| Breast cancer has become the highest morbidity of malignant tumors in the urban women,and the morbidity of the disease showed a trend of rapid growth,the women’ health and life had been seriously damaged.The treatment and prognosis are very different in different tumor staging,It is particularly important that the early detection and treatment of the breast cancer.The diagnosis of breast cancer mainly depends on clinical palpation and imaging examination.According to international diagnostic standard,Mammography is regarded as the first choice in the diagnosis and screening of breast cancer.Breast ultrasound is often used in dense breast screening and diagnosis as a supplementary imaging method.Ultrasound is widely used because of the advantages of convenient,fast,cheap,better patient tolerance,and no radioactive pollution.The ultrasound can find lesions in size bigger than 0.5cm in diameter of the breast nodules,with the continuous renewal of ultrasonic equipment and technology,the detection and diagnosis of ultrasound in lesions has been improved greatly.However,the traditional ultrasonic imaging has the insurmountable disadvantage,the operator dependent,Ultrasound diagnosis is highly depend on the operator’s experience and technique,Different results directly affects the treatment,improper diagnosis can sometimes bring patients psychological and economic damages,even delay the treatment.The first studies of the whole volume imaging can be tracked on theThe first studies of the whole volume imaging can be tracked on the1970 s,However,it is not used in clinic because the image quality and technical reasons.In recent years,the ABVS(Automated breast volume scanning)from Siemens company can get complete number of image scanning data,through high frequency probe and wide flexible robotic arm,and complete 3D data reconstruction by the off-line dedicated workstations,theautomatic data scan,and 3D data reconstruction will be completed at the same time.It could multidimensional show breast imaging,the model of the separation between the image scanning and diagnosis would be came reality,so this system would be a good prospect.In this study we evaluated the diagnostic performance,validity of the ABVS,by comparing the traditional ultrasound,and with the pathology as the gold standard.Indicators including the accuracy of the diagnosis,the sensitivity,specificity,positive predictive value,negative predictive value,the stability.At the same time,we also study the diagnosis in special types of mammary gland disease.Part one Study on Reproducibility of ABVS in Breast Lesion DetectionPart one Study on Reproducibility of ABVS in Breast Lesion DetectionObjective: The ABVS can get whole volume data of the breast,so it should have high stability and reproduction in theory.However,the mammary gland was an active organ,the uncertainty was existed.Whether the ABVS could overcome the HHUS operator dependent,and improve the objectivity or not,that was very important in its application in clinical.The reproducibility of the ABVS in diagnosis of breast nodules was discussed in this study.Methods: This study was based on the retrospective analysis from patient data of 35 cases which because of breast disease from 2014.2 to 2015.7in our hospital.Reproducibility study was done by two doctors with ABVS,got the number of lesions,location information and size respectively,calculated the intraclass correlation coefficient(ɑ value)with the parameters.Results:1 There were 67 lesions and 68 lesions respectively detected by the two exam methods.2 There were 35 nodules by measuring in the study,include cyst 1 case,6cases of hyperplastic lesions and atypical hyperplasia 1 case,7 cases of fibroadenoma,mammary gland inflammation 1 case,fat necrosis 1 case,17 cases breast ductal carcinoma,mucous adenocarcinoma 1 case,The cases were confirmed by surgery or biopsy pathology besides the cyst.3 Clock position ɑ=0.949,distance from the nipple ɑ=0.343,distance from the skin ɑ=0.883.The consistent parameter ɑ of the vertical diameter,transversal diameter,and anteroposterior diameter was 0.938、0.936、0.948,respectively.The parameters were with high repeatability,besides the distance from the nipple.That the ABVS technology is the combination of ultrasound scan and plain film model,to a certain extent,get rid of the disadvantages