Development and validation of a prediction model for the diagnosis of breast cancer based on clinical and ultrasonic features.

Background: The aim of this study was to develop a simple and effective prediction model for calculating the probability of breast cancer by selecting clinical and sonographic features associated with breast cancer. Methods: A total of 402 lesions from 304 adult females from the ultrasound department of of PLA General Hospital from March 1st, 2020 to April 1st, 2021, were prospectively collected as the development group. The validation group included 121 lesions from 98 patients in our physical examination center from April 1st, 2021 to March 1st, 2022. Least absolute shrinkage and selection operator (LASSO) was applied to select clinical and ultrasonic variables, and R language was applied to build a web version of the interactive dynamic column line graph. The prediction model was validated by the validation group and the Breast Imaging Reporting and Data System (BI-RADS) categories. Calibration, differentiation and effectiveness were evaluated by R2, receiver operating characteristic (ROC) and decision curve analysis (DCA), respectively. Results: One hundred and seventy-nine malignant lesions and 223 benign lesions were included in the development group after exclusion and follow-up, whereas 62 malignant lesions and 59 benign lesions were enrolled in the validation group. Age, bloody nipple discharge, irregular shape, irregular border, heterogeneous echo, microcalcification, attenuation effects, decreased echo in surrounding tissues, lesions in ducts, abnormal lymph node morphology, nourishing vessel and nourishing vessel's resistance index (RI) greater than 0.70 were selected as independent risk factors. There was no significant difference in the area under the curve (AUC) of the development group between the prediction model and the BI-RADS category (0.959 vs. 0.953, P>0.05), and so as the validation group (0.952 vs. 0.932, P>0.05). For the prediction model, R2 of the development and validation group was 0.78 and 0.72. The DCA showed that the net benefits (NB) of the development group were higher than that of the validation group (0-100% vs. 0-90%). Conclusions: A prediction model was developed with the clinical and ultrasonic features for the precise and intuitive probability of breast cancer. This could provide a reliable reference for further examination.

Effect of vitamin D3 on hyperplasia of mammary glands in experimental rats.

BACKGROUND: 1,25(OH)2D3/vitamin D3 receptor (VD3/VDR) signaling pathway can inhibit the occurrence of breast cancer in many ways. We used vitamin D3 to interfere with Hyperplasia of mammary glands (HMG) model rats, and to explore the intervention effect of vitamin D3 on HMG. METHODS: We divided 42 female rats into six groups randomly: blank control group, hyperplasia model group, negative control group, and vitamin D3 (VD3) groups of low-dose (LVD, 5 µg/kg), medium-dose (MVD, 10 µg/kg), and high-dose (HVD, 20 µg/kg). We established HMG model in all groups except for the blank control group, then different dose of VD3 was intraperitoneal injected for VD3 groups and normal saline (NS) was given to the negative control group. After the experiment, the body weights, heights and diameters of nipples, and the thickness of the mammary gland of rats were measured. The serum content of sex hormone and VD3 were detected by enzyme-linked immunosorbent assay (ELISA). The tissues of mammary glands were analyzed by hematoxylin and eosin (HE) stain, and the expression of estrogen receptor α (ERα), progesterone receptor (PR), and VDR were detected by immunohistochemical (IHC) stain. Similarly, the total protein expression of ERα, PR, and VDR were measured by western blot. RESULTS: Compared with the hyperplasia group, rats in the VD3 groups displayed a marked decrease of the thickness of the mammary glands and the height and diameter of the nipples. The serum estrogen (E2), testosterone (T), luteinizing hormone (LH), and VD3 was markedly decreased in all VD3 groups (P<0.05). The IHC results showed that ERα and PR was decreased in all three VD3 groups; however, VDR was increased. Western blot demonstrated that both ERα and PR were reduced in VD3 groups, while the VDR level was significantly enhanced. Overall, the findings suggested that VD3 could be used in HMG treatment. CONCLUSIONS: Supplementation of VD3 could markedly decrease the mammary gland thickness, nipple diameter, and nipple height of rats, accompanied by the decrease of serum E2, T, and LH. Intervention with VD3 can lead to decreased expression of ERa and PR, in conjunction with the increase of VDR.

[Value of Thermal Tomography in Early Diagnosis of Breast Cancer in Animal Models].

