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The presence and extent of metastatic disease in axillary lymph nodes (ALNs) in the setting of breast cancer (BC) are important factors for staging and therapy planning. The purpose of this study was to perform a multiparametric sonographic evaluation of ALNs to better differentiate between benign and metastatic nodes. Ninety-nine patients (mean age 54.1 y) with 103 BCs were included in this study, and 103 ALNs were examined sonographically. B-mode parameters, such as size in two dimensions, shape, cortical thickness and capsule outline, were obtained, followed by vascularity assessment via colour Doppler and microflow imaging and stiffness evaluation via shear wave elastography. Postoperative histopathological evaluation was the reference standard. In the statistical analysis, logistic regression and ROC analyses were conducted to search for feature patterns of both types of ALNs to evaluate the prediction qualities of the analysed variables and their combinations. For a cortex larger than 3 mm, without a circumscribed margin of the LN capsule and SWE (E max > 26 kPa), the AUC was 0.823. Multiparametric assessment, which combined conventional US, quantitative SWE and vascularity analysis, was superior to the single-parameter approach in the evaluation of ALNs. [ABSTRACT FROM AUTHOR]

Simple Summary: Ultrasonography is a basic tool used in the evaluation of thyroid nodules, but there is no single feature of this method which predicts malignancy with statistical significance. The aim of the study is to assess the usefulness of contrast enhanced-ultrasound (CEUS) in the differential diagnosis of thyroid nodules. The highest value of the study results from the multiparameter approach to the evaluation of thyroid lesions in the light of new diagnostics methods and assessment of the unique combinations of both B-mode and CEUS features as predictors of thyroid cancers. Moreover, several qualitative contrast features predicting benign lesions were evaluated. The preliminary results indicate that CEUS is a useful tool in assessing the risk of malignancy of thyroid lesions. The combination of the qualitative enhancement parameters and B-mode sonographic features significantly increases the method's usefulness. Further studies should be performed to introduce CEUS patterns in the diagnostic algorithm of thyroid nodules. Background: Ultrasonography is a primary method used in the evaluation of thyroid nodules, but no single feature of this method predicts malignancy with high accuracy. Therefore, this paper aims to assess the utility of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of thyroid nodules. Methods: The study group comprised 188 adult patients (155 women and 33 men) who preoperatively underwent CEUS of a thyroid nodule classified as Bethesda categories II–VI after fine-needle aspiration biopsy. During the CEUS examination, 1.5 mL of SonoVue contrast was injected intravenously, after which 15 qualitative CEUS enhancement patterns were analysed. Results: The histopathologic results comprised 65 benign thyroid nodules and 123 thyroid carcinomas. The dominant malignant CEUS features, such as hypo- and heterogeneous enhancement and slow wash-in phase, were evaluated, whereas high enhancement, ring enhancement, and a slow wash-out phase were assessed as predictors of benign lesions. Two significant combinations of B-mode and CEUS patterns were noted, namely, hypoechogenicity with heterogeneous enhancement and non-smooth margins with hypo- or iso-enhancement. Conclusions: The preliminary results indicate that CEUS is a useful tool in assessing the risk of malignancy of thyroid lesions. The combination of the qualitative enhancement parameters and B-mode sonographic features significantly increases the method's usefulness. [ABSTRACT FROM AUTHOR]

Simple Summary: Perimenopause begins on average four years before a woman's last menses. At the end of this time, oestrogen levels drop, which leads to physiological and anatomical changes which have a significant impact on the quality of life. Increase in the risk of coronary heart disease (CHD) during the sixth decade of life can be explained by not only oestrogen deprivation, but also an effect on the lipid profile. A study showed that in healthy women, total cholesterol levels increase on average by 25 mg/dL (14%) and the levels of LDL cholesterol increase on average by 20 mg/dL (19%) from 4 years before to 1 year after menopause, which results in a greater atherogenic profile in postmenopausal women. Heart failure (HF) and cardiovascular disease, the risk of which increases during perimenopause, are not considered isolated conditions, but rather complex systemic disorders. Engaging in the amount of moderate physical activity recommended by the World Health Organization (WHO) helps reduce the risk of death and adverse health events. Regular physical activity reduces body weight, improves cardiopulmonary fitness, and reduces inflammation. The aim of the present study was to assess the effect of a 6-month aqua aerobics programme on cardiometabolic (anthropometric and biochemical) parameters in perimenopausal women. Background: Menopause is a time when women experience a number of physiological and anatomical changes resulting from a decline in ovarian function. It can be concluded that cardiovascular disease increases in perimenopausal and postmenopausal women, irrespective of age-related changes. Engaging in the amount of moderate physical activity recommended by the World Health Organization helps reduce the risk of death and adverse health events. The aim of the present study was to assess the effect of a 6-month aqua aerobics programme on cardiometabolic (anthropometric and biochemical) parameters in perimenopausal women. Methods: In this study, 30 women (control group—16, study group—14) participated in the 6-month aqua aerobics training programme. The mean age of women was 47.67 ± 6.79 year and BMI 26.33 ± 3.64 kg/m2. At the beginning and at the end of the study, anthropometric and blood samples analysis were performed. In the blood, lipid profile, morphotic elements were determined. Body composition, waist–hip ratio (WHR), visceral adiposity index (VAI), blood pressure (BP) were measured. Results: The aqua aerobics programme resulted in a significant decrease in the WHR (p < 0.05; ES: 2.143), diastolic blood pressure (DBP) (p < 0.05; ES: 1.005), and platelet-to-lymphocyte ratio (PRL) (p < 0.05; ES: 0.460) and an increase in haemoglobin (HGB) concentration (p < 0.05; ES: 0.643). Conclusions: The type of physical activity described in the present study is a great way for perimenopausal women to take care of their overall well-being. The reduction in selected cardiometabolic parameters is important from the point of view of the protection of women's health. [ABSTRACT FROM AUTHOR]

