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Objective:To explore the feasibility and clinical value of artificial intelligence-assisted breast ultrasound in screening breast cancer in Tibet.Methods:Two hundred and eighty-six women who participated in breast cancer screening in Shigatse People′s Hospital from August to September in 2021 were selected. The study included four groups. Group 1, ultrasound screening by senior breast ultrasound doctors from Shanghai; Group 2: local ultrasound doctors used intelligent-assisted ultrasound equipment for screening; Group 3: local ultrasound technicians used intelligent-assisted ultrasound equipment for screening; Group 4: ultrasound screening by local ultrasound doctors. The pathological results of screening positive cases and six-month ultrasound follow-up results of negative cases were set as the gold standard.Results:Twenty-seven lesions of 21 persons were screened positive. Pathology showed that 1 case of invasive ductal carcinoma, 1 case of severe atypical hyperplasia, 6 cases of fibroadenoma, 5 cases of breast disease, 14 cases of breast hyperplasia. Two hundred and sixty-five persons were screened negative, and the results of the six-month ultrasound follow-up were still negative. The accuracy, sensitivity, and specificity of group 2 were 0.966, 1, and 0.964 respectively; The accuracy, sensitivity, and specificity of group 3 were 0.935, 0.769, and 0.943 respectively; The accuracy, sensitivity, and specificity of group 4 were 0.860, 0.308 and 0.885 respectively. The accuracy and area under the curve of groups 2 and 3 were significantly different from that of group 4 (all P<0.001), and there was no significant difference from that of group 1 ( P=0.063, P=0.055). Conclusions:Artificial intelligence-assisted breast ultrasound screening technology can effectively improve the screening efficiency of non-breast ultrasound specialists and technicians. It is very suitable to solve the problems faced by grass-roots screening in Tibet and has great social significance and clinical value.
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Objective:To investigate the stiffness characteristic of triple-negative human breast cancer at different size in a implantation nude female mice model using shear wave elastography(SWE) and to compare the clinical pathologic features of tumors with elasticity variables.Methods:Human breast cancer MDA-MB-231 cells were injected into 30 nude female mice and 27 transplanted tumors were successfully found in nude female mice. Ultrasound and SWE were longitudinally performed on maximum diameter plane of 21 tumours in 21 nude mice. The elastic parameters of maximal elasticity(Emax), mean elasticity (Emean) and standard deviation of elasticity(Esd) were recorded. The mice were divided into 3 groups according to the tumor size. They were group A with tumor size less than or equal to 5 mm, group B with tumor size greater than 5 mm and less than or equal to 10 mm, group C with tumor size larger than 10 mm and smaller than or equal to 15 mm. Compared with pathology, the relationships between Ki67 of transplanted tumor and elastic parameters were analyzed.Results:As the transplanted tumors increased, the values of Emax, Esd, Ki67 all increased. The lesions maximal size, Emax, Esd, Ki67 were significant higher in group B ( P<0.001, P=0.006, P=0.002, P=0.026) and group C ( P<0.001, P<0.001, P<0.001, P=0.028) than group A. The other parameters were not significantly different among the groups(all P>0.05). The size of transplanted tumors was significantly and positively correlated with Emax ( rs=0.673, P=0.001), Esd ( rs=0.661, P=0.001), and Ki67 ( rs=0.509, P=0.018). Conclusions:SWE Emax and Esd can reflect the tumor tissue stiffness change and biological activity during the tumor growth.
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Objective:To study the correlation between echogenic foci pattern of papillary thyroid carcinoma(PTC) solitary nodule and lateral cervical lymph node metastasis.Methods:The clinical data of 475 patients with echogenic foci in preoperative ultrasound and pathologically confirmed PTC solitary nodule from January to December 2014 in Fudan University Shanghai Cancer Center were retrospectively analyzed, which was categorized into lateral cervical lymph node metastasis group and lateral cervical lymph node non-metastasis group. Echogenic foci was classified into five types: local punctate echogenic foci, diffused punctate echogenic foci, coarse echogenic foci, mixed echogenic foci, peripheral annular and eggshell echogenic foci. The related clinical characteristics and the ultrasonic features were also involved. Chi-Square test and Logistic regression analysis were performed to analyze the correlation.Results:Age, preoperative human thyroglobulin (HTG) level, maximum diameter, location and echogenic foci pattern distributed to lateral cervical lymph node metastasis of PTC solitary nodule in 475 cases, according to univariate analysis ( P<0.05). Multivariate Logistic regression analysis showed diffused punctate echogenic foci, age≤35 years old, maximum diameter >10 mm and upper part were risk factors of lateral cervical lymph node metastasis of PTC solitary nodule. Conclusions:Diffused punctate echogenic foci in PTC solitary nodule, patients younger than 35 years old, maximum diameter larger than 1 cm and nodule location at upper part of the thyroid promote to lateral cervical lymph node metastasis.
