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OBJECTIVE: To reduce the number of biopsies performed on benign breast lesions categorized as BI-RADS 4-5, we investigated the diagnostic performance of combined two-dimensional and three-dimensional shear wave elastography (2D + 3D SWE) with standard breast ultrasonography (US) for the BI-RADS assessment of breast lesions. METHODS: A total of 897 breast lesions, categorized as BI-RADS 3-5, were subjected to standard breast US and supplemented by 2D SWE only and 2D + 3D SWE analysis. Based on the malignancy rate of less than 2% for BI-RADS 3, lesions assessed by standard breast US were reclassified with SWE assessment. RESULTS: After standard breast US evaluation, 268 (46.1%) participants underwent benign biopsies in BI-RADS 4-5 lesions. By using separated cutoffs for upstaging BI-RADS 3 at 120 kPa and downstaging BI-RADS 4a at 90 kPa in 2D + 3D SWE reclassification, 123 (21.2%) participants underwent benign biopsy, resulting in a 54.1% reduction (123 versus 268). CONCLUSION: Combining 2D + 3D SWE with standard breast US for reclassification of BI-RADS lesions may achieve a reduction in benign biopsies in BI-RADS 4-5 lesions without sacrificing sensitivity unacceptably. CLINICAL RELEVANCE STATEMENT: Combining 2D + 3D SWE with US effectively reduces benign biopsies in breast lesions with categories 4-5, potentially improving diagnostic accuracy of BI-RADS assessment for patients with breast lesions. TRIAL REGISTRATION: ChiCTR1900026556 KEY POINTS: ⢠Reduce benign biopsy is necessary in breast lesions with BI-RADS 4-5 category. ⢠A reduction of 54.1% on benign biopsies in BI-RADS 4-5 lesions was achieved using 2D + 3D SWE reclassification. ⢠Adding 2D + 3D SWE to standard breast US improved the diagnostic performance of BI-RADS assessment on breast lesions: specificity increased from 54 to 79%, and PPV increased from 54 to 71%, with slight loss in sensitivity (97.2% versus 98.7%) and NPV (98.1% versus 98.7%).
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Neoplasias da Mama , Técnicas de Imagem por Elasticidade , Feminino , Humanos , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Técnicas de Imagem por Elasticidade/métodos , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Ultrassonografia Mamária/métodosRESUMO
BACKGROUND: The aseptic meningitis caused by varicella zoster virus (VZV) reactivation was less described in the literature, most of which were detected by means of polymerase chain reaction. The authors presented 4 adult immunocompetent patients with acute aseptic meningitis with VZV infection diagnosed by next-generation sequencing (NGS). CASE PRESENTATION: Four patients were admitted to the hospital with headache and fever between March 2018 and August 2019. The median ages were 37 years (range 22-52 years). The median symptoms onset to clinic time was 3.5 days (range 3-6 days). Two patients had signs of meningeal irritation. Rash occurred after the meningitis symptoms in 1 patient (time from meningitis symptoms to rash, 2 days). No other sign or symptom was reported. The brain Magnetic resonance imaging and electroencephalography were normal in all patients. Cerebrospinal fluid (CSF) samples were obtained at a median of 4 days (range 3-7 days) from the meningitis symptoms onset. Opening pressure of lumbar puncture after admission were high in these cases (median 256 mm H2O; range 165-400 mm H2O). White blood cell counts and protein levels were significantly elevated in CSF samples (median 317 × 10^6/L, range 147-478 × 10^6/L; median 1.41 g/L, range 0.57-1.79 g/L). The cytology of CSF demonstrated a lymphocytic pleocytosis, and most multinuclear cells. The culture of CSF was negative for all 4 cases, while T-cell spot test was positive for 2 cases, who were administrated with anti-tuberculosis treatment for suspicious tuberculous meningitis. NGS of CSF (the Vision Medical Research Institute) detected specific sequences of VZV in the 4 cases within 72 h after admission. The inappropriate treatment were stopped while acyclovir were continued intravenously for 10-14 days. All patients recovered completely. CONCLUSIONS: VZV is an infectious agent that causes aseptic meningitis in immunocompetent adults and could not be accompanied by skin manifestations. The NGS of CSF is a rapid detection for the identification and differentiation of meningitis in patients, which is of great importance for providing the rapid and accurate diagnosis and the targeted antimicrobial therapy for central nervous system infection.
