Quantitative Analysis of Shear Wave Elastography and US-Guided Diffuse Optical Tomography for Evaluating Biological Characteristics of Breast Cancer.

RATIONALE AND OBJECTIVES: Shear Wave Elastography (SWE) and Ultrasound-guided Diffuse Optical Tomography (US-guided DOT) demonstrate promise in distinguishing between benign and malignant breast lesions. This study aims to assess the feasibility and correlation of SWE and US-guided DOT in evaluating the biological characteristics of breast cancer. MATERIALS AND METHODS: A cohort of 235 breast cancer patients with 238 lesions, scheduled for surgery within one to three days, underwent B-mode ultrasound (US), US-guided DOT, and SWE. Parameters such as Total Hemoglobin Concentration (THC), Maximal Elasticity (Emax), Mean Elasticity (Emean), Standard Deviation of Elasticity (Esd), and Area Ratio were measured. Correlation with post-surgical pathology reports was examined to explore associations between THC, SWE Parameters, and pathology characteristics. RESULTS: Lesions in patient groups with ER-, PR-, HER2 + , high Ki67, LVI+ , and ALN+ exhibited higher THC, Emax, and Esd compared to groups with ER+ , PR+ , HER2-, low Ki67, LVI-, and ALN-. The increase was seen in all grades of IDC-I to -III. THC significantly correlated with Smax (r = 0.340, P < 0.001), Emax (r = 0.339, P < 0.001), Emean (r = 0.201, P = 0.003), and Esd (r = 0.313, P < 0.001). CONCLUSION: US-guided DOT and SWE prove valuable for the quantitative assessment of breast cancer's biological characteristics, with THC positively correlated with Emax, Emean, and Esd.

Application of ultrasound-based radiomics models of breast masses to predict invasive components of encapsulated papillary carcinoma.

Background: Axillary lymph node (ALN) metastasis is seen in encapsulated papillary carcinoma (EPC), mostly with an invasive component (INV). Radiomics can offer more information beyond subjective grayscale and color Doppler ultrasound (US) image interpretation. This study aimed to develop radiomics models for predicting an INV of EPC in the breast based on US images. Methods: This study retrospectively enrolled 105 patients (107 masses) with a pathological diagnosis of EPC from January 2016 to April 2021, and all masses had preoperative US images. Of the 107 masses, 64 were randomized to a training set and 43 to a test set. US and clinical features were analyzed to identify features associated with INVs. Then, based on the manually segmented US images to obtain radiomics features, the models to predict INVs were built with 5 ensemble machine learning classifiers. We estimated the performance of the predictive models using accuracy, the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, and specificity. Results: The mean age was 63.71 years (range, 31 to 85 years); the mean size of tumors was 23.40 mm (range, 9 to 120 mm). Among all clinical and US features, only shape was statistically different between EPC with INVs and those without (P<0.05). In this study, the models based on Random Under Sampling (RUS) Boost, Random Forest, XGBoost, AdaBoost, and Easy Ensemble methods had good performance, among which RUS Boost had the best performance with an AUC of 0.875 [95% confidence interval (CI): 0.750-0.974] in the test set. Conclusions: Radiomics prediction models were effective in predicting the INV of EPC, whereas clinical and US features demonstrated relatively decreased predictive utility.

Efficacy of anlotinib in Chinese patients with metastatic breast cancer: A retrospective observational study.

