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Abstract Introduction The treatment of papillary thyroid microcarcinoma remains controversial. Central lymph node metastasis is common in papillary thyroid microcarcinoma and it is an important consideration in treatment strategy selection. Objective The aim of this study was to investigate clinicopathologic risk factors and thyroid nodule sonographic characteristics for central lymph node metastasis in papillary thyroid microcarcinoma. Methods We retrospectively reviewed the data of 599 papillary thyroid microcarcinoma patients who underwent surgery from 2005 to 2017 at a single institution. Univariate and multivariate analyses were used to identify the clinicopathologic factors and preoperative sonographic features of central lymph node metastasis. A receiver-operating characteristic, ROC curve analysis, was performed to identify the efficacy of ultrasonographic features in predicting central lymph node metastasis. A nomogram based on the risk factors was established to predict central lymph node metastasis. Results The incidence of central lymph node metastasis was 22.4%. The univariate and multivariate analyses suggested that gender, age, multifocality, extrathyroidal invasion, and lateral lymph node metastasis were independent risk factors for central lymph node metastasis. The univariate and multivariate analyses revealed that nodular shape, margin, and calcification were independently associated with central lymph node metastasis. The ROC curve analysis revealed that the combination of shape, margin and calcification had excellent accuracy in predicting central lymph node metastasis. The nomogram was developed based on the identified risk factors for predicting central lymph node metastasis, and the calibration plot analysis indicated the good performance and clinical utility of the nomogram. Conclusions Central lymph node metastasis is associated with male gender, younger age (<5 years), extrathyroidal invasion, multifocality and lateral lymph node metastasis in papillary thyroid microcarcinoma patients. The ultrasongraphic features, such as irregular shape, ill-defined margin and calcification, may improve the efficacy of predicting central lymph node metastasis. Surgeons and radiologists should pay close attention to the patients who have these risk factors. The nomogram may help guide surgical decision making in papillary thyroid microcarcinoma.
Resumo Introdução O tratamento do microcarcinoma papilífero de tireoide permanece controverso. A metástase em linfonodos centrais é comum e é uma consideração importante na seleção da estratégia de tratamento. Objetivo Investigar os fatores de risco clínico-patológicos e as características ultrassonográficas de nódulos tireoidianos para metástase em linfonodos centrais em microcarcinoma papilífero de tireoide. Método Foram analisados retrospectivamente os dados de 599 pacientes com microcarcinoma papilífero de tireoide submetidos à cirurgia de 2005 a 2017 em uma única instituição. Análises univariadas e multivariadas foram usadas para identificar os fatores clínico-patológicos e as características ultrassonográficas pré-operatórias das metástases em linfonodos centrais. Uma análise de curva ROC (receiver-operating characteristic) foi feita para identificar a eficácia das características ultrassonográficas na previsão dessas metástases. Um nomograma baseado nos fatores de risco foi estabelecido para prever a metástase em linfonodos centrais. Resultados A incidência de metástase em linfonodos centrais foi de 22,4%. As análises univariadas e multivariadas sugeriram que sexo, idade, multifocalidade, invasão extratireoidiana e metástase em linfonodos laterais eram fatores de risco independentes para a metástase em linfonodos centrais. As análises univariadas e multivariadas revelaram que o formato nodular, a margem e a calcificação estavam independentemente associadas à metástase em linfonodos centrais. A análise da curva ROC mostrou que a combinação do formato, margem e calcificação apresentou excelente precisão na previsão dessas metástases. O nomograma foi desenvolvido com base nos fatores de risco identificados para predizer a metástase em linfonodos centrais e a análise do gráfico de calibração indicou o bom desempenho e a utilidade clínica do nomograma. Conclusões Em pacientes com microcarcinoma papilífero de tireoide, metástase em linfonodos centrais está associado ao sexo masculino, menor idade ( < 45 anos), invasão extratireoidiana, multifocalidade e presença de metástase em linfonodos laterais. As características ultrassonográficas, como formato irregular, margem mal definida e calcificação, podem melhorar a eficácia da previsão de metástase em linfonodos centrais. Cirurgiões e radiologistas devem ficar mais atentos aos pacientes que apresentam esses fatores de risco. O nomograma pode ajudar a orientar a tomada de decisão cirúrgica para o microcarcinoma papilífero de tireoide.
