Elastography for the diagnosis of high-suspicion thyroid nodules based on the 2015 American Thyroid Association guidelines: a multicenter study.

BACKGROUND: An accurate diagnosis for high-suspicion nodules based on the 2015 American Thyroid Association (ATA) guidelines would reduce unnecessary invasive examinations. Elastography is a useful tool for discriminating benign and malignant thyroid nodules. The aim of this study is to investigate the diagnostic efficiency of elastography for high-suspicion thyroid nodules based on the 2015 ATA guidelines in the Chinese population. METHODS: Thyroid nodules with high-suspicion characteristics based on the 2015 ATA guidelines were subjected to conventional ultrasound (US) and ultrasound strain elastography (USE) examinations at 12 hospitals from 4 geographic regions across China. Cytology/histology of thyroid nodules was used as a reference method. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic performance of the elasticity score (ES) and strain ratio (SR). Logistic regression analysis was used to determine the predictors of malignancy. RESULTS: Overall, a total of 1445 thyroid nodules (834 malignant, 611 benign) from 12 centers were included in the final analysis. The areas under the curve of the ES and SR were 0.828 and 0.732, respectively. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the ES were 92.4, 60.7, 79.0, 76.3 and 85.5%, respectively, and those of the SR were 81.1, 50.1, 68.9, 65.9 and 67.9%, respectively. The combination of the Thyroid Imaging Reporting and Data System (TI-RADS) and ES led to a significant increase in the sensitivity and NPV (97.1 and 91.9%, respectively) compared with the TI-RADS alone. Logistic regression analysis showed that microcalcifications (OR = 5.290), taller than wide (OR = 12.710), irregular margins (OR = 10.117), extrathyroidal extension (ETE; OR = 6.412), the ES (OR = 3.741) and the SR (OR = 1.083) were independent predictors of malignant thyroid nodules. The sensitivity, specificity, accuracy, PPV and NPV of the ES were all superior in nodules ≥1 cm than in those < 1 cm (95.0% vs 90.4, 68.8% vs 56.8, 85.9% vs 74.4, 85.2% vs 69.9, and 87.8% vs 84.2%, respectively). CONCLUSIONS: Elastography combined with the ES is a valuable tool for the assessment of high-suspicion thyroid nodules based on the 2015 ATA guidelines, especially in nodules ≥1 cm.

The performance of conventional and elasticity ultrasonography of papillary thyroid microcarcinoma under different background / 中华超声影像学杂志

Objective To investigate the conventional ultrasonic and elastographic characteristics of papillary thyroid micro-carcinomas(PTMC) suffered in normal and Hashimoto's thyroiditis(HT).Methods A total of 227 patients with 249 nodules that were confirmed by surgery or biopsy were included in this study.The cases were divided into normal group and HT group.All patients underwent conventional ultrasound and elastography (static pressure).The sonographic characteristics and strain ratio (SR) value were evaluated.Results In the normal group,the ratio between male and female was 1 ∶ 2.9,while in HT group,it was 1 ∶ 11,which was significant different between the two group (P =0.002).Sonographic characteristics that had no significant difference between the two groups (P ＞0.05) include:boundary,shape,vertical and horizontal ratio,halo,echogenicity,calcification,posterior shadowing,vascularity on color Doppler ultrasonography.The strain ratio value was statistically different between the two groups (P =0.034),with 3.44 ± 1.03 in normal group and 3.13 ± 1.13 in HT group.Conclusions The conventional ultrasonographic features of PTMC were similar in both normal thyroid and HT.However,females suffering HT were more susceptible to PTMC,and the strain ratio value of PTMC concomitant HT decreased.

A preliminary study on data mining techniques for utilizing the breast ultrasound database / 生物医学工程学杂志

Based on the breast ultrasound database of West China Hospital from January 1, 2002 to December 31, 2007, a study of data mining techniques for utilizing the diagnostic information of breast ultrasound and breast pathology was carried out. An innovative computerized retrieval system was invented. With the visual user interface of the system, the data of benignancy or malignancy diagnosed by ultrasound and pathologic examination, and the data on the diagnostic correlation of ultrasound and pathology were obtained, respectively. The qualities of data mining were 99. 98%-100%. By means of the retrieval system, the users can secure numerous data from the breast ultrasound database rapidly and accurately; so it contributes to the rational utilization of information from medical database for serving various medical studies. This method may also be helpful for doctors to utilize ultrasound database in other fields.

On the segmentation of malignant halo in ultrasound images of breast tumor / 生物医学工程学杂志

The method for segmenting malignant halo of malignant breast tumor in ultrasound image is useful in providing evidence for the differential diagnosis of breast tumor. In this respect, we adopt an improved anisotropic diffusion filtering method to preprocess the breast tumor ultrasound image, and then apply an improved LBF model with combination of Otsu and morphology methods to extract internal and external contours for obtaining malignant halo based on LBF model proposed by Li. We compare our data of malignant halo with doctor's manual-sketched malignant halo, and make quantitative analysis. The result shows that the malignant halo segmented by the proposed methods in this paper is in accordance with the manual-sketched malignant halo.

