ObjectiveTo investigate the methods and significances of the breast ultrasonographic breast imaging reporting and data system (BI-RADS) category 4 lesions divided into category 4a, 4b, and 4c, and to assess the risk of malig-nancy of lesions with BI-RADS category 4 in order to improve the accuracy of diagnosis. MethodsTwo hundred and eighty-eight breast lesions with BI-RADS category 4 confirmed by histopathology were collected. The ultrasonographic characteristics of benign and malignant lesions, containing the shape, aspect ration, margin, calcification, changes of the surrounding tissue, boundary, blood flow characteristics, internal echo, rear echo of the lesions, were comparatively anal-yzed, and the lesions with BI-RADS-US category 4 were divided into 4a, 4b, 4c according to these ultrasonographic charac-teristics and analyzed by statistics. ResultsThere were 192 malignant lesions and 96 benign lesions in the 288 breast lesions. There were statistical significances in the benign and malignant lesions with the shape, aspect ratio, margin, calci-fication, change of surrounding tissue, and boundary (P < 0.05), in other words, the proportion of these ultrasonographic characteristics were higher in the malignant lesions as compared with the benign lesions. But there were no significant differences of internal echo, rear echo, and blood flow characteristics between two lesions (P > 0.05). The positive predictive value of malignant tumor with BI-RADS category 4a, 4b, and 4c were 21.74%, 58.90%, and 91.78%, respectively, and there was significant difference (χ2=106.09, P=0.000). ConclusionsThe classification of breast lesions with BI-RADS category 4 is refined, it could more accurately assess the risk of benign and malignant breast masses. At the same time, it has an important clinical significance for diagnosis and treatment of benign and malignant breast masses.
ObjectiveTo explore the clinical efficacy of the ultrasound-guided intra-articular injection of platelet-rich plasma (PRP) in the treatment of patients with different stages of knee osteoarthritis.MethodsWe retrospectively analyzed the clinical characteristics and X-ray data of patients with knee osteoarthritis who received ultrasound-guided intra-articular injection of PRP in the Department of Rehabilitation Medicine at Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University between May 2018 and June 2019. The patients were grouped according to the Kellgren & Lawrence Classification (K&L 0, Ⅰ, Ⅱ, Ⅲ, and Ⅳ). All the patients received four injections with a one-week interval. The Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to evaluate the clinical efficacy before the injection, and 3 and 6 months after the injection. Adverse reactions were recorded.ResultsA total of 102 patients were included without any grade 0 cases. There were 20 patients in K&L Ⅰ group, 37 in Ⅱ group, 31 in Ⅲ group, and 14 in Ⅳ group. No adverse event was reported. Significant differences of VAS scores and WOMAC index were observed in Ⅰ, Ⅱ and Ⅲ groups at the 3rd and 6th month follow-up (P<0.05). VAS and WOMAC scores of the three groups at the 3rd and 6th month after the treatment were significantly improved compared with those before the treatment (P<0.05). There was no significant difference in VAS score at the 3rd or 6th month after the treatment three groups (P>0.05). For K&L Ⅰ group, there was no statistically significant difference in WOMAC score at the 3rd or 6th month after the treatment (P>0.05). However, the WOMAC scores at the 3rd month after the treatment were better than those at the 6th month in K&L Ⅱ and Ⅲ groups (P<0.05). There was no significant time-depended changes in VAS score or WOMAC score in K&L Ⅳ group (P>0.05).ConclusionThe ultrasound-guided intra-articular PRP injection is safe and effective for pain relief and function improvement in patients with knee osteoarthritis at the early and middle stage.
