Integrating vascularity into the pattern classification of pilomatricomas on ultrasound provides a more competent approach for discriminative evaluation.

BACKGROUND: Pilomatricoma has various manifestations on color Doppler ultrasound, and a differential diagnosis is challenging. The objective of this study was to investigate which characteristics of skin lesions on color Doppler ultrasound are effective in distinguishing pilomatricoma from epidermoid cyst and dermatofibrosarcoma protuberans. MATERIALS AND METHODS: Records of patients with pilomatricomas (n = 63), epidermoid cysts (n = 76), and dermatofibrosarcoma protuberans (n = 19) who underwent color Doppler ultrasound evaluation and surgical excision were reviewed. The anatomical distribution and color Doppler ultrasound characteristics of these lesions were analyzed. The 63 pilomatricomas were categorized into five types based on their color Doppler ultrasound characteristics, and the roles of these five types in the differential diagnosis of the aforementioned diseases were studied. RESULTS: Pilomatricomas, epidermoid cysts, and dermatofibrosarcoma protuberans exhibited some similar characteristics. Dominantly markedly hyperechoic or hyperechoic appearance, posterior acoustic shadowing, and the presence of vascularity were the major characteristics of pilomatricomas. The pilomatricomas could be categorized into five types, with type II having a diagnostic performance of sensitivity of 65.08%, specificity of 98.95%, area under the receiver operating characteristic curve (AUC) of 0.743, positive predictive value of 97.62%, and negative predictive value of 81.03% for the diagnosis of the aforementioned skin diseases. CONCLUSION: A combination of dominantly markedly hyperechoic or hyperechoic appearance, posterior acoustic shadowing, and the presence of vascularity exhibits higher diagnostic performance for the differential diagnosis of pilomatricomas, epidermoid cysts, and dermatofibrosarcoma protuberans.

Importance of Distending Stomach With Fluid for Ultrasound Detection of Focal Lesion in the Elongated Left Lobe of the Liver.

OBJECTIVES: The purpose of this study was to evaluate distending the stomach with water for ultrasound detection of focal lesions in the elongated left lobe of the liver. METHODS: A total of 13,277 patients undergoing liver ultrasound were evaluated for the presence of an elongated left lobe of the liver and a focal lesion. Patients with an elongated left lobe of the liver had their stomach distended with oral water for further evaluation of a focal lesion. A portion of the patients had computed tomography (CT) examinations, which were compared with the ultrasound studies. RESULTS: A total of 643 patients were found with elongated left lobe of the liver by ultrasound; of them, 451 underwent CT, 259 out of the 451 patients meeting the inclusion criteria underwent second ultrasound and final analysis, and 16 of these 259 patients had focal lesion in the elongated left lobe of the liver on CT study. The sonographic visualization of the liver and spleen at the same scan view before and after distending the stomach were 7% (7 of 100) and 100% (100 of 100), respectively (P < .001). The sonographic detection of the lesions before and after distending the stomach were zero and 87.5%, respectively (P < .001). CONCLUSIONS: Distending the stomach with water can greatly increase ultrasound detection of focal lesions in the elongated left lobe of the liver.

Focal fatty sparing usually does not arise in preexisting nonalcoholic diffuse homogeneous fatty liver.

OBJECTIVES: The purpose of this study was to investigate whether focal fatty sparing can arise in preexisting nonalcoholic diffuse homogeneous fatty liver and its clinical implications. METHODS: This prospective study consisted of 2 parts. In the first part, 8598 people (5202 men and 3396 women; mean age ± SD, 43.4 ± 28.3 years; range, 18-82 years) were consecutively evaluated with sonography for abnormal liver findings; in the second part, participants with diffuse homogeneous fatty liver were followed over approximately 3 years. Sonographic findings of the participants in the first year and findings of the participants with diffuse homogeneous fatty liver in the first and third years were analyzed. RESULTS: In the first part, 778 of 8598 participants (9.05%) were found to have fatty liver, including 752 cases of nonalcoholic diffuse fatty liver (8.75%) and 26 cases of alcoholic fatty liver (0.30%). Of the 752 cases of nonalcoholic diffuse fatty liver, 301 participants had nonalcoholic diffuse homogeneous fatty liver, and 68 (9.04%) had focal fatty sparing. In the second part, the 301 participants with nonalcoholic diffuse homogeneous fatty liver (205 men and 96 women; mean age, 39.6 ± 10.4 years; range, 18-60 years) were followed. In the third year, 2 cases of fatty liver (0.67%) had resolved, 2 cases (0.67%) had inflammatory pseudotumors, and no focal fatty sparing was found (P < .001). CONCLUSIONS: The findings of this study suggest that focal fatty sparing usually does not arise in preexisting nonalcoholic diffuse homogeneous fatty liver, and a newly emerging abnormality is more likely a true lesion.