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Objective To investigate the ultrasonographic features of different pathological types of phyllodes tumors ( PT ) of breast . Methods T he clinical manifestations and sonographic findings were analyzed retrospectively in 132 patients with 136 different subtype PT s . Ultrasonographic features of benign ,borderline and malignant types were compared . Results All the lesions were classified into benign ( 46/136 ,33 .8% ) ,borderline ( 62/136 ,45 .6% ) and malignant ( 28/136 ,20 .6% ) . On sonography ,most tumors were show n as oval or lobulated ( 77 .9% ) ,well‐defined margins ( 70 .6% ) ,and posterior echo enhancement ( 72 .1% ) . Cystic areas were observed in 36 lesions ( 26 .5% ) . No significant difference was observed in age ,lesion shape ,echo patterns ,posterior acoustic features or cystic area ( P ＞ 0 .05 ) . Large size ,indistinct margins and grade Ⅱ － Ⅲ vascularity were more frequent in borderline and malignant tumors ( P ＝0 .002 , P ＝0 .028 , P ＜0 .001 ,respectively ) . Conclusions Phyllodes tumors of breast have certain characteristics on ultrasonography .Large size ,unclear margins and rich blood flow signals may indicate malignancy .
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Objective To evaluate the risk factors in terms of clinical characteristics and sonographic features regarding solitairy thyroid papillary carcinoma (PTC) for the lateral cervical lymph node metastasis (LLNM) and then to establish nomogram model.Methods All patients were confirmed to be solitary PTC in paraffin wax pathology after thyroidectomy in Fudan University Shanghai Cancer Center from January to September 2016.Meanwhile,the status of lateral cervical lymph node metastasis was determined referring to postoperative pathology.Clinical characteristics including gender,age,preoperative thyroid stimulating hormone (TSH),thyroglobulin (Tg),thyroglobulin antibody (TGAb),thyroid peroxidase antibody (TPOAb),central lymph node metastasis (CLNM) and sonographic features of the PTC lesion including maximum tumor diameter,location,aspect ratio,relation with thyroid capsule,echo,margin,acoustic halo,microcalcification were evaluated for the association with lateral cervical lymph node metastasis using univariate and multivariate logistic regression analyses.Then the nomogram model was established and its application value was evaluated using ROC.Results Out of 1 174 patients,125 patients (10.6％) presented lateral neck lymph node metastasis and 10 patients presented skipping metastasis.Univariate analysis showed gender,preoperative Tg and TGAb,CLNM,maximum tumor diameter,location,close to the thyroid tumor capsule,echo,aspect ratio,acoustic halo,microcalcification were associated with LLNM (P ＜0.05).Binomial logistic regression analysis indicated CLNM,maximum tumor diameter of larger than 10 mm,superior or multiple location,microcalcification were independent risk factors of LLNM.The AUC of the nomogram model was 0.865,the sensitivity was 88.0％,the specificity was 75.2％,and the accuracy was 76.6％.Conclusions As for patients with single focal PTC,CLNM,larger lesions,microcalcification,superior location are associated with lateral neck lymph node metastasis.The nomogram model can be tried for clinical application.
