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Background Dentists are a high-risk population of work-related musculoskeletal disorders (WMSDs), where the body part with the highest prevalence is the neck. Objective To analyze potential influencing factors of neck pain among dentists, and explore a prediction model of neck pain in dentists. Methods Dentists from different hospitals in Fuzhou were selected as study subjects by stratified cluster sampling according to hospital characteristics (dental hospitals, general hospitals, and dental clinics). The basic information, presentation of WMSDs, and its influencing factors were investigated by using the Chinese version of Musculoskeletal Disorders Questionnaire and the Subjective Workload Assessment Technique. A total of 655 questionnaires were collected, of which 603 were valid, with an effective rate of 92.1%. Multiple logistic regression was used to analyze potential influencing factors of neck pain in dentists. A prediction model of neck pain of dentists was constructed by using neural network model, and the prediction efficiency of the model was evaluated. Results The neck was the body part with the highest prevalence (43.8%, 264/603) of WMSDs among dentists. The results of multiple logistic regression analysis showed that female (OR=2.709, 95%CI: 1.852-3.962, P <0.001), working age of 10-<20 years (versus <10 years, OR=3.836, 95%CI: 2.471-5.957, P<0.001), keeping head up or down for a long time (OR=8.492, 95%CI: 2.203-32.731, P=0.002), holding head sideways for a long time (OR=2.210, 95%CI: 1.376-3.550, P<0.001), maintaining the same sitting spot for a long time (OR=4.336, 95%CI: 2.192-8.579, P<0.001), and psychological load value ≥70 (versus <40, OR=1.901, 95%CI: 1.038-3.480, P=0.037) increased the risk of neck pain in dentists. Sufficient operating space (OR=0.507, 95%CI: 0.302-0.850, P=0.010) and doing some exercise during work break (OR=0.670, 95%CI: 0.453-0.991, P=0.045) reduced the risk of reporting neck pain among dentists. A neural network prediction model of dentists' neck pain was constructed with 1 hidden layer and 6 hidden layer neurons. The percentage of correct prediction of training set was 89.6%, and the percentage of correct prediction of test set was 83.9%. The order of importance of the independent variables included in the model were working age, holding head sideways for a long time, psychological load, etc. The result of neural network model of neck pain among dentists showed that the area under the curve of receiver operator characteristic (ROC) was 0.940 (95%CI: 0.922-0.958, P<0.001). When the maximum diagnostic value was determined by the ROC curve, the sensitivity was 84.8%, the specificity was 91.2%, and the Youden Index was 0.760. Conclusion Neck pain of dentists is affected by many factors, such as individual factors (gender and working age), ergonomic factors (keeping various postures and operations for a long time, operating space, etc.), psychological factors (different levels of psychological load) and so on. The neural network model can be used as a prediction tool to explore the risk of reporting neck pain among dentists.
