Deep learning-assisted ultrasonic diagnosis of cervical lymph node metastasis of thyroid cancer: a retrospective study of 3059 patients.

Objective: This study aimed to develop a deep learning system to identify and differentiate the metastatic cervical lymph nodes (CLNs) of thyroid cancer. Methods: From January 2014 to December 2020, 3059 consecutive patients with suspected with metastatic CLNs of thyroid cancer were retrospectively enrolled in this study. All CLNs were confirmed by fine needle aspiration. The patients were randomly divided into the training (1228 benign and 1284 metastatic CLNs) and test (307 benign and 240 metastatic CLNs) groups. Grayscale ultrasonic images were used to develop and test the performance of the Y-Net deep learning model. We used the Y-Net network model to segment and differentiate the lymph nodes. The Dice coefficient was used to evaluate the segmentation efficiency. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were used to evaluate the classification efficiency. Results: In the test set, the median Dice coefficient was 0.832. The sensitivity, specificity, accuracy, PPV, and NPV were 57.25%, 87.08%, 72.03%, 81.87%, and 66.67%, respectively. We also used the Y-Net classified branch to evaluate the classification efficiency of the LNs ultrasonic images. The classification branch model had sensitivity, specificity, accuracy, PPV, and NPV of 84.78%, 80.23%, 82.45%, 79.35%, and 85.61%, respectively. For the original ultrasonic reports, the sensitivity, specificity, accuracy, PPV, and NPV were 95.14%, 34.3%, 64.66%, 59.02%, 87.71%, respectively. The Y-Net model yielded better accuracy than the original ultrasonic reports. Conclusion: The Y-Net model can be useful in assisting sonographers to improve the accuracy of the classification of ultrasound images of metastatic CLNs.

Differential Diagnosis of DCIS and Fibroadenoma Based on Ultrasound Images: a Difference-Based Self-Supervised Approach.

Differentiation of ductal carcinoma in situ (DCIS, a precancerous lesion of the breast) from fibroadenoma (FA) using ultrasonography is significant for the early prevention of malignant breast tumors. Radiomics-based artificial intelligence (AI) can provide additional diagnostic information but usually requires extensive labeling efforts by clinicians with specialized knowledge. This study aims to investigate the feasibility of differentially diagnosing DCIS and FA using ultrasound radiomics-based AI techniques and further explore a novel approach that can reduce labeling efforts without sacrificing diagnostic performance. We included 461 DCIS and 651 FA patients, of whom 139 DCIS and 181 FA patients constituted a prospective test cohort. First, various feature engineering-based machine learning (FEML) and deep learning (DL) approaches were developed. Then, we designed a difference-based self-supervised (DSS) learning approach that only required FA samples to participate in training. The DSS approach consists of three steps: (1) pretraining a Bootstrap Your Own Latent (BYOL) model using FA images, (2) reconstructing images using the encoder and decoder of the pretrained model, and (3) distinguishing DCIS from FA based on the differences between the original and reconstructed images. The experimental results showed that the trained FEML and DL models achieved the highest AUC of 0.7935 (95% confidence interval, 0.7900-0.7969) on the prospective test cohort, indicating that the developed models are effective for assisting in differentiating DCIS from FA based on ultrasound images. Furthermore, the DSS model achieved an AUC of 0.8172 (95% confidence interval, 0.8124-0.8219), indicating that our model outperforms the conventional radiomics-based AI models and is more competitive.

[Fucoidan-Modified Phase-Transitional Contrast Agent for Ultrasound Imaging and Targeting of Hepatoma Cells].

