The Study Of Diagnostic Efficacy And Preoperative Evaluation On Mammography, Ultrasound And MRI For Benign And Malignant Of Breast Lump

Part 1The Diagnostic Efficacy and Preoperative Evaluation for the Benign and Malignant of Breast Lump:the Comparision between Mammography, UltrasoundBackgroundBreast disease affect women’s physical and mental health seriously, and the incident of breast diseases is rising all over the countries. Medical image examinations are the main methods to early find and early diagnosis of breast cancer. Mammography and ultrasound are most commonly used for diagnosing breast cancer. However, there are also some questions about the application on two methods:1) there has controversy on diagnostic criteria on this two methods of distinguishing benign and malignant breast lump, it need to be further verified.2) Different individual feature may affect the diagnostic criteria, like age, pre and post menopausal, the density of gland, lump size and so on. It can help clinical doctors to choose appropriate imaging test and use the imaging report rationally to investigate the influence of the individual features on the diagnostic criteria of these two methods. But till now, it still lack of the systems research about this aspect,3) Surgical operation is the main therapy to breast lump, the accuracy of the preoperative assessment of tumor’s size and location is very important for the safety and efficacy of the surgical planning. So far, there is no related study.4) Breast cancer can be classified according to molecular type, there is discrepancy for both treatment plan and prognosis between different types. To investigate the imaging feature of different molecular types can help clinical doctor to judge the molecular type through the image, then to make the therapy plan. However, the imaging features of different molecular types still need further research.ObjectiveTo compare the diagnostic criteria of mammography and ultrasound on benign and malignant breast lump. To discuss the influence of the age, pre and post menopausal, the density of gland on diagnostic criteria of mammography and ultrasound of benign and malignant breast lump. To compare the accuracy of the preoperative assessment of tumor’s size and location by mammography and ultrasound.To analyze the imaging features of different molecular types.Methods247 cases with breast lump which were need surgical treatment were examined with ultrasound and mammography, and graded the degree with BI-RADS (breast imaging reporting and data system), and also recorded the size and location of the lump. The size and location of the lump were measured and recorded during the surgery. Histopathological examination confirmed the pathological type. By means of the immunohistochemistry to examined the expression of ER、PR、HER-2、Ki-67 in 120 breast cancer cases. Breast cancer can be classified in 4 types according to the molecular type:Luminal A、Luminal B、HER-2overexpression and Triple-negative. The ROC (receiver operating characteristic curve) was established on pathological study which is the "gold standard".Then compare the diagnostic criteria of mammography and ultrasound of benign and malignant breast lump. Calculate the agreement of these two methods on evaluating the size and location compared to actual measurement results in surgery, compare the accuracy of the preoperative assessment between these two methods, and analyze the imaging features of different molecular types.Results1. BI-RADS 4b is the best cut-off point for the mammography to diagnosis the benign and malignant breast lump according to the ROC curve, sensitivity, specificity and accuracy is 89%,72% and 70% respectively. BI-RADS 4b is the best cut-off point for the ultrasound to diagnosis the benign and malignant breast lump, the sensitivity, specificity and accuracy is 95%,93% and 94% respectively. The BI-RADS AUC of mammography and ultrasound is 0.884 and 0.960 respectively. There was significant statistical differences between two methods(P<0.01).2. There is difference of different individual features on diagnostic criteria of mammography of benign and malignant breast lump, sensitivity, specificity and accuracy:age>45 (89%,80%,84%), and age<45 (75%,72%,75%), postmenopausal (97%,87%,94%),premenopausal(83%,68%,74%), low density gland (91%,85%, 82%), high density gland (87%,74%,79%).3. The agreement rate of assessing the size of breast lump preoperatively by mammography and ultrasound is 48% and 79%, respectively. The agreement rate of assessing the location of breast lump preoperatively by mammography and ultrasound is 47% and 91% respectively. There were statistical significance between the agreement rate of evaluating the tumor’s size and location of these two methods.4.Irregular lump, spiculation, unclear boundary can be found in different molecular types, there is no significant difference with Color Doppler Flow grade, superior lateral quadrant is the part often involved in all types, the size of lump is about 2-5cm. The features of Luminal A:it often develop in low density gland(63%), microcalcification (32%), size<2cm (55%). The features of Luminal B: it is easy to be misdiagnosed (BI-RADS<3,14%), microcalcification (35%), size 2-5cm (67%), high density gland (52%). The features of HER-2overexpression:it is easy to be misdiagnosed (BI-RADS<3,26%), microcalcification (42%), size>5cm (16%), high density gland (45%). The features of Triple-negative:microcalcification is uncommon, and it has similar incidence of high and low density gland, size 2-5cm is about 50%.Conclusions1. BI-RADS 4b is the best cut-off point for the mammography and