Simple Summary: During the ageing process, a number of changes in body systems and structures occur. Age-related reduction in exercise capacity is manifested by a rapid development of fatigue and reduced exercise activity. Independent authors have confirmed the adverse prognostic value of red blood cell distribution width (RDW-CV), both as an independent factor and in correlation with other parameters, in heart failure, coronary heart disease and myocardial infarction, and chronic obstructive pulmonary disease (COPD). Physical exercise, which can be used by people of all ages as a therapeutic method, improves and helps to maintain cardiorespiratory fitness and fatigue tolerance and is a means to maintain the health and functional performance of older people. Different types of physical exercise result in different post-training adaptations. There is increasing research on the positive impact of combined endurance and resistance training on physiological parameters and health. The aim of our study was to examine the impact of Nordic walking training with classic poles (NW) and NW training with poles with an integrated resistance shock absorber (NW with RSA) on RDW-CV levels and to assess correlations between RDW-CV levels and cardiorespiratory performance in postmenopausal women. Background: Age-related reduction in exercise capacity is manifested by a rapid development of fatigue. Research confirmed the adverse prognostic value of red blood cell distribution width (RDW-CV), an independent factor in heart failure, coronary heart disease and myocardial infarction. Physical exercise improves and helps to maintain cardiorespiratory fitness. The aim of our study was to examine the impact of 8 weeks' Nordic walking training with classic poles (NW) and NW training with poles with an integrated resistance shock absorber (NW with RSA) on RDW-CV levels and to assess correlations between RDW-CV levels and cardiorespiratory performance in postmenopausal women. Methods: In this study, 32 postmenopausal women (NW-16, NW with RSA-16) participated in eight weeks of walking training. The mean age of women was 66.56 ± 4.23 year. and BMI 26.99 ± 3.86 kg/m2. At the beginning and at the end of the study, spirometry and exercise tests were performed. Haematological parameters were determined in the venous blood. Results: Statistical analysis of differences in post-training changes in the parameters between the groups studied showed a significant difference in change in body weight (∆body weight) (p < 0.05; ES: 0.778), BMI (∆BMI) (p < 0.05; ES: 0.778), waist circumference (∆WC) (p < 0.05; ES: 1.225) and (∆RDW-SD) (p < 0.05; ES: 1.215). There were no changes in electrocardiographic and spirometric parameters. Conclusions: Based on the findings from the present study, it can be assumed that endurance and resistance exercise can significantly reduce disease severity and mortality. A clinical analysis of RDW levels, together with other cardiological and biochemical parameters, can provide practical prognostic information relating to cardiovascular disease, mortality risk and treatment outcomes. [ABSTRACT FROM AUTHOR]

Objective. Prediction of the response to neoadjuvant chemotherapy (NAC) in breast cancer is important for patient outcomes. In this work, we propose a deep learning based approach to NAC response prediction in ultrasound (US) imaging. Approach. We develop recurrent neural networks that can process serial US imaging data to predict chemotherapy outcomes. We present models that can process either raw radio-frequency (RF) US data or regular US images. The proposed approach is evaluated based on 204 sequences of US data from 51 breast cancers. Each sequence included US data collected before the chemotherapy and after each subsequent dose, up to the 4th course. We investigate three pre-trained convolutional neural networks (CNNs) as back-bone feature extractors for the recurrent network. The CNNs were pre-trained using raw US RF data, US b-mode images and RGB images from the ImageNet dataset. The first two networks were developed using US data collected from malignant and benign breast masses. Main results. For the pre-treatment data, the better performing network, with back-bone CNN pre-trained on US images, achieved area under the receiver operating curve (AUC) of 0.81 (±0.04). Performance of the recurrent networks improved with each course of the chemotherapy. For the 4th course, the better performing model, based on the CNN pre-trained with RGB images, achieved AUC value of 0.93 (±0.03). Statistical analysis based on the DeLong test presented that there were no significant differences in AUC values between the pre-trained networks at each stage of the chemotherapy (p -values > 0.05). Significance. Our study demonstrates the feasibility of using recurrent neural networks for the NAC response prediction in breast cancer US. [ABSTRACT FROM AUTHOR]

Thyroid cancer is a tumour with a steadily increasing incidence. It accounts for 7% to 15% of focal lesions detected by ultrasound, depending on age, gender and other factors affecting its occurrence. Fine-needle aspiration biopsy is an essential method to establish the diagnosis but, in view of its limitations, sonoelastography is seen as a non-invasive technique useful in differentiating the nature of lesions and monitoring them after fine-needle aspiration biopsy. This paper presents a literature review on the role of both sonoelastographic techniques (relative strain sonoelastography, shear wave sonoelastography) to assess the deformability of focal thyroid lesions. Ultrasound examination is a relatively subjective method of thyroid imaging, depending on the skills of the examiner, the experience of the centre, and the quality of equipment used. As a consequence, there are inconsistencies between the results obtained by different examiners (inter-observer variability) and by the same examiner (intra-observer variability). In this paper, the authors present a review of the literature on inter-observer and intra-observer variability in the assessment of individual features of ultrasound imaging of focal lesions in the thyroid. In addition, the authors report on an analysis of cut-off thresholds for the size of lesions constituting the basis for fine-needle aspiration biopsy eligibility assessment. The need to diagnose carcinomas up to 10 mm in diameter is highlighted, however a more liberal approach is recommended in terms of indications for biopsy in lesions associated with a low risk of malignancy, where, based on consultations with patients, active ultrasound surveillance might even be considered. [ABSTRACT FROM AUTHOR]

Numerous scientific societies around the world have published their TIRADS (Thyroid Imaging Reporting and Data System) classifications that evaluate the risk of malignancy of focal thyroid lesions, presenting different ultrasound features for each category and lesion size thresholds to determine eligibility for biopsy. The use of such risk estimation systems in focal thyroid lesions facilitates the reporting of thyroid ultrasound findings and improves the qualification of focal lesions for fine-needle aspiration biopsy (FNAB). In this publication, the three most popular TIRADS classifications, European - EU-TIRADS, Korean - K-TIRADS, and developed by the American Society of Radiology - ACR-TIRADS, are presented and discussed based on a literature review. The results of available head-to-head statistical analyses comparing the classifications are also presented. The advantage of the EU-TIRADS and K-TIRADS systems is that they include only the most important ultrasound features, so their application is not time-consuming, and the scores are easy to incorporate into clinical practice. ACR-TIRADS, unlike other scales, is based on a unique classification system and represents the most comprehensive classification. Each of the five categories of ultrasound features - morphology, echogenicity, shape, margins, microcalcifications - are evaluated and assigned a score from 0 to 3, with a higher score being associated with a higher risk of cancer. Based on the available data, the greatest benefit has been demonstrated for the ACR-TIRADS classification, which also has implications for minimising the number of unnecessary FNABs. However, limitations related to the heterogeneity of the groups analysed in the study, including differences in the populations studied, inclusion criteria, proportions of patients of either sexes, and the number of malignant lesions analysed, should also be taken into account. [ABSTRACT FROM AUTHOR]