Objective: To prepare a fucoidan-modified phase-transitional contrast agent (FPCA) and to evaluate its in vitro capabilities for ultrasound imaging and targeting of hepatoma cells. Methods: Nano-liposomes encapsulated with perfluoropentane were prepared using thin-film hydration and ultrasonic emulsification methods. Then, FPCA nanoparticles were prepared through chemical grafting of fucoidan and the characterization of their physical and chemical properties was performed. After applying external stimuli of heating with hot water bath and microwave irradiation, the phase-transition status of FPCA was observed with microscope. The imaging abilities of phase-transited FPCA on two-dimensional ultrasound and contrast-enhanced ultrasound were observed with ultrasonic diagnostic instrument. The ability of FPCA to target at hepatoma cells was evaluated and verified with fluorescence confocal observation and flow cytometry analysis. Results: The FPCA prepared in the study had an average diameter of (222.1±32.5) nm, displaying spherical appearance, good dispersion, good stability, and good biocompatibility. The phase-transition of FPCA was induced by both heating with hot water bath and microwave irradiation. For phase transition, the optimal temperature was found to be 50 ℃ and the preferred microwave power was 1.5 W/cm 2. Moreover, after phase transition, FPCA showed significant imaging enhancement on both two-dimensional ultrasonography and contrast-enhanced ultrasonography. Through fluorescein isothiocyanate (FITC) labeling, FPCA could specifically bind with hepatoma cells at a high binding rate of (96.19±1.62)%, while it rarely bound with normal liver cells, showing a binding rate of less than 10%. Conclusion: A new type of phase-transitional ultrasound contrast agent with good stability and biocompatibility was successfully prepared. It not only could enhance ultrasound imaging through phase transition, but also had specific active hepatoma cell-targeting properties.

Metastasis to the thyroid gland from primary breast cancer presenting as diffuse goiter: A case report and review of literature.

BACKGROUND: Metastasis to the thyroid gland (TM) from primary breast cancer is uncommon and usually presents as thyroid nodules; however, diffuse goiter without thyroid nodules is the first sign of TM in rare cases. Skip metastases (SMs) to the lymph nodes in breast cancer, defined as discontiguous higher-level metastases in the absence of lower levels of contiguous metastases, have been reported in the contralateral cervical area of the primary tumor site in rare cases. CASE SUMMARY: A 49-year-old previously healthy Chinese woman was diagnosed with right lateral invasive ductal carcinoma and underwent neoadjuvant chemotherapy treatment and bilateral mastectomy with axillary lymph node dissection. No malignancy of the left breast or axillary or distant metastases were identified preoperatively. However, enlarged left cervical lymph nodes were detected 36 mo after surgery, and rapidly enlarging thyroid glands without nodules were detected 42 mo after surgery. Fine-needle aspiration cytology was performed on the left cervical lymph nodes and left lobe of the thyroid, which were both revealed to contain metastases from the primary breast cancer. Additionally, the immunostaining profiles changed in the process of metastases. The patient was discharged with the NP (vinorelbine and cisplatin) regimen for subsequent treatment, and stable disease was determined when the curative effect was evaluated. CONCLUSION: Diffuse goiter may be the first sign of TM, and enlarged lymph nodes in the contralateral cervical area may be SMs of primary breast cancer.

Multimodal ultrasound imaging of primary thyroid schwannoma: A case report.

RATIONALE: Primary schwannoma of the thyroid gland is very rare, and its preoperative diagnosis is difficult. PATIENT CONCERNS: We report the case of a thyroid nodule in an 18-year-old woman, who presented with a mass in her left neck with stiffness and normal thyroid function. However, the patient complained of numbness in her left upper extremity, and ultrasound (US) features were suspicious of malignancy. DIAGNOSES: Multimodal US imaging was performed using B-mode, color doppler, ultrasonic elastography (UE), and contrast-enhanced ultrasound (CEUS). CEUS revealed heterogeneous enhancement and "target sign" within the tumor. The nodule was suspicious for malignancy and classified as TI-RADS 4b, while the elasticity values measured by UE indicated a benign lesion. Fine needle aspiration (FNA) was subsequently performed in the markedly contrast-enhanced area for biopsy. Cytological results revealed a benign schwannoma. INTERVENTION: The patient underwent left lobe resection. Postoperative pathology confirmed it to be a primary benign schwannoma of the thyroid. OUTCOMES: After thyroidectomy, the patient was followed-up with US. At present, all laboratory tests and thyroid imaging are normal, and the numbness of the left upper limb has disappeared. LESSONS: The combination of different US modalities is useful for the diagnosis of thyroid lesions. FNA performed under CEUS guidance improves the accuracy of biopsy sampling.