Objective To evaluate the diagnostic performance of thyroid imaging reporting and data system (TI-RADS)classification and elastography in differentiating benign and malignant thyroid nodules according to size. Methods A total of 222 thyroid nodules (209 cases) with solid or predominantly solid internal contentdiagnosed at pathological findings were enrolled in this study, all the 209 cases underwent surgery in our hospital from Jan.2014 to Jun.2014. The diagnostic performance of TI-RADS classification and elastography in differentiating benign and malignant thyroid nodules according to size nodules were evaluated (for≤1 cm and > 1 cm respectively). Results By using TI-RADS category and elastography, 178 thyroid nodules were diagnosed as malignant nodules, and 44 thyroid nodules were diagnosed as benign nodules. The high predictive factors for malignant thyroid nodules of > 1 cm were irregular shape(OR=6.376), microcalcification(OR=21.525), and capsule invasion(OR=3.852), P < 0.05. The factors for thyroid nodules of≤1 cm were anteroposterior to transverse diameter ratio≥1(OR=3.406), capsule invasion (OR=3.922), and high elastography score(OR=1.606), that suggested the possibility of malignant (P < 0.05). For nodules of > 1 cm, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden index of TI-RADS combining with elastography were 98.3%(59/60), 68.6%(24/35), 87.4%(83/95), 84.3%(59/70), 96.0% (24/25), and 66.9% respectively; for nodules of≤1 cm, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden index were 98.5%(67/68), 30.5%(18/59), 66.9%(85/127), 62.0%(67/108), 94.7%(18/19), and 29.0% respectively. Conclusion TI-RADS category combined with elastography for diagnosis of thyroid nodules in different size has just a bit differently diagnostic indicators, but that play a high diagnostic performance on the thyroid nodules with maximum diameter > 1 cm.
Objective To determine the value of contrast-enhanced ultrasound (CEUS) in the differentiation of primary liver cancer (PLC) and hepatic alveolar echinococcosis (HAE). Methods The data of 56 patients with PLC or HAE were collected between January 2010 and May 2015. Grayscale and CEUS features of the patients were analyzed retrospectively. The frequency of each imaging finding, including calcification, arterial enhancement, and internal enhancement were evaluated and compared. Results Statistically significant difference of the proportion of gender and age were detected between the two groups (P=0.013, 0.002). Thirty-eight PLC lesions were detected in 32 patients. The diameters of PLC lesions were 3-10 cm with an average of (5.6±2.1) cm. Thirty-two HAE lesions were found in 24 patients. The diameters of HAE lesions were 4-12 cm with an average of (9.1±4.4) cm. Statistically significant difference of lesion size and the incidence rate of calcification (5.3% vs. 75.0%) were seen between PLC and HAE (P<0.001). Peripheral enhancement were seen in 100.0% (38/38) PLC lesions, including 84.2% (32/38) hyperenhancement and 15.8% (6/38) dendritic hyperenhancement. All PLC lesions demonstrated hypoenhancement in late phase. Irregular peripherally hyperenhancement both in arterial and late phase were detected in 43.8% (14/32) HAE lesions. The other 56.2% (18/32) HAE lesions showed no peripheral enhancement both in arterial and late phase. No internal enhancement were seen in HAE lesions. The presence of arterial enhancement (100.0% vs. 43.8%) and absence of internal enhancement (0 vs. 100.0%) were significantly different between PLC and HAE (P<0.001). Conclusions PLC is predicted by arterial phase hyperenhancement and late phase hypoenhancement on CEUS. HAE is predicted with calcification on baseline sonography and internal non-enhancement on CEUS. Arterial phase enhancement is less common and less intensive in HAE than in PLC which also contributes to the differentiation of these lesions.
