声触诊组织成像定量指标及超声图像特征与乳腺癌分子分型的相关性

Correlation of molecular typing of breast cancer between quantitative indices of virtual touch tissue imaging quantification and ultrasonic image characteristics

目的:探讨常规二维超声和声触诊组织成像定量技术(VTIQ)图像特征及定量指标与乳腺癌不同分子分型的相关性,并分析VTIQ定量指标联合二维超声图像类型在预测乳腺癌分子分型中的价值。方法:纳入2021年1月至2023年2月于广州医科大学附属第三医院乳腺外科就诊的乳腺病变女性患者110例,共112个病变。术前行二维超声及VTIQ检查,记录患者一般资料及超声图像特征。根据术后病理结果将患者分为恶性组与良性组,记录恶性肿瘤分子标记物的表达情况,并根据免疫组化结果将患者分为不同亚型。以乳腺病变的良、恶性及分子分型为因变量,绘制受试者工作特征曲线(ROC),分析剪切波速度最大值(SWVmax)、剪切波速度最小值(SWVmin)、剪切波速度平均值(SMVmean)定量参数对乳腺病变的诊断效能。结果:二维超声图像中肿块边缘、形态、高回声晕、钙化、后方回声、彩色多普勒血流显像(CDFI)的血流分级、VTIQ图像类型及SWVmax、SWVmean、SWVmin对乳腺良、恶性肿瘤鉴别差异具有统计学意义(P<0.05)。乳腺癌不同分子分型中,Luminal A型不易出现淋巴结转移及钙化,VTIQ图像以边缘型为主,SWVmax及SWVmean明显低于非Luminal型(P<0.05)。Her-2过表达型较Luminal A型更易出现钙化,其中SWVmax明显高于Luminal A型,SWVmin明显低于Luminal B型(P均<0.05)。三阴型乳腺癌后方易出现回声增强,VTIQ图像以中央型多见,其中SWVmin明显低于Luminal B型(P<0.05)。VTIQ定量、VTIQ定量联合图像类型、VTIQ定量联合图像类型及二维超声图像特征在乳腺肿瘤良、恶性及乳腺癌分子分型中的诊断效能均逐级提高。结论:VTIQ技术联合二维超声图像特征对乳腺肿瘤良、恶性及乳腺癌分子分型的诊断效能较单一VTIQ技术均有提高,为临床术前无创评估乳腺肿瘤性质提供新思路。

Objective:To investigate the correlation between image features,quantitative indices of conventional two-dimensional ultrasound and Virtual Touch Tissue Imaging Quantification(VTIQ)with different molecular subtypes of breast cancer.Then this study further assesses the value of integrating VTIQ quantitative indices with two-dimensional ultrasound imaging types in predicting molecular subtypes of breast cancer.Methods:A total of 110 cases of female breast diseases(112 lesions)who received medical treatment at the department of breast surgery of the Third Affiliated Hospital of Guangzhou Medical University from January 2021 to February 2023 were included.Preoperative two-dimensional ultrasound and VTIQ examinations were performed,recording patient demographics and ultrasound image characteristics.Patients were divided into malignant and benign groups based on postoperative pathology,with molecular markers expression recorded,and subtyped according to immunohistochemical results.Using the benign and malignant breast lesions and molecular subtypes as dependent variables,receiver operating characteristic(ROC)curves were drawn to analyze the diagnostic efficacy of maximum shear wave velocity(SWVmax),minimum shear wave velocity(SWVmin),and mean shear wave velocity(SWVmean)parameters.Results:Statistical significance(P<0.05)was found for tumor margin,shape,hyperechoic halo,calcification,posterior echo,color Doppler flow imaging(CDFI)blood flow grading,VTIQ image type,and SWVmax,SWVmean,SWVmin in distinguishing between benign and malignant breast tumors.Among different molecular subtypes of breast cancer,Luminal A type was less likely to exhibit lymph node metastasis and calcification,with VTIQ images predominantly showing edge type and SWVmax and SWVmean significantly lower than non-Luminal types(P<0.05).Her-2 overexpression type was more prone to calcification compared to Luminal A type,with SWVmax significantly higher and SWVmin significantly lower than Luminal B type(P<0.05).Triple-negative breast cancer often showed increased posterior echo enhancement,with VTIQ images predominantly central type and SWVmin significantly lower than Luminal B type(P<0.05).The diagnostic efficacy of VTIQ quantitative parameters,VTIQ quantitative parameters combined with image types,and VTIQ quantitative parameters combined with image types and two-dimensional ultrasound image characteristics in identifying benign and malignant breast tumors and molecular subtypes of breast cancer progressively improved.Conclusion:Combining VTIQ technology with two-dimensional ultrasound improves diagnostic efficacy for distinguishing benign and malignant breast tumors and identifying molecular subtypes of breast cancer,offering new perspectives for non-invasive preoperative evaluation.