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The interaction between breast cancer cells and the tumor microenvironment plays a vital role in the occurrence and development of breast cancer. Cancer-associated fibroblasts are heterogeneous stromal cells that are abundant in the tumor microenvironment. They participate in tumor angiogenesis, treatment resistance and distant metastasis by secreting a variety of cytokines, growth factors and chemokines. It has great potential as a biomarker for targeted therapy and clinical prognosis of breast cancer, and it can also provide new ideas for adjuvant treatment of breast cancer.
ABSTRACT
Objective To study the ultrasonic imaging of breast cancer with or without filling defect with contrast-enhanced ultrasound and clinical pathologic correlation.Methods The suspicious breast lesions underwent contrast-enhanced ultrasound examination, the imaging of 1 1 9 breast cancer with pathological results were retrospectively analyzed,and the contrast enhanced ultrasound effect,distribution of contrast agent,sequence of contrast agent into the tumor,contrast enhanced ultrasound mode,perforator vessel,filling defect and flow classification were observed.Then clinical and pathological data were collected including the tumor size,clinical stage,pathological grade and the situation of micro calcification.The perfusion defect as the grouping factor,there were 37 cases of perfusion defect and 82 cases without perfusion defect.A mono-pactor and multi factor analysis was performed by the logistic regression models to the relationship between perfusion defect and contrast-enhanced ultrasonography,clinical pathological parameters.Results Both mono factor and multifactor analysis displayed that whether to display the filling defect in contrast enhanced ultrasound was associated with ultrasound contrast distribution,the sequence of contrast agent into the tumor and histological grade(χ2=19.5050,21.1210,10.3640,OR =6.977,0.261, 2.509,all P <0.05).Multivariate analysis showed that tumor size and whether to display the filling defect in contrast enhanced ultrasound were close(OR =1.692,P <0.05).Clinical stage,whether the blood flow signal penetrates was meaningful in univariate analysis but excluded in multivariate analysis.Both mono factor and multifactor analysis displayed that contrast enhanced ultrasound mode,contrast enhanced ultrasound effect,flow classification and pathological micro calcification were not associated with whether to display the filling defect.Conclusions Whether to display the filling defect and the related factors of contrast-enhanced ultrasound in diagnosis of benign and malignant were not completely consistent.Breast cancers with filling defects of contrast-enhanced ultrasound tend to present large masses,contrast agent distribution of peripheral enhancement,centripetal filling of ultrasound contrast agents and the higer histological grading.
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Objective To explore the application value of contrast-enhanced ultrasound(CEUS) in evaluating the effect of neoadjuvant chemotherapy(NAC) on breast cancer.Methods Image features of 80 breast cancer patients with neoadjuvant chemotherapy were observed and analyzed by CEUS.In the process,the changes of primary foci before and after neoadjuvant chemotherapy and the changes of qualitative and quantitative indexes of blood perfusion were evaluated.The correlation between qualitative change and pathological response was also studied.Results The change of focus size measured by CEUS was higher than that of conventional ultrasound before and after neoadjuvant chemotherapy(P ＜0.05).However,there was no significant difference between the two measurements before NAC(P ＞ 0.05).All the qualitative observation indexes of the ultrasound contrast after NAC revealed obviously benign conversion(P ＜0.05).Among them,the pathological response was closely related to the changes of the enhancement degree,the distribution of the contrast agent,the order of the contrast and the contrast mode.After NAC,the perfusion parameters of the lesions showed slowly crawl and slowly retreat,low enhancement and the diminished total amount of microcirculation perfusion.Conclusions Before and after neoadjuvant chemotherapy,the changes of the lesion size deteted by CEUS were more close to the pathological evaluation than those detected by conventional ultrasound.The benign outcome of qualitative and quantitative indexes of the CEUS was more obvious than the changes of the lesion size,which had practical value for guiding the neoadjuvant chemotherapy for breast cancer,especially the CEUS indexes related to pathological assessment.
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Objective To investigate whether there are differences of the characteristics of the contrast‐enhanced ultrasound among breast cancer vary in size .Methods The contrast‐enhanced ultrasound perfusion mode were retrospectively analyzed in 113 cases of breast cancer patients with 119 lesions .They were divided into two groups according to the maximum diameter of the lesion based on ultrasound measured ,one group (≤2 0. cm ) 47 cases ,the other group (> 2 0. cm ) 72 cases .The characteristics and mode of contrast‐enhanced ultrasound of the lesion were analyzed ,including whether is greater than the two‐dimensional ultrasound in enhanced range ,enhanced strength ,the distribution of the contrast agent ,contrast agent perfusion sequence in lesions ,contrast mode ,and the existence of perforator vessels and perfusion defects .Results Enhanced strength ,the existence of perforator vessels and perfusion defects associated with the size of the lesions .The breast cancer lesions more than 20 cm were apt to higher enhance strength ,the presence of perfusion defects ,perforator vessels ( P 0 0.5) .Regardless of breast lesions size ,the enhanced range tended to larger than two‐dimensional ultrasound range ,and contrast‐enhanced ultrasound present inhomogeneous ,centrality and integrity filling and perfusion mode of quickly rising and falling .Conclusions Within breast tumor angiogenesis is gradual .With the increase of tumor volume ,more significant vascular heterogeneity ,breast cancer lesion are more prone to uneven high perfusion ,accompanied by perfusion defects and perforating vessels ,but the main sign of differentiating benign and malignant showed consistency between different sized lumps in breast cancer ,which included whether or not contrast mode and enhanced range greater than two‐dimensional ultrasonic range .