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Líquido Cefalorraquidiano/virologia , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Meningite Asséptica/etiologia , Meningite Viral/etiologia , Infecção pelo Vírus da Varicela-Zoster/complicações , Aciclovir/uso terapêutico , Adulto , Antivirais/uso terapêutico , Líquido Cefalorraquidiano/citologia , Exantema/etiologia , Exantema/virologia , Herpesvirus Humano 3/genética , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningite Asséptica/diagnóstico , Meningite Asséptica/tratamento farmacológico , Meningite Viral/diagnóstico por imagem , Pessoa de Meia-Idade , Infecção pelo Vírus da Varicela-Zoster/diagnóstico por imagem , Infecção pelo Vírus da Varicela-Zoster/tratamento farmacológico , Adulto JovemRESUMO
OBJECTIVE: To explore the relationship between the imaging features of ultrasonography and thermal tomography and molecular subtypes of breast cancer. METHODS: 404 female breast cancer patients with complete imaging data and pathological findings from January 2014 to June 2017 were reviewed in the West China Hospital of Sichuan University. Breast cancer pathological molecules were classified into Luminal A like type, Luminal B like type, human epidermal growth receptor-2 (HER-2) overexpression type and Basal like type according to the expression of various immune markers. The correlation of ultrasonographic BI-RADS signs, thermal tomography characteristics and immunohistochemical results of breast cancer was analyzed. RESULTS: Breast cancer lesions with regular morphology, sharp margins, and enhanced posterior echo were more common in Basal like type; Microcalcification was more likely tend to appear in HER-2 expression breast cancer than other subtypes; The q-r curve of Luminal A like breast cancer was nearly 30°, and that was more common between 30°and 45° of HER-2 expression and Basal like breast cancerï¼The ratio of vertical and horizontal ≥1 of tumors and limited lymph node metastasis could not be used for distinguishing between different subtypes. CONCLUSION: Different molecular subtypes of breast cancer may behave routine ultrasound and thermal tomography imaging features.
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Neoplasias da Mama , Tomografia , Ultrassonografia , Neoplasias da Mama/classificação , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/genética , China , Feminino , HumanosRESUMO
OBJECTIVE: To determine the clinical value of breast thermal tomography and high frequency ultrasound imaging in diagnosing breast cancer. METHODS: Breast thermal tomography and high frequency ultrasound imaging were performed in 298 patients with breast lumps. The results were compared with pathological diagnosis. RESULTS: The ultrasound imaging had a sensitivity, specificity and the area under the curve (AUC) of 99.02%, 62.78% and 0.814, respectively, compared with 83.33%, 83.16% and 0.830 of thermal tomography, for diagnosing breast cancer. The two imaging results showed statistical significance in the test of non-inferiority (P < 0.001). A combination of the two imaging results produced a sensitivity, specificity and AUC of 83.33%, 89.79% and 0.866, respectively. CONCLUSION: Thermal tomography is not inferior to ultrasonography in detecting breast cancer. The two combined can improve specificity and accuracy of the diagnosis of breast cancer.
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Neoplasias da Mama/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Área Sob a Curva , Feminino , Humanos , Sensibilidade e Especificidade , UltrassonografiaRESUMO
OBJECTIVE: To investigate the findings of contrast enhanced ultrasound for papillary thyroid carcinoma and its pathological bases. METHODS: Seventy two (72) patients with thyroid nodules underwent routine conventional ultrasound and color Doppler examination, and 86 nodules with TI RADS 3 were examined by contrast-enhanced ultrasound (CEUS . Histopathological examination was kept as standard reference and the findings of CEUS were analyzed. Pathological studies of all nodules were made after post-operative CD34 immunohistochemistry staining examination. RESULTS: Of the total 86 nodules, Adler CDFl classification grades were: grade 0-26. grade I-34. grade II-23 and grade III-3 nodules respectively. Enhancement pattern on CEUS showed that there was low enhancement on 71 nodules, iso enhancement on 12 and high enhancement on 3 nodules. The differences of echo mean intensity. the peak intensity, area under the curve for enhancement intensity and CD34 count between the nodules and surrounding tissue were statistical significant (P < 0. 001). CONCLUSION: Low enhancement pattern on CEUS is the most common finding for papillary thyroid carcinoma, which is related to the difference of microvessel density between the nodules and surrounding tissues in papillary thyroid carcinoma.
