The application value of ultrasound BI-RADS classification combined with serum FGFR1 and GDF3 in the differential diagnosis of benign and malignant breast masses

doi:10.11958/20241974

Abstract

Abstract:

Objective To explore the application value of combining the ultrasound breast imaging reporting and data system (BI-RADS) classification with serum fibroblast growth factor receptor 1 (FGFR1) and growth differentiation factor 3 (GDF3) in the differential diagnosis of benign and malignant breast masses. Methods A total of 159 patients with breast masses were selected and divided into the benign mass group (n=83) and the malignant mass group (n=76) based on postoperative pathological diagnosis. All patients underwent ultrasound examination, and enzyme-linked immunosorbent assay (ELISA) was applied to detect serum levels of FGFR1 and GDF3. Receiver operating characteristic (ROC) curve was applied to analyze the diagnostic value of ultrasound BI-RADS classification and serum FGFR1 and GDF3 levels for benign and malignant breast masses. Kappa test was applied to analyze the consistency between various diagnostic methods and pathological diagnosis. Results The serum levels of FGFR1 and GDF3, the proportions of irregular morphology, unclear boundaries, spiculation, microcalcifications, blood flow grade Ⅱ-Ⅲ and posterior echo attenuation, RI and PI were higher in the malignant tumor group than those in the benign tumor group (P<0.05). The area under the curve (AUC) of FGFR1, GDF3 and ultrasound BI-RADS classification in the differential diagnosis of benign and malignant breast masses separately and in combination was 0.802 (95%CI: 0.732-0.871), 0.817 (95%CI: 0.751-0.884), 0.848 (95%CI: 0.784-0.912) and 0.956 (95%CI: 0.918-0.993), respectively. The combined diagnosis was more effective than that of the individual diagnosis of each indicator. The consistency between the individual and combined diagnosis of benign and malignant breast masses and pathological diagnosis showed that the Kappa values were 0.517, 0.514, 0.688 and 0.912, respectively, with the highest consistency observed in the combined diagnosis (P<0.05). Conclusion Ultrasound BI-RADS classification combined with serum FGFR1 and GDF3 has high application value in the differential diagnosis of benign and malignant breast masses.

Key words: breast neoplasms, ultrasonography, receptor, fibroblast growth factor, type 1, growth differentiation factor 3, diagnosis, differential, breast lump, breast imaging reporting and data system

CLC Number:

