Effects of Vascularity and Differentiation of Hepatocellular Carcinoma on Tumor and Liver Stiffness: In Vivo and in Vitro Studies

Tissue stiffness has been found to be a useful predictor of malignancy in various cancers. However, data on the stiffness of hepatocellular carcinomas (HCCs) and their background livers are contradictory. The aim of this study was to investigate the effects of vascularity and histologic differentiation on HCC stiffness. Elastography point quantification (ElastPQ), a new shear wave-based elastography method, was used to measure liver stiffness in vivo in 99 patients with pathology-proven HCC. Lesion vascularity was assessed using contrast-enhanced ultrasound, computed tomography and/or magnetic resonance imaging. The association of HCC vascularity and differentiation with liver stiffness was determined. In addition, in vitro stiffness of 20 of the 99 surgical HCC specimens was mechanically measured and compared with in vivo measurements. We found that in vivo stiffness was significantly higher than in vitro stiffness in both HCCs and their background livers (p < 0.0001). Moreover, significantly higher stiffness was observed in hyper-vascular and poorly differentiated lesions than in hypo-vascular (p = 0.0352) and moderately to well-differentiated lesions (p = 0.0139). These in vivo and in vitro studies reveal that shear wave-based ultrasound elasticity quantification can effectively measure in vivo liver stiffness.     

Sonographic differentiation of benign and malignant papillary lesions of the breast.

OBJECTIVE: The purpose of this study was to evaluate sonographic findings of breast papillary lesions and the effectiveness of the American College Radiology Breast Imaging Reporting and Data System sonographic assessment system for differentiation of benign and malignant papillary lesions. METHODS: We retrospectively reviewed breast sonographic findings of 46 surgically proven benign papillomas and 22 papillary carcinomas. All sonographic images of patients were interpreted by 2 radiologists. Sonographic findings were analyzed according to the Breast Imaging Reporting and Data System classification. RESULTS: The shape of the lesion was round or oval in 33 benign lesions (71.7%) and 13 papillary carcinomas (61.9%). As for the margin, a circumscribed margin was found in 31 benign papillomas (67.4%) and 12 malignant lesions (57.1%). Differences in the predominant shape and margin between the 2 groups were not statistically significant (P > .05). Fourteen benign papillomas (30.5%) and 12 papillary carcinomas (57.1%) showed a complex echo pattern. It was more frequently observed in malignant lesions; however, it was not statistically significant (P = .09). A nonparallel orientation, an echogenic halo, posterior acoustic enhancement, and associated microcalcification were more frequently found in malignant than in benign lesions (P < .05). When the presence of any suspicious sonographic feature (nonparallel orientation, echogenic halo, posterior enhancement, or calcification) was considered to indicate malignancy, interpretation of the sonographic features gave sensitivity of 85.7%, specificity of 64.9%, a positive predictive value of 47.4%, and a negative predictive value of 92.5% for detection of malignant papillary lesions. The only differential finding between noninvasive and invasive papillary cancers was a circumscribed margin (P < .05). CONCLUSIONS: Sonographic features more specific to malignancy include a nonparallel orientation, an echogenic halo, posterior acoustic enhancement, and associated microcalcification.     

Detecting angiogenesis in breast tumors: comparison of color Doppler flow imaging with ultrasound-guided diffuse optical tomography

We investigated the correlation between color Doppler flow imaging (CDFI) and ultrasound (US)-guided diffuse optical tomography (DOT) for detection of breast tumor angiogenesis. Both CDFI and DOT were performed in 214 breast lesions scheduled for biopsy. The lesions were classified as vascular or nonvascular on CDFI and total hemoglobin concentration (THC) was measured by DOT. Sonographic results were correlated with the THC measurements. Pathologic examination showed 118 breast cancers and 96 benign breast masses. When vascularization on CDFI as a sign of malignancy and a cutoff of 140 μmol/L was used, the sensitivity, specificity and accuracy were 83.9, 50.0 and 68.7% for CDFI and 83.9, 66.7 and 76.2% for DOT, respectively. Thirteen (11.0%) nonvascular breast cancers presented high THC levels. Twenty-five (52.1%) vascular benign tumors demonstrated low THC levels. Mean THC did not differ significantly in malignancies with vascular or without vascular (228.14 ± 85.37 μmol/L vs. 191.42 ± 92.59 μmol/L; p > 0.05). Likewise, for benign lesions, the difference between THC values in vascular lesions and nonvascular lesions was not statistically significant (140.86 ± 79.63 μmol/L vs. 110.13 ± 85.05 μmol/L; p > 0.05). Our results suggest that the addition of DOT to CDFI could be helpful for characterizing CDFI nonvascular lesions that are suspicious for malignancy or vascular lesions that are probably benign.     