Objective To obtain ultrasound and thermal tomography images of breast cancer during its growth and to assess the value of thermal tomography in detecting breast cancer. Methods Breast cancer models were established with NOD/SCID mice and SD rats. These animal models were examined by thermal tomography,plain ultrasound,and contrast-enhanced ultrasound. Tumor tissues were stained with CD34 to explore the relationship between tumor heat production and vascular pathology. Results Thermal tomography detected breast cancer 2-4 days earlier than ultrasound. The expression of CD34 in tumor tissues was increased,along with thickened,increased,and irregular blood vessels. Conclusion Thermal tomography can detect early breast cancer and is a promising tool for screening breast cancer.

HIF-1α interacts with Kindlin-2 and influences breast cancer elasticity: A study based on shear wave elastography imaging.

Breast cancer was the most frequent and the second most deadly cancer in women in 2018 in China; thus, early diagnosis of breast cancer is important. Studies have reported that tissue stiffness promotes cancer progression through increased collagen or fibrosis. Shear wave elastography (SWE) is a technique for measuring tissue stiffness. However, the mechanisms underlying cancer tissue stiffness or fibrosis are not entirely clear. Hypoxia-inducible factor 1 (HIF-1α) is expressed in response to hypoxia and contributes to tumor progression and metastasis. Kindlin-2 is an important co-activator of integrin. We have reported that Kindlin-2 influences breast cancer stiffness and metastasis. In this study, SWE was used to determine the maximum elasticity (Emax ) of patients before operation or core needle biopsy. The specimens were used for staining. Knockdown, overexpression, co-immunoprecipitation, and immunofluorescence assays were used to explore the relationship between HIF-1α and Kindlin-2. We found that HIF-1α and Kindlin-2 were highly expressed in invasive breast cancer and that the expression levels of HIF-1α and Kindlin-2 were correlated with Emax . HIF-1α interacts with Kindlin-2. Besides, HIF-1α and Kindlin-2 influence the expression of P4HA1, an important protein in collagen biogenesis through the integrin/FAK pathway. Our study first identified a new mechanism of invasive breast cancer stiffness by linking HIF-1α and Kindlin-2 to collagen biogenesis. Therefore, based on SWE, Emax could be a physical biomarker of invasive breast cancer for early, noninvasive diagnosis, and HIF-1α and Kindlin-2 could be pathological markers for early diagnosis and targeted therapy.

Precise visual distinction of brain glioma from normal tissues via targeted photoacoustic and fluorescence navigation.

The vexing difficulty in distinguishing glioma from normal tissues is a major obstacle to prognosis. In an attempt to solve this problem, we used a joint strategy that combined targeted-cancer stem cells nanoparticles with precise photoacoustic and fluorescence navigation. We showed that traditional magnetic resonance imaging (MRI) did not represent the true morphology of tumors. Targeted nanoparticles specifically accumulated in the tumor area. Glioma was precisely revealed at the cellular level. Tumors could be non-invasively detected through the intact skull by fluorescence molecular imaging (FMI) and photoacoustic tomography (PAT). Moreover, PAT can be used to excise deep gliomas. Histological correlation confirmed that FMI imaging accurately delineated scattered tumor cells. The combination of optical PAT and FMI navigation fulfilled the promise of precise visual imaging in glioma detection and resection. This detection method was deeper and more intuitive than the current intraoperative pathology.

Value of Computer Software for Assisting Sonographers in the Diagnosis of Thyroid Imaging Reporting and Data System Grade 3 and 4 Thyroid Space-Occupying Lesions.