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Carcinoma/diagnóstico por imagem , Meios de Contraste , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Carcinoma/patologia , Carcinoma Papilar , Humanos , Imuno-Histoquímica , Período Pós-Operatório , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide/patologia , UltrassonografiaRESUMO
OBJECTIVE: To determine the perfusion pattern of lymphadenopathy in contrast-enhanced ultrasonography (CEUS) under different reference conditions. METHODS: The CEUS perfusion patterns of 78 superficial lymph node lesions were compared with their pathology results. Time-intensity curves were used for comparison between benign and malignant lymph nodes. RESULTS: Inhomogeneous hyperenhancement was the main perfusion pattern (7/17, 41. 2%) in metastatic lymph nodes; compared with homogeneous hyperenhancement (2/4, 50. 0%) in lymphoma, homogeneous hyperenhancement and isoenhancement (6/52, 11. 5%) in reactive lymph nodes, and circle enhancement (2/4,50. 0%) in tuberculosis. Benign lymph nodes showed different mean value, peak intensity and area under the curve compared with their surrounding arteries (P<0. 05). But the differences in mean value, rise time, time to peak, peak intensity and the area under the curve between benign lymphadenopathy and their surrounding tissues were not statistically significant (P>0. 05). Malignant lymph nodes showed different mean value and peak intensity compared with their surrounding arteries and tissues (P<0. 05). The differences in time to peak between malignant lymph nodes and their surrounding tissues were also statistically significant (P< 0. 05). CONCLUSION: Different CEUS perfusion patterns are associated with different types of lymph node lesions. Time intensity curves with surrounding tissues as reference condition offer great values for the differential diagnosis of superficial lymphadenopathy.
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Meios de Contraste , Linfonodos/patologia , Doenças Linfáticas/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Linfonodos/diagnóstico por imagem , UltrassonografiaRESUMO
The sonographic features of male breast lesions, which underwent ultrasound examination in our hospital for the past 10 years, were retrospectively analyzed. Sonographic features of these lesions were standardized as BI RADS image lexicon. The differences in ultrasonic malignant signs were assessed between the benign and the malig nant diseases. Between the two groups, incomplete boundary was statistically different. The specificity was above 95% within the two groups in terms of speculated margin, echogenic halo, calcification, axillary lymphadenopathy, thickening of skin and eccentric of mass to the nipple. High-frequency sonographic examination has a high level of differential diagnosis for male breast lesions.
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Neoplasias da Mama Masculina/diagnóstico , Mama/patologia , Ultrassonografia Mamária , Neoplasias da Mama Masculina/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Masculino , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Infections of the central nervous system (CNS) are potentially life-threatening and can cause serious morbidity. We evaluated the clinical value of metagenomic next-generation sequencing (mNGS) in the diagnosis of infectious encephalitis and meningitis and explored the factors affecting the results of mNGS. METHODS: Patients with suspected cases of encephalitis or meningitis who presented in Northern Jiangsu People's Hospital from 1 March 2018 to 30 September 2022 were collected. Demographic, historical, and clinical information were obtained, and cerebrospinal fluid (CSF) samples were treated with mNGS. The pathogen was identified using National Center for Biotechnology Information (NCBI) GenBank sequence data. RESULTS: Ninety-six patients were screened and finally 90 subjects enrolled. Of the 90 enrolled cases, 67 (74.4%) were diagnosed with central nervous system infections, which included 48 cases (71.6%) of viral infection, 11 (12.2%) of bacterial infection, 5 (7.5%) of mycobacterium tuberculosis, 2 (3.0%) of fungal infection, and 1 (1.5%) of rickettsia infection. From these cases, mNGS identified 40 (44.4%) true-positive cases, 3 (3.3%) false-positive case, 22 (24.4%) true-negative cases, and 25 (27.8%) false-negative cases. The sensitivity and specificity of mNGS were 61.5% and 88%, respectively. mNGS of CSF could show a higher positive rate in patients with marked CSF abnormalities, including elevated protein concentrations and monocyte counts. CONCLUSION: mNGS of CSF is an effective method for detecting infectious encephalitis and meningitis, and the results should be analyzed combined with conventional microbiological testing results.
