The Value Research Of Multi-quantitative Parameters Of Ultrasound Jointed MRI In Diagnosis Of Mammary Duct Ectasia And Breast Cancer

IntroductionMammary duct ectasia (MDE) is a type of non-puerperal and non-specific inflammation. Mammary inflammation may give rise to bacterial infections, non-bacterial infections and tumor growing. Different pathogenesis had different therapy methods, so doctors should make a distinction between cancerous inflammation and noncancerous inflammation. Sometime it was difficult to distinguish because they were similar to clinical features. Clinic features of MDE were usually atypical, for example it attacked hiddenly and only showed local mass without inflammation. It is so difficult to be diagnosed that some imaging features were similar to breast cancer. Some patients were misdiagnosed as breast cancer and lead to a complete breast resection. At the same time, some imaging features of breast cancer were similar to benign lesion, especially inflammatory cancer resembled MDE and breast abscess. It was important to differentiate between MDE and breast cancer.Though there were many reports about breast cancer using ultrasound (US) and magnetic resonance imaging (MRI) technology, there were few reports about MDE, especially the dynamic enhanced MRI (DCE-MRI) has not been discussed. Basing on the point, the research choose the patients, suspected MDE and breast cancer by clinical doctors, to study and aimed to increase the level of diagnosis and differential diagnosis of the disease which was carried out by the multi-parametres to access the values of ultrasound, MRI and US jointed MRI. The study was divided three parts:Part I:the value of multi-quantitative parameters of ultrasound jointed magnetic resonance imaging in diagnosis of mammary duct ectasia; Part Ⅱ:the value of multi-quantitative parameters of ultrasound jointed magnetic resonance imaging in diagnosis of breast cancer; Part Ⅲ:the control study of multi-quantitative parameters of ultrasound jointed magnetic resonance imaging in diagnosis of mammary duct ectasia and breast cancer.Part I:The value of multi-quantitative parameters of ultrasound and magnetic resonance imaging in diagnosis of mammary duct ectasiaPurposeThis study is to evaluate the diagnostic value of US, MRI and US jointed MRI in diagnosis of mammary duct ectasia by the characteristics of morphology and some quantitative and semi-quantitative parameters with US (ultrasonogram, CDFI and elastography) and MRI (plain scan and dynamic enhanced scan) for early clinical diagnosis and treatment.Materials and MethodsA total of 46 patients, suspected MDE by clinical doctors, were recruited for a total of 48 lesions between May 2012 and December 2014. A retrospective analysis of cases was carried out. All patients were examined by US (two dimensions, CDFI and elastography) and MRI (plain scan, DCE-MRI and DWI). All patients underwent a aspiration biopsy or surgical resection within two weeks of the imaging examinations and sent to pathology. Pathological diagnosis was golden standard. All data were processed using SPSS 17.0 software.Results1. In 48 cases, pathological diagnosis contain 35 cases of MDE,7 cases of intraductal papilloma,4 cases of breast cancer, mammary tuberculosis in 1 case, granulomatous mastitis in 1 case. There were MDE in 36 cases, intraductal papilloma in 8 cases, breast cancer in 4 cases with US. There were MDE in 37 cases, intraductal papilloma in 6 cases and breast cancer in 5 cases with MRI. There were MDE in 37 cases, intraductal papilloma in 7 cases and breast cancer in 4 cases with US jointed MRI. Sensitivity in the diagnosis of MDE with US, MRI and US jointed MRI were 85.7%, 91.4%,94.3% respectively. Specificity were 53.8%,61.5%,69.2% and accuracy were 77.1%,83.3% ,87.5% respectively. Positive predictive value were 83.3%,86.5%,89.2% and negative predictive value were 58.3%,72.7%,81.8%respectively. Area under the ROC curve were 0.698,0.765,0.818. By chi-square test, the diagnostic difference among three methods were statistically significant (χ2=7.912,15.05,21.65, P<0.05).2. In all of 48 lesions, Sensitivity of ultrasonogram, CDFI grading, RI and elastography were 77.1%,80%,76.5%,80%; specificity were 30.8%,30.8%,46.2%, 46.2%; accuracy were 64.6%,66.7%,66.7%,70.8%; PPV were 75%,75.6%,78.7%, 80%; NPV were 33.3%,36.4%,40%,46.2%respectively. There were no statistically significant among the four parameters(χ2=0.316,0.622,0.813,1.033, P>0.05) Compared with the combined the four parameters, there were