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The similar visual appearance of high-risk basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) may cause confusion for diagnosis. High-frequency ultrasound (HFUS) may provide additional intralesional information and thus help to distinguish them.In this retrospective study, we analyzed the clinical characteristics, HFUS grayscale, and color Doppler flow imaging (CDFI) features of pathologically confirmed high-risk BCC and cSCC lesions (n = 65 vs n = 68). Subsequently, discrimination models based on the significant HFUS features were established.Between high-risk BCC and cSCC lesions, the HFUS grayscale features of the lesion size (10.0 mm vs 17.4 mm), thickness (3.1 mm vs 5.9 mm), internal hyperechoic spots (80.0% vs 23.5%), and posterior acoustic shadowing (16.9% vs 66.2%) were statistically different (all p 0.001). As for the CDFI features, high-risk BCC lesions mainly appeared as pattern II (47.7%), while cSCC lesions mainly appeared as pattern III (66.2%). Based on the above five features, an optimal discrimination model was established with a sensitivity of 91.2%, a specificity of 87.7%, and an accuracy of 89.5%.HFUS features, including size, thickness, internal hyperechoic spots, posterior acoustic shadowing, and Doppler vascularity pattern, are useful for differential diagnosis between high-risk BCC and cSCC.

Thyroid nodules have a high prevalence and a small percentage is malignant. Many non-invasive methods have been developed with the help of the Internet of Things to improve the detection rate of malignant nodules. These methods can be roughly categorized into two classes: radiomics based and deep learning based approaches. In general, convolutional neural networks based deep learning methods have achieved promising performance in many medical image analysis and classification applications; however, no existing comparison has been done between radiomics based and deep learning based approaches. Therefore, in this paper, we aim to compare the performance of radiomics and deep learning based methods for the classification of thyroid nodules from ultrasound images. On one hand, we developed a radiomics based method, which consists of extracting high throughput 302-dimensional statistical features from pre-processed images. Then dimension reduction was performed using mutual information and linear discriminant analysis respectively to achieve the final classification. On the other hand, a deep learning based method was also developed and tested by pre-training a VGG16 model with fine-tuning. Ultrasound images including 3120 images (1841 benign nodules and 1393 malignant nodules) from 1040 cases were retrospectively collected. The dataset was divided into 80% training and 20% testing data. The highest accuracies yielded on the testing data for radiomics and deep learning based methods were 66.81% and 74.69%, respectively. A comparison result demonstrated that the deep learning based method can achieve a better performance than using radiomics.

To evaluate the feasibility of a 5G-based telerobotic ultrasound (US) system for thyroid examination on a rural island.From September 2020 to March 2021, this prospectively study enrolled a total of 139 patients (average age, 58.6 ± 12.7 years) included 33 males and 106 females, who underwent 5G-based telerobotic thyroid US examination by a tele-doctor at Shanghai Tenth People's Hospital and a conventional thyroid US examination at Chongming Second People's Hospital 84 km away. The clinical feasibility of 5G-based telerobotic US for thyroid examination were evaluated in terms of safety, duration, US image quality, diagnostic results, and questionnaire survey.92.8% of patients had no examination-related complaints. The average duration of the 5G-based telerobotic US examination was similar as that of conventional US examination (5.57 ± 2.20 min vs. 5.23 ± 2.1 min, P = 0.164). The image quality of telerobotic US correlated well with that of conventional US (4.63 ± 0.60 vs. 4.65 ± 0.61, P = 0.102). There was no significant difference between two types of US examination methods for the diameter measurement of the thyroid, cervical lymph nodes, and thyroid nodules. Two lymphadenopathies and 20 diffuse thyroid diseases were detected in two types of US methods. 124 thyroid nodules were detected by telerobotic US and 127 thyroid nodules were detected by conventional US. Among them, 122 were the same thyroid nodules. In addition, there were good consistency in the US features (component, echogenicity, shape, and calcification) and ACR TI-RADS category of the same thyroid nodules between telerobotic and conventional US examinations (ICC = 0.788-0.863). 85.6% of patients accepted the telerobotic US, and 87.1% were willing to pay extra fee for the telerobotic US.The 5G-based telerobotic US system can be a routine diagnostic tool for thyroid examination for patients on a rural island.

BACKGROUND: To evaluate whether MicroPure imaging, an ultrasound (US) image-processing technique with computer-aided analysis, can quantitatively detect crystal dissolution during urate-lowering therapy (ULT) in gout. METHODS: This was a prospective study of gout patients requiring ULT. The first metatarsophalangeal joints were examined using US and MicroPure before and after 3 months of ULT. Elementary lesions of gout, including the double contour sign (DCS), aggregates, tophi, erosion, and other US features were recorded at baseline and 3 months. MicroPure imaging features were automatically calculated by a self-developed software. Patients were divided into goal-achieved and goal-not-achieved groups according to their urate levels at 3 months. The US and MicroPure imaging features of the two groups were analyzed at baseline and 3 months. RESULTS: A total of 55 consecutive patients were enrolled (25: goal-achieved group; 30: goal-not-achieved group). US findings demonstrated that the power Doppler signal grade decreased at 3 months, regardless of the group (both P0.05). CONCLUSIONS: In comparison with B-mode US, computer-aided MicroPure imaging can sensitively and quantitatively detect aggregate dissolution during effective ULT after only 3 months of treatment.

