Evaluation Of Ultrasound Score、Sonoelastography Strain Ratio And Mammography In Nonpalpable Breast Lesions

BackgroundBreast cancer is the most common female malignancy, is also one of the leading causes of cancer death in women. As the breast cancer screening work and the imaging technology development, more and more nonpalpable breast lesions (NPBL) were detected. Mammography is the traditional examination in breast, which is still widely used in clinical diagnosis. Breast imaging report and Data system (BI-RADS) as a means of quality control was used for standardization mammography reports, assessment of lesion, recommending the treatment measures.Elastography as a new technology was developed in recent years, which through evaluated the hardness of breast masses to judge the benign and malignant of lesions. Previous elasticity imaging techniques using scoring method, it can be limited by the subjective factors and affect doctor’s diagnosis. Strain ratio (SR) measurement techniques using semi quantitative method, can be more objective to evaluate the hard and soft degree of breast lesions. The purpose of this study was to evaluate the diagnostic of Mammography and strain ratio measure method for nonpalpable breast masses, and help the clinical to improve the diagnosis of breast disease.ObjectiveEvaluation of sonoelastography strain ratio and mammography in nonpalpable breast lesions.Methods97nonpalpable breast masses in93women who had been scheduled for a sonographically guided core biopsy or operation were examined with mammography and sonoelastography. The pathologic diagnosis was as golden standard. The diagnostic performance of the two methods was evaluated with receiver operating characteristic curve (ROC)Results1. The results showed that there was a significant difference in the mean strain indices between nonpalpable benign and malignant breast masses:2.71±2.75for benign masses versus6.16±4.31for malignant masses (P<0.01)2. According to the ROC, the best strain index cutoff point to achieve the maximal sum of the maximal sum of the sensitivity and specificity was3.27. The sensitivity, specificity and accuracy were89.3%、91.2%and90.6%, respectively.3. Receiver operating characteristic curves for the elastographic strain index and mammograms. The Az walues(Z=2.265,P=0.026) were statistically different for the strain index0.898and mammograms0.783.Conclusion1. Sonoelastography strain ratio was found to have a diagnostic performance for differentiation of nonpalpable breast masses.2. It is a simple, convenient operation, strong repeatability, non-invasive diagnostic examination that provides information about the stiffness of a mass, and have a good diagnostic performace than mammograms. BackgroundWith the continuous development of imaging and the improvement of awareness of women’s health, more and more non-palpable breast lesions (NPBL) have been detected. It is reported in available literature non-palpable breast cancer and palpable tumor breast cancer are greatly distinguished in characters. Non-palpable breast tumor’s cell atypia, metastatic potential and growth activity are lower than those of the palpable mass of breast cancer. In2003, Breast Imaging Reporting and Data System (BI-RADS) published by the American College of Radiology included new ultrasound diagnostic criteria (BI-RADS-US), and it provides the basis for standardized diagnosis. Malignant breast tumor is typical vascular dependent lesions. Color Doppler ultrasound has an important role in the diagnosis of breast disease. Sensitive high-frequency ultrasound can show the tumor periphery and the blood flow inside the case. Strain ratio (SR) is the real-time ultrasound elastic imaging technology in new method to estimate the tissue hardness, and that makes it possible to avoid subjective judgment of lesions and it can also measure hardness values of the lesions.With the BI-RADS-US classification in clinical application, showing a good diagnosis effect, but there are still some problems, on one hand the blood dilution by Doppler ultrasound features, lists only within the lesion, adjacent to and surrounding tissues without increasing diffuse flow signal and so on, and did not include blood flow patterns and spectrum analysis and other benign and malignant breast lesions in the differential diagnosis of important parameters. On the other hand, along with the elastic imaging technology for the development of BI-RADS-US grade, perfect aspect also looking forward to joining ultrasound elasticity imaging index.This essay is aimed at the study of the commonly used diagnostic criteria which can determine the nature of breast lumps NPBL, in other words, can help to find out whether these lumps are benign or malignant. The study will propose the analysis of using the ultrasonic score and comparison of each individual standard to provide more theoretical basis for clinical diagnosis.ObjectiveTo research the differential diagnosis value of nonpalpable breast lesions using ultrasound score.MethodsConventional US and elastographic images were obtained using a EUB-900scanner(Hitachi Medical, Tokyo). All of breast lesions were nonpalpable and detected by ultrasound or mammography before sonographically guided core biosy and operations. Of the98lesions,76benign and22were malignant, and cumulated ultrasound score. We measured and recorded four US parameters:BI-RADS-US, Adler flow grading, Doppler spectrum resistance index (resistance index, RI) and elastic strain ratio, and the total US score of each nonpalpable breast lesions, he pathologic diagnosis was as golden standard. Using receiver operating characteristic curves analysis, we researched weather the US score was more accurate than each parameter and which was the best cut-off value for differential diagnosis of nonpalpable breast lesions. All data analyses were conducted with SPSS13.0and MedCalc12.1.3.0statistic software.Results1. The area under the ROC cure values were0.871for the strain index,0.859for the BI-RADS-US,0.693for the Adler flow grade and0.690for the RI for differentiation of benign and malignant NPBL.Receiver operating characteristic curves for the elastographic strain index and BI-RADS-US. The Az walues(Z=0.208, P=0.835) were no statistically different for the strain index0.871and0.859. There were statistically different for the strain index and Color Doppler flow imaging (P=0.016) or strain index and spectral Doppler resistance index((P=0.020). There were statistically different for BI-RADS-US and Color Doppler flow imaging (P=0.008) or BI-RADS-US and spectral Doppler resistance index (P=0.020). There were no statistically different for Color Doppler flow imaging and spectral Doppler resistance index(P=0.976). 2. Results shows ultrasound score≤1are benign, ultrasound score≥4points are malignant, a score of2and3of malignant lesions were7%(2/28) and40%(6/15). Ultrasound score were the higher the greater proportion of malignant.3. The area under the ROC cure values were0.956for ultrasound score method to differentiate benign and malignant NPBL, There were statistically different between ultrasound score and strain index、BI-RADS-US、Color Doppler flow imaging or spectral Doppler resistance index (P<0.05). According to the ROC curve to determine the optimal diagnostic cutoff points was≥3, the sensitivity, specificity and accuracy were90.9%,88.2%and88.8%.ConclusionFor clinically non-palpable breast lesions, ultrasound scoring method is helpful to determine the benign and malignant lesions, compared with single application of conventional ultrasound and elastography have greater clinical application value. It is simple and practical, accurate and highly reproducible, will raise the NPBL malignant lesion detection rates, and makes the need for biopsy to identify benign and malignant patients number has been greatly reduced, it has high value in clinical application. Main Innovative Points1. Based on the clinical demand, this study first used US score to differential diagnosis nonpalpable breast lesions. It can greatly increase the diagnostic sensitivity and specificity of differentiation of benign and malignant nonpalpable breast lesions. So US score is a simple、practical and accurate new method which is worthwhile for clinical application.2. We first study on the comparison between strain ratio and mammograms to differential diagnosis nonpalpable breast lesions. the results show the strain ratio method for the diagnosis of nonpalpable breast lesions is better than BI-RADS grading standard for mammography, It provides a new method for clinical to improve the diagnostic rate...