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Objective@#To evaluate the risk factors in terms of clinical characteristics and sonographic features regarding solitairy thyroid papillary carcinoma (PTC) for the lateral cervical lymph node metastasis(LLNM) and then to establish nomogram model.@*Methods@#All patients were confirmed to be solitary PTC in paraffin wax pathology after thyroidectomy in Fudan University Shanghai Cancer Center from January to September 2016. Meanwhile, the status of lateral cervical lymph node metastasis was determined referring to postoperative pathology. Clinical characteristics including gender, age, preoperative thyroid stimulating hormone (TSH), thyroglobulin (Tg), thyroglobulin antibody (TGAb), thyroid peroxidase antibody (TPOAb), central lymph node metastasis (CLNM) and sonographic features of the PTC lesion including maximum tumor diameter, location, aspect ratio, relation with thyroid capsule, echo, margin, acoustic halo, microcalcification were evaluated for the association with lateral cervical lymph node metastasis using univariate and multivariate logistic regression analyses. Then the nomogram model was established and its application value was evaluated using ROC.@*Results@#Out of 1 174 patients, 125 patients (10.6%) presented lateral neck lymph node metastasis and 10 patients presented skipping metastasis.Univariate analysis showed gender, preoperative Tg and TGAb, CLNM, maximum tumor diameter, location, close to the thyroid tumor capsule, echo, aspect ratio, acoustic halo, microcalcification were associated with LLNM(P<0.05). Binomial logistic regression analysis indicated CLNM, maximum tumor diameter of larger than 10 mm, superior or multiple location, microcalcification were independent risk factors of LLNM. The AUC of the nomogram model was 0.865, the sensitivity was 88.0%, the specificity was 75.2%, and the accuracy was 76.6%.@*Conclusions@#As for patients with single focal PTC, CLNM, larger lesions, microcalcification, superior location are associated with lateral neck lymph node metastasis. The nomogram model can be tried for clinical application.
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Objective@#To compare the difference of diagnostic ability between ultrasound radiomics (USR) and different conventional imaging models of central neck (Ⅵ) lymph node metastasis in papillary thyroid carcinoma (PTC).@*Methods@#A training set of 609 cases was set up. USR features were extracted and screened by USR method. A weighted formula was established to calculate the USR score of each patient by ultrasound image. The USR score of the best diagnostic ability was obtained by statistical method and set as the diagnostic criterion. A test set of 326 cases was established to compare the diagnostic ability of USR score with ultrasound (US), computed tomography (CT) and US combined CT.@*Results@#The accuracy, sensitivity, specificity, area under ROC curve and Youden index of USR score in test set were 0.804, 0.867, 0.770, 0.766, 0.533, respectively, which were significantly higher than the corresponding values of US, CT and US combined CT(all P=0.000).@*Conclusions@#USR score obtained with USR method can effectively predict lymph node metastasis in Ⅵ region of PTC. The diagnostic efficiency and clinical value of USR score were significantly higher than those of conventional medical imaging models.
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Objective To compare the difference of diagnostic ability between ultrasound radiomics ( USR) and different conventional imaging models of central neck ( Ⅵ ) lymph node metastasis in papillary thyroid carcinoma ( PTC) . Methods A training set of 609 cases was set up . USR features were extracted and screened by USR method . A weighted formula was established to calculate the USR score of each patient by ultrasound image . T he USR score of the best diagnostic ability was obtained by statistical method and set as the diagnostic criterion . A test set of 326 cases was established to compare the diagnostic ability of USR score with ultrasound ( US ) ,computed tomography ( CT ) and US combined CT . Results T he accuracy ,sensitivity ,specificity ,area under ROC curve and Youden index of USR score in test set were 0 .804 ,0 .867 ,0 .770 ,0 .766 ,0 .533 ,respectively ,which were significantly higher than the corresponding values of US ,CT and US combined CT ( all P ＝ 0 .000 ) . Conclusions USR score obtained with USR method can effectively predict lymph node metastasis in Ⅵ region of PTC . T he diagnostic efficiency and clinical value of USR score were significantly higher than those of conventional medical imaging models .