Sonographic Characteristics of Papillary Thyroid Carcinoma with Coexistent Hashimoto's Thyroiditis: Conventional Ultrasound,Acoustic Radiation Force Impulse Imaging and Contrast-Enhanced Ultrasound

Our objective was to provide the various sonographic characteristics of papillary thyroid carcinomas for Hashimoto's thyroiditis (HT) patients, including conventional ultrasound (US), acoustic radiation force impulse Virtual Touch imaging and quantification (ARFI-VTIQ) and contrast-enhanced ultrasound (CEUS). Sixty-nine HT patients with 85 thyroid nodules (TNs) (49 malignant and 36 benign) were enrolled in this study. We evaluated the size, shape, margin, echogenicity, presence of halo, calcification, vascularity and ARFI-VTIQ and CEUS parameters for each nodule and compared the findings with the reference standards of histopathological and/or cytologic results. Univariate analysis indicated that compared with benign TNs with HT, papillary thyroid carcinomas with HT more often had taller-than-wider shapes, ill-defined margins, microcalcifications, peripheral vascularity, relatively harder stiffness with a higher shear wave speed, hypo-enhancement, peak intensity index <1 and area under the curve index <1 at pre-operative US, ARFI-VTIQ and CEUS. Multivariate analysis revealed that ill-defined margins, microcalcifications and peak intensity index <1 are independent characteristics related to malignant TNs for their differentiation from benign TNs (all p < 0.05). Our study indicated that pre-operative multiparameter US characteristics may serve as a useful tool to identify malignant TNs in HT patients.     

What Help Could Ultrasound Elastography Give to the Diagnosis of Breast Papillary Lesions?

On the basis of results of our previous studies and the findings of other scholars, the most common histologic type of false-positive diagnosis with strain elastography (SE) was papilloma. The objectives of our study were to evaluate whether SE could contribute to conventional ultrasound differentiation between benign and malignant papillary lesions and between papillary lesions and other common benign breast lesions. Data on 89 papillary lesions at our hospital, including 74 benign and 15 malignant papillary lesions, were included in our study. In addition, 198 non-papillary benign tumors were selected as the control group, including 126 fibroadenomas and 72 cases of fibrocystic mastopathy. All patients gave written informed consent. All patients with breast lesions underwent conventional ultrasound and SE examination. Breast Imaging Recording and Data System (BI-RADS) category and SE score were compared with respect to sensitivity, specificity and accuracy in differentiating between benign and malignant papillary lesions. We then explored the possibility of using BI-RADS combined with SE to differentiate papillary lesions from non-papillary benign tumors. For differentiating between benign and malignant papillary lesions, the area under the receiver operating characteristic curve (AUC) of BI-RADS was 0.568, whereas the AUC values of SE score, strain ratio and BI-RADS combined with SE were 0.517, 0.584 and 0.509, respectively (p > 0.05). For differentiating between papillary lesions and non-papillary benign lesions, the AUC of BI-RADS combined with SE was 0.835, which was higher than the values for BI-RADS (0.775) and SE (SE score: 0.648, strain ratio: 0.661) (p < 0.001). The specificity and accuracy of BI-RADS combined with SE were significantly higher than those for BI-RADS alone without a decrease in sensitivity (p < 0.05). SE could not improve the diagnostic efficiency of BI-RADS in differentiating between benign and malignant papillary lesions. However, BI-RADS combined with SE could improve the specificity of BI-RADS without decrease in sensitivity for differentiating breast papillary lesions from non-papillary benign lesions.     