Breast cancer is a heterogeneous disease both in its clinical and radiological manifestations and response to treatment. This is largely due to the polymorphism of the histological types as well as diversified molecular profiles of individual breast cancer types. Progress in the understanding of the biology of breast cancer was made with the introduction of immunohistochemical research into the common practice. On this basis, four main breast cancer subtypes were distinguished: luminal A, luminal B, HER2 positive (human epidermal growth factor receptor-2 positive), and triple negative cancer. The classification of a tumour to an appropriate subtype allows for the optimisation of treatment (surgery or pre-operative chemotherapy). In this study, the authors present different patterns of breast cancer subtypes in ultrasound examination and differences in their treatment, with particular emphasis on aggressive breast cancer subtypes, such as triple negative or HER2 positive. They can, unlike the luminal subtypes, create diagnostic problems. Based on multifactorial analysis of the ultrasound image, with the assessment of lesion margins, orientation, shape, echogenicity, vascularity, the presence of calcifications or assessment by sonoelastography, it is possible to initially differentiate individual subtypes. [ABSTRACT FROM AUTHOR]

Aim of the study: Deep neural networks have achieved good performance in breast mass classification in ultrasound imaging. However, their usage in clinical practice is still limited due to the lack of explainability of decisions conducted by the networks. In this study, to address the explainability problem, we generated saliency maps indicating ultrasound image regions important for the network's classification decisions. Material and methods: Ultrasound images were collected from 272 breast masses, including 123 malignant and 149 benign. Transfer learning was applied to develop a deep network for breast mass classification. Next, the class activation mapping technique was used to generate saliency maps for each image. Breast mass images were divided into three regions: the breast mass region, the peritumoral region surrounding the breast mass, and the region below the breast mass. The pointing game metric was used to quantitatively assess the overlap between the saliency maps and the three selected US image regions. Results: Deep learning classifier achieved the area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity of 0.887, 0.835, 0.801, and 0.868, respectively. In the case of the correctly classified test US images, analysis of the saliency maps revealed that the decisions of the network could be associated with the three selected regions in 71% of cases. Conclusions: Our study is an important step toward better understanding of deep learning models developed for breast mass diagnosis. We demonstrated that the decisions made by the network can be related to the appearance of certain tissue regions in breast mass US images. [ABSTRACT FROM AUTHOR]

Objectives: The main aim of this work is to assess the level of knowledge about diabetes prevention and the consequences of untreated diabetes in the Polish society, as well as to indicate the variables that have a significant impact on that knowledge.Material and Methods: The analysis is based on the results of the National Multicenter Health Survey - WOBASZ II. The number of subjects surveyed was 6170, including 2760 men and 3410 women, aged 20-74 years. Data on socio-demographic variables, lifestyle and subjective health assessment were collected using the face-to-face technique.Results: The results obtained in the WOBASZ II project showed that >85% of the respondents had an unsatisfactory level of knowledge about diabetes prevention methods and approximately to 85% of the respondents - about the consequences of untreated diabetes. Moreover, one-fourth of the respondents were unable to identify a single way of preventing diabetes, and more than one-third could not identify a single disease caused by diabetes. The risk of a lack of knowledge about diabetes prevention and the consequences of untreated diabetes is more common for men, people with a low level of education, not married, non-diabetic, and without diagnosed diabetes in the family.Conclusions: The presented results indicate that there is an prevailing lack of knowledge about diabetes prevention and the consequences of untreated diabetes in the Polish society. It is associated with several variables like: sex, level of education, age, marital status, subjective health assessment and diabetes diagnosed in the respondent and/or in the respondent's family. Int J Occup Med Environ Health. 2021;34(5):667-78. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the inter- and intra-observer variability and accuracy of ultrasound assessment of thyroid nodules using a descriptive lexicon. Materials and methods: A prospective study was performed on complete ultrasound examinations, including sonoelastography and color Doppler ultrasound of 18 patients with 20 thyroid nodules. A total of 20 records of thyroid nodules from these techniques were duplicated, numbered, and randomly arranged. Five radiologists assessed the recordings independently. Cohen Kappa and Fleiss Kappa statistics were used to determine the degree of intra- and inter-observer agreement. Results: Mean accuracy rates for all radiologists, for all ultrasound features, ranged from 82.7 to 87.8%. For B-mode and strain elastography, accuracies ranged from 65.0 to 100% and 47.4 to 86.8%, respectively. Concerning intra-observer variability, three radiologists demonstrated almost perfect agreement (the κ-value ranged from 0.81 to 0.86), and a substantial agreement was noted for the two remaining radiologists. The κ-values for inter-observer agreement ranged from 0.61 for macrocalcifications (substantial agreement) to 0.33 for Asteria four-point elastography scale criteria (fair agreement). Conclusions: The results suggest relatively good inter-observer and excellent intra-observer agreement in the assessment of thyroid nodules using ultrasound, and fair agreement in the case of strain elastography. [ABSTRACT FROM AUTHOR]

To evaluate the ultrasound (US) response in patients with breast cancer (BC) during neoadjuvant chemotherapy (NAC). Prospective US analysis was performed on 19 malignant tumors prior to NAC treatment and 7 days after each first four courses of NAC in 13 patients (median age = 57 years). Echogenicity, size, vascularity, and sonoelastography were measured and compared with posttreatment scores of residual cancers burden. Changes in the echogenicity of tumors after 3 courses of NAC had the most statistically strong correlation with the percentage of residual malignant cells used in histopathology to assess the response to treatment (odds ratio = 60, p < 0.05). Changes in lesion size and elasticity were also significant (p < 0.05). There is a statistically significant relationship between breast tumors' echogenicity in US, neoplasm size, and stiffness and the response to NAC. In particular, our results show that the change in tumor echogenicity could predict a pathological response with satisfactory accuracy and may be considered in NAC monitoring. • The alteration of the echogenicity of breast cancer tumors during NAC correlated with pathological response. • Persistent tumor hypoechogenicity after 3 courses of NAC predicts a poor response to treatment. • Lesion size and elasticity were important factors in predicting response to NAC. [ABSTRACT FROM AUTHOR]

