Differential Diagnosis Study Of Ultrasonography In Breast Neoplasms

Breast cancer is a kind of the most common malignancy in female. Currently, there are many ways about clinical diagnosis of breast cancer, imageological examination is an important device early detection of breast cancer. CT and MRI examinations are not yet widely applied,because they need expensive examination cost and so precise equipment. Molybdenum target X-ray examination doesn't easily identify Benign and malignant calcification of breast neoplasms, locates inaccurately and has higher rate of misdiagnosis. Ultrasound diagnosis of breast stands out due to accurate location ,simple operation,no pain ,no radioactivity and low cost. Ultrasound examination has become a kind of the best method of breast cancer detection.This research applys the two-dimensional imaging to observe the tumor's location,size,shape,edge,amicula,internal echo,rear echo microcalciffcation and make sure whether or not existing axillary- nodes-megaly,and compute the ratio of longitudinal and transverse diameter. Then ,Apply the CDFI and CDE to examine the blood flow distribution and micro-blood-vessels of mammary tumor,and record haemodynamic parameter(PSV,RI, PI, AT)to find out a significant critical value. To Apply semiquantitative method to determine the abundance of mammary tumor's blood flow signal and the distribution of the blood flow,it provides more reference to diagnose Benign and malignant breast neoplasms with ultrasound diagnosis, and improve the veracity of breast neoplasms diagnosis. Material and method 1,Research object 90 Female patients(20-80 year's old) who are diagnosed breast neoplasms at breast surgical department in the second hospital attached Jilin university, 58 Female patients are Benign and 40 Female patients are malignant.2,InstrumentAll subjects were detected by Hp sonos 5500 Ultrasonographic machine with 7.5～10.0MHz probe.3,MethodChoose the pre-established mammary condition generally, adjust the depth, impulse repeat frequency, focus,sampling volume width,color stream blood gain,paries smoothing ,an angle between sound beam and blood stream and the blood﹤60°,according to the concrete circumstance. The patients are on back ,exposing the breast , necessarily they can lean to one side. Take the papilla as the center,spoke-sweep along full clockwise 360°from the edge of breast to nipple,especially neoplasm. The sections should be lapped,without blind area.When examined armpit,the patient should unfold the upper arms and expose armpit,then observed whether or not existing growing axillary-nodes- megaly and the blood sream.4,Observe contents(1) Observe the tumor's location,size,shape,edge, amicula,internal echo, rear echo microcalciffcation and make sure whether or not existing axillary- nodes- megaly,and compute the ratio of longitudinal and transverse diameter.(2) Observe the circumference of tumor ,the plenty degree and the characteristic distribute of blood stream.(3)To make sure whether the lymphatic gland of same side armpit is tumid, observe the condition of number, size, appearance, the blood stream of the internal echoes flow to identify whether it is the metastasis tumour.(4) Record the result, give the diagnosis and compare with pathologic result.5,Statistical methodAll datas are statistically analysed with the statistical software package SPSS.According to the type of datas,apply T-test,Chi-square Test and Rank Sum Test.When p<0.05,it is statistical meaning.Result and discussion1,Clinic information and pathologic result(1) The size of benign breast neoplasm: 0.4×0.5×0.6㎝ 3～5.5×4.6×3.3㎝3, the size of malignant breast neoplasm: 0.7×0.7×0.4㎝ 3～6.6×5.1×3.7㎝ 3,The high incidence of the age ranges from 35 to 55.(2) Totally 98 breast neoplasms, 45 left breast neoplasms, ,53 right breast neoplasms, all are single neoplasms, mostly locate out and up side quadrant. 58 benignbreast neoplasms, mostly are fibroadenomas,40 malignant breast neo plasms, mostly are invasive ductal carcinomas.(3) Pathologic type of the neoplasms:Totally 98 breast neoplasms.:58 Benign breast neoplasms,including 22 fibroadenomas,19 denosis,8 papilloade- -nocystomas, 2 mastadenitis,3 lobular adenomatoid hyperplasias, 4 Phyllodes tumor;40 malignant breast neoplasms,including 25 invasive ductal carcinomas, 8 intraductal carcinomas in situ, 3 Intraductal carcinoma,2 duct cancer,2 mucinous adenocarcinoma.2,Two-dimensional ultrasonic imaging characteristic of Benign and malignant breast neoplasms :In the study, contrast between two-dimensional ultrasonic imaging of benign neoplasms and malignant neoplasms,it shows ultrasonic imaging characteristic of malignant neoplasms:irregular shape,dark egde, no amicula, hyperecho halo in the circumference of partial neoplasms, spiculated margin, uneven internal echo,dot or sand microcalcification, dampped rear echo;ultrasonic imaging characteristic of benign neoplasms: neoplasms similar to rotundity or ellipse,clear edge, amicula in exist, regular shape, even internal echo,no dampped rear echo