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Objective:To investigate the mammography, ultrasound and MRI features of breast ductal carcinoma in situ within papillomas (DCIS-WP) and ductal carcinoma in situ in general (DCIS-IG), and to select the appropriate screening methods for breast cancer.Methods:A retrospective analysis of 134 patients with DCIS-WP and DCIS-IG confirmed by pathology from January 2015 to October 2018 was conducted, including 40 patients with DCIS-WP and 94 patients with DCIS-IG. Mammography, ultrasound and MRI images were analyzed based on BI-RADS criteria, to evaluate the missed diagnosis rate and accuracy rate of three imaging methods, and the consistency of preoperative puncture, intraoperative frozen section and postoperative paraffin section was also observed. Qualitative data were compared using the χ 2 test or Fisher′s exact test. Results:The X-ray missed diagnosis rate of DCIS-WP group and DCIS-IG group was 42.50%（17/40） and 5.32%（5/94）, respectively, while the diagnostic accuracy rate was 22.50%（9/40） and 77.66%（73/94） respectively. The difference between the two groups was statistically significant (χ2=28.268, 35.952, P<0.001). In DCIS-WP group and DCIS-IG group, there were 8 and 2 cases with multiple hypoechoic nodules in the lesions, the difference was statistically significant (χ2=20.819, P<0.001); the missed diagnosis rate was 0 and 24.47%（23/94）, the difference was statistically significant ( P<0.05). On MRI, there were 24 cases and 15 cases of DCIS-WP group and DCIS-IG group with the signs of catheter dilation, 21 cases and 16 cases with multiple papillomas background, 15 cases and 12 cases with sparse internal ring manifestations, 19 cases and 13 cases with different sizes, respectively. The difference between the two groups was statistically significant (χ2=26.378, 17.671, 8.524, 14.530, P<0.05). In DCIS-WP group and DCIS-IG group, 12 cases and 82 cases had the same diagnosis of preoperative puncture, intraoperative frozen pathology and postoperative paraffin pathology respectively, and the difference between the two groups was statistically significant (χ2=44.165, P<0.001). Conclusions:The features of DCIS-WP are different from those of DCIS-IG on mammography and ultrasound. DCIS-WP is likely to be missed on mammography as there is less calcification, while it is easier to be detected by ultrasound. MRI has good diagnostic efficacy for both types of DCIS and is helpful in differentiating them.
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@#To explore the effect of Astragalus membranaceus, a traditional Chinese medicine, on metabolic homeostasis of heart, brain and blood in mice, and to elucidate the cardio-cerebrovascular protective mechanisms of AR from the perspective of metabolic regulation. Thirteen ICR male mice were randomly divided into two groups which were intragastrically administered with ultrapure water and aqueous extract of Astragalus membranaceus for 10 consecutive days, respectively. Liquid chromatography-mass spectrometry (LC-MS) and gas chromatography-mass spectrometry (GC-MS) were used to comprehensively characterize the metabolic profiles of serum, heart and brain tissues. Multivariate statistical analysis combined with nonparametric tests were applied to screen and identify different metabolites, and then the related metabolic pathways were uncovered. Multivariate statistical analysis showed that the metabolic profiles of serum, heart, and brain tissues of mice after Astragalus membranaceus intervention significantly changed compared with the control group. A total of 15, 19, and 17 metabolites were identified in serum, heart, and brain tissues, respectively, among which palmitic acid and LysoPC (20∶3) were screened out from all types of biological samples. The results of metabolic pathway enrichment analysis showed that amino acid metabolism, phospholipid metabolism, fatty acid metabolism and tricarboxylic acid cycle were significantly affected. Astragalus membranaceus may protect the cardio-cerebrovascular system by regulating the metabolic homeostasis of amino acids, lipids and energy.
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OBJECTIVE: To analyze the prevalence of work-related musculoskeletal disorders(WMSDs) among dentists and explore its influencing factors. METHODS: A total of 455 dentists from 9 medical organizations of Beijing and Fuzhou cities were selected as study subjects. The disease occurrence and mental workload were investigated using China Musculoskeletal Disorders Questionnaire and Subjective Workload Assessment Technique. The influencing factors of WMSDs were analyzed by multivariate logistic regression. RESULTS: The total prevalence of WMSDs was 58.9%(268/455) among dentists. The top three body parts of WMSDs were neck(41.5%), shoulder(33.6%) and lower back(28.1%). The median of mental workload score was 58. Multivariate logistic regression analysis results indicated that female dentists showed a higher risk than male dentists(P<0.01) after excluding the influence of confounding factors. The higher the length of service, the higher their risk for WMSDs(P<0.01). Dentists who hold their heads sideways for long time, bent frequently, and use vibrating tools had relatively high risks of developing WMSDs(P<0.01). Dentists who use armchairs had a relatively low risk of WMSDs(P<0.01). There was no correlation between the mental workload and the prevalence of WMSDs in dentists(P>0.05). CONCLUSION: The prevalence of WMSDs among dentists is high. Individual factors, awkward posture and using vibrating tools are risk factors of WMSDs among dentists.Armchair use can help reduce the risk of WMSDs.