Objective: Neoadjuvant chemotherapy was initially used in locally advanced breast cancer, and currently it is recommended for patients with Stage 3 and with early-stage disease with human epidermal growth factor receptors positive or triple-negative breast cancer. Ultrasound imaging in combination with a quantitative ultrasound method is a novel diagnostic approach. Aim of study: The aim of this study was to analyze the variability of the integrated backscatter coefficient, and to evaluate their use to predict the effectiveness of treatment and compare to ultrasound examination results. Material and method: Ten patients (mean age 52.9) with 13 breast tumors (mean dimension 41 mm) were selected for neoadjuvant chemotherapy. Ultrasound was performed before the treatment and one week after each course of neoadjuvant chemotherapy. The dimensions were assessed adopting the RECIST criteria. Tissue responses were classified as pathological response into the following categories: not responded to the treatment (G1, cell reduction by .9%) and responded to the treatment partially: G2, G3, G4, cell reduction by 10.29% (G2), 30.90% (G3), >90% (G4), respectively, and completely. Results: In B-mode examination partial response was observed in 9/13 cases (completely, G1, G3, G4), and stable disease was demonstrated in 3/13 cases (completely, G1, G4). Complete response was found in 1/13 cases. As for backscatter coefficient, 10/13 tumors (completely, and G2, G3, and G4) were characterized by an increased mean value of 153%. Three tumors 3/13 (G1) displayed a decreased mean value of 31%. Conclusion: The variability of backscatter coefficient, could be associated with alterations in the structure of the tumor tissue during neoadjuvant chemotherapy. There were unequivocal differences between responded and non-responded patients. The backscatter coefficient analysis correlated better with the results of histopathological verification than with the B-mode RECIST criteria. [ABSTRACT FROM AUTHOR]

Background: Neoadjuvant chemotherapy (NAC) is used in patients with breast cancer to reduce tumor focus, metastatic risk, and patient mortality. Monitoring NAC effects is necessary to capture resistant patients and stop or change treatment. The existing methods for evaluating NAC results have some limitations. The aim of this study was to assess the tumor response at an early stage, after the first doses of the NAC, based on the variability of the backscattered ultrasound energy, and backscatter statistics. The backscatter statistics has not previously been used to monitor NAC effects. Methods: The B-mode ultrasound images and raw radio frequency data from breast tumors were obtained using an ultrasound scanner before chemotherapy and 1 week after each NAC cycle. The study included twenty-four malignant breast cancers diagnosed in sixteen patients and qualified for neoadjuvant treatment before surgery. The shape parameter of the homodyned K distribution and integrated backscatter, along with the tumor size in the longest dimension, were determined based on ultrasound data and used as markers for NAC response. Cancer tumors were assigned to responding and non-responding groups, according to histopathological evaluation, which was a reference in assessing the utility of markers. Statistical analysis was performed to rate the ability of markers to predict the final NAC response based on data obtained after subsequent therapeutic doses. Results: Statistically significant differences (p<0.05) between groups were obtained after 2, 3, 4, and 5 doses of NAC for quantitative ultrasound markers and after 5 doses for the assessment based on maximum tumor dimension. Statistical analysis showed that, after the second and third NAC courses the classification based on integrated backscatter marker was characterized by an AUC of 0.69 and 0.82, respectively. The introduction of the second quantitative marker describing the statistical properties of scattering increased the corresponding AUC values to 0.82 and 0.91. Conclusions: Quantitative ultrasound information can characterize the tumor's pathological response better and at an earlier stage of therapy than the assessment of the reduction of its dimensions. The introduction of statistical parameters of ultrasonic backscatter to monitor the effects of chemotherapy can increase the effectiveness of monitoring and contribute to a better personalization of NAC therapy. [ABSTRACT FROM AUTHOR]

Purpose The aim of this paper is to provide access to a database consisting of the raw radio-frequency ultrasonic echoes acquired from malignant and benign breast lesions. The database is freely available for study and signal analysis. Acquisition and validation methods The ultrasonic radio-frequency echoes were recorded from breast focal lesions of patients of the Institute of Oncology in Warsaw. The data were collected between 11/2013 and 10/2015. Patients were examined by a radiologist with 18 yr' experience in the ultrasonic examination of breast lesions. The set of data includes scans from 52 malignant and 48 benign breast lesions recorded in a group of 78 women. For each lesion, two individual orthogonal scans from the pathological region were acquired with the Ultrasonix SonixTouch Research ultrasound scanner using the L14-5/38 linear array transducer. All malignant lesions were histologically assessed by core needle biopsy. In the case of benign lesions, part of them was histologically assessed and another part was observed over a 2-year period. Data format and usage notes The radio-frequency echoes were stored in Matlab file format. For each scan, the region of interest was provided to correctly indicate the lesion area. Moreover, for each lesion, the BI- RADS category and the lesion class were included. Two code examples of data manipulation are presented. The data can be downloaded via the Zenodo repository () or the website . Potential applications The database can be used to test quantitative ultrasound techniques and ultrasound image processing algorithms, or to develop computer-aided diagnosis systems. [ABSTRACT FROM AUTHOR]

