Enhancing the Extent of Resection in Glioma Surgery Through the Integration of Intraoperative Contrast-Enhanced Ultrasound and Fluorescein Sodium.

OBJECTIVE: Due to the infiltrative nature and high local recurrence of gliomas, particularly high-grade gliomas, gross total resection (GTR) of a tumor is the first critical step in treatment. This study aimed to determine whether the integration of intraoperative contrast-enhanced ultrasound (CEUS) and fluorescein sodium can improve the identification of tumor boundaries and residuals, and increasethe extent of resection (EOR) to better protect neurological function. METHODS: We retrospectively analysed clinical data from 87 glioma surgeries and categorised the patients into 3 groups: CEUS plus fluorescein sodium, fluorescein sodium alone and microsurgery alone. RESULTS: In terms of EOR, GTR was achieved in 22 (91.7%) patients in the CEUS plus fluorescein sodium group, which was significantly higher than that in other groups. In the subgroup analysis of tumors with lobulated or satellite lesions and WHO grade III or IV gliomas, CEUS plus fluorescein sodium group showed the highest GTR (86.7% and 88.9% respectively) among the groups. Logistic regression analysis of factors that may affect the GTR of tumors showed that the functional areas involvement and the presence of lobulated or satellite lesions were risk factors, whereas CEUS plus fluorescein sodium group was a protective factor. However, CEUS plus fluorescein sodium group had the longest surgery time. CONCLUSIONS: Intraoperative CEUS with fluorescein sodium is a real-time, straightforward, safe, and effective approach to perform surgical resection of gliomas. This approach assists surgeons in identifying tumor boundaries, residual tumors, and normal brain parenchyma, which increases the EOR.

Imaging manifestations of small cell neuroendocrine carcinoma of the ureter.

Small cell neuroendocrine carcinoma (SCNEC) of the ureter is a rare malignant tumor originating from the metaplasia of urothelial cells. This report presents a case of ureteral SCNEC that was preliminarily disclosed by computed tomography; thereafter, transabdominal ultrasonography, transrectal ultrasonography, and magnetic resonance urography were performed to characterize the mass.

Endorectal power Doppler/grayscale ultrasound-guided biopsies vs. multiparametric MRI/ultrasound fusion-guided biopsies in males with high risk of prostate cancer: A prospective cohort study.

Multiparametric MRI fusion with transrectal ultrasound (mpMRI/TRUS)-guided biopsy has the sensitivity of mpMRI with the practicality of TRUS, but males with no cancerous lesion(s) detected on mpMRI have a considerable remaining risk of cancer. Endorectal power Doppler ultrasound improves the sensitivity of grayscale ultrasound-guided biopsies. The objective of the present study was to evaluate the beneficial effect of endorectal power Doppler/grayscale ultrasound-guided biopsy over that of mpMRI/TRUS-guided biopsy for decision-making regarding prostatectomy in males with a high risk of prostate cancer. Data regarding endorectal power Doppler/grayscale ultrasound-guided biopsies and mpMRI/TRUS-guided biopsies of 1,094 males with elevated specific prostate antigen, were included. Radical prostatectomy was performed in males aged <70 years with Gleason scores ≥3+4 in any one of the biopsy reports. The histopathological data of the surgical specimen of 776 males were included in the analysis. Compared to the histopathology of the surgical specimen, endorectal power Doppler/grayscale ultrasound-guided biopsies had a lower sensitivity (0.930 vs. 1.000; P<0.0001) but mpMRI/TRUS-guided biopsies had the same sensitivity (0.990 vs. 1.000; P=0.02). The accuracy of mpMRI/TRUS-guided biopsies was higher than that of endorectal power Doppler/grayscale ultrasound-guided biopsies (0.944 vs. 0.783). On mpMRI, lesions of 105 subjects (10%) with a Likert scale score of <3 were identified. Among them, 14 subjects (2%) had Gleason scores of ≥3+4 as determined by endorectal power Doppler/grayscale ultrasound-guided biopsies. In addition, 20 (2%) false-positive lesions compared to the histopathological analysis of the surgical specimen were identified from mpMRI/TRUS-guided biopsies. In conclusion, mpMRI/TRUS-guided biopsy was indicated to have a moderate performance and endorectal power Doppler/grayscale ultrasound-guided biopsy had a scant performance for decision-making regarding prostatectomy.

