Early diagnosis of breast cancer is very important for treatment and prognosis. Color Doppler ultrasound diagnostic instrument has the advantages of no radiation, low price, continuous dynamic observation, etc. It plays an important role in the diagnosis and treatment monitoring of breast diseases.

The literature shows that:

Folkman J's tumor angiogenesis theory: on the one hand, when the tumor volume reaches 2m3, it needs to rely on new blood vessels to supply its further growth, even further invasion and metastasis of the tumor. The overexpression of vascular endothelial growth factor (VEGF) in malignant tumor lesions increases the microvessel density of the tumor, increases the permeability of blood vessels, and causes a series of matrix changes. At the same time, angiogenesis promotes the development of the tumor, and both promote each other. As long as there is a tumor, it will cause an increase in blood supply around the tumor, regardless of the size of the tumor. The larger the tumor, the more and more functional microvessels in the mass; The surrounding tumor blood vessels are also more abundant.

Color Doppler Ultrasound Diagnosis of breast cancer

Under normal circumstances, the distribution of blood vessels in benign tumors is relatively average, while that in malignant tumors is relatively rich, and the distribution has certain regularity. The blood vessels grow from the periphery to the interior of the lesion, and the closer to the edge of the lesion, the richer the blood vessels are. The tumor blood vessels are uneven in thickness, tortuous and dilated, with rich anastomoses, and may be accompanied by arteriovenous fistula formation. Most of the lack or incompleteness of the basement membrane have certain characteristics and distribution patterns, which are mainly manifested by the thickening of the diameter of the blood supply vessels, tortuous or rigid, mainly distributed at the edge of the focus. The blood flow can be expressed by grades. Grade 0 means no blood flow signal, Grade I means a little blood flow signal, Grade III means rich blood flow signal, and Grade II is between Grade I and Grade III.

Ultrasonic features of breast cancer:

1. Two dimensional ultrasound is hypoechoic in nature, irregular in shape, unclear in boundary, burry in edge, aspect ratio>1, microcalcification, lymph node metastasis, etc. (interested parties can browse this link: ultrasound diagnosis of breast cancer)

2. Color Doppler: ① The blood flow at the edge, center or edge and center of the focus is rich, the blood vessels are uneven in thickness, irregular in course, disorderly in distribution, and most of them are peripheral penetrating blood vessels; ② With the enlargement of the lesion and the increase of blood flow grade, the blood vessels of the lesion increased; ③ The abnormal increase of one breast blood vessel is closely related to the occurrence of ipsilateral breast cancer; ④ The number and distribution of blood vessels around breast cancer are not related to the shape of the lesion; ⑤ Peripheral penetrating vessels have high diagnostic value for malignant lesions of breast cancer and can be regarded as one of the diagnostic criteria, with a sensitivity of about 70% and a specificity of more than 95%; ⑥ When the maximum blood flow velocity (PSV) of breast cancer focus is>20 cm/s and the resistance index (RI) is>0.7, the detection results have diagnostic significance for the diagnosis of breast cancer (some scholars do not support this point).

Color Doppler ultrasound is a non-invasive method to evaluate tumor blood vessels, which can accurately display the blood flow morphology and distribution of breast lesions. It is a common clinical screening method for breast cancer. During the examination, the blood flow signal cannot be displayed due to the pressure scanning; For better display of low speed blood flow, attention should be paid to the adjustment of blood flow scale, blood flow gain and wall filter; Even the low-speed scale, low-pass filter and slightly higher color gain will make the high-speed blood flow display as multicolor mosaic blood flow signal, but when there is no high-speed blood flow, the display of low-speed blood flow is particularly important.

Two dimensional ultrasound combined with blood flow distribution characteristics of breast tumors can greatly improve the diagnostic accuracy of breast cancer. However, color Doppler could not display low velocity blood flow with flow velocity less than 1 cm/s and pipe diameter less than 0 2 mm microvessel. Contrast-enhanced ultrasound and ultra micro vascular imaging can accurately display the blood supply characteristics of breast cancer, and can obtain higher diagnostic accuracy of breast cancer. Pay attention to the rational use of various diagnostic techniques. Pathological diagnosis is the golden standard. Pay attention to differential diagnosis and avoid over-diagnosis and over-intervention. However, the author believes that proper over-diagnosis and positive pathological diagnosis of breast masses are not necessarily undesirable!