结合免疫组化标记物分析超声造影对乳腺癌预后评估的价值

目的：分析与免疫组化标记物预后参数相关的乳腺癌超声造影特征，探讨超声造影对乳腺癌预后评估的价值。方法：于2019年1月至2020年12月，选择温州市中心医院收诊的150例乳腺肿块患者作为研究对象，所有患者均接受常规超声及超声造影检查，以手术和（或）穿刺活检病理为金标准，比较超声造影与常规超声诊断乳腺癌的敏感度、特异度、准确率、阳性预测值、阴性预测值，分析乳腺癌患者超声造影特征与p53、Ki-67、雌激素受体（ER）、孕激素受体（PR）表达的相关性。结果：超声造影在乳腺癌诊断中的敏感度、特异度、准确率、阳性预测值、阴性预测值均高于常规超声（P ＜0.05）。乳腺恶性肿块的超声造影强化程度高于乳腺良性肿块患者（P ＜0.05），乳腺恶性肿块造影剂开始增强时间、达峰时间、峰值消退时间均短于乳腺良性肿块患者（P ＜0.05）。乳腺癌患者超声造影图像中血流灌注缺损与p53、Ki-67阳性表达呈正相关（r =0.814、0.839，P ＜0.05），与ER、PR阳性表达呈负相关（r =-0.780、-0.769，P ＜0.05）；造影后肿瘤范围较造影前扩大与p53、Ki-67阳性表达呈负相关（r =-0.820、-0.841，P ＜0.05），与ER、PR阳性表达呈正相关（r =0.803、0.785，P ＜0.05）；高增强与p53、Ki-67阳性表达呈正相关（r =0.789、0.773，P ＜0.05），与ER、PR阳性表达呈负相关（r =-0.754、-0.781，P ＜0.05）。结论：超声造影能提高乳腺癌术前诊断的准确性，超声造影部分特征性表现与乳腺癌免疫组化指标存在密切关联，反映了乳腺癌的生物学特性，可作为术前无创评估乳腺癌预后的参考指标。

The value of contrast-enhanced ultrasound combined with immunohistochemical markers in the prognostic evaluation of breast cancer

Objective: To investigate the characteristics of contrast-enhanced ultrasound (CEUS) related to the prognostic parameters of immunohistochemical markers in breast cancer, and to explore the value of CEUS in the prognosis evaluation of breast cancer. Methods: From January 2019 to December 2020, 150 patients with breast masses in Wenzhou Central Hospital were selected as subjects. All patients were examined by conventional ultrasound and contrast-enhanced ultrasound. The gold standard was the pathological diagnosis of surgical and/or puncture biopsy. The expressions of p53, Ki-67, estrogen receptor (ER) and progesterone receptor (PR) in patients with breast cancer and benign breast masses were detected by immunohistochemical staining. The correlation between the positive expression of p53, Ki-67, ER and PR and the characteristics of contrast enhanced ultrasound in breast cancer patients were analyzed. Results: The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of contrast-enhanced ultrasound in the diagnosis of breast cancer were significantly higher than those of conventional ultrasound (P<0.05). The peak intensity of breast cancer patients was higher than that of benign breast masses (P<0.05), the time of onset enhancement, the time to peak and the peak extinction time of breast cancer patients were shorter than those of benign breast tumor patients(P<0.05). Blood perfusion defect in contrast-enhanced ultrasound images of breast cancer patients was positively correlated with the positive expression of p53 and Ki-67 (r=0.814, 0.839, P<0.05), but negatively correlated withthe positive expression of ER and PR (r=-0.780, -0.769, P<0.05). The tumor range after contrast was larger than that before, and it was positively correlated with the negative expression of p53 and Ki-67 (r=-0.820, -0.841,P<0.05), but positively correlated with the positive expression of ER and PR (r=0.803, 0.785, P<0.05). The high peak enhancement was positively correlated with the positive expression of p53 and Ki-67 (r=0.789, 0.773,P<0.05), and it was negatively correlated with the positive expression of ER and PR (r=-0.754, -0.781, P<0.05).Conclusion: Contrast-enhanced ultrasound can improve the preoperative diagnostic accuracy of breast cancer.Some characteristics of CEUS are closely correlated with immunohistochemical markers of breast, reflecting the biological characteristics of breast cancer, which can be used as a reference indicator for preoperative noninvasive evaluation of prognosis of breast cancer.