statistically significant (χ2=7.912, P<0.05). There were significant correlation between ultrasonographic classification and CDFI rating or elastography scores(r=0.74,0.89, P<0.05)3. ADC value, with little worth, ranged between 1.01 to 2.30×10-3 mm2/s (1.31± 0.19×10-3 mm2/s in average) because it was between benign and malignant.4. DCE-MRI indicated that the lesions exhibited a significantly-enhanced signal, a ring-like or duct enhancement with a thickened wall and no enhancement in the center in delayed phase was found in 28 lesions, which were characteristic and 26 cases were diagnosed MDE. Detailed measurements indicated EER ranging between 0.35 and 1.07 (0.75±0.35 in average) and mean was 0.67±0.30 in 35cases of MDE (malignant:≥0.8), which was lower than malignant lesions. Tpeak ranged between 192 and 330s (224±29s in average) and mean was 248±37s in 35 cases of MDE. PER ranged between 1.26 and 3.06 (2.14±0.25 in average) and mean was 2.59±0.33 in 35 cases of MDE, which were higher than malignant lesions. The time-signal intensity curve (TIC) was classified into three types±33 lesions (68.75%) in type 1,10 lesions (20.83%) in type Ⅱ and 5 lesions (10.42%) in type Ⅲ. In 35 cases of MDE,28 (80%) cases belonged to type Ⅰ,5 (14.28%) cases to type Ⅱ and 2 (5.72%) cases to type Ⅲ. Most of MDE showed type Ⅰ, according with the characteristics of benign lesions.ConclusionIn summary, it was very important that using multi-quantitative parameters of ultrasound (ultrasonogram, CDFI and elastography) and DCE-MRI (enhancement forms, EER, Tpeak, PER and time signal intensity curve) to assess the value in the diagnosis and differential diagnosis of MDE. MDE was diagnosed with high sensitivity, acuracy and PPV by US, MRI and US jointed MRI, but specificity and NPV was not high. US jointed MRI was the most efficient ways. Using these imaging technologies jointly can significantly improve the sensitivity, specificity, accuracy, PPV and NPV.Part Ⅱ:The value of multi-quantitative parameters of ultrasound jointed magnetic resonance imaging in diagnosis of breast cancerPurposeThis study is to evaluate the diagnostic value of US, MRI and US jointed MRI in diagnosis of breast cancer by the characteristics of morphology and some quantitative and semi-quantitative parameters with US (two dimension, CDFI and elastography) and MRI (plain scan, DWI and DCE-MRI) for early clinical diagnosis and treatment and comparing with MDE.Materials and MethodsA total of 156 patients, suspected MDE by clinical doctors, were recruited for a total of 169 lesions between May 2012 and December 2014. A retrospective analysis of cases was carried out. All patients were examined by US (two dimensions, CDFI and elastography) and MRI (plain scan, DCE-MRI and DWI). All patients underwent a aspiration biopsy or surgical resection within two weeks of the imaging examinations and sent to pathology. Pathological diagnosis was golden standard. All data were processed using SPSS 17.0 software.Results1. In 169 cases, pathological diagnosis contain 105 cases of breast cancer and 64 cases of benign lesions. There were 105 cases of breast cancers, including of 6 cases of benign lesions and 64 cases of benign lesions, including of 6 cases of breast cancers with US. There were breast cancers in 106 cases, including of 5 cases of benign lesions and benign lesions in 64 cases, including 6 cases of breast cancers with MRI. There were breast cancers in 104 cases, including of 2 cases of benign lesions and benign lesions in 65 cases, including of 3 cases of breast cancers with US jointed MRI. Sensitivity in the diagnosis of breast cancer with US, MRI and US jointed MRI were 94.3%,96.2%,97.1% respectively. Specificity were 90.6%,92.2%,96.9% and accuracy were 92.9%,94.7%,97% respectively. Positive predictive value were 94.3%,95.3%, 98.1% and negative predictive value were 90.6%,93.7%,95.4% respectively. Area under the ROC curve were 0.925,0.942 0.970. By chi-square test, the diagnostic difference among three methods were statistically significant (χ2=121.8,132.8,148.5, P<0.05).2. Sensitivity in the diagnosis of breast cancer using the multi-parameters of US, inclding of the morphologic characteristics of US (aspect ratio>1, obscure boundary, irregular and microcalcification), CDFI grading, RI and elastography, were 83.8%, 29.5%,51.4%,85.7% respectively. Specificity were 82.8%,87.5%,75%,85.9% and accuracy were 83.4%,51.5%,60.3%,85,8% respectively. Positive predictive value were 88.9%,79.5%,77.1%,90.9% and negative predictive value were 