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

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.