| Objective:To explore the differential diagnostic value of conventional ultrasound(ultrasonography and color doppler flow imaging), ultrasound elastography(UE)and 18F-FDG PET/CT in benign and malignant breast lessions.Material and Method:The clinical data of 66 patients with breast lessions(77 breast lessions) in Wuxi No. 4th People’s Hospital from Jan 2010 to Dec 2014 was analyzed retrospectively. All patients were examined using 18F-FDG PET/CT and ultrasound including both conventional ultrasound and UE, and all lessions were confirmed by pathology or clinical follow-up. The receiver operating characteristic curve(ROC) was used to evaluate the diagnostic value of conventional ultrasound(ultrasonography and color doppler flow imaging), UE and 18F-FDG PET/CT in benign and malignant breast lessions and to determine the cut-off point of SUVmax. The characteristic parameters of ultrasonic diagnosis in breast cancer were summarized.Results:1.The typical characteristics of breast cancer in conventional ultrasound and UE were as follows: irregular shape, heterogeneouts internal echo, no clear border, posterior attenuation, microcalcification, aspect ratio >1, level blood flow being mostly at Ⅱ-Ⅲ, resistance index≥0.7, UE≥4. There were significant statistical differences of every parameter between benign and malignant breast lessions(P<0.05).2. The AUC of conventional ultrasound,UE, conventional ultrasound combined with UE were 0.822, 0.880, 0.912 respectively. The AUC of three methods were compared in pairs, and there were significant differences in all the pairs(Z=1.972,2.326,1.917,all P<0.05). It revealed that the highest diagnostic efficiency was in the method of conventional ultrasound combined with UE.3. There were significant statistical differences of SUVmax between malignant and benign breast masses(P<0.05). SUVmax of breast masses in malignant group(6.29±5.49) was significantly higher than that of benign guoup(1.62±1.15).4.Breast malignant lessions with volume=3.09 mm3 as boundary value were divided into two groups, SUVmax of two groups had significant statistical differences(U=114.0, P=0.003),the volume of breast malignant lessions correlated with the SUVmax5. The up-left cut-off value of SUVmax at ROC was 4.02, while the sensitivity and specificity were 61.4% and 97.0% respectively. The data 4.02 was determined as the optimum SUVmax cut-off point for diagnosing breast cancer using PET/CT.The sensitivity, specificity, Yoden index of evaluation of benign and malignant breast lessions by using PET/CT were 72.7%, 81.8%, 54.5% respectively, When selecting SUVmax =2.5 as the cut-off value, they were 61.4%,97.0%, 58.4% respectively, When selecting SUVmax =4.02 as the cut-off value. The diagnostic accuary of SUVmax≥4.02 was higher than that of SUVmax≥2.5.6. The AUC of PET/CT(SUVmax≥4.02),conventional ultrasound combined with UE and the combination of PET/CT and conventional ultrasound combined with UE were 0.792, 0.912,0.875 respectively. The AUC of three diagnostic methods were compared in pairs, and the result showed that the AUC of PET/CT and conventional ultrasound combined with UE 、PET/CT and the combination of PET/CT and conventional ultrasound combined with UE had significant differences(Z=3.38,2.177, P<0.05). The AUC of conventional ultrasound combined with UE and the combination of PET/CT and conventional ultrasound combined with UE had no significant differences.( Z=1.643, P=0.1003). It revealed that conventional ultrasound combined with UE had the highest diagnostic efficiency.Conclusions:1.These parameters including irregular shape, heterogeneous internal echo, no clear border, posterior attenuation, microcalcification, aspect ratio>1, level blood flow being mostly at Ⅱ-Ⅲ, more than 0.7 resistance index, UE ≥4 were good parameters for diagnosing breast cancer in conventional ultrasound combined with UE.2.The diagnostic efficiency of conventional ultrasound combined with UE was higher than that of conventional ultrasound or UE.3. The value of 4.02 was selected as the optimum SUVmax cut-off point for diagnosing primary breast lessions using PET/CT.The diagnostic efficiency of SUVmax≥4.02 was higher than that of SUVmax≥2.5.4. The diagnostic accuracy of conventional ultrasound combined with UE was higher than that of PET/CT(SUVmax≥4.02). |
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