Anlotinib, a multitarget tyrosine kinase inhibitor, can inhibit tumour angiogenesis proliferation, metastasis, promote vascular normalization, increase T cell and NK cell activity and infiltration, remodel tumour microenvironment and synergistic immune enhancement. Our study aimes to evaluate the efficacy of anlotinib in the treatment of advanced metastatic breast cancer (MBC) after multiple lines of therapy. Patients included were treated with anlotinib for advanced MBC in the Affiliated Cancer Hospital of Zhengzhou University from 1 January 2019 to 30 June 2023. The objective remission rate, disease-free progression survival and adverse reactions were analysed. We compared and analysed the efficacy of anlotinib in the treatment of advanced metastatic breast cancer, which showed that ORR was 23.6% and DCR was 69.1%. The DCR of monotherapy was 66.7% and that of combination therapy was 69.6% in MBC patients. The combination therapy, combined with chemotherapy had the best effect (79.3%), combined with immunotherapy came second. In addition, the DCR (88.9%) was higher in MBC patients having received prior antiangiogenic therapy. According to the Kaplan-Meier (K-M) survival estimate analysis, the mPFS was 4.17 months (95% CI, 1.758-6.582 months) in Her-2 positive MBC patients, and 7.83 months (95% CI, 2.416-9.104) in Her-2 negative MBC patients. The mPFS was 5.76 months (95% CI, 3.231-8.298 m) in HR positive MBC patients, 7.83 months (95% CI, 3.182-12.478 m) in TNBC patients. Fatigue (20.0%), hypertension (21.8%) and liver dysfunction (18.2%) were common adverse reactions, followed by bone marrow suppression (16.4%), anorexia (14.5%), hypothyroidism (14.5%) and diarrhoea (14.5%). Altogether, Anlotinib monotherapy or combination therapy provides a viable third (or above)-line therapeutic strategy in patients with metastatic breast cancer. The adverse reactions of anlotinib are well tolerated and controllable.

Molecular breast cancer subtype identification using photoacoustic spectral analysis and machine learning at the biomacromolecular level.

Breast cancer threatens the health of women worldwide, and its molecular subtypes largely determine the therapy and prognosis of patients. However, an uncomplicated and accurate method to identify subtypes is currently lacking. This study utilized photoacoustic spectral analysis (PASA) based on the partial least squares discriminant algorithm (PLS-DA) to identify molecular breast cancer subtypes at the biomacromolecular level in vivo. The area of power spectrum density (APSD) was extracted to semi-quantify the biomacromolecule content. The feature wavelengths were obtained via the variable importance in projection (VIP) score and the selectivity ratio (Sratio), to identify the biomarkers. The PASA achieved an accuracy of 84%. Most of the feature wavelengths fell into the collagen-dominated absorption waveband, which was consistent with the histopathological results. This paper proposes a successful method for identifying molecular breast cancer subtypes and proves that collagen can be treated as a biomarker for molecular breast cancer subtyping.

Differential diagnosis of B-mode ultrasound Breast Imaging Reporting and Data System category 3-4a lesions in conjunction with shear-wave elastography using conservative and aggressive approaches.

Background: The high false-positive rates of US Breast Imaging Reporting and Data System (BI-RADS) category 3-4a breast lesions leads to excessive biopsies of many benign lesions, and our aim was to investigate the diagnostic performance achieved by adding a maximum elasticity (Emax) of shear-wave elastography (SWE) to ultrasound (US) to evaluate US BI-RADS category 3-4a breast lesions using conservative and aggressive approaches. We explored the capacity of using this method to avoid unnecessary biopsies without increasing the probability of missing breast cancers. Methods: A total of 123 breast lesions of 120 patients classified as BI-RADS category 3 or 4a were enrolled from January 2019 to December 2019. The US features were evaluated according to the US BI-RADS lexicon. The maximum diameter measured on the US was defined as the size of the lesion. The Emax was assessed by SWE, and the average Emax of breast lesions on two images were calculated and recorded as the final maximum Young's modulus. The diagnostic performance of the combined B-mode US and SWE approach for BI-RADS category 3-4a breast lesions was tested using a conservative approach and an aggressive approach. In the conservative approach, the lesions were downgraded with Emax of 30 kPa or less and upgraded with Emax of 160 kPa or more. In the aggressive approach, the lesions were downgraded with Emax of 80 kPa or less and upgraded with Emax of 160 kPa or more. Pathologic results were defined as the reference standard. Results: Among all 123 breast lesions, there were 60 lesions classified as BI-RADS category 3 and 63 lesions classified as BI-RADS category 4a. Compared to the B-mode US, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the receiver operating characteristic (ROC) curve (AUC) of the combined B-mode US and SWE with a conservative approach changed from 88.9% to 94.4%, 55.2% to 60.0%, 25.4% to 28.8%, 96.7% to 98.4%, 60.2% to 65.0%, and 0.721 to 0.772, respectively. The specificity, PPV, and accuracy of combined B-mode US and SWE with an aggressive approach increased from 55.2% to 72.4%, 25.4% to 29.3%, and 60.2% to 71.5%, respectively, but this was accompanied with decreases in the sensitivity from 88.9% to 66.7%, the NPV from 96.7% to 92.7%, and the AUC from 0.721 to 0.695. Conclusions: The addition of SWE improves the diagnostic performance of breast US. Adding the diagnostic criteria of SWE to the BI-RADS assessment of B-mode US, downgrading the lesions with Emax 30 kPa or less, and upgrading the lesions with Emax 160 kPa or more helped discriminate low suspicion lesions from benign lesions in order to decrease false-positive findings and avoid missing cancer diagnosis.