Combined checkpoint blockade (e.g., PD1/PD-L1) with traditional clinical therapies can be hampered by side effects and low tumour-therapeutic outcome, hindering broad clinical translation. Here we report a combined tumour-therapeutic modality based on integrating nanosonosensitizers-augmented noninvasive sonodynamic therapy (SDT) with checkpoint-blockade immunotherapy. All components of the nanosonosensitizers (HMME/R837@Lip) are clinically approved, wherein liposomes act as carriers to co-encapsulate sonosensitizers (hematoporphyrin monomethyl ether (HMME)) and immune adjuvant (imiquimod (R837)). Using multiple tumour models, we demonstrate that combining nanosonosensitizers-augmented SDT with anti-PD-L1 induces an anti-tumour response, which not only arrests primary tumour progression, but also prevents lung metastasis. Furthermore, the combined treatment strategy offers a long-term immunological memory function, which can protect against tumour rechallenge after elimination of the initial tumours. Therefore, this work represents a proof-of-concept combinatorial tumour therapeutics based on noninvasive tumours-therapeutic modality with immunotherapy., Immunotherapy for the treatment of cancer can be complicated by side effects and poor efficacy. Here, the authors use a nanoparticle-based approach in combination with a TLR7 agonist and sonodynamic therapy, and find that when used together with anti-PD-L1, tumour formation and metastases are impacted.

Purpose: This prospective study explored the value of synchronous tele-ultrasound (US) to aid doctors inexperienced in US with breast US examinations.Methods: In total, 99 patients were enrolled. Two trainee doctors who were inexperienced in US (trainee A [TA] and trainee B [TB]) and one doctor who was an expert in US completed the US examinations sequentially. TA completed the US examinations independently, while TB was instructed by the expert using synchronous tele-US. Subsequently, the expert performed on-site US examinations in person. Separately, they selected the most clinically significant nodule as the target nodule. Consistency with the expert and image quality were compared between TA and TB to evaluate tele-US. Furthermore, TB and the patients evaluated tele-US through questionnaires.Results: TB demonstrated higher consistency with the expert in terms of target nodule selection than TA (93.3% vs. 63.3%, P0.75) with the expert on five US features (5/9, 55.6%), while TA only did so for one (1/9, 11.1%) (P=0.046). TB’s image quality was higher than TA’s in gray value, time gain compensation, depth, color Doppler adjustment, and the visibility of key information (P=0.018, P

Objectives: Ultrasound-guided fine-needle aspiration (FNA) is the most accurate and economical means for the differential diagnosis of thyroid nodules, but false negative results also existed. This study aimed to predict the false negative results of FNA, reduce the missed diagnosis and improve the current management strategy of thyroid nodules. Methods: A total of 1232 consecutive patients with thyroid nodules who received FNA and BRAF V600E detection were adopted. All patients received both CUS (conventional ultrasound) and SWE (shear wave elastography) examinations and characteristics of these thyroid nodules were analyzed to evaluated the diagnostic performances of risk factors for malignancy.Results: Finally, 26 nodules with benign cytology and BRAF V600E mutations were enrolled. Undefined boundary, microcalcification and E max ratio > 1.49 were risk factors for malignancy (P 1.49 respectively. There was no difference between benign and malignant nodules in the patient age, sex and nodule sizes (P>0.05).Conclusions: Undefined boundary, microcalcification and E max ratio > 1.49 were risk factors for malignancy in benign cytology nodules. When FNA results were benign but above characteristics could be found in the thyroid nodules with BRAF V600E mutation, further clinical decisions should be carried out to reduce the missed diagnosis.

BACKGROUND Esophageal varices (EV) are the most fatal complication of chronic hepatitis B (CHB) related cirrhosis. The prognosis is poor, especially after the first upper gastrointestinal hemorrhage. AIM To construct nomograms to predict the risk and severity of EV in patients with CHB related cirrhosis. METHODS Between 2016 and 2018, the patients with CHB related cirrhosis were recruited and divided into a training or validation cohort at The First Affiliated Hospital of Wenzhou Medical University. Clinical and ultrasonic parameters that were closely related to EV risk and severity were screened out by univariate and multivariate logistic regression analyses, and integrated into two nomograms, respectively. Both nomograms were internally and externally validated by calibration, concordance index (C-index), receiver operating characteristic curve, and decision curve analyses (DCA). RESULTS A total of 307 patients with CHB related cirrhosis were recruited. The independent risk factors for EV included Child-Pugh class [odds ratio (OR) = 7.705, 95% confidence interval (CI) = 2.169-27.370, P = 0.002], platelet count (OR = 0.992, 95%CI = 0.984-1.000, P = 0.044), splenic portal index (SPI) (OR = 3.895, 95%CI = 1.630-9.308, P = 0.002), and liver fibrosis index (LFI) (OR = 3.603, 95%CI = 1.336-9.719, P = 0.011); those of EV severity included Child-Pugh class (OR = 5.436, 95%CI = 2.112-13.990, P < 0.001), mean portal vein velocity (OR = 1.479, 95%CI = 1.043-2.098, P = 0.028), portal vein diameter (OR = 1.397, 95%CI = 1.021-1.912, P = 0.037), SPI (OR = 1.463, 95%CI = 1.030-2.079, P = 0.034), and LFI (OR = 3.089, 95%CI = 1.442-6.617, P = 0.004). Two nomograms (predicting EV risk and severity, respectively) were well-calibrated and had a favorable discriminative ability, with C-indexes of 0.916 and 0.846 in the training cohort, respectively, higher than those of other predictive indexes, like LFI (C-indexes = 0.781 and 0.738), SPI (C-indexes = 0.805 and 0.714), ratio of platelet count to spleen diameter (PSR) (C-indexes = 0.822 and 0.726), King's score (C-indexes = 0.694 and 0.609), and Lok index (C-indexes = 0.788 and 0.700). The areas under the curves (AUCs) of the two nomograms were 0.916 and 0.846 in the training cohort, respectively, higher than those of LFI (AUCs = 0.781 and 0.738), SPI (AUCs = 0.805 and 0.714), PSR (AUCs = 0.822 and 0.726), King's score (AUCs = 0.694 and 0.609), and Lok index (AUCs = 0.788 and 0.700). Better net benefits were shown in the DCA. The results were validated in the validation cohort. CONCLUSION Nomograms incorporating clinical and ultrasonic variables are efficient in noninvasively predicting the risk and severity of EV.

