超声造影和超声弹性成像特征与乳腺癌HER-2表达的相关性分析

Correlation analyses between the ultrasound contrast feature and HER-2 expression,and between the ultrasound elastography feature and that in breast cancer

目的:分析超声造影和超声弹性成像技术特征与乳腺癌分子生物学指标人类表皮生长因子受体2(HER-2)表达的相关性。方法:抽样选取2019年2月至2022年6月南京医科大学附属苏州医院及佳木斯大学附属第-院收治的63例女性浸润性乳腺癌患者,采用免疫组织化学方法检测患者乳腺癌分子生物学指标HER-2阳性表达情况,根据免疫组织化学结果将患者分为阳性组(22例)和阴性组(41例)。所有患者均接受超声造影与超声弹性成像检查,分析比较两组患者超声造影与超声弹性成像特征差异,采用二元logistic回归分析HER-2表达阳性的影响因素,依据受试者工作特征(ROC)曲线,评估超声造影与超声弹性成像特征单独及联合预测HER-2阳性的价值。结果:两组患者超声弹性成像特征比较有显著差异,HER-2阳性患者成像特征显示形态为不规则、边缘呈毛刺征占比分别为86.4%、77.3%,显著大于HER-2阴性组患者(58.5%、51.2%),差异有统计学意义(x^(2)=5.117、4.060,P<0.05)。两组患者超声造影特征比较差异显著,HER-2阳性患者造影特征显示有滋养血管、造影后病灶扩大≥3 cm占比分别为77.3%、81.8%,显著大于HER-2阴性组患者患者(41.5%、39.0%),差异有统计学意义(x^(2)=7.390、10.554,P<0.05)。以超声造影与超声弹性成像特征(形态、边缘、滋养血管、造影后病灶变大)为自变量,HER-2阳性表达为因变量,logistic回归分析显示,形态规则、边缘光滑、无滋养血管以及造影后病灶变大<3 cm是乳腺癌患者HER-2阳性表达的保护因素(OR=0.185、0.199、0.070、0.186,P<0.05)。超声造影与超声弹性成像特征(形态、边缘、滋养血管、造影后病灶变大)单独预测乳腺癌患者HER-2阳性表达ROC曲线下面积为0.630、0.639、0.679和0.714,联合预测曲线下面积为0.874。结论:超声造影与超声弹性成像特征中形态、边缘,以及滋养血管、造影后病灶变大均为乳腺癌患者HER-2阳性的影响因素,术前采用超声造影、超声弹性成像进行联合评估对预测HER-2表达有一定临床参考价值。

Objective:To analyze the correlations between the ultrasound contrast features and the expression of human epidermal growth factor receptor 2(HER-2)of molecular biological indicators of breast cancer,and between ultrasound elastography features and that.Methods:A total of 63 patients with invasive breast cancer who admitted to The Affiliated Suzhou Hospital of Nanjing Medical University and The First Affiliated Hospital of Jiamusi University from February 2019to June 2022 were selected as the study subjects.The HER-2 positive expression of molecular biological indicator of breast cancer was measured by immunohistochemistry.According to the immunohistochemical results,the patients were divided into positive group(22 cases)and negative group(41 cases).All patients underwent examinations of ultrasound contrast and ultrasound elastography.The differences of the features of ultrasound contrast and ultrasound elastography between the two groups were analyzed and compared.The influencing factors of HER-2 positive expression were analyzed by binary logistic regression,and the receiver operating curve(ROC)was established to assess respectively the values of single ultrasound contrast,single ultrasound elastography and the combination of them in predicting HER-2 positive expression.Results:There was significant differences in the features of ultrasound elastography between the two groups.The ratios of the irregular shape and burr at the edge of the imaging features of the patients with HER-2 positive expression were significantly higher than those of the patients with HER-2 negative expression[(86.4%vs.58.5%)and(77.3%vs.51.2%)],and the differences were statistically significant(x^(2)=5.117,4.060,P<0.05),respectively.The difference of the features of ultrasound contrast between two groups was significant.The ratios of nourishing vessels,and the lesion enlargement≥3 cm after angiography in patients with HER-2positive expression were significantly higher than those in the patients with HER-2 negative expression[(77.3%vs.41.5%)and(81.8%vs.39.0%)],the differences were statistically significant(x^(2)=7.390,10.554,P<0.05),respectively.The features(shape,edge,nourishing vessels and lesion enlargement after contrast)of ultrasound contrast and ultrasound elastography were used respectively as independent variables,and the HER-2 positive expression was used as dependent variables.The logistic regression analysis showed that regular shape,smooth edge,without nourishing vessels and enlarged lesion<3 cm after angiography were protective factors for HER-2 positive expression of patients with breast cancer(OR=0.185,0.199,0.070,0.186,P<0.05),respectively.The areas under curve(AUC)values of the ROC curve of imaging features(shape,edge,nourishing vessels,and lesion enlargement after angiography)of ultrasound contrast and ultrasound elastography were respectively 0.630,0.639,0.679 and 0.714 in single predicting HER-2 positive expression of patients with breast cancer,and that of the combination of them was 0.874 in prediction.Conclusion:In features of ultrasound contrast and ultrasound elastography,the shape,edge,nourishing vessels and the enlargement lesion after contrast were the influencing factors of HER-2 positive expression in patients with breast cancer.The combined assessment of ultrasound contrast and ultrasound elastography before surgery has certain clinical reference value in predicting HER-2 expression.