The aims of our study were to determine whether shear wave elastography (SWE) can improve the conventional B-mode differentiation of thyroid lesions, determine the most accurate SWE parameter for differentiation and assess the influence of microcalcifications and chronic autoimmune thyroiditis on SWE values. We examined 119 patients with 169 thyroid nodules who prospectively underwent B-mode ultrasound and SWE using the same ultrasound machine. The parameters assessed using SWE were: mean elasticity within the entire lesion (SWE-whole) and mean (SWE-mean) and maximum (SWE-max) elasticity for a 2-mm-diameter region of interest in the stiffest portion of the lesion, excluding microcalcifications. The discriminant powers of a generalized estimating equation model including B-mode parameters only and a generalized estimation equation model including both B-mode and SWE parameters were assessed and compared using the area under the receiver operating characteristic curve, in association with pathologic verification. In total, 50 and 119 malignant and benign lesions were detected. In generalized estimated equation regression, the B-mode parameters associated with higher odds ratios (ORs) for malignant lesions were microcalcifications (OR = 4.3), hypo-echogenicity (OR = 3.13) and irregular margins (OR = 10.82). SWE-max was the only SWE independent parameter in differentiating between malignant and benign tumors (OR = 2.95). The area under the curve for the B-mode model was 0.85, whereas that for the model combining B-mode and SWE parameters was 0.87. There was no significant difference in mean SWE values between patients with and without chronic autoimmune thyroiditis. The results of the present study suggest that SWE is a valuable tool for the characterization of thyroid nodules, with SWE-max being a significant parameter in differentiating benign and malignant lesions, independent of conventional B-mode parameters. The combination of SWE parameters and conventional B-mode parameters does not significantly improve the diagnosis of malignant thyroid nodules. The presence of microcalcifications can influence the SWE-whole value, whereas the presence of chronic autoimmune thyroiditis may not. [ABSTRACT FROM AUTHOR]

For centuries tissue palpation has been an important diagnostic tool. During palpation, tumors are felt as tissues harder than the surrounding tissues. The significance of palpation is related to the relationship between mechanical properties of different tissue lesions. The assessment of tissue stiffness through palpation is based on the fact that mechanical properties of tissues are changing as a result of various diseases. A higher tissue stiffness translates into a higher elasticity modulus. In the 90's, ultrasonography was extended by the option of examining the stiffness of tissue by estimating the difference in backscattering of ultrasound in compressed and non-compressed tissue. This modality is referred to as the static, compression elastography and is based on tracking the deformation of tissue subjected to the slowly varying compression through the recording of the backscattered echoes. The displacement is estimated using the methods of cross-correlation between consecutive ultrasonic lines of examined tissue, so calculating the degree of similarity of ultrasonic echoes acquired from tissue before and after the compression was applied. The next step in the development of ultrasound palpation was to apply the local remote tissue compression by using the acoustic radiation force generated through the special beam forming of the ultrasonic beam probing the tissue. The acoustic radiation force causes a slight deformation the tissue thereby forming a shear wave propagating in the tissue at different speeds dependent on the stiffness of the tissue. Shear wave elastography, carries great hopes in the field of quantitative imaging of tissue lesions. This article describes the physical basis of both elastographic methods: compression elastography and shear wave elastography. [ABSTRACT FROM AUTHOR]

Breast cancer is the most common malignancy and the leading cause of death due to cancer in European women. Mammography screening programs aimed to increase the detection of early cancer stages were implemented in numerous European countries. Recent data show a decrease in mortality due to breast cancer in many countries, particularly among young women. At the same time, the number of sentinel node biopsy procedures and breast-conserving surgeries has increased. Intraoperative sentinel lymph node biopsy preceded by lymphoscintigraphy is used in breast cancer patients with no clinical signs of lymph node metastasis. Due to the limited sensitivity and specificity of physical examination in detecting metastatic lesions, developing an appropriate diagnostic algorithm for the preoperative assessment of axillary lymph nodes seems to be a challenge. The importance of ultrasound in patient qualification for sentinel lymph-node biopsy has been discussed in a number of works. Furthermore, different lymphoscintigraphy protocols have been compared in the literature. The usefulness of novel radiopharmaceuticals as well as the methods of image acquisition in sentinel lymph node diagnostics have also been assessed. The aim of this article is to present, basing on current guidelines, literature data as well as our own experience, the diagnostic possibilities of axillary lymph node ultrasound in patient qualification for an appropriate treatment as well as the role of lymphoscintigraphy in sentinel lymph node biopsy. [ABSTRACT FROM AUTHOR]

Our goal in this study was to evaluate the relevance of shear wave sonoelastography (SWE) in the differential diagnosis of masses in the breast with respect to ultrasound (US). US and SWE were performed (Aixplorer System, SuperSonic Imagine, Aix en Provence, France) in 76 women (aged 24 to 85) with 84 lesions (43 malignant, 41 benign). The study included BI-RADS-US (Breast Imaging Reporting and Data System for Ultrsound) category 3–5 lesions. In elastograms, the following values were calculated: mean elasticity in lesions ( E av.l ) and in fat tissue ( E av.f. ) and maximal ( E max.adj. ) and mean ( E av.adj. ) elasticity in lesions and adjacent tissues. The sensitivity and specificity of the BI-RADS category 4a/4b cutoff value were 97.7% and 90.2%. For an E av.adj. of 68.5 kPa, the cutoff sensitivity was 86.1% and the specificity was 87.8%, and for an E max.adj. of 124.1 kPa, 74.4% and 92.7%, respectively. For BI-RADS-US category 3 lesions, E av.l , E max.adj. and E av.adj. were below cutoff levels. On the basis of our findings, E av.adj. had lower sensitivity and specificity compared with US. E max.adj. improved the specificity of breast US with loss of sensitivity. [ABSTRACT FROM AUTHOR]