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Objective:To investigate the predictive value of MRI radiomics model in assessing the early response to concurrent chemoradiotherapy for locally advanced cervical squamous cell carcinoma.Methods:A total of 367 patients with pathologically proven locally advanced cervical squamous cell carcinoma (International Federation of Gynecology and Obstetrics stage ⅡB-ⅣA) in Liaoning Cancer Hospital & Institute from January 2013 to June 2019 were retrospectively collected. The patients were unable to undergo surgery and received complete concurrent chemoradiotherapy. Pelvic plain MRI, DWI and dynamic contrast-enhanced MRI were performed within 2 weeks before treatment and at the end of the 4th week of treatment. Patients were divided into complete response (CR) group ( n=247) and non-CR group ( n=120) according to response evaluation criteria in solid tumors 1.1. The patients were divided into a training set ( n=256) and a validation set (n=111) via a randomized split method at a ratio of 7∶3. Two radiologists drew the region of interest on the DWI, T 2WI and contrast-enhanced T 1WI (delayed phase) images before treatment to form the volume of interest finally. Totally 1 906 radiomics features were extracted from 3 single sequence images, respectively. Feature correlation analysis and tree model were used for feature selection. Three classifier learning algorithms, namely logistic regression (LR), support vector machine and random forest, were used for machine learning and the best classifier was selected. Based on the best classifier, 3 single sequence radiomics models were built, and a multi-sequence combined model was obtained by multivariate LR analysis. The differences in the area under the receiver operating characteristic curve (AUC) of the 3 single sequence models and the multi-sequence combined model were compared by DeLong test. The clinical application value of the multi-sequence combined model was evaluated by decision analysis curve. Results:In the training set and validation set, the LR classifier model had the best performance. Based on the LR classifier, AUCs of DWI, T 2WI, contrast-enhanced T 1WI and combined sequences in the training set were 0.77, 0.74, 0.79 and 0.86, respectively, and AUCs in the validation set were 0.71, 0.66, 0.75 and 0.77, respectively. In the training set, the AUC of multi-sequence combined model was higher than those of DWI, T 2WI and contrast-enhanced T 1WI sequence models, and the differences were statistically significant ( Z=3.01, 3.56, 2.83; P=0.003, 0.001, 0.005). In the validation set, the AUC of multi-sequence combined model and T 2WI model had significant difference ( Z=2.46, P=0.015). The decision analysis curve showed that when the threshold probability was in the range of 0.44 to 0.88, the multi-sequence combined model yielded a net benefit. Conclusion:Based on the LR classifier, the combined model built by radiomics features of multi-sequence MRI images has predictive value for assessing the early response of concurrent chemoradiotherapy for locally advanced cervical squamous cell carcinoma.
