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Objective:To evaluate the diagnosis and critical value reporting of ruptured tubal pregnancy by ultrasound.Methods:The clinical and ultrasound data of 70 patients with ruptured tubal pregnancy diagnosed by surgery in Peking Union Medical College Hospital from August 2017 to May 2021 were retrospectively analyzed to evaluate the diagnosis and critical value reporting of ruptured tubal pregnancy by ultrasound.Results:Among the 70 patients, 68 patients underwent gynecological ultrasonography and two patients did not. Sixty-three cases (92.6%, 63/68) were accurately diagnosed as adnexal ectopic pregnancy mass, abdominal and pelvic effusion/blood clot, and 5 adnexal ectopic pregnancy masses (7.4%, 5/68) were missed.Among the 5 missed cases, 4 cases (80%, 4/5) were heterotopic pregnancy (2 cases of IVF-ET 2 embryos, 1 case of patient taking ovulation induction drugs, 1 case of gravida with twin family history) and 1 case (20%, 1/5) of single tubal pregnancy. Critical values were reported in the all 63 cases of ruptured tubal pregnancy diagnosed by preoperative ultrasound.Conclusions:Ultrasound could accurately diagnose tubal pregnancy and assess its rupture, and timely report the critical value, effectively guarantee the medical safety. The particularity and complexity of ultrasound diagnosis in early pregnancy with assisted reproductive technique deserve more attention.
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Beh?et′s syndrome is a kind of chronic systemic vasculitis with involvement of multiple organs. Intestinal involvement of Beh?et′s syndrome is presently named as intestinal Beh?et′s syndrome. Recently, there is considering another kind of disease type with only typical intestinal ulcers. Since it is difficult to differentiate intestinal Beh?et′s syndrome from Crohn′s disease, intestinal tuberculosis, intestinal lymphoma, and intestinal manifestations of many other autoimmune diseases, and there is limited evidence for the therapy of intestinal Beh?et′s syndrome, proposing diagnosis and treatment recommendations for intestinal Beh?et′s syndrome through evidence-based judgment will be of great significance for clinical practice.
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Disfiguring dermatoses are a group of cutaneous diseases that affects the appearance and mental health of patients to various extents. Patients usually have high expectations for the treatment outcome, and there is an urgent need for convenient and accurate non-invasive auxiliary evaluation tools for better diagnosis and treatment. With the development of high-frequency ultrasonography, more and more skin diseases, including disfiguring dermatoses, have been objectively and accurately assessed by this technology. This review summarizes research progress in the application of high-frequency ultrasonography in the diagnosis and treatment of some disfiguring dermatoses.
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Objective:To analyze the inter-observer consistency of Smart 3D super microvascular imaging (Smart-3D SMI) in evaluating the blood flow of breast lesions.Methods:Prospective study on Smart-3D SMI images of 225 cases of continuous breast lesions in Peking Union Medical College Hospital from January to December 2018. Two sonographers conducted qualitative evaluation of vascular architecture(VA) under Smart-3D SMI, and took the mean value of three measurements evaluations of vascular index(VI). Weighted Kappa was used to test the consistency of the vascular architecture, and Bland-Altman scatter plot was used to calculate the 95% consistency limit of the measured data for the VI value. Spearman correlation coefficient was used to analyze whether the absolute difference of VI between observers was correlated with the mean value of VI.Results:The Weighted Kappa coefficient of Smart-3D SMI for the evaluation of VA by two sonographers was 0.839 (95% CI was 0.795-0.881, P<0.001), showing strong inter-observer consistency. Bland-Altman plot analysis of VI value showed that the value of 95.11% was within the clinically acceptable range and had good consistency, and there was a correlation between the difference of VI value between observers and the value of VI mean ( r s=0.639, P<0.001). Conclusions:There is a good inter-observer consistency in evaluating the blood vascular architecture and quantitatively measuring the blood flow abundance by Smart-3D SMI.
