Feasibility and safety of ultrasound-guided percutaneous microwave ablation for tertiary hyperparathyroidism.

Background: Tertiary hyperparathyroidism (THPT) is very common in hemodialysis patients with secondary hyperparathyroidism. However, a medical treatment is not indicated for THPT.Purpose: To investigate the feasibility, safety and efficacy of microwave ablation (MWA) in treating THPT.Materials and methods: Twenty-three patients with THPT were enrolled and treated with MWA. Clinical characteristics, serum levels of intact parathyroid hormone (iPTH), calcium, phosphorus and alkaline phosphatase (ALP), as well as treatment outcomes, were evaluated pre- and post-MWA. All patients were followed for >36 months for all assessable clinical data.Results: All patients successfully completed MWA. The mean follow-up was 47.0 ± 8.4 months. Immediately 1-day post-MWA, iPTH, calcium, phosphorus and ALP levels significantly decreased (all p < 0.001). During the long-term follow-up, iPTH levels increased gradually until 24 months and then remained at stable levels. After MWA, serum calcium reached stable levels at 24 months, while phosphorus and ALP reached stable levels at 6 months, and the levels were in the normal range or slightly higher than the upper normal limit. No obvious blood flow signals or significant recurrence was observed in the surgical nodules during follow-up. In the last follow-up, all nodules were persistent, but their maximum diameter and average volume were significantly lower after MWA (both p < 0.001), with an average reduction of 75.9 ± 11.3%. All patients had no major complications during MWA and follow-up.Conclusions: MWA is feasible, safe, effective and minimally invasive in treating THPT. Thus, MWA can be a nonsurgical alternative for treating THPT patients who are ineligible for surgery.

A multicenter study of a contrast-enhanced ultrasound diagnostic classification of breast lesions.

PURPOSE: To evaluate a classification model of contrast-enhanced ultrasound (CEUS) and examine the characteristics of patients with false-negative diagnosis. PATIENTS AND METHODS: A retrospective secondary analysis of a multicenter trial of CEUS for breast cancer diagnosis (from August 2015 to April 2017) was undertaken. Patients (n=1,023) with Breast Imaging Reporting and Data System 4-5 lesions on B-mode ultrasound underwent CEUS. Pathological diagnoses were available from surgical or biopsy specimens for correlation. Lesion maximum diameter (LMD), distance to the papilla (DtP), distance from the superficial edge of the lesion to the skin (DtS), distance from the deep edge of the lesion to the pectoralis muscle (DtPM), and body mass index (BMI) were evaluated. RESULTS: Median age and BMI were 48.0 and 41.2 years and 23.2 and 22.4 kg/m2 for patients with malignant and benign lesions, respectively. Overall sensitivity, specificity, and accuracy of CEUS for malignancy were 89.4%, 65.3%, and 75.8%, respectively. The patients with true-positive and false-negative diagnosis (ie, with malignant lesion) were older than those with false-positive and true-negative diagnosis (ie, with benign lesion). Patients with true-positive and false-positive diagnoses had higher BMI than patients with true-negative and false-negative diagnoses (P=0.004). Patients with true-positive and false-negative diagnoses had larger LMD and DtP, as well as smaller DtS and DtPM. CONCLUSION: Older age, higher BMI, larger LMD and DtP, and smaller DtS and DtPM were associated with malignant lesions on CEUS. Patients with these characteristics should undergo further imaging.

Factors influencing the performance of a diagnostic model including contrast-enhanced ultrasound in 1023 breast lesions: comparison with histopathology.

BACKGROUND: We aimed to investigate the influence of patient and lesion characteristics on our diagnostic model for contrast-enhanced ultrasound (CEUS) of the breast, comparing its accuracy with that of histopathology. METHODS: Conducting a study with eight medical centers, we compared 1,023 breast lesions categorized as BI-RADS 4 or 5 with the score from our newly-established CEUS-based diagnostic model, comparing the results with pathological outcomes. Univariate and multivariate logistic regression analyses were conducted to determine the influence of clinicopathological characteristics on the performance of this CEUS model. RESULTS: Logistic regression analysis showed that patients' age, maximum lesion diameter, and distance from the lesion's deep edge to the pectoralis major were significant independent influencing factors. The model's diagnostic accuracy was greater for patients >35 y (P=0.005), for maximum lesion diameter >20 mm, and for distance from the lesion's deep edge to the pectoralis major ≤3.05 mm. There was no significant difference in accuracy between lesions with maximum lesion diameter 10-20 and <10 mm (P=0.393). CONCLUSIONS: The diagnostic performance of the proposed CEUS model for breast lesions is influenced by patients' age, maximum lesion diameter, and distance from the lesion's deep edge to the pectoralis major. Consideration of influencing factors is required to optimize clinical use of the CEUS model.

The implementation of the elastography score in combination with ultrasound prevents unnecessary biopsy of cardiac lesions.

The pathological technique is time consuming, costly, and patients are not preferred routinely. Histopathological findings have very low affectability and greater occurrence of ß-errors, specifically in the diagnosis of cardiomyopathies. Angiography provides a two-dimensional view only. Vascular ultrasound elastography is a comparatively simple diagnostic method with a high resolution of images. The objective of this study was to compare the accuracy of ultrasound, followed by elastography with coronary angiography and endomyocardial biopsy, in the diagnosis of cardiovascular diseases in a Chinese population. A total of 792, patients pathologically abnormal (study group, n=396) and normal (non-study group, n=396), respectively, were included in the experimental diagnostic study. The patients were diagnosed by coronary angiography, endomyocardial biopsy of cardiac lesions, and the Lagrangian speckle model estimator implementation followed by elastography. The study group patients were observed for 38 months after diagnosis. The Mann-Whitney U test followed by Dunnett's multiple comparisons test was used to compare histopathological findings and elastic modulus values between study group and non-study group subjects at a 99% of confidence level. Pathology did reveal a significant cardiac abnormality in the study group patients at baseline. In the angiogram, indistinguishable differences between two distinct parts of the artery were reported. However, the ultrasound images were showed an obvious change in the diameter of the artery for the study group patients (p<0.0001, q=34.301). The histopathological findings were failed to detect a cardiac abnormality in the study group (p=0.0426). However, a significant a cardiac abnormality was observed in elastic modulus values in the study group (p<0.0001 q=4.121). During follow-up, physicians were detected significant cardiovascular diseases in study group patients. Vascular ultrasound elastography is a non-invasive method of diagnostic technique and can increase the confidence of the diagnosis in cases of cardiovascular diseases.