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Encefalite , Encefalite Infecciosa , Meningite , Humanos , Estudos Retrospectivos , Meningite/diagnóstico , Encefalite Infecciosa/diagnóstico , Encefalite/diagnóstico , Sensibilidade e Especificidade , Sequenciamento de Nucleotídeos em Larga Escala/métodosRESUMO
Breast cancer is one of the most common cancers threatening women's health. Our previous study found that silibinin induced the death of MCF-7 and MDA-MB-231 human breast cancer cells. We noticed that silibinin-induced cell damage was accompanied by morphological changes, including the increased cell aspect ratio (cell length/width) and decreased cell area. Besides, the cytoskeleton is also destroyed in cells treated with silibinin. YAP/TAZ, a mechanical signal sensor interacted with extracellular pressure, cell adhesion area and cytoskeleton, is also closely associated with cell survival, proliferation and migration. Thus, the involvement of YAP/TAZ in the cytotoxicity of silibinin in breast cancer cells has attracted our interests. Excitingly, we find that silibinin inhibits the nuclear translocation of YAP/TAZ in MCF-7 and MDA-MB-231 cells, and reduces the mRNA expressions of YAP/TAZ target genes, ACVR1, MnSOD and ANKRD. More importantly, expression of YAP1 gene is negatively correlated with the survival of the patients with breast cancers. Molecular docking analysis reveals high probabilities for binding of silibinin to the proteins in the YAP pathways. DARTS and CETSA results confirm the binding abilities of silibinin to YAP and LATS. Inhibiting YAP pathway either by addition of verteporfin, an inhibitor of YAP/TAZ-TEAD, or by transfection of si-RNAs targeting YAP or TAZ further enhances silibinin-induced cell damage. While enhancing YAP activity by silencing LATS1/2 or overexpressing YAPS127/397A, an active form of YAP, attenuates silibinin-induced cell damage. These findings demonstrate that inhibition of the YAP/TAZ pathway contributes to cytotoxicity of silibinin in breast cancers, shedding lights on YAP/TAZ-targeted cancer therapies.
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Neoplasias da Mama , Silibina , Proteínas com Motivo de Ligação a PDZ com Coativador Transcricional , Proteínas de Sinalização YAP , Feminino , Humanos , Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Neoplasias da Mama/metabolismo , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Peptídeos e Proteínas de Sinalização Intracelular/metabolismo , Células MCF-7 , Simulação de Acoplamento Molecular , Fosfoproteínas/metabolismo , Transdução de Sinais/efeitos dos fármacos , Silibina/farmacologia , Transativadores/metabolismo , Fatores de Transcrição/metabolismo , Proteínas com Motivo de Ligação a PDZ com Coativador Transcricional/antagonistas & inibidores , Proteínas com Motivo de Ligação a PDZ com Coativador Transcricional/efeitos dos fármacos , Proteínas com Motivo de Ligação a PDZ com Coativador Transcricional/metabolismo , Verteporfina/farmacologia , Proteínas de Sinalização YAP/antagonistas & inibidores , Proteínas de Sinalização YAP/efeitos dos fármacos , Proteínas de Sinalização YAP/metabolismoRESUMO
Background: Low nuclear grade ductal carcinoma in situ (DCIS) patients can adopt proactive management strategies to avoid unnecessary surgical resection. Different personalized treatment modalities may be selected based on the expression status of molecular markers, which is also predictive of different outcomes and risks of recurrence. DCIS ultrasound findings are mostly non mass lesions, making it difficult to determine boundaries. Currently, studies have shown that models based on deep learning radiomics (DLR) have advantages in automatic recognition of tumor contours. Machine learning models based on clinical imaging features can explain the importance of imaging features. Methods: The available ultrasound data of 349 patients with pure DCIS confirmed by surgical pathology [54 low nuclear grade, 175 positive estrogen receptor (ER+), 163 positive progesterone receptor (PR+), and 81 positive human epidermal growth factor receptor 2 (HER2+)] were collected. Radiologists extracted ultrasonographic features of DCIS lesions based on the 5th Edition of Breast Imaging Reporting and Data System (BI-RADS). Patient age and BI-RADS characteristics were used to construct clinical machine learning (CML) models. The RadImageNet pretrained network was used for extracting radiomics features and as an input for DLR modeling. For training and validation datasets, 80% and 20% of the data, respectively, were used. Logistic regression (LR), support vector machine (SVM), random forest (RF), and eXtreme Gradient Boosting (XGBoost) algorithms were performed and compared for the final classification modeling. Each task used the area under the receiver operating characteristic curve (AUC) to evaluate the effectiveness of DLR and CML models. Results: In the training dataset, low nuclear grade, ER+, PR+, and HER2+ DCIS lesions accounted for 19.20%, 65.12%, 61.21%, and 30.19%, respectively; the validation set, they consisted of 19.30%, 62.50%, 57.14%, and 30.91%, respectively. In the DLR models we developed, the best AUC values for identifying features were 0.633 for identifying low nuclear grade, completed by the XGBoost Classifier of ResNet50; 0.618 for identifying ER, completed by the RF Classifier of InceptionV3; 0.755 for identifying PR, completed by the XGBoost Classifier of InceptionV3; and 0.713 for identifying HER2, completed by the LR Classifier of ResNet50. The CML models had better performance than DLR in predicting low nuclear grade, ER+, PR+, and HER2+ DCIS lesions. The best AUC values by classification were as follows: for low nuclear grade by RF classification, AUC: 0.719; for ER+ by XGBoost classification, AUC: 0.761; for PR+ by XGBoost classification, AUC: 0.780; and for HER2+ by RF classification, AUC: 0.723. Conclusions: Based on small-scale datasets, our study showed that the DLR models developed using RadImageNet pretrained network and CML models may help predict low nuclear grade, ER+, PR+, and HER2+ DCIS lesions so that patients benefit from hierarchical and personalized treatment.