[Multiple Calcification of the Nipple Areola Complex: a Case Report of Infiltrating Syringomatous Adenoma of the Nipple].

A 41 years old female patient experienced enlarged right nipple more than 6 years ago. Physical examination showed enlarged and hardened right nipple (about 2 cm) but no tenderness. Mammographic results showed the mixed calcification pattern, which was presenting multiple sizes of circular and granular calcification of the nipple areola complex. Ultrasound revealed large calcification in the nipple areola area with posterior acoustic shadow. This patient underwent extensive excision of the nipple areola complex. The surgical margin was confirmed to be negative. Postoperative pathology confirmed an infiltrating syringomatous adenoma with ossification in some areas. Tumor cell infiltration was not found at the surgical margin. After 4 years of follow-up, no recurrence was found. The mammography and ultrasound findings of this benign tumor were significantly different from those reported in previous literatures. We should improve the understanding of the variousness of clinical imaging manifestations of this disease.

Partially cystic thyroid cancer on conventional and elastographic ultrasound: a retrospective study and a machine learning-assisted system.

BACKGROUND: Thyroid carcinoma constitutes the vast majority of all thyroid cancer, most of which is the solid nodule type. No previous studies have examined combining both conventional and elastic sonography to evaluate the diagnostic performance of partially cystic thyroid cancer (PCTC). This retrospective study was designed to evaluate differentiation of PCTC from benign partially cystic nodules with a machine learning-assisted system based on ultrasound (US) and elastography. METHODS: Patients with suspicious partially cystic nodules and finally confirmed were included in the study. We performed conventional US and real-time elastography (RTE). The US features of nodules were recorded. The data set was entered into 6 machine-learning algorithms. Sensitivity, specificity, accuracy, and area under the curve (AUC) were calculated. RESULTS: A total of 177 nodules were included in this study. Among these nodules, 81 were malignant and 96 were benign. Wreath-shaped feature, micro-calcification, and strain ratio (SR) value were the most important imaging features in differential diagnosis. The random forest classifier was the best diagnostic model. CONCLUSIONS: US features of PCTC exhibited unique characteristics. Wreath-shaped partially cystic nodules, especially with the appearance of micro-calcifications and larger SR value, are more likely to be malignant. The random forest classifier might be useful to diagnose PCTC.

[The Characteristics of Ultrasonography and Thermal Tomography in Various Molecular Subtypes of Breast Cancer].

OBJECTIVE: To explore the relationship between the imaging features of ultrasonography and thermal tomography and molecular subtypes of breast cancer. METHODS: 404 female breast cancer patients with complete imaging data and pathological findings from January 2014 to June 2017 were reviewed in the West China Hospital of Sichuan University. Breast cancer pathological molecules were classified into Luminal A like type, Luminal B like type, human epidermal growth receptor-2 (HER-2) overexpression type and Basal like type according to the expression of various immune markers. The correlation of ultrasonographic BI-RADS signs, thermal tomography characteristics and immunohistochemical results of breast cancer was analyzed. RESULTS: Breast cancer lesions with regular morphology, sharp margins, and enhanced posterior echo were more common in Basal like type; Microcalcification was more likely tend to appear in HER-2 expression breast cancer than other subtypes; The q-r curve of Luminal A like breast cancer was nearly 30°, and that was more common between 30°and 45° of HER-2 expression and Basal like breast cancer；The ratio of vertical and horizontal ≥1 of tumors and limited lymph node metastasis could not be used for distinguishing between different subtypes. CONCLUSION: Different molecular subtypes of breast cancer may behave routine ultrasound and thermal tomography imaging features.

Ultrasound Diagnosis of Breast Lymphoma and the Identification of Breast Infiltrating Ductal Carcinoma.

