Contrast Study On Images Of Non-palpable Breast Cancer Microcalcification And Benign Breast Microcalcification

ObjectiveMicrocalcification(MC)is an important sign of non-palpable breast cancer(NPBC).The objectives of this article are as follows:1.To find the image difference and identification points of MC between benign breast lesions and NPBC.2.Evaluating the value of digital breast tomography(DBT)in distinguishing the intermediate MC in dense gland types.Diagnosing and screening early breast cancer to reduce misdiagnosis and missed diagnosis.3.To explore the correlation between pathological grading and microcalcification imaging characteristics,to provide reference for clinical early treatment and intervention.Materials and methodsThis study retrospectively analyzed 77 NPBC and MC patients with benign lesions,aged 31-67 years old,with an average of 48.3 years old,all the cases were confirmed by breast surgery and pathology in our hospital from Jan.2017 to Dec.2018.There were 26 cases in NPBC group,aged 42-67 years old,with an average of 53.5 years old.51 cases in benign group,aged 31-52 years,with an average of 41.2 years.All of the above cases were studied with the consent of the Hospital Ethics Committee.The selected cases were examined by Selenia Dimensions digital tomosynthesis system and digital mammography system(Hologic,USA).A Siemens Magnetom Skyra 3.0 T MRI scanner(Siemens AG,Munich,Germany)with a dedicated bilateral eight-channel phased array breast coil was used for 4 cases of dense glands.All 77 breast images were interpreted strictly by two senior doctors according to the standard of BI-RADS 5th edition,including breast type,MC morphological classification,grading and MC location distribution.According to the pathological types of MC,the morphological characteristics of intermediate calcification in BI-RADS type Ⅲ and Ⅳ glands were emphatically analyzed.The NPBC group was observed to analyze the correlation between pathological grade,type and imaging characteristics of MC.Results1.Experimental data(1)According to BI-RADS in77 patients,type Ⅰ(Fatty dense)accounted for 6.49%and type Ⅱ(Scattered dense)for 11.69%,type Ⅲ(Heterogeneous dense)accounted for 64.94%and type Ⅳ(Extreme dense)for 16.88%.(2)Morphological grading of 77 patients with MC lesions was 46.75%for possibly benign MC,45.45%for intermediate MC and 7.80%for possibly malignant MC.(3)Distribution frequencies of benign and malignant MC in their each group:diffuse and scattered,NPBC group accounted for 7.69%,benign group 52.94%;regional distribution,NPBC group accounted for 19.23%,benign group 25.49%;cluster distribution,NPBC group 57.69%,benign group 17.65%;linear and segmental distribution,NPBC group accounted for 15.39%,benign group 3.92%.(4)Pathological types of MC in NPBC group and benign group:In NPBC group,carcinoma in situ,microinvasion and local early invasion were the main pathological types.In benign group,hyperplasia,atypical duct hyperplasia(ADH),papilloma,adenoma,or coexistence were predominant.(5)Pathological grading,types and morphological characteristics of MC in NPBC group:Of 26 NPBC patients,10(38.46%)had high-grade ductal carcinoma in situ(DCIS)related lesions;the morphology of MC was mainly manifested by its typical fine-line branches and fine pleomorphic.(6)Comparison of DBT and FFDM in showing nodules or infiltration around MC of dense glands in 39 patients.In the experiment,39 patients with nodules or infiltration burrs around microcalcification were screened out,including 22 patients(56.4%)in NPBC group and 17 patients(43.6%)in benign group.(7)The positive discovery of DBT and FFDM were compared in NPBC group(22 patients with nodules or infiltration).Kappa statistical analysis was carried out by SPSS 22 software.The results showed that the diagnosis of DBT and FFDM were not consistent,and Kappa = 0.089.(8)The potential of DBT and FFDM in showing breast nodules.Seventy-seven cases were included in the statistic.The sensitivity,specificity,positive predictive value,negative predictive value,false positive rate/misdiagnosis,false negative rate/missed diagnosis rate for DBT and FFDM were respectively:89.74%and 35.90%,94.74%and 71.05%,94.59%and 56%,90%,and 51.92%,5.26%and 13.75%,10.26%and 64.10%.(9)MRI imaging in 4 cases:The signal of benign hyperplasia of mammary glands were uniformly,the signal of tumor lesion in NPBC showed nodule and burr-like signs.2.Research shows that(1)The distribution of benign calcification was mostly scattered and multi-regional,but may also be cluster distribution.The cluster distributed MC of benign lesions was easily misdiagnosed as NPBC.(2)MC with localized unilateral mammary glands was commonly found in ADH,breast dysplasia,sclerosing gonadism,lobular fibrosis,adenoma formation,etc,which was easily misdiagnosed as NPBC.(3)The density and the edge of benign microcalcifications were often more uniform and sharp than NPBC.(4)In NPBC,the distribution,morphology and expression of clinically relevant receptors of high-grade DCIS microcalcifications had characteristics.(5)Comparing DBT and FFDM to show signs such as nodules or infiltration burrs around MC in NPBC,the consistency of diagnostic results was poor(Kappa=0.089).The positive rate of DBT diagnosis was 86.4%,which was significantly higher than FFDM diagnosis(22.7%),and the difference was obviously significant(P<0.01).Conclusion1.Understanding the morphological characteristics of microcalcification is helpful in the differential diagnosis between benign MC and MC in NPBC.2.Among the denseglands,DBT can better show the small nodules and microinfiltration of tumors around NPBC microcalcifications,which is of great significance for distinguishing NPBC microcalcifications from benign microcalcifications.3.The application of DBT can amend the positive predictive value of lesion area,which is of great significance for the screening of early breast cancer.