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Objectives: This study investigated the occurrence rate of unexpected breast cancer (UEBC) mimicking benign lesions [Breast Imaging Reporting and Data System (BI-RADS) category 3 or 4a] using ultrasound-guided vacuum-assisted excision biopsy (US-VAEB), and explored the factors responsible for late diagnosis of T2 stage UEBC. Materials and methods: We collected clinicopathologic data and preoperative US imaging features within 3 months before US-VAEB of patients who were diagnosed with UEBC from January 2002 to September 2022. The UEBC were divided into T1 and T2 stageUEBC. The US imaging features as well as clinical and pathological information of T1 and T2 stage UEBC were compared to explore the factors responsible for late diagnosis of T2 stage UEBC. Results: Breast cancer was diagnosed in 91 of 19 306 patients who underwent US-VAEB. We excluded eight patients with breast cancer assigned to BI-RADS 4b category by preoperative US, and two for whom US imaging records were unavailable. Finally, we enrolled 81 patients. The occurrence rate of UEBC after US-VAEB was 0.42%(81/19296). Of the 81 cases of UEBC, 22 were at T2 stage. The ratio of T2 stage UEBC was 27.2%. The differences in risk factor of breast cancer and routine breast US screening between T1 and T2 stage UEBC were significant[96.6% (57/59) vs 81.8% (18/22), 44.1% (26/59) vs 13.6% (3/22), respectively, P<0.05). Conclusion: UEBC was rarely detected by US-VAEB. Most cases of T2 stage UEBC were diagnosed late because of the absence of routine US screening and risk factors for breast cancer. Stricter clinical management regulations for breast lesions and performing regular US screening may be helpful to reduce T2 stage UEBC.
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Background: Plasma S100A1 protein is a novel inflammatory biomarker associated with acute myocardial infarction and neurodegenerative disease's pathophysiological mechanisms. This study aimed to determine the levels of this protein in patients with acute ischemic stroke early in the disease progression and to investigate its role in the pathogenesis of acute ischemic stroke. Methods: A total of 192 participants from hospital stroke centers were collected for the study. Clinically pertinent data were recorded. The volume of the cerebral infarction was calculated according to the Pullicino formula. Multivariate logistic regression analysis was used to select independent influences. ROC curve was used to analyze the diagnostic value of AIS and TIA. The correlation between S100A1, NF-κB p65, and IL-6 levels and cerebral infarction volume was detected by Pearson correlation analysis. Results: There were statistically significant differences in S100A1, NF-κB p65, and IL-6 among the AIS,TIA, and PE groups (S100A1, [230.96 ± 39.37] vs [185.85 ± 43.24] vs [181.47 ± 27.39], P < 0.001; NF-κB p65, [3.99 ± 0.65] vs [3.58 ± 0.74] vs [3.51 ± 0.99], P = 0.001; IL-6, [13.32 ± 1.57] vs [11.61 ± 1.67] vs [11.42 ± 2.34], P < 0.001). Multivariate logistic regression analysis showed that S100A1 might be an independent predictive factor for the diagnosis of disease (P < 0.001). The AUC of S100A1 for diagnosis of AIS was 0.818 (P < 0.001, 95% CI [0.749-0.887], cut off 181.03, Jmax 0.578, Se 95.0%, Sp 62.7%). The AUC of S100A1 for diagnosis of TIA was 0.720 (P = 0.001, 95% CI [0.592-0.848], cut off 150.14, Jmax 0.442, Se 50.0%, Sp 94.2%). There were statistically significant differences in S100A1, NF-κB p65, and IL-6 among the SCI,MCI, and LCI groups (S100A1, [223.98 ± 40.21] vs [225.42 ± 30.92] vs [254.25 ± 37.07], P = 0.001; NF-κB p65, [3.88 ± 0.66] vs [3.85 ± 0.64] vs [4.41 ± 0.45], P < 0.001; IL-6, [13.27 ± 1.65] vs [12.77 ± 1.31] vs [14.00 ± 1.40], P = 0.007). Plasma S100A1, NF-κB p65, and IL-6 were significantly different from cerebral infarction volume (S100A1, r = 0.259, P = 0.002; NF-κB p65, r = 0.316, P < 0.001; IL-6, r = 0.177, P = 0.036). There was a positive correlation between plasma S100A1 and IL-6 with statistical significance (R = 0.353, P < 0.001). There was no significant positive correlation between plasma S100A1 and NF-κB p65 (R < 0.3), but there was statistical significance (R = 0.290, P < 0.001). There was a positive correlation between IL-6 and NF-κB p65 with statistical significance (R = 0.313, P < 0.001). Conclusion: S100A1 might have a better diagnostic efficacy for AIS and TIA. S100A1 was associated with infarct volume in AIS, and its level reflected the severity of acute cerebral infarction to a certain extent. There was a correlation between S100A1 and IL-6 and NF-κB p65, and it was reasonable to speculate that this protein might mediate the inflammatory response through the NF-κB pathway during the pathophysiology of AIS.