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Objective:To investigate the value of tumor hemodynamics and morphological features from conventional dynamic contrast-enhanced MRI (DCE-MRI) scan before surgery in predicting postoperative recurrence time in breast cancer patients.Methods:A retrospective analysis of 58 patients with breast cancer who had recurred after operation from November 2012 to December 2014 in Liaoning Cancer Hospital was performed. According to the recurrence time, the patients were divided into early recurrence group (≤2 years after surgery, 33 cases) and late recurrence group (>2 years after surgery, 25 cases). All patients underwent routine DCE-MRI scans before surgery, and hemodynamic features of the three-dimensional volume of the tumor and the morphological and textural features of the tumor in each phase were extracted by computer. The counts and measurement data of patients in early recurrence group and late recurrence group were compared by Fisher′s exact probability method and Mann-Whitney U test, and receiver operating characteristic (ROC) curves were drawn. The multivariate logistic regression was used to calculate the combined efficacy in predicting early recurrence and late recurrence. Kaplan-Meier method was used to analyze the survival prognosis, and Log-Rank test was used to compare the differences in survival curves between groups. Results:There was no significant difference in background parenchymal enhancement, lesion margin, lesion internal enhancement characteristics, lesion morphology, time-signal intensity curve type and the degree of whole-breast vascularity increase between early recurrence and late recurrence groups ( P>0.05).There were significant differences in the maximum concentration of contrast (Max Conc), the area under the time signal curve (AUC) and the maximum slope value of the time signal curve (Max Slope) ( P<0.05). Comparative analysis of the radiomics parameters of 8 phases DCE-MRI found that the sphericity of morphological characteristic parameters in the phase 3 was statistically different between the early recurrence and late recurrence groups ( P=0.03). Area under the ROC curve of AUC, Max Conc, Max Slope and parameter sphericity of phase 3 morphological characteristics for predicting early and late recurrence were 0.664, 0.659, 0.684 and 0.670, respectively. The area under the ROC combined with the above four parameters for prediction was 0.765, with a specificity of 63.6% and a sensitivity of 84.0%; the predictive efficacy was higher than that of univariate. Fifty-eight patients were followed up for 17 to 64 months with a median follow-up of 47 months. The disease-free survival and overall survival in the early recurrence group were significantly lower than those in the late recurrence group, and the difference was statistically significant ( P<0.05). Conclusion:It is of certain value to predict the postoperative recurrence time of breast cancer based on the tumor hemodynamic characteristics combined with morphological characteristics from preoperative non-invasive conventional DCE-MRI.
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Objective To investigate the value of differential diagnosis of benign and malignant of breast cystic lesion with thin-wall in MRI. Methods Retrospective analysis from January 2012 to December 2016 Liaoning Cancer Hospital diagnosis confirmed by surgery and pathology, and a total of 81 lesions (76 patients) of breast cystic lesions with thin-wall on MRI enhanced images (thickness no more than 5 mm, mural node less than 10 mm and solid position less than 50％)were enrolled. All patients underwent bilateral breast plain scan and dynamic contrast-enhanced scan. Using MRI breast imaging reporting and data system (BI-RADS) standard to analyze the MRI plain scan and dynamic contrast-enhanced scan images. Analysis of the margin of the lesion, internal enhancing features and time signal intensity curve (TIC) type and other characteristics. The feature of wall margin, thickness and enhancement form, mural nodules and internal septation morphological were analysed by Chi-square test. TIC type and wall nodule position were analysed by Fisher method. Wall nodule sizes were analysed by using independent sample t test. Results Of the 81 lesions, 67 were benign lesions and 14 were malignant. Among benign lesions, 56 were with well-defined margin, 58 were with uniform wall thickness and 7 were with mural nodule. Among malignant lesions, 5 were with well-defined margin, 8 were with uniform wall thickness and 9 were with mural nodule, which showed statistically significant difference between benign and malignant lesions (P<0.05). Of the 9 malignant lesions with wall nodules, 7 were located outside the wall, 1 between the wall, and 1 within the wall. Of the 7 benign lesions with wall nodules, 4 were located between the wall, 1 within the wall and 2 outside the wall, which were significant difference in the location of nodules between benign and malignant lesion (χ2=6.228,P=0.043). There was no significant difference between benign and malignant lesions in the homogeneous enhancing, internal separations and wall nodule size (P>0.05). Nine lesions can not obtain TIC to analyse enhancement degree due to thin linear enhancement of cyst wall. Through the analysis of TIC type of 58 benign lesions and 14 malignant lesions, Type Ⅰ and type Ⅱ TIC were more commonly presented in benign lesions. Type Ⅱ and type Ⅲ were more commonly found in malignant lesions, and TIC types were statistically different (P<0.05). There was no significant difference in the degree of cystic wall enhancement (P>0.05). Conclusion Most of breast cystic lesion with thin-wall are benign lesion, cystic wall enhancement characteristics combined with time-signal intensity curve helps to find malignant lesion.
