Value of Contrast-Enhanced Ultrasound Combined with Immune-Inflammatory Markers in Predicting Axillary Lymph Node Metastasis of Breast Cancer.

RATIONALE AND OBJECTIVES: To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) combined with immune-inflammatory markers in predicting axillary lymph node metastasis (ALNM) in breast cancer patients. METHODS: From January 2020 to June 2023, the clinicopathological data and ultrasound features of 401 breast cancer patients who underwent biopsy or surgery were recorded. Patients were randomly divided into a training set (321 patients) and a validation set (80 patients). The risk factors for ALNM were determined using univariate, least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analysis, and prediction models were constructed. Receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were used to assess their diagnostic performance. RESULTS: Logistic regression analysis demonstrated that systemic immunoinflammatory index (SII), CA125, Ki67, pathological type, lesion size, enhancement pattern and Breast Imaging Reporting and Data System (BI-RADS) category were significant risk factors for ALNM. Three different models were constructed, and the combined model yielded an AUC of 0.903, which was superior to the clinical model (AUC=0.790) and ultrasound model (AUC=0.781). A nomogram was constructed based on the combined model, calibration curves and DCA demonstrated its satisfactory performance in predicting ALNM. CONCLUSION: The nomogram combining ultrasound features and immune-inflammatory markers could serve as a valuable instrument for predicting ALNM in breast cancer patients. DATA AVAILABILITY STATEMENT: The original contributions presented in the study are included in the article. Further inquiries can be directed to the corresponding authors.

Diagnosing sentinel lymph node metastasis of T1/T2 breast cancer with conventional ultrasound combined with double contrast-enhanced ultrasound: a preliminary study.

Background: In patients with T1/T2 breast cancer (BC), sentinel lymph node (SLN) status is essential for prognosis and treatment. This study investigated the value of conventional ultrasound combined with double contrast-enhanced ultrasound in diagnosing the metastasis of SLNs in patients with T1/T2 BC. Methods: This study employed a prospective design (this diagnostic study was not registered on a clinical trial platform), and the participants formed a convenience series. Based on the inclusion and exclusion criteria, 163 patients with BC who received treatment in the First Affiliated Hospital of Soochow University from July 2017 to December 2021 were included in this study. A total of 165 SLNs from 163 patients with T1/T2 BC were analyzed. All patients underwent percutaneous contrast-enhanced ultrasound (PCEUS) to trace SLNs before the operation. Subsequently, all patients underwent conventional ultrasound and intravenous contrast-enhanced ultrasound (ICEUS) examinations to observe the SLNs. The results of the conventional ultrasound, ICEUS, and PCEUS of the SLNs were analyzed. The associations between the risk of SLN metastasis and imaging features were evaluated via a nomogram based on the pathological results. Results: Overall, 54 metastatic SLNs and 111 nonmetastatic SLNs were evaluated. Metastatic SLNs displayed a greater cortical thickness, area ratio, eccentric fatty hilum, and hybrid blood flow on conventional ultrasound compared with nonmetastatic SLNs (P<0.001). According to PCEUS, 75.93% of metastatic SLNs showed heterogeneous enhancement (type II and III), and 73.88% of nonmetastatic SLNs showed homogeneous enhancement (type I; P<0.001). According to ICEUS, heterogeneous enhancement (type B/C, 20.37% vs. 11.71%) and overall enhancement (55.56% vs. 23.42%) were more common in metastatic SLNs than in nonmetastatic SLNs (P<0.001). Logistic regression analysis showed that the cortical thickness and enhancement type of PCEUS were independent predictors of SLN metastasis. Moreover, a nomogram combining these factors showed a high diagnostic ability for SLN metastasis (unadjusted concordance index 0.860, 95% CI: 0.730-0.990; bootstrap-corrected concordance index 0.853). Conclusions: The nomogram of cortical thickness and enhancement type of PCEUS could effectively diagnose SLN metastasis in patients with T1/T2 BC.

Value of contrast-enhanced ultrasound area ratio in identifying benign and malignant small breast masses.

BACKGROUND: Tumor size affects clinical staging and is closely related to prognosis. Therefore, early diagnosis of breast cancer is one of the most important methods to reduce mortality and improve prognosis. However, minimal breast cancer is difficult to differentiate from small benign breast masses due to insufficient typical malignant signs. The significantly increased range of enhancement can be an important indication for the prediction of malignancy; however, quantitative studies on the extent of enhancement are rarely reported. The purpose of this study was to investigate the value of contrast-enhanced ultrasound (CEUS) area ratio in finding benign and malignant small breast masses. METHODS: A retrospective analysis was conducted on 88 patients with breast masses confirmed by surgery or needle biopsy (the maximal diameter not over 1 cm). 88 breast masses were divided into the younger age group (not over 40 years old) and older age group (over 40 years old) according to the patient's age. The receiver operating characteristic (ROC) curve was used to determine the cutoff values of CEUS area ratio in diagnosing benign or malignant small breast masses in each group. The efficiency of different cutoff values in finding benign and malignant small breast masses of the distinct groups was analyzed. RESULTS: The CEUS area ratio of malignant mass was larger than benign masses (P<0.05). The CEUS area ratio of malignant masses in the younger age group was larger than that in the older age group (P<0.05). The results of the ROC curve analysis showed that the area under the curve (AUC) and the cutoff values of the entire group, the younger age group, and the older age group were 0.887, 1.65; 0.909, 1.95; and 0.908, 1.22, respectively. When the cutoff value of the older age group was reduced from 1.65 to 1.22, its diagnostic sensitivity was improved significantly (P<0.05). CONCLUSIONS: CEUS area ratio has specific application value in finding benign and malignant small breast masses. Proper reduction of the cutoff value of elderly patients can further improve its diagnostic sensitivity without significantly reducing the specificity.