Dynamic changes in ultrasound characteristics of nodules in cirrhotic liver and their implications in surveillance for malignancy.

OBJECTIVE: To investigate whether there are ultrasound characteristics that can suggest HCC in ultrasound surveillance of nodules in cirrhotic liver. METHODS: Data from 277 patients with hepatitis B virus-related nodules in cirrhotic liver undergoing ultrasound surveillance of the nodules for malignancy were reviewed. Size of the nodules ranged 6-23 mm. The nodules were followed by color Doppler ultrasound at 3- to 6-month intervals, with focus on size, shape, echogenicity, margin, halo sign, and vasculature. Suspicious malignant nodules underwent contrast-enhanced CT/MRI, and some indeterminate nodules underwent biopsy. RESULTS: Nodules in 189 patients were hypo/isoechoic/faint high echoic, 23 were hyperechoic, and 65 were both hypo/isoechoic/faint high echoic and hyperechoic. Forty-two patients developed hepatocellular carcinoma: 35 from nodules and 7 from background parenchyma. Fourteen nodules recessed (size >10 mm), 11 new nodules emerged (size >10 mm), and the total number of nodules increased over 5 years. All hepatocellular carcinomas developed from hypo/isoechoic/faint high echoic nodules, and no typical hyperechoic nodules developed into hepatocellular carcinomas. The size increased significantly when the nodules developed into hepatocellular carcinomas. No nodule presented an overt halo, seven hepatocellular carcinomas developed from nodules with a halo, and ill-defined margins of 16 nodules became well defined when they developed into hepatocellular carcinomas. No vasculature was detectable in the nodules, while it was detectable in eight hepatocellular carcinomas. No significant change occurred in nodules without malignancy. CONCLUSION: The characteristics for dynamic surveillance of nodules in cirrhotic liver for malignancy should include nodule growth, margin, halo, and vasculature. Apart from evident growth, an ill-defined margin becoming a well-defined margin, a newly emerged halo, and newly detectable vasculature are strongly suggestive of nodule malignancy.

Endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced lumen-apposing metal stent for malignant biliary obstruction: A promising procedure.

In this editorial, we comment on the article by Peng et al. Palliative drainage for biliary obstruction resulting from unresectable malignant lesions includes internal and external drainage. The procedures of biliary drainage are usually guided by fluoroscopy or transcutaneous ultrasound, endoscopic ultrasound (EUS), or both. Endoscopic retrograde cholangiopancreatography (ERCP) has been primarily recommended for the management of biliary obstruction, while EUS-guided biliary drainage and percutaneous transhepatic biliary drainage (PTBD) are alternative choices for cases where ERCP has failed or is impossible. PTBD is limited by shortcomings of a higher rate of adverse events, more reinterventions, and severe complications. EUS-guided biliary drainage has a lower rate of adverse events than PTBD. EUS-guided biliary drainage with electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) enables EUS-guided biliary-enteric anastomosis to be performed in a single step and does not require prior bile duct puncture or a guidewire. The present meta-analysis showed that ECE-LAMS has a high efficacy and safety in relieving biliary obstruction in general, although the results of LAMS depending on the site of biliary obstruction. This study has highlighted the latest advances with a larger sample-based comprehensive analysis.

Integrating the incident angle of main vessel of breast nodule with BI-RADS can improve the efficacy of breast malignancy evaluation.