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Objective:To investigate the correlations between the labor process and the elastography parameters, and to explore the correlations among the elastography parameters.Methods:A total of 48 pregnant women in the late periods of pregnancy in Beijing Hospital from November 10, 2018 to January 30, 2019 were recruited prospectively. Elastography was performed to measure several elastographic parameters including the cervical length (CL), elasticity contrast index (ECI), hardness ratio (HR), internal orifice uterus(IOS) and external orifice uterus(EOS). They were followed up to delivery, and were divided into normal group and prolonged group according to the time duration of the first stage of labor. The correlation between the parameters and the time duration of the first stage of labor, as well as the relationships among the parameters were evaluated.Results:Among the 48 pregnant women, 35 cases were delivered by the vagina, 13 by cesarean section, 4 of whom were due to the prolongation of the first stage of labor and the other 9 cases for other reasons. The values of the CL and HR in normal group were significantly lower than that in prolonged group ( P=0.004, 0.02). The ECI in the normal group was significantly higher than that in the prolonged group ( P=0.046). Both the IOS and EOS in the normal group were higher than those in prolonged group without no significant difference( P>0.05). For the 35 women who underwent cervical elasticity assessment before labor and finally delivered vaginally, the duration of the first stage of labor was negatively correlated with cervical ECI ( r=-0.415, P<0.05). The ECI were negatively correlated with CL and HR ( r=-0.528, -0.374; P<0.05), and HR were negatively correlated with IOS and EOS ( r=-0.669, -0.558; P<0.01), whereas HR had no significant correlation with CL( P>0.05). Conclusions:The ECI of cervical tissue measured by cervical elastography can be used to semi-quantitatively evaluate the maturity of the cervix, it has potential value in predicting the labor duration and guiding clinical decision-making.
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Objective@#To evaluate the application value of ultrasound and dermoscopy in the precise preoperative evaluation of basal cell carcinoma (BCC) , and to analyze the association of high-frequency ultrasound and dermoscopic findings with pathological recurrence risk of BCC.@*Methods@#Clinical data were collected from 33 outpatients with confirmed BCC in the Department of Dermatology, Peking Union Medical College Hospital between April 2016 and December 2018, and high-frequency ultrasonographic and dermoscopic findings from 36 BCC lesions were analyzed. The lesions were classified into high-risk and low-risk groups based on pathological findings. Statistical differences in ultrasound and dermoscopic characteristics between high-risk and low-risk BCC groups were analyzed by using Fisher′s exact test, and the correspondence between high-frequency ultrasonographic and dermoscopic features of BCC was analyzed by calculating the simple matching coefficient.@*Results@#Of the 36 BCC skin lesions, 4 were high-risk lesions and 32 were low-risk lesions. Ultrasonographic features of the high-risk and low-risk lesions overlapped markedly, and no significant differences were observed between the high-risk and low-risk lesions with regard to the shape, boundary, internal echo, hyperechoic spots, or posterior echo (all P > 0.05) . However, 24 (75.0%) low-risk lesions were confined to the dermis, whereas 4 high-risk lesions involved the subcutaneous tissue, and there was a significant difference between the high-risk and low-risk BCC groups with regard to the distribution of BCC (P = 0.008) . In 5 BCC lesions, ultrasound could identify small easy-to-ignore lesions or deep and invisible lesions besides obvious lesions. There were no significant differences in dermoscopic features between high-risk and low-risk groups. However, none of spoke-wheel area, milky-red structureless area, milia-like cysts, comedo-like openings and rainbow pattern was observed in 4 high-risk BCC lesions. The simple matching coefficient between enhanced hyperechoic spots in the lesion observed by ultrasound and milia-like cysts under a dermoscope was 36.1%, and the simple matching coefficient between discontinuous hyperechoic echo in the epidermis on ultrasonography and ulcer/erosion under a dermoscope was 75.0%.@*Conclusion@#High-frequency ultrasound and dermoscopy both provide important information for preoperative evaluation of risk of BCC lesions, and high-frequency ultrasound can identify easy-to-ignore hidden lesions in clinical practice.
