Elastography for the diagnosis of high-suspicion thyroid nodules based on the 2015 American Thyroid Association guidelines: a multicenter study.

BACKGROUND: An accurate diagnosis for high-suspicion nodules based on the 2015 American Thyroid Association (ATA) guidelines would reduce unnecessary invasive examinations. Elastography is a useful tool for discriminating benign and malignant thyroid nodules. The aim of this study is to investigate the diagnostic efficiency of elastography for high-suspicion thyroid nodules based on the 2015 ATA guidelines in the Chinese population. METHODS: Thyroid nodules with high-suspicion characteristics based on the 2015 ATA guidelines were subjected to conventional ultrasound (US) and ultrasound strain elastography (USE) examinations at 12 hospitals from 4 geographic regions across China. Cytology/histology of thyroid nodules was used as a reference method. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic performance of the elasticity score (ES) and strain ratio (SR). Logistic regression analysis was used to determine the predictors of malignancy. RESULTS: Overall, a total of 1445 thyroid nodules (834 malignant, 611 benign) from 12 centers were included in the final analysis. The areas under the curve of the ES and SR were 0.828 and 0.732, respectively. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the ES were 92.4, 60.7, 79.0, 76.3 and 85.5%, respectively, and those of the SR were 81.1, 50.1, 68.9, 65.9 and 67.9%, respectively. The combination of the Thyroid Imaging Reporting and Data System (TI-RADS) and ES led to a significant increase in the sensitivity and NPV (97.1 and 91.9%, respectively) compared with the TI-RADS alone. Logistic regression analysis showed that microcalcifications (OR = 5.290), taller than wide (OR = 12.710), irregular margins (OR = 10.117), extrathyroidal extension (ETE; OR = 6.412), the ES (OR = 3.741) and the SR (OR = 1.083) were independent predictors of malignant thyroid nodules. The sensitivity, specificity, accuracy, PPV and NPV of the ES were all superior in nodules ≥1 cm than in those < 1 cm (95.0% vs 90.4, 68.8% vs 56.8, 85.9% vs 74.4, 85.2% vs 69.9, and 87.8% vs 84.2%, respectively). CONCLUSIONS: Elastography combined with the ES is a valuable tool for the assessment of high-suspicion thyroid nodules based on the 2015 ATA guidelines, especially in nodules ≥1 cm.

Consistency of different physicians in diagnosis of malignant breast lesions with breast CEUS predictive model: A multicenter study / 中国医学影像技术

Objective To explore the consistency of different physicians in diagnosis of malignant breast lesions with breast CEUS predictive model.Methods Totally 953 patients with solitary breast nodule from multicenter who underwent ultrasound and CEUS were collected.The research team was composed by the initial group (one junior physician from each hospital),check group (one or two physicians who had at least two-year experience of CEUS examination from each hospital),research group (two senior physicians from Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital) and cross-blinded group (one or two vice directors or chief physicians from each hospital).At first,the lesions were classified according to the breast imaging reporting and data system (BI RADS) by the initial group and the check group,then new BI RADS classifications were performed by research group and cross blind group with breast CEUS predictive model.The consistency of different physicians in diagnosis of malignant breast lesions was analyzed.Results Among 953 patients,benign lesions were found in 451 patients (451/953,47.32％),malignant lesions were found in 435 patients (435/953,45.65％),and precancerous lesions were found in 67 patients (67/953,7.03％).The accuracy of the initial group,check group,research group and cross-blinded group was 71.67％(683/953),74.92％(714/953),80.17％ (764/953) and 83.42 ％ (795/953),respectively.The consistency of different physicians for diagnosis of malignant breast lesions between initial group and check group was good (Kappa =0.82,P＜0.001),while between initial group and crossblinded group,initial group and research group were both moderate (Kappa =0.56,0.41;all P＜0.001).The consistency of different physicians for diagnosis of malignant breast lesions between cheek group and cross-blinded group,between check group and research group were both moderate (Kappa =0.68,0.51;all P＜0.001).The consistency between research group and cross-blinded group with breast CEUS predictive model was moderate (Kappa =0.74,P＜ 0.001).Conclusion The consistency of different physicians in diagnosis of malignant breast lesions with breast CEUS predictive model was moderate.

