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Objective:To evaluate the value of conventional ultrasound(US) combined with contrast-enhanced ultrasound(CEUS) in the diagnosis of Breast Imaging Reporting and Data System( BI-RADS) category 4 small(≤ 2 cm) breast nodules.Methods:A total of 175 breast nodules in 175 patients from Fujian Cancer Hospital between September 2015 and August 2018 classified as BI-RADS category 4 breast nodules with maximum diameter ≤2 cm were evaluated by US and CEUS examinations. All nodules were examined by core-needle biopsy or surgical pathology.The collected ultrasound images and videos were analyzed by blind method. Stepwise Logistic regression was used to analyze the odds ratio of malignant nodules in ultrasound images, and the risk prediction score model was constructed according to OR value. The BI-RADS category was readjusted, and the diagnostic efficiencies before and after adjustment were compared with the ROC curve. Results:Multivariate Logistic regression analysis showed that the odds ratios of breast malignant nodules were non-circumscribed margin ( OR=3.32, P=0.052), calcification in the mass ( OR=7.42, P=0.002), architectural distortion ( OR=38.58, P<0.001), ductal dilatation ( OR=0.01, P=0.010), suspicious or abnormal axillary lymph nodes ( OR=10.92, P=0.003), enlarged lesion scope ( OR=3.38, P=0.040), penetrating vessels ( OR=10.79, P=0.006), and non-circumscribed margin after enhancement( OR=6.24, P=0.003). When the cut-off value was 3.5, the area under ROC curve, sensitivity, specificity and accuracy were 0.951, 87.80%, 89.20% and 88.57%, respectively. After adjusting BI-RADS classification and taking the adjusted BI-RADS category 4a as the biopsy threshold, the biopsy rate decreased from 100% to 58.86%, the cancer detection rate increased from 46.86% to 75.73%, and the risk of missed diagnosis was 2.29%. The area under ROC curve before and after BI-RADS classification adjustment was 0.838 and 0.937, respectively. Conclusions:US combined with CEUS can improve the diagnostic efficiency of BI-RADS category 4 small breast nodules and reduce unnecessary biopsy.
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Objective:To explore the characteristics of color Doppler ultrasound images of breast lymphoma, and to improve the coincidence rate of ultrasound diagnosis.Methods:The color Doppler ultrasound images characteristics of 24 lesions in 21 patients with breast lymphoma in Fujian Cancer Hospital from June 2011 to January 2020 were retrospectively analyzed, and the diagnostic coincidence rate was counted.Results:All the patients were female, 18 cases were unilateral, 3 cases were bilateral. ALL cases were confirmed as primary or secondary breast lymphoma by coarse needle biopsy or surgical pathology. Pathological types included 18 cases (85.7%) of diffuse large B-cell lymphoma, 1 case of anaplastic large cell lymphoma kinase (ALK)-negative anaplastic large cell lymphoma, 1 case of Burkitt lymphoma, 1 case of Burkitt lymphoma or unclassifiable lymphoma with features intermediated between diffuse large B-cell lymphoma and Burkitt lymphoma. The maximum diameter of the lesions was (5.7±2.1) cm (range 1.4-16.0 cm), and all lesions were solid in ultrasound images; 19 lesions (79.2%) were mass-type and 5 lesions (20.8%) were diffuse. According to the characteristics of internal echo, the lesions were divided into hypoechogenicity (2 lesions, 8.3%), hyperechogenicity packed with hypoechogenicity (12 lesions, 50.0%), and hyperechogenicity interweaved with hypoechogenicity (10 lesions, 41.7%). According to Adler semi-quantitative method, the blood flow of the lesions was 3 lesions (12.5%) in grade Ⅰ, 6 lesions (25.0%) in grade Ⅱ, and 15 lesions (62.5%) in grade Ⅲ. The detection rate of lesions by color Doppler ultrasound was 100.0% (24/24), but the diagnostic coincidence rate was only 41.7% (10/24).Conclusions:Most of the breast lymphoma is diffuse large B-cell lymphoma, and the lesions can be effectively screened by color Doppler ultrasound, but the diagnostic coincidence rate is low. Most of the breast lymphoma grows in the form of mass with abundant internal blood flow signals. When the ultrasound image of the breast lesion is hyperechoic packed or interweaved with hypoechoic, the possibility of breast lymphoma should be considered.