of conventional ultrasound operator dependence,with high repeatability,to provide a new way in review and curative effect evaluation of the neoadjuvant chemotherapy in breast benign lesions.Part two The Consistency Analysis between ABVS and HHUS in Breast Lesions DetectionObjective: The ABVS was developed from the HHUS,this study was to discuss the ability of diagnosis of ABVS in breast lesions and the consistency of HHUS.Methods: This study was based on the retrospective analysis from patient data of 90 cases which because of mammary gland disease from2014.2 to 2015.7 in our hospital.The consistency analysis of ABVS and HHUS was based on the lesion number,size,location,breast lesions ultrasonographic features and the final classification.Results: The patient number of mammary gland disease was 90,there were 138 nodules detected by HHUS and 148 nodules detected by ABVS,113 lesions detected by ABVS and HHUS,35 lesions detected by ABVS independently,25 lesions detected by ABVS independently,intraclass correlation coefficient of the two methods(ɑ = 0.870).The comparison of the coherence in diagnosis of the two methods,clock position(ɑ=0.684),distance from the nipple(ɑ=0.241),distance from the skin(ɑ=0.772).The consistent parameter ɑ of the vertical diameter,transversal diameter,and anteroposterior diameter was 0.625,0.610,0.511,respectively.The consistent parameters of the characteristics of ultrasound image were shap(κ=0.554),aspect ratio(κ=0.617),edge(κ=0.722),inside echo(κ=0.392),back echo(κ=0.177),microcalcification(κ=0.130).The final diagnosis of nodules were κ=0.539.That the ABVS and HHUS had good consistent in the nodules detection and diagnosis.The ABVS can be used to supplement the HHUS method in the disease screening,follow-up and neoadjuvant chemotherapy curative effect evaluation,of the mammary gland disease in methodology.Part Three The Comparison of ABVS and HHUS in diagnostic PerformanceObjective: The aim is to analyze the diagnostic performance of ABVS by comparing with HHUS。Methods: This study was based on the retrospective analysis from patient data of 114 cases with mammary gland disease from 2014.2 to 2015.7in our hospital.The comparative analysis between ABVS and HHUS was conducted based on pathological results.Results: The sensitivity,specificity,and accuracy for HHUS was 94.1%,74.0%,85.6%,and for ABVS was 95.6%,74.0%,and 86.4% respectively.There was no difference found between two methods.That the ABVS had equal diagnostic performance with HHUS in sensitivity,specificity,and accuracy when as a method to diagnose breast cancer.But ABVS create a new way in optimizing the work place by separating detection and diagnosis.Part Four The Advantages and Diagnostic Value of ABVSObjective: the ABVS(Automated breast volume scanning)can get whole volume data,through high frequency probe and wide flexible arm,the advantage is to get the similar coronal imaging with the surgical perspective.In this study,we want to discuss the diagnostic values of coronal images from the ABVS in diagnosis and differential diagnosis of malignant breast tumor.Methods: This study was based on the retrospective analysis from patient data of 114 cases which because of mammary gland disease from2014.2 to 2015.11 in our hospital.A total of 114 patients with 118 nodules had been detected by ABVS,which were screened by Hand-held Ultrasound,and got pathological results by ultrasound guided biopsy or surgery operation.We want to discuss the diagnostic values of coronal images from the ABVS in diagnosis and differential diagnosis of malignant breast tumor,comparing with pathological results.Results: There were 118 nodules in 114 cases of mammary gland,46 cases in benign lesions group,50 nodules,including 18 cases of fibroadenoma,a total of 20 nodules,mammary gland inflammation,7 cases and 7 nodules,21 cases of mammary gland disease,a total of 23 lesions;There were 68 nodules in 68 cases of mammary gland in malignant lesions group,including 7 nodules in 7 cases of the precursor lesions and micro invasive carcinoma.The ABVS coronal features of the benign and malignant breast lesions in morphology,edge,convergence sign,envelope,bulky calcification,microcalcification and the performance of fat tissue around the lesion had statistically significant(P < 0.05).The Logistic regression model was established with