Differentiation Between Phyllodes Tumors And Fibroadenomas Based On Mammographic Sonographic And MRI Features

Objective: This study was performed to compare the mammographic,sonographic,and magnetic resonance imaging(MRI)characteristics of phyllodes tumors and fibroadenomas,which may resemble each other.Materials and Methods: A total of 60 cases of breast neoplasms confirmed by pathology in the Liaoning Cancer Hospital from September 2016 to September 2017 were collected,including 32 patients with phyllodes tumors of the breast and 28 patients with breast fibroadenomas.28 cases were female,aged 21 to 66 years,with an average of 44.9±9.5 years.Mammography was performed using the US GE digital mammography machine.The cranio-caudal(CC)and medio-lateral oblique(MLO)views of the breast were routinely recorded.The size,shape,margin,density,calcification within the mass were recorded.Ultrasound was performed using a Siemens S2000 ultrasound system with a probe frequency of 4-9 MHz and breast condition examination.The breasts and axillae were scanned regularly.The size,shape,margin,echo pattern and posterior features were observed in two dimensions.The color Doppler ultrasonography was used to observe the blood flow pattern,walking and classification in the tumor.MRI examination was performed using the US GE Signa HDxt 1.5T superconducting magnetic resonance scanner,choosing the breast phased array surface coil,scanning horizontal axis,sagittal supplement,flat scan,dynamic enhancement and subtraction imaging,observed the size,shape,margin,internal structure on T2-weighted TSE sequence with fat suppression,signal intensity/time curve description and measured ADC.Multi-phase scan raw data was imported into Omni-Kinetics software(GE Healthcare)Linear Reference Region Model(LRRM)pharmacokinetic model to obtain volume transfer constant(Ktrans),rate constant(Kep)and extravascular extracellular volume fraction(Ve)and other indicators.Statistical analysis was performed using the SPSS19.0 software package to compare the differences in mammography,ultrasonography,and MRI features between breast phyllodes tumors and fibroadenomas.P<0.05 suggested that the difference was statistically significant,P?0.05 suggested that the difference was not statistically significant.Mammography,ultrasonography,and MRI features were compared between the phyllodes tumor group and the fibroadenomas group.Univariate analysis was performed by Chi-square test(Fisher's exact test),and multivariate analysis was performed by logistic regression analysis.The ktrans,Kep,Ve and ADC of the two groups of tumors were compared by Student's t test.If the normal distribution is consistent,the mean±standard deviation(x±s)is expressed;the non-normal distribution is expressed as median(inter quartile range).Results: According to univariate analysis,the differences in size,shape,and margin of phyllodes tumors and fibroadenomas were significantly different.The differences in echo pattern and vascularity observed on ultrasound were significantly different.The difference in T2 WI fat suppression signal performance on MRI was significantly different.According to multivariate analysis,the vascularity on ultrasound is of great significance for the differential diagnosis of phyllodes tumors and fibroadenomas.The three multi-factor analysis indicators combined with differential diagnosis of the two groups of tumors had the highest overall accuracy,which was 81.4%.Conclusion: The imaging findings of phyllodes tumors lack specificity.The coincidence rate of preoperative diagnosis of single imaging examination is low,and the imaging features of mammography,ultrasound and MRI should be considered comprehensively,especially the signs of blood flow grading on ultrasound.A comprehensive analysis of multiple indications for imaging diagnosis can help to improve the diagnostic accuracy of phyllodes tumors,and has obvious clinical practical value.