A Combination of UTMD-Mediated HIF-1α shRNA Transfection and TAE in the Treatment of Hepatic Cancer.

To explore the antitumor effect of hypoxia-inducible factor-1α short hairpin RNA (HIF-1α shRNA) delivered by ultrasound targeted microbubble destruction (UTMD) and transcatheter arterial embolization (TAE) on rats with hepatic cancer. After the models of transplantation hepatoma were established, Wistar rats were randomly divided into 4 groups: Control group, UTMD group, TAE group, and UTMD+TAE group. Contrast-enhanced ultrasound (CEUS) was used to monitor tumor size on day 14 after four different treatments. Western blotting and immunohistochemistry were applied to measure the protein level of HIF-1α and VEGF in the hepatic cancer tissue. In comparison with UTMD+TAE group (21.25±10.68 days), the mean survival time was noticeably shorter in the Control group and TAE group (13.02±4.30 days and 15.03±7.32 days) (p<0.05, respectively). There was no statistical difference between UTMD+TAE group and UTMD group of the mean survival time (p>0.05). In addition, our results proved that the tumor sizes in UTMD+TAE group were obviously smaller than those in other groups (p<0.05, respectively). By CEUS, we clearly found that the tumor size was the smallest on day 14 in the UTMD+TAE group. The western blotting and immunohistochemistry results proved that the protein levels of HIF-1α and VEGF in UTMD+TAE group were obviously lower than those in TAE group and Control group on days 7 and 14 (p<0.05, respectively). However, there was no statistical difference between UTMD+TAE group and UTMD group (p>0.05). In this study we tried to explore the antitumor effect through a combination of UTMD-mediated HIF-1α shRNA transfection and TAE on rats with hepatic cancer. Our results showed that UTMD-mediated HIF-1α shRNA transfection and TAE can obviously silence HIF-1α and VEGF expression, thereby successfully inhibiting the growth of the tumor.

Systemic immune-inflammation index and ultrasonographic classification of breast imaging-reporting and data system predict outcomes of triple-negative breast cancer.

INTRODUCTION: This research was conducted to explore the relationship between the systemic immune-inflammation index (SII) and breast imaging-reporting and data system (BI-RADS) classification using ultrasonography and the survival of patients with triple-negative breast cancer (TNBC) in a cohort of Chinese. METHODS: A total of 215 TNBC patients treated at our hospital between November 2008 and March 2016 were enrolled in this study. We used the log-rank test and Kaplan-Meier curves to assess the overall survival (OS) and disease-free survival (DFS) differences between groups. The prognostic role of SII and other clinicopathological characteristics in TNBC patients were identified using the Cox regression model. RESULTS: Patients with low and high SII had median OS of 60.9 and 40.3 months, respectively, (HR=3.78, 95% CI: 2.16-4.15, P<0.001); while the median DFS was 22.4 months and 14.4 months for TNBC patients with low and high SII, respectively (HR =3.16, 95% CI: 1.82-4.02, P<0.001). For patients with grade 5 ultrasonographic BI-RADS classification, the median DFS and OS were 41.2 and 16.5 months, respectively, whereas, it was 57.7 and 21.3 months, respectively, for those with BI-RADS grades 3-4 (P<0.01). According to multivariable analyses, increased SII was a risk factor that independently predicted poor OS (HR =2.96, 95% CI: 2.18-3.98, P<0.001) and DFS (HR = 2.85, 95% CI: 1.62-3.81, P=0.005). In addition, tumor stage, BI-RADS, and histological grade also independently predicted poor OS (P=0.002, <0.001, 0.004). CONCLUSION: Pretreatment SII and BI-RADS 5 were independent indicators for prognosis in TNBC patients. It is imperative to conduct prospective studies to evaluate the potential role of SII in patient selection, treatment guidance, and design of clinical trials.