Objectives: The aim of this study was to develop an ultrasound consolidated score (UCS) in determining the activity of Crohn’s disease (CD) and evaluate it with reference to simple endoscopic score (SES). Methods: From June 2014 to June 2017, 66 patients with CD were retrospectively enrolled in this study. Each patient underwent endoscopy and transabdominal ultrasound (US) examination. The morphological symmetry, echogenicity of bowel wall, bowel wall layer structure, echogenicity of peri-bowel fat, bowel wall thickness (BWT), and Limberg type on power Doppler US were assessed with transabdominal US, and an UCS scoring system was developed based on these characteristics. Endoscopic results were used as the reference standard and SES was calculated to determine the CD activity. Receiver operating characteristic curve analysis was performed to assess the diagnostic performance for determining CD activity and the correlation between UCS and SES was assessed using Spearman correlation analysis. Results: 330 intestinal segments in 66 patients were included. The UCS of the segments in the remission phase ranged from 3.0 to 9.0 (mean, 3.6 ± 0.9) whereas in the active phase from 3.0 to 20.0 (mean, 10.6 ± 4.0) (p < 0.001). The cut-off value of UCS was 6. The associated area under ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 0.980, 88.3%, 95.5%, 93.8%, 91.3%, and 92.3%, respectively. The correlation coefficient between UCS and SES was 0.90, which was higher than the correlation coefficient of 0.83 between BWT and SES. Conclusions: The newly developed UCS with transabdominal US has a good performance and potentially provides an effective alternative for evaluating the activity of CD. Advances in knowledge: UCS is an effective method to evaluate the activity of CD because it provides comprehensive information of the disease. Therefore, it could be employed as an alternative for diagnosis of CD.

With the increasing incidence rate of thyroid cancer, the diagnosis of thyroid nodules has become an important task. In this paper, we designed a deep neural network (DNN) to classify whether a thyroid nodule is benign or malignant, and proposed a structure which combines local binary pattern (LBP) with deep learning. Our method mitigates the effects of overfitting in medical image diagnosis tasks. With well-designed transfer leaning, we achieve an accuracy of 85% on our own ultrasound thyroid dataset. To ensure the reliability of our experiments, all examples are estimated by experts in Shanghai Tenth People’s Hospital using fine needle analysis (FNA), which is a gold standard for thyroid nodules diagnosis. The experimental results show that combinations of the traditional medial image features can help the deep learning network get more semantic information from low-level inputs.

// Bao-Ding Chen 1,2,3,4,5 , Hui-Xiong Xu 1,2,3,4 , Yi-Feng Zhang 1,2,3,4 , Bo-Ji Liu 1,2,3,4 , Le-Hang Guo 1,2,3,4 , Dan-Dan Li 1,2,3,4 , Chong-Ke Zhao 1,2,3,4 , Xiao-Long Li 1,2,3,4 , Dan Wang 1,2,3,4 and Shuang-Shuang Zhao 5 1 Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China 2 Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Clinical College of Nanjing Medical University, Shanghai, China 3 Thyroid Institute, Tongji University School of Medicine, Shanghai, China 4 Shanghai Center of Thyroid Diseases, Shanghai, China 5 Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang, China Correspondence to: Hui-Xiong Xu, email: // Keywords : thyroid nodule, calcification, ultrasound, shear-wave elastography, point shear-wave measurement Received : June 30, 2016 Accepted : August 26, 2016 Published : August 31, 2016 Abstract Conventional ultrasound cannot satisfactorily distinguish malignant and benign thyroid nodules. Shear-wave elastography (SWE) can evaluate tissue stiffness and complement conventional ultrasound in diagnosing malignant nodules. However, calcification of nodules may affect the results of SWE. The purposes of this study are to compare the differences of shear-wave speed (SWS) measurement among different calcification groups and compare the diagnostic performance between using a single uniform SWS cutoff value and multiple individual calcification-specific cutoff values using technique of point SWS measurement. We retrospectively identified 517 thyroid nodules (346 benign and 171 malignant nodules) examined by conventional ultrasound and point SWS measurement. There were 177 non-calcified, 159 micro-calcified and 181 macro-calcified nodules. The diagnostic performance was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC) was computed. The mean SWS in malignant nodules more than doubled that of benign nodules (4.81±2.03 m/s vs. 2.29±0.99 m/s, p 2.42 m/s), micro- (SWS >2.88 m/s) and macro-calcification (SWS >3.59 m/s) nodules in the whole group, the AUC was 0.859 (95% confidence interval [CI], 0.826-0.888), which was significantly better than the AUC of 0.816 (95% CI, 0.780-0.848) if a single uniform cutoff value (SWS >2.72 m/s) was applied to all the nodules regardless of calcification status (p=0.011). The cutoff values of SWS for different calcified nodules warrant future prospective validation.

Studies have shown the potential of nanomaterials for the accurate and early detection of cancer. The aim of the present study was to design and evaluate the value of prostate-specific membrane antigen (PSA)-targeted manganese oxide–mesoporous silica nanoparticles (Mn–Msns) for the detection of prostate cancer. Mn–Msns were prepared, and then conjugated with the PSA antibody and Cy7 to create the multimodality PSA-Mn-Msn-Cy7. Their particle size, zeta potential, stability and magnetic resonance imaging (MRI) features of the nanoparticles were characterized. Optical and MR imaging were evaluated in cell and tumor-bearing mouse models. The Mn in tissues was measured by inductively coupled plasma mass spectrometry. The fabricated nanoparticles were stable and showed good T1relaxivity. The targeted nanoparticles accumulated to a great extent in prostate cancer cells in vitro but not in noncancerous cells. In vivo studies further demonstrated a targeted distribution of PSA-Mn-Msn-Cy7 to cancer tissues as shown by high optical and T1 signals. The targeted distribution was also confirmed by determining the Mn content in the cancer tissues. Our data demonstrate that PSA targeted fluorescence and MR dual-functional nanoparticle can visualize prostate cancer and can be used as NIRF/MR contrast agents.

