Abstract
This study is to explore the correlation between the contrast-enhanced ultrasound (CEUS) characteristics of breast cancer and the epithelial-mesenchyme transformation (EMT). Totally 119 patients of breast cancer underwent CEUS. Tissues in the active area were collected and subjected to the immunohistochemical detection, PT-PCR and Western blot. Correlation analysis was conducted between the clinical pathological parameters and the CEUS indicators. The expression levels of CD44, N-cadherin, and β-catenin in breast cancer tissues were higher than those in adjacent tissues (P<0.05). However, the expression levels of CD24 and E-cadherin in breast cancer tissues were lower than those in adjacent tissues (P<0.05). There was no significant difference in E-cadherin mRNA and Vimentin levels between cancer and adjacent tissues (P>0.05). The expressions were up-regulated in the CSCs, with higher histological grade, lymph node metastasis, and negative estrogen receptor (ER) expression. Smaller breast tumors, with no lymph node metastasis, lower clinical stage, and positive ER expression, tended to exhibit the up-regulated epithelial phenotype. Breast tumors, with high histological grade, lymph node metastasis, high clinical staging grade, and negative ER expression, tended to exhibit the up-regulated interstitial phenotype. The peak intensity of the time-intensity curve (TIC) for the CEUS was positively correlated with the CSC marker CD44 and the interstitial phenotype marker N-cadherin. The starting time of enhancement was negatively correlated with the N-cadherin. Area under the curve was positively correlated with the expression of CD44 and N-cadherin, while negatively correlated with the epithelial phenotype marker β-catenin. The time to peak was negatively correlated with the interstitial phenotypes Vimentin and N-cadherin, with no correlation with the E-cadherin or β-catenin. Breast cancers show the enlarged lesions after enlargement and perfusion defect for the CEUS. The fast-in pattern, high enhancement, and high perfusion in the TIC are correlated with the CSCs and EMT expressions, suggesting poor disease prognosis.
Highlights
Breast cancer accounts for 23% of the malignant tumors, and early screening and prognosis assessment is of great significance for the breast cancers [1]
The expressions were up-regulated in the Cancer stem cells (CSCs), with higher histological grade, lymph node metastasis, and negative estrogen receptor (ER) expression
The peak intensity of the time-intensity curve (TIC) for the Contrast-enhanced ultrasound (CEUS) was positively correlated with the CSC marker CD44 and the interstitial phenotype marker N-cadherin
Summary
Breast cancer accounts for 23% of the malignant tumors, and early screening and prognosis assessment is of great significance for the breast cancers [1]. Non-invasive assessments for breast are needed for the prognosis of breast cancers. The relationship between the ultrasound features and the biological features of breast cancers has been quantitatively evaluated based on the radiomics, and the accuracy of predicting the hormone receptor expression in breast cancer is as high as 67.7%, indicating that the tumor features could be obtained at the genetic and cellular levels through the ultrasound images [3]. The qualitative CEUS indicators well correlated with the prognostic factors (i.e., the tumor size, histological grade, and clinical stage) have been screened and selected, including the perfusion defect, enhancement range, enhancement degree, and time to peak, peak intensity, starting time of enhancement, and area under the curve [5]
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