Identification Of Breast Postoperative Radiation-like Scar And Breast Cancer With High-frequency Ultrasound

Objective:Breast cancer is one of the more common malignancy in women, has become the cause of women deaths due to malignant tumors in developed countries, and it is second only to cervical cancer in developing countries. According to the literature reported that, surgery survival time is relatively long after breast cancer, if it is detected early and then with standard treatment,95%of patients’survival time are more than10years. With the carry out of the mammary census and the improvement of the people’s health awareness in recent years, the rate of early detection of breast cancer has been greatly improved. Whether the effect of the surgical treatment of breast cancer is mainly depended on the distant metastases, while the size of the local resection is not important to the survival. There has been reported that early breast conserving surgery and radical surgery prognosis were no significant different. Because the conserving surgery has cosmetic effect, and can save function, so more and more patients want to take breast conserving surgery. Attendant problems, breast conserving surgery or the local excision of breast benign lesions would form a more obvious scar, and the scar has the hard texture, poor activity, clinical palpation difficulty to identify with the breast cancer. And radiation-like scar on the image has the irregular shape, and the boundary is not clear, which is also very similar to the breast cancer. Because the ultrasound research literature on radial scar are very few, so there is no reliable diagnostic criteria, which resulted in a lot of misdiagnosis. For ultrasound worker, found the different sonographic appearance is very important. The purpose of this research is to study of radial scar sonographic appearance and discuss the differential diagnosis with the breast cancer.The aim of this study was to observe the appreance of the radial scar after local excision of breast lesions, and to compared with the breast cancer, and to have a better understanding of radiation-like scar, to get theoretical knowledge for the identification of radiation-like scar with breast cancer. This study reviews the performance of46cases of radiation-like scar tissue after breast partial resection with the high-frequency ultrasound, and to explore the differential diagnosis with the breast cancer.Methods:Collecting outpatient and inpatient cases in our hospitalfrom2008to2012, which have been examined by the breast high frequency ultrasound,1826cases of surgical biopsy or lesions local excision of history, of which46cases found the radiation-like scar in the postoperative follow-up examination. All46cases were female, aged31-78years old,30malignant lesions tumor size less than20mm, underwent breast-conserving surgery, the surgical margin was negative.postoperative scar follow-up were more than twice (the interval is6-24months), and the twice are compared, there was no significant increase in the second follow-up than the first follow-up.16patients with benign breast lesion excision have went more than one follow-up (follow-up time after12-18months).30cases touched nodules in surgical biopsy incision and near,10cases touched a thickening of the breast tissue in the surgical biopsy incision and near, six cases touched unclear because of breast glandular tissue is thick Breast cancer cases for the same period of continuous ultrasound examination revealed75cases of breast cancer, all women, age25-67years, with a median age of40years old. Clinical manifestations conscious25cases of breast lumps,30cases of the breast pain and discomfort,20patients found the breast tumor in the health examination.Retrospectively evaluated by two doctors who has experienced sonographer ultrasound experiences. Using the philip HDI5000or IU22, probe frequency7.5MHz-10MHz. Orthostatic supine position, recumbency position on the left and the right side of recumbency, the double arm elevation placed on top of the head on both sides, bilateral breast fully exposed, continuous scanning each quadrant of the breast by the longitudinal section and cross-section, and compared both sides with each other. Two-dimensional gray-scale ultrasound observe the breast skin, glands and glands surrounding structures, including the gland thickness, internal echo of the glands, ductal direction and whether the merger expansion, if expansion, it is necessary to carefully observe dilatation catheter internal echo, to see if the merger the presence of the intraductal mass. To the founded lumps, focused on observing the tumor size, shape, border, observe whether the capsule around the mass, to measure the mass of the vertical and horizontal diameter ratio, observed mass internal echo and posterior echo, and observe whether the merger microcalcifications, whether mass posterior echo attenuation and compared the mass internal echo with the normal glands echo, but also observed ipsilateral axillary lymph node enlargement, followed by use of color Doppler and spectral