ObjectiveTo assess the values of MRI, ultrasound (US), and X-ray in the differential diagnosis of benign and malignant breast lesions. MethodsThe image data of 50 breast lesions confirmed with histopathology were analyzed retrospectively and the values of MRI, US and X-ray mammography in the differential diagnosis of benign and malignant breast lesions based on the breast imaging reporting and data system (BI-RADS) were assessed. The diagnostic efficiency of MRI, US, and X-ray in 50 benign and malignant breast lesions were compared using receiver operating characteristics (ROC) curves. The areas of ROC curves of MRI, US, and X-ray were calculated with Z test using SPSS 16.0. ResultsThere were 44 patients with 50 breast lesions, 26 malignant lesions, 24 benign lesions. Based on the BI-RADS, according to X-ray imaging features, 26 malignant breast lesions were classified as 5 lesions of category 5, 7 lesions of category 4, 6 lesions of category 3, 3 lesions of category 2, 1 lesion of category 1, 4 lesions of category zero. Twenty-four benign breast lesions were classified as 1 lesion of category 4, 3 lesions of category 3, 4 lesions of category 2, 13 lesions of category 1, 3 lesions of category zero. According to the characteristics of US findings, 26 malignant breast lesions were classified as 17 lesions of category 5, 4 lesions of category 4, 1 lesion of category 3, 1 lesion of category 2, 3 lesions of category 1. Twenty-four benign breast lesions were classified as 1 lesion of category 5, 2 lesions of category 4, 4 lesions of category 3, 14 lesions of category 2, 2 lesions of category 1, 1 lesion of category 0. According to MRI imaging findings, 26 malignant breast lesions were classified as 6 lesions of category 5, 18 lesions of category 4, 1 lesion of category 3, 1 lesion of category 1. Twenty-four benign breast lesions were classified as 20 lesions of category 1, 3 lesions of category 2, 1 lesion of category 3. The area under the ROC curve of the MRI, US, and X-ray was 0.977, 0.835, and 0.764, respectively. The differences of MRI with US (Z=2.05, P < 0.05) and MRI with X-ray mammography (Z=2.81, P < 0.05) were statistically significant. While the difference of US with X-ray mammography (Z=0.73, P > 0.05) was't statistically significant. ConclusionsDynamic contrast-enhanced MRI is an accurate examination in the differential diagnosis of benign and malignant breast lesions. The differential diagnostic efficiency of MRI is significantly better than those with US and X-ray.
ObjectiveTo explore the differences in ultrasonographic features of testicular teratoma and yolk sac tumor (YST) in children.MethodsA total of 44 patients were selected, including 30 with testicular teratoma and 14 with YST, whose diagnoses were confirmed by surgery and pathology in West China Second University Hospital, Sichuan University from January 2015 to June 2019. The differences in ultrasonograhic characteristics of the two groups were compared, such as the size, location, internal echo, composition, and blood supply of the tumors.ResultsThe mean value of maximum diameters of testicular teratomas was (24.25±12.13) mm and that of YSTs was (29.71±18.75) mm, with no statistically significant difference between the two groups (F=0.531, P=0.383). In terms of the compositions of the tumors, cystic-solid lesions were the most common in testicular teratomas (17/30), followed by solid lesions (8/30) and cystic lesions (5/30); while solid lesions were the most common in YSTs (12/14), followed by cystic-solid lesions, and cystic lesions did not appear. The difference in the compositions of tumors was statistically significant between children’s testicular teratomas and YSTs (P=0.001), especially in the proportion of solid lesions. In terms of Adler grade of blood flow, there were 9 cases of Adler 0, 10 cases of Adler 1, 10 cases of Adler 2, and 1 case of Adler 3 in testicular teratomas, while there were 0 case of Adler 0, 1 case of Adler 1, 4 cases of Adler 2, and 9 cases of Adler 3 in YSTs. The difference in the blood supply was statistically significant between children’s testicular teratomas and YSTs (P<0.001). Testicular teratomas tended less to behave as Adler 3, while Adler 3 was the most common in YSTs. There was no statistically significant difference in other ultrasonic features, like the location, internal echo, or the existence of calcification (P>0.05).ConclusionsUltrasound has a certain meaning for the differential diagnosis of testicular teratoma and YST in children. By comparing the solid component and the blood supply of the tumor, it is helpful for enhancing the diagnostic confidence of sonographer.
Objective To evaluate the therapeutic effects of percutaneous microwave ablation (MWA) for metastatic liver cancer. Methods Ultrasound-guided percutaneous MWA technique was used to treat 27 cases of hepatic metastases with 69 nodules 〔0.9-13.2 (3.0±2.0) cm in diameter〕. Local therapeutic effect, local and distant recurrence rate and survival rate were evaluated respectively. Results The complete ablation (CA) rate which was used to evaluate the local therapeutic effects was 92.8% (64/69), with 100% (34/34), 92.3%(24/26) and 66.7% (6/9) in a diameter of nodules lt;3.0 cm, 3.0-5.0 cm and ≥5.0 cm respectively. The CA rate was lower in the group of a diameter of nodules ≥5.0 cm as compared with other two groups (Plt;0.05). The local recurrence rate was 9.4% (6/64), with 2.9% (1/34), 16.7% (4/24) and 16.7% (1/6) in a diameter of nodules lt;3.0 cm, 3.0-5.0 cm and ≥5.0 cm respectively. The intrahepatic distant recurrence rate was 44.4% (12/27). The follow-up time after MWA was 3－34 (17.0±8.7) months. During the follow-up period, 6 months, 1 and 2-year cumulative survival rate was 88.9%, 63.0% and 34.4% respectively, with a mean survival time of 17.8 months, and with a median survival time of 19.0 months.Conclusion Percutaneous MWA treatment offers satisfactory local tumoricidal efficacy to metastatic liver cancer and the patients with recurrence and new metastases can be therapy repeatedly to improve long-term survival.
