Objective: To observe growth orientation of breast masses with contrast-enhanced ultrasonography (CEUS) combined with breast MRI. Methods: A total of 103 patients with conventional ultrasound (CUS) showed non-parallel-orientation growth breast masses were enrolled and divided into benign group (n=35) and malignant group (n=68). Tumor growth orientation shown with CEUS was observed in the same section. Twenty patients underwent MRI, the relationships between mass and adjacent skin were observed and compared with mass location shown on CEUS. Results: After CEUS, growth orientation was changed in 4 cases but not in 31 cases of benign group, while in malignant group, changes of tumor growth orientation was noticed in 59 cases but not in 9 cases, indicating that the growth orientation of malignant tumor was more easily to change than benign ones (χ2=55.210,P<0.001). The sensitivity, specificity, positive predictive value and negative predictive value of CEUS in diagnosis of benign and malignant breast masses was 93.65% (59/63), 77.50% (31/40), 86.76% (59/68) and 88.57% (31/35), respectively. MRI showed consistent Results: with CEUS for growth orientation in 19 cases (P=0.500). CEUS was consistent with MRI in determination of tumor location (Kappa=0.828). Conclusion: Among breast masses CUS showed non-parallel position, most benign ones had some founding in CEUS, but most malignant breast masses showed parallel growth in CEUS. CEUS has good consistency with MRI in determining the orientation of breast masses, which is more reliable than CUS in evaluation on the growth location of breast tumors.

Objective: To investigate the gray-scale CEUS features and diagnostic value of triple negative breast cancer (TNBC). Methods: Data of 37 TNBC patients (TNBC group) and 74 non-triple negative breast cancer (NTNBC) patients (NTNBC group) were retrospectively analyzed. The arrival time and peak time of contrast agent in the mass of gray scale CEUS were observed, and the maximum diameter of the lesion was measured. A total of 11 features of gray scale contrast enhancement were recorded, including internal enhancement features, marginal enhancement features, morphology, margin, internal echoes, peripheral radial vessels, internal filling defects and the number of filling defects, enhancement type, internal and peripheral contorted or penetrating vessels, as well as contrast agent retention. Results: The maximum diameter of lesions in TNBC group was significantly larger than that in NTNBC group ([25.26±10.33]mm vs [18.64±6.11]mm, t=4.445, P<0.001]). Moreover, there were statistically significant difference of marginal enhancement characteristics (χ2=6.518, P=0.011), morphology (χ2=15.686, P<0.001), margin (χ2=12.727, P<0.001), peripheral radial vessels (χ2=50.825, P<0.001), internal filling defects (χ2=5.556, P=0.018) and the number of filling defects (χ2=13.096, P<0.001), enhancement type (χ2=13.072, P<0.001) and contrast agent retention (χ2=17.731, P<0.001) between the two groups. No statistically significant difference was found between the two groups in the other characteristics of gray-scale CEUS (all P>0.05). Conclusion: TNBC lesions are larger than NTNBC in general. Certain characteristics displayed in gray-scale CEUS are helpful to differential diagnosis of TNBC and NTNBC.

Objective:To explore the predictive value of a regression model based on diffusion kurtosis imaging (DKI) parameters for prediction of the recurrence risk in patients with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER-2)-negative early invasive breast cancer.Methods:A retrospective cross-sectional study was designed. The clinicopathological (age, histological grade, Ki-67 level, etc.) and imaging data of 50 patients (50 lesions) with ER-positive, HER-2 negative early invasive breast cancer who underwent treatment at Wuxi People′s Hospital from January 2016 to December 2018 were retrospectively analyzed. All patients were female, aged 29 to 81 years, and underwent pre-operation conventional MRI and DKI examinations. The volume of breast fibroglandular tissue (FGT), background parenchymal enhancement (BPE), and internal enhancement features were recorded; the peak enhancement (PH), peak enhancement rate, time to peak, mean kurtosis (MK), and mean diffusivity (MD) were calculated. Based on the 21-gene recurrence risk scores, patients were divided into low recurrence risk group and medium-high recurrence risk group. Independent sample t test, Mann-Whitney U test, χ2 test were used to compare the differences of various indicators between the two groups. Two logistic models were constructed with age, PH, MD, and MK as independent variables (Pre1), and with Ki-67, age, PH, MD, and MK as independent variables (Pre2), respectively. The efficacy of the models in predicting low recurrence risk in patients was assessed using receiver operating characteristic curve and area under the curve (AUC). Results:There were 25 cases in the low recurrence risk group and 25 cases in the medium-high recurrence risk group. The differences in age, FGT, PH, MD, MK, and Ki-67 between the low recurrence risk group and the medium-high recurrence risk group were statistically significant (all P<0.05), while other indexes showed no statistically significant differences (all P>0.05). The AUC of Pre1 in predicting low recurrence risk of ER-positive, HER-2 negative early invasive breast cancer was 0.87, with a sensitivity of 0.76 and specificity of 0.88. The AUC of Pre2 for predicting the low recurrence risk of ER-positive, HER-2 negative early invasive breast cancer was 0.92, with a sensitivity of 0.84, and specificity of 0.92. Conclusions:A multi-parameter model based on DKI can effectively predict the recurrence risk of ER-positive and HER-2 negative breast cancer. The model with combination of Ki-67 can further improve the predictive efficacy, and help effectively identify patients at low recurrence risk.