OBJECTIVES: By analyzing the B-mode ultrasound and color Doppler flow imaging characteristics of breast lymphoma (BL) and breast infiltrating ductal carcinoma (BIDC), we expected to discriminate these diseases. METHODS: Thirty-two patients with BL and 30 with BIDC confirmed pathologically were selected. The BL group was divided into nodular and diffuse groups. We analyzed and compared the general and imaging characteristics of the BL subgroups and the BIDC group. RESULTS: The mean maximum diameter of BL was 54.93 ± 43.74 cm, and that of BIDC was 23.90 ± 6.79 cm (P < .05). The differences between the nodular BL and BIDC groups in a circumscribed margin (60.00% versus 20.00%), calcification (20.00% versus 53.33%), aggregation characteristics (0.00% versus 53.33%), and density (73.33% versus 10.00%) were statistically significant (P < .05). The differences between the diffuse BL and BIDC groups in calcification (6.67% versus 53.33%), aggregation characteristics (6.67% versus 53.33%) and density (40.00% versus 10.00%) were statistically significant (P < .05). The difference in a circumscribed margin (60% versus 13.33%) between the BL subgroups was statistically significant (P < .05). The blood flow signal in BL lesions was richer than that in BIDC lesions (P < .05). CONCLUSIONS: Extrasuperior-quadrant single lesions in the BL group were larger than those in the BIDC group. The edges of the lesions in the nodular BL group were circumscribed and dense. Lesions in the diffuse BL group did not have a circumscribed margin, calcification, aggregation characteristics, or density. The blood flow signal in BL lesions was richer than that in BIDC lesions.

[Clinical and Ultrasonographic Features of Hepatic Infantile Hemangioendothelioma].

OBJECTIVE: To investigate the clinical manifestations and ultrasound features of hepatic infantile hemangioendothelioma (IHE). METHODS: This study retrospectively analyzed the clinical features and ultrasound characteristics of 8 patients of IHE,whose diagnosis was confirmed by surgery or liver biopsy from January 2010 to October 2016. RESULTS: Among the eight IHE patients,the male-to-female ratio was 1:1,with the mean age ranged from 15 d to 3 yr.,of which six individuals were younger than 3 months old. Seven patients had single lesion and one case was multiple. The average size of the lesions was (8.2±1.0) cm diameter. Hypoechoic (4 cases) and echogenic lesions (3 cases) were shown by echography,the lesions border and morphology were clearly defined in 7 cases.Furthermore,internal echoes were mostly inhomogeneous (4 cases),and calcification or peripheral halo were even visible. Color Dopplar flow imaging (CDFI) showed internal visible line or more abundant blood flow signal in 6 cases,mainly to venous blood flow. CONCLUSION: The age of onset for hepatic IHE seems less than three months. The echography with single lesion with clear border,regular solid mass or calcification in the tumor,should come to the possibility of IHE.

[Breast Thermal Tomography and High Frequency Ultrasound Imaging in Predicting Breast Cancer: a Preliminary Study].

OBJECTIVE: To determine the clinical value of breast thermal tomography and high frequency ultrasound imaging in diagnosing breast cancer. METHODS: Breast thermal tomography and high frequency ultrasound imaging were performed in 298 patients with breast lumps. The results were compared with pathological diagnosis. RESULTS: The ultrasound imaging had a sensitivity, specificity and the area under the curve (AUC) of 99.02%, 62.78% and 0.814, respectively, compared with 83.33%, 83.16% and 0.830 of thermal tomography, for diagnosing breast cancer. The two imaging results showed statistical significance in the test of non-inferiority (P < 0.001). A combination of the two imaging results produced a sensitivity, specificity and AUC of 83.33%, 89.79% and 0.866, respectively. CONCLUSION: Thermal tomography is not inferior to ultrasonography in detecting breast cancer. The two combined can improve specificity and accuracy of the diagnosis of breast cancer.

Ultrasonic Elastography Research Based on a Multicenter Study: Adding Strain Ratio after 5-Point Scoring Evaluation or Not.