The aim of this study was to investigate the measurement of the incident angle of the main blood vessel, and the benefits of its integral with ultrasound malignant features of breast nodules for the assessment of breast malignancy based on BI-RADS. The incident angles of main blood vessels of 185 breast nodules in 185 patients who underwent breast nodule surgical excision or biopsy were quantitatively measured using color Doppler ultrasound from October 2022 to October 2023 in a tertiary hospital, and related data were collected and analyzed. Based on histopathology as the gold standard, the breast nodules were classified into benign and malignant groups. The incident angle values of both groups were compared, Receiver Operating Characteristic (ROC) curves were plotted, and the optimal cutoff value for distinguishing between benign and malignant breast nodules was determined. The malignancy risk of the breast nodules was assessed using the incident angle of the breast main vessel, BI-RADS classification, and a combination of ultrasound malignant features with the incident angle. The areas under the ROC curves (AUC) for each method were calculated and compared. The average incident angle of the main vessel of the breast nodule for the benign and malignant breast nodule groups was (41.47 ± 14.27)° and (22.65 ± 11.09)°, respectively, with a statistically significant difference (t = 10.027, P < 0.001). There was a significant negative correlation between the breast nodule vessel incident angle and histopathological malignancy (r = - 0.593, P < 0.001). The ROC curve and Youden index suggested that the optimal cutoff value for distinguishing between benign and malignant breast nodules using the vascular incident angle was 26.9°, with a sensitivity of 76.34%, specificity of 84.78%, positive predictive value of 83.53%, negative predictive value of 78.00%, and AUC of 0.853. The diagnostic performance of BI-RADS classification based on ultrasound malignant features of the breast nodules alone in assessing the malignancy risk of breast nodules showed a sensitivity of 78.50%, specificity of 92.39%, positive predictive value of 91.25%, negative predictive value of 79.95%, and AUC of 0.905. The integral of ultrasound malignant features and vascular incident angle for BI-RADS based assessment for breast nodule malignancy risk demonstrated a sensitivity of 90.32%, specificity of 89.13%, positive predictive value of 89.36%, negative predictive value of 90.11%, and AUC of 0.940. The differences in negative predictive value and AUC between ultrasound malignant features BI-RADS classification alone and the combination of ultrasound malignant features BI-RADS classification with the incident angle of the main vessel of the breast nodule were all statistically significant (x2 = 3.243, P = 0.042; Z = 2.955, P = 0.003). Measuring the incident angle of the main blood vessel of breast nodules and combining this measurement with ultrasound malignant features for BI-RADS classification can enhance the effectiveness of malignancy risk assessment of breast nodules, increase the negative predictive value, and potentially reduce unnecessary biopsies.

Hybrid cell membranes camouflage liposomes containing payloads to improve breast cancer chemo and photodynamic therapy.

The treatment of unresectable locally advanced triple-negative breast cancer (TNBC) and TNBC with metastasis is challenging. Many anticancer drugs, such as doxorubicin, still hinder positive therapeutic outcomes due to severe side effects. Photodynamic therapy (PDT) has an anticancer effect, and combining PDT with chemotherapy may improve breast cancer therapy. The use of cargo-loaded biomimetic PEGylated liposomes for cancer therapy may enhance efficacy and reduce side effects. In this study, liposomes were formulated to accommodate doxorubicin (Dox) and IR780. Breast cancer cells (4T1 cells) and macrophage cell membranes were isolated and camouflaged onto the PEGylated liposomes, creating a new biomimetic platform called Dox-IR780@Lip@Ms. The Dox-IR780@Lip@Ms platform was characterized and tested in vitro and in vivo. The results showed that the Dox-IR780@Lip@Ms had an ovoid shape with a double lamina structure, monodispersity, and uniform distribution. The size was 132.37 ± 1.22 nm, the PDI was 0.044 ± 0.067, and the zeta potential was -9.67 ± 1.08 mV. The encapsulation efficiency of Dox and IR780 in Dox-IR780@Lip@Ms was 89.36% ± 3.07% and 92.34% ± 0.66%, respectively. The release rate of Dox from Dox-IR780@Lip@Ms was good after laser irradiation. At pH 7.4, the release rate of Dox was 23.85% ± 0.62% at 3 h without laser irradiation and 36.62% ± 1.32% at 3.5 h with laser irradiation. At pH 6.5, the release rate of Dox was 32.54% ± 0.32% at 3 h without laser irradiation and 62.79% ± 2.15% at 3.5 h with laser irradiation. The cytotoxicity of IR780@Lip@Ms was lower than that of Dox-IR780@Lip@Ms. The cell uptake and generation of reactive oxygen species of Dox-IR780@Lip@Ms were significant. Dox-IR780@Lip@Ms exhibited immune escaping ability in vitro, homotypic targeting ability to cancer cells, high capability to kill cancer cells after laser irradiation, minimal cardiotoxicity, increased accumulation of Dox and IR780 in the tumor, and an increased anticancer effect in a tumor-bearing animal model. In conclusion, hybrid cell membranes of breast cancer and macrophages camouflaging PEGylated liposomes loaded with Dox and IR780 can significantly improve breast cancer therapy after laser irradiation in murine models.

