Differential Diagnosis Of 3.0T MR United-sequences Examination In Benign And Malignant Breast Diseases

Breast cancer is a serious threat to the health of women,the early detection and early differential diagnosis of benign and malignant lesions is significant for the selection of appropriate treatment and accurate evaluation of the prognosis of patients.This study was analyzed the sensitivity,specificity and accuracy of 3.0T MRI united-sequences examination in the diagnosis of benign and malignant breast lesions,and to investigate the value of its application in the differential diagnosis of benign and malignant breast lesions.Prospective included 59 cases of patients,which be treated at the Sichuan Provincial People's Hospital during July 2015 to January 2017.These patients have been diagnosed by clinical or other imaging suspected breast lesions needing further confirmed.All patients were underwent bilateral breast 3.0T Magnetic resonance plain scan,diffusion weighted imaging and dynamic enhanced scan successively before surgical operation,radiotherapy and chemotherapy or other anti-tumor therapy in this hospital.All patients were required to obtain pathological confirmation by surgery after MRI examination within two week.Of the 59 patients,43 cases of malignant lesions,49 lesions,the maximum diameter of lesions was 0.4-5.1cm,average 1.9±0.7cm;16 cases of benign lesions,18 lesions,the maximum diameter of lesions was 0.4-3.0cm,average1.6±0.4cm.The dynamic enhancement scanning morphological features of the benign and malignant breast lesions were analyzed.The time-signal intensity curve was drew and the apparent diffusion coefficient(ADC)was measured.With pathologic diagnosis as the gold standard,the statistical differences of magnetic resonance imaging and the dynamic enhancement scanning morphological features of the benign and malignant breast lesions were summarized;The best ADC threshold of benign and malignant breast lesions were explored by plotting the receiver operating characteristic curve(ROC);The statistical differences of TIC curve and ADC value between benign and malignant breast lesions were analyzed;The sensitivity,specificity,accuracy and so on of 3.0T MRI alone sequences and their combined sequences in the diagnosis of the benign and malignant breast lesions were calculated;A plurality of indexes of the above magnetic resonance examination methods were used to draw the receiver operating characteristiccurve and preferably the diagnostic index of the MR examination.Of the 59 patients,67 lesions were confirmed by histopathology,including 43 cases of 49 malignant lesions,infiltrating breast cancer(not classified)(n=5),infiltrating ductal carcinoma(n=37),ductal carcinoma in situ(n=2),infiltrating ductal carcinoma with ductal carcinoma in situ composition(n=2),melanoma(n=1),mucinous carcinoma(n=2),16 cases of 18 benign lesions,adenosis of breast(n=7),adenosis of breast with cyst(n=3),fibroadenoma(n=3),fibroadenoma with adenosis(n=2),fibrous tissue hyperplasia with collagen(n=1).The margin,shape,border and evenness of benign and malignant breast lesions showed statistical significance(P<0.05).The sensitivity,specificity and accuracy of the morphological features of dynamic enhancement in the diagnosis of benign and malignant breast lesions were 89.8%(44/49),61.1%(11/18)and 82.1%(55/67)respectively.The Kappa value was 0.528.The types of TIC curve of dynamic enhancement of benign and malignant breast lesions showed statistically significant(?2=22.629,P<0.05).The sensitivity,specificity and accuracy of the TIC curves were 83.7%(41/49),77.8%(14/49)and 82.1%(55/67)respectively.The Kappa value was 0.574.ADC value of the differential diagnosis of breast lesions was statistically significant(t=6.696,P<0.05).The diagnostic threshold of ADC value was 1.012×10-3mm2 / s and the sensitivity,specificity and accuracy of the diagnosis were 91.8%(45/49),83.3%(15/18)and 89.6%(60/67)respectively,The Kappa value was 0.793.The sensitivity,specificity and accuracy of combining dynamic contrast enhancement scan morphology and TIC curve for diagnosis of benign and malignant breast lesions were 95.9%(47/49),72.2%(13/18)and 89.6%(60/67),The Kappa Value was 0.719.The sensitivity,specificity and accuracy of combining dynamic contrast enhancement scan and ADC value of benign and malignant breast lesions were98.0%(48/49),83.3%(15/18)and 94.0%(63/67).The Kappa was 0.843.The area under the ROC curve of several methods,including the morphology,TIC,morphology+ TIC,ADC and morphology + TIC + ADC for the diagnosis of benign and malignant breast lesions were 0.767,0.796,0.856,0.900 and 0.936 respectively.The differential diagnosis value of the breast benign and malignant lesions 3.0T magnetic resonance imaging is very limited,only as a reference.The differential diagnosis of breast benign and malignant lesions with 3.0T magnetic resonance dynamic contrast-enhanced scan has a high sensitivity,but the specificity is relatively low.The threshold of ADC value between breast benign and malignant lesions is 1.012 ×10-3mm2/s.A malignancy was diagnosed below this threshold has a high diagnostic efficacy.So,DWI should be one of the routine of mammary gland examination.The combination of morphology,TIC curve and diffusion-weighted imaging for the differential diagnosis of breast benign and malignant lesions was more effective than single imaging method.It can improve the accuracy of MRI preoperative diagnosis and reduce unnecessary puncture biopsy.