The Application Research Of The Breast Local Lesions By Contrast-enhanced Ultrasound

Objective: 1.compared with conventional ultrasound(US)、contrast-enhanced ultrasound(CEUS) and conventional US combined withCEUS, to evaluate the differential diagnosis value of benign and malignantmasses in breast respectively. 2. Compared with the qualitative diagnosis andquantitative diagnosis of CEUS, to evaluate theirs diagnosis role of breastmalignant lesions. 3. According to analysis the conventional US and CEUSfeatures of the breast cancers and axillaries lymph nodes, to summarize theultrasonographic characteristics of the lymph nodes metastases, and to sum upthe main factors to predict the lymph nodes metastases. 4. To discuss therelationship between the breast cancer CEUS features and expression ofC-erbB-2 and nm23.Material and method: Collected from the September 2010 toSeptember 2011 at the north Sichuan medical college affiliated medicalhospital, the patients of breast masses were confirmed by puncture biopsy oroperation and pathology, 32 masses benign and 41 masses malignant(29 caseshad lymph nodes metastasized, 12 cases had not). All patients were female,aged 19-68 years old, average 44 years old. All breast lesions and doubtenlarged lymph nodes had examined by conventional US and CEUS beforeoperation. All patients were examined by Co. Philips IU22 ultrasoundmachine, L9-3 broadband linear array probe, under the contrast enhancedcondition, and set the mechanical index at 0.07. The SonoVue (Co. Bracco,Italy) as the contrast agents, were injected into bodies with 3.0ml from the median cubital vein of patients at bolus method. The lesions’CEUScharacteristics were observed by eyes-watching, and the parameters data ofCEUS were created by the time-intensity curve (TIC) from using the QLABsoftware to make it. After operations or puncture biopsy, the C-erbB-2 andnm23 expression of breast lesions were tested by SABCimmunohistochemical method.Results: 1.The main CEUS features of breast cancer were fastflow-in(92.7%)、enhanced inhomogeneous(63.4%)、lesions enlarged afterenhanced(87.8%)、radial peripheral enhanced(46.3%)、not-clear display inboundary(80.5%)、high enhancement at peak time(90.2%). However, thebenign lesions were slow flow-in(62.5%)、enhanced uniformity(78.1%)、lesions diameter no changed after enhanced(87.5%)、no radial peripheralenhanced(96.9%)、low or secondary enhancement(59.4%). The peak intensitydB、the relative peak intensity dB and the relative area under the curve of themalignant lesions were higher than correspond values of the benign lesions,but the relative start time of the malignant lesions was shorter than thecorrespond values of the benign lesions. Single using the US or CEUS todiagnosis the breast malignant lesions, the diagnosis accuracy, sensitivity andspecificity respectively were 88.9%、91.4%、84.2% and 87.7%、89.7%、84.6%.Combined the two methods of ultrasound, the diagnosis accuracy、sensitivityand specificity respectively were 92.3%、97.1%、83.3%. 2. In qualitativeanalysis of CEUS, the follow features were related to diagnosis the breastbenign or malignant lesion, including the radial peripheral or not afterenhanced、the flow-in speed、the enhanced characteristics、the lesion enlargedor not after enhanced、the degree of enhancement and clear display or not in boundary. And the accuracy to predict the breast malignant lesion was 91.8%.In quantitative analysis of CEUS, the followed parameters difference betweenthe breast benign lesions and breast malignant lesions groups had thestatistical significance, including the peak intensity dB、the relative peakintensity dB、the relative area under the curve and the relative start time toenhance. The accuracy to predict the breast malignant lesions were 61.5%.The correspond receiver operator characteristic curves (ROC) were 91.3%and 75.7%, after Z test, the ROC difference between the two analysis methodshad the statistical significance (P<0.05). 3. It was divided into two groups ofthe 41 breast malignant lesions by lymph nodes pathology, 29 lymph nodesmetastasized and 12 lymph nodes no metastasized. The followultrasonography signs or parameters difference between the two groups hadthe statistical significance: the relative area under the curve of the breastmalignant lesions、the ratio of length and diameter of axillaries lymph nodes、the cortex most thickness of lymph nodes、the blood grades of lymph nodes、the surrounding echo enhancement of lymph nodes、the perfusion sequence oflymph nodes、the enhanced feature of lymph nodes、the lesion enlarged oflymph nodes and the radial peripheral after enhanced of lymph nodes(P<0.05).After the multiple analyses, the enhanced feature of lymph nodes and thelesion enlarged of lymph nodes were connnected with lymph nodesmetastases. The accuracy、sensitivity and specificity by the method combinedwith breast lesions CEUS and lymph nodes CEUS to predict the lymph nodesmetastasized were 95.1%、93.5% and 100%. 4. The fast flow-in mode in 41breast cancer CEUS were correlated with C-erbB-2 and nm23 expression, andthe relative slop of rising and falling were concerned with nm23 expression. Conclusion: 1.Combined conventional US with CEUS, the differentialdiagnosis the breast masses accuracy were increased apparently. 2. Comparedto the quantitative analysis of CEUS to identify the breast benign andmalignant lesions, it was more accuracy by the qualitative analysis of CEUS.3. It was more accuracy for predicting the metastases of lymph nodes bycomprehensive analysis the features of US and CEUS in the breast lesions andaxillaries lymph nodes. 4. The perfusion model、the relative slop of risingand falling of the breast malignant lesions CEUS were relevant to theexpression of C-erbB-2 and nm23 at some certain, which could assistantdoctors to predict the breast caner patients prognosis and outcome.