Semi-Quantitative and Qualitative Assessment of Breast Ultrasound Elastography in Differentiating Between Malignant and Benign Lesions

The purpose of this study was to evaluate the diagnostic value of qualitative and semi-quantitative assessment of ultrasound elastography in differentiating between benign and malignant breast lesions. This prospective study was conducted in two tertiary medical centers. Consecutive B-mode ultrasound and real-time elastographic images were obtained for 67 malignant and 101 benign breast lesions in 168 women. Four experienced radiologists analyzed B-mode ultrasound alone and B-mode ultrasound combined with elastography independently. Conventional ultrasound findings were classified according to the American College of Radiology Breast Imaging Reporting and Data System classification. The elastographic assessment was based on qualitative and semi-quantitative parameters (i.e., strain pattern, width ratio, strain ratio). The sensitivity and specificity of combined elastography and conventional ultrasound were significantly higher than that of conventional ultrasound alone. The sensitivity, specificity, positive predictive value and negative predictive value was 97%, 61.4%, 62.5% and 96.8%, respectively, for conventional ultrasound and 100%, 93%, 99% and 90%, respectively, for combined technique. The semi-quantitative assessment with strain ratio and width ratio in elastography were the most useful parameters in differentiating between benign and malignant breast lesions. Cut-off point values for width ratio of more than 1.1 and strain ratio of more than 5.6 showed a high predictive value of malignancy with specificities of 84% and 76%, respectively (p < 0.001). This combined technique also had the best results in detecting carcinoma and could reduce the need of unnecessary biopsy for benign lesions with indeterminate or equivocal features.     

Effect of Calcifications on Shear-Wave Elastography in Evaluating Breast Lesions

This study aimed to investigate the effect of calcifications on shear-wave elastography in evaluating breast lesions. We retrospectively reviewed ultrasound images of 673 breast lesions and compared the elasticity between lesions with and without calcifications in three subgroups: benign lesions, in situ carcinomas and invasive carcinomas. Breast lesions were confirmed histologically (n = 401) or by follow-up images for more than 2 y (n = 272). Calcifications were present in 25.3% (170/673) of the lesions. The E_mean values with and without calcifications, respectively, were as follows: 62.8 and 29.8 kPa in benign lesions (p = 0.000), 114.6 and 52.8 kPa in in situ carcinomas (p = 0.037) and 171.9 and 146.4 kPa in invasive carcinomas (p = 0.018). The presence of calcifications significantly increased the E_mean of breast lesions. Shear-wave elastography should be carefully interpreted in benign lesions with calcifications and in situ carcinomas without calcifications.     

Implementation of Elastography Score and Strain Ratio in Combination with B-Mode Ultrasound Avoids Unnecessary Biopsies of Breast Lesions

The aim of this study was to evaluate whether the combination of B-mode ultrasound, elastography score (ES) and strain ratio (SR) improves diagnostic performance with respect to breast lesions. One hundred thirty lesions were prospectively evaluated by B-mode ultrasound and strain elastography, followed by fine-needle aspiration cytology/biopsy in 117 woman who were scheduled for regular breast BUS. The median ES (4.5 vs. 2.9, p < 0.001) and SR (4.9 vs. 2.3, p < 0.001) were significantly higher for malignant than for benign lesions. A sensitivity of 90.5% and specificity of 93.2% for the ES (cutoff point = 3.8) and a sensitivity of 87.5% and specificity of 87.6% for the SR (cutoff point = 3.5) were obtained. Elastography combined with B-mode ultrasound improved the specificity, accuracy and positive predictive value. Receiver operating characteristic curves yielded a higher value for the combined technique for diagnosis of breast lesions. Routine use of such a diagnostic algorithm could reduce the number of unnecessary biopsies.     

Comparative Diagnostic Performance of Contrast-Enhanced ultrasound versus Baseline Ultrasound for Renal Pelvis Lesions

