Ultrasound Localization Of Breast Lesions And Scar Light Scattering Tomography Study

Objective1. To evaluate the ultrasound-guided diffused optical tomography (DOT) of the benign and malignant lesions.2. To inverstigate the correlation between the total hemoglobin concentration and histological classification, grade, lymph node metastasis and immunohistochemistry by using DOT measurement.3. To investigate that the lesion size and depth of the ultrasound measurement affect on the light scattering tomography of THC.Materials and methodsFrom October 2007 to February 2010, Prospective study has been conducted in Beijing Union Medical College Hospital which includes 521 subjects of excision biopsy of breast lesions. Routine preoperative ultrasonography was carried out to record the various ultrasound signs. After the ultrasound showed a clear lesion, Ultrasound localization of light scattering tomography was utilized to measure the total hemoglobin concentration within lesions (total heamoglobin concentration, THC), and generate the optical absorption map. Take the surgical pathology results as the ultimate gold standard for diagnosis. The pathological diagnosis of breast cancer includes histological type, invasive ductal carcinoma of histological grade and immunohistochemical detection ER, PR, c-erBb-2, P53 expression status.Results1. This study employed a total 521 subject of breast lesions which include 270 benign lesions and 251 malignant lesions. The average THC of the Benign lesions is 121.70±64.16μmol/L, and the average THC of the malignant lesions is 222.17±82.40μmol/L respectively. The THC of the malignant lesions was significantly higher than that of benign lesions (P <0.001). When 140umol/L was taked as the the cutoff value for the differential diagnosis from benign lesions, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 84.86%,64.07%,74.09%,68.71% and 81.99%.2. The mean THC of the benign lesions group (fiber adenoma, adenosis group, intraductal papilloma) was no significant difference (P=0.689), there was no significant difference (P=0.414) to be discovered in the mean THC of the malignant group (invasive ductal carcinoma, ductal carcinoma, invasive lobular carcinoma, phyllodes tumor group).3. The THC of invasive ductal carcinoma was significantly different (P<0.05) in the different histological grading, and the THC value increased with the grading, however, the THC was not significantly different (P=0.173) in the invasive ductal carcinoma(>2cm) different histological grading.4. The THC of breast cancer and lymph node metastasisis were closely related, the THC with lymph node metastasis was higher than the none lymph node metastasis (P=0.01), however, the THC between the Lymph node of the breast cancer (>2cm) metastasis and without metastasis was not siginificantly different (P=0.971).5. The THC of ER(+)PR(+) group is lower than that of ER(-)PR(-) group, and the difference is significant (P<0.01). The THC trended to increase (P=0.002) with the decrease of the ER, PR positive rate. The positive expression of c-erbB-2 is higher than the negative THC of c-erbB-2 (P <0.05)。The THC tended to increase with the increase of the positive rate of c-erbB-2. The THC of P53 positive group is higher than the negative group, but no siginificat difference discovered (P=0.468).6. Maximum diameter of benign lesions have a weak correlation with the THC (P<0.05, Correlation coefficient r=0.151). Lesion depth did not affect the measured values of benign and malignant THC (P=0.061, P=0.221).Conclusion1. Ultrasound localization of the light scattering tomography plays an important role in the differential diagnosis of the breast benign and malignant lesions, the THC within the malignant lesions was significantly higher than tha of the benign lesions.2. The correlation of THC and its histological grade in breast cancer, lymph node metastasis, ER, PR and c-erbB-2 and other prognostic indicators take an important potential value to the Non-invasive preoperative assessment of breast cancer.3. The breast lesion size influences the measured value of THC, and the breast lesion depth measured value has no effect on THC. Objectvie1. To study the relationship between the total hemoglobin concentration and postoperative time of the scar by using ultrasound-guided diffused optical tomography.2. To observe the ultrasonographic characteristics of the scar of the benign and malignant lesion, to study the scar size, the blood flow varivation with time and its morphological characteristics.Materials and methodsFrom November 2008 to February 2010, we investigated 71 scars of local excision of breast nodules which include 41 benign nodules scars and 30 malignant breast nodules scars. Routine preoperative ultrasonography was carried out to record the various ultrasound signs. After the ultrasound showed a clear lesion, the ultrasound localization of light scattering tomography was utilized to measure the total hemoglobin concentration within lesions (total heamoglobin concentration, THC), and generate the optical absorption map.10 of them were selected for 3,6,12 months regular follow-up.Results1. The THC in scar was correlated with the postoperative time as power function, the power curve regression equation Y=303.253270*(X)-0.227733 (R2 value 0.567). the postoperative THC of benign and malignant lesions perform as the correlation of Power function, the power curve regression equations are Y=335.778297*(X)-0.262060 (R2 vlaue 0.574) and Y=287.735996*(X)-0.208156 (R2value 0.547), respectively. Through the scatter plots and regression curves, a conclusion can be drawed that the postoperative THC scar in 12 months decreased considerably fast, and after 12 months, the THC decreased slowly till to the stabilization. The postoperative THC after 12 months was lower than the threshold diagnosis of breast cancer.2. The postoperative 45 scars in 12 months; the THC and the postoperative time are negative correlated, and the regression line equation Y=310.14-10.88X. The benign 25 scars; the THC and the postoperative time are negative correlated, and the regression line equation Y=300.46-11.19X; The malignant lesions 20 scars; the THC and the postoperative time are negative correlated, and the regression line equation Y=314.07-8.32X;3. In the same period of time after operation, the scar formation of benign and malignant nodules performed no significant difference in THC.4. The ultrasonography of breast scar was shown as:irregular 100% (71/71), fuzzy boundaries 100% (71/71), posterior echo attenuation 87.3% (62/71), hypoechoic sheet 66.2% (47/71), star sign 43.7% (31/71), and attached with shin 52.1% (37/71). Among them, the irregular, fuzzy borders and posterior echo attenuation are the non-specific sonography of the scar, in contrast, the hypoechoic in sheets, star sign, and scar attached with the skin perform as the specifity of scar.5. This study showed that the diameter and width of the scar were negatively correlated with the postoperative time, and they are r=-0.42 and r= -0.304 respectively. The diameter and width of the scar were not correlated with the THC.6. The 86.4%(19/22) scar with rich blood flow detected by Color Doppler was the scar in 6 months postoperative, and the blood flow of scar was in the peripheral (94.7%). The blood flow of scar decreased with the postoperative time extension. Conclusion1. The THC in the scar of the local excision of breast nodules changes with time by the power function. The THC of postoperative scar decreases fastly in 12 months, and slow down till to stabilization after 12 months. After 12 monthts of operation, the average THC of scar is less than the threshold diagnosis of breast cancer, hence, THC value can be usful in distinguishing the scar after 12 months and recurrent foci. This will play an important role in clinical value.2. The blood flow in scar decreased with the operation time extention. The blood flow of scar was sufficient in the peripheral and very little blood flow inside.3. The characteristic of the scar sonographies are expressed as:irregular, fuzzy borders, posterior echo attenuation, low echo sheet, star sign, and scar tissue attached with skin. The scar size (diameter and width) decreased with the time extension, but no significant correlation with THC measured value.