Comparison Study Of Color Doppler Ultrasound And Mammography For The Diagnosis Of Breast Lesion

IntroductionThe purpose of breast iconography diagnosis is to distinguish benign or malignant in breast lesion. The mammography is the first - line tool to diagnose breast lesion, but its false negative is as high as 15% to 30% ,the specificity is only 55% for the symptomatic patients. Limitations become clearer in detecting both small and dense breasts in our country. With the increasing resolution of ultrasonography (US) , until recently, the US becomes principle in detecting breast disease. 140 patients were underwent US and mammography, the diagnosis were compared with pathology diagnosis. The purpose is to evaluate the clinical value of breast US, mammography, and combination of both modalities for the diagnosis of breast diseases.Materials and methods1. Objectives140 patients with breast disease were underwent operation at breast surgical department in Liaoning tumor hospital. Two patients have two lesions, so the total lesions were 142.2. Methods UltrasonographyAll the US was performed using a probe with frequency 7 - 12MHz (LOGIQ9 US system, made by GE company USA). Operator should scan breast and axilla and use a clockwise ,sequential, overlapping radial approach. If detect lesion operator record lesion number, size, shape, intensity of internal ech-oes, microcalcification. All the lesions were underwent CDFI and CDE. The blood flow were divided into 0 - III class according to Alder semiquantitative method and record RI and PI values.MammographyAll mammographic examinations were undertaken by full - field digital mammography ( Senographe 2000 D, made by GE company USA) .The US and mammography diagnosis were performed by double blind, the ultrasonography datum and mammography X - ray were read by ultrasonography physician and radiologist respectively. The results were recorded as ( 1) conform;( 2 ) misdiagnosis .3. Statistical analysisThe accuracy, sensitivity, specificity, positive predictive, negative predictive for US diagnosis were calculated.The accuracy, sensitivity, specificity, positive predictive, negative predictive for mammography diagnosis were calculated.The accuracy, sensitivity, specificity, positive predictive, negative predictive for combination US and mammography diagnosis were calculated.Chi - square Test is applied for categorical variables.T - test is applied for continuous variables.Rank Sum Test is applied for ordinal variables.The above statistical analysis were conducted with the statistical software package SPSS for Window, version 13.0.Results1. Of the total 142 breast lesions, there were 38(26. 8% ) benign lesions and 104(73.2%) malignant lesions.2. US detected 140 lesions of all 142 breast lesions. The shape, boundary, internal echoes, backward echo, microcalcification were compared between benign lesions and malignant lesions, the differences were significant. The color signals difference was significant between two groups. The difference of values RI and PI was significant between two groups.3. Comparison between US and mammography diagnosisThe accuracy, sensitivity, specificity, positive predictive, negative predictive for US diagnosis were 90.1% ,89.4% ,92.1% ,96.7% ,76.1%.The accuracy, sensitivity, specificity, positive predictive, negative predictive for mammography diagnosis were 87. 3% ,86. 5% ,89. 5% ,93. 8% ,73. 9%.There was no difference in the diagnosis accuracy between US and mammography for the all patients.Of the patients with benign breast lesions who were younger than 50, the accuracy of US was 93. 3% , the accuracy of mammography was 90. 0% , ( P > 0.05).Of the patients with benign breast lesions who were older than 50, the accuracy of US was 87. 5% , the accuracy of mammography was 87. 5% , (P > 0.05).Of the patients with malignant breast lesions who were younger than 50, the accuracy of US was 95. 1% ,the accuracy of mammography was 80. 3% , ( P < 0.05).Of the patients with malignant breast lesions who were older than 50, the accuracy of US was 90. 1% , the accuracy of mammography was 95. 3% , (P < 0.05).4. The accuracy, sensitivity, specificity, positive predictive, negative predictive for combination US and mammography diagnosis were 97. 2% ,97. 1% , 97.4% ,99.0% ,92.5% o Their combination was significantly better than either modality used alone( P < 0.05 ).Conclusion1. Color Doppler ultrasound will show the character of breast lesion. The characters of malignant lesions included: irregular shape, ill - defined, no capsule, hypoechogenecity with posterior attenuation, with microcalcification, aboundant vascularity with high values of PI and RI.2. The diagnose accuracy of US and mammography was similar, the good-ness of fit to pathological diagnosis was high. Thus, the US and mammography were ideal diagnostic tool for the dection of breast lesion.3. For the patients with benign breast lesions the accuracy of US and mammography was similar;for the patients with malignant breast lesions who were younger than 50, the accuracy of US was higher than the accuracy of mammography;for the patients with malignant breast lesions who were older than 50, the accuracy of mammography was higher than the accuracy of US.4. A higher accuracy could be achieved by using combination of ultrasonog-raphy and mammography than using either modality alone. Ultrasonography and mammography have complementary advantage when they were used to detect breast disease.