The aim of this study was to assess the relative efficacy of contrast-enhanced ultrasound (CEUS) and baseline ultrasound (B-US) in diagnosing renal pelvic lesions. B-US findings on 58 suspected renal pelvis lesions were examined. The B-US and CEUS results were classified into five grades. Receiver operating characteristic curve analysis was used to compare the diagnostic efficacy of the two imaging modalities. CEUS characteristics of renal pelvis malignancies at different tumor stages and pathologic grades were examined. In the final diagnosis, 29 patients had malignant lesions (27 transitional cell carcinomas, 1 squamous cell carcinoma and 1 renal cell carcinoma) and 29 had benign lesions. On B-US, echogenicity and renal pelvis separation pattern in patients with malignant renal lesions overlapped those of patients with benign lesions. CEUS significantly increased the diagnostic grade of malignant lesions and decreased the grade of benign lesions (p = 0.000). The area under the receiver operating characteristic curve of CEUS was larger than that of B-US (p = 0.030). Enhancement shape and intensity in the wash-in phase markedly differed in lesions of higher tumor stage and higher pathologic grade, compared with lesions of lower stage and grade. In this study, compared with B-US, CEUS had significantly higher diagnostic efficacy in patients with renal pelvis lesions.     

Peripheral Enhancement of Breast Cancers on Contrast-Enhanced Ultrasound: Correlation with Microvessel Density and Vascular Endothelial Growth Factor Expression

There is little evidence of an association between peripheral enhancement on contrast-enhanced ultrasound and histopathologic prognostic factors in breast cancer. The purpose of our study was to investigate the relationship of peripheral enhancement on contrast-enhanced ultrasound with microvessel density, vascular endothelial growth factor (VEGF) expression and other prognostic factors in patients with breast cancer. In 51 patients with BI-RADS (Breast Imaging Reporting and Data System) category 5 lesions scheduled for surgery, contrast-enhanced ultrasound with an 8-4 linear transducer and B-mode pulse inversion harmonic imaging was performed after administration of SonoVue. Forty-three histologically confirmed breast cancers were included in the study and divided into the peripheral enhancement group and non-peripheral enhancement group on the basis of their features on contrast-enhanced ultrasound. The ratio of peripheral to central microvessel density, VEGF expression, tumor size, histopathologic type, stage, lymph node metastasis and expression of estrogen receptor, progesterone receptor, c-erb-B2 and p53 were compared between the two groups. The ratio of peripheral to central microvessel density and a peripherally positive/centrally negative VEGF expression pattern were significantly higher in the peripheral enhancement group than in the non-peripheral enhancement group (t-test, p = 0.023, and χ² test, p = 0.035, respectively). There were no significant differences in breast cancer size, histopathologic type, stage, lymph node metastasis or expression of estrogen receptor, progesterone receptor, c-erb-B2 and p53 between the two groups (χ² test, p = 0.416, 0.877, 0.543, 0.124, 0.453, 0.554, 0.350 and 0.479 respectively). The peripheral enhancement pattern of breast cancer on contrast-enhanced ultrasound may be valuable in the evaluation of peripheral/central tumor angiogenesis and VEGF expression.     

Quantitative Evaluation of Vascularity Using 2-D Power Doppler Ultrasonography May Not Identify Malignancy of the Thyroid

The purpose of this study was to evaluate the usefulness of a quantitative vascular index in predicting thyroid malignancy. A total of 1309 thyroid nodules in 1257 patients (mean age: 50.2 y, range: 18–83 y) were included. The vascularity pattern and vascular index (VI) measured by quantification software for each nodule were obtained from 2-D power Doppler ultrasonography (US). Gray-scale US + vascularity pattern was compared with gray-scale US + VI with respect to diagnostic performance. Of the 1309 thyroid nodules, 927 (70.8%) were benign and 382 (29.2%) were malignant. The area under the receiver operating characteristics curve (A_z) for gray-scale US (0.82) was significantly higher than that for US combined with vascularity pattern (0.77) or VI (0.70, all p < 0.001). Quantified VIs were higher in benign nodules, but did not improve the performance of 2-D US in diagnosing thyroid malignancy.     