OBJECTIVES: To analyze the ability of thyroid ultrasound computer-aided diagnosis (CAD) detection software (AmCAD-UT; AmCAD BioMed Corporation, Taipei, Taiwan) to assist sonographers in diagnosing Thyroid Imaging Reporting and Data System grade 3 and 4 space-occupying lesions and to provide evidence for ultrasound doctors (UDs) to use the diagnostic recommendations of the AmCAD system to inform clinical decisions. METHODS: In group 1, a retrospective study was performed on 234 cases of thyroid lesions confirmed by surgical pathology. The sensitivities, specificities, and accuracies of the diagnoses determined by the same UD independent of the software (UD) and after consulting the CAD software (UD + CAD) and by the software alone (CAD) were compared. In group 2, a prospective study was performed on 220 individuals with thyroid space-occupying lesions recommended by physicians from our hospital to undergo needle biopsy to confirm the diagnosis. Ultrasound images were imported into AmCAD, and recommendations for needle biopsy or periodic follow-up were obtained. According to the pathologic results of needle biopsy, consistency and coincidence rates of diagnostic recommendations for AmCAD were obtained. RESULTS: In group 1, CAD and UD + CAD diagnoses achieved significantly higher sensitivities and accuracies of diagnosis than did independent diagnosis by the UD (P < .05). In group 2, the software showed an overall intraclass correlation (κ = 0.786) and a diagnosis coincidence rate of 93.6% with needle biopsy results. CONCLUSIONS: AmCAD-UT Detection improved the ability of UDs to diagnose Thyroid Imaging Reporting and Data System grade 3 and 4 space-occupying lesions. Diagnostic recommendations of AmCAD are relatively consistent with needle biopsy results and can reduce the rate of unnecessary diagnostic needle biopsies.

Breast cancer research and treatment reconstruction of unilateral breast structure using three-dimensional ultrasound imaging to assess breast neoplasm.

PURPOSE: To develop and evaluate the accuracy of a three-dimensional (3D) US method for assessing unilateral breast reconstruction and discuss the feasibility of breast ultrasound 3D reconstruction of the unilateral breast compared with 3D MRI. METHODS: Sixty-four breast lesions were collected for surgical resection. (1) MRI and US imaging were used to reconstruct the 3D models of the breast neoplasm. The diameters for maximum length, width, and depth of the negative tumor margins were used as the primary standards for comparison. (2) The measurement direction was determined by the largest gravity change between the two body positions. (3) The vertical distance from the midpoint of breast neoplasm to the ipsilateral nipple was calculated via MRI and US reconstruction. RESULTS: (1) Comparison of the measured size and histopathology of the breast neoplasm showed that US, MRI, and histopathology were highly correlated (p < 0.001). (2) When compared with the other two vertical directions, the direction with the largest gravity change had the greatest difference between MRI and US measurements. (3) The vertical distance from the breast neoplasm to the ipsilateral nipple and skin junction was significantly different (p > 0.05). CONCLUSIONS: We have presented a novel US 3D reconstruction method for evaluating tumor size, which can provide a basis for investigated advanced visualization techniques for assessing breast tissue such as holographic presentation of 3D image data. These methods can provide physicians with a novel approach for making accurate surgical plans, for better communication with patients, and for more effective navigating throughout the operation.

Inhibition of hepatocellular carcinoma cell proliferation, migration, and invasion by a disintegrin and metalloproteinase-17 inhibitor TNF484.

BACKGROUND: The aim of this study was to test the effect of TNF484 on cell proliferation, migration, and invasion of hepatocellular carcinoma (HCC) cells. MATERIALS AND METHODS: Various doses (0, 1, 10, 50, and 100 nM) of TNF484 were applied to the HepG2 and Bel7402 cells, and cell proliferation was measured by using 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyl tetrazolium bromide assay after 72 h. Cell migration rate was measured using the xCELLigence system, and the cell invasion ability was examined by the three-dimensional spheroid BME cell invasion assay. The expression level of ADAM17 was also measured with RT-PCR. RESULTS: With the treatment of TNF484, the cell proliferation of HepG2 and Bel7402 cells was inhibited in a dose-dependent manner. Moreover, under TNF484 treatment, the cell migration rate as well as cell invasion ability of the HepG2 and Bel7402 cells were suppressed. CONCLUSION: TNF484 could inhibit the cell proliferation, migration, and invasion of some HCC cell lines, making it a potential therapeutic option for liver cancer treatment.

Chinese association of ultrasound in medicine and engineering, superficial organs and peripheral vessels committee expert consensus on clinical frequently asked questions in breast ultrasonography, June 2018.

