Risk factors of positive margins and residual lesions following LEEP conization in CIN3 patients / 中华全科医师杂志

The clinical data of 380 patients undergoing loop electrosurgical excision procedure(LEEP) conization for cervical intraepithelial neoplasia grade 3(CIN3) at the Affiliated Hospital of Xuzhou Medical University from January 2017 to December 2019 were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to determine the risk factors of positive margin and residual lesions following conization. One hundred and twelve cases (29.5%) had positive margins, and the risk factors for positive margins were positive high-risk human papillomavirus ( OR=4.92, 95% CI: 1.81-13.36), high-grade lesions on thin cytologic test (TCT)screening ( OR=3.95, 95% CI: 2.42-6.42), and glandular involvement ( OR=3.58, 95% CI: 1.93-6.63). The hysteretomy was performed following conization in 169 hundred and sixty-nine patients who had difficulty in follow-up or no fertility intension, among whom 51 (30.2%) had residual lesions; logistic regression analysis showed that positive margins on LEEP were a risk factor for residual lesions at the time of hysterectomy ( OR: 2.83, 95% CI: 1.44-5.59). The study indicates that positive HR-HPV, high-grade TCT lesions, and lesions involving glands are risk factors for positive margins in CIN3 patients undergoing LEEP conization; and positive margins is risk factor for residual lesions following conization,to which more attention should be paid in clinical practice.

Preliminary study on virtual touch tissue quantification for evaluation of small focal liver lesions / 中华超声影像学杂志

Objective To evaluate the application value of virtual touch tissue quantification (VTQ)for evaluating small focal liver lesions.Methods Seventy-seven patients with 89 small focal liver lesions,whose largest diameter were less than or equal to 3 cm were evaluated with VTQ.The shcar wave velocity (SWV) of the tumor and background liver parenchyma were calculated,and their results were compared with those of 40 healthy subjects.Statistical analysis was performed on the SWV for the differentiation of normal liver,background liver parenchyma and lesions.The cut-off point for SWV was obtained by using ROC curve analysis which was used to predict malignancy lesions.Results The SWV of malignant lesions was significantly higher than that of benign ones [(2.56-± 0.67) m/s vs (1.70 ± 0.55) m/s,P =0.000].The SWV of metastatic liver carcinoma which came from lung cancer and breast cancer were higher than that of gastrointestinal tract cancer transfers (P =0.000).Based on 1.93 m/s as the cut-off point of SWV value,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value for diagnosing malignancies were 82.0 ％,84.6％,83.15 ％,87.23 ％ and 78.57 ％ respectively.Conclusions VTQ technique can help the differential diagnosis of small focal liver lesions.

Acoustic radiation force impulse elastography in differential diagnosis of breast masses / 中华超声影像学杂志

ObjectiveTo explore the application value of acoustic radiation force impulse(ARFI) in the differential diagnosis of breast lesions.Methods Eighty six patients with 107 lesions were performed ARFI elastography.The stiffness of the masses in virtual touch tissue image(VTI) were scored.The pathological diagnosis as the gold standard,drawed the ROC curve to find the cut off point of area ratio to predict breast cancer.Shear wave velocity(SWV) within the breast masses were measured using virtual touch tissue quantification(VTQ) technique.ResultsThe elastography hardness score higher than grade 4 was mainly distributed in the malignancies compared to benign lesions( P ＜0.01).1.53 as the cut-off point of area ratio,sensitivity and specificity of diagnosing breast cancer were 95.7 ％,92.5 ％.SWV of malignant group higher than benign group,the difference was statistically significant (P ＜ 0.001 ).Conclusions Hardness score in VTI imaging,area ratio of benign and malignant lesions,SWV within the breast masses can help the differential diagnosis of breast lesions.

Measurement of virtual touch tissue quantification in healthy liver of adults / 中华超声影像学杂志

ObjectiveTo explore the feasibility of detecting liver stiffness by virtual touch tissue quantification (VTQ) technique and establish a reference range of shear-wave velocity in healthy liver of adults.MethodsOne hundred and sixty-one healthy adults underwent VTQ detection to obtain the shearwave velocities of livers.Each subject received VTQ measurement in four parts of liver.Ten subjects were performed twice by two sonographers,respectively.Results① The liver shear-wave velocities of 161 healthy adults had a 95％ confidence interval from 1.089 to 1.105 m/s.Shear-wave speed values of intrahepatic different parts had no statistically significant.The ICC of measurement value of four parts in healthy liver was 0.80(95 ％ CI:0.75- 0.85).②The difference of shear-wave velocities in healthy livers in different age groups had no statistically significant,whereas the mean values in different gender had statistically significant (P =0.001).③No statistically significant was observed between the mean shear-wave velocity values obtained by different operators (P =0.82).ConclusionsThe liver shear-wave velocities of the healthy group have a reference range from 1.089 to 1.105 m/s.VTQ technique has a good reproduction and stability,therefore,using this technology to assess hepatic stiffness is noninvasive and feasible.

Study in the correlativity between liver shear-wave velocities and liver fibrosis stages of patients with chronic hepatitis B / 中华超声影像学杂志

Objective To explore the correlativity between liver shear-wave velocities and liver fibrosis stages in chronic hepatitis B patients.Methods One hundred and twelve patients with chronic hepatitis B accepted virtual touch tissue quantification (VTQ) testing to obtain shear-wave speed and compared to histological stages.Each patient received VTQ measurements in right lobe of liver.The standards of histological examination of the stages of fibrosis refered to the Hepatitis Pathology Diagnostic Standard Xi'an formulated in 2000.Results Of 112 patients,S0,S1,S2,S3 and S4 were 15,17,15,23 and 42 respectively.There was no significant statistically difference of the mean values of liver shear-wave speed between S0 and S1,while among the rest subgroup had significant statistically differences by multiple comparisons.The areas under the ROC curves were 0.94 for S2,0.87 for S3,and 0.95 for S4.The cut-off values of the shear wave velocity were as follows:1.27 m/s for S2(sensitivity 80.0％,specificity 89.5％),1.43 m/s for S3 (sensitivity 71.8 ％,specificity 87.7 ％ ) and 1.79 m/s for S4 (sensitivity 83.3 ％,specificity 89.4％).Hepatic fibrosis expressed by the histological scale correlated well with the VTQ values of all patients ( r =0.92).Conclusions Along with the increase of liver fibrosis degree,the hepatic parenchyma shear wave velocities increase gradually.The more advanced the degree of fibrosis,the higher the shear wave velocities.