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Objective@#To investigate the visual application of the CiteSpace software in the field of work-related musculoskeletal disorders (WMSDs) .@*Methods@#The literature on WMSDs research, published from 1991 to 2017, was retrieved in Web of Science database. The CiteSpace 5.2 was used to make visualization analysis on the hotspots and tendency of the keywords, authors, countries (regions) and research institutes in relevant literature.@*Results@#A total of 3224 literatures were included in the analysis. The amount of the literatures published was increasing annually. The key word co-occurrence network showed that the research hotspots mainly focused on the study of epidemiology, risk factors, symptoms, and other aspects of WMSDs. The cooperation network and time network of counties and regions showed that America and Europe were at the leading position in the field of WMSD, and the top three were America, Canada and Sweden. The developing countries, like Brazil and China, had also begun to make relative research since 2000. In research cooperation, the collaboration among countries, research institutions was relatively close, and multiple leading core authors and teams were formed in the international arena.@*Conclusion@#The CiteSpace software can directly demonstrate the hotspots and tendency in the area of WMSDs.
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Objective: To investigate the imaging features of primary adenoid cystic carcinoma (ACC) of the breast. Methods: In total, 31 patients were confirmed to have primary ACC in the breast based on histopathological findings from January 2012 to September 2018 in Tianjin Medical University Cancer Institute and Hospital. Mammography and ultrasonography findings of these patients were retrospectively analyzed according to the breast imaging-reporting and data system (BI-RADS) recommended by the American College of Radiology (ACR) and compared with pathological findings. Results: Mammography findings in 31 cases of ACC of the breast were as follows: 25 cases with masses, including 16 high-density masses (14 were categorized as BI-RADS 4C or 5, one as 4A, and one as 4B); 7 equal-density masses (5 were categorized as BI-RADS 4B, one as 4A,and one as 3); and 2 mixed-density masses (one was categorized as BI-RADS 4A and one as 2). The other 6 patients presented with focal asymmetric density. No calcification was found in all cases. Ultrasonography findings included hypoechoic mass, mixed-echo mass, and non-mass-like hypoechoic or heterogeneous echoic areas. A total of 22 patients presented with hypoechoic masses; of these, 14 showed typical ultrasonographic findings of breast cancer and their tumors were categorized as BI-RADS 4C or 5. Three patients presented with mixed-echo masses, of which two showed a mixed-echo mass containing hyper-echoic areas and one showed a complex cystic and solid echo mass; all tumors were categorized as BI-RADS 4B. The remaining 6 patients presented with non-mass-like hypoechoic or heterogeneous echoic areas; all were without a tendency to distribute along the direction of the breast ducts. Conclusions: The mammographic and ultrasonographic appearances of primary ACC of the breast are similar to those of general carcinoma, with no specificity. Some specific findings, such as irregular high-density masses containing low-or fatty-density areas with indistinct margins on mammography and mixed-echo masses containing hyper-echo or non-mass-like heterogeneous echoic areas not distributed along the breast duct on ultrasonography, have certain significance. The final diagnosis depends on histopathology.
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Breast cancer is the most common cancer for Chinese women. Early screening is the best way to improve the rates of early diagnosis and early treatment of breast cancer. The peak ages of breast cancer in Chinese women are obviously different from those in the European and American countries. It is imperative to develop a guideline for breast cancer screening that is suitable for Chinese women. Based on the analysis and summary of breast cancer screening data in China, and the latest guidelines and consensus on breast cancer screening in Europe, the United States and East Asia, China Anti-Cancer Association and National Clinical Research Center for Cancer (Tianjin Medical University Cancer Institute and Hospital) has developed a population-based guideline for breast cancer screening in Chinese women. This guideline has provided detailed recommendations on the screening starting age, screening modalities, and screening interval in Chinese women with average risk and high risk of breast cancer, respectively. This article aims to interpret the above guideline, providing references for professionals in breast cancer screening.
