| Breast cancer is now the most common female malignant tumor. More than 400 thousands people died of the disease each year in the world, and the morbidity is increasing recent years. Early diagnosis and treatment are very important for improving survival of the patients. Doctors are interested in how to differentiate malignant from benign masses correctly. Ultrasonography is the most simple, harmfulless and suitable method in detection of breast. Part One The value of color and power Doppler ultrasound in the differential diagnosis of breast massObjective To evaluate the value of color and power Doppler ultrasound in differential diagnosis of breast neoplasms.Methods Eighty-nine breast masses (42 malignant,47 benign) were prospectively assessed by color Doppler ultrasound and power Doppler ultrasound before operation and were identified by histopathology.Results The vascularity was predominant, both in central and peripheral area of the mass, with a positive rate of 63.4% in the malignant tumors, in comparison, it was only 28.0% in the benign ones, and the difference was statistically significant (P=0.013). The branching signals were seen in 65.9% of the malignants and in 24.0% of the benigns, and the difference was statistically significant (P=0.001). The presence of penetrating vessels was 63.4% in the malignants and 20.0% in the benigns, respectively, and the difference was statistically significant (P=0.001). Doppler spectral parameters, such as RI and PI, was found to be significantly higher in the malignant group than those in the benign group (P<0.001), but AT was significantly lower in the malignants (P<0.001). When the PI>1.35, RI> 0.75, and AT<90ms, the detection of malignant neoplasms presented a sensitivity of 87%, 87%, and 39%, a specificity of 88%, 80%, and 96%, and a accuracy of 88%, 85%, and 61%, respectively. Conclusions Hyperechic halo and microcalcification play an important role in detection of breast cancer by ultrasonography. The color Doppler flow signals were more abundant in malignant tumors than that in benign tumors. The branching signals and penetrating vessels are usually detected in the malignant tumors. RI and PI showed significantly higher in malignant group than those in benign group. AT were significantly lower in malignant group. Color and power Doppler ultrasound used as noninvasive method in detecting and evaluating vascularity of the breast neoplasms, and further more in differential diagnosis of breast neoplasms was suggested.Part Two The study of correlation between vascularity in CPDI and angiogenesis of breast cancerObjective To study the relationships between color power Doppler ultrasonographic measurement of breast tumor vascularity and immunohistochemical analysis of VEGF positive cells optical density (OD) for the quantitation of angiogenesis.Methods 42 women with palpable breast masses were scanned with CPDI , vessel counts were performed on sonographic images before operation. vessel counts were devided into four grades according to Adler's methods. All tumors were proved to be breast cancer by pathologic examination The 42 specimens were stained immunohistochemically with VEGF antibody. The VEGF positive cells stained in brown, which was evaluated by optical density(OD) equipment. The more express of VEGF , the stronger stained in brown. The grades of sonographic measure of vascularity was correlated with VEGF positive cells OD. OD was correlated with the size of mass and metastasis of axillary lymphnodes.Results The detection rate of color Doppler flow signals in 42 cases of breast cancer was 97.6%, and it was 100% in LN+ group, 93.3% in LN- group. There was no significant difference between LN+ group and LN- group. The detection rate ofⅡ-Ⅲgrade flow signals was 88.9% in LN+ group, 53.3% LN- group. The rate VEGF positive cells was 83.3% in 42 cases of breast cancer. The flow grades were higher in LN+ group than in LN- group. A significant positive correlation was observed between the grades of vascularity in CPDI and OD in IHC(r=0.61885, p<0.05). The VEGF positive cells OD showed a significant positive correlation with tumor size(r=0.56999, p<0.05). Higher OD was noted in LN+ breast cancer than in LN- group. The difference was significant. OD showed no significant difference in different histopathologic types.Conclusions Tumor vascularity could be maped and depicted by CPDI .It is more usueful in differential diagnosis of breast neoplasms. The vascularity of mass was different between malignant and benign tumor. Our study showed that : CPDI sonographic measurement of tumor vascularity was significant correlated with VEGF positive cells OD by IHC analysis. The OD showed a significant positive correlation with tumor size. Higher OD was noted in LN+ breast cancer than in LN- group. Angiogenesis is closely correlated with axillary lymphnode metastasis in breast carcinoma. Combining with CPDI and IHC, may be a parameter for determining tumor potential metastasis and prognosis.Part Three The correlation between vascularity in CPDI and MVD in breast carcinomaObjective To evaluate the relationships between color power Doppler ultrasonographic measurement of breast tumor vascularity and immunohistochemical analysis of MVD of CD31,CD34 for the quantitation of angiogenesis.Methods 42 women with palpable breast masses were scanned with CPDI , vessel counts were performed on sonographic images before operation. vessel counts were devided into four grades according to Adler's methods. All tumors were proved to be breast cancer by pathologic examination and underwent immunohistochemical analysis for CD31, CD34 MVD assessment. Microvessel staining was performed in 42 cases of breast carcinoma.who underwent mastectomy. The specimens were stained immunohistochemically with CD31,CD34 antibody. which was used for the evaluation of MVD. Areas of highest neovascularization were select by scanning the tumor sections at low power views(100×magnification). Microvessels stained in brown were counted in the three most hypervascular areas at a 400×magnified field. The average value is the value of HPF. The grades of sonographic measure of vascularity was correlated with MVD. MVD was correlated with the size of mass and metastasis of axillary lymphnodes.Results The detection rate of color Doppler flow signals in 42 cases of breast cancer was 97.6%, and it was 100% in LN+ group, 93.3% in LN- group. There was no significant difference between LN+ group and LN- group. The detection rate ofⅡ-Ⅲgrade flow signals was 88.9% in LN+ group, 53.3% LN- group. The flow grades were higher in LN+ group than in LN- group.The MVD of CD31 was 15.67±6.61/HPF. LN+ group 19.11±4.93 / HPF,LN- 9.47±4.32/ HPF. The MVD of CD34 was 24.09±10.88/ HPF ,LN+ group was 29.22±9.61 / HPF, LN- group was 14.87±5.77 / HPF,A significant positive correlation was observed between the grades of vascularity in CPDI and MVD of CD31,CD34. The MVD of CD31, CD34 showed a significant positive correlation with tumor size.Conclusions CPDI was more useful in detection of Tumor vascularity. The vascularity features was very important in differential diagnosis of breast neoplasms. Our study showed that : CPDI sonographic measurement of tumor vascularity was significant correlated with MVD of CD31,CD34 in IHC analysis. The MVD showed a significant positive correlation with tumor size. Higher MVD was noted in LN+ breast cancer than in LN- group. Angiogenesis is closely correlated with axillary lymphnode metastasis in breast carcinoma. Microvessel angiogenesis in IHC analysis was correlated with vasculature in CPDI. CPDI would be an useful method to assess the tumor angiogenesis preoperation. Combining with CPDI and IHC, may serve as a parameter for determining tumor potential metastasis and prognosis.
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