声弹性成像、常规超声、钼靶X线技术在乳腺癌诊断中的应用

目的：探讨声弹性成像（AE）、常规超声（US）及钼靶X线技术在乳腺癌术前诊断和联合诊断中的应用价值。方法术前采用声弹性成像、常规超声及钼靶X线技术对山东省淄博市妇幼保健院临床触及乳腺肿块的104例患者进行检查，并与手术病理诊断结果对照，总结分析声弹性成像、常规超声、钼靶X线及声弹性成像、常规超声与钼靶X线联合诊断乳腺癌的准确性及影像学特征。结果104例患者乳腺病变手术病理诊断良性39例，恶性65例。术前声弹性成像、常规超声、钼靶X线诊断结果：（1）声弹性成像诊断乳腺良性病变36例，恶性病变56例，良性病变声弹性评分为1~2分（92.3%，36/39）；恶性病变声弹性成像评分为3~5分（86.2%，56/65）；与病理诊断结果对照术前声弹性成像诊断符合率为88.4%（92/104）。（2）术前常规超声诊断乳腺良性病变37例，恶性病变53例，超声显示良性病变呈圆形或椭圆形，边缘光滑，内未见明显微小钙化；乳腺癌恶性征象为毛刺征（76.9%，50/65），病变厚度/长度比＞1（73.8%，48/65），血流阻力指数＞0.7（70.8%，46/65），病变内多见微小钙化（53.8%，35/65）。与病理诊断结果对照术前常规超声诊断符合率为86.5%（90/104）。（3）术前钼靶X线诊断乳腺良性病变33例，恶性病变54例，乳腺病变恶性超声征象为致密影（73.8%，48/65），毛刺征（70.8%，46/65）及钙化（69.2%，45/65）；乳腺良性病变无上述超声征象；与病理诊断结果对照术前钼靶X线诊断符合率为83.7%（87/104）。术前声弹性成像、常规超声与钼靶X线联合诊断结果：（1）术前声弹性成像与常规超声联合检查诊断良性病变34例，恶性病变63例，与病理诊断符合率为93.3%（97/104）。（2）术前常规超声与钼靶X线联合检查诊断乳腺良性病变31例，恶性病变63例，与病理诊断符合率为90.4%（94/104?

Application of acoustic elastography,conventional ultrasonography and mammography in the diagnosis of the breast cancer

Objective To explore the value of the diagnosis of breast cancer by acoustic elastography, conventional ultrasonography （including gray-scale ultrasonography, color Doppler flow imaging and Doppler spectrum） and mammography. Methods One hundred and four patients with breast disease confirmed by surgical pathology were studied retrospectively in Zibo Maternal and Children Health Hospital. All the patients were examined by acoustic elastography, conventional ultrasonography and mammography before surgery. Results Pathological results of 104 cases were： sixty-five malignanies and 39 benignities. The most common signs in the diagnosis of breast cancer by conventional ultrasonography were spicule sign （76.9%, 50/65）, taller-than-wide sign （73.8%, 48/65）, vascular resistance index 〉 0.7 （70.8%, 46/65）, calcification （53.8%, 35/65）. And breast masses without these signs were regarded as benign lesions. The diagnostic criteria of breast cancer by acoustic elastography was 5-point method. We regarded the lesions got more than 3 points as malignancy. The most common signs in the diagnosis of breastcancer by mammography were dense shadow （73.8%, 48/65）, spicule sign （70.8%, 46/65）, calcification （69.2%, 45/65）. And breast masses without these signs were regarded as benign lesions. The diagnostic accuracy of acoustic elastography, conventional ultrasonography, mammography, conventional ultrasound plus acoustic elastography, conventional ultrasound plus mammography and acoustic elastography plus mammography for breast tumor were 88.4% （92/104）, 86.5% （90/104）, 83.7% （87/104）, 93.3% （97/104）, 90.4% （94/104） and 89.4% （93/104）, respectively. Conclusions The combination of any two imaging modalities can improve the diagnostic accuracy of breast cancer. And conventional ultrasound combined with acoustic elastography could be an effective method in the diagnosis of breast cancer.