Predicting Breast Cancer in Breast Imaging Reporting and Data System (BI-RADS) Ultrasound Category 4 or 5 Lesions: A Nomogram Combining Radiomics and BI-RADS.

Radiomics reflects the texture and morphological features of tumours by quantitatively analysing the grey values of medical images. We aim to develop a nomogram incorporating radiomics and the Breast Imaging Reporting and Data System (BI-RADS) for predicting breast cancer in BI-RADS ultrasound (US) category 4 or 5 lesions. From January 2017 to August 2018, a total of 315 pathologically proven breast lesions were included. Patients from the study population were divided into a training group (n = 211) and a validation group (n = 104) according to a cut-off date of March 1st, 2018. Each lesion was assigned a category (4A, 4B, 4C or 5) according to the second edition of the American College of Radiology (ACR) BI-RADS US. A radiomics score was generated from the US image. A nomogram was developed based on the results of multivariate regression analysis from the training group. Discrimination, calibration and clinical usefulness of the nomogram for predicting breast cancer were assessed in the validation group. The radiomics score included 9 selected radiomics features. The radiomics score and BI-RADS category were independently associated with breast malignancy. The nomogram incorporating the radiomics score and BI-RADS category showed better discrimination (area under the receiver operating characteristic curve [AUC]: 0.928; 95% confidence interval [CI]: 0.876, 0.980) between malignant and benign lesions than either the radiomics score (P = 0.029) or BI-RADS category (P = 0.011). The nomogram demonstrated good calibration and clinical usefulness. In conclusion, the nomogram combining the radiomics score and BI-RADS category is potentially useful for predicting breast malignancy in BI-RADS US category 4 or 5 lesions.

[Explore new clinical application of Huanglian and corresponding compound prescriptions from their traditional use].

Huanglian is a commonly used Chinese medicinal herb in the ancient and the present. It has a history of 2000 years in clinical application, having the efficacy of "Clear away heat and remove dampness, purge the sthenic fire and eliminate toxic materials", therefore can be used for various diseases or syndromes in types of dampness-heat and fire-toxin by internal or external use. Compound prescriptions mainly based on Huanglian or prescribed by Huanglian, such as Puji Xiaodu Yin, Huanglian Jiedu Tang, Zhusha Anshen Wan, Qingying Tang, Angong Niuhuang Wan, Niuhuang Qingxin Wan, Jiaotai Wan, Huanglian Ejiao Tang, Zuojin Wan, Danggui Longhui Wan, Huanglian Yanggan Wan, Wu Xiexin Tang, Lianpu Yin, Gegen Huangqin Huanglian Tang, Baitouweng Tang, Xianglian Wan etc. All of these are well-known formulas for clearing away toxin of heat-fire of heart and liver, as well as dampness-heat of stomach and intestines. Nowadays, Huanglian is generally considered as a kind of antibiotic and antivirus herb and is widely used for many infective diseases. In fact, it is also used to cure cardiovascular and cerebrovascular diseases, diabetes and cancer based on pharmacological studies. Having been using Huanglian in treating the above diseases and having conducted clinical and experimental research on cancer and liver diseases, the author observed that Huanglian and its compound prescriptions have obvious effects on liver diseases such as acute or chronic hepatitis, liver fibrosis, liver cirrhosis and liver cancer due to types of dampness-heat and fire-toxin. Part of the effects has been proved by experimental research and it is worth carrying out more research in this area for development and clinical application.