Value Of Ultrasonography In Diagnosis And Differential Diagnosis Of Non-lactation Mastitis And Breast Cancer

Objective To observe the ultrasonographic characteristics and diagnostic value of twodimensional and color Doppler ultrasonography in pathologically confirmed nonlactation mastitis(NLM),ductal carcinoma in situ(DCIS)and invasive ductal carcinoma(IDC)using ultrasound technique,and to investigate the value of shear wave elastrography(SWE)in differential diagnosis of NLM,DCIS and IDC,and to improve the accuracy of ultrasonic diagnosing NLM and differential diagnose level with breast cancer.Methods According to inclusion and exclusion criteria,select 134 cases(143 lesions)with NLM and 315 cases(325 lesions)with breast cancer in our hospital from January 2015 to September 2016.All patients were divided in to three groups according to pathology results: NLM group(34 cases with 143 lesions),DCIS group(102 cases with108 lesions)and IDC group(213 cases with 217 lesions).The NLM group was further divided into four subgroups base on pathology subtypes:mammary ductal ectasia(MDE),granulomatous lobular mastitis(GLM),fat necrosis of the breast and sclerotic lymphocytic mastitis.MDE subgroup had 63 cases(47.0%)with67 lesions;GLM subgroup had 64 cases(47.8%)with 69 lesions;fat necrosis of the breast subgroup had 4 cases(3.0%)with 4 lesions;MDE subgroup had 3 cases(2.2%)with 3 lesions.Among them 103 cases(107 lesions)underwent SWE,including 12 cases(12 lesions)in NLM group,14 cases(15 lesions)in DCIS group and 77 cases(80 lesions)in IDC group.According to the sonographical features,465 lesions except 3 cases with diffuse type were classified into two subtypes: mass and ductal lesions.NLM group: 131 cases(140 lesions)in total,including 114 cases(87.0%)with 123 lesions in mass subtype and 17 cases(13.0%)with 17 lesions in ductal subtype.Among them,63 cases(69 lesions)in MDE subgroup,including 55 cases(87.3%)with 61 lesions in mass subtype and 8 cases(6.0%)with 8 lesions in ductal subtype;61 cases(66 lesions)in GLM subgroup,including 52 cases(85.2%)with57 lesions in mass subtype and 9cases(14.8%)with 9 lesions in ductal subtype.DCIS group: 102 cases(108 lesions)in total,including 92 cases(90.2%)with 98 lesions in mass subtype and 10 cases(9.8%)with 10 lesions in ductal subtype.IDC group: 213 cases(217 lesions)in total,all in mass subtype.Preoperative sonograms of NLM,DCIS and IDC patients were retrospectively analyzed and compared,which were further confirmed by histopathology,to summarize characteristic sonographic findings of NLM for its differential diagnosis with breast cancer.The elastic modulus(Emax,Emin,Emax range,SD and Eratio)and qualitative indexes(“Hard-ring sign” sand “black hole sign”)of NLM,DCIS and IDC were compared to investigate the value of SWE in differential diagnosis of the three groups.Results1.The average age of patients in NLM group were(39.4±10.9)years,obviously younger than(49.3±9.9)years in DCIS group and(50.4±13.1)years in IDC group(P<0.001).The mean size of lesionsand was(3.3±2.4)cm,larger than(2.3±1.4)cm in DCIS group and(2.6±1.4)cm in IDC group(P<0.05).The lesion location of NLM,DCIS and IDC were more around the mamary gland,but IDC group was more commom than NLM group(P<0.05).2.The average age of patients in MDE subgroup were(42.8±10.6)years,obviously older than(33.7±6.7)years in GLM subgroup(P<0.05).The mean size of lesionsand was(2.3±1.9)cm,smaller than(4.5±2.5)cm in GLM subgroup(P<0.05).The lesion location of MDE and GLM were all more around the mamary gland(P>0.05).3.Compared to IDC group,NLM group showed less lesions with irregular shape,large A/T ratios(≥ 0.7),calcification,spiculate margin,peripheral hyperechoic zone or posterior echo attenuation and blood flow richness(P<0.05),more lesions with inhomogeneous interior echoes(P>0.05).There were more lesions with spiculate margin and axillary lymph node enlargement found in NLM group than in DCIS group(P<0.05),but less calcification(P<0.05).NLM group showed higher detection rate of no internal echogenicity compared to DCIS and IDC groups(P<0.05).4.The elastic modulus(Emax,Emin,Emax range,SD and Eratio)and qualitative indexes(“Hard-ring sign” sand “black hole sign”)were less found in NLM group compared to IDC group.While the elastic modulus and qualitative indexes for lesions with NLM were similar with DCIS(P>0.05).Conclusions1.Most NLM lesions are MDE and GLM,Different pathological types have different sonographic findings.2.The mean size of NLM lesions are larger than the breast cancer,but the average age of NLM patients are obviously younger than the breast cancer.3.The coincidence rate of conventional ultrasonic diagnosis and pathological diagnosis is very low.The NLM lesions are more in mass subtype and less in ductal subtype.The main sonographic features of NLM lesions are low echo of mixed mass with irregular shape,no internal echogenicity inside the lesion with moving intensive dotted high-echo when pressurised.There are some differences between NLM and IDC,such as the stubby spiculate margin,the thin peripheral hyperechoic zone,blood flow distribution,calcification and axillary lymph node enlargement.There are significant differences between NLM and IDC in the elastic modulus and qualitative indexes.Fully recognizing ultrasonographic features of NLM can help to improve the value of ultrasonography diagnosis in it and its differential diagnosis with IDC.4.NLM lesions show higher detection rate of no internal echogenicity and axillary lymph node enlargement than DCIS,but lower detection rate of calcification compared to DCIS.There are no obvious difference between NLM and DCIS in the elastic modulus and qualitative indexes.