Radiotranscriptomics identified new mRNAs and miRNA markers for distinguishing prostate cancer from benign prostatic hyperplasia.

The present study investigated ultrasound (US) phenotypes reflecting prostate cancer (PCa)-related genetic mutations. Herein, integration of radiotranscriptomic data, US and contrast-enhanced ultrasound (CEUS) radiomic images, and RNA sequencing was performed with the aim of significantly improving the accuracy of PCa prognosis. We performed radiotranscriptomic analysis of clinical, imaging, and two genomic (mRNA and microRNA expression) datasets from 48 and 22 men with PCa and benign prostatic hyperplasia (BPH), respectively. Twenty-three US texture features and four microvascular perfusion features were associated with various patterns of 52 differentially expressed genes related to PCa (p < 0.05); 17 overexpressed genes were associated with two key texture features. Twelve overexpressed genes were identified using microvascular perfusion features. Furthermore, mRNA and miRNA biomarkers could be used to distinguish between PCa and BPH. Compared with RNA sequencing, B-mode and CEUS features reflected genomic alterations associated with hormone receptor status, angiogenesis, and prognosis in patients with PCa. These findings indicate the potential of US to assess biomarker levels in patients with PCa.

Predictors of metastasis in cervical indeterminate lymph nodes after thyroid cancer ablation by long-term ultrasound follow-up.

OBJECTIVES: To investigate the pattern of change over time and predictors for metastasis in indeterminate lymph nodes (LNs) among patients with thyroid cancer post-ablation. METHODS: We enrolled patients who developed new cervical LNs after papillary thyroid carcinoma (PTC) ablation. Changes in the ultrasound characteristics of the indeterminate LN were recorded at months 1, 3, 6 and 12 after ablation. LN puncture pathology and long-term follow-up were standard of diagnosis. The indeterminate LNs were divided into benign and malignant groups, the differences between the two groups were compared, and the risk characteristics of malignant LNs were screened using generalized estimating equations (GEE). RESULTS: In total, we included 138 LNs from 99 patients, of which 48 were indeterminate LNs. When following up indeterminate LNs, non-cervical lymph node metastasis (non-CLNM) lesions demonstrated a statistically significant gradual decrease in volume (p = 0.012), though there was no significant change in the volume of CLNM lesions (p = 0.779). Compared to non-CLNM lesions, the diagnostic efficiency was the highest for CLNM lesions at 1-3 months after ablation, when the LN volume changed by -0.08 to 0.12 mL (p = 0.048). The third month after ablation became an important time point for review. Moreover, GEE analysis showed that microcalcifications, cystic changes, and vascularity were strongly associated with CLNMs (p = 0.004, p = 0.002, and p = 0.010, respectively). CONCLUSIONS: There is a pattern of volume change of indeterminate LNs after PTC ablation, which, together with microcalcifications, cystic changes, and vascularity, can be used as criteria for differentiating the benignity and malignancy of indeterminate LNs.

Lymphatic Contrast-enhanced US to Improve the Diagnosis of Cervical Lymph Node Metastasis from Thyroid Cancer.

Background The presence of cervical lymph node (LN) metastases (LNMs) affects clinical staging and prognosis of thyroid cancer, but the role of conventional B-mode US is limited for preoperative diagnosis of LNMs. The diagnostic value of lymphatic contrast-enhanced US (LCEUS) in thyroid cancer is still being explored. Purpose To explore the diagnostic performance of LCEUS by means of thyroidal injection of contrast agent in comparison with US in detecting LNMs of suspected thyroid cancer. Materials and Methods In this single-center prospective study conducted from November 2020 to January 2021, consecutive participants with suspected thyroid cancer underwent B-mode US and LCEUS of cervical LNs before biopsy. LNMs were confirmed with fine-needle aspiration cytologic examination, thyroglobulin washout assessment, or histopathologic examination after surgery. The diagnostic performance of LCEUS for cervical LNs was compared with that of conventional B-mode US, and its association with LN size and location was evaluated. Results The final data set included 64 participants (mean age, 45 years ± 12 [SD]; 52 women) with 76 LNs. The sensitivity, specificity, and accuracy of LCEUS for LNM were 97%, 90%, and 93%, respectively, whereas they were 81%, 80%, and 80%, respectively, for LNM at conventional B-mode US. Compared with US, LCEUS had better diagnostic accuracy for the LNs smaller than 1 cm (82% vs 95%; P = .03) and for central neck LNs (level VI) (83% vs 96%; P = .04). Conclusion Lymphatic contrast-enhanced US had better diagnostic performance than conventional B-mode US for detecting cervical LN metastases in suspected thyroid cancer before surgery, especially for LNs smaller than 1 cm and central neck LNs. © RSNA, 2023 See also the editorial by Grant and Kwon in this issue.

