Abstract Objective To investigate the high-frequency color Doppler ultrasound in the differential diagnosis of breast cancer and breast hyperplasia value. Methods A retrospective analysis of 50 cases of breast cancer diagnosed by pathology, 46 cases of mammary hyperplasia patients (solid mass) of the two-dimensional ultrasound morphology seven indicators, the mass flow signal level, arterial blood flow spectrum parameters and arterial spectrum morphology. Results of the two-dimensional ultrasound of the cancer group with hyperplasia seven indicators compare the difference was statistically significant (P <0.01); The cancer group flow signals significantly higher than the hyperplasia group, multi-Ⅱ or Ⅲ hyperplasia group 0 or I level the main difference between the two groups was statistically significant (P <0.01); cancer group systolic peak velocity (Vmax), resistance index (RI) than proliferative group, the difference between the two groups was statistically significant (P <0.05, P <0.01); cancer group with hyperplasia artery blood flow spectrum morphological differences between two groups was statistically significant (P <0.01). The conclusions of the high-frequency color Doppler ultrasound in the differential diagnosis of breast cancer and breast hyperplasia have a higher value.

【Key Words】 breast cancer; breast hyperplasia; high frequency color Doppler; identify diagnostic

  Value of High  frenquency Color Doppler Ultrasound in Differential Diagnosis in Breast Cancer and Breast Hyperplasia

    WANG Juan1, YANG Jie2, WU Yan  qu3, JIA Jie1, LI Xiu  kun1 *, ZHANG Jing1 *, CHONG Zhen  yu1 *, YU Dun  xiang1 *, YU Xue  huan1 *

    1.Department of Electrodiagnosis, Chian  Japan Union Hospital, Jilin University, Changchun 130021, China (* Graduate student), 2.Department of Emergency, 3. Department of Ophthalmology

    Corresponding Author: JIA Jie, E  mail: meilidejie  100@163.comAbstract: Objective Discussion on the value of the high  frequency color Doppler ultrasound in the differential diagnosis in the breast cancer and breast hyperplasia. Methods Retrospective analysis by opration to obtain the pathologiocal diagnose on 50 patients with breast cancer and 46 patients with breast hyperplasia (concrete tumour). Seven indexes in the tumour under the two  dimensional ultrasound morphology were observed. The blood stream signal, the artery blood stream frequency spectrum parameter and the artery frequency spectrum shape in the tumour were detected. Results In comparision, there are striking differences (P <0.01) in the seven indexes between the cancer group and the hyperplasia group under the two  dimensional ultrasound. The blood stream signal in the cancer group is obviously higher than that in the hyperplasia group. The blood stream signal in the cancer group is mainly level Ⅱ or level Ⅲ, while the blood stream signal in the hyperplasia group is mainly level 0 or level Ⅰ. In comparision, the differences between the two groups are remarkable (P <0.01). The contraction time peak flow value (Vmax) and the resistance index (RI) in the cancer group are higher than those in the hyperplasia group. In comparision, the differences between the two groups are remarkable ( P <0.05, P <0.01). The differences in the artery frequency spectrum shape between the two groups are remarkable (P <0.01). Conclusion The high  frequency color Doppler ultrasound has the significant value in the differential diagnosis in the breast cancer and the breast hyperplasia.

    Key words: Breast cancer; Breast hyperplasia; High frequency color Doppler ultrasound; Differential diagnosis

 0 Introduction

    Breast cancer is the diseases of serious harm to the health of women in our country, women malignant. Classification of mammary hyperplasia solid mass with breast cancer sonographic sign like there are some overlapping phenomenon. Ultrasound field of differential diagnosis, both at home and abroad rarely reported, and there is a certain rate of misdiagnosis. To this end, the study of both a more in-depth study designed to prompt high-frequency color Doppler ultrasound diagnosis and differential diagnosis of breast cancer and breast hyperplasia.

    1 Data and methods

    1.1 The object of study

    Cancer group of 50 patients with breast cancer and 46 cases of breast hyperplasia hyperplasia patients from February 2004 to March 2007 in hospital surgical resident female patients, all confirmed by surgery and pathology. Aged 18 to 72 years, with an average age of 52 years old.

    1.2 Instruments and Methods

    SEQUOIA  512 color Doppler ultrasonic diagnostic apparatus, linear frequency probe, frequency 7 ~ 13MHz. Observed lesions, the patient was supine, arms on the move demonstrated bilateral breast and axillary direct examination system of bilateral breast scan, and then using color Doppler examination, to find the most abundant blood flow cut and whether the blood flow and blood flow signal how much. Then switch taken the most obvious aliasing blood flow spectrum Doppler spectrum, frozen and saved in the machine’s hard disk, unified playback analysis image detection indicators.