Sonographic features of nonpalpable breast cancer: a study based on ultrasound-guided wire-localized surgical biopsies

The purpose of this study is to investigate the correlation between surgicopathological findings and ultrasonic images of nonpalpable breast lesions. The study was composed of 220 nonpalpable breast lesions from 193 patients. The breast lesions were classified into soft tissue type (185 lesions) and calcification type (35 lesions). Of the 220 lesions, 62 (28%) were malignant. For soft tissue type lesions, the sonographic features of sound attenuation (p < 0.001) and irregular border (p < 0.001) were significantly associated with the malignant diagnosis. For soft tissue-type and calcification-type lesions, the presence of increased vascularity (p < 0.001) or calcification (p < 0.001) was significantly associated with the malignant diagnosis. Of the 164 breast lesions with corresponding mammograms, 37 of 74 mammographically identifiable lesions were pathologically malignant, as compared with 16 of 90 lesions with negative mammograms (p < 0.001). In our study, the more sensitive sonographic features for predicting malignancy were irregular border and increased vascularity (sensitivity 88% and 82%, respectively), whereas the features of sound attenuation and presence of calcifications were more specific (specificity 88% and 80%, respectively). In conclusion, ultrasound-guided wire localization of breast lesions is not only useful in assisting surgical biopsy, but the sonographic findings obtained by this procedure correlate with pathologic diagnosis.     

乳腺黏液癌的影像学特征分析

目的 评价乳腺黏液癌的超声、X线等影像学特征及其与病理组织类型的相关性.方法 回顾性分析21例经手术病理证实的乳腺黏液癌患者(22个病灶)的超声、X线特征及与病理组织类型之间的关系.结果 病理组织学分类包括14个单纯型(6个富细胞型,8个少细胞型)和8个混合型病灶.超声:所有病例均存在实性肿块,85.71％(12/14)的单纯型肿块境界清晰,回声等或略低于皮下脂肪,92.86％(13/14)的单纯型病灶后方回声增强;75.00％(6/8)的混合型和14.29％(2/14)的单纯型肿块边界较模糊并细小毛刺,内部回声较脂肪回声低.超声和X线片术前怀疑恶性的比例均为63.64％(14/22).恶性X线表现包括肿块(10个)、局限性不对称致密影(2个)、结构扭曲并恶性钙化和单纯不定性钙化(各1个).肿块主要为高密度,单纯型边界清楚或呈浅分叶状,混合型边界不规则和毛刺改变.81.82％(18/22)的病灶被超声或X线之一疑诊恶性,45.45％(10/22)的病灶术前超声和X线均疑为恶性.结论 乳腺黏液癌尤其单纯型影像学特征不典型,超声和X线诊断均可能诊断为良性病变;肿块边缘特征是鉴别良恶性的重要依据,混合型肿块较单纯型更具有浸润性特征;超声和X线联合诊断有利于避免误诊,两者之一怀疑恶性时,即应行穿刺活检以明确诊断.     

Value of Contrast-Enhanced Ultrasound in Differentiating Clinically Atypical Subacute Thyroiditis from Papillary Thyroid Carcinomas

Our objective was to provide the various sonographic characteristics of clinically atypical subacute thyroiditis (CAST) in distinguishing CAST from papillary thyroid carcinomas (PTCs) by using conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS). Forty-six CAST patients and 50 PTC patients were enrolled in this study. We evaluated the size, shape, margin, echogenicity, calcification, vascularity and CEUS parameters for each nodule. The final diagnosis of CAST was confirmed via fine-needle aspiration (FNA) or surgery. Of the 46 CASTs, 13 (28.3%) were confirmed by surgery to be benign, and 33 (71.7%) were proven by FNA to be benign. Univariate analysis indicated that compared with PTCs, CAST lesions more frequently had wider-than-taller shapes, blurred margins, the absence of microcalcifications, peripheral high echogenicity, the absence of internal vascularity, hypo-enhancement, centrifugal perfusion and a peak intensity index <1 and area under the curve index <1 on pre-operative US and CEUS. A multivariate analysis revealed that clear margins, microcalcifications and centripetal perfusion were independent characteristics related to PTCs for their differentiation from CAST (all p values <0.05). Our study indicated that the pre-operative multiparameter US characteristics may serve as a useful tool for distinguishing CAST from malignant thyroid nodules to avoid surgical excisions or unnecessary FNAs.     

