| Research Background:Breast disease is one of the most common diseases in women around the world.Although the incidence of female breast disease in China is lower than that of developed countries,it has been showing a significant upward trend in recent years.Especially in urban areas,the incidence rate is more obvious than that of rural areas.It has caused serious threat to women’s physical and mental health in China.At present.clinical methods for the diagnosis of breast disease are clinical breast examination(CBE).mammography(MAM),ultrasonography,magnetic resonance imaging(MRI)and so on.But because of the characteristics of small size,high dcnsity in Chinese women’s breast and the incidence age of breast cancer in(China is lower than that in developed countries(mostly in premenopausal),and of ultrasound’s convenience,fast,real-time dynamic images,low price and other advantages,ultrasound has become the preferred way to check the breast disease.Two-dimensional ultrasound and color Doppler ultrasound,identify the benign and the malignant of the lesion mainly through its shape,edge,border,echo,microcalcification,blood flow.But as a result of overlap to a certain extent between two-dimensional ultrasound images and blood flow images of benign and malignant breast lesions,conventional ultrasound diagnosis of breast lesions have certain limitations.The emergence of ultrasound elastography imaging,result in a new way of diagnosis by the soft and hard degree of the lesion to determine its benign and malignant.The pathological characteristics of the lesion,which generally considered the malignant lesions are harder,the benign lesions are mostly softer,is the basis of clinicians palpation.This technology can transform the softness of the lesion into a color image to visual display,benefit the diagnosis of clinicians.At present,a few scholars have conducted on the ultrasound elastic imaging of distinguishing benign and malignant breast lesions,and made abundant progress.Breast tumor size,one of the two biological indicators of predicting breast cancer prognosis,is an important preoperative evaluation of breast conserving surgery,which is negatively correlated with survival rate,accordance of tumor TM staging and neoadjuvant chemotherapy(NCT)efficacy evaluation.At the same time,the size of benign breast lesions for surgical options,incision location and postoperative aesthetics is closely related.At present,as the first choice test for the breast disease,research of the ability to measure the size of breast lesions by two-dimensional ultrasound and ultrasound elastography imaging technology is relatively less my study was designed to evaluate the ability of assessing the size of benign and malignant breast lesions by two-dimensional ultrasound and ultrasound elastography.by comparing with the histopathological size which as a reference standard.Research purposes:Ultrasound elastography can improve the diagnosis accuracy of benign and malignant breast lesions by estimating the hardness of soft tissue,but the data for its ability to assess the size of lesions is relatively small.This study was designed to evaluate the ability of assessing the size of benign and malignant breast lesions by two-dimensional ultrasound and ultrasound elastography,by comparing with the histopathological size which as a reference standard.Research methods:Preoperative two-dimensional ultrasound and ultrasound elastiography were put into practice on 85 breast lesions of 74 patients who underwent surgical resection in Qilu Hospital of Shandong University from May 201 5 to July 2016.According to the pathological results,the lesions were divided into benign and malignant groups.The size of the lesions measured by the two methods were recorded and averaged.The results were compared with pathological size which as the final reference standard.The measurement size by two-dimensional ultrasound,ultrasound elastography and pathology and the difference between each of them were paired t test,P<0.05 was considered that the difference was statistically significant.At the same time,the Bland-Altman plots were analyzed by the consistency of the measurement size by two-dimensional ultrasound,ultrasound elastography and pathology,and the clinical criteria was used to determine whether they could be used as an alternative of gold standard(ie,pathological measurement size).Research result:1.85 breast lesions of 74 patients who underwent insurgical resection included 54(63.5%)benign lesions(mainly breast hyperplasia nodules and fibroadenoma)and 31(36.5%)malignant lesions(mainly invasive breast cancer).The average size of benign lesions was(1.42 ± 0.67)cm,and the mean size of malignant lesions was(1.92±0.70)cm.The mean size of malignant lesions was bigger than that of benign lesions(P= 