| Objective:Malignant and benign breast diseases are very common.Although clinical palpation.image,biopsy and surgical diagnosis and treatment methods have been relatively mature with many guidelines issued in the industry at home and abroad,there are still a lot of confiusion concerning various imagination diagnosis evaluation and treatment process due to limitations on hospital equipment condition,personnel business level,economic conditions and other factors.This paper intends to make a retrospective summary including three parts of the cases confirmed by biopsy or surgery through large samples,analyzing the efficacy of various diagnostic methods including clinical?ultrasound?MRI and further discussing the diagnostic process.Research purposes:(1)The large hierarchical data statistics is applied to analyze the diagnostic efficiency of ultrasound in the diagnosis of different anatomic sites and space-occupying lesions of breasts,so as to evaluate the overall diagnostic efficacy in space-occupying lesions of breasts and explore the advantage,disadvantage and currently existing issues of breast ultrasonography as the main imaging method for the diagnosis of breast space-occupying lesions.(2)Through the large hierarchical data statistics,analysis on the diagnostic efficiency of magnetic resonance imaging(MRI)in the diagnosis of different pathological type of breast space-occupying lesions and the diagnostic features of MRI in the diagnosis of space-occupying lesions in different anatomical locations of breasts is carried out to explore the advantage,disadvantage and currently existing issues of breast MRI as supplementary imaging examination in diagnosis of mammary gland space-occupying lesions.(3)Compare and analyze the proportion of negative palpation(patient self-examination+clinical palpation)to breast occupying cases found by ultrasonography,discuss the necessity of ultrasonography as routine imaging examination of clinical breast diseases.Analyze the characteristics and problems of the diagnostic procedures of breast occupied lesions.Through comparative analysis of the diagnostic characteristics of breast ultrasonography and breast MRI,this paper discusses how to improve the accuracy of breast space-occupying lesions by optimizing the breast imaging examination process and explores the feasibility of ultrasonography assisted breast surgeons in reasonably applying for the diagnostic process of mammography.Methods:(1)Samples are divided into two groups.The first group as the surgery group:collect data from a total of 4668 cases of mammary space-occupying lesions including 4157 surgical treatment cases of malignant breast lesions and 511 cases of benign breast placeholder occupied lesions to obtain BI-RADS classification,characteristic description and preoperative ultrasound diagnosis results in the mammary gland preoperative ultrasonography diagnosis reports.Analyze the diagnostic efficiency of ultrasonography in the diagnosis of breast space-occupied lesions and collect the data regarding the diagnostic efficiency of ultrasound in diagnosis of different pathological type through the analysis on the comparisons between preoperative ultrasound diagnosis results of different pathological types.The second is biopsy and puncture group:2672 cases of breast space-occupied lesions(benign:1679 cases)diagnosed by biopsy in recent 3 years in our hospital have been collected Malignant:993 cases).According to the pathological results of aspiration biopsy,the characteristics of ultrasonic diagnosis are analyzed,and the specific pathological types and positive rate of diagnostic aspiration biopsy cases were calculated and analyzed.(2)Collect data from the 2332 cases of mammary gland malignant placeholder lesions and 230 cases of breast benign placeholder lesions in 2012-2017 which have conducted surgical treatments and breast MRI examinations before operations,to analyze BI-RADS classification and calculate the diagnostic ratio and characteristics of breast MRI in different pathological types of breast space-occupied lesions based on pathological diagnosis results,as well calculating ROC curve to analyze the diagnostic efficiency of breast MRI in the diagnosis of breast space-occupied lesions according to the area under the curve.(3)Collect and analyze the detailed clinical data of patients undergoing breast occupying lesions surgery in our hospital from 2012 to 2017,focusing on the analysis of the characteristics of breast lesions detection and diagnosis as well as the specific imaging diagnosis process information of breast lesions.The proportion of negative palpation(self-examination+clinical palpation)in breast cases detected by ultrasound is calculated.The correlation between tumor size and lymph node metastasis is studied,and the diagnostic characteristics of breast ultrasound and MRI for different pathological types are compared to explore the feasibility of assisting clinicians to apply for imaging examination and diagnostic procedures.Results:(1)The area under the ROC curve of the overall diagnostic efficacy of ultrasound in the surgery group is 751.Among the patients in the surgery group,3.7%are missed diagnosis,mainly non-invasive ductal carcinoma,and about the 44%of misdiagnosed cases are mainly fibroadenoma and intraductal papilloma.The positive diagnostic rate of diagnostic biopsy is 31.8%,and the sensitivity and specificity of the diagnosis with the BI-RADS 3 of ultrasonic diagnosis as the cutoff value are 94.6%and 40.4%,respectively.Additionally,the area under the ROC curve of the overall diagnostic efficiency of ultrasound in the biopsy group is 668.(2)Among malignant cases diagnosed with MRI in this group,54 cases are diagnosed as BI-RADS 3,that is,missed diagnosis cases,accounting for 2.1%of the total sample size.The main missed case is invasive ductal carcinoma.In this group,165 benign cases are correctly diagnosed as BI-RADS 3,accounting for 71.7%of the total benign sample size.Among them,65 cases diagnosed with BI-RADS 4 accounts for 28.3%of the total benign sample size with the highest misdiagnosis rates on fibroadenoma intraductal papilloma,hyperhidrosis,inflammation and plasma cell mastitis.The area under the ROC curve of breast MRI for overall diagnosis of breast space-occupying lesions is 854.(3)For malignant breast lesions below 1cm,the positive palpation rate occupies 29.2%and 62.1%for breast lesions between 1-2cm,as well as 94.3%for malignant breast lesions above 2cm.For malignant breast lesions smaller than 1cm,1-2cm and>2cm,the lymph node metastasis rate are 10.7%?31.6%and 46.4%,respectively.Univariate analysis shows that the proportion of malignant tumors is higher than that of benign tumors in terms of ratio,blood flow,microcalcification,intraductal and posterior echo attenuation ultrasound diagnostic indicators,with of statistically significant(p<0.05).The area under the ROC curve of ultrasound and NMR are 750 and.847,respectively.In terms of invasive ductal carcinoma,intraductal papilloma and fibroadenoma,the diagnostic accordance rate of MRI is higher than that of ultrasound examination(p<0.05),and the accuracy of ultrasound diagnosis in inflammatory breast lesions is more accurate than that of MRI.Conclusion:ultrasound has a strong ability to detect breast lesions as the sensitivity of breast cancer detection up to 94%and can be used as the preferred imaging examination of breast lesions combined with the good capability of conventional ultrasound in explaining cystic and solid benign lesions.Ultrasound scanning radially along the duct is the most common and important advantage in the diagnosis of breast diseases,recommending ultrasound physicians to make full use of radiological scanning for facilitating accurate understanding on the lesion site and making a reasonable diagnosis.Even though the overall diagnostic efficacy of breast MRI is better than that of ultrasound,due to the high false positive rate,high cost and low prevalence of inflammatory lesions,it cannot be routinely used.For BI-RADS 4a lesions that are difficult to be differentiated by ultrasound and are treated as BI-RADS O,MRI examination is recommended.As for the similar results of ultrasonography for 4c and 5 types of lesions with those of nuclear magnetic examination,puncture biopsy could be directly recommended.MRI examination or direct puncture biopsy may be recommended for ultrasonographic diagnosis of class 4b lesions.For patients with BI-RADS 3 diagnosed by ultrasonography with the need of rotary excision therapy,the rotary excision therapy can only be performed on patients diagnosed as BI-RADS 3 after MRI examination on lobular and partially undefined boundaries,as well closely combining with ultrasonographic radiographic examination. |
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