R445.1，R737.9

Figures/Tables 6

References 24

[1]	XIA C, DONG X, LI H, et al. Cancer statistics in China and United States,2022:profiles,trends,and determinants[J]. Chin Med J, 2022, 135(5):584-590. doi:10.1097/CM9.0000000000002108.
[2]	SUNG H, FERLAY J, SIEGEL R L, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249. doi:10.3322/caac.21660.
[3]	WANG Y, LI Y, SONG Y, et al. Comparison of ultrasound and mammography for early diagnosis of breast cancer among Chinese women with suspected breast lesions:A prospective trial[J]. Thorac Cancer, 2022, 13(22):3145-3151. doi:10.1111/1759-7714.14666.
[4]	TADESSE G F, TEGAW E M, ABDISA E K. Diagnostic performance of mammography and ultrasound in breast cancer:a systematic review and meta-analysis[J]. J Ultrasound, 2023, 26(2):355-367. doi:10.1007/s40477-022-00755-3.
[5]	YU Y, YE X, YANG J, et al. Application of a shear-wave elastography prediction model to distinguish between benign and malignant breast lesions and the adjustment of ultrasound breast imaging reporting and data system classifications[J]. Clin Radiol, 2022, 77(2):147-153. doi:10.1016/j.crad.2021.10.016.
[6]	荣鹿, 周敏, 于鲁欣, 等. 超声造影参数联合血清FGF23和FGFR1水平检测对乳腺癌的临床诊断价值研究[J]. 现代检验医学杂志, 2023, 38(5):185-189.
	RONG L, ZHOU M, YU L X, et al. Clinical diagnostic value of contrast-enhanced ultrasound parameterscombined with serum FGF23 and FGFR1 levels in breast cancer[J]. J Mod Lab Med, 2023, 38(5):185-189. doi:10.3969/j.issn.1671-7414.2023.05.035.
[7]	王智宝, 孙宏, 崔伟, 等. 多模态磁共振成像联合血清GDF3、HSP90A诊断乳腺癌的临床价值[J]. 中国CT和MRI杂志, 2023, 21(8):85-87.
	WANG Z B, SUN H, CUI W, et al. Clinical value of multimodal magnetic resonance imaging combined with serum GDF3 and HSP90A in the diagnosis of breast cancer[J]. Chinese Journal of CT and MRI, 2023, 21(8):85-87. doi:10.3969/j.issn.1672-5131.2023.08.027.
[8]	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2021年版)[J]. 中国癌症杂志, 2021, 31(10):954-1040.
	Breast Cancer Professional Committee of China Anti Cancer Association. Guidelines and specifications for breast cancer diagnosis and treatment of China Anti Cancer Association(2021)[J]. China Oncology, 2021, 31(10):954-1040. doi:10.19401/j.cnki.1007-3639.2021.10.013.
[9]	HEINIG J, WITTELER R, SCHMITZ R, et al. Accuracy of classification of breast ultrasound findings based on criteria used for BI-RADS[J]. Ultrasound Obstet Gynecol, 2008, 32(4):573-578. doi:10.1002/uog.5191.
[10]	LI X, SUN W, ZHANG H. The value of elastography strain rate ratio in benign and malignant BI-RADS-US 3-4 breast masses[J]. Biomol Biomed, 2024, 24(3):625-632. doi:10.17305/bb.2023.9878.
[11]	XUE F, MENG Y, JIANG J. Diagnostic value of dynamic enhanced magnetic resonance imaging combined with serum CA15-3,CYFRA21-1,and TFF1 for breast cancer[J]. J Healthc Eng, 2022,2022:7984591. doi:10.1155/2022/7984591.
[12]	满祎, 许娅, 何先成, 等. 三阴性乳腺癌EGFR、Ki-67、P53及CTC表达与预后的关系研究[J]. 天津医药, 2024, 52(8):862-867.
	MAN Y, XU Y, HE X C, et al. Relationship between expression levels of EGFR,Ki-67,P53 and CTC and the prognosis of triple negative breast cancer[J]. Tianjin Med J, 2024, 52(8):862-867. doi:10.11958/20231529.
[13]	LITTRUP P J, MEHRMOHAMMADI M, DURIC N. Breast tomographic ultrasound:the spectrum from current dense breast cancer screenings to future theranostic treatments[J]. Tomography, 2024, 10(4):554-573. doi:10.3390/tomography10040044.
[14]	RADAK M, LAFTA H Y, FALLAHI H. Machine learning and deep learning techniques for breast cancer diagnosis and classification:a comprehensive review of medical imaging studies[J]. J Cancer Res Clin Oncol, 2023, 149(12):10473-10491. doi:10.1007/s00432-023-04956-z.
[15]	周永刚, 孙汶齐, 邢长洋, 等. 超声BI-RADS分类联合血浆外泌体miRNA在乳腺肿块良恶性鉴别诊断中的应用[J]. 中国超声医学杂志, 2021, 37(12):1340-1344.
	ZHOU Y G, SUN W Q, XING C Y, et al. Application of ultrasound BI-RADS classification combined with plasma exosomal miRNA in the differential diagnosis of benign and malignant breast masses[J]. Chinese J Ultrasound Med, 2021, 37(12):1340-1344. doi:10.3969/j.issn.1002-0101.2021.12.006.
[16]	张耀辉, 郑章增, 高星. 超声BI-RADS分类联合SWE技术鉴别诊断乳腺肿块良恶性的价值研究[J]. 实用癌症杂志, 2022, 37(10):1689-1691.
	ZHANG Y H, ZHENG Z Z, GAO X. Study on the value of ultrasound BI-RADS classification combined with SWE technology in differential diagnosis of benign and malignant breast masses[J]. The Practical Journal of Cancer, 2022, 37(10):1689-1691. doi:10.3969/j.issn.1001-5930.2022.10.033.
[17]	SHI Y, MA Z, CHENG Q, et al. FGFR1 overexpression renders breast cancer cells resistant to metformin through activation of IRS1/ERK signaling[J]. Biochim Biophys Acta Mol Cell Res, 2021, 1868(1): 118877. doi:10.1016/j.bbamcr.2020.118877.
[18]	BOFIN A M, YTTERHUS B, KLÆSTAD E, et al. FGFR1 copy number in breast cancer:associations with proliferation,histopathological grade and molecular subtypes[J]. J Clin Pathol, 2022, 75(7):459-464. doi:10.1136/jclinpath-2021-207456.
[19]	SERVETTO A, KOLLIPARA R, FORMISANO L, et al. Nuclear FGFR1 regulates gene transcription and promotes antiestrogen resistance in ER+ breast cancer[J]. Clin Cancer Res, 2021, 27(15):4379-4396. doi:10.1158/1078-0432.CCR-20-3905.
[20]	MASURKAR N, BOUVET M, LOGEART D, et al. Novel cardiokine GDF3 predicts adverse fibrotic remodeling after myocardial infarction[J]. Circulation, 2023, 147(6):498-511. doi:10.1161/CIRCULATIONAHA.121.056272.
[21]	MOGHADDAM S T, FORGHANIFARD M M. Clinicopathological relevance of stem cell marker growth and differentiation factor 3 in esophageal squamous cell carcinoma[J]. Explor Target Antitumor Ther, 2023, 4(2):217-226. doi:10.37349/etat.2023.00130.
[22]	WANG L, LI Y, WANG X, et al. GDF3 protects mice against sepsis-induced cardiac dysfunction and mortality by suppression of macrophage pro-inflammatory phenotype[J]. Cells, 2020, 9(1):120. doi:10.3390/cells9010120.
[23]	ZEKRI A N, BAHNASSY A, MOURAD M, et al. Genetic profiling of different phenotypic subsets of breast cancer stem cells (BCSCs) in breast cancer patients[J]. Cancer Cell Int, 2022, 22(1):423. doi:10.1186/s12935-022-02841-2.
[24]	王绪麟, 孟娟, 李慧璇, 等. 彩色多普勒超声结合血清CA153,MUC1,GDF3对早期乳腺癌的诊断价值研究[J]. 现代生物医学进展, 2023, 23(16):3169-3172.
	WANG X L, MENG J, LI H X, et al. Diagnostic value study of color doppler ultrasound combined with serum CA153,MUC1 and GDF3 in early breast cancer[J]. Progress in Modern Biomedicine, 2023, 23(16):3169-3172. doi:10.13241/j.cnki.pmb.2023.16.033.