The utility of quantifying the orientation of breast masses in ultrasound imaging.

The aim of this study was to quantify the orientation of breast masses and determine whether it can enhance the utility of a not parallel orientation in predicting breast mass malignancy. A total of 15,746 subjects who underwent breast ultrasound examinations were initially enrolled in the study. Further evaluation was performed on subjects with solid breast masses (≤ 5 cm) intended for surgical resection and/or biopsy. The orientation angle, defined as the acute angle between the align of the maximal longitudinal diameter of the breast mass and the surface of the breast skin, was measured. Receiver operating characteristic (ROC) curve analysis was conducted, and various performance measures including sensitivity, specificity, positive and negative predictive values, accuracy, odds ratio, and the area under the ROC curve (AUC) were calculated. Multivariate analysis was performed to determine if the orientation angle was an independent predictor of breast malignancy. Decision curve analysis (DCA) was also conducted to assess the net benefit of adopting the orientation angle for predicting breast mass malignancy. The final analysis included 83 subjects with breast cancer and 135 subjects with benign masses. The intra-group correlation coefficient for the measurement of the orientation angle of breast masses was 0.986 (P = 0.001), indicating high reproducibility. The orientation angles of malignant and benign breast masses were 36.51 ± 14.90 (range: 10.7-88.6) degrees and 15.28 ± 8.40 (range: 0.0-58.7) degrees, respectively, and there was a significant difference between them (P < 0.001). The cutoff value for the orientation angle was determined to be 22.9°. The sensitivity, specificity, positive and negative predictive values, accuracy, odds ratio, and AUC for the prediction of breast malignancy using the orientation angle were 88.0%, 87.4%, 81.1%, 92.2%, 87.6%, 50.67%, and 0.925%, respectively. Multivariate analysis revealed that the orientation angle (> 22.9°), not circumscribed margin, and calcifications of the breast mass were independent factors predicting breast malignancy. The net benefit of adopting the orientation angle for predicting breast malignancy was 0.303. Based on these findings, it can be concluded that quantifying the orientation angle of breast masses is useful in predicting breast malignancy, as it demonstrates high sensitivity, specificity, AUC, and standardized net benefit. It optimizes the utility of the not parallel orientation in assessing breast mass malignancy.

Added value of ratio of cross diameters of the appendix in ultrasound diagnosis of acute appendicitis.

BACKGROUND: The maximum outer diameter (MOD) of the appendix is an essential parameter for diagnosing acute appendicitis, but there is space for improvement in ultrasound (US) diagnostic performance. AIM: To investigate whether combining the ratio of the cross diameters (RATIO) of the appendix with MOD of the appendix can enhance the diagnostic performance of acute appendicitis. METHODS: A retrospective study was conducted, and medical records of 233 patients with acute appendicitis and 112 patients with a normal appendix were reviewed. The MOD and RATIO of the appendix were calculated and tested for their diagnostic performance of acute appendicitis, both individually and in combination. RESULTS: The RATIO for a normal appendix was 1.32 ± 0.16, while for acute appendicitis it was 1.09 ± 0.07. The cut-off value for RATIO was determined to be ≤ 1.18. The area under the receiver operating characteristic curve (AUC) for diagnosing acute appendicitis using RATIO ≤ 1.18 and MOD > 6 mm was 0.870 and 0.652, respectively. There was a significant difference in AUC between RATIO ≤ 1.18 and MOD > 6 mm (P < 0.0001). When comparing the combination of RATIO ≤ 1.18 and MOD > 6 mm with MOD > 6 mm alone, the combination showed increased specificity, positive predictive value (PPV), and AUC. However, the sensitivity and negative predictive value decreased. CONCLUSION: Combining RATIO of the appendix ≤ 1.18 and MOD > 6 mm can significantly improve the specificity, PPV, and AUC in the US diagnosis of acute appendicitis.

Introducing the ratio of cross diameters of the appendix for ultrasound diagnosis of acute appendicitis can significantly increase specificity.

