Value Of Ultrasonography In Early Diagnosing And Preoperative TNM Staging For Breast Cancer

ObjectiveComparsion and analysis of the ultrasound image of ductal carcinoma in suit(DCIS)、microinvasive breast carcinoma(MBC)、 invasive ductal carcinoma(IDC),to investigate three types of breast cancer ultrasonic characteristics and changes, to summarize the early stages of breast cancer imaging features,in order to improve the early diagnostic sensitivity and accuracy,At the same time explore ultrasonography in breast cancer infiltration degree of value judgment;Through compared with postoperative pathology,to evaluate the value of ultrasonography for preoperative TNM staging on invasive ductal carcinoma.MethodsRandom selection breast patients in our hospital confirmed by pathology 3010 cases from January 2010 to September 2014,According to inclusion and exclusion criteria of the study,Select 436 cases(448 lesions) breast cancer among them,According to the pathological diagnosis were divided into three groups: A group(ductal carcinoma in situ) : DCIS 75 patients(79 lesions) B group(micro-invasive cancer): MBC 101 patients(109 lesions) C group(invasive ductal carcinoma): IDC 260 patients(260 lesions) According to histological grade which is subdivided into the following seven groups: A1 group : low grade ductal carcinoma in situ 21 patients(21 lesions) A2 group : intermediate grade ductal carcinoma in situ 21 patients(22 lesions) A3 group : high grade ductal carcinoma in situ 33 patients(36 lesions) B group(micro-invasive cancer): MBC 101 patients(109 lesions) C1 group : Ⅰgrade invasive ductal carcinoma 24 patients(24 lesions) C2 group : Ⅱgrade invasive ductal carcinoma 136 patients(136 lesions)C3 group : Ⅲ grade invasive ductal carcinoma 100 patients(100 lesions) From A, B, C three groups,elected maximum diameter≤1cm of breast lesions(called small breast cancer) in turn divided into three groups: Amin group: ductal carcinoma in situ 11 patients(11 lesions) Bmin group: micro-invasive cancer 12 patients(12 lesions) Cmin group: invasive ductal carcinoma 13 patients Based on sonography, the 448 lesions are divided into two types: mass type and ductal type. 76.0%(57/75) A group(61 lesions),88.1%(89/101) B group(95 lesions) and 100.0%(260/260) IDC(260 lesions) were classified as mass type. 24.0%(18/75) A group(18 lesions),11.9%(12/101) B group(14 lesions) and 0%(0/260) IDC(0 lesions) were classified as ductal type. The ultrasonic characteristics of A, B, C three groups and Amin, Bmin, Cmin three groups of small breast cancer were analyzed retrospectively,and compared with pathology, Analysis in A1~ C3 seven groups lesions ultrasonic characteristics distributed,and draw a graph summarizes the characteristics,to investigate the ultrasonic regularities of 7 groups,summarized the early stages of breast cancer imaging features; The TNM-staging for IDC by preoperative ultrasonography was evaluated according to pathology,to evaluate the value of ultrasonography for ultrasonography TNM staging.Results1.A Group: 61 mass type lesions maximum diameter of 0.60 cm ~ 6.2cm, the average(2.28±1.23) cm, B group: 95 mass type lesions maximum diameter of 0.40 cm ~ 15.2cm, the average(2.71±2.11) cm, C group: 260 mass type lesions maximum diameter of 0.6cm ~ 9.8cm, the average(2.44±1.30) cm. 2.A1 ~ C3 seven groups focus maximum diameter at an early stage(A1 Group to A2 group) can occur significantly increased,most of them sonograms showed solid hypoechoic lesions,irregular shape,uneven internal echo,unclear border,aspiculate margin,calcification,few showed A/T ratio(≥0.7),posterior acoustic attenuation,lymphnode abnormalities.Early stage(Group A、Group B) cancer with higher calcification than invasive cancer stage(Group C).Early stage showed the less rate of masses,unclear border,aspiculate margin,coustic halos,A/T ratio(≥0.7),posterior acoustic attenuation,lymph node abnormalities than invasive cancer stage.In A1 group the main detecion rate of internal blood flow is grade 0,From A2 group to the subsequent group was significantly higher than A1. 3.From group A to group B to group C,Early stage showed the less rate of masses,A/T ratio(≥0.7),aspiculate margin,coustic halos,lymph node abnormalities than invasive cancer stage(P <0.0125).From each of early cancer to invasive cancer, by atypical into typical. 4.Small breast lesions A/T ratio(≥0.7),aspiculate margin, internal blood flow(grade 2~3) Group B significantly increased, to the more typical of group C.Early stage cancer with higher calcification than invasive cancer stage. 5.Ductal lesions found only in early cancer(A group,B group),majority sonograms showed uneven internal echo, calcification,B group(71.4%)had a higher detection rate of internal blood flow(grade 2~3) than A group(44.4%)(P>0.05). Meanwhile,More ductal type lesions displayed indistinct duct wall in B group(71.4%) than A group(33.3)(P<0.05). 6.The rate of accuracy of ultrasonic diagnosis on A,B,C, Amin,Bmin,Cmin was 66.7%,85.1%,95.1%,36.4%,66.7%,69.2%,respectively.The rate of accuracy of ultrasonic diagnosis on A group, B group ductal lesions was 38.9%,71.4%. 7.According to pathology,the ultrasonic coincidence rate for T staging was 68.5%,and T1 staging was 72.6% on.The sensitivity,specificity,positive predictive value and negative predictive value of ultrasonic diagnosis on lymph node metastasis was 52.5%,87.1%,77.8% and 68.2%,respectively.Conclusion1.Sonographic features of early stage breast cancer have some differences with invasive cancer,Early breast carcinoma with irregular shape,uneven internal echo,unclear border for the most common signs, and has certain characteristic. "Duct" sign, mass lesions in echogenicity of the pipeline,microcalcification are characteristic features of early cancer.Early cancer aspiculate margin was not typical.few showed A/T ratio( ≥ 0.7),posterior acoustic attenuation,lymph node abnormalities. 2.Lesion enlarged, micro- calcifications detected, blood flow increased is important to the evolution of the early stages. 3.Familiar with the imaging characteristics of early cancer, to improve early cancer detection rate has important clinical significance. 4. "Ductal" sign,typically spiculate margin,coustic halos for early cancer and invasive cancer have a differential diagnosis.Ultrasonography has a certain significance in estimate Breast cancer infiltration degree.The final diagnosis was still need to depend on pathology. 5. Ultrasonography has significant clinical value in in breast cancer early detection, early diagnosis. 6. Ultrasonography has possessed certain value for preoperative TNM staging.