Hepato-biliary-enteric stent drainage as palliative treatment for proximal malignant obstructive jaundice.

The proximal malignant obstructive jaundice remains one of the most challenging problems for hepato-biliary surgeons. Particularly when the findings preclude surgical resection at exploration, the next decision seems hard to make. A novel palliative treatment called "hepato-biliary-enteric stent drainage" was designed for these proximal malignant obstructive jaundice patients. Hepato-biliary-enteric stent drainage was performed with silicone tube whose diameter was determined according to the degree of dilated biliary ducts, and the proximal end of the tube was placed to intrahepatic ducts as far as possible, the distal end was placed across the duodenal papilla. Between February 2011 and August 2012, 23 patients with the proximal malignant obstructive jaundice of unresectable tumors at exploration received hepato-biliary-enteric stent drainage. Patient's liver function results, symptoms, complications, and survival time were documented. The bilirubin levels of all 23 patients had a considerable and persistent decrease after operation and remained low or normal before death except for four cases of recurrent jaundice (two resulted from migration of tube and other two resulted from hepatocellular carcinoma extensively involving liver parenchyma). After effective drainage, clinical symptoms of cholangitis such as fever or pain were markedly relieved. No procedure-related bleeding, bile leakage, pancreatitis were observed. The median survival time was 212 days, half-year and 1-year survival rate were 56.5 and 21.7%, respectively. Hepato-biliary-enteric stent drainage with less expense, less complications, and easy operation may be an ideal option for patients with unresectable malignancy in the hilar region at exploration.

Performance of shear wave elastography for differentiation of benign and malignant solid breast masses.

OBJECTIVES: To perform a meta-analysis assessing the ability of shear wave elastography (SWE) to identify malignant breast masses. METHODS: PubMed, the Cochrane Library, and the ISI Web of Knowledge were searched for studies evaluating the accuracy of SWE for identifying malignant breast masses. The diagnostic accuracy of SWE was evaluated according to sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) curves. An analysis was also performed according to the SWE mode used: supersonic shear imaging (SSI) and the acoustic radiation force impulse (ARFI) technique. The clinical utility of SWE for identifying malignant breast masses was evaluated using analysis of Fagan plot. RESULTS: A total of 9 studies, including 1888 women and 2000 breast masses, were analyzed. Summary sensitivities and specificities were 0.91 (95% confidence interval [CI], 0.88-0.94) and 0.82 (95% CI, 0.75-0.87) by SSI and 0.89 (95% CI, 0.81-0.94) and 0.91 (95% CI, 0.84-0.95) by ARFI, respectively. The HSROCs for SSI and ARFI were 0.92 (95% CI, 0.90-0.94) and 0.96 (95% CI, 0.93-0.97), respectively. SSI and ARFI were both very informative, with probabilities of 83% and 91%, respectively, for correctly differentiating between benign and malignant breast masses following a "positive" measurement (over the threshold value) and probabilities of disease as low as 10% and 11%, respectively, following a "negative" measurement (below the threshold value) when the pre-test probability was 50%. CONCLUSIONS: SWE could be used as a good identification tool for the classification of breast masses.