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Objective To evaluate the application value of ultrasound and dermoscopy in the precise preoperative evaluation of basal cell carcinoma (BCC),and to analyze the association of high-frequency ultrasound and dermoscopic findings with pathological recurrence risk of BCC.Methods Clinical data were collected from 33 outpatients with confirmed BCC in the Department of Dermatology,Peking Union Medical College Hospital between April 2016 and December 2018,and high-frequency ultrasonographic and dermoscopic findings from 36 BCC lesions were analyzed.The lesions were classified into high-risk and low-risk groups based on pathological findings.Statistical differences in ultrasound and dermoscopic characteristics between high-risk and low-risk BCC groups were analyzed by using Fisher's exact test,and the correspondence between high-frequency ultrasonographic and dermoscopic features of BCC was analyzed by calculating the simple matching coefficient.Results Of the 36 BCC skin lesions,4 were high-risk lesions and 32 were low-risk lesions.Ultrasonographic features of the high-risk and low-risk lesions overlapped markedly,and no significant differences were observed between the high-risk and low-risk lesions with regard to the shape,boundary,internal echo,hyperechoic spots,or posterior echo (all P ＞0.05).However,24 (75.0％) low-risk lesions were confined to the dermis,whereas 4 high-risk lesions involved the subcutaneous tissue,and there was a significant difference between the high-risk and low-risk BCC groups with regard to the distribution of BCC (P =0.008).In 5 BCC lesions,ultrasound could identify small easy-to-ignore lesions or deep and invisible lesions besides obvious lesions.There were no significant differences in dermoscopic features between high-risk and low-risk groups.However,none of spoke-wheel area,milky-red structureless area,milia-like cysts,comedo-like openings and rainbow pattern was observed in 4 high-risk BCC lesions.The simple matching coefficient between enhanced hyperechoic spots in the lesion observed by ultrasound and milia-like cysts under a dermoscope was 36.1％,and the simple matching coefficient between discontinuous hyperechoic echo in the epidermis on ultrasonography and ulcer/erosion under a dermoscope was 75.0％.Conclusion High-frequency ultrasound and dermoscopy both provide important information for preoperative evaluation of risk of BCC lesions,and high-frequency ultrasound can identify easy-to-ignore hidden lesions in clinical practice.
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Objective To evaluate the diagnostic features, characteristics, value, and clinical significance of the automated breast volume scanner (ABVS) in breast lesions. Methods A total of 288 patients with breast lesions diagnosed at the Breast Surgery Department of Peking Union Medical College Hospital between 2011 and 2015 were selected. Diagnostic and image data of preoperative ABVS examinations, hand-held breast ultrasound (HHUS), and surgery or biopsy pathology were collected. Pathology and imaging report results were recorded, accounting for the retraction phenomenon; receiver operating characteristic(ROC)curve analysis was used to calculate the diagnostic performance of the single and combined diagnostic methods. Results (1) A total of 311 breast lesions were found in 288 patients using the ABVS;histopathological diagnosis showed that there were 141(45.3%)malignant lesions and 170 (54.7%)benign lesions.(2)The detection rates of the retraction phenomenon using the ABVS in malignant and benign lesions were, respectively, 31.2% (44/141) and 1.8% (3/170); the difference was statistically significant (χ2=52.075,P=0.000). The detection rates of the retraction phenomenon using the ABVS in invasive ductal carcinoma (IDC), ductal carcinoma in situ (DCIS), and other types of carcinomas were, respectively, 38.5% (40/104), 10.5% (2/19), and 11.1% (2/18). There were significant differences between IDC and DCIS and between IDC and other types of carcinomas (χ2=5.575, P=0.018; χ2=5.085, P=0.024, respectively). (3) The sensitivity, specificity, and accuracy rates of single ABVS were 89.4%, 80.6%, and 90.1%,respectively,and those of single HHUS were 91.5%,74.1%,and 91.3%,respectively,for malignant lesion diagnosis. For diagnosis with combined ABVS with HHUS, the sensitivity, specificity, and accuracy rates were 93.6%,72.9%,and 93.2%,respectively.Sensitivity and specificity rates,and the advantage ratio of the retraction phenomenon were, 31.2%, 98.2%, and 25.251, respectively. Conclusions Use of the ABVS for coronary sections with the retraction phenomenon has important clinical value in identifying malignant breast lesions,especially in identifying IDC,but ABVS cannot completely replace HHUS.ABVS combined with HHUS can improve the diagnostic capacity, and is helpful for early diagnosis of malignant breast lesions.