Doppler observed mass internal and peripheral blood flow, and measure the mass feeding artery hemodynamic parameters. The richness of the breast tumor blood flow signal is measured by the Adler semi-quantitative method for classification, divided into four. No significant blood flow signal which is0class in the mass; a visible a small amount of blood flow signals within the mass, punctate distribution of blood flow signals observed in1-2, and its inner diameter is less than0.1cm in size, this is the first class;The second class is in distribution of the amount of blood flow signal, the mass can be seen within a major vessels exist, and its length is greater than the mass of the radius, or occur simultaneously2-3small distribution of blood vessels, and its length is smaller than the radius of the mass; The third class is rich blood flow signal distribution, mass seen in four or more vascular distribution, or distribution of blood vessels intertwined into a mesh. The data are processed with the SPSS13.0statistical software, X2test and Fisher’s exact method. Take P=0.05for the test, the difference was statistically significant when P<0.05.Results:The75cases of breast cancer which ultrasound has found were pathologically confirmed, including62cases of invasive ductal carcinoma, four intraductal carcinoma in situ,3invasive lobular carcinoma, the four mucinous carcinoma,2medullary carcinoma.Five cases in the46cases of radiation-like scar which considered to be malignant, and can not be ruled out the possibility of recurrence of breast cancer, were carried out ultrasound-guided needle biopsy several times and ruled out malignancy.The sonographic characteristics of75cases of breast cancer:1, the vast majority of irregular tumor morphology, the boundary is not clear, jagged, crab-like, pleomorphic, angular protrusions (66/75,88%), some burr invasive the Cooper’s ligament and caused skin changes.2, Around the lump appeared hyperechoic band and performanced as irregular sidewalls, and the thickness of the hyperechoic band was uneven (60/75,80%).3, The internal echo is heterogeneous, the main echo is hypoechecho, and the gravel calcification may be seen(33/75,44%).4, the majority of rearward echo is decayed (65/75,86%).5, the aspect ratio of the lumps are greater than1(42/75,56%).6, the axillary lymph nodes are swelled(69/75,92%).7The color Doppler flow characteristics of the breast tumor is graded by Adler semi-quantitative method:the0grade is16cases, the1grade is30cases, the2grade is23cases, and the3grade is6cases. The performance of the spectrum Doppler:The max flow velocity in the detected arterialof the mass is45cm/s, while the minimum flow velocity is only4cm/s, and the RI is0.6-1.0.The sonographic features of the46cases of radiation-like scar1, tumor shape is irregular, jagged, crab-like protrusions (46/46,100%), a hypoechoic sheet channels which is connected with skin scar and doesn’t affect Cooper’s ligament.2, the internal echo is heterogeneous and the benign calcification may be seen partially (9/46,20%), no gravel calcification.3, the rear echo of the mass is attenuation (26/46,57%).4, the strong echo halo around the lump is not seen (0/46,0%).5, the mass aspect ratio is (L/T)>1(17/46,37%), and in the section which is vertical to the largest lump of imaging planes measuring tumor thickness, and the mass width/thickness ratio is>2(40/46,87%).6, the axillary lymph nodes is swelled (3/46,7%).7, The color Doppler flow characteristics:the42cases is grade0, three cases is grade1;2cases is grade2, and0cases is grade3.The ultrasonography performance of the breast cancer compared with radial scar are as follows:irregular shape (radial scar46cases, breast cancer66cases)100%vs.88%, P>0.05; halo sign (radial scar0cases, breast cancer60cases)0%vs80%; mass aspect ratio greater than1(28cases of radial scars, breast cancer42cases),37%vs.56%, P>0.05; the section which is vertical to the largest lump of imaging planes measuring tumor thickness, and the mass width/thickness ratio is>2(radial scar40cases, breast cancer0cases)87%vs.0%;gravel calcification (radial scars0cases, breast cancer33cases)0%vs.44%, mass posterior echo attenuation (radial scar26cases, breast cancer65cases),56%vs.86%, P<0.05, axillary lymph nodes swelled(3cases of radial scars, breast cancer69cases)6%vs92%, P<0.05;mass internal blood stream signal (radial scar four cases, breast cancer59cases)9%vs79%, P<0.05.Conclusion:As can be seen from the comparison of the two diseases, there is no diagnosis value between the irregular shape and the aspect ratio greater than1. The width and thickness of the mass ratio is greater than2, this indicator is a strong sensitivity for the diagnosis of postoperative radial scar. For breast cancer, the surrounding hyperechoic halo, internal gravel calcification, relatively rich blood flow signal, and axillary swelled lymph nodes have high sensitivity for the diagnosis of breast cancer. From these indicators, we can know the differential diagnosis of breast cancer and radial scar, then can reduce unnecessary repeat biopsy on a patient’s pain.