超声弹性成像定量指标和半定量评分与乳腺肿瘤成纤维细胞分布的关联性分析

目的:探讨乳腺占位性病变超声弹性成像定量指标和半定量评分与成纤维细胞分布的关联性,阐明超声弹性成像定量指标和半定量评分在乳腺肿瘤诊断中的价值。方法:对38例乳腺占位性病变进行超声弹性成像检查,并对弹性图像进行定量分析,获得11个特征量及相应的弹性应变率比值,进行半定量评分,根据病理结果将其分为良性组和恶性组,采用免疫组织化学法分别检测乳腺间质穿膜糖蛋白(CD34)和α-平滑肌肌动蛋白(α-SMA)的表达,分析成纤维细胞在乳腺病变中的分布特征,研究乳腺弹性成像定量评价指标和半定量评分与成纤维细胞分布的关联性。结果:恶性组乳腺组织中CD34表达水平明显低于良性组,而恶性组α-SMA表达水平明显高于良性组,CD34和α-SMA在良性和恶性乳腺占位病变中表达水平比较差异有统计学意义(P<0.01)。 恶性组弹性成像以蓝色为主,良性组弹性成像以绿色为主,2组间弹性成像评分比较差异有统计学意义。CD34在乳腺肿瘤组织中的表达与弹性成像评分呈负相关关系(r=-0.4237,P=0.0273),α-SMA在乳腺肿瘤组织中的表达与弹性成像评分呈正相关性关系(r=0.3970,P=0.0142)。CD34与11个特征量中应变均值及均等性、蓝色区域百分比、峰度、偏度、杂乱度均有相关性(P<0.05),其中与应变均值(r=0.3856,P=0.0168)及均等性(r=0.3805,P=0.0185)呈正相关关系,与蓝色区域百分比(r=-0.3517,P=0.0304)、峰度(r=-0.4277,P=0.0074)、偏度(r=-0.3946,P=0.0142)、杂乱度(r=-0.3443,P=0.0343)、一致性(r=-0.4849,P=0.0020)及弹性应变率比值(r=-0.3790,P=0.0475)呈负相关关系,与标准偏差、复杂度、相关性和对比度无相关性(P>0.05);而α-SMA与峰度(r=0.3569,P=0.0278)和偏度(r=0.3230,P=0.0479)、蓝色区域百分比(r=0.3820,P=0.0216)以及弹性应变率比值(r=0.4033,P=0.0120)有相关性,并呈正相关关系。结论:超声弹性成像定量指标和半定量评分与成纤维细胞在乳腺肿瘤中的分布具有相关性,有助于在术前通过无创手段初步判断患者预后,可为乳腺癌的术前诊断、治疗和手术时机选择提供重要参考依据。

Analysis on correlation between quantitative results and semi-quantitative scores from ultrasound elastography and distribution of myofibroblasts in breast tumor

Objective To investigate the correlation between the quantitative results,the semi-quantitative scores from ultrasound elastography and the distribution of myofibroblasts (MFS)in breast tumor,and to analyze the value of quantitative results and the semi-quantitative score from ultrasound elastography in the diagnosis of breast tumor.Methods Thirty eight patients with breast lesions underwent ultrasound elasticity examinations,tissue dispersion quantitative analysis technique was used to assess the 11 characteristic quantities and the corresponding strain ratios in all lesions,and the score of ultrasonic elastography was evaluated.38 cases were divided into benign and malignant group according to pathological diagnosis results.The expression levels of CD34 andα-SMA protein in breast tissue were examined by immunohistochemistry.The distribution patterns of MFS in breast tumor were analyzed. The correlation between the quantitative results, the semi-quantitative scores from ultrasound elastography and the distribution of MFS in breast tumor was studied.Results The expression level of CD34 in malignant group was significantly higher than that in benign group, while the expression level of α-SMA was significantly higher than that in benign group;the differences in the expression levels of CD34 andα-SMA between benign and malignant breast tumor patients were statistically significant (P < 0.01 ).The masses observed in malignant group by elastography were shown in blue,while most of the masses in benign group were shown in green.There were statistically significant differences between two groups in elastography scores (P < 0.05 ). There was a anegative correlation between the CD34 expression in tumor tissue and the score of ultrasound elastography (r=-0.423 7,P =0.027 3).There was a negative correlation between the CD34 expression and the score of ultrasound elastography (r=-0.423 7,P =0.027 3),while the positive correlation was found between theα-SMA expression and the score of ultrasound elastography (r=0.397 0,P =0.014 2).The CD34 expression was significantly correlated with the average relative strain value,entropy,area ratio of low-strain region,kurtosis, skewness and inverse difference moment (P <0.05).Among the 11 characteristics,CD34 was positively correlated with the average relative strain value (r=0.385 6,P =0.016 8)and entropy (r=0.380 5,P =0.018 5);CD34 was negatively correlated with area ratio of low-strain region (r = - 0.351 7,P = 0.030 4),kurtosis (r =-0.427 7,P =0.007 4),skewness (r=-0.394 6,P =0.014 2),inverse difference moment (r = -0.344 3, P =0.034 3),angular second moment (r = - 0.484 9,P = 0.002 0)and strain ration (r = - 0.379 0,P =0.047 5);CD34 was not correlated with standard deviation,complexity and contrast (P > 0.05).The α-SMA espression was positively correlated with kurtosis (r = 0.356 9,P = 0.027 8),skewness (r = 0.323 0,P =0.047 9),area ratio of low-strain region (r=0.382 0,P =0.021 6)and strain ratio (r=0.403 3,P =0.012 0). Conclusion The features and its scores of ultrasound elastography are correlated with the distribution of MFS in breast tumor,suggesting that the ultrasound elastography is very informative and helpful in the diagnosis of breast tumor.