Objective: To investigate the ultrasonographic features of fibrocystic breast change (FBC) and improve the ultrasonographic diagnosis and differential diagnosis of FBC. Methods: Fifty-five patients of FBC with 60 lesions and 39 patients of invasive ductal carcinoma (IDC) with 42 lesions, which were confirmed by pathology after operation in the Affiliated Union Hospital of Fujian Medical University from January 2014 to February 2019 were enrolled. The preoperative sonographic findings of FBC and IDC were retrospectively analyzed and compared. Results: There was no significant difference between the two groups in the rates of showing irregular shape, which were 86.7% in FBC group and 88.1% in IDC group, respectively (P>0.05), but the rate of showing crab feet or burrs on the edge of lesions in FBC group was lower than that in IDC group(P<0.05). The occurrence rates of posterior echo enhancement and cystic degeneration in FBC group were 81.7% and 71.7% respectively, which were significantly higher than those in IDC group (38.1% and 16.7%)(P<0.001). In addition, the FBC group showed fewer features such as hyperechoic halo and more features such as hypovascular supply than that of IDC group (all P<0.001). Conclusions In terms of ultrasonic features, including irregular shape or even crab feet and burrs, FBC can be easily misdiagnosed as malignant tumors. However, posterior echo enhancement, interior scattered small cysts, lack of blood supply and rare hyperechoic halo may be the characteristics of FBC, which can be differentiated from malignant tumors.

Objective To investigate the ultrasonographic features of fibrocystic breast change ( FBC) and improve the ultrasonographic diagnosis and differential diagnosis of FBC . Methods Fifty‐five patients of FBC with 60 lesions and 39 patients of invasive ductal carcinoma ( IDC ) with 42 lesions ,which were confirmed by pathology after operation in the Affiliated Union Hospital of Fujian M edical University from January 2014 to February 2019 were enrolled . T he preoperative sonographic findings of FBC and IDC were retrospectively analyzed and compared . Results T here was no significant difference between the two groups in the rates of showing irregular shape ,which were 86 .7% in FBC group and 88 .1% in IDC group , respectively ( P ＞0 .05) ,but the rate of showing crab feet or burrs on the edge of lesions in FBC group was lower than that in IDC group( P ＜0 .05 ) . T he occurrence rates of posterior echo enhancement and cystic degeneration in FBC group were 81 .7% and 71 .7% respectively ,w hich were significantly higher than those in IDC group ( 38 .1% and 16 .7% ) ( P ＜0 .001) . In addition ,the FBC group showed fewer features such as hyperechoic halo and more features such as hypovascular supply than that of IDC group ( all P ＜0 .001 ) . Conclusions In terms of ultrasonic features ,including irregular shape or even crab feet and burrs ,FBC can be easily misdiagnosed as malignant tumors . However ,posterior echo enhancement ,interior scattered small cysts ,lack of blood supply and rare hyperechoic halo may be the characteristics of FBC ,w hich can be differentiated from malignant tumors .

Objective: To evaluate the value of ultrasound-guided fine needle aspiration(US-FNA) combined with detection of BRAF V600E and thyroid imaging reporting and data system(TI-RADS) in diagnosis of benign and malignant thyroid nodules. Methods: In this study, 123 operative thyroid nodules from 114 patients who underwent US-FNA and detection of BRAF V600E were enrolled. TI-RADS was apply for the classification of each nodule before surgery. Specimens from each nodule were subjected for hematoxylin and eosin (HE) staining and cytological diagnosis and detection of BRAF V600E mutation. Results: ①BRAF V600E mutation was found in 71 (71/123) nodules with histologic confirmation of papillary-thyroid carcinoma, 58 of which were cytologically diagnosed as carcinoma and 13 were indeterminate. Compared with the postoperative pathological results, US-FNA combined with BRAF V600E could improve the sensitivity and accuracy of diagnosis to thyroid nodules compared with individual US-FNA, and the difference was statistically significant(P<0.001). ②The mutation rate of BRAF V600E was associated with thyroid capsular invasion(χ²=8.44, P=0.004), and combined with TI-RADS could indicate the high-risk of this invasion. ③Among 123 operative nodules, 18 nodules were BRAF V600E negative and cytologically diagnosed as indetermination, 10 of which were TI-RADS 3b or above. After thyroidectomy, 6 nodules were confirmed as papillary-thyroid carcinoma, 1 nodule was thyroid follicular carcinoma, and 3 nodules were benign ones. Conclusions US-FNA combined with detection of BRAF V600E and TI-RADS can improve the diagnostic accuracy and decrease the misdiagnosis in indeterminate nodules.