ObjectivesTo systematically review the efficacy and safety of ultrasound-guided percutaneous microwave ablation versus traditional open surgical operation in the treatment of benign thyroid nodules.MethodsPubMed, The Cochrane Library, EMbase, CBM, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on ultrasound-guided percutaneous microwave ablation versus traditional open surgery for benign thyroid nodules from inception to June 30th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was then performed by RevMan 5.3 software.ResultsA total of 38 RCTs involving 4 078 patients were included. The results of meta-analysis showed that: ultrasound-guided percutaneous microwave ablation might be more effective than traditional open surgery for the treatment of benign thyroid nodules (RR=1.09, 95% CI 1.00 to 1.19, P=0.04), and compared with traditional open surgery, ultrasound-guided percutaneous microwave ablation reduced the rate of postoperative complication (RR=0.26, 95%CI 0.21 to 0.31, P<0.000 01), shortened postoperative hospital stay (MD=–3.60, 95%CI –4.04 to –3.15, P<0.000 01) and the time consumed in operation (MD=–48.79, 95%CI –54.16 to –43.41, P<0.000 01), and reduced operative blood loss (MD=–22.02, 95%CI–23.87 to –20.17, P<0.000 01). Meanwhile, microwave ablation reduced the elevated levels of serum IL-6 content (MD=–10.34, 95%CI –10.70 to –9.97, P<0.000 01), serum CRP content (MD=–9.70, 95%CI –10.95 to –8.44, P<0.000 01) and serum TNF-α content (MD=–7.94, 95%CI –9.00 to –6.88, P<0.000 01).ConclusionsCurrent evidence shows that ultrasound-guided percutaneous microwave ablation may improve clinical efficacy and can reduce postoperative complications, bleeding volume, operation time, hospitalization days and postoperative inflammatory reaction. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Early screening is an important means to reduce breast cancer mortality. In order to solve the problem of low breast cancer screening rates caused by limited medical resources in remote and impoverished areas, this paper designs a breast cancer screening system aided with portable ultrasound Clarius. The system automatically segments the tumor area of the B-ultrasound image on the mobile terminal and uses the ultrasound radio frequency data on the cloud server to automatically classify the benign and malignant tumors. Experimental results in this study show that the accuracy of breast tumor segmentation reaches 98%, and the accuracy of benign and malignant classification reaches 82%, and the system is accurate and reliable. The system is easy to set up and operate, which is convenient for patients in remote and poor areas to carry out early breast cancer screening. It is beneficial to objectively diagnose disease, and it is the first time for the domestic breast cancer auxiliary screening system on the mobile terminal.
ObjectiveTo evaluate the diagnostic value of ultrasound for gallbladder carcinoma (GA), in order to improve the ability of early ultrasonic and clinical diagnosis of GA. MethodsWe analyzed and compared the clinical data and ultrasonic results of 42 GA cases confirmed by surgery and pathology between January 2008 and December 2013, and summarized the classification, ultrasonographic features, and diagnosis of GA. ResultsAmong the 42 cases, 25 were correctly diagnosed by ultrasound (59.5%), among which 9 were thick-wall type, 11 were protrusion type and 5 were solid type. Seventeen cases were misdiagnosed (40.5%). Pathological results showed 14 cases of highly-differentiated adenocarcinoma, 16 of moderately differentiaed adenocarcinoma, 9 of poorly-differentiated adenocarcinoma, 2 of squamous adenocarcinoma and 1 of neuroendocrine carcinoma. ConclusionUltrasound is the preferred method for the diagnosis of GA because of its convenience, although the diagnostic accuracy is still not good and more efforts should be done.