Predictive Value of Estimated Tumor Volume Measured by Ultrasonography for Occult Central Lymph Node Metastasis in Papillary Thyroid Carcinoma

The clinical and prognostic value of tumor volume in various solid tumors has been investigated. However, there have been few studies on the clinical impact of tumor volume in papillary thyroid carcinoma (PTC). This study was performed to investigate the predictive value of estimated tumor volume measured by ultrasonography for occult central neck metastasis (OCNM) of PTC. A total of 264 patients with clinically node-negative PTC on ultrasonography and computed tomography who underwent total thyroidectomy in conjunction with at least ipsilateral prophylactic central neck dissection were enrolled in this study. Tumor volume was derived with the formula used to calculate ellipsoids from two orthogonal scans during 2-D ultrasonography at initial aspiration biopsy. We retrospectively evaluated demographic characteristics, pre-operative ultrasonographic features (tumor size, volume and multifocality) and pathologic results. The OCNM rate was 35.6%; estimated tumor volume was used to predict OCNM (p = 0.035). At 0.385 mL, sensitivity and specificity were 51.1% and 66.5%, and the area under the curve for OCNM detection was 0.610. In multivariate analysis, tumor volume, but not size, was an independent predictive factor for OCNM (odds ratio = 1.83, p = 0.029). The other factors were extrathyroidal extension (odds ratio = 2.39, p = 0.004) and male gender (odds ratio = 3.90, p < 0.001). The estimated tumor volume of PTC measured by ultrasonography could be a pre-operative predictor of OCNM.     

Clinical value of relative quantification ultrasound elastography in characterizing breast tumors

ObjectivesTo evaluate ultrasound elastography (USE) using strain ratio (SR), a relative quantification approach for breast lesions characterization.MethodsOne hundred forty-seven consecutive patients with a total of 156 breast lesions underwent USE. Technical accuracy was assessed automatically. For SR evaluation a rounded ROI was depicted inside fat (F), glandular tissue (G) and inside the lesion (L), preferably at the same depth. R1, mean value of the G and F ratio, stands for in background tissue composition elasticity. R2; mean value of L/F stands for in lesion elasticity, both evaluated in arbitrary unit (au). Two-years follow-up and pathology results were standard of reference. Mann–Whitney test, ROC analysis and Chi-square with Yates correction were used.ResultsWith the exception of 27 cysts, 17 malignant and 112 benign lesions were found. R1 values were 1.6 ± 0.7 au and 1.2 ± 0.9 au (p = 0.015 NS); R2 values were 6.1 ± 2.5 au and 1.9 ± 1.3 au (p < 0.001) for malignant and benign lesions, respectively. A threshold of 3.3 au showed a sensitivity and specificity of 88% and 87%, respectively with an AUC of 93%. Fifteen false positive and two false negative were detected.ConclusionRelative quantification of ultrasound elastography allows to find high levels of diagnostic accuracy in characterizing breast tumors above all in downgrading BI-RADS 3 and 4 lesions.     

Breast examinations with continuous wave and color Doppler.

Continuous wave Doppler has been used for many years to characterize malignant breast lesions. With continuous wave Doppler pencil probes, operating at frequencies between 8 and 10 MHz, 94% of the carcinomas have shown abnormal vascularity. Flow assessment with continuous wave Doppler alone is only possible in palpable lesions. We have improved the diagnostic accuracy by combining continuous wave Doppler and B-mode ultrasound which allows for flow detection in non-palpable lesions. This procedure is rather complicated, because of sound interference, and requires a good deal of experience.Ultrasound equipment with color flow mapping has been available for several years. However, during the last 3 years, the sensitivity of the instruments has been improved, allowing the detection of flow in microscopic vessels which are not visible in B-mode scanning. Evaluation of this method is difficult, as the sensitivity of color Doppler equipment shows remarkable variations.In order to evaluate the capability of color Doppler for investigation of abnormal blood flow in breast malignancies, we examined 120 symptomatic women using different types of equipment and compared the findings to those of continuous wave Doppler. In ten of 44 carcinomas, no color flow signals were found. However, continuous wave Doppler showed low vascularity in all of these ten false-negative cases. Among the remaining patients with benign disease, no false-positive reports were made. The major difficulty in flow assessment with color Doppler was the heterogeneous vascularity of breast malignancies. When a low Doppler frequency (相似文献   

US-Guided Optical Tomography: Correlation with Clinicopathologic Variables in Breast Cancer

