Ultrasound-based Radiomics for Predicting Metastasis in the Lymph Nodes Posterior to the Right Recurrent Laryngeal Nerve in Patients with Papillary Thyroid Cancer.

BACKGROUND: Dissection of the lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLNs) in papillary thyroid cancer (PTC) remains controversial. OBJECTIVE: This study aimed to determine the capability of ultrasonography (US)-based radiomics for presurgical prediction of metastasis in LN-prRLNs in PTC. METHODS: Patients were retrospectively enrolled and pathologically confirmed as LN-prRLN metastasis with PTC after surgery. Radiomic analysis based on preoperative US images with manual segmentation of targets was used to develop a radiomics model. US features described in ACR TI-RADS were collected to construct a clinical model. The Radiomics model, a combined model integrating radiomics and clinical model, was also developed for the presurgical prediction of metastasis in LN-prRLNs. RESULTS: A total of 570 patients, including 488 patients with non-LN-prRLN metastasis and 82 with LN-prRLN metastasis, were assessed. The 15 topperforming features finally remained significant for constructing the radiomics model. The combined model showed that US measured tumor size (OR: 1.036, P = 0.044), US suspected lateral lymph node metastasis (OR: 2.247, P = 0.009), multifocality (OR: 1.920, P = 0.021), Delphian lymph node metastasis (DLNM) (OR: 2.300, P = 0.039), VIa compartment metastasis (OR: 5.357, P = 0.000), the radiomics score (OR: 1.003, P = 0.001) were significant risk factors for predicting LN-prRLN metastasis. The combined model achieved a higher AUC of 0.849 than that of the clinical model (AUC: 0.759) and radiomics model (AUC: 0.826). CONCLUSION: The US-based radiomics combined model can more effectively predict LN-prRLN metastasis in PTCs patients preoperatively. This approach had the potential to assist surgeons indecision-making regarding LN-prRLN dissection.

[Value of nomogram based on the ultrasonographic features of prostatic calcification and varicocele and serological indicators in differential diagnosis of prostate cancer].

OBJECTIVE: To explore the diagnostic performance of the nomogram based on the transabdominal ultrasonographic features of prostatic calcification and varicocele (VC) and serological indicators in differentiating PCa with BPH from simple BPH. METHODS: This retrospective study included 108 cases of PCa with BPH and 317 cases of simple BPH, all pathologically confirmed after surgery from January 2014 to December 2021. Using t test or χ2/Fisher test, we compared the clinicopathologic data, transabdominal ultrasonographic features of prostatic calcification, VC severity and serological indicators between the two groups of patients. We identified the significant independent factors for differentiating PCa with BPH from simple BPH by multivariate logistic regression analysis and constructed a nomogram for visualizing the differential diagnostic performance. RESULTS: There were significant differences in the types and diameters of prostatic calcification, PSA density (PSAD), total PSA (tPSA), VC severity, and serum testosterone level between the two groups (P < 0.05). The types of calcification, PSAD and VC severity were identified as independent factors for differentiating PCa with BPH from simple BPH. Nomogram analysis of the above factors showed a good predicting performance, with an AUC of 0.805, a sensitivity of 83.28% and a specificity of 70.37%. CONCLUSION: Transabdominal ultrasonographic features and types of prostatic calcification, PSAD and VC severity are correlated with the development and progression of PCa. Nomogram analysis of the above factors contributes to the differentiation of PCa with BPH from simple BPH.

Contrast-enhanced ultrasound for differentiating benign from malignant solid small renal masses: comparison with contrast-enhanced CT.

PURPOSE: The study aimed to compare the diagnostic efficiency of contrast-enhanced ultrasound (CEUS) with that of contrast-enhanced computed tomography (CECT) in the evaluation of benign and malignant small renal masses (SRMs) (<4 cm) confirmed by pathology. METHODS: A total of 118 patients with 118 renal masses smaller than 4 cm diagnosed by both CEUS and CECT were enrolled in this study, including 25 benign lesions and 93 malignant lesions. All lesions were confirmed by histopathologic diagnosis after surgical resection. The diagnostic imaging studies of the patients were retrospectively reviewed by two independent ultrasonologists and two independent radiologists blinded to the CT or ultrasound findings and final histological results. All lesions on both CEUS and CECT were independently scored on a 3-point scale (1: benign, 2: equivocal, and 3: malignant). The concordance between interobserver agreement was interpreted using a weighted kappa statistic. The diagnostic efficiency of the evaluation of benign and malignant lesions was compared between CEUS and CECT. RESULTS: All the 118 included lesions were detected by both CEUS and CECT. In CEUS and CECT imaging evaluation of the 118 lesions, the weighted kappa value interpreting the concordance between interobserver agreement was 0.89 (95% CI 0.79-0.98) and 0.93 (95% CI 0.87-0.99), respectively. Both CEUS and CECT demonstrated good diagnostic performance in differential diagnosis of benign and malignant SRMs with sensitivity of 93.5% and 89.2%, specificity of 68% and 76%, PPV of 91.6% and 93.3%, NPV of 73.9% and 65.5%, and AUC of 0.808 and 0.826, respectively. There was no statistically significant difference in any of the diagnostic performance indices between these two methods (P > 0.05). However, the qualitative diagnosis of small papillary renal cell carcinoma (RCC) by CEUS was significantly better than that by CECT (P < 0.05), while there was no significant difference in qualitative diagnostic accuracy on other histotypes of SRMs between CEUS and CECT (P > 0.05). CONCLUSIONS: Both CEUS and CECT imaging modalities are effective for the differential diagnosis of benign and malignant SRMs. Furthermore, CEUS may be more effective than CECT for the qualitative diagnosis of small papillary RCC.

