shorter PT and higher AUC.CEUS is a useful method for evaluating the genesis and distribution of VM.