The Study Of Three-dimensional Ultrasonography And Quantification Of Vascularity On Breast Tumor

Objective:On the basis of two-dimensional ultrasonography and through three-dimensional ultrasound techniques to reconstruct the breast neoplsams, to investigating the three-dimensional ultrasonic features of the benign and malignant breast neoplasms and the effects of blood flow gradation and vascular morphology of 3D-CPA (Three-dimensional color power angiography) on the definition and identification of the tumor's benign or malignant properties. Making use of the quantitative function of 3D-CPA, to measure and quantify the blood flow related parameters inside the breast tumor to contrast whether there is a difference existed between the benign and malignant tumor on these parameters, thus to evaluate the clinical efficacy of 3D-CPA's quantitative function in measuring the blood flow related parameters inside the breast tumor on the definition and identification of the benign and malignant breast tumors.Materials and methods:A total of 72 female patients, 16-75 years old, who visited the Chinese PLA General Hospital from January, 2007 to January, 2008 and underwent ultrasound examination for their breast tumors were enrolled in this study. All the subjects did not receive any treatment before the examination. The employed instruments were the ultrasonoscope GEVoluson730Expert and volume high-frequency transducer RSP5-12MH. On the basis of two-dimensional ultrasonography, totally 77 neoplasms in 72 patients received three-dimensional reconstruction and 3D-CPA. Its results were compared with the outcomes of the surgery and pathology. The characteristics and coronary convergence of 3D reconstruction image, the contour and borderline features of the neoplasm and the 3D-CPA blood flow gradation and vascular morphology features of the neoplasm was then analyzed to determine its diagnostic values.56 of the total patients, the 3D-US data were collected used into 3D-CPA reconstruction. The following parameters were then analyzed using VOCAL (virtual organ computer-aid analysis) software by selecting three-dimensional power bar chart: vascularization index (VI), flow index and vascularization- flow index (VFI) and the blood flow inside the breast neoplasm was graded with 3D-CPA.The subjects were divided into the benign and malignant groups by their pathological data. The value of VI, FI and VFI between the benign and malignant tumor and their relationship to the blood flow gradation inside the tumor were then compared.Results:The three-dimensional reconstruction image corresponding features of breast tumors with different pathology were: infiltrative ductal carcinoma, showing as an extremely hypoechoic and uneven lump, having pile-like hyperechoic points, irregularity in its contour and apparentness in coronary convergence; breast fibroadenoma, equal echoing, may be lobulated, completeness and smoothness in its contour (capsule) and having signs of compression; breast adenosis, clearness or unclearness in the contour, not completely bordered with the surrounding tissues and some peripheral breast tissue may extend into the neoplasm; breast inflammatory neoplasm (2 cases), showing as uneven and hypoechoic zone, bordered unclearly with the surrounding tissues and irregularity in contour; intraductal papilloma (2 cases), its rotating 3D reconstruction image showing papillary neoplasm in the duct, smoothness in its contour and no infiltration to the duct. In the malignant tumor group, using breast coronary convergence sign to diagnose has a sensitivity of 65.79%, specificity of 94.87% and accuracy of 80.52%. Accompanied by the enhancement of the tumor's maximal diameter, its sensitivity would decrease gradually. The irregularity of contour used into the diagnosis of malignant tumor has a sensitivity of 97.37%, specificity of 71.79% and accuracy of 76.62%. In the malignant group, the dominated vascular morphology is irregular pattern and penetration pattern vs. ring like pattern in benign group. There is a statistical significance among the irregular pattern, penetration pattern and embracing pattern (P<0.05). In the benign group, the dominated grade of 3D-CPA blood flow gradation is Grade I (61.54%) vs. Grade III in the malignant type (71.05). The magnificent differences occurred in all three groups (P<0.05).In the blood flow gradation on the benign and malignant breast tumors, the values of vascular parameters, VI, FI and VFI in Grade III were higher than those in Grade II, showing a magnificent difference (P<0.05). The vascular quantitative parameters of 3D-CPA to quantify the benign and malignant breast tumors were: VI=2.356±1.199 in malignant group vs. 0.855±0.787 in benign group; FI=36.974±4.577 in malignant group vs. 31.677±7.452 in benign group and VFI=1.058±0.632 in malignant group vs. 0.333±0.347 in benign group, all of which in malignant group were significantly higher than those in benign group (P<0.05). Given VI≥1.157 as a critical value to diagnose the breast malignant tumor, the sensitivity, accuracy and specificity were 87%, 77% and 68% respectively; given FI≥32.397 to diagnose the breast malignant tumor, the sensitivity, accuracy and specificity were 83%, 67% and 52% respectively; given VFI≥0.426 to diagnose the breast malignant tumor, the sensitivity, accuracy and specificity were 83%, 73% and 61% respectively.Conclusions:1. Three-dimensional reconstruction can stereoscopically and directly reflect the stereo configuration of the breast neoplasm, its relationship with the peripheral tissues and its inner minute structure features.2. The coronary plane of the three-dimensional reconstruction and the detection rate of tumor convergence have shown differences and statistical significances between the benign and malignant tumors. Their specificity and accuracy are high in defining the breast malignant tumor and its sensitivity has a tendency to decrease accompanied by the enhancement of the tumor's maximal diameter. 3. 3D-CPA can completely, radically and stereoscopically present the vascular morphology and the flow extent inside the breast neoplasm and can be used into the semi-quantitative analysis. In the irregular and penetration type of the vascular morphology and the flow gradation of the benign and malignant breast tumor, the Grade III maintains statistical significances vs. the other groups.4. The levels of 3D-CPA vascular quantifying analysis parameters VI, FI and VFI in the breast malignant neoplasm are all higher than those in the benign one, which is benefit to the identification between benign and malignant breast tumors.5. The values of 3D-CPA vascular quantitative analysis parameters VI, FI and VFI in the breast malignant neoplasm are identical to the outcomes of breast neoplasm blood flow gradations, which can be used to assess the vascular abundance extent inside the breast neoplasm.