Underlying a cancer phenotype is a specific gene regulatory network that represents the complex regulatory relationships between genes. It remains, however, a challenge to find cancer-related gene regulatory network because of insufficient sample sizes and complex regulatory mechanisms in which gene is influenced by not only other genes but also other biological factors. With the development of high-throughput technologies and the unprecedented wealth of multi-omics data it gives us a new opportunity to design machine learning method to investigate underlying gene regulatory network. In this paper, we propose an approach, which use Biweight Midcorrelation to measure the correlation between factors and make use of Nonconvex Penalty based sparse regression for Gene Regulatory Network inference (BMNPGRN). BMNCGRN incorporates multi-omics data (including DNA methylation and copy number variation) and their interactions in gene regulatory network model. The experimental results on synthetic datasets show that BMNPGRN outperforms popular and state-of-the-art methods (including DCGRN, ARACNE, and CLR) under false positive control. Furthermore, we applied BMNPGRN on breast cancer (BRCA) data from The Cancer Genome Atlas database and provided gene regulatory network.

EVA1A (also known as transmembrane protein 166) is a transmembrane protein involved in the regulation of autophagy that acts as an adaptor protein to recruit or bind proteins in the lysosome or endoplasmic reticulum. In the present study, we identified EVA1A as a target of microRNA-125b (miR-125b), a member of a highly conserved family of miRNAs that has been proposed as a biomarker for hepatocellular carcinoma (HCC). Analysis of oxaliplatin-sensitive and oxaliplatin-resistant HCC cell lines showed that miR-125b is downregulated in resistant cells and its overexpression in sensitive cells decreased resistance to oxaliplatin by inhibiting cell proliferation, migration and epithelial-mesenchymal transition (EMT). EVA1A expression was shown to be upregulated in tissue samples from oxaliplatin-resistant HCC patients, and its ectopic expression partially induced autophagy and reversed the effect of miR-125b on inhibiting the growth of oxaliplatin-resistant cell lines and xenograft tumors. Taken together, our results suggest that miR-125b plays a role in the resistance of HCC cells to chemotherapy via a mechanism involving the downregulation of EVA1A-mediated autophagy.

Prostate sarcoma is a rare malignancy with an extremely poor prognosis. The extremely low morbidity and atypical clinical symptoms contribute to a missed diagnosis. The typical features of prostate sarcoma in transrectal ultrasound (US) and magnetic resonance imaging, such as a markedly enlarged volume and irregular prostatic contours, cannot usually be found until dysuria or even uroschesis occurs, and may then be too late to treat. However, there appears to no specific tumor marker for the disease in the serum. The present study reports a case of a young male patient who was diagnosed with prostate rhabdomyosarcoma. This was, to the best of our knowledge, the first case of this diagnosis using contrast-enhanced US (CEUS) when the symptoms were not severe. In this case, the intralesional non-enhancement areas and rim-like hyper-enhancement around the lesion were considered to be the main CEUS features of prostate rhabdomyosarcoma. The present study also reviews the associated literature.

To evaluate the value of fusion imaging with post-treatment contrast-enhanced ultrasound (CEUS) and pre-treatment contrast-enhanced CT/MRI (CECT/CEMRI) in evaluating ablative safety margin after percutaneous ultrasound (US)-guided radiofrequency ablation (RFA) for liver cancers.34 consecutive patients with 47 liver lesions who had undergone RFA were included. Fusion imaging with post-treatment CEUS and pre-treatment CECT/CEMRI was carried out to evaluate local treatment response and ablative safety margin within 1-3 days after RFA. The minimal ablative safety margins of the ablation zones were recorded. The complete response (CR) rate was calculated with reference to CECT/CEMRI results 1 month after RFA. The local tumour progression (LTP) was also recorded.Of the 47 ablation zones, 47 (100%) were clearly depicted with CEUS-CECT/CEMRI fusion imaging, 36 (76.6%) with US-CECT/CEMRI fusion imaging and 21 (44.7%) with conventional US (both p0.001). The minimal ablative safety margins were great than or equal to 5 mm in 28 ablation zones, between 0 and 5 mm in 15, and less than 0 mm in 4. For the four lesions without enough ablative safety margin, three were referred to follow-up because CEUS showed larger ablation zones than pre-treatment lesions and the remaining lesion was subject to additional RFA 5 days after the first RFA. The CR rate was 95.7% (45/47) with reference to CECT/CEMRI results 1 month after RFA. During 2 to 34 months follow-up, LTP was found in two (4.4%) of 45 lesions with CR. Insufficient ablative safety margin was more commonly found in those lesions with LTP than those without LTP (1/4 vs 1/43, p0.001).Fusion imaging with post-treatment CEUS and pre-treatment CECT/CEMRI can depict the ablative safety margin accurately after RFA. Inadequate ablative safety margin is associated with LTP. Depiction of ablative safety margin by fusion imaging after ablation might be considered as a routine procedure to assess the treatment response of RFA. Advances in knowledge: Fusion imaging with post-treatment CEUS and pre-treatment CECT/CEMRI is an effective method to evaluate the ablative safety margin early after RFA. Therefore, it should be recommended to be used as a routine procedure after RFA for liver cancers.