Effect of intermittent operation model on the function of soil infiltration system.

To enhance denitrification in a process of solute infiltration through a soil, a two-section mixed-medium soil infiltration system (TMSIS) for urban non-point pollution was developed. The artificial aerobic respiration and nitrification took place in the upper aerobic section (AES), while grass powders and sawdust were mixed in the bottom anaerobic section (ANS) to supply organic carbon source for denitrification bacteria, and the reduction was increased by iron addition in the ANS. Measured resident concentrations from the bottom of each ANS column were assumed to represent mean values averaged over the column cross-sectional area. The TMSIS with hydraulic loading rates (HLR) of 0.32, 0.24, and 0.16 m3 m-2 day-1 and with wetting-drying ratio (RWD) of 1.0 showed remarkable removal efficiencies for chemical oxygen demand (COD), NH4+-N, and TP, respectively. The hydraulic loading rate of 0.32 m3 m-2 day-1 was selected as the optimal HLR due to the high contaminated runoff treatment efficiency. When RWD was 1.0, 0.5, or 0.2 with hydraulic loading rate of 0.32 m3 m-2 day-1, the TMSIS could treat synthetic urban runoff contaminants very well. The corresponding effluent water met the China's national quality standard for class V surface water. The wetting-drying ratio of 0.5 with hydraulic loading of 0.32 m3 m-2 day-1 was selected as the optimal operation conditions for the TMSIS. Aerobic respiration and nitrification mainly took place in the upper AES, in which most of the COD and the NH4+-N were removed. Mixed sawdust and grass powders used as a carbon source and heterotrophic denitrification were put at the bottom of the ANS. The developed TMSIS has the potential to be applied for urban non-point pollution removal.

Removal of chemical oxygen demand and dissolved nutrients by a sunken lawn infiltration system during intermittent storm events.

Urban surface water runoff typically contains high but varying amounts of organic matter and nutrients that require removal before reuse. Infiltration systems such as sunken lawns can improve water quality. However, there is currently insufficient information describing the treatment efficiency of lawn-based infiltration systems. In this study, novel sunken lawn infiltration systems (SLISs) were designed and their pollutant removal effectiveness was assessed. The results revealed that SLISs with Poa pratensis and Lolium perenne effectively removed most chemical oxygen demand (CODCr) and dissolved nutrients. Average CODCr, total nitrogen (TN), ammonium-nitrogen (NH4(+)-N) and total phosphorus (TP) concentrations were reduced by 78.93, 66.64, 71.86 and 75.83%, respectively, and the corresponding effluent concentrations met the standard for urban miscellaneous water consumption in China. The NH4(+)-N in the synthetic runoff was shown to be removed by adsorption during the stormwater dosing and nitrification during subsequent dry days, as well as through uptake by plants. Phosphorus was mainly removed by adsorption and chemical precipitation. The NH4(+)-N and phosphorus Langmuir isotherm model fitted the clay loam soil adsorption process better than the Freundlich model. Overall, these results indicate that an SLIS provides an alternative means of removing runoff pollutants owing to its efficiency, easy operation and maintenance.

Efficiencies of multilayer infiltration systems for the removal of urban runoff pollutants.

Current rates of urban development will result in water runoff becoming a major complication of urban water pollution. To address the worsening situation regarding water resource shortage and pollution, novel multilayer infiltration systems were designed and their effectiveness for removing pollutants in urban runoff tested experimentally. The multilayer infiltration systems effectively removed most pollutants, including organic matter (chemical oxygen demand (CODCr)), total nitrogen (TN), ammonia-nitrogen (NH4(+)-N) and total phosphorus (TP). CODCr, TN, NH4(+)-N, and TP were reduced by 68.67, 23.98, 82.66 and 92.11%, respectively. The main mechanism for nitrogen removal was biological nitrogen removal through nitrification and denitrification. Phosphorus in the urban runoff was removed mainly by fixation processes in the soil, such as adsorption and chemical precipitation. The results indicate that the proposed novel system has potential for removal of pollutants from urban runoff and subsequent reuse of the treated water.