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.

Prediction of treatment responses to neoadjuvant chemotherapy in breast cancer using contrast-enhanced ultrasound.

BACKGROUND: Elucidation the efficacy of neoadjuvant chemotherapy (NAC) in breast cancer is important for informing therapeutic decisions. This study aimed at evaluating the potential value of contrast-enhanced ultrasound (CEUS) parameters in predicting breast cancer responses to NAC. METHODS: We performed CEUS examinations before and after two cycles of NAC. Quantitative CEUS parameters [maximum intensity (IMAX), rise time (RT), time to peak (TTP), and mean transit time (mTT)], tumor diameter, and their changes were measured and compared to histopathological responses, according to the Miller-Payne Grading (MPG) system (score 1, 2, or 3: minor response; score 4 or 5: good response). Prediction models for good response were developed by multiple logistic regression analysis and internally validated through bootstrap analysis. The receiver operating characteristic (ROC) curve was used to evaluate the performance of prediction models. RESULTS: A total of 143 patients were enrolled in this study among whom 98 (68.5%) achieved a good response and while 45 (31.5%) exhibited a minor response. Several imaging variables including diameter, IMAX, changes in diameter (Δdiameter), IMAX (ΔIMAX) and TTP (ΔTTP) were found to be significantly associated with good therapeutic responses (P<0.05). The areas under the curve (AUC) increased from 0.748 to 0.841 in the multivariate model that combined CEUS parameters and molecular subtypes with a sensitivity and specificity of 0.786, 0.745, respectively. Tumor molecular subtype was the primary predictor of primary endpoint. CONCLUSIONS: CEUS is a potential tool for predicting responses to NAC in locally advanced breast cancer patients. Compared to the other molecular subtypes, triple negative and HER2+/ER- subtypes are more likely to exhibit a good response to NAC.

Feasibility of Shear Wave Elastography Imaging for Evaluating the Biological Behavior of Breast Cancer.