Objective To investigate the value of color Doppler ultrasonography in mammary ductal ectasia( MDE). Methods Preoperative sonograms of 54 MDE,135 invasive ductal carcinoma( IDC) and 68 ductal carcinoma in situ ( DCIS ) patients were retrospectively analyzed and further confirmed by histopathology. Results MDE showed 88.9% (48/54) mass type and 11.1% (6/54) ductal type.The average age of patients in MDE was younger than that in IDC( P ＜0.05). The number of MDE located around the areola was more than that of IDC( P ＜0.05). Mean maximum diameter of MDE was smaller than that of DCIS ( P ＜0.05). Compared to DCIS and IDC,MDE in mass type showed higher detection rate of liquidity area and mammary ductal ectasia( all P ＜0.05),while lower detection rate of hyperecho, peripheral hyperechoic zone,posterior echo attenuation or blood flow richness( all P ＜0.001). Compared to IDC,MDE in mass type showed higher detection rate of inside ductal echolocation,while showed lower detection rate of irregular shape,spiculate margin or axillary lymph node enlargement. Compared to DCIS, MDE showed higher detection rate of large aspect ratios( ≥0.7). Less MDE in ductal type with hyperecho were found than DCIS in ductal type ( P ＜ 0.001 ). The coincidence rate of ultrasonic diagnosis and postoperative histopathhology results in 54 MDE patientis was 13.0% ( 7/54 ). Conclusions The sonographic findings of MDE has diverse manifestations. It shows important value of ultrasonography for MDE in its diagnosis and differential diagnosis with breast cancer.

Objective To investigate the correlation between the features of conventional ultrasound& shear wave elasticity and axillary lymph node involvement in breast cancer . Methods A total of 169 breast cancers patients were divided into lymph node metastasis group( n = 115) and non metastasis group ( n = 54 ) according to the postoperative pathological results . Preoperative conventional ultrasonographic features and preoperative shear wave elastography quantitative parameters ( E values ) of the two groups breast lessons were analyzed by single factor analysis to screen out statistically significant factors ,then Logistic regression analysis was performed to analyze the relationship between above factors and lymph node involvement . Results Single factor analysis showed the microcalcification and hyperechoic halo detection rates of lymph node metastasis group [ 81 .7％ ( 94/115) and 71 .3％ ( 82/115 ) ,respectively] were higher than those in non metastasis group [ 61 .1％ (33/54) and 50 .0％ ( 27/54) ,respectively] . The elastography maximum value( Emax) of lymph node involvement group was ( 182 .2 ± 74 .0) kPa ,which was larger than that in non metastasis group′s ( 153 .3 ± 76 .9) kPa ( P < 0 .05) . Multivariate Logistic regression analysis showed the microcalcification( OR = 2 .498 , P = 0 .022) ,the hyperechoic halo( OR = 2 .482 , P = 0 .013) and the Emax value( OR = 1 .007 , P = 0 .007) were risk factors of axillary lymph node metastasis in breast cancer . Conclusions Breast cancer with microcalcification ,hyperechoic signs and high Emax value is more likely to develop axillary lymph node metastasis .