PURPOSE: To validate whether the introduction of the ratio of the cross diameters on the transverse section of the appendix (RATIO) ≤ 1.18 is useful for improving the ultrasound diagnosis of acute appendicitis (AA). METHODS: Data from 220 patients with AA and 110 patients with a normal appendix were retrospectively studied. The RATIO ≤ 1.18, maximal outer diameter (MOD) > 6 mm, and a combination of RATIO ≤ 1.18 and MOD > 6 mm were used for predicting AA. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated. RESULTS: The RATIO ≤ 1.18, MOD > 6 mm, and a combination of RATIO ≤ 1.18 and MOD > 6 mm for predicting AA showed a sensitivity of 90, 100, and 90%; specificity of 79.1, 27.3, and 88.2%; and AUC of 0.845, 0.636, and 0.891, respectively. When comparing the outcomes between MOD > 6 mm and a combination of MOD > 6 mm and RATIO ≤ 1.18, the specificity and PPV increased from 27.3 to 88.2% and 73.3 to 93.8%, respectively (all P < 0.0001). The sensitivity and NPV decreased from 100 to 90% and 100 to 81.5%, respectively (all P < 0.0001). The AUC increased from 0.636 to 0.891 (P < 0.0001). When comparing the AUC of MOD > 6 mm, and a combination of RATIO ≤ 1.18 and MOD > 6 mm for predicting AA with the AUC in a previous study, there were no significant differences between each other (all P > 0.05). CONCLUSION: Introducing the RATIO ≤ 1.18 for the evaluation of AA can improve the diagnostic performance and significantly increase specificity.

Findings and implications of focal fatty sparing of the liver at follow-up: a preliminary study based on sonography, computed tomography, and magnetic resonance imaging.

OBJECTIVES: The purpose of this study was to investigate the stability of focal fatty sparing of the liver and its clinical implications. METHODS: This prospective study consisted of 2 parts. In the first part, patients who underwent sonography and computed tomography (CT) or magnetic resonance imaging (MRI) were selected, and abnormal findings including focal and diffuse liver abnormalities were documented. In the second part, patients with nonalcoholic hepatic steatosis and focal fatty sparing were included and underwent follow-up with sonography in the second and third years (study interval, 34-37 months; mean ± SD, 35.9 ± 1.14 months). Some cases of focal fatty sparing that were not appreciable on sonography in the third year were reevaluated with CT. RESULTS: A total of 6781 patients with nonalcoholic hepatic steatosis and focal abnormalities were found among 35,337 people undergoing liver sonography; 2133 underwent CT, MRI, biopsy, or a combination thereof. Eighty-nine of those patients (63 male and 26 female; mean age, 37.6 ± 17.5 years; range, 18-72 years) with hepatic steatosis and focal fatty sparing were finally included. In the second part of the study, focal fatty sparing was appreciable on follow-up sonography in 78 cases (87.6%) and 61 cases (68.5%) in the second and third years, respectively. The hepatic steatosis resolved in the third year in 4 patients, and 26 of 28 cases (92.8%) of focal fatty sparing that were not appreciable on follow-up sonography were found on CT in the third year. CONCLUSIONS: Focal fatty sparing may change with fatty liver changes over time, and it is sometimes not appreciable on sonography, although it is often evident on CT. These findings imply that if differentiation between focal fatty sparing and a tumor is undetermined and follow-up is performed, should any change occur, then an abnormality that is no longer appreciable at follow-up is probably focal fatty sparing rather than a true tumor.

Frequency and implication of focal fatty sparing in segmental homogeneous fatty liver at ultrasound.

PURPOSE: The purpose of this study was to investigate whether focal fatty sparing arises from preexisting segmental homogeneous nonalcoholic fatty liver (NAFL). METHODS: Patients with various patterns of fatty liver were recruited from among 16,127 people, and 132 participants with segmental homogeneous NAFL were followed during the second year. All participants underwent ultrasonography. The sonographic findings in segmental homogeneous NAFL were analyzed. RESULTS: Of the 16,127 participants, 1,619 had fatty liver (10.0 %), and of these 1,568 had NAFL (9.72 %) and 51 had alcoholic fatty liver (0.31 %). Of the 1,568 patients with NAFL, 176 had homogeneous fatty liver with focal fatty sparing (11.2 %), 132 had segmental homogeneous fatty liver (8.42 %), and the rest had other patterns. At follow-up, of the 132 patients with segmental homogeneous fatty liver, 3 (2.3 %) were found to have a normal liver and 26 (19.7 %) diffuse homogeneous and heterogeneous fatty liver, and no focal fatty sparing was found (P < 0.001). CONCLUSIONS: Focal fatty sparing usually does not arise in preexisting segmental homogeneous NAFL. This implies that newly appearing nodular hypoechogenicity in segmental homogeneous fatty liver is more likely to be a true lesion rather than focal fatty sparing.

