The Study For Diagnostic Value Of Differentiating Malignant From Benign Breast Lesions With Ultrasonic Elastography

Objective1.To study the differential diagnostic value of conventional ultrasound in benign and malignant breast lesions identification.2.Tostudy the differential diagnostic value of ultrasound elastography in benign and malignant breast tumors identification,to explore the value of real-time ultrasound elastograph indiffereniiating malignant from benign breast lesions.3.Tostudy the differential diagnostic value in benign and malignant breast tissues identification through conventional ultrasound combined with ultrasound elastography score.4.To estimate the diagnostic value in benign and malignant breast lesions by measuring the strain ratio of breast lesion to the same lever breast tissues.5.Tocompare the differences of sensitivity,specificity,accuracy of above four methods of identification of benign and malignant tumors of the breast.Materials and Methods78patients with90breast lesions were examined the department of the breast in Gansu province people’s hospital from August2011to May2012. The number of benign lesions is62,the number of malignant lesions is28. All dates are complete. All patients was female,and the age range is from18years old to75years old. The average age is46.5years. All the patients did not accept chemotherapy and radiation therapy, and confirmed by postoperative pathology results. All the breast lesions were on the conventional sonography and UE check.ACUSON S2000ultrasonic diagnostic apparatus manufactured by Siemens completed with the technology of ultrasonic elastography was used in ultrasonic inspection.The frequency of the probe is9-11L.The patients use routine ultrasonic inspection first,observe the features of lesions like the size,shape,edge,internal echo and relationship with peripheral tissues,ect.And probe diseased-sided if having enlarged lymph-nodes under the arm.By using Color Doppler Flow Imaging(CDFI) inspection to observe the situation of peripheral and internal blood flow of lesions.Then,carry out the ultrasonic elastography inspection,in ultrasonic elastography inspection.The probe was pressurized external force less than10%,it was vertical to the interface as far as possible.The process began with conventional gray-scale ultrasound imaging of the target lesions,then switched to the elasticity imaging mode.The size of ROl is approximately2times, convert to El interface,select appropriate sampling double amplitude real-time display is applied to elastography grading for masses,and measured their strain ratio.Elasticity images were assigned an elasticity score(on the former five—point scale respectively)according to the degree and distribution of strain induced by light compression.The five-point scale criteria were:a score of1indicated even strain in the entire Iesion(i e the entire lesion was evenly shaded in green). A score of2indicated strain in the most of the lesions,with some areas of no strain(i. e. the lesion had a mosaic pattern of dominant green and scattered blue). A score of3indicated strain at the periphery of the lesion,with sparing of the center of the lesion(i. e. the peripheral part of lesion wag green, and the central part was blue).A score of4indicated no strain in the entire lesion(i. e. the entire lesion was blue,but its surrounding area was not included).A score of5indicated no strain in the entire lesion and in the surrounding area(i. e. both the entire lesion and its surrounding area were blue).The SPSS19.0were used to analyze the date.The sensitivity,specificity,accuracy,positive predictive value,negative predictive value of four methods were calculated. The chi-square test was used to observed if the difference of various methods was statistically significant.The receiver operating characteristic curve was drew in order to obtain the best diagnostic threshold values of the strain rate ratio of the solid nodules of benign and malignant and to study diagnostic accuracy of every method according to AUC.Results1.The pathological diagnostic results of90brast lesions:62benign lesions and28malignant lesions.2.The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of evaluation of benign and malignant breast lesions by using conventional ultrasound were82.14%,69.35%,73.33%,54.76%,89.58%.3.The elastography mark≥4was defined malignant.The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of UE scoring method were85.71%,82.25%,83.33%,68.57%,92.72%, respectively.4.The sensitivity, specificity,accuracy, positive predictive value,negative predictive value of evaluation of benign and malignant breast lesion by using conventional ultrasound combined with ultrasonic elastography score were89.28%,91.93%,91.11%,83.33%,95.0%.5.3.11was the best cutoff point of the strain ratio for differentiating malignant from benign breast lesions.Its sensitivity, specificity, accuracy, positive predictive value and negative predictive value were85.71%,83.87%,84.44%,70.58%,92.85%, respectively.6.The data of AUC by using conventional ultrasound,elastography score,strain ratio, conventional ultrasound combined with elastography score were0.817,0.722,0.806,0.896respectively, which were between0.7-0.9. The range of above four methods can tell the diagnostic accuracy in indentifying benign and malignant breast lesion.7.The four methods diagnose benign and malignant breast lesion.The specificity of conventional ultrasound combined with elastography score was higher than the other of each method,compare to conventional ultrasound and their difference was statistically significant(P<0.05).The joint diagnosis was higher than conventional ultrasound and their difference was statistically significant(P<0.05).Conclusion1.Using conventional ultrasound, ultrasound elastography score,the Strain Ratio of elastography,conventional ultrasound combined with elastography score to identify benign and malignant lesions of the breast all have a certain diagnostic value. But it was no statistically significant the alone application of the four methods in the differential diagnostic sensitivity of breast lesions of benign and malignant.2.Conventional ultrasound combined with ultrasound elastography score can improve the diagnostic sensitivity,specificity, accuracy of the breast lesions of benign and malignant.And higher than other methods.We should use the joint diagnosis method of the lesions in the clinical application.And improve early breast cancer detection rates and reduce false positive rate as far as possible. To prevent to delay the best treatment time to patients.3.Though ultrasonic elastography technology and the joint diagnosis method to identify the breast cancer have the difference,the role of ultrasound elastography is not ignored in the differential diagnosis of breast lesions of benign and malignant.