BACKGROUND: This study aimed to confirm whether strain ratio should be added after evaluation of lesions with 5-point elasticity scoring for differentiating benign and malignant breast lesions on ultrasonographic elastography(UE). MATERIALS AND METHODS: From June 2010 to March 2012, 1080 consecutive female patients with breast lesions were recruited into a multicenter retrospective study, which involved 8 centers across China. Each institutional ethic review board approved the study, and all the patients gave written informed consent. All the patients underwent the UE procedure and the strain ratios were calculated and the final diagnosis was made by histological findings. The sensitivity, specificity, accuracy, PPV and NPV were calculated for each of the two evaluation systems and the areas under the ROC curve were compared. RESULTS: The strain ratios of benign lesions (mean, 2.6±2.0) and malignant lesions (mean,7.9±5.8) were significantly different (p <0.01). When the cutoff point was 3.01, strain ratio method had 79.8% sensitivity, 82.8% specificity, and 81.3% accuracy, while the 5-point scoring method had 93.1% sensitivity, 73.0% specificity, and 76.8% accuracy. The areas under the ROC curve with the strain ratio method and 5-point scoring method were 0.863 and 0.865, respectively(p>0.05). The strain ratio method shows better a diagnosis performance of the lesions with elasticity score 3 and 4. CONCLUSIONS: Although the two UE methods have similar diagnostic performance, separate calculation of the strain ratios seems compulsory, especially for the large solid breast lesions and the lesions with elasticity score 3 and 4.

[The Diagnostic Value of Double Contrast Enhanced Ultrasound in Colorectal Neoplasms].

OBJECTIVES: To determine the value of double contrast enhanced ultrasound (DCEUS) in detecting colorectal neoplasms. METHODS: The conventional abdominal ultrasound and DCEUS (hydrocolonal ultrasound+intravenous contrast-enhanced ultrasonography) were performed in 77 patients with 79 colorectal tumors. The clinical, ultrasonic and pathological data of the patients were reviewed. RESULTS: The conventional abdominal ultrasound detected 32 colorectal tumors (32/79, with a sensitivity of 40.1%), compared with 68 tumors found in DCEUS (68/79, with a sensitivity of 86.1%). The tumors were located accurately in 21.9%(7/32) and 88.2%(60/68) cases for the conventional abdominal ultrasound and DCEUS, respectively ( P<0.05). DCEUS accurately located 94.4%(51/54)cased with colon neoplasm. Two types of enhancing modes were found with colorectal neoplasm: entirely homogeneous enhancing and heterogeneous enhancing perpendicularly from the serosal part to the mucosal part. The enhancing modes were associated with the morphology of neoplasm. Thirty-nine segmented-thickened tumors were found with perpendicularly enhancing from the serosal surface to the mucosal surface, while 29 protruding tumors were found with enhancing from their pedicles or fund. CONCLUSIONS: DCEUS has higher detection sensitivity and location accuracy than conventional ultrasound.

Could ultrasonic elastography help the diagnosis of breast cancer with the usage of sonographic BI-RADS classification?

OBJECTIVES: The purpose was to evaluate whether BI-RADS (the Breast Imaging Recording and Data System) combined with UE (ultrasound elastography) could improve the differentiation and characterization of benign and malignant breast lesions by comparing with BI-RADS. METHODS: A total of 1080 patients with 1194 breast lesions were studied retrospectively at 8 different institutions from 3 geographic areas across China (North, South, and West) from June 2010 to March 2012. Each institutional ethic review board approved the study and all patients gave written informed consent. All the cases were examined by conventional US (ultrasonography) and UE prior to ultrasound-guided core biopsy. Performance of BI-RADS and BI-RADS combined with UE were compared in different size groups, age groups and area groups. RESULTS: BI-RADS combined with UE cloud improve the accuracy by 13.2% compared to BI-RADS alone for all lesions, 23.2% for <10 mm lesions, 13.3% for ≥10-20 mm lesions, 6.3% for ≥20 mm lesions, 18.4% for <50 years group, 1.7% for ≥50 years group, 13.7% for northern area group, 17.7% for southern area group and 4.4% for western area group. CONCLUSIONS: The help which UE contributed to BI-RADS was greater for breast lesions <10mm and <50 years group.

Value of contrast-enhanced ultrasonography in the differential diagnosis of enlarged lymph nodes: a meta-analysis of diagnostic accuracy studies.

