Comparative Study Of Multimodal Imaging Technology In Diagnosis Of Breast Cancer

Background Breast cancer is a common malignant tumor of females. Advanced stage breast cancer usually serious impacts women’s physical and mental health and even is life-threatening. How to detect breast cancer at early stage is a decisive factor to improve breast cancer survival rate and reduce mortality. Early stage breast cancer is usually lack of obvious clinical signs and it mainly detected by medical imaging technology. At present, the commonly used three techniques including mammography, ultrasound and magnetic resonance imaging(MRI). Traditional ultrasound and mammography as the most commonly used imaging, their low sensitivity and specificity already cannot meet the needs of clinical practices. MRI has a high resolution of soft tissue lesions and has an important advantage in finding and qualitative diagnosis of lesions. In 2007, the American Cancer Society’s breast cancer screening guidelines recommend MRI a screening imaging examination for people at high risk of breast cancer. However, MRI is high cost, has contraindications, is not sensitive to calcification shows, is not practical as a most conventional method. In recent years, contrast-enhanced ultrasound can provide tumor perfusion characteristics, highlight its important position in the new ultrasonic technology. But the application in breast is still at the preliminary stage. Ultrasonic diffused opticaltomography(DOT) can measure organization internal functional information, have a potential role for the detection of breast cancer.Objective To explore the diagnostic value of contrast-enhanced ultrasound and DOT, to compare the diagnostic value with mammography and MRI in the BI- RADS-US, class 3, 4.and atypical small lesions of breast mass.Methods 1. Contrast enhanced ultrasound(CEUS) and dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) were performed in 65 patients with breast tumors one week before surgical operation, the results of CEUS were qualitatively and quantitatively analyzed. Time-intensity curves of two methods were calculated. Taking the pathologic findings as the golden standard, the diagnostic sensitivity, specificity, positive predictive value and negative predictive value of two methods were calculated. 2. The breast lesions equal or less than 1cm in size of 126 inpatients were scanned by ultrasonic DOT and conventional ultrasound imaging, the results were compared with the golden standard. 3. Ultrasound DOT, ultrasonic elastography(UE), CEUS, mammography and breast enhanced-MR were used in 75 breast lesions equal or less than 2cm in size, to compare the diagnostic ef?ciency of combined ultrasound methods.1. The differences between time to peak(TTP) and Peak intensity were statistically significant in benign and malignant lesions(P<0.05). As to the qualitative analysis, enhancement features had statistically significant differences between benign and malignant lesions(P<0.05). 2. The sensitivity, specificity, positive and negative predictive value were 85.71%, 83.33%, 85.71%, 83.33% for CEUS and 91.43%, 80.00%, 84.21%, 88.89% for DCE-MRI, respectively. No statistical difference was found between them(P>0.05). 3. The sensitivity, specificity, positive and negative predictive value and accuracy forDOT and conventional ultrasound were 92.68%, 81.82%, 90.48%, 85.71%, 88.88% and 85.37%, 77.27%, 87.50%, 73.91%, 82.54%, respectively. The Kappa value for consistency between ultrasonic DOT and pathology results was 0.753, and for conventional ultrasound it was 0.651. Ultrasonic DOT and traditional ultrasound diagnosis’ area under the ROC curve were 0.873 and 0.813, respectively. 4. The sensitivities and the diagnostic negative predictive value for MRI+US+XRM(97.44%,96.15%), DOT +UE +CEUS(94.87%,93.55%)and MRI(94.87%,92.86%) were signi?cantly higher than for XRM(74.36%,71.43%), respectively(P<0.05).The specificity for DOT+UE+CEUS was 82.56%.It was signi?cantly higher than for XRM(P<0.05).Thecorresponding coef?cients for DOT, UE, CEUS, USG(DOT+UE+CEUS), XRM, MRI and MRI+US+XRM were 0.678, 0.624, 0.732, 0.758, 0.439, 0.677 and 0.676, respectively.Conclusions 1. Qualitative and quantitative analysis of CEUS, could better reflect the characteristics of the tumor blood perfusion. CEUS has a good agreement with DCE-MRI. It has clinical value in the differential diagnosis of benign and malignant tumors in breast BI- RADS class 3, grade 4 lesions. 2. Ultrasonic DOT had a higher diagnostic value for early breast cancer than conventional ultrasound imaging. It has an obvious advantage of accurately and quantitatively reflecting the biochemical information within the organization. And it may act as a new functional testing technology for noninvasive and repeat evaluation of breast lesions’ new blood vessels, and also has important clinical value for early diagnosis of breast cancer. 3. Different imaging modalities had different advantages to diagnose malignant or benign lesions. The combined ultrasound methods(DOT+UE+CEUS) have highly important clinical values in breast disease diagnosis.It can improve the diagnostic rate and may be used as the preferred method for early diagnosis of breast cancer.