Simple Summary: B-mode US is a widely available, inexpensive, and non-invasive technique. This method is used in monitoring the neoadjuvant chemotherapy (NAC) in breast cancer (BC). In the presented study we combined the result from B-mode ultrasound examination with quantitative information about the characteristics and structure of the tissue in predicting the response to neoadjuvant chemotherapy in BC patients. We used echogenicity (ΔEcho) as B-mode features and the Kullback-Leibler divergence (ΔKLD) method as a quantitative parameter to provide information on changes in image echogenicity, to determine differences between the distributions of the ultrasound echo amplitude from tumor during NAC. The ΔKLD parameter alone is an accurate predictor of response to treatment after the second course of therapy (cut-off ≥70%, AUC = 0.85). Combining both parameters (ΔKLD and ΔEcho) led to an increase in sensitivity without significant deterioration of other statistical parameters and allowed to accurately predict non-responding tumors. The aim of the study was to improve monitoring the treatment response in breast cancer patients undergoing neoadjuvant chemotherapy (NAC). The IRB approved this prospective study. Ultrasound examinations were performed prior to treatment and 7 days after four consecutive NAC cycles. Residual malignant cell (RMC) measurement at surgery was the standard of reference. Alteration in B-mode ultrasound (tumor echogenicity and volume) and the Kullback-Leibler divergence (kld), as a quantitative measure of amplitude difference, were used. Correlations of these parameters with RMC were assessed and Receiver Operating Characteristic curve (ROC) analysis was performed. Thirty-nine patients (mean age 57 y.) with 50 tumors were included. There was a significant correlation between RMC and changes in quantitative parameters (KLD) after the second, third and fourth course of NAC, and alteration in echogenicity after the third and fourth course. Multivariate analysis of the echogenicity and KLD after the third NAC course revealed a sensitivity of 91%, specificity of 92%, PPV = 77%, NPV = 97%, accuracy = 91%, and AUC of 0.92 for non-responding tumors (RMC ≥ 70%). In conclusion, monitoring the echogenicity and KLD parameters made it possible to accurately predict the treatment response from the second course of NAC. [ABSTRACT FROM AUTHOR]

Background: To validate the European Thyroid Imaging and Reporting Data System EU-TIRADS classification in a multi-institutional database of thyroid nodules by analyzing the obtained scores and histopathology results. Methods: A total of 842 thyroid lesions (613 benign, 229 malignant) were identified in 428 patients (mean age 62.7 years) and scored according to EU-TIRADS, using ultrasound examination. In all tumors, histopathological verification was performed. Results: In EU-TIRADS 2 (154 nodules) all nodules were benign; in EU-TIRADS 3, only 3/93 malignancies were identified. In EU-TIRADS 4, 12/103 were malignant, and in EU-TIRADS 5 (278 benign vs. 214 malignant). The malignant nodules that would not have qualified for biopsy were: EU-TIRADS 3, 2/3 (67%) malignancies were <20 mm, in EU-TIRADS 4, 7/12 (58%) were <15 mm. In EU-TIRADS 5, 72/214 (34%) were <10 mm; in total, 81/229 (36%) malignant lesions would have been missed. The cutoff between EU-TIRADS 3/4 had sensitivity of 100%, specificity of 25.1%. Using cutoff for EU-TIRADS 5, 93.4%, 54.6%, respectively. Conclusion: The application of EU-TIRADS guidelines allowed us to achieve moderate specificity. The vast majority of malignancies in EU-TIRADS 3, 4, and 5 would not have been recommended for biopsy because having a smaller size than that proposed classification. [ABSTRACT FROM AUTHOR]

Purpose: Neo‐adjuvant chemotherapy (NAC) is used in breast cancer before tumor surgery to reduce the size of the tumor and the risk of spreading. Monitoring the effects of NAC is important because in a number of cases the response to therapy is poor and requires a change in treatment. A new method that uses quantitative ultrasound to assess tumor response to NAC has been presented. The aim was to detect NAC unresponsive tumors at an early stage of treatment. Methods: The method assumes that ultrasound scattering is different for responsive and nonresponsive tumors. The assessment of the NAC effects was based on the differences between the histograms of the ultrasound echo amplitude recorded from the tumor after each NAC dose and from the tissue phantom, estimated using the Kolmogorov–Smirnov statistics (KSS) and the symmetrical Kullback–Leibler divergence (KLD). After therapy, tumors were resected and histopathologically evaluated. The percentage of residual malignant cells was determined and was the basis for assessing the tumor response. The data set included ultrasound data obtained from 37 tumors. The performance of the methods was assessed by means of the area under the receiver operating characteristic curve (AUC). Results: For responding tumors, a decrease in the mean KLD and KSS values was observed after subsequent doses of NAC. In nonresponding tumors, the KLD was higher and did not change in subsequent NAC courses. Classification based on the KSS or KLD parameters allowed to detect tumors not responding to NAC after the first dose of the drug, with AUC equal 0.83±$\pm$0.06 and 0.84±$\pm$0.07, respectively. After the third dose, the AUC increased to 0.90±$\pm$0.05 and 0.91±$\pm$0.04, respectively. Conclusions: The results indicate the potential usefulness of the proposed parameters in assessing the effectiveness of the NAC and early detection of nonresponding cases. [ABSTRACT FROM AUTHOR]

The low attendance rate for cancer screening tests in Poland is a major healthcare concern that requires specific analysis and the development of implementation recommendations for prevention, and both actions are likely to benefit culturally similar countries. Four female cancers account for approximately 20% of all cancer cases—breast cancer, cervical cancer, endometrial cancer, and ovarian cancer—suggesting that gynecologists have a significant preventative role. Of the four, breast cancer and cervical cancer are among the 10 most common malignant neoplasms globally, regardless of gender, occur only in women and are known to have effective screening measures. Our research aims to create a screening model that combines cervical cancer and breast cancer to maximize health outcomes for women at risk of both cancers. In the study protocol, we have created a model that maximizes benefits for patients with minimal additional costs to the health care system. To achieve the set goal, instead of regular clinical breast exams as recommended by the gynecological societies, we proposed an ultrasound examination, during which palpation may also be performed (in the absence of elastography). We present a scheme for such a protocol that takes into consideration all types of prevention in both cancers, and that emphasizes breast ultrasound as the most frequently missing element. Our study includes a discussion of the strengths and weaknesses of our strategy, and the crucial need for infrastructure and education for the successful implementation of the program. We conclude that our model merits consideration and discussion among health-care decision makers, as the screening changes we propose have significant potential benefits for the female population. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a systemic inflammatory disease of unknown aetiology. Given its complex clinical presentation, the disorder frequently causes diagnostic challenges. In most cases, the primary manifestation is in the lungs and mediastinum. Breast involvement as the primary manifestation of sarcoidosis is rare, accounting for less than 1% of cases. The authors present the case of a 44-year-old woman whose disease first manifested as multiple non-specific BIRADS 4 lesions in both breasts, accompanied by axillary lymphadenopathy, detected by ultrasound examination. The lesions were not visible on mammography. The course of the disease was clinically silent, with intermittent remissions, until the complete resolution of focal breast lesions on ultrasound after two years of follow-up. The paper presents an algorithm for the management of multifocal breast pathology with associated lymphadenopathy, which led to the prompt verification of sarcoidosis. [ABSTRACT FROM AUTHOR]