75.7%,43.1%,48.5%, 78.6% respectively. By chi-square test, the diagnostic difference among multi-parameters were statistically significant (χ2=72.74,10.06,11.45,84.13, P<0.05).3. DCE-MRI indicated that 135 out of 169 cases exhibited mass enhanced sign, including of 90 cases of invasive ductal carcinoma, which were enhanced the rim rapidly in early phase and enhanced the center slowly in delayed phase. Detailed measurements of 169 cases indicated EER ranging between 0.06 and 2.05 and mean was 0.93±0.41 (malignant:1.03±0.40, benign:0.76±0.38). PER ranged between 0.09 and 3.35 and mean was 1.34±0.41(malignant:1.08±0.40, benign:0.89±0.40). Tpeak ranged between 120 and 420s and mean was 194±74s(malignant:169±63, benign: 236±73). ADC value ranged between 0.22 and 2.32×10-3mm2/s and mean was 1.15±0.37×10-3mm2/s(malignant:1.03±0.32, benign:1.36±0.37). The diagnostic difference of EER, PER, Tpeak, ADC value between breast cancer and benign lesion were statistically significant (t=4.218,2.889,-6.330,-6.036, P<0.001). The time-signal intensity curve (TIC) was classified into three types—40 lesions (23.7%) in type Ⅰ,68 lesions (40.2%) in type Ⅱ and 61 lesions (36.1%) in type Ⅲ. In 105 cases of breast cancer,3 (2.9%) cases belonged to type I,47(44.7%) cases to type Ⅱ and 55 (52.4%) cases to type III. In 64 cases of breast cancer,37 (57.8%) cases belonged to type Ⅰ 21(32.8%) cases to type Ⅱ and 6(9.4%) cases to type Ⅲ. The three types of TIC could be found in benign and malignant lesions. Most of malignant lesions showed type Ⅲ and benign lesions showed type Ⅰ. There were benign and malignant lesions in type Ⅱ.ConclusionIn summary, it was very important that using multi-quantitative parameters of ultrasound (two-dimension, CDFI and elastography) and DCE-MRI (enhancement forms, EER, Tpeak, PER and time signal intensity curve) to assess the value in the diagnosis and differential diagnosis of breast cancer. Breast cancer was diagnosed with high sensitivity, specificity, accuracy, PPV and NPV by US, MRI and US jointed MRI. US jointed MRI was the most efficient ways.Part Ⅲ:The control study of multi-quantitative parameters of ultrasound jointed MRI in diagnosis of mammary duct ectasia and breast cancerPurposeThis study is to evaluate the diagnostic difference of between MDE and breast cancer by the characteristics of morphology and some quantitative and semi-quantitative parameters with US (two-dimension, CDFI and elastography) and MRI (plain scan and dynamic enhanced scan) and ensure the accuracy rate of MDE by decreasing the rate of misdiagnosis and missed diagnosis.Materials and Methods35 cases of MDE in 48 lesions suspected MDE by clinical doctors, and 105 cases of breast cancers in 169 lesions suspected breast cancers by clinical doctors, were proofed by pathology between May 2012 and December 2014. A retrospective analysis of cases was carried out. All date were compared between MDE and breast cancer. All data were processed using SPSS 17.0 software.ResultsThere was significant difference between MDE and breast cancer (t=-5.601, P< 0.001). The ages of MDE group were younger than that of breast cancer. By chi-square test, the diagnostic difference of the ratio of local mass between MDE and breast cancer were no statistically significant (χ2=1.292,P=0.259,>0.05).There were significant difference in aspect ratio> 1, obscure boundary, rough edge and microcalcification of features of breast cancer (χ2=13.27,36.72,56.91,24.35, P<0.001), which of breast cancer were higher than that of MDE.There were significant difference in RI, elastography, TIC, ADC, EER, PER, Tpeak (χ2=7.013,74.56,91.15, t=-4.313,5.259,-18.77,-7.08, P<0.05) expect CDFI grades (χ2=1.20, P=0.273,>0.05), between MDE and breast cancer.By chi-square test, the diagnostic difference between MDE and breast cancer with US, MRI and US jointed MRI were no statistically significant (χ2=2.664,1.253,0.622, P=0.103,0.263,0.403,>0.05).ConclusionThe research showed that multi-quantitative parameters evaluated by ultrasound jointed MRI were helpful to diagnose and differential diagnose of MDE and breast cancer, which not only improved the diagnostic level but also reduce subjective evaluation required for images obtained from ultrasound and MRI. Three techniques were very useful for diagnosing of MDE and breast cancer. US jointed MRI was the most diagnostic efficiency. Quantitative measurements benefit for comparing with different researches. This could improve diagnostic accuracy and supply abundant of information in clinical treatment.