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Objective To analyze the performance of contrast-enhanced uhrasound(CEUS) in the evaluation of response to neoadjuvant chemotherapy (NAC) for breast cancer in different periods.Methods A prospective study consisting of 46 patients with invasive ductal carcinoma who received NAC and surgery subsequently was conducted.One patient underwent CEUS before NAC,after the second cycle of NAC and before surgery.CEUS outcomes were compared with histopathologic response by Kappa test using the Miller-Payne Grading(MPG) system.The changes of CEUS quantitative parameters in different periods of NAC were compared.Results 31 patients showed a good response by histopathology while 29 patients by CEUS,which showed good consistence.Kappa value was 0.713.The peak intensity (PI) of the lesions decreased significantly after the second cycle of NAC compared with that before NAC (P＜0.05).The peak intensity (PI),wash-in slope (WIS),and area under curve(AUC) of the lesions decreased significantly before surgery compared with those before NAC (P＜0.05).Conclusion CEUS shows good consistence with histopathologic outcomes.The peak intensity (PI) is a sensitive indicator of early changes after NAC.
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Objective To investigate the clinical value of ultrasound-guided catheterization in intraperitoneal perfusion chemotherapy for postoperative abdominal malignant tumor without ascites. Methods A retrospective analysis were performed in 146 postoperative patients with abdominal malignancies who were admitted to Fujian Cancer Hospital from April 2013 to September 2018, and there were no ascites founded in these patients before abdominal catheterization. Two hundred and seventy-nine times ultrasound-guided catheterization in intraperitoneal perfusion chemotherapy were performed under clinical guidance. Results Two hundred and seventy-seven times abdominal catheterization was completed, with a success rate of 99.3％(277/279), and the one-time success rate was 83.2％(232/279), 2 times (0.7％, 2/279) had to be abandoned for peritoneal adhesions. Fifty-three patients (36.3％, 53/146) underwent catheterization ≥ 2 times. The intraperitoneal perfusion chemotherapy was successfully completed after catheterization, no intestinal injury and bleeding occurred. Conclusions In the absence of ascites, ultrasound guided catheterization in perfusion chemotherapy is safe, reliable, simple, accurate and has a high success rate. This new approach is good for clinical application when the conventional catheterization with ascites is blocked.
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Objective To investigate the learning curve of contrast-enhanced ultrasonography ( CEUS) in sentinel lymph node( SLN ) of breast cancer and provide a theoretical basis for leaners to learn SLN CEUS . Methods The multi-center study of SLN CEUS in breast cancer" was planned by Sichuan Cancer Hospital . According to the uniform inclusion and exclusion criteria , 511 patients with complete clinical data and follow-up results from 9 hospitals in Multi-center were included in this study . According to the inspection time ,the patients were divided into 3 groups named as group A ( 170 patients) ,group B ( 170 patients) and group C ( 171 patients ) ,respectively . The basic clinical data ,ultrasound imaging data , intraoperative and postoperative pathological findings of all patients were recorded . With the accumulation of cases examined ,analysis was performed to find the learning curve of the SLN CEUS examination time , SLN CEUS detection rate ,SLN CEUS surface marking accuracy rate and SLN CEUS diagnosis rate ,the learning curve was analyzed . Results ① There was no statistical significant difference in patients ages , tumors sizes ,tumors locations ,SLNs numbers and LCs numbers among the three groups( all P > 0 .05) . ②As the number of cases examined increases ,the examination time was reduced gradually ,but SLN detection rate ,surface marking accuracy and SLN diagnostic coincidence rate were increased gradually( F = 151 .75 , 1 .96 ,7 .49 ,5 .50 ; P = 0 .000 ,0 .143 ,0 .001 ,0 .005 ) . Conclusions The skill of the doctor is improved gradually when learning SLN CEUS . With the number of the cases increase ,the operating time of SLN CEUS is shorted ,and the SLN detection rate ,surface marking accuracy and SLN diagnostic coincidence rate of SLN-CEUS are gradually increased . It has an important clinical significance for beginners to learn the SLN CEUS technology .
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Objective To evaluate the diagnostic value of contrast-enhanced ultrasound in breast precancerous lesions . Methods Retrospectively analyzed the contrast-enhanced ultrasound model and angiographic predictive model of 465 cases of the A prospective multicenter study of breast nodules contrast-enhanced ultrasound" that led the Sichuan Provincial People′s Hospital from January 2016 to April 2017 ,which included 69 cases of breast precancerous lesions and 396 other types benign lesions ,and the sensitivity ,specificity and accuracy of the diagnosis of breast precancerous lesions were calculated . Results The sensitivity of ultrasound predictive model for the diagnosis of precancerous lesions was 60 .9％ and AUC was 0 .681 . Precancerous lesions mainly showed non-concentricity , increased homogeneity , and increased lesions;other types of benign lesions mainly showed non-centripetal ,high uniformity enhancement and lesion size unchanged . Conclusions Contrast-enhanced ultrasound shows a potential value in the differential diagnosis of precancerous lesions and other types of benign lesions ,that can help clinicians to take early intervention measures for breast precancerous lesions ,but there are still many problems to be solved .