OBJECTIVE: To evaluate the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) in differentiating between benign and malignant enlarged lymph nodes using meta-analysis. MATERIALS AND METHODS: Pubmed, Embase, SCI and Cochrane databases were searched for studies (up to September 1, 2014) reporting the diagnostic performance of CEUS in discriminating between benign and malignant lymph nodes. Inclusion criteria were: prospective study; histopathology as the reference standard; and sufficient data to construct 2?2 contingency tables. Methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Patient clinical characteristics, sensitivity and specificity were extracted. The summary receiver operating characteristic curve was used to examine the accuracy of CEUS. A meta-analysis was performed to evaluate the clinical utility in identification of benign and malignant lymph nodes. Sensitivity analysis was performed after omitting outliers identified in a bivariate boxplot and publication bias was assessed with Egger testing. RESULTS: The pooled sensitivity, specificity and AUROC were 0.92 (95%CI, 0.85-0.96), 0.91 (95%CI, 0.82-0.95) and 0.97 (95%CI, 0.95-0.98), respectively. After omitting 3 outlier studies, heterogeneity decreased. Sensitivity analysis demonstrated no disproportionate influences of individual studies. Publication bias was not significant. CONCLUSIONS: CEUS is a promising diagnostic modality in differentiating between benign and malignant lymph nodes and can potentially reduce unnecessary fine-needle aspiration biopsies of benign nodes.

[Characteristics of carotid atherosclerotic plaques in contrast-enhanced ultrasonography of neovascularization].

OBJECTIVE: To examine the characteristics of carotid arteriosclerotic plaques in contrast-enhanced ultrasonography (CEUS) of neovascularization. METHODS: Seventy-eight patients with carotid atherosclerotic plaques were examined with real-time CEUS. The perfusion modes of neovascularization in relation to the carotid arteriosclerotic plaques were identified. Patients were categorized into four groups according to their plaque echo. Five patients with serious atherosclerotic carotid artery disease received carotid endarterectomy. The intra-plaque neovascularization recorded by CEUS were validated by post-surgery pathology examinations of the tissues. RESULTS: In routing ultrasound examinations, 23 (29. 49%) plaques were identified with low-echo, 30 (38.46%) with mixed echo, 20 (25. 64%) with equal-echo, and 5 (6. 41%) with high-echo. The CEUS imaging revealed 60 carotid atherosclerotic plaques (76. 9%) with various degrees of enhancement in intra-plaque neovascularization. The thickness of plaques was correlated with the enhanced intensity of ultrasonography, with a Pearson correlation coefficient of 0. 686 (P < 0. 05). Compared with equal and high echo plaques, the enhanced intensity of ultrasonography in low and mixed echo plaques was higher (P<0. 05). The intra-plaque neovascularization recorded by CEUS was correlated with the grade of neovascularization resulted from post-surgery examinations (Spearman coefficient= 0. 886, P 0. 05). CONCLUSION: The real-time CEUS can assess the neovascularization in carotid atherosclerotic plaques non-invasively and quantitatively.

[The perfusion pattern of lymphadenopathy in contrast-enhanced ultrasonograph. under different reference conditions ].

OBJECTIVE: To determine the perfusion pattern of lymphadenopathy in contrast-enhanced ultrasonography (CEUS) under different reference conditions. METHODS: The CEUS perfusion patterns of 78 superficial lymph node lesions were compared with their pathology results. Time-intensity curves were used for comparison between benign and malignant lymph nodes. RESULTS: Inhomogeneous hyperenhancement was the main perfusion pattern (7/17, 41. 2%) in metastatic lymph nodes; compared with homogeneous hyperenhancement (2/4, 50. 0%) in lymphoma, homogeneous hyperenhancement and isoenhancement (6/52, 11. 5%) in reactive lymph nodes, and circle enhancement (2/4,50. 0%) in tuberculosis. Benign lymph nodes showed different mean value, peak intensity and area under the curve compared with their surrounding arteries (P<0. 05). But the differences in mean value, rise time, time to peak, peak intensity and the area under the curve between benign lymphadenopathy and their surrounding tissues were not statistically significant (P>0. 05). Malignant lymph nodes showed different mean value and peak intensity compared with their surrounding arteries and tissues (P<0. 05). The differences in time to peak between malignant lymph nodes and their surrounding tissues were also statistically significant (P< 0. 05). CONCLUSION: Different CEUS perfusion patterns are associated with different types of lymph node lesions. Time intensity curves with surrounding tissues as reference condition offer great values for the differential diagnosis of superficial lymphadenopathy.

