| Background and objectiveBreast cancer, which seriously threatens female's health, remains the most common malignancy in women worldwide. Early detection, diagnosis and therapy of breast cancer are the key to improve the quality of life, survival rate and reduce mortality in patients with breast cancer. For a long time, clinical palpation is an indispensable mean in the diagnosis of breast diseases. With palpation, the clinician can sense the texture and activity of the mass, and its relationship with the surroundings, in order to determine whether it is malignancy or not. However, palpation is limited to large and/or superficial lesions, and it is subjective and operator-dependent.Conventional ultrasound can distinguish benign from malignant breast lesions based on the appearance of the lesion, viz. shape, margin irregularity, echogenicity, shadowing, and lymph node metastasis. But there are still a number of diseases cannot be diagnosed by this method or determine their property. For example, there is a change in consistency of primary lesions, but there is no or not obvious change in the ultrasonic performance. Elastography was first described in 1991 by Ophir. It was expected to accurately reflect the tissue's texture, to get more information about the tissue's pathology, to help clinical diagnosis. Elastography has achieved rapid development in recent years, but analysis methods of elastogram are not uniform. The purpose of this study was to compare the diagnostic performance of the size assessment, including the area ratio and diameter ratio, with that of Itoh scoring system with sonoelastography in the diagnosis of breast solid tumors.Materials and methods1. PatientsFemale patients referred to galactophore surgery department of Qilu Hospital for operation were recruited for the study. A total of 56 consecutive women with 62 lumps were enrolled from September 2010 to February 2011. Of the 62 lesions,14 were invasive ductal carcinomas,4 invasive lobular carcinomas,3 encephaloid carcinomas, 3 mastopathy,2 adipomas, and 36 fibroadenomas. The mean age of the women examined was 35 years, ranging from 20 to 63 years. The diameter of the lesions ranged from 44 to 344 mm.2. MethodsThe ultrasound examinations were performed using standard equipment (GE LOGIQ E9 and Philips iU22 xMATRIX) and broadband linear transducers (6-15MHz and 5-12MHz respectively). All the patients were in supine position. The process began with conventional gray-scale ultrasound imaging of the target lesions, then switched to the elasticity imaging mode. Slight manual pressure was applied in a direction perpendicular to the skin. The lesions were scored with Itoh scoring system. The lesions that scored as 1,2, and 3 were considered to have a higher likelihood of benign result, while lesions graded as 4 or 5 were more likely to be malignant. The area and diameter of the lesion were measured on elastogram and gray-scale ultrasound images. The ratios of the area and diameter were calculated by the computing system of the ultrasound equipment.3. Statistical analysisAll the data were evaluated using SPSS 16.0 software. Measurement data were reported as mean±SD (standard deviation). The area and diameter of the lesion on elastogram and in B-mode images were compared using t test. According to pathologic diagnosis, the diagnostic performance of the 3 methods was evaluated with Chi-square test. A significance difference was considered when the P value was less than 0.05.Results1. Of the 21 malignant lesions,17 (80.95%) lesions had a score of 4 or 5; four (19.05%) lesions had a score of 2 or 3. Of the 41 benign lesions,35 (85.36%) lesions had a score of 1,2, or 3; six (14.64%) lesions had a score of 4 or 5. The Itoh score of 4 and 5 was mainly distributed in the malignancies compared to benign lesions (P< 0.05).2. Benign lesions had a mean area was 0.79 cm2±0.73 on B-mode images,0.76 cm2±0.69 on elastogram. Benign lesions had a mean diameter was 1.18 cm±0.55 on B-mode images,1.14 cm±0.49 on elastogram. There was no significant difference in the mean area and the mean diameter of benign lesions on B-mode images versus on elastogram (P>0.05). Malignant lesions had a mean area was 2.78 cm2±1.26 on B-mode images,4.03 cm2±1.90 on elastogram. Malignant lesions had a mean diameter was 2.08 cm±0.68 on B-mode images,2.76 cm±0.64 on elastogram. The mean area and the mean diameter of malignant lesions on B-mode images versus on elastogram were statistically different (P< 0.05). The mean distance ratio for benign lesions was 0.99 (SD 0.12) and that for malignant lesions was 1.40 (SD 0.39). The mean area ratio for benign lesions was 0.98 (SD 0.13) and that for malignant lesions was 1.42 (SD 0.34). The ratios of lesion area and diameter on elastogram versus on B-mode images were statistically different between benign and malignant lesions (P< 0.05).3. The accuracies were 83.87%, 88.71% and 80.65%, respectively for Itoh scoring system, area ratio and diameter ratio. The accuracy of combining area ratio with Itoh scoring system was 93.55%, while the accuracy of combining diameter ratio with Itoh scoring system was 87.10%. The diagnostic performance of size assessment was almost in the same with Itoh scoring system (P> 0.05). If combined, the diagnostic accuracy would improve.ConclusionSonoelastography objectively reflects relative stiffness of breast lesions. The parameters as ratios of area and diameter on elastogram versus on B-mode images are helpful in the differential diagnosis of breast lesions. In clinical practice, if combined the size assessment and Itoh scoring system, the diagnostic accuracy of breast lesions would improve. |
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