Three-Dimensional Assessment of Automated Breast Volume Scanner Compared with Handheld Ultrasound in Pre-Operative Breast Invasive Ductal Carcinomas: A Pilot Study of 51 Cases.

The aim of the work described here was to compare the accuracy of conventional handheld ultrasound (HHUS) with that of an automated breast volume scanner (ABVS) in 3-D assessment of pre-operative invasive ductal carcinomas. HHUS and ABVS were used in 51 patients to obtain the largest tumor diameter, tumor volume and tumor surface area. The volumetric measurement was also obtained from ABVS data with medical software. With tumor size and volume on pathology as the gold standard, Bland-Altman analysis was used to compare variability. Correlation coefficients and receiver operating characteristic curves were established for all measurements for T2 classification. The correlation coefficients of all ABVS measurements were stronger than those of HHUS measurements, with the ABVS volumetric measurement significantly different with a higher accuracy of 88.24% (45/51) and predicting T-classification with higher area under the receiver operating characteristic curves (0.936). Therefore, 3-D measurements provide stronger correlations with pathology in tumor size measurement. However, more clinical trials are needed to confirm our findings.

Combined use of the automated breast volume scanner and the US elastography for the differentiation of benign from malignant lesions of the breast.

BACKGROUND: Automated breast volume scanner (ABVS) and US elastography (UE) have been useful for the differentiation of benign and malignant lesions. However, combining these two methods applied in diagnosis of breast lesions has not yet been reported. The aim of this study is to analyze the inter-examiner reliability of ABVS and UE, and compare diagnostic performance among ABVS, UE, and the combination of these two methods. METHODS: Forty-one patients (forty-six lesions) underwent both ABVS and UE examinations. ABVS images were acquired by medial and lateral scans for each breast and classified a BI-RADS category based on the distribution, size, shape, echogenicity and microcalcification of the lesions. UE images were assigned an elasticity score according to the distribution of strain induced by light compression. Kappa statistics was used to examine the reproducibility between examiners with ABVS and UE, and the concordance between pathology and ABVS, UE, and the combination of these two methods. χ2 test was used to compare diagnostic performance among these three methods.Two examiners blinded to the patients' history evaluated the results of breast imaging independently. RESULTS: Inter-examiner reliability with ABVS (κ = 0.62, 95% confidence interval (CI): 0.44-0.80) and UE (κ = 0.65, 95% CI: 0.48-0.82) was substantial. With respect to the pathology results, the inter-rater coefficient of concordance was κ = 0.81 (95% CI: 0.64-0.98) for ABVS, κ = 0.77 (95% CI: 0.58-0.96) for UE, and κ = 0.90 (95% CI: 0.77-1.00) for combination of ABVS and UE. Examiner variability was reduced from UE to ABVS, and to the combination of ABVS with UE.The diagnostic accuracy, sensitivity, and specificity for the combination of ABVS and UE were 95.7% (95%CI: 84.0-99.2), 100% (95% CI: 85.9-100), and 87.5% (95% CI: 60.4-97.8), respectively. When comparing, the diagnostic performance of ABVS combined with UE was better than, or at least equal to, that of ABVS (accuracy 91.3% (95% CI: 78.3-97.2), sensitivity 100% (95% CI: 85.0-1.00), specificity 77.8% (95% CI: 51.9-92.6)) or UE (accuracy 89.1% (95% CI: 75.6-95.9), sensitivity 96.4% (95% CI: 79.8-99.8), specificity 77.8% (95% CI: 51.9-92.6)) alone, though the improvement was no statistically significance. CONCLUSIONS: Both ABVS and UE demonstrated substantial inter-examiner reliability. With high diagnostic performance for differentiation of benign and malignant lesions in the breast, the combination of ABVS and UE are useful to improve the diagnostic accuracy and specificity.