    1.3 blood flow signal classification

    0: intralesional flow signals; Level I: a small amount of blood flow, visible 1 to 2 points like blood flow signals, grade II: the amount of blood flow seen a major blood vessel (the length exceeds lesion radius) or a few small blood vessels. Ⅲ: rich blood flow, visible the intertextual four or more blood vessels or vascular network [1].

    The 1.4 spectral shape classification criteria

    Peak appears in one third of the period before the systolic peak centered peaks in one third of the time period in the systolic shift refers to the peak after peak appeared in one third of the period after the systolic peak forward refers to the beginning of wave; diastolic above the midpoint appear above the mid-point of the wave decline in systolic, diastolic starting wave starting waves below the midpoint of the initial wave appears diastolic the systolic wave decline below the midpoint; same refers to the blood flow diastolic Ending the direction of flow spectrum with the same direction as the systolic spectrum, reverse blood flow refers diastolic end of the period of the direction of flow spectrum systolic spectrum direction contrary, no blood flow refers to the end-diastolic flow spectrum.

    1.5 statistical methods

    Respectively using t test, χ2 test.

    2 Results

    2.1 cancer group with hyperplasia group of two-dimensional sonographic seven indicators

    Form of (1): the rules of the cancer group 13 cases, 37 cases of irregular; hyperplasia Rule 31 cases, 15 cases of irregular. (2) boundary: Smooth cancer group 2 cases, the smooth 17 cases; Crab-like 31 cases; hyperplasia of smooth 29 cases, the smooth 15 cases Crab-like two cases. (3) internal echo: cancer group uniform five cases, the uneven 45 cases; the hyperplasia uniform 37 cases, uneven nine cases. (4) calcification: cancer group microcalcifications in 29 cases, coarse calcification in 14 cases, and no calcification seven cases. The hyperplasia group; microcalcifications four cases, coarse calcification in 11 cases, 31 cases of non-calcified. (5): posterior echo attenuation of 36 cases of cancer group, the same 10 cases, the enhanced four cases; hyperplasia group to decay two cases, unchanged in 40 cases, and enhance the four cases. (6) tissue invasion: 34 cases of invasion of the cancer group, 16 cases of invasion. Hyperplasia group: invasion cases, 46 cases of invasion. 1有35例,<1有15例。">(7) Aspect Ratio: cancer group 1, 35 patients, <1 in 15 cases. 1有7例,<1有39例。">Hyperplasia group 1 in 7 cases, <39 cases. 7 difference between the two groups were statistically significant (P <0.01).

    2.2 flow signal richness and hemodynamic indicators

    (1) cancer group Vmax (22.47 ± 12.64) cm / s, the hyperplasia Vmax (11.13 ± 6.17) cm / s, the cancer group than proliferative group, the difference between the two groups was statistically significant (P <0.05) ; (2) cancer group RI (0.76 ± 0.07), hyperplasia RI (0.65 ± 0.08) cancer group than proliferative group, the difference between the two groups was statistically significant (P <0.01); (3) cancer group flow signals: 0 5 cases, 6 cases of grade Ⅰ, Ⅱ grade 17 cases, 22 cases, Ⅲ grade. The hyperplasia group of blood flow signal: 0 of 24 cases, Ⅰ level of 16 cases, 5 cases of grade Ⅱ, Ⅲ grade 1 cases. The Cancer group flow signals much for Ⅱ or Ⅲ Ⅱ + Ⅲ level accounted for 78%. Hyperplasia flow signals was significantly lower than the cancer group, more than 0 or grade Ⅰ + grade Ⅰ accounted for 87%, the difference between the two groups was statistically significant (P <0.01).

    2.3 arterial blood flow spectrum morphology

    2.3.1 systolic peak period, rising to spread the the decreased wave slope cancer group, the hyperplasia group systolic Spectrum morphology shown in Table 1, the difference between two groups was statistically significant (P <0.01).

    2.3.2 systolic rise spread wave decline slope cancer group systolic rise and fall big wave slope, performance decline in the wave steepness patients in 39 cases (78.0%) for the rising spread hyperplasia systolic increase and decrease in the wave slope, ie The rising wave and wave decline tilt in 30 patients (65.2%), the difference between the two groups was statistically significant (P <0.01).

    0.05),而两组末期血流比较差异有统计学">2.3.2 diastolic starting wave starting point and final blood cancer group, hyperplasia diastolic start wave starting point between the two groups showed no significant difference (P> 0.05), and two sets of the final blood flow difference was statistically significance (P <0.05).

