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Objective:To construct a diagnostic model based on the multimodal ultrasound imaging, and to predict the axillary lymph node (ALN) status of breast cancer patients after neoadjuvant chemotherapy (NAC).Methods:A total of 204 female breast cancer patients with ALN metastasis who had undergone puncture biopsy of aspiration in the Second Affiliated Hospital and Harbin Medical University Cancer Hospital between July 2017 to May 2021 were included. According to the pathological results of ALN surgery after NAC, the cases were divided into pathologically complete response (pCR) group and non-pCR group. The ultrasound images, immunohistochemistry and blood routine index were collected and compared between the two groups, the indexes whose P<0.02 were selected. In terms of logistic regression algorithm, a predictive model for the pathological state of axillary lymph nodes in breast cancer patients was established after NAC, and ROC curve was plotted to evaluate the performance of the model. Results:The P values for comparison between the two groups of the breast tumor size, blood flow resistance index (RI), elasticity score, lymph hilum structure, maximum cortical thickness, blood flow distribution, blood flow RI, and immunohistochemical detection indicators including estrogen receptor(ER), progesterone receptor(PR), human epidermal growth factor 2(HER-2), Ki67 molecular expressions were <0.20 by t test, Mann-Whitney U test, and χ 2 test analysis; in the multiple logistic regression analysis, tumor size, lymphatic hilum structure, maximum cortical thickness, lymph node blood flow distribution and blood flow resistance index, PR and HER-2 molecular expressions were the independent factors predicting the pathological status of axillary lymph nodes in breast cancer patients after NAC ( P<0.05). The performance of the predictive model was 0.870 (95% confidence interval: 0.819-0.922, P<0.05), with sensitivity of 86.82% and specificity of 70.67%. Conclusions:The model for predicting the pathological state of ALN in breast cancer patients after NAC using multi-modal ultrasound characteristic and immunohistochemical indexes achieves good diagnostic performance providing more objective evidence for the formulation of clinical treatment plans and prognostic evaluation.
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Objective: To investigate the correlation of routine ultrasound features and BRAFV600E gene to the cervical lymph node metastasis (CLNM) of thyroid papillary carcinoma (PTC). Methods: A hundred and seven patients with thyroid papillary carcinoma who underwent thyroid gland resection and cervical lymph node dissection in the First Medical Center of Chinese PLA General Hospital from January to December 2018 were recruited as study subjects, including 56 patients in the metastatic group and 51 patients in the non-metastatic group. Ultrasound examination and BRFV600E gene detection were performed, and the indicators obtained were compared between the two groups including gender, age, focus position (upper middle or inferior), close to the capsule or to the isthmus, focus located in the lef or right lobes, single or multiple, maximum diameter, aspect ratio, boundary, shape, internal echo, internal components, peripheral halos, calcification, microcalcification, color Doppler features, Hashimoto's disease, and BRFV600E gene mutation. Logistic regression analysis was conducted for gender, age, close to the capsule or to the isthmus, maximum diameter, shape, calcification, microcalcification, color Doppler features, Hashimoto's disease, and BRAFV600E gene mutation to establish a predictive model of cervical lymph node metastasis in patients with thyroid papillary carcinoma, and the predictive efficacy of the model was evaluated. Results: The results compared between the two groups showed that statistically significant differences existed in gender, age, maximum diameter of the lesion, close to capsule, close to isthmus, shape, acoustic halo, calcification and microcalcification (P<0.05). Logistic multivariate regression analysis showed that gender (OR=4.197), age (OR=4.895) and maximum diameter (OR=3.636) were risk factors for cervical lymph node metastasis in patients with thyroid papillary carcinoma (P<0.05). The prediction model established by logistic regression analysis was logistic (P)=-21.957+1.434×gender+1.588×age+1.291×maximum diameter. The efficiency test results of the prediction model showed that the sensitivity and specificity were up to 75.00% and 72.55% respectively. Conclusions: It is preliminarily confrmed that BRFV600E gene mutation is not correlated with cervical lymph node metastasis in patients with thyroid papillary carcinoma. For male patients aged less than 55 years old, the risk of cervical lymph node metastasis should be on guard when the maximum diameter of the carcinoma is large than 10 mm.
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Transvaginal ultrasound is the preferred imaging method for the diagnosis of adenomyosis.The ultrasonographic features of adenomyosis are closely related to its histopathological features.The main sonographic features include spherical enlargement of uterus,asymmetric thickening of anterior and posterior walls,uneven echo of myometrium,linear streaks or island nodules under endometrium,unclear demarcation of endometrium-myometrium,thickening,irregular or interrupted junction zone(JZ),fence-like shadow,intramyometrial cysts,CDFI showing increased blood flow signals in the affected area of myometrium,translesional vascularity and so on.Advanced ultrasound technology,such as cline clips and three-dimensional ultrasound,can complement the shortcomings of conventional ultrasound and improve the diagnostic efficacy of ultrasound for adenomyosis.
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OBJECTIVES: Ultrasound-guided fine-needle aspiration (FNA) is routinely used in the evaluation of thyroid nodules. However, it has several pitfalls, as has been noted in nondiagnostic and indeterminate cases. This study aims to investigate the value of BRAF(V600E) mutation co-testing in FNA cytology. METHOD: A total of 310 patients underwent BRAF(V600E) mutation co-testing in FNA cytology on thyroid nodules between June 2013 and June 2014. Of the 310 patients, 69 patients who had undergone a surgery for thyroid nodules were included in this study. The presence of the BRAF(V600E) mutation was determined by allele-specific polymerase chain reaction amplification of exon 15 of the BRAF gene. RESULTS: Of 69 cases, 33 (47.8%) were BRAF(V600E) mutation positive. The BRAF(V600E) mutation was not significantly associated with high-risk features such as tumor size, lymph node metastasis, and pathological stage. The respective diagnostic performance of FNA (P = 0.02), BRAF(V600E) mutation (P = 0.03), and ultrasonographic (P = 0.00) findings was statistically significant. The sensitivity, specificity and positive predictive value of FNA was 64.9%, 83.3%, and 94.8%. The sensitivity, specificity and positive predictive value of BRAF(V600E) mutation was 56.1%, 91.7%, and 96.9% and the US features was 91.2%, 91.7%, and 98.1% respectively. However, sensitivity of FNA with BRAF(V600E) mutation (77.2%) was lower than FNA with US (92.9%) and combination all together (92.9%). CONCLUSION: In this study, we found that US features were the most useful in preoperative differential diagnosis of thyroid nodules. BRAF(V600E) mutation co-testing in FNA cytology was also useful for diagnosis of thyroid tumors.