Comparison Of Contrast-enhanced Ultrasound And Ultrasonic Elastography In Distinguishing Diagnosis Of Breast Malignant Lumps From Benign

Ob Jective:To appraise the importance of contrast-enhanced ultrasound and ultrasonic elastography in distinguishing diagnosis of breast malignant lumps from benign.Clinical data: Eighty-two cases patients with a total of 96 breast masses who underwent surgery in our hospital were collected from March 2013 to March 2015,except cystic mass.All the patients were female.Age between 23~69 years old, the average age was(43.66 ± 12.38),the size of lump was 0.68cm~4.50 cm,the average was(2.12 ± 0.85)cm,before the operation all the patients were underwent routine ultrasound, CEUS and UE,then the results were compared with pathological findings.Apparatus and method: Siemens Sequoia 512 color doppler ultrasonic diagnostic apparatus,linear probe 9L4 were used in these cases and the transmission frequency was 4~8 MHz. The contrast agent was Sono Vue.The real-time dynamic video memory technology was applied durin the entire process of CEUS,while the main observation was reinforcing phase and the main mode, including start time, peak time, complete clearance clearance time,enhanced performance and clearance performance in the internal structure of the lesions.Estimating be nign and malignant lesions based on the Angiographic perfusion characteristics and Enhanced Mode.Diagnostic instrument of Ultrasound elastography was Hitachi HA710, a high-frequency linear array probe with 6.5 ~ 13.0MHz.Under the conventional ultrasound,maximum mass section was selected and fixed,switch to the elastic mode,observe the two-dimensional map and elastography dynamicly with double the rate.First wasassessed and scored the lesions, then measured and calculated the strain ratio of elastic strain focal region and its surrounding area of the same layer.To infer the hardness of lesions and surrounding breast tissue in order to determine benign or malignant tumors. Compared and analysised the benign and malignant of contrast-enhanced ultrasound and elastography with it’s pathological conclusions.All cases in this study were completed by the same high qualification an experienced sonographer.the images were analysised and carried out independently by the anther two sonographers with rich experience who did not participate in the examination,summary of diagnosis results,obtained the results by discussion of department experts when there was disagreement.Result: 1.The pathology results of 96 breast tumor is 39 malignant and 57 benign. 1.1 malignant tumor: the average start time of the 39 cases with mammary cancer in CEUS was 8.86±4.26 s,the peak time was 15.75±7.54 s,the complete remission time was 25.36±5.48 s.After CEUS,the contrast agents was uneven distribution in the breast cancer lesions,focal filling defect, partially visible traveling through tortuous vessels or perforator vessels,and the maximum diameter of the same section increased after CEUS,visible contrast agent retention after clearance.Ultrasound elasticity scoreof 39 cases with breast cancer were mainly 4 points and SR≥3.03,more than 50% of lesions appeared as blue in the image manifestations,with relatively high hardness.1.2 Benign lesions:After CEUS 57 cases of mass showed uniformity or unevenness weak enhancement, part with no enhancement,basically with the same range compared the before with the after of CEUS,few lumps diffused to the edge,the border of benign lesions appeared as annular reinforcing or semi-annular reinforcing,After the clearance no contrast agent remained.The elastography score of Benign lesions mainly were 1, 2 and SR < 3.03,more than 50% of lesions appeared as green in the image manifestations,with relatively low hardness. 2.After CEUS of 96 cases,The start time, time to peak, peak intensity time and complete regression showed significant differences between benign and malignant lesions, and the difference was statistically significant(P<0.05). 3.The Sensitivity,specificity and accuracy of ultrasonography and elastography in diagnosing breast lumps were 71.8%,89.5%,82.3% and 82.1%,86.0%,84.4%,while Elastography combined with CEUS had the highest diagnostic efficiency,the sensitivity was 94.9%,the ecificity was 96.5%,the accuracy was 95.8%.Conclusions: CEUS and elastography for differentiating malignant and benign breast masses had a high value,they were both promising ultrasound technique,while combined diagnosis contributed more to improve the accuracy of diagnosis, reduced the misdiagnosis and missed diagnosis.UE has its unique advantages of non-invasive and cost-effective, so it can be used as a priority, and CEUS can be used as an effective supplementary means.