The Clinical Value Of Ultrasound Elastography In Breast Diseases

Part I The clinical value of different ultrasound elastography assessment methods of in breast diseasesObjective: To study the clinical diagnosis value of the different assessment methods of ultrasound elastography in breast diseases.Methods: From November 2013 to March 2014, we collected 191 inpatients with 207 lesions,who have different breast diseases to surgery, 110 benign lesions, 97 malignant lesions, were performed in the preoperative routine breast ultrasound and ultrasound elastography imaging. Different elastography assessment methods, including the Itoh's 5 scores method, the strain ratio method, the histogram mean method, the hard level method and the trichotomy method of breast lesions evaluated.Results: The best critical values of these five kinds of evaluation methods for diagnosis of breast malignant lesions were following, the Itoh's 5 scores method:3.5, the strain ratio method:1.962, the histogram mean method:25.500, the hard level method: 20% of the hard level of the lesion area under the percentage of 45.635%, the trichotomy method:2.5,the sensitivity of the diagnosis of malignant lesions were 73.20%, 89.69%, 82.73%, 72.16%, 77.32%, and specificity were 92.73%, 83.64%, 74.23%, 82.73%, 89.09%, by ROC curve analysis, the area under the curve of 0.857, 0.917, 0.822, 0.821, 0.860.The sensitivity and the area under the curve of the strain ratio method were superior to other methods.Conclusion: Elastography different parameters for assessing breast lesions have a higher diagnostic value, can enhance sonographer ' s diagnostic confidence on breast disease, the method of the strain ratio is more powerful. Part II Breast disease with ultrasound elastogrphy imaging to contribute the BI-RADS-US categories assessmentObjective: To evaluate the value of different methods with ultrasound elasticity imaging technology combined with routine ultrasound breast lesions BI-RADS-US re-evaluation.Methods: From April 2014 to October 2014, 277 patients with 316 lesions by routine US and color Doppler US, according to the BI-RADS category criteria for the classification of breast lesions, and then by ultrasound elastography. The different evaluation of breast lesions assessed reclassification, the Itoh's 5 scores method for 1and 2, the strain ratio method ?1.962, the histogram mean method ?25.500, at a hard level of 20% the proportion of the area of interest ?45.635%, soft lesions, BI-RADS-US classification drop a level,of Itoh 4 points and 5 points law, the strain ratio method>1.962, the histogram mean method <25.500, a 20% interest in the hardness level the proportion of the region> 45.635%, hard lesions, BI-RADS-US classification increased one level, 3 points awarded for Itoh law and the rule of thirds rated the quality of the lesion, then no adjustment. With BI-RADS-US categories 4B and more determined to be malignant, in order to compare different methods of differences between the diagnosis of malignant breast lesions of sensitivity and specificity.Results: The sensitivity, specificity, the area under the curve were 78.92%, 88.67%, 0.887 by applying conventional ultrasound to BI-RADS categories of breast lesions only. After the application of different ultrasound elastography assessment methods to conventional ultrasound BI-RADS categories adjust the sensitivity of the five methods were 85.54%, 86.14%, 78.92%, 78.92%, 84.34% and specificity were 86.00%, 86.00%, 86.00%, 86.67%, 86.67%, the area under the curve of 0.904, 0.911, 0.882, 0.880, 0.902. The Itoh's 5 scores method, the strain ratio method, the trichotomy method can improve the diagnostic sensitivity of malignant breast lesions after reclassify the BI-BRDS categories, and to the strain ratio method is most obvious.Conclusion: Assessment using ultrasound elastography combined with routine ultrasound examination of the breast lesion categories of BI-RADS-US re-evaluation to improve the sensitivity of diagnosis of malignant breast lesions, can objectively reflect the relative the organization's hardness, and play an important role in the clinical application. Part III Breast lesions common pathological types of ultrasonic elastography imaging characters of pathologyObjective: To explore the common breast lesions pathology type of ultrasound elastography and its Relationship with Ki-67 expression levels.Methods: From November 2013 to November 2014, 527 patients with 575 lesions were analyzed using different ultrasound elastography assessment methods, while malignant breast lesions by immunohistochemical analysis, recording its Ki-67 expression, the extent to Ki-67 <14% judged as low expression, ?14% judged to be highly expressed. Relationship between the degree of expression and pathological type of Ki-67, the relationship between elasticity imaging parameters among different pathological types, as well as the performance of elastography relationship with Ki-67 expression levels between.Results: 575 lesions in 283 benign lesions(49.22%), malignant lesions 292(50.78%), 216 infiltrating ductal carcinoma(IDC) in Ki-67 high expression was 72.69%, with an average of 32.22 ± 24.24%, 52 ductal carcinoma in situ(DCIS) high expression of Ki-67 was 42.31%, with an average of 16.87 ± 16.85%. Different ultrasound elastography assessment methods differences distinguish fibroadenoma and intraductal papilloma were not statistically significant(P>0.05), while the distinction between breast IDC and DCIS of the difference statistically significant(P <0.05). Elastography different assessment methods, the strain ratio method to predict the extent of Ki-67 expression has certain reference value(P=0.033).Conclusion: Ultrasound elastography technique not only makes sense to distinguish between benign and malignant breast lesions, there is a certain value of the diagnosis of breast infiltrating ductal carcinoma and ductal carcinoma in situ. The strain ratio method to predict the level of expression of Ki-67 still needed further to expand the sample.