Purpose To explore ultrasonic characteristics of complex fibroadenoma (CF) of breast and its differential diagnosis from invasive ductal carcinoma (IDC).Materials and Methods Sixty-one patients with CF and 81 patients with IDC from January 2010 to February 2016 in the Affiliated Union Hospital of Fujian Medical University were enrolled,and the CF and IDC were confirmed by pathology after operation.The preoperative sonographic findings of CF and IDC were retrospectively analyzed and compared.Results Fifty-nine cases with CF were detected by ultrasonography in 61 cases.Ultrasonic findings of 59 cases of CF showed as follows:79.7％ (47/59) of the CF cases with an aspect ratio ＜0.7;79.7％ (47/59) with blood flow signal of 0 to 1 level;72.9％ (43/59) with liquid dark area,including 67.8％ (40/59) with round or oval cystic fluid area showing local sievelike or diffused distribution;72.9％ (43/59) with irregular shape;61.0％ (36/59) with obscure boundary;61.0％ (36/59) with the largest diameter of tumor ＜2 cm;59.3％ (35/59) with calcifications,including 33.9％ (20/59) with coarse calcification,25.4％ (15/59) with microcalcification and 85.7％ (30/35) with distribution of calcified lesions along the linear high echo zone;54.2％ (32/59) with echo heterogenicity showing linear high echo and high echo in the middle and low echo.There were significant differences in the detection rates of internal regular fluid area,internal linear high echo or high echo area,and alcification distribution along the linear high echo between CF and IDC lesions (all P＜0.01).Compared with IDC,there were higher rates in CF for detecting lesions of largest diameter of tumor ＜2 cm,more regular shape,more clear border,poorer blood flow signal (P＜0.05),but there were lower rates in CF for detecting axillary lymph node enlargement,lesions with edge or spiculation and hyperechoic halo (P＜0.01).Conclusion Color Doppler ultrasonography is of great value in the diagnosis of CF and its differential diagnosis from IDC.

Objective To explore the atypical ultrasonic appearances of breast fibroadenoma and analyze the cause of mis diagnosis.Methods A total of 493 lesions in 485 patients of breast fibroadenoma detected by ultrasound examination andconfirmed by pathology were retrospectively analyzed.Atypical appearances were analyzed and misdiagnosis rate were cal-culated.Statistical methods were taken to compare the misdiagnosis rates in lesions with various atypical appearances andthose with none or single atypical appearance.Misdiagnosis rates in lesions with different sizes and pathological types wereanalyzed statically.Then misdiagnosing causes were analyzed.Results A total of 404 lesions were diagnosed correctly,in-cluding 99 lesions with atypical appearances,and the other 89 lesions were misdiagnosed,which showed atypical appear-ances.The misdiagnosis rate of lesions with ≥2 atypical features was higher than that with none or single atypical feature(x2 =256.40,P＜ 0.05).Large lesions (maximum diameter＞ 3 am) showed higher misdiagnosis rates than small ones(maximum diameter ≤3 cm,x2=6.73,P＜0.05),and complex fibroadenoma lesions also showed higher misdiagnosisrate than simple ones (x2 =188.01,P＜0.05).Conclusion The lesions with various atypical appearances,large size andcomplex fibroadenoma in pathology are easy to be misdiagnosed.

Objective To explore the value of high frequency ultrasound in differential diagnosis in dorsal thyroid (including gland dorsal or posterior) nodules.Methods Ultrasonographic features of 101 patients with ultrasonography suspected or misdiagnosed nodules in the dorsal area of the thyroid gland,which were then confirmed by pathology or hyaluronography/gastroscopy,were retrospectively analyzed.Ultrasonographic homogeneity (other nodules with similar ultrasonographic features were found in the ipsilateral gland),parenchyma homology (nodule parenchyma was continuous with glandular parenchyma) and blood homology (blood flow signals in nodules were continuous with those in glandular parenchyma) were applied as indicators for determinng thyroid nodules.Double-line sign or vascular arch sign at the edge of nodules served as an indicator for determining parathyroid nodules.Results Of the 101 cases,there were 46 thyroid nodules,35 parathyroid nodules,7 enlarged lymph nodes;6 esophageal diverticulum,6 esophageal cancer,1 cleft cyst.The determination of thyroid nodules by at least one of ultrasonographic homogeneity,parenchyma homology and blood homology showed sensitivity of 73.5 ％,specificity of 96.5 ％ and accuracy of 85.8％.In the determination of parathyroid nodules by double-line sign or vascular arch sign at the edge of nodules,sensitivity,specificity and accuracy was 54.1％,85.5 ％ and 74.5 ％,respectively.Conclusions Nodules in the dorsal area of the thyroid gland have different sources,and the understanding of corresponding characteristic ultrasonographic appearances is helpful for improving the differential diagnosis of these nodules.