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Ataque Isquêmico Transitório , AVC Isquêmico , Doenças Neurodegenerativas , Proteínas S100 , Humanos , Infarto Cerebral/diagnóstico , Interleucina-6 , Ataque Isquêmico Transitório/diagnóstico , AVC Isquêmico/sangue , AVC Isquêmico/diagnóstico , NF-kappa B/metabolismo , Estudos Prospectivos , Proteínas S100/sangueRESUMO
The use of immune checkpoint inhibitors (ICIs) has shown remarkable efficacy in the treatment of various malignancies, significantly reshaping cancer treatment. However, as a result of the widespread use of ICIs, several immune-related adverse events (iRAEs) have emerged, some of which can be rare and potentially fatal. In this paper, we reported the earliest case of Sintilimab used in the treatment of esophageal cancer with severe inflammatory myopathy (involving the cardiac, respiratory, and skeletal muscles)in China. This patient was an elderly female who presented to our institution with progressive limb weakness and ptosis. Prior to the onset of symptoms, the patient had undergone a radical esophagectomy for esophageal cancer, experienced several cycles of of radiotherapy and chemotherapy, as well as two doses of Sintilimab treatment. Shortly after initiating immunotherapy, the patient developed symptoms including bilateral ptosis, limb weakness, and difficulty swallowing and breathing. The levels of creatine kinase and troponin I in the patient's blood were significantly elevated, and positive results were observed for anti-skeletal and anti-cardiac muscle antibodies, indicating that the patient might be developing ICIs-related inflammatory myopathy. Fortunately, the patient responded well to treatment including corticosteroids, plasmapheresis, intravenous immunoglobulin, and other supportive therapies. Here, we discuss the incidence, mechanisms, and management strategies of fatal iRAEs. Early detection and timely intervention may be critical in reducing the incidence and mortality rates of iRAEs and improving patient outcomes.
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Neoplasias Esofágicas , Miosite , Humanos , Feminino , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/etiologia , Imunoterapia/efeitos adversos , Imunoterapia/métodos , Miosite/induzido quimicamente , Miosite/diagnóstico , Miosite/tratamento farmacológicoRESUMO
Background: Neoadjuvant therapy (NAT) is the preferred treatment for advanced breast cancer nowadays. The early prediction of its responses is important for personalized treatment. This study aimed at using baseline shear wave elastography (SWE) ultrasound combined with clinical and pathological information to predict the clinical response to therapy in advanced breast cancer. Methods: This retrospective study included 217 patients with advanced breast cancer who were treated in West China Hospital of Sichuan University from April 2020 to June 2022. The features of ultrasonic images were collected according to the Breast imaging reporting and data system (BI-RADS), and the stiffness value was measured at the same time. The changes were measured according to the Response evaluation criteria in solid tumors (RECIST1.1) by MRI and clinical situation. The relevant indicators of clinical response were obtained through univariate analysis and incorporated into a logistic regression analysis to establish the prediction model. The receiver operating characteristic (ROC) curve was used to evaluate the performance of the prediction models. Results: All patients were divided into a test set and a validation set in a 7:3 ratio. A total of 152 patients in the test set, with 41 patients (27.00%) in the non-responders group and 111 patients (73.00%) in the responders group, were finally included in this study. Among all unitary and combined mode models, the Pathology + B-mode + SWE model performed best, with the highest AUC of 0.808 (accuracy 72.37%, sensitivity 68.47%, specificity 82.93%, P<0.001). HER2+, Skin invasion, Post mammary space invasion, Myometrial invasion and Emax were the factors with a significant predictive value (P<0.05). 65 patients were used as an external validation set. There was no statistical difference in ROC between the test set and the validation set (P>0.05). Conclusion: As the non-invasive imaging biomarkers, baseline SWE ultrasound combined with clinical and pathological information can be used to predict the clinical response to therapy in advanced breast cancer.