To investigate the diagnostic performance of combination of ultrasound (US) thyroid imaging reporting and data system (TI-RADS) and a new US scoring system for diagnosing thyroid nodules (TNs) with indeterminate results (Bethesda categories III, IV and V) on fine-needle aspiration (FNA) cytology. 453 patients with 453 cytologically indeterminate TNs were included in this study. Multivariate analyses were performed to construct the scoring system. The diagnostic performances of TI-RADS and the combined method were evaluated and compared. Multivariate analyses revealed that marked hypoechogenicity, taller than wide shape and absence of halo sign were independent predictors for malignancy in cytologically indeterminate TNs. Scoring system was thereafter defined as follows: risk score (RS) = 3.2 x (if marked hypoechogenicity) + 2.8 x (if taller than wide shape) + 1.3 x (if absence of halo sign). Compared with TI-RADS alone, the areas under the receiver operating characteristic curves (AUC), specificity, accuracy and positive predictive value (PPV) of the combined method increased significantly with 0.731 versus 0.569, 48.5% versus 14.1%, 76.2% versus 62.3%, and 70.9% versus 59.9%, respectively (all P

Integrin β4 (ITGB4) is a transmembrane receptor involved in tumorigenesis and the invasiveness of many cancers. However, its role in hepatocellular carcinoma (HCC), one of the most prevalent human cancers worldwide, remains unclear. Here, we examined the involvement of ITGB4 in HCC and explored the underlying mechanisms. Real-time PCR and immunohistochemical analyses of tissues from 82 patients with HCC and four HCC cell lines showed higher ITGB4 levels in tumor than in adjacent non-tumor tissues and in HCC than in normal hepatic cells. Silencing of ITGB4 repressed cell proliferation, colony forming ability and cell invasiveness, whereas ectopic expression of ITGB4 promoted the proliferation and invasion of HCC cells and induced epithelial to mesenchymal transition (EMT) in parallel with the upregulation of Slug, as shown by transwell assays, WB and immunocytochemistry. Knockdown of Slug reduced cell viability inhibited invasion and reversed the effects of ITBG4 overexpression on promoting EMT, and AKT/Sox2-Nanog may also be involved. In a xenograft tumor model induced by injection of ITGB4-overexpressing cells into nude mice, ITGB4 promoted tumor growth and metastasis to the lungs. Taken together, our results indicate that ITGB4 plays a tumorigenic and pro-metastatic role mediated by Slug and suggest IGTB4 could be a prognostic indicator or a therapeutic target in patients with HCC.

To evaluate the diagnostic performance of a new two-dimensional shear wave speed (SWS) imaging (i.e. Toshiba shear wave elastography, T-SWE) in differential diagnosis of breast lesions. 225 pathologically confirmed breast lesions in 218 patients were subject to conventional ultrasound and T-SWE examinations. The mean, standard deviation and ratio of SWS values (m/s) and elastic modulus (KPa) on T-SWE were computed. Besides, the 2D elastic images were classified into four color patterns. The area under the receiver operating characteristic (AUROC) curve analysis was performed to evaluate the diagnostic performance of T-SWE in differentiation of breast lesions. Compared with other quantitative T-SWE parameters, mean value expressed in KPa had the highest AUROC value (AUROC = 0.943), with corresponding cut-off value of 36.1 KPa, sensitivity of 85.1%, specificity of 96.6%, accuracy of 94.2%, PPV of 87.0%, and NPV of 96.1%. The AUROC of qualitative color patterns in this study obtained the best performance (AUROC = 0.957), while the differences were not significant except for that of Eratio expressed in m/s (AUROC = 0.863) (P = 0.03). In summary, qualitative color patterns of T-SWE obtained the best performance in all parameters, while mean stiffness (36.05 KPa) provided the best diagnostic performance in the quantitative parameters.

This study is to compare the health-related quality of life (HRQoL) and cost-effectiveness of radiofrequency ablation (RFA) and open thyroidectomy (OT) for benign thyroid nodules (BTNs) treatment. HRQoL and utility were assessed for 404 BTN patients immediately before treatments (RFA:OT = 137:267) and at 6-month visit. A cost-effectiveness analysis was performed from societal perspective in the China context. Resource use (hospitalization, sick leaves) was collected. We used the net monetary benefit approach and computed cost-effectiveness acceptability curves for RFA and OT. Sensitivity analyses of costs of RFA were performed. At 6-month visit, patients treated with RFA had significantly better HRQoL than patients treated with OT on general health (68.5 versus 66.7, P = 0.029), vitality (71.3 versus 67.5, P P = 0.038). RFA was more effective than OT in terms of quality-adjusted life-years (QALYs; 0.01QALY/patient) but more expensive (US$823/patient). The probability that RFA would be cost effective at a US$50,000/QALY threshold was 15.5% in China, and it would be increased to 88.4% when price of the RFA device was lowered by 30%. RFA exhibited a significant improvement of HRQoL relative to OT, but is unlikely to be cost effective at its current price in short time.

The aim of this prospective study was to propose a new rating system using a risk model including conventional ultrasound (US) and acoustic radiation force impulse (ARFI) elastography for predicting central lymph node metastasis (LNM) in patients with papillary thyroid microcarcinoma (PTMC). A total of 252 patients with PTMCs were enrolled, who were preoperatively evaluated by US and ARFI elastography including virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ). Risk factors of independent variables for central LNM were analyzed by univariate and multivariate analyses. A multivariate analysis was performed to create a predicting model and rating system. Of the 252 patients, 72 (28.6%) had central LNMs. Multivariate analysis revealed that rare internal flow (odds ratio [OR]: 4.454), multiple suspicious foci on US (OR: 5.136), capsule involvement (OR: 20.632), and VTI area ratio (VAR) > 1 (OR: 5.621) were independent risk factors for central LNM. The final predicting model was obtained and the risk score (RS) was defined as 1.5 × (if rare internal flow) + 1.6 × (if multiple suspicious foci on US) + 1.7 × (if VAR > 1) + 3.0 × (if capsule involvement). The rating system was divided into 5 stages. Stage I, 1 on ARFI elastography are the risk factors for predicting central LNM. The risk model developed in the study clearly predicts the risk of central LNM in patients with PTMC and thus has a potential to avoid unnecessary central compartment node dissection.