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Objective To evaluate the contrast enhanced perfusion pattern of PTC micro-vascular imaging (MVI) quantitatively.Investigate the correlation between PTC MVI features and CD34 micro-vascular density (MVD).Methods Thirty-nine pathological and clinical confirmed sporadic PTCs were evaluated with real-time gray-scale contrast-ernhanced micro-vascular imaging under a low mechanical index.The micro-bubble agent was SoneVue.Of the 39 PTCs,33 were classical PTCs,6 were PTC with follicular variant (FVPTC).The △ ROI,which is the subtraction of peak echo intensity between the lesion region of interest (ROI) and normal thyroid parenchyma ROI,was used to evaluate the perfusion characteristics of PTC MVI quantitatively.The paraffined specimens were selected for immunohistochemical (IHC) staining for CD3,and the correlation between △ ROI and the CD34 were evaluated.Results △ ROI was strongly correlated with the CD34 expression (P=0.000),significant differences were detected in the distribution pattern of △ ROI value among different CD34 expression levels,no overlapping of the mean △ ROI values and the 95％ confidence intervals was found among the 3 CD34 expression levels.The PTC MVI perfusion was classified into 3 patterns,low perfusion,focal perfiusion and high perfusion,on the basis of combining△ ROI values with the peak ehco pattem in time-intensity curve.Conclusions The △ ROI is strongly correlated with the CD34 expression in papillary thyroid cancer.It can be used for the quantitative evaluation ofPTC MVI pattem and intensity as an objective indicator.
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Objective To study the correlation between the sonographic features of papillary thyroid microcarcinoma (PTMC) and high volume lymph node metastasis. Methods Medical records of 463 PTMC patients were reviewed. Cases of all patients are completed with lymph node metastasis identified by histopathology. Sonographic features such as lesion number, lesion size, echogenicity, calcification, envelope and vascularity of papillary microcarcinoma are recorded. Univariate and multivariate analysis was performed to investigating relationship between sonographic features and high volume lymph node metastasis. Results Twenty four patients have high volume central lymph node metastasis (5.2%, 24/463), in univariate analysis,sex(11.2% in male vs 3.4% in female),age(8.3% in<45 years vs 2.4% in≥45 years),calcification(8.3% in micro vs 0.0% in coarse, 3.2% in mixed and 0.7% in non) , extracapsular invasion (9.3% with vs 3.2% without)and size(9.2% in ≥7 mm vs 2.5% in <7 mm)showed significant difference;multiple logistic regression analysis showed that male(OR=3.205,P=0.009),age<45 years(OR=2.923,P=0.031), microcalcification(OR=9.380,P=0.031)and tumor size≥7mm(OR=3.272,P=0.013)is independent risk factor for high volume lymph node metastasis in the central compartment of PTMC. 10 patients have high volume lateral lymph node metastasis(2.2%,10/463),in univariate analysis,age(4.1% in<45 years vs 0.4% in≥45 years),number of lesions(5.3% in multiple vs 0.9% in single)showed significant difference;multiple logistic regression analysis showed that age < 45 years (OR=11.939,P=0.024) and multiple lesion (OR=7.247, P=0.007) is independent risk factor for high volume lymph node metastasis in the lateral compartment of PTMC. Conclusion Sonographic features of primary papillary microcarcinoma of the thyroid has correlation with high volume lymph node metastasis.
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Objective To compare the application of ultrasound and positron emission tomography/computed tomography (PET/CT) in diagnosis and lymph node staging of breast cancer. Methods Using automated breast volume scanner (ABVS) and PET/CT examination of 40 lesions in 38 patients, and for comparison with the pathological findings, the diagnostic accuracy of PET/CT and ABVS in breast cancer was comparatively analyzed. Results The sensitivity of ABVS in the diagnosis of breast cancer was 95.65%, the specificity was 70.59%, and the accuracy rate was 85.00%; the sensitivity of PET/CT in the diagnosis of breast cancer was 86.96%, the specificity was 82.35%, and the accuracy rate was 85.00%;the diagnostic sensitivity of their combined application was 86.96%, the specificity was 94.12%, and the accuracy rate was 90.00%. In 10 cases of breast cancer patients with lymph node metastasis, the sensitivity、specificity and accuracy rate of PET/CT in the diagnosis of metastatic lymph nodes were 90.0%, 92.8%, and 92.1% respectively; the sensitivity, specificity and accuracy rate of ultrasound in the diagnosis of metastatic lymph nodes were 70.0%, 96.4% and 89.5%, respectively. Conclusions The ABVS and PET/CT are both effective approaches in the diagnosis of breast cancer. Their combined application may significantly improve the specificity and accuracy of diagnosis. For patients with lymph node metastases, the sensitivity of PET/CT for lymph node metastases was high and conducive to clinical staging, which is an important implication in guiding the choice of clinical treatment and prognosis of patients.
