Diagnostic and prognostic values of contrast‑enhanced ultrasound combined with diffusion‑weighted magnetic resonance imaging in different subtypes of breast cancer

Abstract

The present study aimed to investigate the diagnostic and prognostic values of contrast‑enhanced ultrasound (CEUS) combined with diffusion‑weighted magnetic resonance imaging (DW‑MRI) in different subtypes of breast cancer (BC). CEUS and DW‑MRI were conducted in 232 patients with BC prior to surgical treatment. Patients were categorized as having the luminal A subtype, the luminal B subtype, triple‑negative subtype or the human epidermal growth factor receptor 2 (Her‑2)‑positive subtype according to their expression of the estrogen receptor (ER), progesterone receptor (PR) and Her‑2, as detected by immunohistochemistry. The CEUS and DW‑MRI parameters of patients with different subtypes of BC were obtained and analyzed. The risk factors for the prognosis of patients with different subtypes of BC were analyzed using Kaplan‑Meier and COX regression analyses. The diagnostic accuracy rate of CEUS combined with DW‑MRI (93.10%) was higher than that of CEUS (88.79%) or DW‑MRI (82.33%) alone. The local recurrence rate and distant metastasis rate of the Her‑2‑positive subtype were the highest among all the subtypes. Furthermore, patients with Her‑2‑positive BC exhibited a higher proportion of lesions with indistinct margins and histological grade III. Lymph node metastasis and BC subtype were independent risk factors for the prognosis of BC. The overall survival and disease‑free survival of patients with the luminal A subtype were higher than those of patients with the Her‑2‑positive subtype. The results of the current study therefore indicate that CEUS combined with DW‑MRI is more effective at diagnosing the different subtypes of BC than either CEUS or DW‑MRI alone.

Figure 1

Expression of ER, PR and Her-2 in different subtypes of breast cancer in the nucleus as detected by immunohistochemistry. Positive expression was indicated by brown/yellow staining while negative expression was indicated by blue staining. Sections were visualized using a magnification of ×200; magnified sections of the images are the distinct part of the tissue specificity and visualized at a magnification of ×400. Black arrows point to cells that positively expressed ER; red arrows point to cells that positively expressed PR and the blue arrow points to cells that positively expressed Her-2. ER, estrogen receptor; PR, progesterone receptor; Her-2, human epidermal growth factor receptor 2.

Figure 2

DW-MRI and ADC images of patients with different subtypes of BC. (A-a) DW-MRI and (A-b) ADC images from a 29-year-old female patient with the luminal A subtype of BC; (B-a) DW-MRI and (B-b) ADC images from a 54-year-old female patient with the luminal B subtype of BC; (C-a) DW-MRI and (C-b) ADC images from a 62-year-old female patient with the Her-2-positive subtype of BC; (D-a) DW-MRI and (D-b) ADC images from a 38-year-old female patient with the triple negative subtype of BC. DW-MRI, magnetic resonance diffusion-weighted imaging; ADC, apparent diffusion coefficient; BC, breast cancer.

Figure 3

Kaplan-Meier curves of OS and DFS in patients with different subtypes of breast cancer. (A) The ROC for DFS in all subtypes of BC; (B) the ROC for OS in all subtypes of BC; ROC, receiver operating characteristic; CEUS, contrast-enhanced ultrasound; DW-MRI, diffusion-weighted magnetic resonance imaging; OS, overall survival; DFS, disease-free survival.