This prospective study of comparing transperineal prostate biopsy (TPBx) with transrectal prostate biopsy (TRBx) was aimed to provide evidence for clinicians to select the appropriate biopsy approach under different conditions. TPBx (n = 173) and TRBx (n = 166) were performed randomly for 339 patients who were suspicious of prostate cancer (PCa). The cancer detection rate (CDR), complication rate, visual analogue scale (VAS) score, most painful procedure, number of repeated biopsy and additional anesthesia and operating time (starting from lying down on the operating table to getting up) were recorded. The results showed that TPBx and TRBx were equivalent in CDR (35.3% vs. 31.9%) and minor complication rate (44.9% vs. 41.0%) (both P > 0.05). The major complication rate was lower in TPBx than in TRBx (0.6% vs. 4.3%, P PBx was more time-consuming (17.51 ± 3.33 min vs. 14.73 ± 3.25 min) and painful (VAS score: 4.0 vs. 2.0); and it had higher rates of repeated biopsy (3.2% vs. 1.1%) and additional anesthesia (15.0% vs. 1.2%) (all P

The aim of the study was to evaluate the diagnostic performance of acoustic radiation force impulse (ARFI) induced strain elastography (SE), point shear wave elastography (p-SWE), and their combined use in differentiating thyroid nodules. This retrospective study included 155 thyroid nodules (94 benign and 61 malignant) in 136 patients. Ultrasound, ARFI-induced SE and p-SWE were performed on each nodule. Receiver operating characteristic curve (ROC) analyses were performed to assess the diagnostic efficacy of ARFI-induced SE, p-SWE and their combined use to distinguish benign from malignant thyroid nodules with histological results used as the reference standard. The areas under the ROC for ARFI-induced SE, p-SWE, and their combined use were 0.828, 0.829, and 0.840, respectively (both P > 0.05). The specificity of ARFI-induced SE was higher than that of p-SWE as well as their combined use (both P < 0.05). The combination of the two methods significantly improved the diagnostic sensitivity and NPV compared with either ARFI-induced SE or p-SWE alone (both P < 0.05). For nodules ≤ 10 mm, the combination of the two methods significantly improved the diagnostic sensitivity only. For nodules > 10 mm, there were no significant differences in sensitivity and NPV among the three methods in differentiating thyroid nodules (all P > 0.05). In conclusions, ARFI-induced SE and p-SWE are both valuable tools for detecting malignant thyroid nodules. The combined use of ARFI-induced SE and p-SWE improves the diagnostic sensitivity and NPV significantly whereas ARFI-induced SE alone achieves the highest specificity.

The aim of this study was to evaluate the diagnostic performance of quantitative shear wave velocity (SWV) measurement on acoustic radiation force impulse (ARFI) elastography for differentiation between benign and malignant thyroid nodules using meta-analysis. The databases of PubMed and the Web of Science were searched. Studies published in English on assessment of the sensitivity and specificity of ARFI elastography for the differentiation of thyroid nodules were collected. The quantitative measurement of ARFI elastography was evaluated by SWV (m/s). Meta-Disc Version 1.4 software was used to describe and calculate the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and summary receiver operating characteristic curves. We analyzed a total of 13 studies, which included 1,854 thyroid nodules (including 1,339 benign nodules and 515 malignant nodules) from 1,641 patients. The summary sensitivity and specificity for differential diagnosis between benign and malignant thyroid nodules by SWV were 0.81 (95% confidence interval [CI]: 0.77-0.84) and 0.84 (95% CI: 0.81-0.86), respectively. The pooled positive and negative likelihood ratios were 5.21 (95% CI: 3.56-7.62) and 0.23 (95% CI: 0.17-0.32), respectively. The pooled diagnostic odds ratio was 27.53 (95% CI: 14.58-52.01), and the area under the summary receiver operating characteristic curve was 0.91 (Q* = 0.84). In conclusion, SWV measurement on ARFI elastography has high sensitivity and specificity for differential diagnosis between benign and malignant thyroid nodules and can be used in combination with conventional ultrasound.

This meta-analysis was aimed to assess the diagnostic performance of acoustic radiation force impulse (ARFI) elastography for the differentiation of malignant and benign breast lesions. The databases of PubMed, Web of Science(TM), WanFang, Vip, SinoMed and China National Knowledge Infrastructure were searched for all studies that evaluated the diagnostic performance of ARFI including virtual touch tissue quantification (VTQ) and virtual touch tissue imaging (VTI). All the studies were published prior to Mar. 21, 2014. The studies published in English or Chinese were collected. A total of 11 studies, including 1,408 breast lesions from 1,245 women, were analyzed. The values of summary sensitivity and summary specificity were 0.843 (95% confidence interval [CI]: 0.811-0.872) and 0.932 (95% CI: 0.913-0.948) for VTQ of ARFI, and 0.864 (95% CI: 0.799-0.914) and 0.882 (95% CI: 0.832-0.922) for VTI of ARFI, respectively. Subgroup analysis excluding mucinous carcinoma and carcinoma in situ showed higher summary sensitivity (0.877 95% CI: 0.835-0.911), higher summary specificity (0.943 95% CI: 0.921-0.960) and lower heterogeneity (I(2)=23.5%). The cut-off values for shear wave velocity of VTQ ranged widely from 2.89 to 6.71 m/s, while the VTI ranged narrowly from 1.37 to 1.66. In general, ARFI elastography seems to be a good method for differentiation between benign and malignant breast lesions. However, its usefulness for identifying breast mucinous carcinoma and breast carcinoma in situ is limited. VTI seems to be more reliable and repeatable than VTQ.

