The Value Of3.0T MRI For The Clinical Diagnosis Of Breast Cancer Combined With Histopathology

Objective: To investigate the value of3.0T MRI dynamic contrast enhanced imaging（DCE-MRI）, diffusion-weighted imaging （DWI） and ultrasonography （US） for thediagnosis of breast cancer combined with histopathology.Methods:63cases of breast cancer patients with77lesions were reviewed.74cases ofbenign tumor patients with93lesions were enrolled as the control group. All ofpatients were confirmed with surgery and histopathology. They were performed withMRI and ultrasonography before surgery. All of the patients had complete image data.The ultrasonography examination was described from morphology, boundary, echo,and calcification. The blood stream signals were also showed by color doppler flowimaging （CDFI）. The examination of3.0T MRI included T1WI, T2WI, dynamiccontrast-enhanced magnetic resonance imaging （DCE-MRI） in which fat suppressionwere used. The mean apparent diffusion coefficients （ADC） of the lesions werecalculated on diffusion weighted imaging （DWI） with b value of1000s/mm². Theresults of ultrasonography imaging were compared in morphology, boundary, echo,calcification and blood stream signals of the lesions between breast cancer and benigntumor. The signal intensities of T1WI, T2WI, TIC and ADC were analyzed.Results:（1）72lesions were certified by MRI in77lesions of breast cancer. The MRIdiagnosis sensitivity in breast cancer was93.51%.9lesions were misdiagnosed byMRI in93lesions of benign tumor. The specificity was90.32%. The diagnosis of156lesions in total170was consistent with pathobiology. The consistency rate was91.76%. The diagnosis sensitivity and specificities of MRI in invasive ductal carcinoma （IDC）were higher （96.49%）. Vice verse, the sensitivity to ductal carcinoma in situ （DCIS）was lower （81.82%）.（2） In77lesions of breast cancer,55lesions were classified astype III TIC （71.43%）;21lesions were classified as type II （27.28%）;1lesion wasclassified as type I （1.29%）. In93breast benign lesions,82lesions were classified astype I TIC （88.17%）,9lesions were classified as type II （9.68%）;2lesions wereclassified as type III （2.15%）. The results showed statistical significance by chi squarecriterion. The type of TIC was associated with the identification of breast lesions（P<0.05）.（3） The mean ADC of77breast cancer lesions calculated on DWI with bvalue of1000s/mm²was （1.05±0.316）×10-3mm²/s. The mean ADC of93breastbenign lesions was （1.41±0.373）×10-3mm²/s. The result showed statisticalsignificance by student’s test （P<0.05）. The critical value of ADC was1.11×10-3mm²/s （sensitivity81.3%, specificity78%） calculated by ROC curve. The diagnosissensitivity of breast cancer by ADC was75.32%（58/77）. The specificity was88.17%（82/93）. The consistency rate was82.35%（150/170）.（4）58lesions were certified byultrasonography in77breast cancer lesions. The diagnosis sensitivity ofultrasonography was75.32%.10lesions were misdiagnosed in93benign tumors. Thespecificity was89.25%. The consistency rate was89.25%.（5） There were77lesions inbreast cancer.70lesions’ morphology were irregular （90.91%） by ultrasonography.73lesions had obscure boundary （94.81%）.74lesions had unequal ultrasonic echo（96.10%）.49lesions had calcification （63.64%）.67lesions had obvious blood streamsignals （87.01%）.93lesions were examined by ultrasonography in breast benign tumor.39lesions’ morphology were irregular （41.94%）.22lesions had obscure boundary（23.66%）.39lesions had unequal ultrasonic echo （41.94%）.25lesions had calcification（26.88%）.33lesions had obvious blood stream signals （35.48%）.Conclusion:（1） DCE-MRI has high diagnosis sensitivity and specificity in diagnosis of breast cancer. MRI can increase the rate of early diagnosis of breast cancer, reducethe misdiagnosis. MRI has the essential significance to diagnose and treat breast cancer.（2） ADC calculated on DWI can provide valuable information in diagnosis anddifferential diagnosis of breast lesions. It can be a routine examination in MRI. DWIcan increase the rate of diagnosis of breast affiliated with DCE-MRI.（3） With theadvantages of easy operation, safety, well repeatability. Ultrasonography plays animportant part in diagnosis of breast cancer and has a wide role of breast tumorscreening. Objective: To investigate the relationships between types of TIC, ADC andexpressions of breast tumor markers: ER, PR, Her-2, Ki-67, P53.Methods:53patients of breast cancer were reviewed. All of patients were confirmedwith surgery and pathology. They were performed with MRI before surgery. Theexpressions of breast tumor markers（ER, PR, Her-2, Ki-67, P53） were measured byimmunohistochemistry in pathology specimens. The examination of3.0T MRIincluded T1WI, T2WI, diffusion weighted imaging （DWI）, dynamic contrast-enhancedmagnetic resonance imaging （DCE-MRI）. The mean ADC value of the lesions wascalculated on DWI with b value of1000s/mm². Spearman correlation coefficientswere used for statistical analysis.Results: There were43ER positive （81.13%）,39PR positive （73.58%）,24Her-2positive （45.28%）,50Ki-67positive （94.34%）,25P53positive （47.17%） according toimmunohistochemistry in53patients. The result showed3Type I TIC,16Type II TICand34Type III TIC by DCE-MRI. The critical value of ADC was1.11×10-3mm²/scalculated by ROC curve in part one,41lesions’ ADC <1.11×10-3mm²/s,12lesions’ADC>1.11×10^-3mm²/s. Spearman correlation coefficients were used for statisticalanalysis. There was not significant correlation between the ADC and breast tumormarkers （ER, PR, Her-2, Ki-67, P53）（P>0.05）. The types of TIC were no correlationwith ER, PR, Ki-67, but correlated with Her-2and P53.Conclusion: There are no correlations between ADC and breast tumor markers （ER, PR, Her-2, Ki-67, P53）. The types of TIC have no correlations with ER, PR, Ki-67, buthave correlations with Her-2and P53.