Approach to improving sonographic visualization of elongated left lobe of the liver and its implications.

PURPOSE: To determine whether visualization of the elongated left lobe of the liver can be improved by distending the stomach with water and the implications of this technique. METHODS: Forty-three out of 87 patients with elongated left lobe of the liver found at abdominal CT were included in this study after obtaining informed consent. Their livers were examined using ultrasound before and after drinking water. The left lobe of the liver was scanned from the subxiphoid and left subcostal approaches, with the sound beam directed to the spleen and the left lobe of the liver neighboring or behind the stomach; the elongated left lobe of the liver overlying the spleen was detected by scanning from the 9th-11th intercostal approach of the left flank. RESULTS: The overall visualization of the elongated left lobe of the liver before and after filling the stomach with water was 4.7 % (2/43) and 100.0 % (43/43), respectively (P < 0.001); and the overall visualization of the spleen before and after filling the stomach with water was 4.7 % (2/43) and 100.0 % (43/43), respectively (P < 0.001). CONCLUSION: Distending the stomach with sufficient water can substantially improve visualization of elongated left lobe of the liver at ultrasound, potentially improving detection of tumors in the liver and preventing misdiagnosis.

An alternative second performance of contrast-enhanced ultrasound for large focal liver lesion is necessary for sufficient characterization.

Focal liver lesions (FFLs) evaluated using contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT) may have the same or similar findings or substantial discrepant findings. Such phenomenon can be found in two performances of CEUS that the second performance of CEUS conducted shortly following the initial performance of CEUS. Discrepancy of two performances of CEUS for FFLs occurring in the same patient at a short internal has not been well addressed, which raises challenge for CEUS for the evaluation of FFLs. In this case study, such phenomenon is illustrated and implication is obtained.

Efficacy of logistic regression model based on multiparametric ultrasound in assessment of cervical lymphadenopathy - a retrospective study.

OBJECTIVES: To investigate whether a multiparametric ultrasound (MPUS) diagnostic model improves differential diagnosis of benign and malignant cervical lymph nodes. METHODS: MPUS evaluation was performed on 87 lesions in 86 patients, and related characteristics and parameters of the patients and lesions were studied and logistic regression models based on the MPUS characteristics of cervical lymph nodes were built. A receiver operating characteristic curve and area under the curve (AUC) were built for the evaluation of diagnostic performances. RESULTS: Of the 87 lesions in 86 patients, there were 31 benign and 56 malignant lesions. Regression models for Duplex ultrasound and MPUS were established. The Duplex ultrasound regression model showed a sensitivity, specificity, positive predictive value and negative predictive value of 94.4, 61.3, 86.3 and 80.9%, respectively. The predictive accuracy was 82.4%, and the AUC was 0.861. The MPUS regression model showed a sensitivity, specificity, positive predictive value and negative predictive value of 98.1, 61.3, 81.5 and 95.0%, respectively. The predictive accuracy was 84.7%, and the AUC was 0.894. The differences in AUCs between the Duplex ultrasound model and MPUS model, ultrasound model and ultrasonic elastography (UE), and Duplex ultrasound and UE were not significant (all p > 0.05); the differences in AUCs between the MPUS model and Duplex ultrasound, Duplex ultrasound model and Duplex ultrasound, and MPUS model and UE were significant (all p < 0.05). CONCLUSIONS: The Duplex ultrasound and MPUS models achieve significantly higher diagnostic performance for differentiating between benign and malignant cervical lymph nodes.

Research update on cell membrane camouflaged nanoparticles for cancer therapy.