ultrasound to diagnosis the benign and malignant breast lump,ultrasound is better than mammography.2. The diagnostic criteria is relatively better when age>45, postmenopausal, and with low density gland.3. Ultrasound is better than mammography on the preoperative assessment of tumor size and location.4. Luminal B and HER-2overexpression breast cancer are more easily to be misdiagnosed, the size of Luminal A is smaller, the size of HER-2overexpression is larger, and microcalcification is uncommon in Triple-negative.Part 2The diagnosis efficiency research between the Breast MRI BI-RADS category evaluation and TIC curves for the benign and malignant of breast lumpBackgroundCompared with Mammography and ultrasound,breast MRI has the advantages of late start and rapid development. It detects breast diseases by using the MRI examination methods and dedicated breast coil. Breast MRI has no radiation and also has high spatial resolution and resolution of soft tissue. It obviously better than the Mammography and ultrasound in the breast cancer diagnosis and tumor staging combined with multiple sequences parameter imaging, which plays an important role in the diagnosis of breast cancer. In the Breast MRI scanning sequences, dynamic enhanced MRI (DCE-MRI) is conducted on the basis of fast imaging sequences dynamic scanning techniques and can obtain the time signal intensity curve (TIC) of hemodynamic changes. Dynamic observe and analyze are carried out on the lesions in TIC curve, which can observe the tumor angiogenesis, the distribution and clearing of contrast agent in the tumor. It used to be thought that TIC curve has a great diagnostic value in the identification of benign and malignant in breast tumors. But there are some problems in the application. Such as the capillary density and permeability and some other factors, it will lead to some benign and malignant lumps of TIC curve have the similar performance. And so the diagnosis specificity will decline. At the same time in 2003 MRI-BI-RADS part was first published when The American College of Radiology(ACR) published the fourth edition of breast imaging reporting and data system(BI-RADS) X-ray part. The Breast MRI - BI - RADS is similar with the mammography and ultrasonic BI - RADS category. It can analyze pathological changes and hemodynamic changes after enhancement. It also can provide quantitative indicators and balance the subjective factors. This shows more objectively and accurately evaluation of lesions and also can improve the diagnostic efficiency. Preliminary studies have sufficient showed the high sensitivity and specificity of MRI-BI-RADS. Morphological features and hemodynamic characteristics after enhancement are equally important in breast MRI lesions. And its performance characteristic morphology usually can improve the diagnostic specificity. But for the signs of breast MRI morphological are more and wide, morphological descriptors are not comprehensive and previous studies focus on hemodynamic indexes. So there is few contrast research on the sign of benign and malignant of breast disease.This study compares the diagnostic efficiency of the TIC curve of the breast lesions and the BI-RADS-MRI grading evaluation and also analyzes the MRI image morphological signs of benign and malignant of breast tumors so as to offer help to join morphology characteristic index to complete the breast MRI - BI - RADS category.ObjectiveTo compare the diagnosis efficiency of the BI-RADS-MRI grading evaluation and the TIC curve of benign and malignant of breast lumps.Methods110 cases of breast lump patients for surgery were chosen to take the breast MRI preoperative. Made the TIC curve according to the DCE-MRI sequences and assessed the MRI - BI - RADS category. With pathological diagnosis as golden standard, built the ROC of breast MRI - BI - RADS category evaluation and TIC curve, then compare the diagnosis efficiency for diagnosing benign and malignant of breast lumps by the BI-RADS-MRI grading evaluation and the TIC curve. To Analyze the MRI imaging morphological characteristic of benign and malignant of breast tumors.Results1. The AUC of the BI-RADS-MRI was 0.946 and the standard error was 0.02. The AUC of the TIC curve was 0.843 and the standard error was 0.04. Compared the diagnosis efficiency of the two methods, it has significant difference (P< 0.05). According to the ROC curve of MRI - BI - RADS category we determine the best diagnostic cut-off point was BI - RADS 4b and their sensitivity, specificity and accuracy were 95%,88% and 92%.2. Different MRI morphology of Benign and malignant of breast lumps Malignant tumors show burr (56%), lobulated (48%), sample or branching (24%), edge blur (89%), increased peripheral vascular sign (66%). Compared with benign lumps the incidence of these signs has significant difference (P< 0.05). Large duct, funnel sign, thick skin sign, COOPER ligament thickening and axillary lymph nodes around masses are the characteristic of malignant lumps. The surrounding tissue infiltration of benign lump were more rare and the indirect signs were less than malignant tumor. Its characteristics signs were clear boundary (94%), round shape (85%), and lobulated, sample and branching signs were rare.Conclusions1. The diagnosis efficiency of breast BI-RADS-MRI category is better than the TIC curve.2. The MRI morphological performance of breast caner included burr, lobulated, sample or branching, edge blur, increased peripheral vascular sign, etc. Large duct, funnel sign, thick skin sign, COOPER ligament thickening and axillary lymph nodes around masses are the characteristic of breast cancer.