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Objective: To establish a prediction model for the distant metastasis of breast cancer based on qualitative magnetic reso-nance imaging (MRI) parameters. Methods: A retrospective analysis of 3,032 patients with breast MRI from January 2011 to Decem-ber 2016 in Tianjin Medical University Cancer Institute and Hospital was conducted. After the confirmation of invasive breast cancer, the subjects were divided in 2 groups: metastasis and metastasis-free. A total of 93 patients were included in the metastasis group, and 186 patients without the presence of distant metastasis in the metastasis-free group. We analyzed the correlation between breast cancer molecular subtypes and distant metastasis in the metastasis group. Univariate and Logistic regression analyses of qualitative MRI features were performed for the groups. Subsequently, we used the results to establish prediction models. Results: The results showed that hormone receptor-positive tumors (Luminal type) had a greater tendency to develop bone metastasis in the metastasis group. Triple-negative tumors showed a greater tendency to develop lung metastasis. Human epidermal growth factor receptor 2 gene overexpression cases were more likely to develop liver metastasis. The results of the univariate analysis showed that the type of le-sion, multifocality or multicentricity of the cancer, T1-weighted signal uniformity, T2-weighted signal uniformity, and tumor size were statistically different between the groups (P<0.05). The results of the logistic regression analysis showed that the type of lesion, multi-focality or multicentricity of the cancer, T2-weighted signal uniformity, and tumor size were independent predictors of distant metasta-sis. Based on select independent predictors, we established a prediction model for the distant visceral metastasis of breast cancer. The accuracy, area under the curve, sensitivity, and specificity of the model were 82.8%, 0.801, 85.7%, and 75.0%, respectively. Conclu-sions: The prediction model based on the clinical pathology and MRI features established in this study can predict the distant metasta-sis of breast cancer.
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Objective: To investigate the correlations between parameters of histograms of the apparent diffusion coefficient (ADC) with multi-b-value diffusion-weighted imaging (DWI) at 3.0T MRI and prognostic factors and molecular subtypes of breast cancer, to evaluate the diagnostic performance of ADC histograms at different b values. Methods: A total of 114 patients (116 lesions) with inva-sive ductal carcinomas confirmed by surgical pathology who underwent breast magnetic resonance imaging from March 2015 to Janu-ary 2016 in Tianjin Medical University Cancer Institute and Hospital were analyzed retrospectively. The histograms of ADC with b val-ues of 0, 500, 800, 1000, and 1,500 s/mm2 were generated using Image J software. Various parameters were calculated: for example, the minimum, mean, mode, skewness, and kurtosis. Different groups were based on the molecular subtypes, tumor size (T1 vs . T2-3), histologic grade (high vs. low), and lymph node status (positive vs. negative) that were recorded. Mann-Whitney U tests were used to compare the differences in ADC histogram parameters between two different groups. Receiver operating characteristic curves (ROC) were constructed. Results: The skewness was lower in Luminal tumors than that in non-Luminal tumors with b values of 500, 800, 1, 000, and 1,500s/mm2 (P<0.05). The ADCmin was higher in human epidermal growth factor receptor-2 (HER-2) over-expression than in non-HER-2 over-expression (P<0.05). The kurtosis was lower in stage T1 tumors than stage T2-3 tumors (P<0.05), and kurtosis was cor-related with tumor size (P<0.05). ADCmode and ADCmean were different between different histological subtypes with a b value of 500 s/mm2 (P<0.05). Under different b values, there were no significant differences in terms of areas under the curve for each histogram pa-rameter, which had statistically significant differences (P>0.05). Conclusions: Multi-b-value DWI ADC histogram analysis, as a quantita- tive method to characterize tumor heterogeneity, can reflect the biological behavior and prognosis of breast cancer to some extent, and the diagnostic performance of ADC histograms showed no significant differences in differentiating molecular types and prognostic factors of breast cancer at different b values.