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Objective To evaluate the risk factors in terms of clinical characteristics ,serological indicators and sonographic features regarding thyroid papillary carcinoma ( PTC) for the central neck lymph node metastasis . Methods One thousand one hundred and seventy‐four patients accepted thyroid cancer surgery at Fudan University Shanghai Cancer Center from January to September 2016 were enrolled . All patients were confirmed to be solitary PTC in paraffin wax pathology after thyroidectomy .M eanwhile ,the status of central neck lymph node metastasis was determined referring to postoperative pathology . All features of the PTC lesion in terms of clinical ,serological and sonographic features were evaluated for the association with central neck lymph node metastasis using univariate and multivariate logistic regression analysis . Meanwhile ,a nomogram model was established for the determined risk factors . Results Out of 1 174 patients ,469 patients ( 39 .9% ) presented central neck lymph node metastasis ,univariate analysis showed that age , gender , preoperative thyroglobulin ( Tg ) and thyroid peroxidase antibody ( T POAb ) , maximum diameter ,location ,close to the thyroid capsule ,AP/T R ,echo ,acoustic halo ,and presence of microcalcification were related with CLNM ( P ＜ 0 .05 ) . M ultivariate logistic regression analysis demonstrated that less than 55 years‐old , male , Tg higher than 20 eg/L , T POAb less than 1 kU/L , maximum diameter larger than 10 mm ,and presence of microcalcification were independent risk factors for CLNM . T he nomogram was established based on independent risk factors determined by the logistic regression with the AUC 0 .714 ,specificity 73 .1% ,and sensitivity 59 .7% . Conclusions For patients with single focal PTC lesion , younger age , male , higher Tg , lower T POAb , and larger lesions containing microcalcificatin on ultrasound are associated with central neck lymph node metastasis .
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Objective@#To investigate ultrasonographic and magnetic resonance imaging features of pure mucinous adenocarcinoma of breast, and to discuss the diagnose value.@*Methods@#Eighty-eight patients with 92 breast lesions of pure mucinous adenocarcinoma had undergone ultrasonography and MRI. The imaging features were reviewed and the diagnostic values were compared between the two imaging examinations.@*Results@#On ultrasonography, tumors were mostly showed well-defined margins (77.2%), lobulated shape (60.9%), hypoechoic (51.1%), heterogeneous texture (63.0%), posterior echo enhancement (82.6%). Color Doppler imaging showed vascularity in 75% of these lesions.On magnetic resonance imaging, most tumors showed circumscribed mass with lobulated shape. Sixty-four lesions (69.6%) showed hypointensity on T1-wighted images.Hyperintensity and strongly hyperintensity on T2-weighted images were identified in 71 cases and 21 cases, respectively. After contrast, 54 cases showed rim enhancement and the other 38 cases showed heterogeneous enhancement. There was no significant difference in diagnostic accuracy between ultrasonography and MRI (72.8% vs 77.2%, P=0.481). Combined the two imaging examinations, the diagnostic accuracy was higher than that of ultrasonography (84.8% vs 72.8%, P=0.001) and MRI (84.8% vs 77.2%, P=0.016).@*Conclusions@#Pure mucinous adenocarcinoma of breast has some typical characteristics in ultrasonography and MRI, combination of the two imaging examinations can improve the diagnostic accuracy.
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Objective To investigate the clinical value of conventional ultrasonographic ( US),US-guided diffuse optical tomography ( US-guided DOT ) and both combined to assess treatment response of breast cancer to neoadjuvant chemotherapy( NAC). Methods Eighty-eight breast cancer patients,totally 93 lesions were included in the study. Pre-and post-last chemotherapy,size,and total hemoglobin concentration ( THC) of each lesion were measured by conventional US and US-guided DOT before biopsy,the change of lesion Size( ΔSize) and the change of THC( ΔTHC) were calculated respectively.Based on the guidelines to evaluate the response to treatment in solid tumors,the responses to NAC were classified into complete response, partial response, static disease, progressive disease groups. The histological response to chemotherapy were categorised as partial pathological response and complete pathological response using Miller and Payne system. Results Of 93 breast cancers,the overall response rate was 81.7%,the cPR rate was 24.7%. According to ROC curve analysis,when ΔSize 42.6% and ΔTHC 23.9% as cutoff values to evaluate the complete response and partial response,the area under the curve ( AUC ) were 0.666 and 0.751,respectively,the AUC of US and US-guided DOT combined in parallel and in series were 0.680 and 0.737 respectively.When ΔSize 64.5% and ΔTHC 27.2% as cutoff values to evaluate complete pathologial response,the AUC were 0.690 and 0.728 respectively,the AUC of US and US-guided DOT combined in parallel and in series were 0.693 and 0.726 respectively. Conclusions US-guided DOT and US can be used to predict breast cancers response to NAC,US and US-guided DOT combined in parallel and in series can not improve response prediction comparing with US or US-guided DOT alone.