OBJECTIVE: To explore the feasibility of shear wave elastography (SWE) parameters for assessing the biological behavior of breast cancer. MATERIALS AND METHODS: In this prospective study, 224 breast cancer lesions in 216 female patients were examined by B-mode ultrasound and shear wave elastography in sequence. The maximum size (Smax) of the lesion was measured by B-mode ultrasound, and then shear wave elastography was performed on this section to obtain relevant parameters, including maximum elasticity (Emax), mean elasticity (Emean), standard deviation of elasticity (SD), and the area ratio of shear wave elastography to B-mode ultrasound (AR). The relationship between SWE parameters and pathological type, histopathological classification, histological grade, lymphovascular invasion status (LVI), axillary lymph node status (ALN), and immunohistochemistry of breast cancer lesions was performed according to postoperative pathology. RESULTS: In the univariate analysis, the pathological type and histopathological classification of breast cancer were not significantly associated with SWE parameters; with an increase in the histological grade of invasive ductal carcinoma (IDC), SD (p = 0.016) and Smax (p = 0.000) values increased. In the ALN-positive group, Smax (p = 0.004) was significantly greater than in the ALN-negative group; Smax (p = 0.003), Emax (p = 0.034), and SD (p = 0.045) were significantly higher in the LVI-positive group than in the LVI-negative group; SD (p = 0.043, p = 0.047) and Smax (p = 0.000, p = 0.000) were significantly lower in the ER+ and PR+ groups than in the ER- and PR- groups, respectively; AR (p = 0.032) was significantly higher in the ER+ groups than in the ER- groups, and Smax (p = 0.002) of the HER2+ group showed higher values than that of the HER2- group; Smax (p = 0.000), SD (p = 0.006), and Emax (p = 0.004) of the Ki-67 high-expression group showed significantly higher values than those of the Ki-67 low-expression group. In the multivariate analysis, Ki-67 was an independent factor of Smax (p = 0.005), Emax (p = 0.004), and SD (p = 0.006); ER was an independent influencing factor of Smax (p = 0.000) and AR (p = 0.032). LVI independently influences Smax (p = 0.006). CONCLUSIONS: The SWE parameters Emax, SD, and AR can be used to evaluate the biological behavior of breast cancer.

The volumetric-tumour histogram-based analysis of intravoxel incoherent motion and non-Gaussian diffusion MRI: association with prognostic factors in HER2-positive breast cancer.

BACKGROUND: To evaluate the imaging biomarkers of human epidermal growth factor receptor 2 (HER2) positive breast cancer in comparison to other molecular subtypes and to determine the feasibility of identifying hormone receptor (HR) status and lymph node metastasis status using volumetric-tumour histogram-based analysis through intravoxel incoherent motion (IVIM) and non-Gaussian diffusion. METHODS: This study included 145 breast cancer patients with 148 lesions between January and November in 2018. Among the 148 lesions, 74 were confirmed to be HER2-positive. The volumetric-tumour histogram-based features were extracted from the combined IVIM and non-Gaussian diffusion model. IVIM and non-Gaussian diffusion parameters obtained from images of the subjects with different molecular prognostic biomarker statuses were compared by Student's t test or the Mann-Whitney U test. The area under the curve (AUC), sensitivity, and specificity at the best cut-off point were reported. The Spearman correlation coefficient was calculated to analyse the correlations of clinical tumor nodule metastasis (TNM) stage and Ki67 with the IVIM and non-Gaussian diffusion parameters. RESULTS: The entropy of mean kurtosis (MK) was significantly higher in the HER2-positive group than in the HER2-negative group (p = 0.015), with an AUC of 0.629 (95% CI 0.546, 0.707), a sensitivity of 62.6%, and a specificity of 66.2%. For HR status, the MD 5th percentile was higher in the HR-positive group of HER2-positive breast cancer (p = 0.041), with an AUC of 0.643 (95% CI 0.523, 0.751), while for lymph node status, the entropy of mean diffusivity (MK) was lower in the lymph node positive group (p = 0.040), with an AUC of 0.587 (95% CI 0.504, 0.668). The clinical TNM stage and Ki67 index were correlated with several histogram parameters. CONCLUSION: Volumetric-lesion histogram analysis of IVIM and the non-Gaussian diffusion model can be used to provide prognostic information about HER2-positive breast cancers and potentially contribute to individualized anti-HER2 targeted therapy plans .

US-guided Diffuse Optical Tomography: Clinicopathological Features Affect Total Hemoglobin Concentration in Breast Cancer.