In this paper, we propose a novel deep learning method for joint classification and segmentation of breast masses based on radio-frequency (RF) ultrasound (US) data. In comparison to commonly used classification and segmentation techniques, utilizing B-mode US images, we train the network with RF data (data before envelope detection and dynamic compression), which are considered to include more information on tissue's physical properties than standard B-mode US images. Our multi-task network, based on the Y-Net architecture, can effectively process large matrices of RF data by mixing 1D and 2D convolutional filters. We use data collected from 273 breast masses to compare the performance of networks trained with RF data and US images. The multi-task model developed based on the RF data achieved good classification performance, with area under the receiver operating characteristic curve (AUC) of 0.90. The network based on the US images achieved AUC of 0.87. In the case of the segmentation, we obtained mean Dice scores of 0.64 and 0.60 for the approaches utilizing US images and RF data, respectively. Moreover, the interpretability of the networks was studied using class activation mapping technique and by filter weights visualizations. • Ultrasound RF data can be used to train deep learning models. • Networks for classification and segmentation of breast masses based on RF data. • Comparison of ultrasound image and RF data based deep learning methods. [ABSTRACT FROM AUTHOR]

Osteosarcoma (OSA) is the most common malignant bone neoplasia in humans and dogs. In dogs, treatment consists of surgery in combination with chemotherapy (mostly carboplatin and/or doxorubicin (Dox)). Chemotherapy is often rendered ineffective by multidrug resistance. Previous studies have revealed that Dox conjugated with 4 nm glutathione-stabilized gold nanoparticles (Au-GSH-Dox) enhanced the anti-tumor activity and cytotoxicity of Dox in Dox-resistant feline fibrosarcoma cell lines exhibiting high P-glycoprotein (P-gp) activity. The present study investigated the influence of Au-GSH-Dox on the canine OSA cell line D17 and its relationship with P-gp activity. A human Dox-sensitive OSA cell line, U2OS, served as the negative control. Au-GSH-Dox, compared to free Dox, presented a greater cytotoxic effect on D17 (IC50 values for Au-GSH-Dox and Dox were 7.9 μg/mL and 15.2 μg/mL, respectively) but not on the U2OS cell line. All concentrations of Au-GSH (ranging from 10 to 1000 μg/mL) were non-toxic in both cell lines. Inhibition of the D17 cell line with 100 μM verapamil resulted in an increase in free Dox but not in intracellular Au-GSH-Dox. The results indicate that Au-GSH-Dox may act as an effective drug in canine OSA by bypassing P-gp. [ABSTRACT FROM AUTHOR]

Computer-aided diagnosis (CAD) and other risk stratification systems may improve ultrasound image interpretation. This prospective study aimed to compare the diagnostic performance of CAD and the European Thyroid Imaging Reporting and Data System (EU-TIRADS) classification applied by physicians with S-Detect 2 software CAD based on Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and combinations of both methods (MODELs 1 to 5). In all, 133 nodules from 88 patients referred to thyroidectomy with available histopathology or with unambiguous results of cytology were included. The S-Detect system, EU-TIRADS, and mixed MODELs 1–5 for the diagnosis of thyroid cancer showed a sensitivity of 89.4%, 90.9%, 84.9%, 95.5%, 93.9%, 78.9% and 93.9%; a specificity of 80.6%, 61.2%, 88.1%, 53.7%, 73.1%, 89.6% and 80.6%; a positive predictive value of 81.9%, 69.8%, 87.5%, 67%, 77.5%, 88.1% and 82.7%; a negative predictive value of 88.5%, 87.2%, 85.5%, 92.3%, 92.5%, 81.1% and 93.1%; and an accuracy of 85%, 75.9%, 86.5%, 74.4%, 83.5%, 84.2%, and 87.2%, respectively. Comparison showed superiority of the similar MODELs 1 and 5 over other mixed models as well as EU-TIRADS and S-Detect used alone (p-value < 0.05). S-Detect software is characterized with high sensitivity and good specificity, whereas EU-TIRADS has high sensitivity, but rather low specificity. The best diagnostic performance in malignant thyroid nodule (TN) risk stratification was obtained for the combined model of S-Detect ("possibly malignant" nodule) and simultaneously obtaining 4 or 5 points (MODEL 1) or exactly 5 points (MODEL 5) on the EU-TIRADS scale. [ABSTRACT FROM AUTHOR]

Introduction: Since the protective value of gluteofemoral subcutaneous adipose tissue against cardiovascular risk factors has already been described in scientific reports, it is important to pay more attention to its evaluation. Aim of the study: The purpose of this study was to evaluate sex and body mass index implications on gluteofemoral subcutaneous tissue morphology visualized by ultrasonography. Material and method: A population of 40 participants between 20-50 years of age was examined. All individuals underwent the ultrasound examination of subcutaneous adipose tissue in three locations: anterior, posterior and lateral side of a thigh in the 1/3 distal part. All examinations were collected, and the following parameters were evaluated: thickness of subcutaneous adipose tissue in general, thickness of superficial and deep subcutaneous adipose tissue. Results: The study revealed significant differences in the architecture of subcutaneous adipose tissue between male and female subgroups. In the group of males, a significantly thinner layer of not only subcutaneous adipose tissue in general (0.65 vs. 1.67 cm, p <0.0001), but also in its main compartments was observed. Moreover, we observed strong positive correlation between body mass index and all subcutaneous adipose tissue layers in the female subgroup. Interestingly, there was no relation between the thickness of the subcutaneous adipose tissue layers between subgroups with a decreased and normal body mass index and an increased body mass index. Conclusions: The presented data indicates that sex is an important factor in the determination of subcutaneous adipose tissue architecture of a thigh. The ultrasound examination of this structure can be a useful prognostic tool in the assessment of cardiovascular risk. [ABSTRACT FROM AUTHOR]

