The Value Of Ultrasonic Elastography And Magnetic Resonance Imaging In Diagnosis For Breast Cancer

BackgroundBreast cancer is one of the most common malignancies of women, and only early diagnosis and early treatment can improve the survival rate and quality of life. Although in recent years, great progress has been made in the early diagnosis on breast cancer, such as the X ray mammography, Doppler ultrasound, and magnetic resonance imaging (MRI) technology, these methods also have misdiagnosis rate in certain circumstances. Therefore, how to find a diagnostic technique with higher effectiveness and accuracy is the critical issue we need to address. Ultrasonic elastography (UE) technology can not only find tumors, but also tell benign and malignant pathologies by detecting the flexibility and elasticity. In this study, we prospectively studied the effectiveness of US, UE and MRI on diagnosis of breast cancer, and by comparing to the pathologic diagnosis, we evaluated the value of US, UE, MRI and combination strategy into diagnosis on breast cancer.Objective1. To assess the value of US, UE and MRI in detecting breast mass and in identifying benign and malignant lesions of breast lumps; to figure out the difference among the three diagnostic methods in sensitivity,specificity and other aspects of the diagnosis.2. To evaluate ultrasound elasticity imaging technique in combination with magnetic resonance imaging in detecting and diagnosing breast masses. ROC curve analysis was used to analyze the effectiveness of ultrasound elasticity imaging and MRI in telling the benign and malignant breast pathologies. And its consistency with pathological examination was analyzed.3. Retrospective analysis of color Doppler ultrasound and MRI in early diagnosis of breast cancer.Materials and Methods1. All patients enrolled in the study with breast masses were undergone mass resection in our hospital, from November 2009 to December 2009. One week before surgery, all patients took the examination of ordinary two-dimensional ultrasound examination, ultrasound elasticity imaging and magnetic resonance imaging. According to general analysis of two-dimensional ultrasound imaging, ultrasound elasticity imaging method and MRI, we got a benign or malignant tumor diagnosis on breast lump. Then the results of postoperative pathologic examination were collected, as the final diagnosis. Statistical analysis were conducted to analyze sensitivity, specificity, and positive predictive value of three diagnostic methods, and especially, the accuracy of ultrasound elasticity imaging technique in combination with magnetic resonance imaging in diagnosis of breast cancer was assessed.2. A retrospective study of 71 cases of breast cancer was conducted. These patients were all with detailed data on preoperative color Doppler ultrasound and MRI examination. The specificity, sensitivity, positive predictive value, and negative predictive value were analyzed and the ROC curves were drawn.Results1. 30 patients, with one solid lesions detected by conventional ultrasonography(us,including grey—scale sonography, CDFI and Doppler spectrum)and UE and thereafter underwent pathological assessments, were included in a respective study. Among them, the median age was 50 years, ranging from 20 to 75 years. There were 11 benign and 19 malignant lesions.(1). The sensitivity,specificity, positive predictive value and negative predictive value of US diagnosis were 84.2%, 72.7%, 84.2% and 72.7%. The sensitivity, specificity, positive predictive value,negative predictive value of UE were 89.5%, 81.8%,89.5% and 81.8%.The UE score of benign lesions was significantly lower than that of malignant leisions (P<0.001); The sensitivity, specificity, positive predictive value,negative predictive value for MRI diagnosis were 94.7%, 100%, 100% and 96.7%; The sensitivity,specificity positive predictive value and negative predictive value of UE combined with MRI diagnosis were 100%, 81.8%, 90.4% and 100%.(2). As to the analysis of the diagnostic results of US, UE or MRI, in contrast to the pathologic diagnosis, the results of K test showed that the kappa value between UE and pathologic results was 0.713(P<0.000); that between US and pathologic results was 0.569(P=0.002); that between MRI and pathologic results was 0.930(P<0.000); and that between UE combined with MRI and pathologic results was 0.769(P<0.000). So the results showed that the kappa value between MRI and pathologic was much higher than the other diagnosis methods.(3).The Youden index of US, UE, MRI, UE combined with MRI were 0.57, 0.71, 0,92, 0.79, respectively. Based on the Youden index and positive predictive value, the data showed that diagnostic significance of MRI excelled US, UE or UE combined with MRI in diagnostic effectiveness.(4). Taking pathologic diagnosis as the gold standard,ROC curves were obtained. The areas under the ROC curve(Az) were calculated to assess the performance of the different methods, including UE, US, MRI and UE combined with MRI.The Azs of US ,UE, MRI and UE combined with MRI were 0.785, 0.856, 0.974 and 0.909 respectively, and the differences between each otherwere significant (P<0.05).2. From Janaury 2009 to December 2010,71 patients, with one solid lesions detected by conventional ultrasonography(us,including grey—scale sonography, CDFI and Doppler spectrum) and MRI, thereafter underwent pathological assessments, were included in a respective study. Among them, the median age was 53.2 years. There were 25 benign and 46 malignant lesions.(1)Using improved elasticity scores (P<0.05), the sensitivity of the ultrasound and MRI were 87.0 %,89.1%, and the specifity were 64.0%,88.0 %, and further more, the accuracy of both examinations were 78.9%,88.7% respectively. The sensitivity of combined application can be improved to 95.7%,which was higher than the diagnosis of ultrasonic and MRI(P<0.05).(2)Taking pathologic diagnosis as the gold standard,ROC curves were obtained. The areas under the ROC curve(Az) were calculated to assess the performance of the different methods, includingUS, MRI and US combined with MRI.The Azs of US , MRI and US combined with MRI were 0.755, 0.866 and 0.918 respectively, and the differences between each otherwere significant (P<0.05).(3)Over 80% patients with adenosis of mammary may be diagnosied breast cancer by US.Conclusion1. US and UE were feasible methods with high sensitivity for the imageology examination of breast tumor. Combined with the morphologic characteristics and plastic score, US and UE were with high practical value on telling the benign and malignant pathologies of breast.2. MRI was superior to US, UE with regard to sensitivity, specificity and consistency with pathological examination. So if condition allowed, MRI could be an important method for the diagnosis of breast carcer.3. Combination of US and MRI can improve the sensitivity of diagnosis, but MRI alone may be with the highest effectiveness of diagnosis. 4. Combination of US and MRI, improving the diagnostic sensitivity, could reduce the rate of misdiagnosis.5. Combination of UE and MRI, or the combination of US and MRI, can be used as a scanning method on the people who are with high risk to breast cancer. They can improve the early detection and diagnosis of breast cancer, and reduce the rate of misdiagnosis. So they are with great significances in selecting treating strategy and improving prognosis of the disease.