PURPOSE: To investigate breast cancers total hemoglobin concentration (THC) characteristics and its association with clinical pathologic findings. MATERIALS AND METHODS: The study was approved by the institutional review board and all patients provided written informed consent. 447 breast cancer patients, totally 455 lesions were included in our study. The size and THC of breast lesions were measured by conventional ultrasound (US) and US-guided Diffuse Optical Tomography (DOT) 1-2 days before surgery. Clinical and pathology information of patients was collected. RESULT: The average THC values of ER- or PR- lesions were significantly higher than the positive ones (P = .005 and P = .01,respectively); The average THC values of axillar LN+ or LVI+ were higher than the negative ones (P = .042 and P = .043, respectively). No significant THC difference was found in groups of infiltrating vs. non-infiltrating, HER2+ vs. HER2-, Ki67 high vs. Ki67 low, and different menstrual phases (P = .457, P = .917, P = .417, P = .213, respectively).The incidence ages and the lesion-nipple distances of T3 patients were lower than that of T1 and T2 (P < .001 and P < .001 respectively). The THC values and Ki67 indexes of T2 and T3 lesions were similar, but were higher than that of the T1 group (P < =0.001 and P = .006, respectively). CONCLUSION: Clinicopathological features of breast cancer, such as ER and PR status, axillary lymph node metastasis, lymphovascular invasion, correlate with THC values. Furthermore, the Ki67 indexes can be predicted using tumor size and THC, useful for pre-surgical evaluation of cancer biology and real-time, non-invasive monitoring of NAC efficacy.

Solid Papillary Carcinoma of the Breast: Magnetic Resonance Mammography, Digital Mammography, and Ultrasound Findings.

BACKGROUND: The aim of this study was to investigate the MR mammography (MRM), digital mammography (DM), and ultrasound (US) findings of solid papillary carcinoma (SPC) of breast and to raise awareness of this rare breast tumor. MATERIAL AND METHODS: Thirty patients diagnosed with breast SPC (age range, 21-72; mean age, 60.27 years) from January 2013 to August 2015 were enrolled. Their clinical presentation and MRM, DM, and US findings were retrospectively reviewed. All patients underwent both MRM and US, and 20 of them underwent DM. The research primarily investigated MRM features correlated with clinicopathological characteristics. RESULTS: Of all the patients, 13 were pure SPC in suit, whereas 17 were microinvasive SPC. The detection rates of US, DM, and magnetic resonance imaging for SPC were 30%, 50%, and 100%, respectively, and there were no specific imaging features on DM and US. The most common MRM appearances were located in the retroareolar area (16/30, 53.34%) with T2WI hyperintensity (24/30, 80%) and ductal ectasia (18/30, 60%). Non-mass enhancement of a linear or segmental distribution (17/18, 94.44%) together with clumped enhancement (12/18, 66.66%) and mass with a rim (6/12, 50%) or heterogeneous (6/12, 50%) enhancement were 2 of the typical enhancement features of SPC. Compared with pure SPC, SPC with microinvasive showed larger size of the lesion (t = 1.083, P = 0.026). CONCLUSION: Although SPC was difficult to detect in both DM and US, MRM gave better detection of this rare tumor. The MRM characteristics of SPC were distinct and highly similar to its clinicopathological features.

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.

Predicting Treatment Response of Breast Cancer to Neoadjuvant Chemotherapy Using Ultrasound-Guided Diffuse Optical Tomography.

