| Background and Objectives:Breast disease has been one of the most common diseases which threatens many women's physical and mental health. Especially the malignant tumor of breast with high incidence has become the most common malignant disease in some areas, and the patients tend to be younger. Unfortunately, the pathogenesis unclear up to now. Hence, the correct diagnosis and timely treatment of breast diseases are the only way to reduce mortality and improve the quality of the patient's life. With the development of medical imaging science, the diagnostic level of breast diease has greatly improved. Ultrasound with the advantages of non-invasion, non-radioactivity, low cost, simple operation has been playing an important role in the detection of breast diseases. In particular, the application of Color Doppler Flow Imaging (CDFI) and Ultrasound Elastography (UE) which develops rapidly in recent years, has greatly improved the differential diagnosis of breast lesions. The differential diagnosis of benign from malignant tumors with CDFI is based on detecting the richness of blood flow and vascular distribution characteristics in the mass. The color Doppler flow signals in malignant tumors are more abundant than those in benign tumors. The vessels in malignant tumors are tortuous under pressure and their diameters varies, and the arteriovenous fistula is also usually detected. Their peak velocities are higher than those in benign tumors. However, UE is applied for diferential diagnosis of malignant from benign tumors by testing the elastic coefficient of the different tissues in mammary gland. Although UE was firstly reported by Ophir in 1991, it was applied in the differential diagnosis of breast lesions just in recent years. Because the hardness of tisues in differenct tumors differs, their deformations will be different after pressed by external force as well. Through forcing some external pressure on tissues with the probe, collecting echo signal of tissue pressure before and after the pressing and calculating the extent of deformation, the hardness of the tissues will be reflected by different color, which can be applied for the differential diagnosis of tumors. CDFI and UE have different principles, and both of them can provide the information of biological characteristics, so as to help the docters to make a diagnosis. However, on the other hand, both of them have their own limitations, the diagnosis with CDFI and that with UE are same in most cases, but they are still opposite in rare cases, which suggests they have relevance, but vary in some stituations. Why? What is the difference? How to make good use of new technology to maximize the diagnostic accuracy? These become urgent questions for ultrasonic doctors.Most of the past researches focused on a simple comparison of these two methods, this study aims to improve the application of UE and CDFI by comparing their advantages and disadvantages and evaluating the correlation of elastographic scores and the grade of blood flow.Methods:246 patients with 274 lesions were included, both CDFI and UE were performed on these patients. Before the examination, all of them never received a surgery of breast, so we were sure all lesions were not scar. All lesions were pathologically comfirmed at last. First of all, two-dimensional ultrasound was performed to find breast lesions, and the size, location, border, internal and posterior echo characteristics of the lesions were recorded. Then CDFI was used to observe the number and distribution of blood flow, Adler's method of grading blood flow was adopted. The lesions with score 0 andⅠwere regarded as benign, and those with scoreⅡ,Ⅲwere diagnosed to be malignant. At last, UE was performed by means of pressing and vibrating the probe, professor Luo Baoming's inproved grading method was adopted, lesions with score 1-3 were diagnosed as benign, and those with 4,5 were diagnosed as malignant. SPSS 13.0 statistical software was used. We applied rank-sum test to analyze the difference and the correlation of UE and CDFI. Pathology finding were regqrded as gold standard, the sensitivity, specificity, and accuracy of UE and CDFI were compared. The significant level was:α=0.01.Results:1. The grade of blood flow with CDFI was positively correlated with the elastographic grade with UE. (rs=0.395, P<0.01). 2. The grade of blood flow in the lesions with different elastographic scores significantly differed. (P<0.01).3. The sensitivity, specificity, and accuracy of UE in differential diagnosis of malignant breast tumors were significantly higher than CDFI. (P<0.01).Conclusions:1. UE and CDFI have a good agreement in differential diagnosis of benign and malignant breast lesions. They support each other in most cases.2. The diagnosis with UE and that with CDFI are inconsistent in rare cases. The application of UE can reduces false positive result of the lesions with rich bloods, and it can detect breast cancer with a high sensitivity so as to reduce misdiagnosis.3. UE with high accuracy is a simple, reliable technique. Hence, it could be widely applied as the conventional method in the differential diagnosis of breast tumors. |
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