Purpose: The management criterion of thyroid nodules is to evaluate the risk of malignancy, based on cytological examinations. Ultrasound-guided fine-needle aspiration biopsy (US-FNAB) has a highly diagnostic value for thyroid nodules. The aim of this study was to compare the efficacy of US-FNAB for thyroid nodules with different sizes. Material and methods: From August 2013 to November 2013, 344patients with thyroid nodules who had undergone US-FNAB were divided into three groups, according to the largest diameter of their nodules (group A, ≤ 5.0 mm; group B, 5.1-10.0 mm; group C, > 10.0 mm). All the nodules were subsequently verified by histology or follow-up findings. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value of aspiration cytology in each group was compared. Results: Among 344 thyroid nodules diagnosed by cytology, the cytology was classified as nondiagnostic or unsatisfactory for 53 (15.4%) lesions, benign for 144 (41.9%) lesions, atypia of undetermined significance or follicular lesion of undetermined significance for 20 (5.8%) lesions, follicular neoplasm or suspicious for a follicular neoplasm for 26 (7.6%) lesions, suspicious for malignancy for 36 (10.5%) lesions, malignant for 65 (18.9%) lesions. There were 243 benign and 101 malignant nodules confirmed by the pathological or follow-up ultrasound. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were confirmed to be 87.5% (14/16), 92.5% (37/40), 91% (51/56), 82.3% (14/17), and 94.8% (37/39) in group A; 92.3% (36/39), 96.9% (94/97), 95.5% (130/136), 92.3% (36/39), and 96.9% (94/97) in group B; and 91.3% (42/46), 93.4% (99/106), 92.7% (141/152) 85.7% (42/49), and 96.1% (99/103), in group C. There were no statistical differences in accuracy, sensitivity, specificity, false positive accuracy, false negative rate of fine needle aspiration of thyroid nodules with different sizes (P > 0.05). Conclusion: US-FNAB has similar diagnostic efficacy to thyroid nodules with different sizes.

Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are both regarded as primary liver cancers, having different biological behaviors and prognoses. Correct differentiation between them is essential for surgical planning and prognosis assessment. In 2005, the American Association for the Study of Liver Diseases (AASLD) recommended that noninvasive diagnosis of HCC is achievable by a single dynamic technique (including contrast-enhanced ultrasound (CEUS)) showing intense arterial uptake followed by washout of contrast in the venous-delayed phases. However, CEUS has been dropped from the diagnostic techniques in the latest AASLD guideline according to the opinion of some authors from Europe that CEUS may offer false positive HCC diagnosis in patients with ICC. Since the update of AASLD guideline has been released, increased attention has been paid to this interesting topic. Remarkable controversy over this issue is present and this removal was not well received in Europe and Asia. This commentary summarized the opinions for the role of CUES in differentiation between HCC and ICC in recent years. It is concluded that prospective studies with strict design and large case series are mandatory to solve the controversies and stratification of ICC in terms of tumor size and liver background is also essential.

Objectives: To investigate the value of contrast-enhanced ultrasound (CEUS) in the differential diagnosis between gallbladder adenomas and gallbladder adenomas canceration. Methods: CEUS data from 34 patients (25 patients with gallbladder adenomas and 9 patients with gallbladder adenomas canceration) were retrospectively analyzed, including the characteristics of contrast arrival time, time to peak enhancement, enhancement extend, enhancement morphology and the intactness of gallbladder wall below the lesions. Results: On CEIS, the contrast arrival time and the time to peak enhancement were significantly shorter in patients with gallbladder adenomas than in patients with gallbladder adenomas canceration (12.63 ± 3.37 s vs. 18.11 ± 3.26 s, P < 0.001; 17.42 ± 3.69 s vs. 24.56 ± 4.36 s, P < 0.001). The time to iso-enhancement showed no significant difference between the two groups; while the time to hypo-enhancement was significantly shorter in patients with gallbladder adenomas canceration than in patients with gallbladder adenomas (55.56 ± 15.48 s vs. 84.71 ± 36.07 s, P = 0.027), and the enhancement time of the liver was significantly slower in patients with gallbladder adenomas canceration than in patients with gallbladder adenomas (22.78 ± 5.28 s vs. 16.63 ± 4.66 s, P = 0.004). Using receiver operating characteristic (ROC) analysis, the time to peak enhancement greater than 20 s had 89% sensitivity and 84% specificity for detecting patients with gallbladder adenomas canceration. The enhancement level showed no difference between the two groups. Inhomogeneous enhancement was found in 33% (3/9) gallbladder adenoma canceration and none (0/25) of gallbladder adenoma (P < 0.01). Destruction of gallbladder wall intactness was found in 66.7% (6/9) gallbladder adenoma canceration and none (0/25) of gallbladder adenoma (P < 0.01). Conclusion: CEUS is useful in differentiation between gallbladder adenoma and gallbladder adenoma canceration. The time to peak enhancement, the enhancement morphology and the intactness of gallbladder wall below the lesions are the diagnostic clues in differentiating diagnosis between gallbladder adenoma and gallbladder adenoma canceration.

Objective: To evaluate the value of conventional ultrasound and contrast-enhanced ultrasound (CEUS) in determining the severity of active Crohn’s disease. Methods: Thirty-seven patients who were considered to be in active period of Crohn’s disease were included. Conventional ultrasound was employed to measure the thicknesses of interior, exterior and the whole bowel walls. Qualitative and quantitative CEUS analysis of the interior, exterior and the whole intestinal walls were also performed. Correlations between these methods and the severity of Crohn’s disease were assessed. Results: Endoscopy grading system identified 19 patients with mild disease and 18 with severe disease. In discriminating severe Crohn’s disease from mild disease, the cut-off value for the thickness of the entire bowel wall was 6.8 mm by receiver operating characteristic (ROC) analysis, with area under ROC (AUROC) of 0.84, sensitivity of 94.4%, specificity of 68.4%, positive predictive value (PPV) of 61.1%, negative predictive value (NPV) of 69.2%, and Youden’s index of 0.628. The cut-off value for thickness of the interior intestinal wall was 4.8 mm (AUROC, 0.81; sensitivity, 88.9%; specificity, 63.2%; PPV, 85.7%; NPV, 69.6%; Youden’s index, 0.521). The sensitivity, specificity, PPV, NPV, accuracy, and Youden’s index of CEUS qualitative analysis were 100% (18/18), 57.9% (11/19), 64.3% (18/26), 100% (11/11), 78.4% (29/37), and 0.579, respectively. Quantitative comparison revealed that patients with mild disease and those with severe disease differed only in Imax of inner bowel wall enhancement (2746.9 ± 911 vs. 12814.5 ± 9802.4; P = 0.02) and Imax of entire wall enhancement (2106 ± 660 vs. 9864 ± 6994; P = 0.03). The cut-off value for the Imax of the entire bowel wall was 3067, with the AUROC of 0.96, sensitivity of 100%, specificity of 67.7%, PPV of 100%, NPV of 88.9%, and Youden’s index of 0.677; and the cut-off value for the Imax of the interior intestinal layer was 3356, with the AUROC of 1.00, sensitivity of 100%, specificity of 100%, PPV of 100%, NPV of 100%, and Youden’s index of 1.0. Conclusions: Both conventional ultrasound and CEUS are reliable methods in determining the severity of active Crohn’s disease. The diagnostic performance in terms of Youden’s index was highest for the Imax of the interior layer, in comparison with all other features on conventional ultrasound, qualitative CEUS, and quantitative CEUS.