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Objective To analyze the characteristics of skeletal muscle cells gene markers in septic patients by using bioinformatics. Methods The differential gene expression of marker microarrays (GSE13205) in skeletal muscle tissue of patients with sepsis was obtained from gene expression omnibus (GEO) database of National Center for Biotechnology Information (NCBI). Gene differential expression analysis was carried out using online GEO2R provided by NCBI. Data processing, analysis and mapping were carried out using online bioinformatics array research tool (BART) and Cytoscpe software, the software of the national resource for network biology. Functional annotation and pathway analysis of differential expression genes were performed using Kyoto encyclopedia of genes and genomes (KEGG) and gene ontology (GO) provided by the database for annotation, visualization and integrated discovery (DAVID), and protein interaction analysis was further performed in search tool for the retrieve of interacting genes/proteins (STRING-DB). Results The TOP250 genes were extracted from the GSE13205 dataset. A total of 242 differentially expressed genes were included in the analysis. Among them, 78 up-regulated genes and 164 down-regulated genes were identified. After extensive data analysis, these differentially expressed genes were enriched into different biological processes or subsets of molecular functions, mainly enriched in the positive and negative regulation of growth, mineral absorption and other pathways. The 14 most closely related genes among differentially expressed genes were identified from the protein interaction network. Conclusion The differential expression genes in patients with sepsis were mainly concentrated on cell growth and apoptosis and mediating tumor-related immune function regulation.
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Objective To investigate the correlation between female age,menstrual status and the density of breast fibrous glandular tissue. Methods A total of 1 734 subjects with mammography examination were retrospectively analyzed,who were with 28 to 30 d menstrual cycle,or underwent natural menopause for more than 1 years,or with at least one side of the breast had no lesions,from October 2015 to August 2016 in Medical University Of Tianjin Cancer Hospital. At the same time, another 139 cases with mammography examination were treated as nonnatural menopause group, who received hysterectomy or postoperative chemotherapy of breast cancer. The breast fibrous gland tissue density of each subject was automatically calculated by the computer aided diagnosis system. One thousand seven hundred and thirty four subjects were divided into 4 groups according to age,including≤35 years old group(n=217),36 to 45 years old group(n=533),46 to 55 years old group(n=491),≥56 years old group(n=493),and was divided into premenopausal group(n=1 015)and natural postmenopausal group(n=719)according to the menstrual status.The premenopausal group was further divided into four subgroups:menstruation(n=158),one week after menstruation(n=311),two weeks after menstruation(n=316),and one week before menstruation(n=230). According to the status of menopause, the nonnatural postmenopausal group was divided into hysterectomy group(n=62)and drug menopause group(n=77)because of the postoperative chemotherapy of breast cancer. Pearson method was used to evaluate the correlation between age and breast fibrous glandular tissue density.A single factor analysis of variance was used to compare the differences in tissue density of subjects from different age groups and subjects from different menstrual status groups. The independent sample t test was used to compare the difference of the breast fibrous glandular tissue density between the premenopausal group and the natural postmenopausal group and between the nonnatural menopause group and the natural postmenopausal group.Results The tissue density differences of subjects from different age groups were statistically significant, and the tissue density of ≥56 years old group was lower compared to the other groups(P<0.05).A moderately negative correlation was presented between age and breast fibrous glandular tissue density(r=-0.456,P<0.01).The breast fibrous glandular tissue density of the premenopausal group was higher than that of natural postmenopausal group [(20.11 ± 8.54)% vs. (11.30±6.05)%,t=25.138,P<0.05].As to the different menstrual status,there was a significant differences between one week after menstruation subgroup and one week before menstruation subgroup(P<0.05).The density of fibrous glandular tissues in the hysterectomy group and the drug menopause group was(16.27± 6.91)% and(15.44±7.31)%, respectively. There was significant difference between drug postmenopausal group and natural postmenopausal group(t=-5.592, P<0.05). Conclusions Breast fibrous glandular tissue density decreases with the age. The breast fibrous glandular tissue density of the premenopausal women is significantly higher than that of natural postmenopausal women.The breast fibrous glandular tissue density of one week after menstruation is lower than that of the one week before menstruation.