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Objective To explore the ultrasound-guided diffuse optical tomography (DOT) distribution difference and clinical characteristics of T 1-T3 breast carcinoma. Methods Four hundred and forty-seven breast cancer patients with 455 breast lesions were enrolled.The lesion maximal diameter and total hemoglobin concentration(THC) were obtained by ultrasound-guided DOT before breast surgery biopsy.The patients age,body mass index(BMI),and the distances from lesion to skin and nipple were measured,lymph node status were also assessed.According to the 7th Edition of the AJCC Cancer Staging, all tumors were divided into T1( ≤ 2 cm),T2(2 cm < lesion ≤ 5 cm),and T3( > 5 cm) three groups according to maximum diameter on ultrasound.Results Out of 455 breast cancer lesions,148 lesions were stage T1,251 lesions were stage T2,56 lesions were T3.The age,lesion size,lesion THC and the distances between lesions and nipples of breast cancer patients were found that there were significant differences among T1,T2 and T3(all P = 0.000). With T stages increasing,the age of breast cancers patients decreased,the distance between lesions and nipples decreased,the THC increased.THC of breast cancer T 2 [(221.0 ± 56.0)μmol/L] and T3[(233.1 ± 54.0)μmol/L] were significant higher than that of T1 [(181.6 ± 70.4)μmol/L](all P = 0.000).There were all no significant difference for BMI and the distancefrom lesion to skin among different stages T( P > 0.05).With T stages increasing,the ratio of lymph node metastasis increased(T1 26.4%,T2 49.8%,T3 55.4%; P =0.000).Conclusions With breast cancer T stages increasing,T HC increases,the age of the patients decreases,lymph node metastasis rate increases.
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Objective To study the value of ultrasound-guided fine needle aspiration (FNA) in the diagnosis of axillary lymph node metastasis in breast cancer,and to compared with conventional ultrasound in the diagnosis of metastatic lymph nodes of breast cancer.Methods Five hundred patients were enrolled into study prospectively from our hospital.The set of standard for patients into study:patients were diagnosed by BI-RADS and classified into class 4 or class 5 preoperative,the maximum diameter of the tumor was less than 2 cm,and there was no case of distant metastasis.Ultrasound guided FNA was performed in each case,and the results were compared with conventional ultrasound diagnosis results,using pathological findings as gold standard.Results The sensitivity,specificity,positive predictive value,negative predictive value and accuracy in the diagnosis of axillary lymph node by conventional ultrasound were 60.6%,67.6%,77.2%,48.7%,and 63.1%,respectively,and by ultrasound-guided FNA were 78%,100%,100%,71.6%,and 85.6%,respectively.There were significant differences between the two diagnostic methods statistically(χ2=113.2,P<0.001).Conclusions Ultrasound-guided FNA can effectively reduce the number of sentinel lymph node biopsy,which displays a certain clinical value.
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Objective To investigate the diagnostic value of ultrasonography for neck lymph node metastasis in papillary thyroid carcinoma(PTC) and Hashimoto's thyroiditis(HT) coexistent with PTC.Methods Two hundred and seventy-eight patients who accepted thyroid surgery were retrospectively reviewed for the pre-operative ultrasonographic and post-operative pathological reports.All patients were confirmed as PTC by surgery and pathology.According to the presence of HT confirmed in pathology,all patients were divided into two groups:group of PTC and group of HT with PTC.The status of neck lymph node metastasis and the diagnostic value of pre-operative ultrasound in detecting neck lymph node metastasis were studied.Results There were 185 cases in the group of PTC,and the rate of neck lymph node metastasis was 59.5 ％;while there were 93 cases in the group of HT with PTC,in which the rate of neck lymph node metastasis was 45.2％.The difference between the two groups in lymph node metastasis was statistically significant (P =0.024).The predictive accuracy of pre-operative ultrasound for central neck lymph node was 53.9％ in the group of PTC,which was statistically higher than 18.8％ in the group of HT with PTC(P =0.01).The predictive accuracy of pre-operative ultrasound for lateral neck lymph node was 79.4％ in the group of PTC,which had no statistical difference with that in the group of HT with PTC (73.1％,P =0.565).Conclusions The neck lymph node metastasis in PTC patients occurs more frequently than that in PTC patients with HT.The value of pre-operative ultrasound examination is lower for the detection of central lymph node metastasis,especially in PTC patients with HT;while ultrasound is more sensitive and accurate for lateral lymph node detection regardless of the existence of HT.