PURPOSE: To prospectively investigate ultrasound-guided diffuse optical tomography (US-guided DOT) in predicting breast cancer response to neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS: Eighty-eight breast cancer patients, with a total of 93 lesions, were included in our study. Pre- and post-last chemotherapy, size and total hemoglobin concentration (THC) of each lesion were measured by conventional US and US-guided DOT 1 day before biopsy (time point t0, THC THC0, SIZE S0) and 1 to 2 days before surgery (time point tL, THCL, SL). The relative changes in THC and SIZE of lesions after the first and last NAC cycles were considered as the variables ΔTHC and ΔSIZE. Receiver operating characteristic curve was performed to calculate ΔTHC and ΔSIZE cutoff values to evaluate pathologic response of 93 breast cancers to NAC, which were then prospectively used to predicate response of 61 breast cancers to NAC. RESULTS: The cutoff values of ΔTHC and ΔSIZE for evaluation of breast cancers NAC treatment response were 23.9% and 42.6%. At ΔTHC 23.9%, the predicted treatment response in 61 breast lesions for the time points t1 to t3 was calculated by area under the curve (AUC), which were AUC1 0.534 (P=.6668), AUC2 0.604 (P=.1893), and AUC3 0.674(P =. 0.027), respectively; for ΔSIZE 42.6%, at time points t1 to t3, AUC1 0.505 (P=.9121), AUC2 0.645 (P=.0115), and AUC3 0.719 (P=.0018). CONCLUSION: US-guided DOT ΔTHC 23.9% and US ΔSIZE 42.6% can be used for the response evaluation and earlier prediction of the pathological response after three rounds of chemotherapy.

Association Between Background Parenchymal Enhancement and Pathologic Complete Remission Throughout the Neoadjuvant Chemotherapy in Breast Cancer Patients.

PURPOSE: To retrospectively investigate the quantitative background parenchymal enhancement (BPE) of the contralateral normal breast in patients with unilateral invasive breast cancer throughout multiple monitoring points of neoadjuvant chemotherapy (NAC) and to further determine whether BPE is associated with tumor response, especially at the early stage of NAC. MATERIALS AND METHODS: A total of 90 patients with unilateral breast cancer who then received six or eight cycles of NAC before surgery were analyzed retrospectively. BPE was measured in dynamic contrast-enhanced MRI at baseline and after 2nd, 4th, and 6th NAC, respectively. Correlation between BPE and tumor size was analyzed, and the association between pathologic complete remission (pCR) and BPE was also analyzed. RESULTS: The BPE of contralateral normal breast showed a constant reduction throughout NAC therapy regardless of the menopausal status (P<.001 in all). Both the BPEs and the changes of BPE in each of the three monitoring points were significantly correlated with those in tumor size (P<.05 in all), and the reduction of BPE after 2nd NAC had the largest diagnostic value for pCR (AUC=0.726, P<.001), particularly in hormonal receptor (HR)-negative patients (OR=0.243, 95%CI=0.083 to 0.706, P=.009). CONCLUSION: The BPE of contralateral normal breast had a constant decreased tendency similar to the change of tumor size in NAC. Reduction of BPE at the early stage of NAC was positively associated with pCR, especially in HR-negative status.

Solid breast lesions: clinical experience with US-guided diffuse optical tomography combined with conventional US.

PURPOSE: To prospectively investigate the clinical efficacy of using diffuse optical tomography (DOT) and ultrasonographic (US) localization with conventional US to differentiate malignant solid breast lesions from those that are benign. MATERIALS AND METHODS: The study was approved by the institutional review board and all patients provided written informed consent. One hundred two consecutive women (mean age, 43 years; range, 18-86 years) who were referred for open biopsy with 136 breast lesions underwent conventional US and DOT with US localization. Total hemoglobin concentration and oxygen saturation were measured for each breast lesion. Sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value were determined with surgical pathologic examination results as the verification standard. RESULTS: Of the 136 biopsied lesions, 54 were carcinomas and 82 were benign. The average total hemoglobin concentration in the malignant group was 223.3 µmol/L±55.8 (standard deviation), and the average hemoglobin concentration in the benign group was 122.5 µmol/L±80.6 (P=.005). When the maximum hemoglobin concentration of 137.8 µmol/L was used as the threshold value, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of DOT with US localization were 96.3%, 65.9%, 65.0%, 96.4%, and 76.5%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of conventional US were 96.3%, 92.6%, 89.7%, 97.4%, and 93.4%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of conventional US combined with DOT were 100%, 93.9%, 91.5%, 100%, and 96.3%, respectively. CONCLUSION: US-guided DOT combined with conventional US improves accuracy compared with DOT alone.

[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.