| Objective: To appreciate the diagnostic values of mammography, color Doppler ultrasonography and MRI for breast-conserving surgery of breast cancer.Methods: 54 female patients with breast cancer, received breast- conserving surgery, were studied. The median age was 48 years (range 32-56 years). All the cases were examined by mammography, color Doppler ultrasonography and MRI before operation. Mammography examination was performed by GE Senographe 2000D Full Field Digital mammography unit with Mo-Rh two-sided target. Color Doppler ultrasonography examination was performed by GE Logiq 9 color Doppler ultrasonography unit. MRI examination was performed by GE 1.5 T HD MRI system with aisle 8 of Vibrant dedicated breast receiver coil. After conventional examination,dynamic enhancement was conducted using GE Vibrant technique for all patients. Applying GE ADW 4.3 workstation,we processed the image. After each inspection, there were two doctors observing the number of lesions, size, location, shape, edge, the relationship between lesions and surrounding tissues, the axillary lymph nodes, and so on. The same work was done in pathological specimen. We observed the pathological grade differentiated of breast lesions and diagnosed the metastasis of axillary lymph nodes under microscope. Moreover, we must observe the expression of c-erbB-2, ER and PR with immunohistochemical staining method. Data was processed by SPSS 10.0 statistical software, the statistical method used X~2 test.Results: After operation, 54 breast lesions were discovered. The number of breast lesions detected by mammography, color Doppler ultrasonography and MRI was 45, 50 and 54. The detection rate was 83.33%, 92.59%, 100% respectively. The average diameter of lesions measured was 16.46±6.76 by pathology,19.42±9.26 by mammography, 14.63±5.82 by color Doppler ultrasonography and 17.69±6.75 by MRI. The correlation was best between MRI and pathology (P<0.05). On the diagnosis of lesion's shape, compared with pathology, the correct-diagnostic rate was 80% by mammography, 84% by color Doppler ultrasonography and 87.03% by MRI. There were 16 low-grade differentiated lesions, 21 medium-grade differentiated lesions, 17 high-grade differentiated lesions proved by pathology. In mammography images, there were 20 sentus-shape-lumps, 55.00% of which were low-grade differentiated lesions; 12 cycle-shape- lumps, 66.67% of which were high-grade ones; 13 lumps with sub-lobe, in which there were 7 medium-grade ones. In sonographies, there were 19 cases with grade III blood signal, 73.68% of which were low-grade differentiated lesions; 18 cases with grade II blood signal, 72.22% of which were medium-grade ones; 13 cases with grade I blood signal, in which 10 cases were high-grade ones. In MRI enhancement images, there were 19 cases with asymmetrical enhancement, 68.42% of which were low-grade differentiated lesions; 17 cases with ring-shape- enhancement, 70.59% of which were medium-grade ones; 18 cases with symmetrical enhancement, in which 14 cases were high-grade ones. It had been analyzed what is the relationship between the pattern of enhancement of MRI and the expression of molecular biology. The positive rates of C-erbB-2 expression in the lesions with asymmetrical enhancement, those with ring-shape-enhancement and those with symmetrical enhancement, were 63.16%,58.82% and 44.44% respectively. The positive rates of ER expression in the lesions with asymmetrical enhancement, those with ring-shape-enhancement and those with symmetrical enhancement were 52.63%, 52.94% and 72.22% respectively. The positive rates of PR expression in the lesions with asymmetrical enhancement, those with ring-shape-enhancement and those with symmetrical enhancement, were 42.11% , 47.05% and 55.56% respectively. There were 36 metastasized axillary lymph nodes, in which 12 ones were detected by Mammography, 21 cases were detected by sonography and 20 cases were detected by MRI.Conclusion: Compared with mammography and color Doppler ultrasonography, the sensitivity by MRI was higher to detect the breast lesions and higher to measure accurately. In evaluating the shape of breast lesions, the diagnostic accuracy was highest. It was helpful for appreciating the grade differentiated of breast lesion to judge its shape, its blood signal and its enhancement mode. And it was also helpful for appreciating the biological behavior and prognosis of breast cancer through observing the enhancement mode. In diagnosing the metastasis of axillary lymph nodes, the accuracy by sonography and MRI was higher than that of mammography. Therefore, it is of great significance to appreciate the probability and the prognosis of breast-conserving surgery by mammography, color Doppler ultrasonography and MRI. |
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