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Objective To develop and validate a radiomics predictive model based on mammogram for preoperative predicting triple-negative breast cancer (TNBC) or non-triple-negative breast cancer (NTNBC). Methods We retrospectively analyzed 459 Chinese women who were diagnosed with invasive breast cancer (confirmed by pathology) during August 2015 to November 2015. Our cohort included 34 TNBC and random selected 102 NTNBC cases. Regions of interest (ROIs) were manually selected from craniocaudal and mediolateral oblique mammograms by radiologists through manual lesion segmentation, and 43 radiomics features were evaluated. Craniocaudal (CC) single-view, mediolateral oblique (MLO) single-view and CC and MLO double-view classification model were constructed respectively. Classification performance was evaluated by the area under receiver operating characteristic curve (AUC), accuracy, sensitivity and specificity. Kruskal-Walls U test and t test were used to compare the radiomics features between TNBC and UTNBC. Results The model that used the combination of both the CC and MLO view images achieved the overall best performance than using either of the two views alone, yielding an AUC of 0.791, accuracy of 0.798, sensitivity of 0.776 and specificity of 0.806 for TNBC comparing with NTNBC. Three features were selected by the model (gray scale span and inverse different moment for CC, roundness for MLO) showed a statistical significance (P<0.05) and AUC>0.6 in the subtype classification. Conclusion This research constructed model based on mammograms classification model can effectively distinguish between TNBC and NTNBC. This model has potential value for breast cancer molecular subtype classification and clinical treatment.
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Objective To characterize the imaging features of fibroblastic and (or) myofibroblastic benign tumors. Methods The imaging manifestations were analyzed in fourteen patients with fibroblastic and (or) myofibroblastic benign tumors of the breast area confirmed by histopathology from July, 2010 to July, 2017. Independent-samples t test was performed to compare ADC values between lesions and normal breast tissue. Results Thirteen cases were adhered to superficial facia of breasts and 1 case was located in the pectoralis. Five lesions were presented as a mass on MRI, 9 lesions were presented as a non-mass. Twelve cases showed low signal intensity on T1WI, 8 cases showed high signal intensity and 4 cases showed moderately or slightly high signal intensity on T2WI. TIC analysis showed that 10 cases had typeⅠenhancement and 4 cases had typeⅢenhancement. There was no difference between mean ADC values of lesions and normal breast tissue (P>0.05). All the cases showed hypoechoic and spiculated margins on ultrasound. Twelve cases were hypovascular ones. Twelve cases underwent mammography. Five cases were presented as a mass and 7 cases were presented as asymmetric. These cases showed equal density without suspicious calcifications. Conclusion The location, MRI, ultrasound and mammography manifestations of fibroblastic and (or) myofibroblastic benign tumors have some characteristics and these imaging findings may help to establish an accurate preoperative diagnosis.
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Objective To study the features of mucinous carcinoma and myxoidfibroadenoma of the breast on MRI.Methods Fourty patients with pure mucinous carcinoma and myxoidfibroadenoma confirmed by surgical pathology who underwent breast MRI from January 2010 to May 2017 in Tianjin Medical University Cancer Institute and Hospital were analyzed retrospectively, including 26 patients with mucinous carcinoma and 14 patients with myxoidfibroadenoma. By use of the Breast Imaging Reporting and Data System (BI-RADS) lexicon, an analysis of the shape, margin, infiltration to adjacent tissues, the lesion location, signal intensity in the T1WI and fat-suppressed T2WI, dark internal septation, the pattern of time-signal intensity curve (TIC),rim enhancement, delayed internal enhancement, the DWI signal and ADC values was performed. Qualitative data and quantitative data were compared with χ2test and independent sample t test respectively. Results There were significant differences in the margin,dark internal septation,the lesion location, rim enhancement and delayed internal enhancement between mucinous carcinoma and myxoidfibroadenoma(P＜0.05). The shape, signal intensity in the T1WI and fat-suppressed T2WI,infiltration to adjacent tissues, the pattern of TIC, the DWI signal and ADC values were not statistically significant between the two groups(P＞0.05).Conclusion The combination of irregular margin, less frequent dark internal septation, rim enhancement in the early phase, delayed heterogeneous enhancement and the lesion location where was in the shallow layer of fibro-glandular tissue were significant findings for differentiation between mucinous carcinoma and myxoidfibroadenoma.