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Objective To summarize the clinical and sonographic features of mammary Paget's disease (MPD). Methods Totally 34 female patients with pathologically confirmed MPD were retrospectively recruited. According to diagnosis,the clinical data and sonographic findings were reviewed and analyzed. Results Among these 34 patients,7 patients had single MPD; in the remaining 27 patients,16 were accompanied by invasive ductal carcinoma (IDC),7 by ductal carcinoma in situ (DCIS),3 by both IDC and DCIS,and 1 by other pathologic types of carcinoma. Twenty-four patients presented with typical clinical features of MPD,whereas 10 patients had no typical features of MPD. Among the 24 patients with typical clinical features,ultrasound examinations showed that 11 had echoic abnormality in nipple-areolar complex,14 had lesions of breast,and 14 had microcalcifications. Among the 10 patients without typical clinical features,ultrasound examinations revealed echoic abnormality in nipple-areolar complex in 3 cases,breast lesions in 9 cases,and microcalcifications in 6 cases. Among the 14 patients with echoic abnormality in nipple-areolar complex,all of them presented as rich blood flow in nipple detected by color Doppler ultrasonography. Conclusions The main clinical feature of MPD is abnormalities in nipple-areolar complex. Sonography can recognize the echoic abnormalities of nipple and lesions of breast. Sonographer should be careful of the nipple-areolar complex when mass is found in breast.
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Objective To discuss the clinical value of sonographic patterns of thyroid nodules in 2015 American Thyroid Association (ATA) management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer.Methods From January 2008 to December 2010,483 thyroid nodules in 480 patients who underwent ultrasound-guided fine-needle aspiration biopsy (US-FNAB) in Peking Union Medical College Hospital were included in this study.Ultrasound images of the thyroid nodules were reviewed and their sonographic patterns were determined as high suspicion,intermediate suspicion,low suspicion and very low suspicion according to 2015 ATA guidelines.112 nodules had surgical pathology.Diagnosis of other nodules depended on both US-FNAB pathology and follow-up of patients.Independent-sample t test was used to compare ages and sizes between benign and malignant nodules.Independent sample rank sum test was used to compare the malignancy risks between nodules of male and female patients,and between nodules that were solid,hypoechoic,with irregular margins,with microcalcifications and with taller than wide shape and each control group.Independent sample rank sum test was also used to compare malignancy risks of nodules with different sonographic pattems in 2015 ATA guidelines.Defining high-suspicion as positive,and intermediate to very low suspicion as negative,the diagnostic performance of sonographic patterns in 2015 ATA guidelines was calculated,including sensitivity,specificity,positive predictive value,negative predictive value,and accuracy.Results Of the 483 thyroid nodules,381 (78.9％) were benign and 102 (21.1％) were malignant proven by operation and follow-up.The malignancy rates were higher in nodules that were solid,hypoechoic,with irregular margins,with microcalcifications and with taller than wide shape than each control group,all of which had statistically significant differences (z=-6.255,-6.893,-13.000,-11.080,-6.718,P ＜ 0.001).Actual malignancy rates of nodules determined as high,intermediate,low and very low suspicion according to the ATA guidelines were 53.3％ (90/169),5.5％ (6/109),3.9％ (6/154),and 0 (0/51),respectively,with statistically significant differences between the four patterns (x2=161.462,P ＜ 0.001).When defining high suspicion as positive,and intermediate to very low suspicion as negative,the negative predictive value of sonographic patterns in ATA guidelines was relatively high (96.2％).Conclusion Sonographic patterns in 2015 ATA guidelines provide effective malignancy risk stratification for thyroid nodules.High suspicion is a good indication of US-FNAB for thyroid nodules and has relatively high negative predictive value.
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Background and purpose:Three-dimensional power Doppler angiography (3D-PDA) is a new technique to investigate the vessels in the organs, but the research in thyroid is limited. The purpose of this research was to investigate three-dimensional power Doppler angiography (3D-PDA) in differentiating malignant from benign thyroid nod-ules.Methods:This study prospectively evaluated 103 lesions in 94 patients who were scheduled for surgery. The patients underwent preoperative 3D-PDA scanning. Analysis of the 3D-PDA characteristics includes blood flow pattern, the num-ber of blood vessels, the shape of vessels, the spatial distribution of the vessels, the existence of rich local blood flow within nodules or in the parenchyma surrounding the nodules. This study also analyzed the difference between the benign lesions and the malignant lesions.Results:There were 50 benign lesions and 53 malignant lesions. The sensitivity and specificity of irregular vessels, the asymmetry spatial distribution, rich local blood flow within nodules or in the parenchyma surround-ing the nodules were 64.2%, 96.0%; 56.0%, 88.0%; 54.7%, 96.0%; 60.4% and 94.0%, respectively. The sensitivity, speci-ficity, positive predictive value, negative predictive value and accuracy of 3D-PDA were 83.0%, 94.0%, 93.6%, 83.9% and 90.3%, respectively.Conclusion:3D-PDA provides a useful tool to investigate vascularization of thyroid leisions.This technique is feasible for clinical application and plays an important role in diagnosis of thyroid nodules.