or enganced rear echo, unwonted microcalcification which is coarse microcalcification.3,The Colour Doppler Flow Imaging characteristic of breast neoplasms and differential diagnosis value of correlated blood stream parameters(1) Blood stream signal in neoplasms shows: The detection rate of vessels in malignant neoplasms is 95%,ⅡⅢgrades is 80%; The detection rates of vessels in benign neoplasms is 82.7%,ⅡⅢgrades is 46.6%; There is no statistically significant in blood stream rate between benign and malignant neoplasms, There is statistically significant in blood stream grade between benign and malignant neoplasms.So it indicates it is localized that The detection rate of vessels diagnoses benign and malignant neoplasms.The blood stream of malignant neoplasms is more abundant than benign neoplasms, the blood stream grade of malignant neoplasms is higher than benign neoplasms.Higher is the blood stream grade,more possible it is malignant neoplasms. The blood steam of malignant neoplasms extends inside,while The blood steam of benign neoplasms consist in circumference.(2) Configuration and location of breast neoplasms'blood stream Location:Malignant neoplasms'blood stream mostly distributes inside and in circumference,the proportion is 57.9%;Three kinds of Benign neoplasms' blood stream account for definite proportion, there was little more(42%) in circumference. There was statistically significant in the location of blood stream between them(P<0.01). Configuration: In Benign neoplasms, there is 14% in penetration,24% in branch,36% in strip, and 40% in dot; In malignant neoplasms, there is 65.8% in penetration,68.4% in branch,26.3% in strip, and 5.3% in dot. There was statistically significant in the location of blood stream between them(P<0.01).Malignant neoplasms'blood stream distributes in penetration,which accounts for 65.8% it presents sensitivity of 65.8% ,specificity of 81%,accuracy of 80.2%, positive predictive value of 81.6% and negative predicative value of 86.7%, with penetration diagnosing breat tumors. Thus it can be seen, with penetration diagnosing breat tumors, specificity and positive predictive value is higher, so it is significant.(3) Breast neoplasms'parametersPSV, PI, RI are higher in malignant neoplasms (12.58±8.32cm/s, 0.87±0.13,1.76±0.31 respectively) than in benign neoplasms (12.13±3.59cm/s, 0.64±0.15,1.16±0.25 respectively), There was statistically significant between them(P<0.01). AT is higher in benign neoplasms (188±33ms) than in malignant neoplasms (103±30.36 ms),it shows that it is short time that from.Diagnose malignant neoplasms'sensitivity of 78.5%,specificity of 73.6%, accuracy of 76.1%, positive predictive value of 77.4% and negative predicative value of 78.2% with PSV≥18cm/s. Diagnose malignant neoplasms'sensitivity of 85%,specificity of 83.8%, accuracy of 84.5%, positive predictive value of 87% and negative predicative value of 80% with RI≥0.75. Diagnose malignant neoplasms'sensitivity of 83.6%,specificity of 80.1%, accuracy of 82.3%, positive predictive value of 80% and negative predicative value of 85% with PI≥1.4. Diagnose malignant neoplasms'sensitivity of 46%,specificity of 93%, accuracy of 91%, positive predictive value of 56% and negative predicative value of 68% with AT≥100cm/s.Result: Diagnose malignant neoplasms with two-dimensional ultrasonic imaging,it presents sensitivity of 93% ,specificity of 70% ,accuracy of 80%, positive predictive value of 73% and negative predicative value of 88% ;Diagnose malignant neoplasmms with CDFI,it presents sensitivity of 88.6% ,specificity of 72% ,accuracy of 80.6%,positive predictive value of 75.7% and negative predicative value of 85.5%; Diagnose malignant neoplasms with CDE, it presents sensitivity of 88.6%, specificity of 76.8% ,accuracy of 82.6%,positive predictive value of 81.6% and negative predicative value of 84.5%; Diagnose malignant neoplasms with two-dimensional ultrasonic imaging ,CDFI and CDE, it presents sensitivity of 93.8% ,specificity of 84.5% ,accuracy of 89.5%,positive predictive value of 86.5% and negative predictative value of 92.6%.4,Ultrasonic grade of breast ultrasonic tumorsUultrasonic imaging grades 98 tumors as list 1-3,including I grade of 42,Ⅱgrade of 12,Ⅲgrade of 12 andⅣgrade of 32,there are 3 malignant neoplasms and 39 benign neoplasms in I grade, 2 malignant neoplasms and 10 benign neoplasms inⅡgrade, 8 malignant neoplasms and 4 benign neoplasms inⅢgrade,and 27 malignant neoplasms and 5 benign neoplasms inⅣgrade according as pathologic diagnosis.The percents of malignant tumors in four grades are respectively 7.1%,16.7% ,66.7% and 84.4%.Ultrasound diagnosis of breast is applied widely due to no pain , and low cost. simple operation, clearly displayd two-dimensional ultrasonic imaging and the location of inside and peripheral blood stream,which is analysed in blood stream parameters quantitatively,So that it provides more reference to diagnose Benign and malignant breast neoplasms with ultrasound diagnosis, and improve the veracity of breast neoplasms diagnosis.