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Objective: This retrospective study aimed to analyze the ultrasound (US) imaging features of solitary papillary thyroid carcinoma (PTC) located in the isthmus and to assess the risk factors for lymph node metastasis (LNM) and tumor capsular invasion. Methods: We included a total of 135 patients with solitary PTC located in the isthmus. All the cases underwent US, total thyroidectomy, and prophylactic central lymph node dissection. Patients' demographic and thyroid isthmus nodules' US characteristics, as well as risk factors associated with LNM and tumor capsular invasion, were analyzed. Results: It was revealed that the occurrence of LNM was higher in male patients than in female patients (P < 0.001). As risk factors, the size of PTC in the isthmus was found to be associated with LNM and tumor capsular invasion (P = 0.005 and 0.000, respectively). The area under the receiver operating characteristic curve (AUC) of the size of the isthmus PTC was 0.64 [95% confidence interval (CI) = 0.55-0.72], indicating a probability for LNM. The AUC value for tumor capsular invasion was 0.77 (95% CI: 0.68-0.83). When the threshold was set to 1.1 cm, the larger size indicated that there was a probability of occurrence of LNM with sensitivity and specificity of 47.4 and 73.7%, respectively. When the threshold was set to 0.7 cm, the larger size indicated that there was potentially a tumor capsular invasion, with sensitivity and specificity of 80.6 and 56.3%, respectively. Wider-than-tall nodules were found to be significantly different from those in LNM and tumor capsular invasion (P = 0.038 and 0.030, respectively). There were significant differences in tumor capsular invasion in extrathyroidal extension (ETE) compared with smooth or ill-defined and lobulated or irregular nodules (P = 0.017). Conclusions: This study showed that the incidence of LNM in male patients was higher than that in female ones. When a US image shows a thyroid isthmus nodule with a wider-than-tall shape, LNM and tumor capsular invasion were likely to occur. When a US image shows a thyroid isthmus nodule with an ETE, tumor capsular invasion was likely to occur. ETE and wider-than-tall may be indicators of FNA under US guidance, even though the size of thyroid isthmus nodule may be <1 cm.
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OBJECTIVE: To investigate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the differentiation of primary thyroid lymphoma (PTL) and nodular Hashimoto's thyroiditis (NHT) in patients with background of heterogeneous diffuse Hashimoto's thyroiditis (HT). METHODS: Sixty HT patients with 64 thyroid nodules (31 PTL and 33 NHT) who had undergone CEUS examination were included in this study. With histopathological results as the reference, we evaluated the imaging features of each nodule on both conventional ultrasonography (US) and CEUS. Quantitative CEUS parameters including peak intensity (PI), time to peak (TTP), and area under the time-intensity curve (AUC) were gathered in the nodule and background parenchyma. The ratio indexes of theses parameters were calculated by the ratio of the lesion and the corresponding thyroid parenchyma. Logistic regression and receiver operating characteristic (ROC) curves analyses of valuable US indicators were further preformed to evaluate the diagnostic capability of CEUS in discrimination of PTL and NHT. RESULTS: Among all the observed US imaging features and CEUS parameters, 10 indicators showed significant differences between PTL and NHT (all P < 0.05). All the significant indicators were ranked according to the odds ratios (ORs). Eight of them were CEUS associated including imaging features of enhancement pattern, degree, homogeneity, and quantification parameters of PI, AUC, ratios of PI, AUC, and TTP, while indicators on conventional US, including vascularity and size ranked the last two with ORs less than 3. The five single CEUS parameters showed good diagnostic performance in diagnosis of PTL with areas under ROC curves of 0.72-0.83 and accuracies of 70.3-75.0%. The combination of CEUS imaging features and the ratios of PI, AUC, and TTP demonstrated excellent diagnostic efficiency and achieved area under ROC curve of 0.92, which was significantly higher than any of the five single parameters (all P < 0.05), with a sensitivity of 83.9%, specificity of 87.9%, and accuracy of 85.9%. CONCLUSIONS: CEUS is an efficient diagnostic tool in the differential diagnosis of PTL and NHT for patients with diffuse HT. Conjoint analysis of CEUS imaging features and quantification parameters could improve the diagnostic values.