Objective To investigate the value of color Doppler ultrasonography in metaplastic breast carcinoma(MBC).Methods The ultrasonic characteristics of 23 MBC and 1 1 8 invasive ductal carcinoma (IDC) confirmed by pathology were analyzed retrospectively.And the ultrasound characteristics of different types of MBC was analyzed according to pathology.Results Mean maximum diameter of(3.73±1 .74)cm in MBC was larger than that in IDC[(2.57 ± 1 .19)cm,P = 0.005].Most MBC lesions showed larger diameter(>3 cm),clear border(56.5%),irregular shape(65.2%),lack of hyperechoic halos(65.2%), posterior enhancement(60.9%),no calcification(60.9%) and grade 2 - 3 of blood flow (56.5%).The detection rate of unclear border,unsmooth edge and hyperechoic halos of MBC was lower than those of IDC (P <0.05).But MBC had a higher detection rate in the masses with larger than 3 cm in diameter and posterior enhancement than IDC.Five (45.5%) lesions of 1 1 squamous cell carcinoma showed cystic constituent.The mean maximum diameter of 5 MBC with mecenchymal tissue lesions was larger than spindle cell carcinoma,but smaller than squamous cell carcinoma.And 4 lesions of the 5 MBC with mecenchymal tissue showed calcification,which occupied the highest proportion among different pathological types of MBC. The ultrasonic coincidence rate for MBC was 86.96%.Conclusions The ultrasonic appearances of MBC have a certain characteristics,and different pathological types of MBC also have corresponding characteristics.It shows important value of ultrasonography in preoperative diagnosis for MBC.

Objective To investigate ultrasonic findings of pure invasive micropapillary carcinoma (PIMPC) of breast. Methods A total of 18 patients with surgically confirmed PIMPC and 40 patients with surgically confirmed invasive ductal carcinoma (IDC) treated between January 2010 and August 2015 in Affiliated Union Hospital of Fujian Medical University, who had undergone preoperative ultrasound examination, were included in the study. To compared with the postoperative pathological examination, the value of ultrasonography in the diagnosis of axillary lymph node metastasis was discussed.Ultrasound findings of PIMPC and pathological results were compared. Results Ultrasound analysis of PIMPC masses identified predominantly hypoechoic lesions and irregular shape 100% (18/18), obscure lesion boundaries 88.9% (16/18), spiculated or angular margins 83.3% (15/18), combined microcalcifications 83.3% (15/18), with posterior acoustic enhancement or normal 88.9% (16/18), dcrab claws changes 77.7% (14/18),witout hyperechoic halo72.2% (13/18) and with 0- Ⅰ grade flow signals 55.6% (10/18). Compared to the IDC, the PIMPC had lower proportions in long speculation, hyperechoic halo, aspect ratio ≥ 0.7, posterior echo attenuation, Ⅱ- Ⅲ grade blood flow signals (P < 0.05), while their lesions in the maximal tumor size,shape, boundary, edge bur, microcalcification has no significance (P>0.05). The rate of lymph node metastasis of PIMPC was 72.2% (13/18), which was significantly higher than that of IDC 45.0% (18/40) (t=3.697,P=0.05). 13 cases were pathologically confirmed lymph nodes metastasis in 18 cases, and among them, the ultrasound indicated abnormal 46.2% (6/13), and showed abnormal cortex and medulla structure 30.8% (4/13), eccentric lymph door 30.8% (4/13), poor blood flow signals 38.5% (5/13). The sensitivity, specificity,positive predictive value, negative predictive value and accuracy of PIMPC lymph node metastasis by preoperative ultrasound were respectively 46.2%, 60.0%, 75.0%, 30.0%, 50.0%. Ultrasound performance of PIMPC has a certain relationship with its special pathological characteristics. Sonography findings were compared with pathological results: Microscopically, PIMPC cell arranged as pseudo-papillary or tubuloalveolar structures floating in empty spaces; PIMPC with 0-Ⅰ grade flow signals were seen that the small amount of new blood vessels of the tumor were mainly found in the pellucid zone around the cell clusters under the microscope, while IDC with Ⅱ - Ⅲ grade blood flow signals were found that more regenerated blood vessels were distributed in the collagen fibers. PIMPC witout hyperechoic halo were noticed that under the microscope, there were no fibrous tissue clusters in the edge of the tumor, meanwhile, IDC with hyperechoic halo were discovered that fibrous tissue was seen at the edge of the mass of the lens. Conclusions Ultrasound performance of PIMPC has a close relationship with its special pathological characteristics. To be familiar with ultrasound characteristic of PIMPC is significant for improving its ultrasound detection rate.