Clinical Application Of Three-Dimensional Ultrasound In The Diagnosis Of Breast Lump

Objective:To investigate the diagnostic value of retraction phenomenon of three-dimensional imaging in breast lumps and the prognosis estimation by observing the morphological characteristics of edge in breast lumps. Observing the vascular morphology characteristic and blood flow gradation of breast lumps by using three-dimensional color power angiography (3D-CPA). Evaluated the diagnostic value of3D-CPA in qualitative and quantitative analysis in breast lump under the use of color histogram technique.Method:165patients with breast lumps underwent three-dimensional ultrasound, being observed the morphological characteristics of lump edge. Compared with pathological findings, analysis of the detection rate of retraction phenomenon in benign and malignant breast lumps, and analyzed the correlation between the detection rate of retraction phenomenon and the histological type, tumor size, histologic grade, lymph node status, and estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor2(CerbB-2) and Ki-67expression. Using3D-CPA technique to observe the blood supply in and surrounding the breast lumps on basis of three-dimensional reconstruction, making objective evaluation of blood flow gradation of lumps. The color histogram of virtual organ computer-aid analysis (VOCAL) was applied to make quantitative analysis of blood supply in and peripheral3mm of breast lumps, then the results were statistically compared.Result:The sensitivity and specificity of retraction phenomenon in diagnosis of breast cancers were67.7%,93.1%respectively. The detection rate of retraction phenomenon in invasive cancer and non-invasive cancer was80.3%and11.8%,being statistically significant difference(P<0.001).The assessment of retraction phenomenon in breast cancer prognosis (1) The retraction phenomenon was correlated to tumor size and histologic grade. It was more commonly found in invasion tumors of diameter less than20mm and a lower histologic grade with grade Ⅱ; Compared with the group without retraction phenomenon, the lumps with retraction phenomenon had a higher positive rate of ER and PR (P<0.05)(2) The lymph node status, the expression of the CerB-2and Ki-67in the two groups had no significant difference(P>0.05).Breast cancer had richer blood supply than the benign lumps. Analysis by3D-CPA classification, the main blood flow gradation of malignant tumors was grade Ⅱ or Ⅲ, and the main blood flow gradation of benign lumps was grade Ⅰ or Ⅱ. Blood flow gradation of Ⅱ overlaped between benign and malignant lumps. There was significant differences occurred between benign and malignant groups in all the three blood flow gradation(P<0.05).The indices of vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) had certain value in the diagnosis of breast tumors. VI-in, VFI-in, VI-out, FI-out and VFI-out in malignant tumors were significantly higher than those in benign lumps group(all P<0.05). Base on the receiver operating characteristic (ROC) curve, they all demonstrated high sensitivity and specificity at each of their diagnostic cut-off values. In these indices, VI-out was the best index for the diagnosis of breast lumps, VI-in、 VFI-in and VFI-out were the second, and FI-out ranked last. Given VI-out≥2.630as a critical value to diagnose the breast malignant tumor, the sensitivity and specificity were92.2%and83.3%respectively; given VI-in≥1.725to diagnose the breast malignant tumor, the sensitivity and specificity were92.2%and74.1%;given VFI-in≥0.411to diagnose the breast malignant tumor, the sensitivity and specificity were90.6%and74.1%; given VFI-out≥0.648to diagnose the breast malignant tumor, the sensitivity and specificity were87.5%and79.6%; given FI-out^23.030to diagnose the breast malignant tumor, the sensitivity and specificity were85.9%and48.1%respectively. But the indices of V-in, V-out and Fl-in in two groups showed no significant difference (P>0.05).Conclusion:Three-dimensional ultrasound could show the morphology of lumps and its relationship with surrounding tissue clearly. The detection rate of retraction phenomenon was difference in the benign and malignant breast lumps. The retraction phenomenon in the coronal plane of three-dimensional ultrasound may be useful in the noninvasive prediction of prognostic factors of breast cancers. Moreover, the qualitative and quantitative analysis of3D-CPA have a certain value in the differential diagnosis of benign and malignant lumps of breast. Particularly, the quantitative analysis of blood flow in the lump periphery allows us to find a new method to evaluate the surrounding blood supply of the lumps.