超声造影对不同分子分型乳腺癌的诊断价值

目的探讨超声造影特征及时间-强度曲线定量参数在不同分子分型乳腺癌中的差异性。方法回顾性分析142例乳腺癌患者（142个癌灶）的超声造影资料；根据雌激素受体、孕激素受体、人表皮生长因子受体-2（HER-2）、Ki-67的表达状态，将乳腺癌分为Luminal A、B型（管腔上皮型）、三阴型、HER-2过表达型4个分型，分析不同分子分型乳腺癌患者的超声造影特征及时间-强度曲线定量参数。结果Luminal A型表现为低或等增强比例为80.8%（21/26），出现放射状汇聚比例为69.2%（18/26）；Luminal B型出现低或等增强比例为60.3%（35/58），出现放射状汇聚比例为56.9%（33/58）；HER-2过表达型出现高增强比例为90.0%（27/30），内部出现灌注缺损比例为73.3%（22/30），周边有穿入血流比例为70.0%（21/30），三阴型表现为高增强比例为92.9%（26/28），增强后边界清楚比例为92.8%（26/28）。不同分子分型乳腺癌在增强边界、增强强度、穿入血流、灌注缺损比较差异均有统计学意义（P<0.05），而在增强后范围扩大、造影剂分布、造影剂增强顺序、造影模式与分子分型表达差异无统计学意义（P>0.05）；三阴型、HER-2过表达型峰值强度高于Luminal A型和Luminal B型，差异有统计学意义（P<0.05），而不同分子分型乳腺癌病灶达峰时间、平均渡越时间、曲线下面积、消除斜率比较差异均无统计学意义（P>0.05）。结论不同分子分型乳腺癌超声造影特征存在差异，可为术前乳腺癌分子分型预测提供有价值的影像学信息。 

Comparative study of contrast-enhanced ultrasound in different molecular breast cancers

ObjectiveTo explore the differences between contrast-enhanced features and time-intensity curve quantitative parameters in different molecular types of breast cancer.MethodsWe retrospectivly analyzed 142 cases of breast cancer patients (142 tumors) by contrast-enhanced data. The estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 (HER-2), Ki-67 expression status were analyzed. The breast cancer were divided into four types: Luminal A, B (luminal epithelium), triple negative, and HER-2 overexpression. The contrast-enhanced features and time-intensity curve of breast cancer patients with different molecular classification were analyzed.ResultsLuminal type A showed a low or equal enhancement ratio of 80.8% (21/26), with a radial aggregation ratio of 69.2% (18/26). Luminal type B showed a low or equal enhancement ratio of 60.3% (35/58). The proportion of radial aggregation was 56.9% (33/58). The ratio of high enhancement of HER-2 overexpression was 90.0% (27/30), and the proportion of internal perfusion defect was 73.3% (22/30). The proportion of blood flow was 70.0% (21/30). The proportion of triple-yin showed high enhancement rate was 92.9% (26/28), and the clear ratio of enhanced boundary was 92.8% (26/28). The differences of the enhancement of borderline, enhancement intensity, perforation blood flow and perfusion defects between different molecular types of breast cancer were significant (P<0.05). But the differences of range of enhancement, contrast agent distribution, contrast agent enhancement sequence between angiographic pattern and molecular typing were not significant (P>0.05).ConclusionThere are differences in the features of contrast-enhanced ultrasound in different molecular types of breast cancer. It can provide valuable imaging information for preoperative prediction of breast cancer molecular classification.