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ObjectiveTo investigate the correlation of ultrasonographic features of mesenteric fibromatosis and its pathological findings.MethodsTen mesenteric fibromatosis confirmed histopatho1ogica1ly in Peking Union Medical College Hospital were retrospectively reviewed.Results There were 7 females and 3 males. Their ages ranged 32~74 years (mean age 50.5±13.1 years). Of the 10 cases, 5 occurred in mesentery of the small bowels, 4 in the mesocolons, and 1 in junction portion of duodenum and jejunum. On ultrasound image, the diameters of the masses were 4.3~22.0 cm (mean 8.8±5.2 cm). 6 were regular and 4 were irregular. 9 of 10 cases were well-defined and 1 was poor defined. 6 has capsule echoic. All the 10 cases were hypoechoic. 9 presented as solid mass and 1 was solid-cystic leision. On gross pathology,they were solid, firm, grey and yellowish. Histopathology, there were boundles of fibroblasts in collagenous stroma with scarce degeneration. The cystic changes noted on sonograms corresponded histopathologically to areas of myxoid and cystic degeneration.ConclusionsMesenteric fibromatosis is a rare disease with characteristic ultrasonographic features, which were well correlated with their pathology findings. They mostly presents as well-circumscribed masses with hypoecho, regular shape and little vascularity. Ultrasound was important in the diagnosis of this disease.
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Objective To investigate the clinical and sonographic features of automimune pancreatitis (AIP). Methods We analyzed the clinical and sonographic features of 28 patients who were diagnosed as AIP in Peking Union Medical College Hospital from January 2013 to December 2014. Results Clinical features: the initial manifestation was obstructive jaundice in 19 cases. Fourteen cases were accompanied with type 2 diabetes. Eight cases were accompanied with IgG4-related diseases in other organs. Twenty-five cases had elevated IgG4 serum levels. Six cases had positive antinuclear antibodies. Eighteen cases had steroids therapy, 15 of whom had a good response to steroids, 3 of whom had a poor response. The ultrasonographic features were as follows:(1) Among 18 cases of diffuse type of AIP were as follows:16 cases had a diffused,“sausage-like”enlarged pancreas. Fifteen cases had diffusely decreased echogenicity, with fibrous hyperechoic spots. (2) Ten cases of local type of AIP were as follows:the pancreas had local enlarged segment or a“tumor”was formed, but the echogenicity of tumor was similar to the rest of the pancreas. Six cases had irregular shape. (3) Seven cases had ill-defined margin. Six cases had a little blood flow. Two cases had no blood flow. Seven cases had upstream dilation of the main pancreatic duct. Nineteen cases had dilation of the proximal section of the common bile duct. Twelve cases had dilation of the intrahepatic bile duct. Conclusions AIP have some sonographic features. Patients are often older, having abdominal pain, obstructive jaundice, and diffused or local enlargement of pancreas. Combining with the clinical data and laboratory examination may help the diagnosis of AIP.
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Objective To observe the ultrasonographic features of primary squamous cell carcinoma of the breast and its clinical and histopathological characteristics. Methods The ultrasonographic features, clinical and histopathological characteristics of 7 middle-aged women (median age 61 years old) with primary squamous cell carcinoma of the breast confirmed histopathologically from January 1995 to December 2014 in Peking Union Medical College Hospital were retrospectively reviewed. Results There were 8 lesions in seven cases. Six cases were single lesion and 1 case with multiple lesions, the diameters of the lesions were 7.0-60.0 mm [mean (34.0±19.6) mm]. On grayscale ultrasound, 6 lesions with solid compoments were hypoechoic, 2 lesions with solid and cystic compoments were complex echogenic, the lesions all had irregular shape and indistinct margin, 2 lesions had calcifications. On color Doppler flow imaging, 7 lesions had rich blood flow signals (Ⅱor Ⅲ) and 1 lesion had no blood flow signal. On gross histopathological examination, 6 masses were solid, pale-white colored, medium texture and the boundary was not clear. Two masses had cystic cavity. One old patient who was 70 years old had several times chest wall recurrence after mastectomy. On ultrasonography, the lesion showed an anechoic cyst with thick wall. Two chest wall recurrence lesions were cystic with thick wall. Microscopic examination showed squamous cell carcinoma infiltrating into the fiber adipose and skeletal muscle tissue. Conclusions Primary squamous cell carcinoma of the breast is more common in large tumor size. Ultrasound can show the more cysticcomponents of the tumor and abundant vascularity, which is helpful for diagnosis.