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BACKGROUND: Thyroid carcinoma constitutes the vast majority of all thyroid cancer, most of which is the solid nodule type. No previous studies have examined combining both conventional and elastic sonography to evaluate the diagnostic performance of partially cystic thyroid cancer (PCTC). This retrospective study was designed to evaluate differentiation of PCTC from benign partially cystic nodules with a machine learning-assisted system based on ultrasound (US) and elastography. METHODS: Patients with suspicious partially cystic nodules and finally confirmed were included in the study. We performed conventional US and real-time elastography (RTE). The US features of nodules were recorded. The data set was entered into 6 machine-learning algorithms. Sensitivity, specificity, accuracy, and area under the curve (AUC) were calculated. RESULTS: A total of 177 nodules were included in this study. Among these nodules, 81 were malignant and 96 were benign. Wreath-shaped feature, micro-calcification, and strain ratio (SR) value were the most important imaging features in differential diagnosis. The random forest classifier was the best diagnostic model. CONCLUSIONS: US features of PCTC exhibited unique characteristics. Wreath-shaped partially cystic nodules, especially with the appearance of micro-calcifications and larger SR value, are more likely to be malignant. The random forest classifier might be useful to diagnose PCTC.
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BACKGROUND: Static shear wave elastography (SWE) is used to detect breast lesions, but slice and plane selections result in discrepancies. OBJECTIVE: To evaluate the intraobserver reproducibility of continuous SWE, and whether quantitative elasticities in orthogonal planes perform better in the differential diagnosis of breast lesions. METHOD: One hundred and twenty-two breast lesions scheduled for ultrasound-guided biopsy were recruited. Continuous SWE scans were conducted in orthogonal planes separately. Quantitative elasticities and histopathology results were collected. Reproducibility in the same plane and diagnostic performance in different planes were evaluated. RESULTS: The maximum and mean elasticities of the hardest portion, and standard deviation of whole lesion, had high inter-class correlation coefficients (0.87 to 0.95) and large areas under receiver operation characteristic curve (0.887 to 0.899). Without loss of accuracy, sensitivities had increased in orthogonal planes compared with single plane (from 73.17% up to 82.93% at most). Mean elasticity of whole lesion and lesion-to-parenchyma ratio were significantly less reproducible and less accurate. CONCLUSION: Continuous SWE is highly reproducible for the same observer. The maximum and mean elasticities of the hardest portion and standard deviation of whole lesion are most reliable. Furthermore, the sensitivities of the three parameters are improved in orthogonal planes without loss of accuracies.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/diagnóstico , Técnicas de Imagem por Elasticidade/métodos , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Técnicas de Imagem por Elasticidade/normas , Feminino , Humanos , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Ultrassonografia de IntervençãoRESUMO
OBJECTIVE: To evaluate the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) in differentiating between benign and malignant enlarged lymph nodes using meta-analysis. MATERIALS AND METHODS: Pubmed, Embase, SCI and Cochrane databases were searched for studies (up to September 1, 2014) reporting the diagnostic performance of CEUS in discriminating between benign and malignant lymph nodes. Inclusion criteria were: prospective study; histopathology as the reference standard; and sufficient data to construct 2?2 contingency tables. Methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Patient clinical characteristics, sensitivity and specificity were extracted. The summary receiver operating characteristic curve was used to examine the accuracy of CEUS. A meta-analysis was performed to evaluate the clinical utility in identification of benign and malignant lymph nodes. Sensitivity analysis was performed after omitting outliers identified in a bivariate boxplot and publication bias was assessed with Egger testing. RESULTS: The pooled sensitivity, specificity and AUROC were 0.92 (95%CI, 0.85-0.96), 0.91 (95%CI, 0.82-0.95) and 0.97 (95%CI, 0.95-0.98), respectively. After omitting 3 outlier studies, heterogeneity decreased. Sensitivity analysis demonstrated no disproportionate influences of individual studies. Publication bias was not significant. CONCLUSIONS: CEUS is a promising diagnostic modality in differentiating between benign and malignant lymph nodes and can potentially reduce unnecessary fine-needle aspiration biopsies of benign nodes.