Application Value Of Multimodal Ultrasound In Qualitative Diagnosis Of Non-Puerperal Mastitis

Chapter one The diagnostic value of conventional ultrasound characteristics of different types of NPMObjective To explore the value of conventional ultrasound in distinguishing periductal mastitis(PDM)from granulomatous lobular mastitis(GLM)and to summarize the sonographic features of non-puerperal mastitis(NPM).Methods The data of 134 patients with NPM(84 cases of PDM and 50 cases of GLM)were analyzed retrospectively.The baseline data and conventional ultrasound findings of PDM and GLM were compared,and the ultrasonic characteristics of NPM were summarized.Results Compared with GLM,PDM was more likely to be associated with ipsilateral axillary lymph node enlargement((x~2=4.209,P=0.040).The sonograms of NPM lesions were divided into 7 types according to their shape and echo changes:local glandular hypoechoic type,glandular duct dilatation type,cyst type,nodular type(both the long diameter and the anteroposterior diameter are<2 cm),mass type(both the long diameter and,or anteroposterior diameter≥2 cm),cystic-solid mixed type,abscess type.Compared with PDM,abscess type is more common in GLM((x~2=4.928,P=0.026).Conclusion According to the shape and echo changes,NPM sonograms can be divided into seven types,which is helpful for ultrasound doctors to master the sonographic features of NPM and to identify NPM early in the clinic.However,it isn’t easy to distinguish PDM from GLM only by conventional ultrasound,and enlargement of ipsilateral axillary lymph nodes may be helpful to determine them.Chapter two Nomogram based on conventional ultrasound features to identify non-puerperal mastitis from breast cancerObjective Establishing nomogram based on clinical baseline data and conventional ultrasonic features to distinguish non-puerperal mastitis(NPM)from breast cancer(BC).Methods 134 cases of NPM and 97 cases of BC were retrospectively included as the training group and internal validation group,and 41 cases of NPM and 71 cases of BC were included as the external validation group.Univariate and multivariate analyses were performed on the patients’primary data and ultrasound characteristics,and a nomogram was constructed based on the results of the multivariate analysis.The receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the predictive accuracy of the nomogram.Results In the training group,Patients’age,distance from the lesion to the nipple(<1 cm,≥1 cm),peripheral hyperechoic halo(presence or absence),and calcification(presence or absence)were independent predictors for distinguishing NPM from BC;nomogram and ROC curve were constructed based on the above independent predictors,with an area under the curve(AUC)of 0.976.Based on this model,the cutoff value of NPM and BC is predicted to be 0.5.Both internal verification and external verification show that the nomogram has high predictive power.Conclusion The nomogram based on the age of the patient,the distance from the lesion to the nipple(<1cm,≥1cm),the peripheral hyperechoic halo(with or without)and calcification(with or without)is helpful for the differential diagnosis of NPM and BC.Chapter three Contrast-enhanced ultrasound in the qualitative diagnosis value of NPMObjective To analyze the(Contrast-enhanced ultrasound)CEUS features of NPM and BC,to improve the ability of CEUS in differentiating NMP and BC.Methods Patients with NPM and BC who were examined by conventional ultrasound and contrast-enhanced ultrasound in our Hospital were analyzed retrospectively,including 70 patients with NPM and 70 patients with BC.The CEUS characteristics of NPM and BC were compared by univariate and multivariate analysis.Results Univariate analysis showed that there were statistical differences between NPM and BC in perfusion defect(presence or absence),the boundary of perfusion defect(clear or vague),enhancement speed(fast-forward,simultaneous/slow-forward),enhancement direction(centripetal and non-centripetal),enhancement range(enlarged or not)and nutrient vessels(visible or invisible)(P<0.05).Logistic regression analysis showed that perfusion defect(presence or absence),enhancement direction(centripetal and non-centripetal)and nutrient vessels(visible or invisible)were independent predictive variables to differentiate NPM from BC.Conclusion CEUS has a certain value in the differential diagnosis of NPM and BC.It is expected to reduce unnecessary invasive testing.Chapter four A comparative study of ultrasound and magnetic resonance imaging in the diagnosis of NPMObjective The imaging data of patients with NPM and BC were analyzed,and the value of ultrasound and magnetic resonance imaging(MRI)in the differential diagnosis of NPM and BC was compared.Methods A total of 165 patients who underwent ultrasound and MRI in our hospital were retrospectively analyzed,including 74 cases of NPM and 91 cases of BC.Both ultrasound and MRI were classified by BI-RADS according to the imaging features of lesions.The BI-RIDS classification≥4 was defined as the high probability of BC,and the BI-RADS classification<4 was defined as the high probability of NPM.SPSS 21.0 statistical software was used to compare the differential diagnosis ability of ultrasound and MRI for NPM and BC by calculating AUC.Results The AUC of ultrasound and MRI BI-RADS in differentiating NPM and BC were about 0.870 and 0.859 respectively.There was no statistical difference between the two imaging methods in distinguishing NPM from BC((x~2=0.028,P=0.867).Conclusion Ultrasound and MRI both have high diagnostic value in the differential diagnosis of NPM and BC by BI-RADS.The two imaging methods have equal importance in identifying of NPM and BC,and each has its own advantages.