The Application Of Ultrasound Elastography In The Differential Diagnosis And Prognosis Of Breast Nodules

Objective:1. To evaluate the value of the Strain Ratio(SR) in the differential diagnosis of breast lesions in order to provide more reliable information for clinical to selecting and formulating the rational therapeutic schedule.2. To explore the relation of the strain ratio with axillary lymph node metastasis and the gene expression of Ki-67 in breast cancer.Methods:257 patients with 271 lesions were performed by conventional ultrasound and Ultrasound Elastography(UE)and the strain ratio of all lesions were recorded. All tumor tissues resected by surgery were confirmed by pathological histology and the immunohistochemical staining technique was used to detect the gene expressions of Ki-67 in patients with breast cancer.Results:1. The pathological results of 271 lesions: There were 203 cases of benign tumor,including 86 cases of fibroadenoma,47 cases of adenosis,25 cases of adenosis with fibroadenoma formation, 27 cases of intraductal papilloma, 6 cases of granulomatous mastitis,5 cases of phyllode tumor,sclerosing adenosis and tubular adenoma had 2 cases respectively,the mammary duct ectasia、mammary lipoma and chronic suppurative inflammation had 1 case respectively; There were 68 cases of malignant tumor,including 56 cases of invasive ductal carcinoma,8 cases of ductal carcinoma in situ,2 cases of high differentiation ductal carcinoma in situ with micro infiltration,mucinous carcinoma and medullary carcinoma had 1 case respectively.There were 32 cases occurred the axillary lymph node metastasis and 36 cases without axillary lymph node metastasis in 68 cases of breast cancer.2. The benign and malignant breast nodules elastic strain ratio respectively(1.85±0.54)and(3.60±0.84),were significantly different(P<0.01).According to the ROC curve analysis, the best cutoff point of the ultrasound elastography for differentiating benign and malignant breast lesions by strain ratio method wasdetermined as 2.87,the sensitivity,specificity were 83.8%,96.1%,respectively. The strain ratio of ultrasound elastography has great application value in the differential diagnosis of benign and malignant breast nodule.3. The ANOVA was used to analysis the difference of elastic strain ratio between the different pathological types of breast lesions. Fibroadenoma、Adenosis、Adenosis with Fibroadenoma Formation and Intraductal Papilloma respectively with Invasive Ductal Carcinoma and Ductal Carcinoma In Situ; Fibroadenoma with Adenosis;Intraductal Papilloma with Adenosis were significant different in statistics(P<0.05).4. There was no relation between the strain ratio and axillary lymph node metastasis(P>0.05), but positive correlation with the Ki-67 expression of breast cancer(r = 0.326,P=0.007).Conclusions:1. Ultrasound Elastography can evaluate the tissue hardness effectively, the strain ratio of breast lesions had the correlation between the pathological types so it can improve the diagnostic accuracy rate of different pathological types of breast nodules.2. The result about the strain ratio with axillary lymph node metastasis was no correlation but positive correlation with the Ki-67 expression of breast cancer represented that through joint detection of SR and Ki-67 gene expression can predict the proliferation of breast cancers cells and be more help for to estimate the prognosis.