Cell membrane-camouflaged biomimetic functionalization of nanoparticles has emerged as a promising strategy for cancer theranostics. These cell membranes used for camouflaging are generally isolated from natural or engineered erythrocytes, neutrophils, macrophages, T lymphatic cells, stem cells, and cancer cells. The camouflaging strategy of coating nanoparticles with cell membranes allows for tumor homotypic targeting through self-recognition as source cells, immune evasion, and a prolonged blood circulation time, thereby improving the effective payload delivery and tumor therapy. More so, some engineered cell membranes with functionalized peptides, proteins and moieties on membrane surface can be transferred for therapy in the same time. In this review, we summarize the latest research on various types of cell membrane-camouflaged nanoparticles aimed at anti-cancer therapy, focusing on the biological advantages of different cell membranes, constitutions of nanoparticles, fabrication processes, key findings, potential therapies, and discuss the major challenges and future opportunities.

Ultrasound classification of non-mass breast lesions following BI-RADS presents high positive predictive value.

PURPOSE: To investigate the positive predictive value of ultrasound classification of non-mass breast lesions (NMLs) following breast imaging reporting and data system (BI-RADS), and enhance understanding of NMLs. MATERIALS AND METHODS: Fifty-nine women with 59 ultrasound-detected breast NMLs were finally enrolled. The ultrasound (US) features of breast NMLs were analyzed; the incidence of malignant NMLs was calculated; the malignancy risk stratification of US for breast NMLs was established using BI-RADS. RESULTS: The incidence of malignant NMLs was 4.59% of all breast carcinoma. Non-ductal hypoechoic area, microcalcifications and posterior shadowing are the main US features of malignant NMLs, and there were significant differences between malignant and benign NMLs for microcalcifications and posterior shadowing. Taking BI-RADS 4B as a cutoff value, the sensitivity, specificity, area under the receiver operating characteristic curve (AUC), positive and negative predictive values, and odds ratio of the BI-RADS category were 82.98%,41.67%,0.62,84.78%,38.46% and 3.48, respectively. CONCLUSIONS: Stratifying the malignancy risk of breast NMLs using the BI-RADS the sensitivity and positive and predictive value are promising, but the likelihood of malignancy of malignant NMLs is underestimated, and that of benign NMLs is overestimated. The solution may be that to separate NMLs from breast masses and use different malignancy risk stratification protocols.

Validating and Comparing C-TIRADS, K-TIRADS and ACR-TIRADS in Stratifying the Malignancy Risk of Thyroid Nodules.

The thyroid imaging reporting and data system (TIRADS) was proposed by experts for optimal ultrasound evaluation of malignancy risk of thyroid focal lesions. There are several versions of TIRADS, some of them have been validated sufficiently, and the others have not been well assessed. In this study, a recently launched Chinese version of TIRADS (C-TIRADS) for malignancy risk stratification of thyroid nodules was validated, and the performance was compared to that of the Korean TIRADS (K-TIRADS) and American College of Radiology(ACR) TIRADS (ACR-TIRADS). Archives of 2177 patients who had undergone thyroid ultrasound examination, coarse needle tissue biopsy and/or surgery were reviewed, and 1978 patients with 1982 thyroid nodules were assessed according to the three TIRADSs. The histopathology was taken as the golden standard. The results showed the 1982 thyroid nodules were consisted of 1306 benign nodules and 676 malignant nodules. The malignancy risk accounted for 1.09%, 2.14%, 10.34%, 49.28%, 88.19% and 85.29% of the total nodules that were categorised as C-TIRADS 2, 3, 4A, 4B, 4C and 5, respectively; 0.00%, 1.64%, 2.87%,18.71% and 82.22% of the total nodules that were categorised as ACR-TIRADS 1, 2, 3, 4 and 5, respectively; 0.85%, 3.27%, 24.27% and 80.96% of the total nodules that were categorised as K-TIRADS 2, 3, 4 and 5, respectively. The correlation between the category of TIRADS and percentile of malignancy was 0.94 in the C-TIRADS, 1.00 in the ACR-TIRADS, and 1.00 in the K-TIRADS, respectively. The highest values of accuracy(AUC) of ROC curves of C-TIRADS 4B, K-TIRADS 5 and ACR-TIRADS 5 were taken as the cut-off values for risk stratification, respectively. The sensitivity, specificity, positive and negative predictive values and AUC by C-TIRADS 4B, K-TIRADS 5 and ACR-TIRADS 5 for malignancy risk stratification of thyroid nodules were 90.83%, 84.23%, 74.88% and 94.66% and 0.88, respectively; 83.58%, 89.82%, 80.95%, 91.36% and 0.87, respectively; and 85.50%, 90.35%, 82.10%, 92.33% and 0.88, respectively (P>0.05 for all). We concluded that the C-TIRADS has excellent performance in the malignancy risk stratification of thyroid nodules by the optimized cut-off value, which is comparable to that in K-TIRADS and ACR-TIRADS.