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Objective: To assess the relationship between mammographic features and molecular subtypes in invasive breast cancer pa-tients. Methods: We performed a retrospective review of mammographic images from a total of 182 histopathologically diagnosed-breast cancer patients treated in Tianjin Medical University General Hospital and Tianjin Medical University Cancer Institute and Hospi-tal between January 2016 and March 2016. Mammographic features were assessed according to the Breast Imaging Reporting and Da-ta System(BI-RADS). Molecular subtypes were classified according to the St Gallen International Expert Consensus. Statistical analysis was performed to assess the correlation between mammographic features and molecular subtypes of breast cancer. Results: There was a relationship between mammographic calcifications and molecular subtypes of invasive breast cancer (V=0.221, P<0.05). In com-parison with Luminal A (12/20), Luminal B (80/132), and HER-2 enriched (4/10) breast cancers, most triple-negative breast cancers (18/20) were non-calcified lesions (P<0.05). The proportion of spiculated masses was higher in Luminal breast cancer (30/85) than in non-Luminal breast cancer (1/16) (P<0.05). Conclusions: There is a relationship between mammographic features and molecular subtypes of invasive breast cancer.
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Objective To investigate the magnetic resonance imaging (MRI) features and differential diagnosis of axillary schwannomas, and analyze the causes of misdiagnosis. Methods A retrospective study from October 2014 to October 2017 was performed in 5 patients with axillary schwannomas, confirmed by surgery and pathology, in whom clinically suspected axillary metastases have been diagnosed. All the patients underwent breast MRI to summarize the key points of diagnosis and differential diagnosis. Results Five tumors located in neurovascular bundles extending along the brachial plexus nerve distribution. The tumors presented as single, spindle or ovoid masses, well-circumscribed margins in 4 cases, entering and exiting nerve signs in 5 cases, the split fat sign in 4 cases, vascular compressed sign in 5 cases, and target sign in 1 case. The tumors were isointense or slight hypointense on T1WI compared to the adjacent muscle. Three tumors manifested heterogeneous slight hyperintense, 1 tumor was slight hyperintense, and the target sign was seen in 1 tumor on T2WI. Diffusion-weighted image was heterogeneous hyper or slightly hyper-intense. When b＝500 and 1 000 s/mm2, the apparent diffusion coefficient (ADC) was (1.40 - 2.23) × 10 -3mm2/s and (1.31 -2.94) × 10-3mm2/s respectively. All the 5 tumors manifested persistent enhancement on dynamic contrast-enhanced MRI (DCE-MRI). Three tumors were heterogeneously enhanced, and 2 tumors were circularly enhanced. Conclusions Axillary schwannomas has certain characteristics which can be helpful for the identification of metastatic lymph nodes.
