剪切波弹性成像各向异性与乳腺癌预后因素关系的研究

Study on the relationship between anisotropy and prognostic factors of breast cancer by shear wave elastography

目的探讨剪切波弹性成像(SWE)各向异性与乳腺癌病灶大小、组织学分级、淋巴结受累情况,以及免疫组化标志物表达等预后因素之间的关系。方法选取经手术及病理确诊的69例乳腺癌患者(共73个病灶),术前均行常规超声和SWE检查,记录病灶大小,采集病灶最大直径切面和正交直径切面的弹性图像并获取弹性模量最大值(Emax)、平均值(Emean)及标准差(Esd),计算病灶最硬处与正常脂肪组织比值(Eratio),采用各向异性因子(AF)来量化乳腺癌病灶各弹性参数的各向异性(AFmax、AFmean、AFsd、AFratio)。比较不同大小、组织学分级、淋巴结受累情况及免疫组化标志物表达的病灶弹性参数各向异性的差异。结果73个乳腺癌病灶中,最大径≥18 mm病灶(39个)的AFmax、AFmean、AFsd、AFratio均高于最大径<18 mm病灶(34个),差异均有统计学意义(均P<0.05)。65个浸润性导管癌中,Ⅲ级浸润性导管癌(13个)的AFmax、AFratio均高于Ⅰ、Ⅱ级(14个、38个),Ⅱ、Ⅲ级浸润性导管癌的AFmean均高于Ⅰ级,差异均有统计学意义(均P<0.05)。ER阴性表达病灶的AFmax高于ER阳性表达病灶,Ki-67阳性表达病灶的AFmax、AFmean高于Ki-67阴性表达病灶;淋巴结转移病灶的AFmax、AFmean、AFsd均高于淋巴结未转移病灶,差异均有统计学意义(均P<0.05)。结论病灶较大、组织学分级较高、淋巴结转移、ER阴性和Ki-67阳性表达的乳腺癌病灶弹性参数的各向异性更加显著,可为乳腺癌早期临床诊断及预后评估提供参考依据。

Objective To investigate the relationship between breast cancer anisotropy and prognostic factors such as lesion size,histological grading,lymph node involvement,and expression of immunohistochemical markers by shear wave elastography(SWE).Methods were selected.Preoperative conventional ultrasound and SWE examination were performed,the lesion size was recorded,and elastic images of the maximum diameter section and orthogonal diameter section of the lesions were collected to obtain the maximum elastic modulus(Emax),mean value(Emean)and standard deviation(Esd).The ratio of the hardest part of the lesion to normal adipose tissue(Eratio)was calculated,and anisotropy factor(AF)was used to quantify the anisotropy(AFmax,AFmean,AFsd and AFratio)of elastic parameters of the breast lesions.The differences of anisotropy of lesion elasticity parameters among different histological grades,lymph node involvement and expression of immunohistochemical markers lesions were compared.Results diameter≥18 mm were higher than those of 34 lesions with maximum diameter<18 mm,the differences were statistically significant(all P<0.05).Among 65 invasive ductal carcinomas,the AFmax and AFratio of gradeⅢinvasive ductal carcinoma(13 lesions)were higher than those of gradeⅠandⅡ(14 lesions and 38 lesions),and the AFmean of gradeⅡandⅢinvasive ductal carcinoma were higher than those of gradeⅠ,the differences were statistically significant(all P<0.05).The AFmax of ER negative expression lesions was higher than that of ER positive expression lesions,the AFmax and AFmean of Ki-67 positive expression lesions were higher than those of Ki-67 negative expression lesions,the AFmax,AFmean and AFsd of lymph node metastasis lesions were higher than those of non-metastasis lesions,the differences were statistically significant(all P<0.05).Conclusion grading,lymph node metastasis,ER-negative expression and Ki-67-positive expression,which can provide certain reference for the early clinical diagnosis,treatment and prognosis evaluation of breast cancer.