Research on the learning curve of contrast-enhanced ultrasonography in sentinel lymph node of breast cancer / 中华超声影像学杂志

Objective To investigate the learning curve of contrast-enhanced ultrasonography ( CEUS) in sentinel lymph node( SLN ) of breast cancer and provide a theoretical basis for leaners to learn SLN CEUS . Methods The multi-center study of SLN CEUS in breast cancer" was planned by Sichuan Cancer Hospital . According to the uniform inclusion and exclusion criteria , 511 patients with complete clinical data and follow-up results from 9 hospitals in Multi-center were included in this study . According to the inspection time ,the patients were divided into 3 groups named as group A ( 170 patients) ,group B ( 170 patients) and group C ( 171 patients ) ,respectively . The basic clinical data ,ultrasound imaging data , intraoperative and postoperative pathological findings of all patients were recorded . With the accumulation of cases examined ,analysis was performed to find the learning curve of the SLN CEUS examination time , SLN CEUS detection rate ,SLN CEUS surface marking accuracy rate and SLN CEUS diagnosis rate ,the learning curve was analyzed . Results ① There was no statistical significant difference in patients ages , tumors sizes ,tumors locations ,SLNs numbers and LCs numbers among the three groups( all P > 0 .05) . ②As the number of cases examined increases ,the examination time was reduced gradually ,but SLN detection rate ,surface marking accuracy and SLN diagnostic coincidence rate were increased gradually( F = 151 .75 , 1 .96 ,7 .49 ,5 .50 ; P = 0 .000 ,0 .143 ,0 .001 ,0 .005 ) . Conclusions The skill of the doctor is improved gradually when learning SLN CEUS . With the number of the cases increase ,the operating time of SLN CEUS is shorted ,and the SLN detection rate ,surface marking accuracy and SLN diagnostic coincidence rate of SLN-CEUS are gradually increased . It has an important clinical significance for beginners to learn the SLN CEUS technology .

Evaluation of contrast-enhanced ultrasonography breast predictive model in optimizing breast lesions BI-RADS classification / 中华超声影像学杂志

Objective To explore the value of contrast-enhanced ultrasonography ( CEUS ) breast predictive model in the optimization of BI-RADS classification of breast lesions . Methods A total of 1049 BI-RADS 4 ,5 breast lesions were obtained from 1039 patients in 8 centers . CEUS examination was performed prior to biopsy or surgery . According to the classification of the model ,class 3 ,4A ,4B and 4C were selected as biopsy thresholds ,and the ROC curve was drawn . The diagnostic sensitivity ,specificity , accuracy ,positive predictive value ,negative predictive value and Jordanian index were calculated for the biopsy threshold . The biopsy rate of breast lesions before and after angiography ,cancer detection rate , follow-up cases of malignant risk were compared . Results There were benign lesions 586 ( 55 .9％ ) , malignant lesions 463 (44 .1％ ) in the 1049 breast lesions . The area of ROC with thresholds of 3 ,4A ,4B and 4C were 0 .695 ,0 .838 ,0 .847 and 0 .757 ,respectively ( all P < 0 .01) . Ultrasonography had a certain diagnostic effect on benign and malignant breast lesions . The diagnostic sensitivity ,specificity ,accuracy , positive predictive value and negative predictive value with class 4A after CEUS set as the biopsy threshold were 93 .32％ ,75 .65％ ,82 .75％ ,75 .57％ and 93 .35％ ,respectively ,and the Jordanian index was 0 .690 . When chass 3 after CEUS was set as the biopsy threshold ,the biopsy rate was reduced from 100％ to 76 .74％ ,the detection rate was increased from 44 .23％ to 56 .77％ ,and the risk of cancer was only 0 .67％ in the follow-up cases . When class 4A was set as the biopsy threshold ,the biopsy rate was reduced from 100％ to 55 .58％ after CEUS . The detection rate of cancer increased from 44 .23％ to 74 .44％ . The risk of cancer was 2 .96％ . Conclusions The biopsy rate of breast lesions in category 4 and 5 would be reduced and cancer detection rate of them would be increased after CEUS ,however ,the risk of malignancy in the follow -up cases would be controlled as low as category 3 and 4A in previous BI-RADS . Thus ,CEUS has a good prospect of in optimizing BI-RADS and reducing biopsy rate in unnecessary lesions .