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Objective To compare the two-dimensional (2D) and three-dimensional (3D) shear wave elastography (SWE) technology in the diagnosis of early stage breast cancer.Methods 84 patients (94 breast lesions) with breast disease confirmed by pathological examination were enrolled from December 2014 to December 2016.All patients underwent 2D and 3D color Doppler ultrasound and the relevant SWE examinations.The optimal maximum and mean elastic modulus of 2D and 3D SWE for diagnosing the benign and malignant breast lesions were obtained by the receiver operating characteristic curve (ROC).Based on the results of pathological examinations,the sensitivity,specificity and accuracy of 2D SWE and 3D SWE in benign and malignant breast lesions diagnosis were evaluated and compared.Results The optimal maximum and mean elastic modulus of 2D SWE for diagnosing the benign and malignant breast lesions were 98.82 kPa and 43.88 kPa respectively,while the corresponding modulus of 3D SWE were 102.54 kPa and 53.87 kPa.The sensitivity of 2D SWE and 3D SWE in breast cancer diagnosis was 89.5％ and 86.3％ respectively,and the difference was not statistically significant (P＞0.05).The specificity and the accuracy of 2D SWE in breast cancer diagnosis were 95.3％ and 92.7％ respectively,which was significant higher than 83.9％ and 85.1％ of 3D SWE,and the differences were statistically significant (all P＜O.05).Conclusions The efficiency of 2D SWE examination is significantly higher than the 3D SWE in benign and malignant breast lesions diagnosis,which can provide a reliable diagnostic basis and is worthy for clinical application.
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Cancer screening has been considered as double-edged sword with both advantages and disadvantages.For decades,there have been strong interests in screening strategies for the early detection of cancers to reduce the mortality,especially breast X-ray (mammography) screening.However,several evidences also suggested that the benefit of reduction of breast-cancer mortality with mammography might become a problem due to the repeat mammography,subsequent biopsies,and overdiagnosis.And different screening strategies with different models,different intervals,and different target populations also incurred debates.After systematical analysis and discussion,we suggested to focus on high-risk population,improve the accuracy of screening technique,conduct the informed consent of participants,and explore individual screening mode in the screening of breast cancer.
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Cancer screening has been considered as double-edged sword with both advantages and disadvantages.For decades,there have been strong interests in screening strategies for the early detection of cancers to reduce the mortality,especially breast X-ray (mammography) screening.However,several evidences also suggested that the benefit of reduction of breast-cancer mortality with mammography might become a problem due to the repeat mammography,subsequent biopsies,and overdiagnosis.And different screening strategies with different models,different intervals,and different target populations also incurred debates.After systematical analysis and discussion,we suggested to focus on high-risk population,improve the accuracy of screening technique,conduct the informed consent of participants,and explore individual screening mode in the screening of breast cancer.
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Objective To investigate two-dimensional color Doppler commissure real-time shear wave elastrography (SWE) examination and its application value in the diagnosis of breast diseases.Methods One hundred and thirty patients (158 breast lesions) confirmed with breast disease were chosen from September 2013 to September 2014,and all patients underwent two-dimensional color Doppler ultrasound and SWE examination.The receiver operating characteristic (ROC) curve was examined to obtain maximum elasticity modulus value,average elastic modulus value and the corresponding critical value for the diagnosis of benign and malignant breast lesions.According to the results of pathological examination,sensitivity,specificity and accuracy of two-dimensional ultrasound and SWE for the diagnosis of breast lesions were evaluated and compared.Results Of all 158 breast lesions in 130 patients,90 were malignant lesions and 68 were benign lesions.The sensitivities of two-dimensional ultrasound and SWE in diagnosis of breast cancer were 89.7％ and 89.5％,the specificities were 85.6％ and 95.3％ and the accuracy were 87.3％ and 91.4％,respectively.The sensitivity,specificity and accuracy in the diagnosis of breast cancer by combination of two-dimensional ultrasound and SWE were 98.5％,93.3％,95.6％,respectively.Conclusions Although two-dimensional color Doppler ultrasound is a commonly used method in the diagnosis of breast lesions,it has certain limitation.The specificity of diagnosis can be improved by SWE,which is a useful complement to traditional two-dimensional ultrasound technology.Combination of the two methods can significantly increase the sensitivity and accuracy of the diagnosis and provide a reliable basis for the differential diagnosis,reduce the rate of misdiagnosis,missed diagnosis and unnecessary biopsy,which has important clinical application value.