| Purpose and significanceRecent year,the incidence of breast cancer is upward trend,have been the top list in many large and medium-sided cities of our country.Breast cancer is a threat to women's physical and mental health,or even to life.So early detection,early diagnosis,and early treatment become important to control breast malignant diseases. With the development of medical imaging and enhancement of people's health awareness,there are more and more breast nodules to be detected.Hyperplasia of breast lesions is the common diseases,currently the majority views is that there is no direct contact between hyperplasia and breast cancer,but hyperplasia is a risk factor for breast cancer.Among lots of examinations,the main purpose is to identify malignant lesions from benign ones.Mammography is the common method,but the false negative rate is 15%-30%,the specificity of positive nudles in palpation was only 55%,so the mammography has significant limitations.High-frequency ultransonography(US) combined with color Doppler flowing imaging(CDFI) technology provides a new direction for the examination of breast lesions,which is a sensitive way without radiation.It is not difficult to identify typical malignant and benign lesions with US,but for the smaller lesions or atypical cases,the accuracy of the diagnosis is not very satisfactory.With the application of minimally invasive surgery,Non-traditional surgical method can be chosen to resect the small lesions.Mammotome system is a new type image-guided vacuum-assisted biopsy devices,since 1994 successfully developed by Burbakn,has widely used in breast biopsy and the removal of benign lesions. Mammotome guided by ultrasound is accurate,minimally invasive,safe and convenient operation,and has less post-operation complication,no obvious scar in the skin.Minimally invasive surgery is particularly suitable for small benign lesion excision with high clinical value.For these patients with smaller breast lesions of uncertainty or suspected to be malignant,Mammotme can also be a method of biopsy.The characteristics of breast lesions impact the choice of surgical method,to judge the benign or malignant becomes the most difficult problem in medicine.In this paper,93 cases with 109 breast nodules were underwent US and mammography,all which were removed by minimally invasive surgery,the diagnosis were compare with pathology diagnosis.The purpose is to evaluate the value of breast US, mammography,and combination of both modalities for breast nodules,to improve the diagnosis rate of pre-operation,particular to the early breast cancer,then to provide a strong reference for choose of clinical examination.Material and Methods1.Subjects in this group 93 patients,age 26-74 years old,median age 46.34±0.79 years old,all the lesions were positioned by US before operation..109 beast nodules,60 were in left breast and 49 in right breast.2.Methods 93 patients were examined with ultrasonography and molybdenum mammography before minimally invasive surgery,all nodlues had the pathological results.All the US was performed using a probe with frequency 7-12MHz(Philips IU22 system).Operator should scan breast and axilla,using a clockwise,sequential,overlapping radial approach.If detect lesion,then record lesion number,size,shape,intensity of internal echoes,microcalcification.All the lesion were underwent CDFI.The blood flow were divided into 0-Ⅲclass according to Alder semiquantitative method and record RI and PI.All mammography examination were undertaken by full-field digital mammography(Senographe 2000D,GE),and used CC position and MLO position, added lateral position and zoom photograph if it is necessary.The diagnostic criteria of US is as follows:the shape of the tumor being irregular,having no distinct boundary and intact amicula,the internal echo being uneven and the bulk being hypo-echo,the quadrate echo of the tumor being attenuated,the length and breadth ratio of the tumor exceeding 1,the blood flow of the tumor surpassing GradeⅡaccording to Alder's grading.The diagnostic criteria of mammography is as follows:barb or sublobe appearance's tumor,having no distinct boundary,focal structure being disorder,or having typical clustering microcalcification.The diagnostic criteria of the two methods combined examination is as follows: The lesion being innocent if the two methods all discover innocent sign.The lesion being malignant if both examinations discover malignant sign.If diagnostic result different with each other,the lesion being malignant to fit one of them 1.US discovered the hypo-echo lesion with irregular boundary,and CDFI show abundant blood flow;2.Mammagraphy found the lesion having clustering microcalcification or typical barb appearance.The lesion being innocent to fit one of them 1.Mammography show loop around the lesion 2.US discovered the lesion as cyst,or with intact amicula.The US and mammography diagnosis were performed by double blind,the ultrasonography datum and mammography were read by ultrasonographysician and radiologist respectively.The results were read as(1) conform;(2) misdiagnosis.3.Statistical analysisThe accuracy,sensitivity,specificity,positive predictive,negative predictive for US diagnosis were calculated.The accuracy,sensitivity,specificity,positive predictive,negative predictive for mammography diagnosis were calculated.The accuracy,sensitivity,specificity,positive predictive,negative predictive for the combination of US and mammography diagnosis were calculated.Chi-square Test is applied for categorical variables.T-test is applied for continuous variables. The above statistical analysis were conducted with the statistical software package SPSS for Window,version 13.0.Results:1.Result of pathology:Of all nodules 88 lesions were benign lesions and other 21lesions were malignant nodules.The benign nodules include 72 lesions of hyperplasia(44 solid lesions and 28 cystic lesions),13 fibroadenoma and 3 intraductal papilloma.The malignant nodules include 5 lesions of atypical hyperplasia and 21 breast cancer.2.Result of ultrasonography:All 0f 109 nodules were detected clearly by ultrasonography.There were differences between benign and malignant nodules,such as the shape,border,internal echoes.And the malignant nodules have much richer blood flow signals than the benign ones.3.Result of molybdenum mammography:only 34 nodules were presented on mammograms,73 cases can be found calcifications in the inside or surrounding of the lesions,of which 23 cases presented as silt-form and hinted at malignancy.Compare of US and mammography diagnosis:The accuracy,sensitivity,specificity for US diagnosis were 89.9%,85.7%,90.9%。The accuracy,sensitivity,specificity for mammography diagnosis were 73.4 %,47.6%,79.5%。The accuracy rate of US was higher than mammography's and has statistical significance(P＜0.05).The accuracy,sensitivity,specificity for combination US and mammography diagnosis were 92.6%,85.7%,94.3%.The accuracy of combination US and mammography was significant higher than mammography's,but there was no significant difference between combination and US(P＞0.05).Conclusion: 1.Color Doppler ultrasound will show the character of breast lesion.The characters of malignant lesions included:irregular shape,ill-defined,no capsule, hypoechogenecity with posterior attenuation,with microcalcification,abundant vascularity.2.The diagnose accuracy of US was higher than mammography,the goodness of fit to pathological diagnosis was general.Thus,compared with mammography,the US was ideal diagnostic tool for the detection of breast lesion.3.Mammography can show calcification significantly better than US,especially microcalcification of malignant lesions.4.A high accuracy could be achieved by using combination of US and mammography.Both ultrasonography and molybdenum mammography are important techniques for evaluation of breast nodules.Combining US and molybdenum mammography can compensate each other,and improve the rate of diagnosis.
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