Ultrasonography, the preferred imaging modality for breast diseases, has merits such as absence of radiation, high diagnostic accuracy, and convenience for follow-up, thus playing an important role in clinical diagnosis and management. The American College of Radiology (ACR) proposed Breast Imaging-Reporting and Data System (BI-RADS ) and has updated for several times. Gradually, the BI-RADS has been accepted and adopted by ultrasound physicians at all levels of hospitals in China, and it has played a certain role in improving the diagnostic level of breast ultrasound in China. In order to standardize breast ultrasound application and raise the status of ultrasound in clinical decision-making of breast diseases, based on the latest edition of ACR BI-RADS Atlas 2013, the committee has reached the "Expert Consensus on Clinical Frequently Asked Questions in Breast Ultrasonography"on a number of controversial Frequently Asked Questions (FAQs) in clinical practice (hereafter referred to as "Consensus"), and will be dedicated to updating the contents of the "Consensus", through further experience in clinical practice and the advent of new information from further studies. This consensus is only for reference purposes for medical personnel, and the processes outlined are not mandatory by law.

Research on the correlation between ultrasonographic features of breast cancer and expressions of ER, CD34 and p53.

PURPOSE: To investigate the expressions of estrogen receptor (ER), highly glycosylated type I transmembrane glycoprotein (CD34) and p53 in breast cancer tissue and analyze their correlation with color Doppler ultrasonographic features. METHODS: 86 patients who were admitted to our hospital with confirmed breast cancer diagnosis from January 2016 to December 2016 were selected. The expressions of ER, CD34 and p53 in cancer tissue and corresponding canceradjacent normal tissue were detected by immunohistochemical staining, and the color Doppler ultrasonographic features of patients were observed and analysed by Spearman correlation test. RESULTS: The positive rates of ER, CD34 and p53 expressions in cancer tissue of the case group were 46.5, 50 and 52.3%, respectively, significantly higher than 1.7% of the control group (p<0.05). The expressions of ER, CD34 and p53 in the cancer tissue of case group were correlated with the existence of calcification, spicule sign and lymph node metastasis detected by Doppler ultrasound (p<0.05), but not associated with tumor diameter and morphology (p>0.05). Spearman correlation test indicated positive correlation between expressions of ER and CD34 in cancer tissue of the case group (r=0.703, p<0.05); ER expression was positively associated with p53 expression (r=0.716, p<0.05) and CD34 expression was positively related to p53 expression (r=0.684, p<0.05). CONCLUSIONS: The expressions of ER, CD34 and p53 have significant roles in the occurrence and development of breast cancer. There is a certain correlation between expressions of ER, CD34 and p53 of breast cancer and color Doppler ultrasonographic features. The expression levels of ER, CD34 and p53 in breast cancer tissue can be evaluated by color Doppler ultrasonographic features, which is conducive to assessing the prognosis of these patients.

Values of ultrasound features and MMP-9 of papillary thyroid carcinoma in predicting cervical lymph node metastases.

Preoperative assessment of the cervical lymph node status is important in therapeutic schedule and further evaluations of prognosis for papillary thyroid carcinoma (PTC) patients. Our aim was to investigate the diagnostic values of conventional ultrasound (US), contrast-enhanced ultrasound (CEUS) features and the expression of MMP-9 of PTC in predicting the cervical lymph node metastases (LNM). In total, 156 patients with PTC confirmed by surgical pathology were included. Seventy-one patients had cervical LNM, while 85 patients had no LNM. The patients had cervical LNM (39.51 ± 13.29 years) were younger than those had no LNM (44.15 ± 10.94 years) (P = 0.02). Multivariate logistic regression results showed that tumor size ≥0.95 cm (OR = 13.47), ill-defined margin (OR = 4.31), internal heterogeneous low-enhancement (OR = 5.19) and ECE (OR = 25.25) were predictive for the presence of cervical LNM. The detection rate of ECE for the PTC with LNM by CEUS (81.48%, 44/54) was higher than by US (46.30%, 25/54). There was significant difference in MMP-9 intensity between PTC with and without cervical LNM (P = 0.000), and intense reactions (+++) were mainly found in the PTCs with LNM (80.95%, 17/21). In conclusion, the combination of conventional US, CEUS features and MMP-9 expression may serve as an effective tool for predicting the cervical LNM of PTC.

Kindlin-2 could influence breast nodule elasticity and improve lymph node metastasis in invasive breast cancer.