0.01).2.In the 54 benign lesions,the paired t test result of the difference between the measurement size by two-dimensional ultrasound and pathology showed that t=1.798,P= 0.078>5%,the difference was not statistically significant;the paired t test result of the difference between the measurement size by ultrasound elastography and pathology showed that t=1.914,P = 0.061>5%.the difference was not statistically significant;the paired t test result of the difference between the measurement size by ultrasound elastography and two-dimensional ultrasound showed that t=-0.174,P=0.863>5%,the difference was not statistically significant.In the 31 malignant lesions,the paired t test result of the difference between the measurement size by two-dimensional ultrasound and pathology showed that t=-0.156,P = 0.877>5%,the difference was not statistically significant;the paired t test result of the difference between the measurement size by ultrasound elastography and pathology showed that t= 4.308,P<0.001<5%.the difference was statistically significant;the paired t test result of the difference between the measurement size by ultrasound elastography and two-dimensional ultrasound showed that t = 7.629,P<0.001<5%,the difference was statistically significant.3.Bland-Altman analysis of the consistency of the measurement size by traditional two-dimensional ultrasound and pathology of the 54 benign lesions showed that there were 2 points beyond the 95%consistency limit(-0.156,0.196),the proportion was 3.7%(2/54)<5%;within the consistency limit,the maximum absolute value of the difference between the measurement size by two-dimensional ultrasound and pathology was 0.18cm,the mean value of the difference was 0.02cm,phase difference was clinical acceptable;Bland-Altman analysis of the consistency of the measurement size by ultrasound elastography and pathology of benign lesions showed that there were 2 points beyond the 95%consistency limit(-0.137,0.177),the proportion was 3.7%(2/54)<5%;within the consistency limit,the maximum absolute value of the difference between the measurement size by two-dimensional ultrasound and pathology was 0.16cm,the mean value of the difference was 0.02cm,phase difference was clinical acceptable;In the 31 malignant lesions.Bland-Altman analysis of the consistency of the measurement size by ultrasound elastography and pathology showed that there was 1 point beyond the 95%consistency limit(-0.277.0.271),the proportion was 3.2%(1/31)<5%;within the consistency limit.the maximum absolute value of the difference between the measurement size by two-dimensional ultrasound and pathology was 0.27cm,the mean value of the difference was-0.003 cm,phase difference was clinical acceptable:Bland-Altman analysis of the consistency of the measurement size by ultrasound elastography and pathology of malignant lesions showed that there were 2 points beyond the 95%consistency limit(-0.303.0.677),the proportion was 6.5%(2/31)>5%;within the consistency limit,the maximum absolute value of the difference between the measurement size by two-dimensional ultrasoundand pathology was 0.61cm.the mean value of the difference was 0.187 cm.phase difference was clinical acceptable;but because of the proportion of the points beyond the 95%consistency limit>5%,it could not be considered that the measurement size of breast lesions by ultrasound elastography was consistent with the size by pathology,that is,the size by ultrasound elastography could not be used to estimate the actual size of malignant lesions.At the same time,Bland-Altman plots showed that 87.1%points(27/31)was above the difference 0 line,12.9%(4/31)below the difference 0 line,it could be considered that ultrasound elastography overestimated the actual size of the malignant lesions,compared with pathology.Research conclusion:1.The measurement size by two-dimensional ultrasound and ultrasound elastography of benign breast lesions compared with that by pathology,the difference was not obvious,consistency was good,both of them could be used to estimate the actual size of benign lesions;2.The measurement size by two-dimensional ultrasound compared with that by pathology,the difference was not obvious,consistency was good,two-dimensional ultrasound could be used to estimate the actual size of malignant breast lesions;the measurement size by ultrasound elastography compared with that by pathology,the difference was obvious,consistency was not good,ultrasound elastography could not be used to estimate the actual size of malignant lesions.At the same time,ultrasound elastography had a tendency to overestimate the size of the lesion,which could be used as an indication of ultrasound elastography in the diagnosis of’ benign and malignant breast lesions. |
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