Ultrasound Diagnosis Of Rare Type Of Breast Tumors And Correlation With Pathology

Objective:To characterize the ultrasound features of rare breast tumors which are different from common benign breast tumor and invasive ductal carcinoma with non special type, and to explore the relationship between ultrasound features and histopathology in order to improve the accuracy rate of preoperative ultrasonic diagnosis and provide more reliable imaging information for surgeon to make reasonable treatment plan.Materials and Methods:From2010January to2013July, the ultrasound findings of71women (aged28～83years old) with72mucinous carcinomas and83women (aged20～71years old) with85phyllodes tumors of the breast were restrospectively analyzed, according to the lexicon of Breast Imaging Reporting and Data System (BI-RADS) designed by American College of Radiology (ACR), including the location, size, morphology (shape, boundary, internal echo, rear echo edge) of breast lesions. The pathologic diagnosis was made according to the standard of the World Health Organization Classification of Tumors (2003). Ultrasonic inspection device used GE Logiq E9, GE Voluson730color ultrasonic diagnostic instrument, the probe frequency was6～15MHz. With the patient in the supine position, fully exposed bilateral breast and axillary, conventional counterclockwise radially scanned the breast in multi sections and angles, including two dimensional gray-scale imaging, color flow imaging, and elasticity imaging. The blood flow of breast lesions was classified by Adler’s semi quantitative method. The score of ultrasound elasticity imaging analyzed by Luo Baoming’s improved5points method. The x2test was used for characterizing the correlation ultrasound findings with histopathology.Results:(1) Of the72mucious carcinomas of the breast, the pathologic diagnosis was pure type in8cases, mixed type in27cases, and37cases were not typed clearly. On two dimensional ultrasound findings, the irregular shape were showed in93.1%, lesions with not clear boundary in75.0%, the halo sign in55.6%, lesions with bad-circumscribed in80.6%, inhomogeneous echo in90.3%, cystic areas inside the tumor in30cases, lesions with posterior acoustic enhancement in66.7%, and only15lesions with microcalcification. On the color doppler flow imaging,51.4%lesons showed blood flow with grade0-I. Of all lesions, only29cases had been performed elasticity imaging, the elasticity score4and5were showed in69.0%. Significant differences were indicated between pure type mucinous and mixed type mucinous carcinoma on internal echo of the tumor (χ2=7.577, P=0.023). The37.5%(3/8) of pure type mucinous carcinoma were showed homogeneous internal echo, but mixed type mucinous carcinoma appeared homogeneous internal echo in3.7%(1/27).(2) Of the85phyllodes tumors of the breast, the pathologic diagnosis was benign in33cases, borderline in28cases, and malignant in24cases, respectively. Lobulated shape of lesions were showed in61.2%(52/85), clear boundary in72.9%(62/85), smooth edge in68.2%(58/85), internal echo was inhomogeneous (97.6%,83/85). Clear boundary was more common in the benign phyllodes tumor (χ2=12.721, P=0.002). Cystic area was appeared more in the malignant phyllodes (χ2=9.677, P=0.046).75.3%of PTB showed blood flow with grade Ⅱ～Ⅲ. Of all the lesions, only26cases had been performed elasticity imaging, and the elasticity score2and3were showed in88.5%.Conclusion:(1) Conventional ultrasound and elastography findings of mucinous carcinoma of the breast has characteristic. Internal echo of mass can be used to differentiate pure type mucinous from mixed type mucinous carcinoma of the breast.(2) Conventional ultrasound and elastography findings of phyllodes tumor of the breast has characteristic. Margin and cystic areas inside the tumor can be used to differentiate benign phyllodes from malignant phyllodes of the breast.