coronal ultrasonographic features of ratings for the independent variables and pathological types as the dependent variable,ultrasonographic features include breast malignant lesions Convergence sign,microcalcification,the changes of fat tissue around the lesion(P < 0.05).Convergence sign,microcalcification,lesions surrounding adipose tissue changes can be used as a risk factor for ultrasonic evaluation of malignant breast lesions,had high clinical value for the diagnosis of breast cancer.Part Five The Diagnostic Value of ABVS in Category 4 LesionsObjective: That the ABVS can get whole volume data of the breast,can provide similar coronal images in the view of the surgical through 3 D reconstruction,fully showed the relationship of the tumor organization and its surrounding tissues,to a certain extent,reflected the biological behavior of tumor tissues.The BI-RADS category 4 nodules were common in the clinical,the malignant of them is between 3% ~ 98%,the diagnosis consistency of this type nodule was the worst by Ultrasound doctors,and the image diagnosis had a great influence on treatment of the disease.The Objective of the study was to discuss whether the ABVS had advantages in the diagnosis of the nodules or not,and evaluate its diagnostic value in the nodules.Methods: This study was based on the retrospective analysis from patient data of 48 cases which were diagnosed for BI-RADS 4 by HHUS,the data included the imaging data and pathological results.the accuracy,sensitivity,specific,positive predictive value and negative predictive value were calculated separately,between the two diagnosis methods With pathology as the gold standard,then perform the statistical analysis.Results:1 Pathology: 53 nodules in 48 cases,confirmed by ultrasound guided biopsy pathology,postoperative pathology confirmed again in some patients,the in-conformity between biopsy and the postoperative pathological cases was not found.There were 32 lesions in 29 cases of the benign group,including breast inflammatory lesions in 1 case,1 case with granulomatous inflammation,5cases of atypical ductal epithelial hyperplasia,mammary gland inflammation with epithelial atypical hyperplasia in 1 case,14 cases of mammary gland disease,4 cases were associated with atypical hyperplasia of mammary gland disease,fiber adenoma 1 case,fibroma hyperplasia 4 cases,1 cases of fat necrosis;There were 21 lesions in 19 cases of the malignant group,including 17 cases breast ductal carcinoma,2 cases of breast carcinoma in situ,breast mucinous carcinoma in 2 cases.2 HHUS :53 lesions classified as 23 cases in category 4a,8 cases in category 4b,and22 cases in category 4c.With pathology as the gold standard,HHUS diagnostic accuracy,sensitivity,specific,positive predictive value and negative predictive value were 54.7%,66.7%,46.9%,45.2%,68.2%.3 ABVS : 53 lesions classified as 12 cases in category 2,13 cases in category 3,6 cases in category 4a,3 cases in category 4b,1 case in 4c class,and 18 cases in category 5.With pathology as the gold standard,HHUS diagnostic accuracy,sensitivity,specific,positive predictive value and negative predictive value were 67.9%,57.1%,75.0%,60.0%,72.7%.Conclusions:1 A high agreement was found between ABVS and HHUS in breast lesion detection and diagnosis,because ABVS had more objectivity,which hinted that ABVS could be a replacement to HHUS in breast cancer diagnose.2 The capacity for gathering standardized views of the entire breast volume by automated scanner,which produced better reproducibility in detection,localization,and measurement.3 The images of breast cancer in coronal planes made by ABVS could reflect biologic features of tumor,so it showed more advantages than HHUS in diagnosis of breast lesions.4 Covenge sign in ABVS coronal plane had a high value in diagnosis of breast cancer,which was a special feature of ABVS.3 D reconstruction of images enhanced the ability to demonstrate fatty tissue changes around tumor,so as to increase the detection rate of breast cancer.5 When came to lesions diagnosed as category 4,ABVS had a higher specificity than that of HHUS,by which,it could reduce misdiagnose and decrease biopsy rate in patients with breast lesions.If we could combine ABVS and HHUS together,we may reduce misdiagnose caught by less work experience in category 4 breast lesions. |
PDF Full Text Request