Application of preoperative ultrasound features combined with clinical factors in predicting HER2-positive subtype (non-luminal) breast cancer.

BACKGROUND: Human epidermal growth factor receptor2+ subtype breast cancer has a high degree of malignancy and a poor prognosis. The aim of this study is to develop a prediction model for the human epidermal growth factor receptor2+ subtype (non-luminal) of breast cancer based on the clinical and ultrasound features related with estrogen receptor, progesterone receptor, and human epidermal growth factor receptor2. METHODS: We collected clinical data and reviewed preoperative ultrasound images of enrolled breast cancers from September 2017 to August 2020. We divided the data into in three groups as follows. Group I: estrogen receptor ± , Group II: progesterone receptor ± and Group III: human epidermal growth factor receptor2 ± . Univariate and multivariate logistic regression analyses were used to analyze the clinical and ultrasound features related with biomarkers among these groups. A model to predict human epidermal growth factor receptor2+ subtype was then developed based on the results of multivariate regression analyses, and the efficacy was evaluated using the area under receiver operating characteristic curve, accuracy, sensitivity, specificity. RESULTS: The human epidermal growth factor receptor2+ subtype accounted for 138 cases (11.8%) in the training set and 51 cases (10.1%) in the test set. In the multivariate regression analysis, age ≤ 50 years was an independent predictor of progesterone receptor + (p = 0.007), and posterior enhancement was a negative predictor of progesterone receptor + (p = 0.013) in Group II; palpable axillary lymph node, round, irregular shape and calcifications were independent predictors of the positivity for human epidermal growth factor receptor-2 in Group III (p = 0.001, p = 0.007, p = 0.010, p < 0.001, respectively). In Group I, shape was the only factor related to estrogen receptor status in the univariate analysis (p < 0.05). The area under receiver operating characteristic curve, accuracy, sensitivity, specificity of the model to predict human epidermal growth factor receptor2+ subtype breast cancer was 0.697, 60.14%, 72.46%, 58.49% and 0.725, 72.06%, 64.71%, 72.89% in the training and test sets, respectively. CONCLUSIONS: Our study established a model to predict the human epidermal growth factor receptor2-positive subtype with moderate performance. And the results demonstrated that clinical and ultrasound features were significantly associated with biomarkers.

Does Lesion Size Affect the Value of Shear Wave Elastography for Differentiating Between Benign and Malignant Thyroid Nodules?

OBJECTIVES: We aimed to investigate the diagnostic performance of shear wave elastography (SWE) combined with conventional ultrasonography (US) for differentiating between benign and malignant thyroid nodules of different sizes. METHODS: A total of 445 thyroid nodules from 445 patients were divided into 3 groups based on diameter (group 1, ≤ 10 mm; group 2, 10-20 mm; and group 3, > 20 mm). The mean elasticity index of the whole lesion was automatically calculated, and the threshold for differentiation between benign and malignant nodules was constructed by a receiver operating characteristic curve analysis. Diagnostic performances of conventional US and SWE were compared by using pathologic results as reference standards. RESULTS: The mean elasticity was significantly higher in malignant versus benign nodules for all size groups. The differences in mean elasticity in the size groups were not statistically significant for malignant or benign nodules. The specificity of US combined with SWE for group 1 was significantly higher than that for groups 2 and 3 (77.8% versus 62.9% and 53.3%; P < .05), and compared with group 1, the sensitivity was significantly higher for groups 2 and 3 (92.4% and 94.3% versus 80.7%; P < .05). When SWE was added, the specificity increased and the sensitivity and diagnostic accuracy decreased for group 1, and the sensitivity increased and the specificity decreased for groups 2 and 3; however, the differences were not significant. CONCLUSIONS: Combined with SWE, US yielded higher specificity for nodules of 10 mm and smaller and higher sensitivity for nodules larger than 10 mm.

[The clinical value and characteristics of subclavian artery angiography for hemoptysis due to pulmonary tuberculosis].

OBJECTIVE: To study the signs of subclavian artery angiography for hemoptysis due to pulmonary tuberculosis and to evaluate its clinical use in artery embolization. METHODS: Thirty-nine patients with hemoptysis due to pulmonary tuberculosis underwent subclavian artery angiography after artery embolization performed in the hemorrhagic branches of descending aorta. Of the 39 cases, 25 had severe pulmonary fibrosis or were complicated with cavity formation, aspergilloma, pleural thickening and postoperative thorax. The signs of subclavian artery angiography were divided into three categories: (-), normal; (+), the branches of subclavian artery and axillary artery chaotic and hyperplasia; (+ +), the branches of subclavian artery and axillary artery appeared tortuosity, dilatation, aneurysm and shunt with pulmonary circulation. Signs of bleeding was designated (+) and (+ +), with (+ +) indicating strongly positive. The signs of subclavian artery angiography were studied and statistically analyzed. Artery embolization was performed in some of the patients, among whom 15 were analyzed for long-term clinical curative effect. RESULTS: Signs of positive bleeding was found in 32/39 of the cases, and strongly positive bleeding in 17/39 of the cases. Positive bleeding arteries accounted for 39/58 of the branches, including 24/58 (+ +) and 15/58 (+). Angiography demonstrated that the internal mammary artery, lateral thoracic artery and subscapular artery were the main hemorrhagic arteries. Patients with severe pulmonary fibrosis or complicated with cavity, aspergilloma, pleural thickening and postoperative thorax showed higher rate of positive and strongly positive bleeding. Artery embolization was performed in 15 cases: cure was achieved in 6, effective in 7 and failure in 2 cases. Of the 15 cases, 8 had been ineffective after embolization of the hemorrhagic branches of descending aorta alone. CONCLUSIONS: Our results suggest that corresponding subclavian artery angiography should be performed after the hemorrhagic branches of descending aorta artery have been embolized for hemoptysis due to pulmonary tuberculosis, especially in cases with failed embolization, or complicated with severe pulmonary fibrosis, cavity formation, aspergilloma, pleural thickening, or postoperative thorax. The hemorrhagic arteries shown by subclavian artery angiography must be embolized.