Tumor size assessment with ultrasound as a prognostic factor for patients with liver transplantation for hepatocellular carcinoma / 中华超声影像学杂志

Objective To evaluate the assessment of tumor's size with ultrasound in research of prognosis of liver transplantation for hepatocellular carcinoma (HCC). Methods Clinical data of 148 patients with HCC who underwent liver transplantation were analyzed retrospectively. Results One-, 2-,3-,and 5-year overall actuarial survival were 73.3% ,45.6% ,35.4% ,and 32.1%,respectively. One-,2-,3-,and 5-year overall recurrence-free survival were 70.7 %, 44.3 %, 38. 5%, and 34. 5%, respectively. The overall tumor recurrence rate was 43.2%. Univariate analysis indicates that (the Kaplan-Meier method with the Log-Rank test) the total tumor burden (TTB) (χ2=15.098,P=0.001) was found to be significantly affecting the actuarial survival. While TTB (χ2=29. 038, P<0.001) was for recurrence-free survival. In multivariate analysis (with the multivariate Cox proportional hazards model), TTB (R2=1.610, P =0. 008) was found to be an independent predictor of actuarial survival. On the other hand, TTB (R2 =2. 206, P<0.001) was identified as the prognostic factor independently related to recurrence-free survival. Conclusions TTB is an independent prognostic factor for patients with liver transplantation for HCC. Assessment of tumor size with ultrasound is beneficial to the evaluation of indication for liver transplantation when patients with HCC were concerned.

Ultrasonographic diagnosis of galactostasis in lactation / 中华超声影像学杂志

Objective To study the value of ultrasonographic diagnosis of galactostasis in lactation.MethodsPatients in lactation and post-lactation were examined by color Doppler ultrasonography.Combined puncture,operation and pathology,the imaging features of different stage were summarized.Results The type of galactostasis included ductal ectasia,galactocele,infection and consolidation.The ultrasonographic examination with imaging features can determine the diagnosis and judge the type and the course of disease.Conclusions Ultrasonography is a first choice in diagnosing galactostasis in lactation.

Clinical application value of ultrasonography in excising breast mass with Mammotome / 中华超声影像学杂志

Objective To investigate the clinical application value of ultrasonography in excising breast mass with Mammotome vacuum assisted biopsy device and a stereotactic unit(MMT).Methods Guided by ultrasonography,breast masses were biopsy and excised with MMT.The property of masses were identified by pathology.The effects were followed up with ultrasonography.Results Sixty one masses of breast in 34 cases were excised.Pathology showed that 54 were fibroadenoma and 7 were fibroadenosis.The patients had little discomfort in operation and few complications post operation.There were no relapses during short interviews.Conclusions MMT can biopsy and excise the breast mass guided by ultrasonography.The operation has little wound and few complications.It is a useful minimally invasive method which does not influence the appearance of breast.Ultrasonography can insure operation safety and precision.The effects are evaluated immediately.

Analysis of 310 patients with benign breast tumor treated by mammotome minimally invasive stereotactic excision therapy / 中国普通外科杂志

Objective To evaluate the therapeutic value of minimally invasive excision of benign breast lesions using stereotactic mammotome minimally invasive surgery system.Methods Under ultrasonographic image monitoring,1160 breast masses of 310 patients were excised using mammotome minimally invasive stereotactic excision system and sent for pathologic examinations immediatly.Patients′condition was follow-ed up and recorded post-operative.Their clinical data were retrospectively analysed.Results Accurate and complete resection of all of the 1160 breast masses was achieved.The resected tissues were large enough to make pathologic diagnosis.The pathologic diagnoses were all found to be benign,and included: fibroadenoma(n=672),fibroadenosis(n=451),intraductal papilloma(n=12),cyst(n=6),cystic hyperplasia(n=17) and tubular adenoma(n=17).Regular follow up every 6-12 months was done.Postoperative surgical scars were unremarkable,the skin incisions were small and concealed,breast appearance and skin sensation were normal and ultrasonography did not reveal residual lesions or recurrences.Conclusions Complete resection of benign breast lesions can be done with mammotome technique.This technique is safe,accurate and effective.Moreover,there is little trauma,low complication rate,and the breast appearance is not affected.This minimally invasive excision technique for benign breast lesions is suitable for wide use.

Comparative study of ultrasonographical and pathological manifestations of juvenile macromastia / 中华超声影像学杂志

Objective To expatiate the ultrasonographical and pathological manifestations of breasts with juvenile macromastia.Methods Four patients with juvenile macromastia were examined by high frequency ultrasonography.The sonographical and pathological images were observed and reported.Results The sonographical characteristics of the breasts with juvenile macromastia were similar: the anatomical structures of the breasts were obscure,which were characterized by cystic formation,reticular structure,patched hypoechoic or hyperechoic regions and distorted gland structure.One patient had fibroadenoma and dermatic erythema.The results of pathological examination showed marked cystic proliferation of glands accompanied with ductal epithelial hyperplasia,irregular ductal distribution,no lobules formation or proliferation of fat tissue,fibrocyte and fibroblast.Conclusions The abnormalities of juvenile macromastia may not only be the huge volume,but also may include abnormal ultrasonographical and pathological manifestations,awaiting more follow-up studies.