Recognition and application of the rectangular sonographic appearance of the urinary bladder.

OBJECTIVES: The purpose of this study was to investigate the rectangular sonographic appearance of the urinary bladder and its application. METHODS: A prospective study was conducted from May 2007 to December 2010. Fifty of 53 healthy women and 31 female patients who had large pelvic fluid-filled cystic lesions but were otherwise healthy in workup were selected. The mean ages ± SDs of the healthy participants and patients were 27.4 ± 13.5 and 30.4 ± 15.2 years, respectively. Both the healthy participants and patients underwent abdominopelvic sonographic evaluations of the pelvic cavity, including the uterus, adnexa, and bladder. The appearance of the bladder was assessed when moderately filled, overfilled, and after voiding, and the volume, presence or absence of the rectangular appearance of the bladder, and presence or absence of large pelvic cystic lesions were observed and compared. RESULTS: The bladders of the 50 healthy participants and 31 patients with pelvic fluid-filled lesions could show the rectangular appearance, but all of the pelvic cystic lesions did not show this finding; the difference between the bladders and cystic lesions was significant (P < .001). The volumes between the moderately filled bladders of the patients (322.7 ± 93.3 mL) and the cystic lesions (320.4 ± 78.9 mL) showed no significant difference (P = .07), and neither did the volumes between the moderately filled bladders of the healthy participants (322.4 ± 75.6 mL) and the cystic lesions (320.4 ± 78.9 mL; P = .38). CONCLUSIONS: The bladder can show a rectangular appearance on sonography. The rectangular appearance is unique and can be used for identification of the bladder. Definitive recognition of the bladder is useful for avoiding errors in situations likely to be associated with bladder-related pitfalls.

Liver stiffness measured with two-dimensional shear wave elastography comparable to histopathology falls dominantly on the severe liver fibrosis.

BACKGROUND: Two-dimensional shear-wave elastography (2D-SWE) has been used for years for liver assessment of patients with chronic hepatitis B (CHB), but its effectiveness remains unclear in different populations and using different ultrasound systems. OBJECTIVE: This study investigated the effectiveness of 2D-SWE in evaluating liver fibrosis in patients with CHB. METHODS: A prospective investigation was conducted after approval by the institutional ethics committee, with 116 out of 133 patients with CHB referred for liver biopsy included and 50 patients with healthy livers selected as controls. Assessment with 2D-SWE of liver stiffness measurement (LSM) was compared with histopathological results. Cutoff values for LSM were set to determine the degree of fibrosis, and area under the receiver operating characteristic (AUROC) curve, sensitivity, and specificity were calculated. RESULTS: The optimal LSM cutoff for differentiating healthy livers from livers with CHB and any liver fibrosis was 6.485 kPa, with an AUROC of 0.927, sensitivity of 94%, and specificity of 19.8%. The optimal LSM cutoff values for F1, F2, F3, and F4 were 6.19 kPa, 6.485 kPa, 7.46 kPa, and 9.62 kPa, respectively, with corresponding AUROCs of 0.516, 0.625, 0.779, and 0.881, respectively. Comparisons of AUROCs between F1 and F3, F1 and F4, F2 and F3, and F2 and F4 were all significantly different (P = 0.0001, P < 0.0001, P = 0.0139, and P = 0.0003, respectively); comparisons of AUROCs between F1 and F2 and between F3 and F4 were not significantly different (P = 0.1232 and P = 0.2462, respectively). Comparisons of LSMs between healthy livers and F0 and between healthy livers and a combination of F0 and F1 were significantly different (P = 0.002 and P = 0.001, respectively). Comparisons of LSMs between F1 and F2 and between F3 and F4 were not significantly different (P = 0.233 and P = 0.072, respectively). Other comparisons between fibrosis score groups were significantly different (F1 and F3, P = 0.003; F1 and F4, P = 0.007; F2 and F3, P = 0.013; F2 and F4, P = 0.015). CONCLUSION: 2D-SWE using a specific diagnostic ultrasound system is effective for the assessment of severe liver fibrosis and cirrhosis, but is limited in diagnosing mild liver fibrosis.