Analysis and prediction of regrowth in benign thyroid nodules undergoing radiofrequency ablation: a retrospective study with a 5-year follow-up.

OBJECTIVES: To evaluate the 5-year follow-up results of radiofrequency ablation (RFA) for benign thyroid nodules (BTNs), and construct pre- and postablation nomogram models to predict regrowth in BTNs undergoing RFA. METHODS: According to the occurrence of regrowth, BTNs were divided into two subgroups, the regrowth group and the nonregrowth group, and the variables were compared between these two subgroups. Then, univariate and multivariate Cox regression analyzes were utilized to filter the independent prognostic factors of regrowth, which then were introduced into the pre- and postablation prognostic nomograms, respectively. The discrimination powers and prediction performances of the nomograms were appraised by receiver operating characteristic (ROC) curves and calibration charts. RESULTS: The 5-year mean volume reduction rate was 88.80%, with a complication rate of 0.35% (7/200). Within 5 years of follow-up, the regrowth rate was 19% (38/200). Pre- and postablation prognostic nomograms were established to predict the probability of nonregrowth at 1, 3, and 5 years after RFA. The preablation nomogram included initial volume, perinodular vascularity, and high enhancement ring. The postablation nomogram incorporated total volume, perinodular vascularity, and energy applied per volume. The area under the ROC curves and concordance index values of these models were all above 0.7, indicating that the prognostic nomograms achieved satisfactory discrimination powers and prediction performances. CONCLUSION: RFA for BTNs has long-term efficacy and safety under the influence of key techniques. The pre- and postablation nomograms constructed in the present study might facilitate clinical decision-making before RFA and for the follow-up management after RFA. KEY POINTS: • Perinodular vascularity, rather than intranodular vascularity was an independent predictor of regrowth, both before and after the RFA procedure. • A high enhancement ring on preablation contrast-enhanced ultrasound was an independent predictor of regrowth. • Pre- and postablation nomograms might facilitate clinical decision-making before RFA and follow-up management after RFA.

Efficacy and safety of radiofrequency ablation for calcified benign thyroid nodules: results of over 5 years' follow-up.

PURPOSE: To evaluate the efficacy and safety of radiofrequency ablation (RFA) for treating calcified benign thyroid nodules (CBTNs). METHODS: Fifty-two patients with 52 CBTNs who underwent RFA in our hospital were included in this retrospective study. According to the size of calcifications, CBTNs were divided into two groups: the punctate echogenic foci (PEF) group and macrocalcification group. Moreover, the macrocalcification group was further subdivided into two groups, the strong group and the weak group, based on their morphologic characteristics. After the RFA procedure, routine ultrasound (US) and clinical evaluation were performed at 1, 3, 6 and 12 months postoperatively and every 12 months thereafter. RESULTS: The mean follow-up time was 68.98 ± 7.68 months (60-87 months), and the 5-year mean volume reduction rate (VRR) after RFA was 92.95%, with a complication rate of 0.6% (3/52). The mean initial volume of the macrocalcification group was significantly larger than that of the PEF group (9.94 ± 24.60 ml vs. 0.23 ± 0.22 ml, respectively; P = 0.011). Thus, their VRRs were not comparable between the two groups. However, baseline characteristics did not show statistically significant differences between the strong and weak macrocalcification subgroups. The VRRs of the strong subgroup were significantly lower than those of the weak subgroup at the 3-year, 4-year, and 5-year follow-ups. CONCLUSION: RFA was effective and safe for treating CBTNs. Strong macrocalcification was related to the VRR of CBTNs after the RFA procedure.

[Comparison between Ultrasonography and CT in Diagnosis of Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma].

