The Controlled Study Of Breast NMLE Lesions With Ultrasonography And Pathology

Background and ObjectiveBreast disease is a common disease.It is a major disease that hazard health and quality of women's lives.It was divided into mastitis,hyperplasia,fibroadenoma,cysts,cancer,etc.The incidence of breast cancer is high and was the first one on the list of female malignant tumor,and its incidence gradually younger and younger.The factors leading to the development of breast disease were complicated.If discover not timely or treatment inappropriately can lead to life-threatening at any time,so early and accurate diagnosis of breast disease is too critical.As has a series of advantages,real-time,simple,fast,non-radiation,non-invasive,nice patient compliance,low price,can be repeated,ultrasound examination is now a routine examination to identify breast lesions.In ultrasound examination of breast disease,we often encounter some do not meet the definition of mass lesions,such as: blurred boundary hypoechoic echo,clutter,tubular hypoechoic like.There are malignant lesions of the breast with such lesions and,so an accurate diagnosis of such non-mass lesions can not be ignored.However,ultrasound Breast Imaging-Reporting and Data System(BI-RADS)classification section did not define the "non-mass" lesions.Previous studies have shown that ultrasound found does not meet the definition of mass lesions in magnetic resonance imaging(MRI)usually show a non-mass type of enhancement,and 95% lesions with pathologically confirmed breast cancer in ultrasound does not meet the definition of mass showed a non-mass-like enhancement pattern in magnetic resonance imaging,also.Accordingly,the present study was to controlled analyze the pathological diagnosis and sonographic performance of non-mass like enhancement(NMLE)lesions in magnetic resonance imaging,aimed at raising awareness and diagnostic levels of ultrasound for non-mass type of breast lesions.Materials and MethodsThe first part: Collected 156 cases NMLE patients who has complete breast MRI,ultrasound and pathological results between 2013.01 and 2014.01 in our hospital.All patients were female,aged 28 to 72 years(mean 45 ± 8 years),clinical data integrity,had no contraindications to MRI.The time of breast examination with MRI was time of 3 days to 2 weeks after menstruation.Inclusion criteria: two doctors for more than five years experience in the collective judgment of the NMLE on the MRI(There was no clear boundaries between lesion and surrounding glands signal in T1 WI,no clear mass effect in enhanced scan),and have the ultrasonic examination.The second part: Selecting patchy hypoechoic lesions in the first part.Q-Box has a diameter of 2mm,placed lesions hardest area to give the average Young's modulus value in shear wave elastography,to get the best diagnostic cutoff value,in order to explore its diagnostic value of elastography.Results1.In final pathologic diagnosis there were 92 cases of benign lesions(59.0%)and 64 cases of malignant lesions(41.0%)in 156 cases of non-mass-like enhancement of breast lesions;patchy hypoechoic lesions 96 cases(61.5%),clutter echo 16 patients(10.3%),mammary duct ectasia 18 cases(11.5%),microcalcifications clustered distribution of 4 cases(2.6%),ultrasound showed negative 22 cases(14.1%)2.BI-RADS classification Category 2,3,4 and 5 were as follows: 10 cases,52 cases,58 cases,14 cases.The sensitivity,specificity,positive predictive value and negative predictive value were 77.8%,59.5%,77.8% and 80.6% with ultrasound diagnostic.3.The abnormal axillary lymph nodes,the blood flow signal(+)in malignant were higher than in the benign group(former x2 = 7.809,P = 0.005;the latter x2 = 36.914,P = 0.000).There were 14 cases of combined calcified lesions with 4 cases of benign and 10 were malignant.4.The area under the curve(AUC)of patchy hypoechoic lesions with shear wave elastography was 0.879,the average Young's modulus of the benign group was(37.76 ± 8.21)kPa,the average Young's modulus of the malignant group was(78.84 ± 24.21)kPa,the best diagnostic cutoff was 45.53 kPa,the diagnostic sensitivity and specificity were 83.5% and 77.2% with this boundary value.Conclusion1.Non-mass breast lesions may be showed patchy hypoechoic echo,clutter,mammary duct ectasia,clustered microcalcifications distribution and can also be expressed as(-)in routine ultrasound.2.Lesions merge axillary abnormal lymph or lesions with blood signal were more likely to be malignant lesions.The internal calcification has some significance of malignant diagnosis.3.Most of the non-mass breast lesions showed patchy hypoechoic lesions with ambiguous BI-RADS classification 3 and 4 class in conventional ultrasound diagnosis,with a relatively high sensitivity and low specificity.4.The shear wave elastography has some value of ultrasound showed patchy hypoechoic lesions.