The Diagnostic Value Of Breast Tumors Combined With A Variety Of Ultrasound Techniques

Objective To explore the diagnostic value of breast tumors combined with four ultrasound techniques including two-dimensional ultrasound, color Doppler ultrasound imaging, ultrasonic elasticity technique and ultrasound contrast imaging.Methods230patients who have been examined by common breast ultrasound examination in our hospital from January2011to August2012were selected. And there were249lesions. Substantial and moderate size lesions were chosen from them, and56patients, having this kind of lesions, who agreed to undergo further test were given elastic ultrasound and contrast-enhanced ultrasound examination. The tumors were scored with EI; the tumor boundaries were observed with VTI and the area ratio between VTI images and grayscale images were calculated; the SWV of masses and the same depth of normal tissues were measured with VTQ, and the SWV D-value between them were also measured with VTQ; the time-intensity curve parameters of benign and malignant breast tumors were observed respectively after contrast-enhanced ultrasound. The results were compared with pathological findings. VEGF expression and MVD were detected by immunohistochemistry, and the results were analyzed with the contrast-enhanced ultrasound mode and the parameters of the time-intensity curve. Then we hoped to get the correlation between them. Results1. Among230patients who were examined by two-dimensional ultrasound and color Doppler flow imaging ultrasound, there were191benign lesions and58malignant tumors.178cases of benign lesions and71cases of malignant lesions have been confirmed by pathologically. The area under the ROC curve was0.830. For this conventional ultrasound, the sensitivity was70.40%, the specificity was95.50%, and the accuracy rate was88.35%.2.56patients were examined by elastography.29cases of benign lesions and27cases of malignant tumors have been confirmed by pathologically. Among benign cases, the elastic score of25cases was no more than3; area ratio between VTI image and grayscale image was1.09±0.12; VTQ shows that SWV was (2.73±1.16) m/s, and the D-value between tumor and the same depth of breast tissue around it was (1.07±1.07)m/s. Among malignant cases, the elastic score of23cases was no less than4; area ratio between VTI and grayscale image was1.68±0.42; VTQ shows that SWV was(6.12±2.06)m/s, and the D-value between tumor and the same depth of breast tissue around it was(4.04±2.51)m/s.3.56patients were examined by contrast-enhanced ultrasound.29cases of benign lesions and27cases of malignant tumors have been confirmed by pathologically. The enhanced range of benign case was the same with the size of the lesion showed by conventional two-dimensional ultrasound. Among them,1case was high enhanced,16cases were moderate enhanced,6cases were low enhanced and6cases were not enhanced. The enhanced range of malignant case was bigger than the size of the lesion showed by conventional two-dimensional ultrasound. Among them,12cases were high enhanced,10cases were moderate enhanced,5cases were low enhanced and no case was enhanced. The time-intensity curves of benign lesions were slow up and fast down type, and the time-intensity curves of malignant lesions were fast up and slow down type.4. In benign group, VEGF was low expression, and MVD was low and it was13.76±6.76; in malignant group, VEGF was high expression, and MVD was high and it was28.90±14.25. There is a positive correlation between the peak intensity and AUC of the contrast agent and the expression of MVD and VEGF.Conclusions1. Conventional two-dimensional ultrasound and color Doppler flow imaging can distinguish most benign and malignant tumors in breast, but the diagnosis results are still cross.2. Elasticity imaging, through El, finds that hardness grade of malignant breast tumor is higher than that of benign lesions; VTI shows that the area ratio between VTI images and gray scale images in malignant tumors are bigger than those in benign tumors; VTQ shows that both the SWV inside masses and the D-value between that and normal breast tissue surrounding in malignant tumors are bigger than those in benign masses. It shows that the elasticity imaging can provide mechanical basis for diagnosis of breast cancer, and is useful for diagnosis and differential diagnosis of benign and malignant breast tumors.3. After contrast enhancement, the range of lesion, form and time-intensity curve are helpful for differential diagnosis of benign and malignant breast tumors.4. There is a positive correlation between the peak intensity and AUC of the contrast agent and the expression of MVD and VEGF. This provides molecular basis for the different manifestations of contrast-enhanced time-intensity curve in benign and malignant breast lesions.