Analysis of monitoring results of soil-borne nematode disease in Jianhe County of Guizhou in 2016 / 中华地方病学杂志

Objective To investigate the infection status of soil-borne nematode in rural areas of Jianhe County of Guizhou Province and to provide scientific basis for formulating prevention and control measures.Methods In 2016,according to "the Implementation Plan of Soil-Borne Nematode Surveillance in Jianhe County",five surveillance sites were set up in Jianhe rural areas,and 200 permanent residents over 3 years old at each monitoring site were selected to collect fecal samples.The eggs of intestinal nematodes (Ascaris,Hookworm,Trichuris,etc.) in samples were detected with the Kato thick smear method,and the enterobius vermicularis was looked for using the transparent adhesive paper anal swab method.Results A total of 1 000 human fecal samples were tested,and 169 persons were identified to be positive for Ascaris,Hookworm,and Trichuris,and the infection rate was 16.90％ (169/1 000),in which the infection rates of Ascaris,Hookworm and Trichuris were 13.80％ (138/1 000),2.00％ (20/1 000) and 1.10％ (11/1 000),respectively,and Tapeworm and Liver fluke were not detected.The infection rates of soil-borne nematode in male and female were 14.09％ (72/511) and 19.84％ (97/489),respectively,and the difference between genders was statistically significant (x2 =5.88,P ＜ 0.05).The infection rates of soilborne nematode in the ages group of 0-,18-,41-and ≥66 were 18.94％ (50/264),13.18％ (29/220),15.12％ (52/344) and 22.09％ (38/172),respectively,but the differences were not statistically significant (x2=7.03,P ＞ 0.05).Hookworm infection was not found in the group of 0 to 17 years old.The prevalence rates of soil-borne nematodes in primary school and below,junior high school,high school and secondary school education were 18.52％ (138/745),14.83％ (31/209),and 0 (0/46),respectively,and the differences in educational levels were statistically significant (x2 =11.39,P ＜ 0.05).A total of 174 children aged 3 to 9 years old were tested for enterobius vermicularis,18 were infected,and the infection rate was 10.34％ (18/174).Conclusions The situation of soilborne nematode infection is still severe in rural areas of Jianhe County.It should be strengthen health education and improve the knowledge of nematode diseases control among the population.

Diagnostic value of contrast-enhanced ultrasound in breast precancerous lesions / 中华超声影像学杂志

Objective To evaluate the diagnostic value of contrast-enhanced ultrasound in breast precancerous lesions . Methods Retrospectively analyzed the contrast-enhanced ultrasound model and angiographic predictive model of 465 cases of the A prospective multicenter study of breast nodules contrast-enhanced ultrasound" that led the Sichuan Provincial People′s Hospital from January 2016 to April 2017 ,which included 69 cases of breast precancerous lesions and 396 other types benign lesions ,and the sensitivity ,specificity and accuracy of the diagnosis of breast precancerous lesions were calculated . Results The sensitivity of ultrasound predictive model for the diagnosis of precancerous lesions was 60 .9％ and AUC was 0 .681 . Precancerous lesions mainly showed non-concentricity , increased homogeneity , and increased lesions;other types of benign lesions mainly showed non-centripetal ,high uniformity enhancement and lesion size unchanged . Conclusions Contrast-enhanced ultrasound shows a potential value in the differential diagnosis of precancerous lesions and other types of benign lesions ,that can help clinicians to take early intervention measures for breast precancerous lesions ,but there are still many problems to be solved .