Objective To evaluate the efficacy of ultrasound and computed tomography (CT) in diagnosing cervical lymph node metastasis (CLNM) of papillary thyroid carcinoma (PTC). Methods The patients with PTC treated by surgery in the Chinese PLA General Hospital from January 2016 to January 2021 were selected for analysis.All the patients underwent preoperative ultrasound and CT examinations,the diagnostic values of which for CLNM were retrospectively analyzed. Results A total of 322 PTC patients were enrolled in this study,including 242 with CLNM and 80 with non-CLNM.The CLNM group and non-CLNM group had significant differences in age,tumor size,and maximum size of lateral CLNM (χ2=20.34,27.34,and 4.30,respectively,all P<0.001).For the central compartment,lateral compartment,and overall compartment,ultrasound diagnosis showed higher sensitivity (χ 2=82.26,P<0.001;χ2=114.01,P<0.001;χ2=82.26,P<0.001) and accuracy (χ2=20.27,P<0.001;χ2=15.56,P<0.001;χ2=44.00,P<0.001) than CT,and had no significant differences from ultrasound combined with CT (all P>0.05).However,ultrasound diagnosis had lower specificity than CT (χ2=17.01,P<0.001;χ2=21.29,P<0.001) in the central compartment and lateral compartment.Receiver operating characteristic curve analysis showed that in the central compartment,lateral compartment,and overall compartment,ultrasound diagnosis had larger AUC than CT (Z=2.99,P=0.003;Z=3.86,P<0.001;Z=4.47,P<0.001) and had no significant difference from ultrasound combined with CT (Z=1.87,P=0.062;Z=1.68,P=0.093;Z=1.61,P=0.107). Conclusions Ultrasound and CT have their own advantages in the diagnosis of central and lateral CLNM.In general,ultrasound has better performance than CT in the diagnosis of CLNM.

Ultrasound-Guided Radiofrequency Ablation Versus Surgical Resection for the Treatment of T1bN0M0 Papillary Thyroid Carcinoma in Different Age Groups.

Purpose: We aimed to compare the efficacy and safety of radiofrequency ablation (RFA) to that of surgical resection (SR) in patients with T1bN0M0 papillary thyroid carcinoma (PTC) in different age groups. Methods: Totally, 204 patients with an isolated, solitary, intrathyroidal T1bN0M0 PTC, who underwent either RFA (n=94) or SR (n=110) between April 2014 and December 2019, were retrospectively enrolled and were divided into two subgroups according to age (<45 years, ≧45 years). Patients with pathologically aggressive or advanced lesions were excluded from the study. Tumor progression and procedural complications were the primary and secondary endpoints, respectively. Tumor recurrence in situ, newly discovered tumors, lymph node involvement, or distant metastases indicated tumor progression. Complications included pain, fever, voice change, choking, numbness in the limbs, and cardiac events. Incidence rates of all endpoint events were compared between different age subgroups. Results: There were no significant differences in age, sex, and tumor size between the treatment groups. While the RFA group incurred less cost and experienced significantly shorter operative duration than the SR group, no significant differences were observed in incidences of both tumor progression and complications. Further, subgroup analysis of patients <45 years versus those ≧45 years showed no significant differences in the incidence of tumor progression and complications within or between different treatment groups. Older patients in the SR group incurred higher hospital costs than younger counterparts, but this difference was not observed in the RFA group. Conclusions: Our results indicated that RFA had a similar prognosis as that of SR but was associated with lower overall cost in both young (<45 years) and middle-aged patients (≧45 years) with T1bN0M0 PTC. Therefore, RFA may be an effective and safe alternative to surgery for the treatment of patients with T1bN0M0 PTC.

Nomogram prediction for the involution of the ablation zone after radiofrequency ablation treatment in patients with low-risk papillary thyroid carcinoma.

OBJECTIVES: To construct a prognostic nomogram to predict the involution of the ablation zone for patients with low-risk papillary thyroid carcinoma (PTC) who underwent radiofrequency ablation (RFA) treatment. METHODS: Data from 204 patients with low-risk PTC without extrathyroidal extension or cervical lymph node or distant metastasis who underwent RFA treatment were collected from January 2018 to January 2019. Clinicopathological and imaging characteristics were analyzed. The prognostic factors associated with the involution of the ablation zone within 12 months after RFA were identified by logistic analysis, and the nomogram was established. Calibration curve and decision curve analysis were used to evaluate the nomogram performance. RESULTS: Of the 204 patients included in this study, the ablation zone in 78 (38%) patients did not completely disappear in the 12 months after RFA. Four variables, including sex (odds ratio [OR], 3.303; 95% confidence interval [CI], 1.418-8.418; p = 0.008), age (OR, 1.045; 95% CI, 1.012-1.081; p = 0.009), calcification size (OR, 1.666; 95% CI, 1.041-2.701; p = 0.035), and RFA energy (OR, 2.902; 95% CI, 1.333-6.683; p = 0.009), were found to be closely associated with ablation zone non-disappearance at 12 months after RFA by multivariate analysis. A nomogram model was constructed, and its accuracy was well validated (C-index = 0.787). CONCLUSIONS: This study constructed and validated a risk model that could accurately predict the involution of the ablation zone after RFA for patients with PTC. This could provide clinicians with useful resource to guide patient counseling regarding tumor prognosis after RFA.