Ultrasound elastography of breast lesions in chinese women: a multicenter study in China.

PURPOSE: Through analysis, the elastograms characteristics of breast lesions of Chinese women, a suitable diagnostic standard of quasistatic ultrasound elastography (UE) for Chinese women was proposed. METHODS: From June 2010 to March 2012, 1036 consecutive female patients (mean age, 44 years old) with breast lesions were recruited into a multicenter retrospective study, which involved 8 centers across China. Each institutional ethic review board approved the study, and all the patients gave written informed consent. All breast lesions underwent ultrasound and UE examination. Two radiologists analyzed the elastograms and separated the elastograms into 10 types. A final diagnosis was made on the basis of histologic findings. The characteristics of the elastograms were analyzed. Receiver operating characteristic curves were plotted for evaluating the diagnostic performance. Sensitivity, specificity, and accuracy were calculated. Differences in sensitivity, specificity, and accuracy were tested by using the McNemar test. RESULTS: There were 1150 lesions (593 benign, 557 malignant). There was a highly significant correlation between the elastogram color distribution and the percentage of malignant lesions, with a value of 0.92 (2P < .0001). Through analysis the different malignant percentages in different elastogram types, UE diagnostic standard was proposed, which was correlated with the blue percentage in the elastogram. The specificity, sensitivity, and accuracy of UE were 86.4%, 80.8%, and 83.5%, respectively. The specificity and accuracy of UE were higher than with ultrasound. The area under the curve was 0.86. CONCLUSION: UE could give valuable assessment in the diagnosis of breast lesions. The proposed UE diagnostic standard was suitable for Chinese women.

[Lateral neck lymph node metastasis in cN0 papillary thyroid carcinoma].

OBJECTIVE: To study the pattern of lymph node spread in papillary thyroid carcinoma (PTC) with clinically negative node (cN0). METHODS: A total of 106 patients with cN0 PTC who underwent total or subtotal thyroidectomy plus unilateral or bilateral lateral neck dissection (LND, level II-V or level I-V) at West China Hospital of Sichuan University between April 2004 and August 2010 were analyzed retrospectively. RESULTS: The lateral neck lymph node metastasis in cN0 PTC was significantly associated with sex (male, P = 0.007), tumor stage (T3/T4, P = 0.006), tumor size (> 1 cm, P = 0.014) and the number of positive central lymph nodes (≥ 2, P < 0.001), but not with age and multifocal tumor. Level III (47/116, 40.5%) was the most prevalent metastatic site, followed by level IV (41/116, 35.3%), level II (18/116, 15.5%) and level V (2/29, 6.9%). Of the cases with lymph node metastases in level III and IV, 89.8% (79/88) of primary thyroid tumors existed in the lower and middle sites of the thyroid lobes, while in the cases with lymph node metastases in level II, 77.8% (14/18) of primary thyroid tumors in the upper sites of the thyroid lobes, and 83.3% of cases with level II metastases were accompanied with level III metastases. Two cases with level V metastases were accompanied with metastases in levels II, III and IV. CONCLUSIONS: LND should be considered for cN0 PTC in male, with T3/T4 lesions and positive central lymph nodes ≥ 2, and the range of dissection should include level III and IV. Dissection of level II should be considered in cN0 PTC with primary tumor localized in the upper site of the thyroid lobe or with level III metastasis. Dissection of level V should be considered at present of metastases in level II, III, and IV. For cN0 PTC with tumor size < 1 cm, confined to the thyroid and without lymph node metastasis in the central compartment, LND is not recommended.