Application of Double Contrast-enhanced Ultrasonography in the Diagnosis of Gastric Cancer / 昆明医科大学学报

Objective To investigate the clinical value of double contrast-enhanced ultrasonography (DCUS) for the diagnosis of gastric cancer.Methods A retrospective analysis was performed to review the DCUS data of 26 patients which were diagnosed as gastric cancer by pathology in the third affiliated hospital of Kunming Medical University from October 2014 to July 2015.The analysis results were compared with postoperative pathology to get accuracy rates.Results The located accuracy,qualitative accuracy and accuracy at T phase of DUCS was 100％ (26/26),100％ (26/26) and 88.5％ (23/26),respectively.Compared with color doppler flow imaging (CDFI),the qualitative accuracy of DUCS was much higher (P ＜ 0.05).The accuracy of DUCS at T phase was higher than that of CDFI with no statistical significance (P ＞ 0.05) Conclusion DUCS has an important application value in the diagnosis of gastric cancer.

A Retrospective Analysis of Ultrasonographic Misdiagnosis of Thyroid Multiple Nodules With Thyroid Carcinoma / 昆明医科大学学报

Objectives To explore the ultrasonic features in the differential diagnosis of thyroid multiple nodules with thyroid carcinoma and summarize the causes of misdiagnosis,and to improve the accuracy of ultrasonic diagnosis of thyroid carcinoma.Methods The ultrasound images from the 40 patients with thyroid carcinoma were selected,whose diagnosis of thyroid carcinoma was confirmed by the pathological examinations after surgery but misdiagnosed or not identified by ultrasound examination.These ultrasound images were retrospectively analyzed through observing the carcinomatous nodules in size,aspect ratio,shape,border,envelope,internal echo,calcification characteristics,posterior echo,acoustic halo,the distribution of blood flow,and the relationship with thyroid capsule and anterior organization,whether to transfer to neck or spraclavicular lymph nodes,and the performance of elasticity imaging,and then these features were compared with the ultrasonic features of the benign thyroid nodules.Results The ultrasonic features of thyroid multiple nodules with thyroid carcinoma were complicated and each nodule should be observed and analyzed individually.The ultrasonic features of carcinomatous nodules were:(1) irregnlar shape,(2)aspect ratio ≥ 1,(3)unclear border,(4)no capsule,(5)heterogeneous hypo echo inside of the carcinomatous nodules,(6)scattered distribution of clustered microcalcifications,(7)incomplete acoustic halo or absent,(8)blood supply to the centrality inside of the carcinomatous nodules,(9)invaded thyroid capsule and anterior organizations,(10)transformation to neck or supraclavicular lymph nodes in the minority of patients,(11) elasticity imaging score of 3 ～ 5.Conclusions It is quite difficult to identify the ultrasonic features of thyroid multiple nodules with thyroid carcinoma and it is with high misdiagnosis rate.A comprehensive analysis of sonographic features is essential in clinical practices,and it will contribute to improving the accuracy of the ultrasonic diagnosis of thyroid multiple nodules with thyroid carcinoma.

Frequent loss of heterozygosity on chromosome 9 in Chinese esophageal squamous cell carcinomas.

Multiple and extensive alterations in chromosome 9 were detected in thirty-four esophageal squamous cell carcinoma patients, using seventeen polymorphic markers localized to chromosome 9 to detect the loss of heterozygosity (LOH) by polymerase chain reaction techniques. The LOH rates detected in this study range from 42.9 to 80.0%. Three commonly deleted regions mapping to 9p23-p22, 9q13-q22.3, and 9q34 were observed. D9S1812 LOH at 9q22.1 was significantly associated with well- and moderately-differentiated tumors; LOH at D9S768, mapping to 9q13-21.3, indicated that drinking habits are not a significant risk factor for Chinese esophagus cancer. Interestingly, no case of microsatellite instability was observed.