组别			n	年龄/岁					BMI/（kg/m²）
良性肿块组			83	50.24±10.68					22.79±3.04
恶性肿块组			76	50.33±10.82					22.91±2.95
t				0.053					0.252
组别		饮酒史				糖尿病	高血压			冠心病
良性肿块组		12（14.46）				5（6.02）	31（37.35）			13（15.66）
恶性肿块组		15（19.74）				7（9.21）	36（47.37）			10（13.16）
χ²		0.784				0.577	1.633			0.201
组别	TG/ （mmol/L）				TC/ （mmol/L）			LDL-C/ （mmol/L）			HDL-C/ （mmol/L）
良性肿块组	1.67±0.42				5.04±1.26			1.89±0.47			1.10±0.22
恶性肿块组	1.62±0.38				5.12±1.33			1.82±0.51			1.09±0.25
t	0.785				0.389			0.901			0.268

组别			n	年龄/岁					BMI/（kg/m²）
良性肿块组			83	50.24±10.68					22.79±3.04
恶性肿块组			76	50.33±10.82					22.91±2.95
t				0.053					0.252
组别		饮酒史				糖尿病	高血压			冠心病
良性肿块组		12（14.46）				5（6.02）	31（37.35）			13（15.66）
恶性肿块组		15（19.74）				7（9.21）	36（47.37）			10（13.16）
χ²		0.784				0.577	1.633			0.201
组别	TG/ （mmol/L）				TC/ （mmol/L）			LDL-C/ （mmol/L）			HDL-C/ （mmol/L）
良性肿块组	1.67±0.42				5.04±1.26			1.89±0.47			1.10±0.22
恶性肿块组	1.62±0.38				5.12±1.33			1.82±0.51			1.09±0.25
t	0.785				0.389			0.901			0.268

组别	n	FGFR1/（μg/L）	GDF3/（ng/L）
良性肿块组	83	7.45±2.32	92.38±24.12
恶性肿块组	76	11.75±3.68	129.85±35.71
t		8.891^＊	7.811^＊

组别	n	FGFR1/（μg/L）	GDF3/（ng/L）
良性肿块组	83	7.45±2.32	92.38±24.12
恶性肿块组	76	11.75±3.68	129.85±35.71
t		8.891^＊	7.811^＊

组别	n	形态不规则	边界不清晰	有毛刺征	有微钙化灶
良性肿块组	83	27（32.5）	22（26.5）	25（30.1）	13（15.7）
恶性肿块组	76	68（89.5）	66（86.8）	55（72.4）	42（55.3）
χ²		53.490^＊	58.439^＊	28.326^＊	27.498^＊
组别	血流分级（0—Ⅰ级/Ⅱ—Ⅲ级）		后方回声衰减	RI	PI
良性肿块组	56/27		10（12.1）	0.64±0.11	0.89±0.21
恶性肿块组	30/46		36（47.4）	0.76±0.15	1.64±0.41
χ²或t	12.522^＊		24.071^＊	5.785^＊	14.695^＊