Study On The Application Value Of MRI In Non-massive Enhancement Lesions Of The Breast

Objective:To explore the value of magnetic resonance imaging?MRI?in the differential diagnosis of benign and malignant non-massive breast lesions?NME?.And analyze the correlation between MRI performance of NME breast cancer and the expression of immunohistochemistry ER,PR,HER-2,Ki-67.Methods:The MRI manifestations,clinical and pathological data of 89cases with NME confirmed by pathology from November 2016 to July 2019in our hospital were analyzed retrospectively.All the patients were performed conventional plain scan and diffusion weighted imaging,DWI)and dynamic contrast-enhanced scanning.According to the 2013 version of MRI breast imaging and reporting data system?BI-RADS-MRI?launched by the American Society of Radiology Imaging,to analyze the distribution characteristics?focal,linear,segmental,regional,multiregional,diffuse distribution?and internal enhancement characteristics?homogeneous,heterogeneous,clumped,cluster ring enhancement?of NME after dynamic contrast-enhanced scanning.The apparent diffusion coefficient?ADC?and time intensity curve?TIC?type of breast lesions was measured by functool post-processing software Coefficient.The MRI findings were compared with the corresponding histopathological findings.To analyze the distribution characteristics,internal enhancement characteristics,TIC type and ADC values of NME lesions in benign and malignant lesions,and to establish regression models of single and combined parameters of statistically significant indicators,draw receiver operating characteristic curve?ROC?to evaluate the diagnostic value for benign and malignant breast lesions.The correlation between MRI and expression of ER,PR,HER-2,Ki-67 was also analyzed.Results:Among the 89 patients,there were 91 NME lesions,including 57benign lesions?62.64%?,34 malignant lesions?37.36%?,and inflammatory lesions accounted for the largest proportion in benign lesions?36,63.16%?.Among the malignant lesions,ductal carcinoma in situ accounted for the largest proportion?15,44.12%?,and 5 of them were accompanied with microinvasion.The frequency of segmental enhancement in malignancy was signifificantly higher than in benign lesion?P<0.05?.There was no significant difference in other distribution characteristics?P>0.05?.Among the types of internal enhancement,cluster ring enhancement had statistical difference?P<0.05?,but there was no statistical difference in other internal enhancement methods?P>0.05?.The type of time signal intensity curve was not statistically significant?P>0.05?between benign and malignant NME.ADC value had differential diagnostic value for benign and malignant lesions?P<0.05?,the best diagnostic threshold was 0.995×10^-3mm ²/s,the sensitivity and specificity were 82.1%and 47.1%,respe-ctively.The area under the curve?AUC?of distribution characteristics,internal enhancement,ADC value,and the combination of distribution characteristics and internal enhancement,the combination of distribution characteristics and ADC value,the combination of internal enhancement and ADC value,the combination of the distribution characteristics,internal enhancement and ADC value are 0.670,0.533,0.744,0.677,0.759,0.736and 0.761,respectively.The AUC of the combination of the distribution characteristics,internal enhancement and ADC value is the largest,and the sensitivity is 79.4%,the specificity is 61.7%.There was no significant correlation between the expression of ER,PR,HER-2,Ki-67 and the distribution,internal enhancement,TIC curve and ADC value of NME breast cancer?P>0.05?.Conclusion:Segmental distribution,cluster-like ring enhancement,and ADC value have diagnostic value for the benign and malignant lesions of breast non-massive enhancement,and the combined diagnosis of the three is the most effective.The TIC curve is of little value in identifying benign and malignant lesions of NME,and there is a certain overlap between benign and malignant lesions.And there was no significant correlation between the expression of ER,PR,HER-2,Ki-67 and the distribution,internal enhancement,TIC curve,ADC value of NME breast cancer.