Correlation between conventional ultrasound features combined with contrast-enhanced ultrasound patterns and pathological prognostic factors in malignant non-mass breast lesions

Article type: Research Article

Authors: Wang, Tong^{a; 1} | Guo, Wenjuan^{a; b; 1} | Zhang, Xuemei^c | Ma, Ji^a | Li, Fang^a | Zheng, Siqi^a | Zhu, Miao^a | Dong, Yi^{b; *} | Bai, Min^{a; *}

Affiliations: [a] Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China | [b] Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China | [c] Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

Correspondence: [*] Corresponding authors: Min Bai, PhD, 100 Haining Road, Department of Ultrasound, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. E-mail: baimin101@126.com. and Yi Dong, PhD, 1665 Kongjiang road, Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. E-mail: drdaisydong@hotmail.com.

Note: [1] Tong Wang and Wenjuan Guo contributed equally to this work.

Abstract: OBJECTIVE:To investigate the correlation between ultrasound performance and prognostic factors in malignant non-mass breast lesions (NMLs). MATERIALS AND METHODS:This study included 106 malignant NMLs in 104 patients. Different US features and contrast enhancement patterns were evaluated. Prognostic factors, including histological types and grades, axillary lymph node and peritumoral lymphovascular status, estrogen and progesterone receptor status and the expression of HER-2 and Ki-67 were determined. A chi-square test and logistic regression analysis were used to analyse possible associations. RESULTS:Lesion size (OR: 3.08, p = 0.033) and posterior echo attenuation (OR: 8.38, p < 0.001) were useful in reflecting malignant NMLs containing an invasive carcinoma component. Posterior echo attenuation (OR: 7.51, p = 0.003) and unclear enhancement margin (OR: 6.50, p = 0.018) were often found in tumors with axillary lymph node metastases. Peritumoural lymphovascular invasion mostly exhibited posterior echo attenuation (OR: 3.84, p = 0.049) and unclear enhancement margin (OR: 8.68, p = 0.042) on ultrasound images. Perfusion defect was a comparatively accurate enhancement indicator for negative ER (OR: 2.57, p = 0.041) and PR (OR: 3.04, p = 0.008) expression. Calcifications (OR: 3.03, p = 0.025) and enlarged enhancement area (OR: 5.36, p = 0.033) imply an increased risk of positive HER-2 expression. Similarly, Calcifications (OR: 4.13, p = 0.003) and enlarged enhancement area (OR: 11.05, p < 0.001) were valid predictors of high Ki-67 proliferation index. CONCLUSION:Ultrasound performance is valuable for non-invasive prediction of prognostic factors in malignant NMLs.

Keywords: Malignant non-mass breast lesions, contrast-enhanced ultrasound, prognosis factors

DOI: 10.3233/CH-231936

Journal: Clinical Hemorheology and Microcirculation, vol. 85, no. 4, pp. 433-445, 2023