This study investigated the relationship between quantitative parameters of shear wave elastography (SWE, maximum elasticity [Emax], minimum elasticity [Emin], mean elasticity [Emean]), collagen intensity and Kindlin-2 expression in benign and malignant breast nodules, and if Kindlin-2 expression is related with lymph node metastasis. A total of 102 breast nodules from 102 patients were included in our study who underwent ultrasound elastography before surgery or core needle biopsy. There was a significant difference between benign and malignant breast nodules in Emax, Emean, collagen intensity and Kindlin-2 expression, but it had no difference in Emin. Collagen intensity and Kindlin-2 expression both correlated positively with Emax, but not with Emean. Among 38 malignant breast nodules, the average Emax of the metastasis group was higher than that of the non-metastasis group, but it had no statistical significance. Compared with the non-metastasis group, Kindlin-2 expression was considerably higher in the metastasis group. However, there was no difference in collagen intensity between the metastasis group and the non-metastasis group. In conclusion, Kindlin-2 and collagen might contribute to breast nodule elasticity through molecular mechanisms. In breast cancer, overexpression of Kindlin-2 might be a risk factor for lymph node metastasis.

Value of Contrast-enhanced Ultrasound and Conventional Ultrasound in the Diagnosis of Papillary Thyroid Carcinoma with Cervical Lymph Node Metastases.

Objective To compare the ultrasound features of papillary thyroid carcinoma with or without cervical lymph node metastasis (LNM). Methods Patients suspected of thyroid cancer underwent the conventional ultrasound and contrast-enhanced ultrasound (CEUS) examinations. Patients' age,sex,and ultrasound characteristics of lesions were recorded. With the surgical pathology as the golden standard,the ultrasound features were compared between the cervical LNM group and non-LNM group. Results Of 144 patients,51 had cervical LNM and 93 did not. Patients' ages,sex and number of lesions had no significant difference between two groups (all P>0.05). Tumor with LNM had maximum size greater than 0.85 cm,ill-defined margin (P=0.000),irregular shape (P=0.007),internal heterogeneous echogenicity (P=0.007),microcalcification (P=0.020),internal heterogeneous low-enhancement (P=0.002),peripheral non-enhancement ring (P=0.030),and extracapsular extension (P=0.000). Conclusion Conventional ultrasound and CEUS are helpful for predicting the cervical LNM of PTC. CEUS can obtain more accurate diagnostic results for the extracapsular extension,which contributes to the prediction of cervical LNM.

Percutaneous Removal of Benign Breast Lesions with an Ultrasound-guided Vacuum-assisted System: Influence Factors in the Hematoma Formation.

Objective To explore the influence factors in hematoma formation after removing benign breast lesions with an ultrasound-guided vacuum-assisted system.Methods A total of 232 females with 312 benign breast masses received excisional biopsy with ultrasound- guided vacuum-assisted system. The pathology of patients, Results of hematoma development and outcome, influence factors for hematoma occurrence (nodule size, nodule location, number of nodule, breast shape, menstrual period, efficacy time of bandage, and application of hemostatic agents during the procedure) were recorded.Results Pathologic examination revealed fibroadenomas in 138 lesions, fibroadenosis in 127 lesions, intraductal papillomas in 39 lesions, inflammatory change in 4 lesions, retention cyst of the breast in 3 lesions, and benign phyllodes tumor in 1 lesion. Thirty hematomas were observed in patients (9.6%). Finally, 97.0% hematomas were absorbed completely within 6 months follow-up. The incidence rates of hematoma were increased by 24.7%, 10.0%, 63.2%, 13.9% in the nodule diameter larger or equal to 25 mm group, removal of larger or equal to two nodules once time from one patient group, menstrual period group, and larger and loose breast group, respectively (all P<0.05). However, the incidences were decreased by 60.6% in the bandage performed for 12-24 hours or beyond 24 hours group (P<0.05). The multiple logistic regression models revealed that nodule size (χ2=15.227, P<0.001), number of nodule (χ2=7.767, P=0.005), menstrual period (χ2=24.530, P<0.001), and breast shape (χ2=9.559, P=0.002) were independent risk factors associated with hematoma occurrence, but efficacy time of bandage was a protective factor associated with hematoma occurrence.Conclusion The occurrence of hematoma after the minimally invasive operation was associated with nodule size, number of nodule, menstrual period, breast shape, and efficacy time of bandage.

Diagnostic Accuracy of Contrast-Enhanced Ultrasound Enhancement Patterns for Thyroid Nodules.