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Objective To explore the value of MRI in differential diagnosis of breast medullary carcinoma and fibroadenoma.Methods Data of 11 patients with medullary carcinoma (medullary carcinoma group) and 36 patients with fibroadenoma (fibroadenoma group) confirmed with pathology were analyzed retrospectively.MRI characteristics were analyzed and compared between the two groups.Results The age of patients in medullary carcinoma group was greater than those in fibroadenoma group (t=2.791,P=0.008).There were statistical differences of the maximum diameter of lesions,internal enhancement characteristics,necrotic and cystic degeneration of lesions,un-enhanced T2WI signal intensity of lesions,DWI signal intensity of lesions and time-signal intensity curve (TIC) type (all P＜0.05),while no statistical difference of lesion numbers,morphology and edge of lesions was found between the two groups (all P＞0.05).Conclusion The features of MRI are helpful to differential diagnosis of medullary carcinoma and fibroadenoma of the breast.
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OBJECTIVE:To establish a method for simultaneous determination of 5 constituents in Phyllanthus emblica,and to conduct principal component analysis and cluster analysis of contents of 5 polyphenolic constituents in P. emblica from different producing areas of Guangxi. METHODS:HPLC method was adopted to determine the contents of gallic acid,epigallocatechin, corilagin,terminalia biphenyl acid and ellagic acid in P. emblica. The determination was performed on Agilent Eclipse XDB column with mobile phase consisted of acetonitrile-0.1％ phosphoric acid aqueous solution (gradient elution) at the flow rate of 1.0 mL/min. The detection wavelength was set at 220 nm,and column temperature was 25 ℃. The sample size was 20 μL. The results of content determination was processed by principal component analysis and cluster analysis. RESULTS:The linear range of gallic acid, gallocatechin, corilagin, chebulagic acid and ellagic acid were 1.994-31.90, 0.1598-2.556, 4.533-45.33, 14.75-88.49, 2.956-47.30 μg/mL(r≥0.9998),respectively. The limits of detection were 0.0256,0.0271,0.0529,0.1867,0.1331 μg/mL;the limits of quantitation were 0.0851,0.0893,0.1706,0.6152,0.4419 μg/mL,respectively. RSDs of precision,stability(24 h) and reproducibility tests were all<2.0％(n=6 or n=7). The average recoveries were 96.19％-101.49％(RSD=0.98％-1.41％, n=6). 12 batches of samples had 3 main components. They could be divided into 2 categories. P. emblica from Rong county of Yulin city in Guangxi Zhuang Autonomous Region had highest comprehensive principal component score and best quality. CONCLUSIONS:Established method is simple,accurate and reliable,and can be used for the simultaneous determination of gallic acid,gallocatechin,corilagin,chebulagic acid and ellagic acid in P. emblica. The quality of P. emblica from different producing areas in Guangxi is different.
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Purpose To evaluate the diagnosis value of real-time ultrasound elastography for differential diagnosis between benign and malignant parotid tumors.Materials and Methods A literature retrieval in PubMed,Embase,High Wire Press,Ovid and CNKI as of May 31,2016 in the English and Chinese languages was conducted.Articles and reviews related to discrimination between benign and malignant parotid gland nodules by means of ultrasound elastography scoring were selected.Pooled sensitivity and specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio as well as summary receiver operating characteristic (ROC) curves were analyzed to evaluate the diagnostic accuracy of ultrasound elasticity scoring.Results A final selection of 7 articles involving 486 nodules in 449 patients was included.Pooled sensitivity and specificity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio of benign and malignant parotid tumors were 0.781 (95％ CI 0.702-0.847),0.797 (95％ CI 0.750-0.838),3.753 (95％ CI 2.293-6.124),0.285 (95％ CI 0.147-0.555) and 13.941 (95％ CI 4.571-42.519) respectively according to ultrasound elasticity scoring.Area under summary receiver operating characteristic curves was 0.8638 (index Q*=0.7944).Conclusion Real-time ultrasonic elastography has certain diagnostic value in differentiating benign parotid tumors and malignant ones.It can be used as a complement to conventional sonography for improving the diagnostic accuracy of parotid lesions.