We tested the relat1ionships between total hemoglobin concentration (THC), as measured with ultrasound (US)-guided optical tomography, and clinicopathologic variables in invasive ductal cancers; and we evaluated the clinical significance of THC. Fifty-three patients with 65 invasive ductal carcinomas underwent US-guided biopsy and were scanned with a hand-held probe consisting of a co-registered US transducer and an NIR (near-infrared) imager. The lesion location provided by co-registered US was used to guide optical imaging. Light absorption was measured at two optical wavelengths. From this measurement, tumor angiogenesis was assessed on the basis of calculated THC. We investigated the relationships between maximum THC and clinicopathologic variables (tumor size [≤2 cm or >2 cm], metastasis to lymph node or distant organ, histologic grade, lymphovascular invasion, status of ER, PR, HER2 and Ki-67, and triple negativity). The mean maximum THC in the breast cancers was 223.3 ± 106.3 μmol/L. In univariate analysis, HER2 positivity, tumor size, and Ki-67 positivity showed significant correlations with maximum THC (p < 0.05). In multivariate analysis including tumor size, and ER, PR, HER2, and Ki-67 status, HER2 positivity correlated with maximum THC significantly (p = 0.007, parameter estimate 76.44). Maximum THC correlated with HER2, Ki-67 and tumor size in this group of ductal breast carcinomas. Thus, US-guided diffuse optical tomography (US-DOT) may potentially be used to predict tumor aggressiveness in patients with invasive breast cancers.     

乳腺可视化触诊成像系统鉴别诊断乳腺良恶性病变：与临床触诊、X线及超声对照

目的 探讨乳腺可视化触诊成像系统对乳腺病灶良恶性病变的鉴别诊断价值。方法 对169例乳腺病变患者（共195个病灶）行触诊成像、临床触诊和X线,对其中151例行超声检查。比较以上4种方法鉴别乳腺良恶性病变的敏感度、特异度,评估各方法对不同腺体类型乳腺病灶的诊断价值。结果 触诊成像对良恶性病灶的诊断敏感度为82.40%,特异度为80.00%,敏感度高于临床触诊（60/125,48.00%,P<0.001）但低于X线（117/125,93.60%,P=0.003）及超声（105/110,95.45%,P<0.001）,特异度高于X线（39/70,55.71%,P=0.002）及超声（38/61,62.29%,P=0.023）。对于不同腺体类型的乳腺,触诊成像鉴别良恶性病灶的敏感度和特异度变化不大。结论 触诊成像对于鉴别乳腺良恶性病灶具有较高的应用价值,有望成为现有乳腺检查技术的补充。     

Evaluation of Sonographic Features for Patients with Urinary Bladder Paraganglioma: A Comparison with Patients with Urothelial Carcinoma

The goals of the work described here were to analyze the ultrasonographic characteristics of urinary bladder paraganglioma and to evaluate the use of ultrasonography (US) in diagnosis. Ten patients with bladder paraganglioma (3 males, 7 females) and 51 patients with urothelial carcinoma (37 males, 14 females) were enrolled. Ultrasonographic characteristics as well as clinical features were analyzed. Patients with urothelial carcinoma were significantly older than those with paraganglioma (62.9 y vs. 48.1 y, p = 0.001). The patients with paraganglioma had higher average systolic blood pressure than those with urothelial carcinoma (146.7 mm Hg vs. 130.7 mm Hg, p = 0.012). All bladder paragangliomas were solitary, and 40% were located on the dome. There was a statistically significant difference in location of lesions between the bladder paraganglioma and urothelial carcinoma groups (p = 0.014). The longest diameters in 80% of the bladder paragangliomas were in the range 1.1–3.0 cm; 60% were hypoechoic, and 40% were located in the submucosa of the bladder. Color Doppler revealed that 40% of the bladder paragangliomas were highly vascular. One patient with paraganglioma and four patients with urothelial carcinoma underwent contrast-enhanced ultrasound, which revealed rapid contrast enhancement and slow wash-out, with a non-enhanced area. Contrast-enhanced ultrasound of urothelial carcinomas revealed rapid homogeneous enhancement and variable wash-out patterns. Pre-operative ultrasonography detected all neoplasms of the urinary bladder in the 10 patients with pathologically confirmed paraganglioma, but made the correct diagnosis in only 2 cases (20%). Although there is overlap in US findings among different diseases, solitary, submucosal masses arising on the dome may be the key US imaging characteristic for bladder paraganglioma.