Feline injection site sarcomas (FISS) are malignant skin tumors with high recurrence rates despite the primary treatment of radical surgical resections. Adjunctive radiotherapy or chemotherapy with doxorubicin is mostly ineffective. Cellular and molecular causes of multidrug resistance, specific physio-chemical properties of solid tumors impairing drug transport, and the tumor microenvironment have been indicated for causing standard chemotherapy failure. Gold nanoparticles are promising imaging tools, nanotherapeutics, and drug delivery systems (DDS) for chemotherapeutics, improving drug transport within solid tumors. This study was conducted to assess the distribution of 4-nm glutathione-stabilized gold nanoparticles in FISS and their influence on kidney and liver parameters in nude mice. The role of gold nanoparticles as a doxorubicin DDS in FISS was examined to determine the potential reasons for failure to translate results from in vitro to in vivo studies. Grade III tumors characterized by a large area of necrosis at their core displayed positive immuneexpression of tumor-associated macrophages (TAM) at both the periphery and within the tumor core near the area of necrosis. Gold nanoparticles did not cause necrosis at the injection site and had no negative effect on liver and kidney parameters in nude mice. Gold nanoparticles accumulated in the tumor core and at the periphery and co-internalized with TAM--an important observation and potential therapeutic target warranting further investigation. The large area of necrosis and high immunoexpression of TAM, indicating "pro-tumor macrophages", may be responsible for FISS tumor progression and therapeutic failure. However, further studies are required to test this hypothesis. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to review two techniques that can be used to verify focal lesions in the breasts: fine-needle aspiration biopsy and core-needle biopsy. Material and methods: Fifty-five articles (original papers and reviews), half of them published within the past 5 years, were included in the analysis. The authors also took their own experience into account. Results: Pre-operative assessment of focal lesions in the breasts is crucial in the planning of further therapeutic management. The role of fine-needle aspiration biopsy has been reduced lately due to its low sensitivity and specificity as well as a high rate of non-diagnostic, suspicious and false negative results. This method does not enable one to differentiate between in situ and invasive disease. Currently, fine-needle biopsy is recommended for cystic lesions, suspected of being recurrences in the chest wall, and lymph node metastases. Core-needle biopsy is the basic diagnostic method of breast lesions. According to the recommendations of the Polish Ultrasound Society and American College of Radiology, BIRADS 4 and 5 lesions should be evaluated histopathologically. Core-needle biopsy makes it possible to establish a final diagnosis more frequently than fine-needle biopsy, both in the case of benign and malignant lesions. It delivers more information about the nature of a tumor (mutation of HER-2, estrogen and progesterone receptors and Ki-67 index). Its limitations include: underestimation of invasion and failure to recognize the components of ductal carcinoma in situ in papillary and atypical lesions. Single fine-needle aspiration biopsy is inexpensive, but when considering the cost of further diagnosis due to non-diagnostic, suspicious and atypical results, this method generates high additional costs. Conclusions: Microscopic verification of focal breast lesions is crucial for further therapeutic decisions. It has been proven that histopathological verification is more accurate and has more advantages than cytological assessment. [ABSTRACT FROM AUTHOR]

Purpose: Statistical modeling of an ultrasound backscattered echo envelope is used for tissue characterization. However, in the presence of complex structures within the analyzed area, estimation of parameters is disturbed and unreliable, e.g., in the case of breast tumor classification. In order to improve the differentiation of breast lesions, the authors proposed a method based on the segmentation of homodyned K distribution parameter maps. Regions within lesions of different scattering properties were extracted and analyzed. In order to improve the classification, the best-performing features were selected from various regions and then combined. Methods: A radio-frequency data set consisting of 103 breast lesions was used in the authors' analysis. Maps of homodyned K distribution parameters were created using an algorithm based on signal-to-noise ratio, kurtosis, and skewness of fractional-order envelope moments. A Markov random field model was used to segment parametric maps. Features of different segments were extracted and evaluated based on bootstrapping and the receiver operating characteristic curve. To determine the best-performing feature subset, the authors applied the joint mutual information criterion. Results: It was found that there were individual features which performed better than the ones commonly used for lesion characterization, like the parameter obtained through averaging of values over the whole lesion. The authors selected and discussed the best-performing features. Properties of different extracted regions were important and improved the distinction between benign and malignant tumors. The best performance was obtained by combining four features with the area under the receiver operating curve of 0.84. Conclusions: The study showed that the analysis of internal changes in lesion parametric maps leads to a better classification of breast tumors. The authors recommend combining multiple features for characterization, instead of using only one parameter, especially in the case of heterogeneous lesions. [ABSTRACT FROM AUTHOR]

Molecular profile of breast cancer provides information about its biological activity, prognosis and treatment strategies. The purpose of our study was to investigate the correlation between ultrasound features and molecular subtypes of breast cancer. From June 2019 to December 2019, 86 patients (median age 57 years; range 32–88) with 102 breast cancer tumors were included in the study. The molecular subtypes were classified into five types: luminal A (LA), luminal B without HER2 overexpression (LB HER2−), luminal B with HER2 overexpression (LB HER2+), human epidermal growth factor receptor 2 positive (HER2+) and triple negative breast cancer (TNBC). Histopathological verification was obtained in core biopsy or/and post-surgery specimens in all cases. Univariate logistic regression analysis was performed to assess the association between the subtypes and ultrasound imaging features. Experienced radiologists assessed lesions according to the BIRADS-US lexicon. The ultrasound scans were performed with a Supersonic Aixplorer and Supersonix. Based on histopathological verification, the rates of LA, LB HER2−, LB HER2+, HER2+, and TNBC were 33, 17, 17, 16, 19, respectively. Both LB HER2+ and HER2+ subtypes presented higher incidence of calcification (OR = 3.125, p = 0.02, CI 0.0917–5.87) and HER2+ subtype presented a higher incidence of posterior enhancement (OR = 5.75, p = 0.03, CI 1.2257–32.8005), compared to other subtypes. The calcifications were less common in TNBC (OR = 0.176, p = 0.0041, CI 0.0469–0.5335) compared to other subtypes. There were no differences with regard to margin, shape, orientation, elasticity values and vascularity among five molecular subtypes. Our results suggest that there is a correlation between ultrasonographic features assessed according to BIRADS-US lexicon and BC subtypes with HER2 overexpression (both LB HER2+ and HER2+). It may be useful for identification of these aggressive subtypes of breast cancer. [ABSTRACT FROM AUTHOR]