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Objective To measure total hemoglobin concentration (THC) of breast lesion using US-guided diffused optical tomography(DOT) and to investigate the THC optimal threshold value in different size breast lesions.Methods DOT was performed on 500 breast lesions and surgical pathology was as the gold standard.The optimal diagnostic threshold and the efficacy were figured out.Results There were 265 benign and 235 malignant lesions.In malignant lesions,THC of ≥2 cm lesion group was higher than that of ＜2 cm lesion group(P =0.000).In benign lesions,there was no statistical difference between ≥2 cm group and ＜2 cm group (P =0.13).As for ＜2 cm breast lesions,when a THC threshold value of 146.9 μmol/L and 102.2 μmol/L were used,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 74.2％,70.0％,71.7％,62.9％,79.9％ and 86.7％,44.4％,61.6％,51.6％,83％,respectively.As for ≥2 cm breast lesions,when a THC threshold value of 210.4 μmol/L were used,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 74.0％,86.7％,79.1％,89.2％,69.2％.Conclusions THC of breast cancer increased with the increasing size of lesions.The different diagnostic threshold value should be used according to different size lesions so as to enhance sensitivity,specificity and accuracy.
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Objective To evaluate the ultrasonographic (US) features and evolution of breast fat necrosis after cosmetic augmentation with autologous fat obtained by liposuction, to help distinguish fat necrosis from more ominous breast masses. Methods Breast sonography was performed on 38 patients underwent bilateral breast augmentation by autologous fat injection to evaluate the grafted fat tissues in interval of 3-6 month after the operation. Observations in follow up sonography included the sizes,positions, shape,echogenicity,margin features, calcifications and evolutions of the suspicious nodules in the breasts. Results Seventy-six nodules occurred in 25 of the 38 patients were detected after the fat graft. Among the 76 nodules,52 were cystic(68. 4%) ,8 were complex(10. 5%) and 16 were solid(21.1%). The analysis of the predominant features of the nodules sonographic appearances were as follows: all the nodules had no flow signal, 66 (86. 8%) had clear margins,54(71. 1%) had regular shapes,52 were cystic(68. 4%) ,63(82. 9% ) had no calcifications, 10(13. 2%) had egg-like calcifications,74(97. 4% ) had no halo,and the positions of the solid components in 8 complex nodules move following the change of the detected body position. There were 7 nodules with fat necrosis removed surgically and confirmed by pathology. Conclusions Breast ultrasound is an accurate and simple method to follow up the temporal changes of the fat nodules after autologous fat injection. It may help to avoid unnecessary biopsies.
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Objective To evaluate the inter-observer variability of static breast sonogram final assessment among observers with different breast imaging experience, using the first edition of the Breast Imaging Reporting and Data System(BI-RADS) for ultrasound. Methods Thirty patients with 30 breast lesions were included who underwent beast lesions resection operation. A pathological diagnosis was available for all 30 lesions:16 (53%) malignant and 14 (47%) benign. Twelve radiologists independently reviewed two sonograms of each lesion, and assigned a final BI-RADS assessment category. Inter-observer variability was measured using kappa statistic. Positive predictive value(PPV) and negative predictive value (NPV) for final assessment were also calculated. Results As for the experienced observers,kappa values of categories 3,4 and 5 were 0.72,0.28 and 0.60,NPV of category 3 was 93% ,PPV of category 5 was 97% ,all of which decreased as the breast imaging experience reduced. PPVs of categories 4a,4b and 4c were 56 % ,88% and 69%, respectively. Conclusions Using BI-RADS final assessment, radiologists with sufficient breast imaging experience can provide accurate and consistent assessment for breast ultrasonography,but the agreement of diagnosis decreased as the breast imaging experience reduced. The clinical feasibility of 4a,4b and 4c subcategories is uncertain.