The Value Of MRI Multi Sequence Imaging In The Differential Diagnosis Of Plasma Cell Mastitis And Breast Cancer

Objective:To explore the value of MRI multi sequence imaging in diagnosis and differential diagnosis of plasma cell mastitis and breast cancer,and to provide strong imaging evidence for early detection,early diagnosis and early treatment of plasma cell mastitis and breast cancer.Methods:A total of 62 cases of plasma cell mastitis and breast cancer diagnosed by histopathology in the Affiliated Hospital of Nanjing University of Chinese Medicine from January 2015 to January 2016 were selected.Among them,there were 38 cases of plasma cell mastitis and 24 cases of breast cancer.All cases in this study received 3.0TMRI scan + enhanced examination before operation.Results:(1)In 62 cases of breast cancer and plasma cell mastitis diagnosed by histological biopsy or clinical diagnosis,57 cases were accurately detected by MRI,and the accuracy was 91.93%.The sensitivity and specificity of MRI in diagnosing breast cancer and plasma cell mastitis were 91.66%and 92.10%respectively.(2)The average age of serous mastitis was 35.97±11.34 years old,and the average age of breast cancer was 44.78±10.00.After t test,P<0.05,which means the age was statistically significant in the differential diagnosis of two groups.(3)Among 38 cases of plasma cell mastitis,there was 1 cases of nipple retraction or depression,21 cases of breast pain,6 cases of breast swelling,and nipple can squeeze out milky white secretions.Among the cases of breast cancer,there were 2 cases of nipple retraction or depression,3 cases of breast pain,I case of nipple discharge which was bloody discharge and 0 case of redness and swelling.In the aspects of red and swelling and pain of the breast,the X2 test was P<0.05,indicating that it has statistical significance.The number of positive cases of papillary depression or retraction of breast cancer and plasma cell mastitis was not enough,so no statistical treatment was done.(4)Among the cases of breast cancer,14 cases were single lesion while 4 were multifocal,3 were diffuse lesions,7 with clear boundary while 17 fuzzy,4 had smooth edge while 13 were lobulated,and 12 had burr sign.In the cases of plasma cell mastitis,8 were single lesions while 10 were multifocal,20 were diffuse lesions,38 boundaries were blurred,and most of the lesions were spotted.There were 3 cases of lobuling,0 case of smooth,and 0 case of burr.The diffuse distribution and the blurred boundary of the lesion were statistically significant in the differential diagnosis of serous mastitis and breast cancer(P<0.05).There were 10 cases of ductal dilatation in breast cancer and 21 cases in serous mastitis.Trough X2 test,P>0.05,it has no statistical significance.The skin edema and thick of breast cancer was 7 cases,and 21 cases in serous mastitis.By X2 test,P<0.05,the difference was statistically significant.(5)With MRI plain scan,there were 18 cases of low signal and 14 cases of equal signal in breast cancer,while 11 cases of low signal and 24 cases of equal signal in serous mastitis of T1WI fat suppressor.It has no statistical significance(P>0.05).There were 14 cases of equal signal and 19 cases of high signal in breast cancer,while 1 case of low signal,2 cases of equal signal and 35 cases of high signal in serous mastitis of T2WI fat suppressor.It also has no statistical significance(P>0.05).(6)In MRI dynamic contrast-enhanced images,there were 21 cases of early enhancement,2 cases of slightly early enhancement,1 of delayed enhancement in breast cancer.23 cases of early enhancement,13 cases of slightly early enhancement,2 of delayed enhancement in serous mastitis.Because of the relatively few data,in order to prevent the test efficiency deviation,it is not included in the statistics.Among all the cases,10 cases of nodular enhancement in breast cancer and 14 in serous mastitis,14 cases of ring enhancement in breast cancer and 15 in serous mastitis,the other cases were patchy enhancement in serous mastitis.The strengthening method has statistical significance in the differential diagnosis of two groups of lesions(P<0.05).In breast cancer cases,there were 14 cases of MIP supplying artery,and 38 cases of serous mastitis showed 18 cases of MIP supplying artery.The difference was not statistically significant(P>0.05).(7)When the b value measured by 1000s/mm2,the real part mean ADC value in breast cancer is 0.997±0.321 and 1.088±0.245 in serous mastitis.By t test,P is 0.059,the difference was not statistically significant.The liquefaction part mean ADC value in breast cancer is 1.432±0.388 and 0.984±0.482 in serous mastitis.By t test,P<0.001,the difference was statistically significant.When the b value is 1000s/mm2,DWI sequence signal is observed.There were 5 cases of breast cancer showing equal or slightly high signal,19 cases showing high signal.In serous mastitis,2 cases show slightly high signal,36 cases show high signal,the difference was not statistically significant(P>0.05).So the ADC value can be used as a useful reference tool for the differential diagnosis of the two,especially the ADC value measurement of the liquefied part.Conclusion:(1)Identification points:?predilection age:Serous mastitis occurs mostly in middle and young people,and breast cancer occurs mostly in middle-aged and old people.?Clinical manifestations:The patients with serous mastitis came to the hospital with red swelling,heat pain or swelling and pain.The patients of breast cancer mostly came with painless lumps or lumps with local mild pain or stabbing pain.?MRI examination showed that two lesions were obviously different in morphology.Serous mastitis is dominated by multiple nodules and diffuse distribution,Often without a complete form,blurred,or nodular,surrounding patches,fuzzy boundary changes,edema and thickening of skin.The distribution is dominated by single nodules of breast lesions.And the lesions are lobulated,clear boundary,visible burr.Edema and thickening of the skin is relatively rare.The enhancement of serous mastitis can see slightly early strengthening and ring enhancement.It may be associated with abscess and fistula formation.The enhancement curve is more common in ? and ?.Early enhancement is common in breast cancer,which is related to the abundant blood supply of breast cancer.The enhancement method can be nodular enhancement and ring enhancement,with nodular enhancement more universal.The enhancement curve is mostly ? type and? type.In the diffusion functional imaging sequence,the ADC value of the central liquefaction region was measured.The signal of breast cancer was high and the signal of serous mastitis was low.(2)Overlapping signs:Serous mastitis and breast cancer have many overlapping features in clinical and imaging findings,both of which can be painless mass.MRI examination can appear mammary duct expansion,MRI scan T1WI fat suppression sequences are mainly low signal,T2WI fat suppression sequences are mainly equal high signal,b values for the DWI sequence of 1000s/square meters with slightly high and high signal.The ADC value of the solid component of the two lesions is also close,and the blood supply artery can appear in the MIP image,and the time signal curve after the enhancement can be ? phase.