[Validated Nomogram Predicting Clinical Outcome after Radiofrequency Ablation in the Treatment of Papillary Thyroid Microcarcinoma].

Objective To establish a prediction model for the short-term efficacy of percutaneous ultrasound-guided radiofrequency ablation(RFA)in the treatment of papillary thyroid microcarcinoma(PTMC). Methods We retrospectively analyzed the preoperative and follow-up data of 159 patients with PTMC who underwent percutaneous ultrasound-guided RFA treatment in the Department of Ultrasound,the First Medical Center of Chinese PLA General Hospital from January to December in 2018.The association with 12-month tumor status(end event)was evaluated by multivariate logistic regression model.A nomogram was built to predict the risk of tumors which did not disappear completely within 12 months after RFA. Results We found that gender(P=0.017),age(P=0.047),and calcification(P=0.049)were the strongest predictors for establishing the model.The tumor maximum diameter and RFA energy were the secondary relevant factors for establishing the model.The constructed model showed good performance in both training cohort(AUC=0.762)and validation cohort(AUC=0.740). Conclusion A quantitative model was established for predicting the tumor status within one year after treatment of PTMC by RFA,which can accurately predict the short-term efficacy of RFA and provide a clinical basis for explaining the recovery results of patients.

[Value of Trans-lymphatic Contrast-enhanced Ultrasound in the Diagnosis of Cervical Lymph Node Metastasis of Thyroid Cancer].

Objective To explore the value of trans-lymphatic contrast-enhanced ultrasound(CEUS)in the diagnosis of cervical lymph node metastasis of thyroid cancer. Methods The patients with suspected thyroid cancer underwent conventional ultrasound and trans-lymphatic CEUS examinations before the biopsy.The differences in ultrasound and CEUS characteristics of cervical lymph nodes between the metastatic group and the non-metastatic group were compared,and pathological results were regarded as the golden standard. Results Twenty patients had thyroid cancer,including 12 cases with lymph node metastasis and 8 cases without metastasis.The diagnostic sensitivity(91.7% vs. 75.0%)and accuracy(90.0% vs.80.0%)of trans-lymphatic CEUS were higher than those of conventional ultrasound.The normal lymph nodes presented homogeneous enhancement,while the metastatic lymph nodes showed heterogeneous or non-enhancement during the trans-lymphatic CEUS examination.Conclusion As a new modality of ultrasound,trans-lymphatic CEUS contributes to the diagnosis of cervical lymph node metastasis of thyroid cancer and supplements the deficiencies of conventional ultrasound.

[Correlation between Contrast-enhanced Ultrasound and Risk of Tumor Recurrence in Papillary Thyroid Carcinoma].

Objective To explore the association between contrast-enhanced ultrasound and risk of tumor recurrence in papillary thyroid carcinoma(PTC). Methods A total of 287 PTCs in 287 patients who underwent surgery,conventional ultrasound,and contrast-enhanced ultrasound(CEUS)were enrolled in this study.According to 2015 American Thyroid Association(ATA)Modified Initial Risk Stratification System,the patients were categorized into three groups:low risk,intermediate risk,and high risk.The CEUS patterns of PTCs were compared between different risk stratifications. Results Hypo-enhancement was presented in 57.6% of ATA low-risk PTCs,iso-enhancement in 62.3% of ATA intermediate-risk PTCs,and hyper-enhancement in 48.2% of ATA high-risk PTCs(P<0.0001).The risk stratifications and enhanced intensity in PTC showcased a positive correlation(Spearman's rho of 0.442,P<0.0001)and a linear trend(χ 2 value of 55.921,P<0.0001).Higher enhancement intensity corresponded to higher risk stratification.Ordinal logistic regression analysis indicated that PTCs with hyper-enhancement and iso-enhancement presented higher risks than those with hypo-enhancement after age and gender were adjusted,and theOR values were 17.5(8.4-36.2)and 3.4(2.0-5.8),respectively. Conclusions CEUS patterns correlate intimately with the recurrence risk in PTC.Hyper-enhancement PTCs tend to present high risks,while hypo-enhancement PTCs tend to present low risks of recurrence.