Evaluation of Tissue Stiffness Around Lesions by Sound Touch Shear Wave Elastography in Breast Malignancy Diagnosis.

The aim of the study described here was to assess the evaluation of tissue stiffness around lesions by sound touch shear wave elastography (STE) in breast malignancy diagnosis. This was an institutional ethics committee-approved, single-center study. A total of 90 women with breast masses examined with conventional ultrasound and STE were eligible for enrollment from December 2020 to July 2021. The maximum and mean elastic values of masses, Emax and Emean, were determined. Shell function was used to measure the maximum and mean elastic values of tissues around masses in annular shells 0.5, 1.0, 1.5 and 2.0 mm wide, recorded as corresponding Emax-shell and Emean-shell. All parameters were analyzed and compared with histopathologic results. Receiver operating characteristic curves were constructed to assess diagnostic performance. Logistic regression analysis was conducted to determine the best diagnostic model. Collagen fiber content of tissues around breast lesions was evaluated using Masson staining and ImageJ software. Ninety women with breast masses were included in this study; 50 had benign (mean diameter 15.84 ± 4.39 mm) and 40 had malignant (mean diameter 17.40 ± 5.42 mm) masses. The diagnostic value of Emax-shell-2.0 was the highest (area under the curve = 0.930) with a sensitivity of 87.5% and specificity of 88%. According to stepwise logistic regression analysis, Emax-shell-2.0 and age were independent predictors of malignancy. Emax-shell-2.0 was also found to be highly correlated with the collagen fiber content of tissue in the malignant group (r = 0.877). Tissue stiffness around lesions measured by STE is a useful metric in identifying malignant breast masses by reflecting collagen fiber content, and Emax-shell-2.0 performs best.

Analysis of Risk Factors Associated With Central Lymph Node Metastasis in Papillary Thyroid Carcinoma With cT1N0 Stage.

Aim: Annual T1 stage papillary thyroid carcinoma (PTC) incidence rates continue to rise, yet the optimal treatment for this cancer type remains controversial. Central lymph node metastasis (CLNM) is a critical determinant in the context of treatment decision-making. While several prior studies have evaluated patients with clinica l T1a(cT1a) stage PTC, there have been fewer analyses of clinical T1b(cT1b) disease to date. The present study was thus formulated to explore predictors of CLNM in patients with cT1a and cT1b stage PTC. Methods: A retrospective analysis of data including clinicopathological characteristics and BRAFV600E mutation status was conducted for 452 PTC patients undergoing surgical treatment. Logistic univariate and multivariate analyses were performed to identify risk factors associated with CLNM in particular patients' characteristics and the accuracy of the established logistic regression models was evaluated using the R software platform. Results: Respective CLNM incidence rates in cT1a and cT1b disease were 39.39% and 67.21%. Factors associated with a higher risk of CLNM among PTC(cT1a) patients included male sex, young age, tumor size, contact with capsule, and multifocality as determined through comparisons of the area under the curve for logistic regression models. Whereas male sex and age were associated with CLNM risk in PTC(cT1b) patients in univariate and multivariate analyses, age was the only risk factor associated with CLNM incidence among women with PTC(cT1b). Conclusion: Predictors of CLNM differ between PTC patients with cT1a and cT1b stage disease, and a comprehensive assessment of these risk factors should thus be conducted when designing individualized treatment regimens for PTC patients.

Transjugular intrahepatic portosystemic shunt for pyrrolizidine alkaloid-related hepatic sinusoidal obstruction syndrome.