    2.3.4-end diastolic cancer group end-diastolic blood flow or reverse blood flow in patients with 43 cases (86.0%), the hyperplasia group end-diastolic forward blood flow in patients with and 32 patients (69.6%). The difference between the two groups was statistically significant (P <0.05), as shown in Table 1, Table 2. Table 1 two sets of the systolic Doppler spectrum morphology Table 2 two groups of diastolic flow Doppler spectral shape

    3 Discussion

    The differential diagnosis of breast cancer and breast hyperplasia has been a hot topic in the ultrasound field, and especially difficult to distinguish breast atypical hyperplasia and breast cancer [2]. Mammary hyperplasia due to ovarian secretion of progesterone to reduce estrogen excessive secretion, stimulate the glandular tissue hyperplasia due to its morphological changes in a complex and diverse organization, and thus the ultrasound image showed the diversity. Part of the real mass type of breast cancer sonographic there are some overlapping phenomenon, hypoechoic mass, irregular borders, even have cornute, the domestic reporting some misdiagnosis rate [3]. To this end, we studied a group of breast cancer and breast hyperplasia, high-frequency color Doppler sonographic comparative analysis, to improve both the differential diagnosis.

    3.1 two-dimensional the sonographic (1) mass internal echo: hyperplasia lumps and cancer tumors showed a hypoechoic solid can be homogeneous or heterogeneous, but the the cancer than hyperplasia echo lower, 50 cases of the cancer group, the performance is very low echo 28 cases. The causes may be, 70% to 80% of the tumor mass as hard cancer, cancer cells less, most of the fibrous tissue. The internal echoes obvious attenuation, so the part was very low echo. Proliferative tumor is more common in the type of fiber adenosis tube bulbs and fibrosis hyperplasia together constitute the boundaries slightly distinct solid mass, a disorder of the normal structure of the breast. So the performance is lower echo. (2) lumps edge: proliferative lumps border than smooth, no infiltration to the surrounding and pectoral muscles, and invasive growth of cancerous lesions were inlaid to the surrounding tissue, penetration, and thus the boundary is not smooth, was a burr-like or Crab-like. To the front in the early intrusion Cooper’s ligament, the late invasion to the rear and chest myofascial [3]. (3) calcification: the cancer mostly gravel calcification, behind the silent film. Showed more divergence in the or were clustered distribution. Hyperplasia with sand-like calcification rare, mostly punctate or blotchy. Currently, most scholars believe: Once the mass sand-like calcification prompted vicious possibility. (4) before and after the mass ratio of the diameter and the diameter: the critical value of 0.77 or 1, is one of the important indicators of the differential between the two. The anteroposterior diameter of how much of the cancer in the long diameter, possible cancer early infiltration of the Cooper’s ligament, and out of the growth of normal tissue plane, a result of increased anteroposterior diameter, and cancer is the smaller the larger trend of this ratio, and hyperplasia Duocheng The flat-shaped, triangular, spindle or flake, generally does not exceed glands layer, anteroposterior diameter / length mostly less than 1. In the breast cancer group in this study, seven patients with tumor diameter <1cm, which none of the five cases of a clear boundary structured within and surrounding exploration and flow signals. 1。">Only anteroposterior diameter / long diameter of nearly 1 /> 1. Pathologically confirmed both breast cancer, suggesting that this indicator is particularly important to identify the nature of breast lumps in breast occupying lesions.

    3.2 Color Doppler image

    Cancer mainly hyperplasia mass 0 or grade Ⅰ Ⅱ or Ⅲ. This is due to cancer release of vascular endothelial growth factor, leading to tumor tissue nascent capillaries. 2cm时,由于滋养血管增多,血流速度加快,即使良性肿物,血流亦可能较丰富。">But in practice, we often feel when the tumor diameter> 2cm, due to increased blood vessels nourish the blood flow faster, even if benign tumor, blood flow may be more abundant. To this end, we studied the characteristics of the spectral shape of the breast, breast hyperplasia artery blood flow.

    3.3 arterial blood flow spectrum form of cancer and hyperplasia mass flow spectrum morphology due to their different pathological basis of the decision, the flow spectrum form of breast cancer usually presents peak systolic forward, up the steep of waves and wave decline diastolic beginning of wave below the midpoint, the final, often without blood flow or reverse flow spectrum. Pathological basis for possible cancer in the process of growth and the formation of organs and tissue destruction. The host local microvascular most were destroyed cancer by release of vascular endothelial growth factor to stimulate the growth of new blood vessels from the embedded Internal around [4], combined with cancer of vascular invasion, tumor thrombus and thrombus formation intravascular cancer the lack of lymphatic network, leading to venous disorders showed high resistance to blood flow in the state, and the flow spectrum shape change [5], as shown in Figure 1.

    Mammary hyperplasia the ovarian endocrine disorders, and sex hormone imbalance caused pathological basis of proliferative and degenerative lesions of the glandular tissue causing confusion of normal breast structure and interaction of epithelial and connective tissue components. Both non-inflammatory, non-neoplastic. Within the blood vessels may be distorted, narrow, resulting in diastolic ventricular contraction end, there are still significant stenosis of the proximal end of the distal end of arterial pressure gradient, and thus, can be detected by continuous, low-speed flow spectrum [6 ], Figure 2.

    In short, the high-frequency color Doppler ultrasound has a high value in the differential diagnosis of breast cancer and breast hyperplasia, a non-invasive, inexpensive and rapid diagnostic method.