The Value Of Breast Contrast-enhanced Ultrasonography In The Diagnosis Of Breast Precancerous Lesions

First part:The Value of Contrast-enhanced Ultrasonography in the Diagnosis of Breast Precancerous LesionsObjective:To explore the value of contrast-enhanced ultrasonography in the diagnosis of breast precancerous lesions.Materials and methods:In this study,selected the hospital from January 2016 to September 2018 during the examination and treatment of 720 cases(720 lesions),including 598 cases of benign lesions,122 cases of breast precancerous lesions,both conventional ultrasound and contrast-enhanced ultrasound examination.BI-RADS classification as a yardstick,BI-RADS 4B as benign lesions and cut-off of breast precancerous lesions.BI-RADS 3?4A as benign lesion group,BI-RADS 4B,4C and 5 as precancerous lesions group.Pathologic results as the gold standard,the sensitivity,specificity and accuracy of routine ultrasound and contrast-enhanced ultrasound in the diagnosis of breast precancerous lesions were calculated and analyzed.Results:The sensitivity of ultrasound contrast-enhanced BI-RADS diagnosis of breast precancerous lesions was 45.9%,specificity was 84.6%,accuracy was 78.1%,and the area under the ROC curve was 0.68.The sensitivity of conventional ultrasound BI-RADS classification to diagnose breast precancerous lesions was 35.2%,the specificity was 77.1%,the accuracy was 70.0%,and the area under the ROC curve was 0.56.The difference was statistically significant(P<0.05).Conclusion:The sensitivity,specificity and accuracy of contrast-enhanced ultrasonography in the diagnosis of breast precancerous lesions are higher than that of conventional ultrasonography.The combination of conventional ultrasonography and contrast-enhanced ultrasonography before surgery can further diagnose breast precancerous lesions and assist clinicians to take intervention measures in advance.Second part:Multivariate Analysis of Features of Ultrasound-enhanced Images of Breast Precancerous Lesions and Benign LesionsObjectives:To explore the differences in the features of contrast-enhanced ultrasound images between breast precancerous lesions and benign breast lesions.Methods:A retrospective analysis of 720 patients(720 lesions)examined and treated in our hospital from January 2016 to September 2018,including 598 benign lesions,122 breast precancerous lesions,and ultrasound contrast analysis of 2 groups Image characteristics:enhanced intensity,enhancement time,contrast agent perfusion direction,enhanced contrast agent distribution characteristics,enhanced lesion edge,enhanced lesion morphology,localized perfusion defect after enhancement,enhanced lesion range,Presence or absence of nourishing blood vessels And with or without contrast agent retention.Statistical methods included ?2 test and binary logistic regression.Results:Among the 720 lesions,the benign lesion group had fibroid adenoma or adenopathy with ductal epithelial hyperplasia,the most cases of catheter dilatation 42.9%(257/598),and the precancerous lesion group had the most cases of intraductal carcinoma in situ or in vivo 33.6%(41/122).Univariate analysis showed that the seven factors of enhanced intensity,enhanced time,distribution characteristics of contrast agent,enhanced lesion edge,enhanced lesion morphology,presence or absence of trophoblastic blood vessels and enhanced lesion range showed statistically significant difference between the breast precancerous lesions and the benign lesion group(P<0.05).Multivariate analysis showed that there were statistically significant differences between the two groups in the time of enhancement,the distribution characteristics of contrast agent and the lesion boundary after enhaneement(P<0.05).Conclusion:when contrast-enhanced ultrasonography is used to distinguish breast cancer precancerous lesions from benign lesions,if the lesion image shows enhancement,fast forward,uneven distribution of contrast agents and unclear edge,precancerous lesions are more likely to be diagnosed.Third part:Multivariate Analysis of the Features of Breast Intraductal Carcinoma and Invasive Ductal Contrast-enhanced UltrasoundObjective:To investigate the difference of contrast-enhanced ultrasonographic features between breast intraductal carcinoma of and invasive ductal carcinoma in order to distinguish them.Materials and methods:A retrospective analysis of 180 patients(180 lesions in total)examined and surgically performed in our hospital from January 2016 to September 2018,including 41 cases of intraductal carcinoma of the breast,139 cases of invasive ductal carcinoma of the breast.The Characteristics of contrast-enhanced images of the two groups were analyzed:enhanced strength,time,contrast enhanced perfusion direction,enhance contrast agent distribution,enhanced lesions after edges,enhanced lesions form,enhanced lesions appear perfusion defects,enhanced lesions scope change,presence of nourishing blood vessels,and presence of contrast agents were stranded,and the observation index of Univariate analysis and multivariate analysis.Statistical methods included ?2 test and binary logistic regression.Results:Univariate analysis showed that there were significant differences between the intraductal carcinoma group and the invasive ductal carcinoma group(P<0.05)in the two factors including enhanced perfusion defect and the presence or absence of nourishing blood vessels in the contrast-enhanced ultrasound image features.Multivariate analysis showed that the differences of the two factors between the two groups were statistically significant(P<0.05).Conclusion:In the differential diagnosis between intraductal carcinoma of breast and invasive ductal carcinoma by contrast-enhanced ultrasonography,if the lesion presents perfusion defect and nourishing blood vessels,invasive ductal carcinoma is more likely.