BACKGROUND The aim of this study was to investigate the accuracy of contrast-enhanced ultrasound (CEUS) enhancement patterns in the assessment of thyroid nodules. MATERIAL AND METHODS A total of 158 patients with suspected thyroid cancer underwent conventional ultrasound (US) and CEUS examinations. The contrast enhancement patterns of the lesions, including the peripheries of the lesions, were assessed by CEUS scans. The relationship between the size of the lesions and the degree of enhancement was also studied. US- and/or CEUS-guided biopsy was used to obtain specimens for histopathological diagnosis. RESULTS The final data included 148 patients with 157 lesions. Seventy-five patients had 82 malignant lesions and 73 patients had 75 benign lesions. Peripheral ring enhancement was seen in 40 lesions. The differences of enhancement patterns and peripheral rings between benign and malignant nodules were significant (p=0.000, 0.000). The diagnostic sensitivity, specificity, and accuracy for malignant were 88%, 65.33%, and 88.32%, respectively, for CEUS, whereas they were 98.33%, 42.67%, and 71.97%, respectively, for TC by conventional US. The misdiagnosis rate by conventional US was 57.33% and 34.67% by CEUS (p=0.005). With regard to the size of lesions, a significant difference was found between low-enhancement, iso-enhancement, high-enhancement, iso-enhancement with no-enhancement area and no-enhancement (p=0.000). CONCLUSIONS In patients with suspicious US characteristics, CEUS had high specificity and contributed to establishing the diagnosis. Therefore, CEUS could avoid unnecessary biopsy.

TACE combined with dendritic cells and cytokine-induced killer cells in the treatment of hepatocellular carcinoma: A meta-analysis.

Patients with hepatocellular carcinoma (HCC), a fatal cancer, have benefited significantly from TACE (transcatheter arterial chemoembolization) and immunotherapy treatments. Immunotherapy that includes dendritic cells and cytokine-induced killer cells (DC-CIK) in combination with TACE has been extensively applied in cases of HCC. Few decisive conclusions about these combined effects on the outcomes of HCC patients have been reached. Therefore, the present meta-analysis was performed to compare the efficacy of the combined usage of DC-CIK with TACE with a TACE therapy alone on the outcomes of HCC patients. Participants were enrolled in eight eligible trials. The efficiency and safety of TACE followed by DC-CIK immunotherapy (experimental group) and of TACE alone (control group) were compared. The meta-analysis results demonstrated that TACE plus DC-CIK immunotherapy is possibly superior to TACE alone in promoting a better overall response, for half-year, 1-year, and 2-year overall survival (OS), median overall survival (OS) and progression-free survival rates (PFS) in HCC patients. Further studies should be performed to confirm the effect of the combined therapy.

[Construction of Nude Mouse Model of Triple Negative Breast Cancer and Value of Thermal Tomography].

OBJECTIVE: To explore the early detection of breast cancer by ultrasonic imaging and thermal tomography of luciferase or green fluorescent protein (GFP)-labeled MDA-MB-231 breast cancer cell line-xenografts in nude mice. METHODS: Fluorescence-tagged lentiviral vectors were transfected into the triple-negative breast cancer cell line MDA-MB-231. These cells were implanted either subcutaneously under the right breast pad or intravenously into the tail vein of nude BALB/C mice. Thermal tomography and ultrasound imaging were used to detect tumor formation and to monitor tumor growth and metastasis in vivo. RESULTS: Triple negative breast cancer cell line-xenografts were used to successfully construct an orthotopic nude mice model of breast cancer metastasis in the peritoneum. Thermal tomography and ultrasound imaging were used together to detect small tumors. Thermal tomography imaging detected small tumors earlier than ultrasound imaging. CONCLUSIONS: Thermal tomography can be used to monitor changes in tumor growth and detect abnormal tissue. Therefore, it can serve as a convenient,rapid,sensitive, and reliable technique for early screening of human breast cancer.

Compression Real-time Elastography for Evaluation of Salivary Gland Lesions: A Meta-analysis.