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Objective To investigate the role of additional post core biopsy ultrasound in clinically node negative breast cancer.Methods Axillary ultrasound was performed before and after breast cancer was diagnosed on core biopsy samples.Post core biopsy ultrasound were performed by radiologists of this department of ultrasound at random.Post-diagnosis ultrasounds were performed by a radiologist with over 20 years of experience for the diagnosis of breast cancer with axi[lary disease.Results were compared to the final axillary pathological result.Results Of the 96 patients,17 were pathology lymph node positive.Post biopsy ultrasound identified 8 of the 17 positive nodes,with a sensitivity 47.1％,specificity 88.6％,positive predictive value of 47.1％,negative predictive value of 88.6％,accuracy of 81.3％.While the diagnosis index of pre-biopsy ultrasound were 47.1 ％,88.6％,47.1％,88.6％,81.3％,respectively.Conclusions Post-biopsy ultrasounds had an increased sensitivity for identifying positive axillary nodes,at the same times,specificity decreased.
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Objective To investigate the value of ultrasound-diffuse optical tomography(US-DOT) in evaluation of the response to neoadjuvant chemotherapy (NCT) in patients with breast cancer.Methods Fifty women with breast cancer confirmed by biopsy-pathology scheduled to undergo NCT were enrolled.US-DOT was performed and the total hemoglobin concentration(HbT) prior to and at the end of NCT.According to the response to treatment in solid tumors,patients were divided into complete response(CR) group,partial response (PR) group,stable disease (SD) group and progressive disease (PD) group.The analysis of variance compared the differences of HbT before and after NCT in each group; Pearson correlation analyzed the relationship between the relative HbT variation and the tumor size changes;Mixedeffects model analyzed the relationship between HbT and tumor size.Results After NCT,CR group had 8 cases,PR group 30 cases,SD group 12 cases and no PD cases.Before and after NCT,the mean relative variations of HbT before and after NCT were-0.525 ± 0.222,-0.328 ± 0.180 and-0.173 ± 0.167 in CR,PR and SD groups,respectively.The differences of HbT before and after NCT were statistically significant in each group (P ＜0.05).There was significant difference among tumor diameter and HbT in CR group and PR group (P ＜0.001);while in the SD group,there was no difference among tumor diameter and HbT (P ＞ 0.05).The change of HbT after NCT showed positive correlation with the change in tumor size (r =0.6).Mixed-effects model also showed that HbT change was associated with tumor size.Conclusions USDOT marker HbT is closely related to tumor size of breast cancer before and after NCT and may be applied to evaluate the response of breast cancer to NCT.
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Ultrasound imaging is a valuable tool in the detection of breast lesions, and the breast imaging and reporting data system (BI-RADS) guides the ultrasound diagnosis of breast lesion to improve the diagnosis accuracy. The research of breast ultrasound computer-aided diagnosis (CAD) with BI-RADS-US is a hot topic now. In this paper, we reviewed the research progress of breast ultrasound CAD with BI-RADS-US, summarized the present problems, and discussed the future development.
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Female , Humans , Algorithms , Artifacts , Breast Neoplasms , Diagnostic Imaging , Diagnosis, Computer-Assisted , Methods , Information Systems , Reference Standards , Sensitivity and Specificity , Ultrasonography, Mammary , MethodsABSTRACT
Objective To evaluate the value of real time three-dimensional ultrasound in differentiating benign and malignant breast tumors. Methods One hundred and fifty-three patients with breast tumors were examined with real time three-dimensional ultrasound. The results were compared with post-operative pathological results. Results A sign of malignancy on the coronal plane was observed by three-dimensional ultrasonography,named “sun-like symptom”,because the sign looked like a shining sun:striated hyperechoic or iso-echoic images scattered radially around cancers,together with the distortion of normal tissue.The accuracy of the sign in differentiating benign and malignant breast tumors was 86.93 %( 133/153 ), the sensitivity was 78.38 %( 58/74 ), and the specificity was 94.94 %( 75/79 ). Conclusions Real time three-dimensional ultrasound is a valuable and new technique in differentiating benign and malignant breast tumors.