BACKGROUND: Treatments for hepatic sinusoidal obstruction syndrome (HSOS) are limited. AIM: To evaluate transjugular intrahepatic portosystemic shunting (TIPS) as a treatment for pyrrolidine alkaloid-related HSOS (PA-HSOS). METHODS: This retrospective analysis included patients with PA-HSOS admitted to the First Affiliated Hospital of the University of Science and Technology of China (June 2015 to January 2019). Baseline clinical characteristics and follow-up data were extracted from the medical records. All patients included in this study experienced failure of initial therapy. Patients were divided into the TIPS and conservative treatment groups according to the therapy they received. Liver function, maximal ascites depth, imaging characteristics, pathology findings, and survival were compared between groups. RESULTS: The TIPS group included 37 patients (28 males), and the conservative treatment group included 17 patients (11 males). Baseline characteristics were similar between groups. There were two deaths in the TIPS group and seven deaths in the conservative treatment group during follow-up (3-48 mo). The 3-, 6-, 12- and 24-mo survival rates were 94.6%, 94.6%, 94.6% and 94.6%, respectively, in the TIPS group and 70.6%, 57.8%, 57.8% and 57.8%, respectively, in the conservative treatment group. Kaplan-Meier analysis revealed significantly longer survival for the TIPS group than for the conservative treatment group (P = 0.001). Compared with the pre-treatment value, maximal ascites depth was significantly lower at 1 wk, 2 wk, 1 mo, and 3 mo for the TIPS group (all P < 0.05) but not in the conservative treatment group. Contrast-enhanced computed tomography demonstrated the disappearance of patchy liver enhancement after TIPS. Pathology showed that liver congestion and hepatocyte swelling improved with time after TIPS placement. CONCLUSION: TIPS may achieve better outcomes than conventional symptomatic treatment in patients with PA-HSOS.

Value of conventional ultrasonography and contrast-enhanced ultrasound in the differential diagnosis of intrahepatic cholangiocellular carcinoma and hepatocellular carcinoma: An analysis based on the logistic regression model / 临床肝胆病杂志

@#ObjectiveTo investigate the value of conventional ultrasonography (US) and contrast-enhanced ultrasound (CEUS) in the differential diagnosis of intrahepatic cholangiocellular carcinoma (ICC) and hepatocellular carcinoma (HCC) by establishing a logistic regression model with the variables of US features and CEUS enhancement pattern (circumferential ring enhancement). MethodsA retrospective analysis was performed for the US and CEUS features of 55 ICC patients and 42 HCC patients, and the results of surgical pathology or biopsy were used as the golden standard for diagnosis. A logistic regression analysis was used to evaluate the value of four US features, lesion echo, blood supply type, bile duct dilatation, and circumferential ring enhancement of CEUS, in the differential diagnosis of ICC and HCC. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. A binary logistic regression analysis was performed for the factors with statistical significance in univariate analysis. Likelihood ratio was used to evaluate the fitting of the whole model, and the feature with the highest likelihood ratio in the qualitative diagnosis of ICC was screened out. The receiver operating characteristic (ROC) curve was plotted for the logistic regression model in the qualitative diagnosis of ICC, and the area under the ROC curve (AUC) was calculated. ResultsThere were significant differences between the two groups in lesion echo (χ2=4.813, P＜0.05), blood supply type (χ2=10.222, P＜0.01), bile duct dilatation (χ2=40.669, P＜001), and circumferential ring enhancement of CEUS (χ2=8.180, P＜0.01), and these four features had a sensitivity of 58.15%, 7273%, 67.27%, and 6909%, respectively, and a specificity of 64.29%, 59.52%, 66.4%, and 95.24%, respectively, all P＜005, in the differential diagnosis of ICC and HCC. Type of lesion echo, blood supply, circumferential ring enhancement of CEUS, and presence or absence of bile duct dilatation had an odds ratio of 3.556, 4.107, 4.223, and 5.776, respectively. The binary logistic regression equation was Logistic (P)=-2.761+1.272X1+1.430X2+1.538X3+1.743X4. The likelihood-ratio test of this model showed a significant difference in this regression equation (χ2=94.691, P＜0.001). In the qualitative diagnosis of ICC, this regression equation had a sensitivity of 743%, a specificity of 822%, and an AUC of 0.856. There was a significant difference in time to peak between the two groups (t=8497, P＜001). ConclusionThe logistic regression model and CEUS qualitative analysis can improve the qualitative diagnosis of ICC.