OBJECTIVES: To evaluate the performance of compression real-time elastography for differentiation between benign and malignant salivary gland lesions. METHODS: A systematic literature database search was conducted. Pooled sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) values for real-time elastography were analyzed. Summary receiver operating characteristic (ROC) curves were also constructed. Heterogeneity was evaluated by χ(2) and I(2) tests. I(2) > 50% or P < .05 indicated heterogeneity, and then a random-effects model was applied. A Deek funnel plot was used to assess publication bias. Fagan plot analysis was performed to evaluate the clinical utility of real-time elastography. When heterogeneity was found, subgroup analyses were used to explore the sources of heterogeneity. A sensitivity analysis was conducted by omitting 1 study at a time and examining the influence of each individual study on the overall results. RESULTS: Nine articles with 581 lesions were included. The pooled sensitivity and specificity of real-time elastography for differentiation between benign and malignant lesions were 76% (95% confidence interval [CI], 65%-85%; 95% prediction interval [PI], 29%-95%) and 73% (95% CI, 62%-81%; 95% PI, 24%-96%), respectively. The LR+ and LR- were 2.81 (95% CI, 1.79-4.39; 95% PI, 0.65-12.16) and 0.33 (95% CI, 0.20-0.55; 95% PI, 0.07-1.69). The area under the ROC curve was 0.81 (95% CI, 0.77-0.84). No publication bias was detected, according to the Deek funnel plot (P = .51). The Fagan plot showed that when pretest probabilities were 25%, 50%, and 75%, positive posttest probabilities were 48%, 74%, and 89%, and negative probabilities were 10%, 25%, and 50%. CONCLUSIONS: Real-time elastography is a novel supplementary adjunct to conventional sonography for evaluation of salivary gland lesions. However, its overall accuracy is less promising, and biopsy may still be necessary in routine clinical practice.

Performance of Ultrasonic Shear Wave Elastography in Assessing Benign and Malignant Breast Lesions.

OBJECTIVE: To determine the best shear wave elastography (SWE) quantitative parameters including the maximum elasticity (Emax), mean elasticity(Emean), minimum elasticity, standard deviation and ratio of Emean (Eratio) in assessing benign and malignant breast lesions. METHODS: Totally 302 breast lesions underwent conventional ultrasound and SWE. Each lesion was classified according to ultrasound Breast Imaging Reporting and Data System (BI-RADS). The receiver operating characteristic(ROC) curves were used to determine the cut-off values of SWE quantitative parameters and to suggest breast lesions as benign or malignant. The sensitivity,specificity and the Youden index (sum of sensitivity and specificity minus 1) of SWE quantitative parameters were compared,and then the sensitivity,specificity and the Youden index of the combinations of each SWE parameters in assessing breast lesions were compared. RESULTS: The sensitivity,specificity and the Youden index of the Emax were 0.87,0.97 and 0.84,which were higher than other SWE parameters (all P<0.01). The sensitivity, specificity and the Youden index of Emax combined with ultrasound BI-RADS were 0.86,0.97 and 0.83, which were higher than other combinations (all P<0.01). CONCLUSIONS: Compared with other parameters, Emax has the best performance in assessing breast lesions. It can be used as an important quantitative indicator for the evaluation of benign and malignant breast lesions.

Comparison of transcutaneous contrast-enhanced ultrasound-guided injected hemostatic agents with traditional surgery treatment for liver, spleen and kidney trauma: a retrospective study.

BACKGROUND/AIMS: There is lack of studies on the effectiveness of transcutaneous contrast-enhanced ultrasound-guided injections of hemostatic agents for liver. spleen and kidney trauma. We compared treatment by hemostatic agents to surgical treatment in a retrospective interventional human study. METHODOLOGY: The study enrolled a total of 135 subjects from emergency unit of the Chinese People's Liberation Army General Hospital in Beijing. Within the cohort, 62 patients received contrast enhanced ultrasound-guided injection of hemostatic agents and the rest received surgical treatments. RESULTS: The injury severity score was lower in the hemostatic agent treatment group than surgical treatment group (p<0.05), but Glasgow coma scale scores did not reach statistical significance. The patients in the surgical treatment group had significantly higher hospital fees than those in the hemostatic treatment group (p<0.05), although the length of hospitalization did not significantly differ between two groups. Safety outcome variables pre- and post-treatment remained within normal limits in both groups. CONCLUSIONS: Hemostatic agents were more cost-effective than surgery to treat patients with liver, spleen and kidney trauma. However, given the limited sample size, subsequent studies drawing upon larger populations from multiple medical centers are necessary for follow-up.