New diagnostic methods are required to diagnose renal mass. Thus, we assessed virtual tissue quantification (VTQ) of acoustic radiation force impulse (ARFI) elastography in differentiation of renal solid masses. Forty-two patients with renal masses were assessed by VTQ in terms of measurement of the shear wave velocity (SWV). The masses were divided into three groups. They were clear cell carcinoma (CCC) angiomyolipoma (AML), and pseudotumor. The differences among the three groups in SWV, as well as between masses and its surrounding parenchyma, were investigated. Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance. We found that the SWV among the three groups were significant different (F = 6.976, P = 0.003) and the SWV of pseudotumor (3.14 ± 0.75 m/s) was significantly higher than CCC (2.46 ± 0.45 m/s) and AML (2.49 ± 0.63 m/s) (P = 0.007 and 0.001 respectively). There were no significant difference between CCC and AML in SWV (P = 0.719). For each group, there was no significant difference between the mass and its surrounding parenchyma (P = 0.693, 0.892, and 0.714, respectively). Between pseudotumor and CCC, the optimal cut-off value of SWV for differential diagnoses was 3.07 m/s; and the area under the ROC curve (AUC) was 0.78 (95% CI: 0.560 to 0.924) (P = 0.004), the sensitivity and specificity were 100% and 58.3%, respectively. Between pseudotumor and AML, the optimal cut-off value of SWV for differential diagnoses was 3.03 m/s, thus AUC curve was 0.786 (95% CI: 0.591 to 0.918) (P = 0.002), the sensitivity and specificity were 100% and 58.3%, respectively. No significant difference was found between AML and CCC (P = 0.587) and the AUC was 0.562. To conclude, our results support that ARFI has potential value in differentiation between CCC and pseudotumor, or between AML and pseudotumor, however, it fails to make a distinction between CCC and AML.

Objective: The aim of the study was to assess the role of contrast-enhanced ultrasound (CEUS) in treatment response evaluation after percutaneous bipolar radiofrequency ablation (BRFA) for liver tumors. Methods: From May 2012 to May 2014, 39 patients with 73 tumors were treated by BRFA. One month after the treatment, CEUS and CEMRI/CECT were conducted to evaluate the treatment response. The results of CEUS were compared with CEMRI/CECT. Results: Of the 73 tumors ablated, eight (11.0%) were found to have residual viable tumor tissue and 65 (89.0%) were successfully ablated based on CEMRI/CECT within 1-month after ablation. CEUS detected seven of the eight residual tumors and 63 of 65 completely ablated tumors. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CEUS were 87.5% (7/8), 96.9% (63/65), 77.8% (7/9), 98.4% (63/64) and 95.9% (70/73), respectively. The complete ablation (CR) rates for the tumors ≤3.0 cm, 3.1-5.0 cm, and >5.0 cm were 96.6% (58/60), 63.6% (7/11), and 0% (0/2), respectively (P

OBJECTIVE: Transperineal ultrasound-guided (TPUS) 12-core prostate biopsy was evaluated as an initial strategy for the diagnosis of prostate cancer, The distribution of prostate cancer lesions was assessed with zone-specific biopsy. METHODS: From January 2010 to December 2012, 287 patients underwent TPUS-guided 12-core prostate biopsy. Multiple cores were obtained from both the peripheral zone (PZ) and the transition zone (TZ) of the prostate. Participants' clinical data and the diagnostic yield of the cores were recorded and prospectively analyzed as a cross-sectional study. RESULTS: The diagnostic yield of the 12-core prostate biopsy was significantly higher compared to the 6-core scheme (42.16 vs. 21.6%). The diagnostic yield of the 10-core prostate biopsy was significantly higher compared to the 6-core scheme (37.6 vs. 21.6%). The 12-core scheme improved the diagnostic yield in prostates >50 ml (12-core scheme: 28.1% vs. 10-core scheme: 20.4%; p = 0.034). CONCLUSIONS: The 12-core biopsy scheme is a safe and effective approach for the diagnosis of prostate cancer. TZ biopsies in patients with larger prostates should be included in the initial biopsy strategy.

Purpose. To evaluate the diagnostic performance of ARFI imaging in differentiating between benign and malignant thyroid nodules Materials and Methods. 173 pathologically proven thyroid nodules (77 benign, 96 malignant) in 157 patients were included in this study. Receiver-operating characteristic curve (ROC) analyses were performed to assess the diagnostic performance of conventional ultrasound (US) and ARFI imaging in papillary thyroid microcarcinoma (PTMC). The independent risk factors for predicting PTMC were evaluated.Results. The mean SWV value of benign and malignant thyroid nodules were 2.57 ± 0.79 m/s (range: 0.90–4.92 m/s) and 3.88 ± 2.24 m/s (range: 1.49–9.00 m/s) (P=0.000). Az for VTI elastography score was higher than that for hypoechoic, absence of halo sign, and type III vascularity (P<0.05). The optimal cut-offs for VTI elastography score and SWV were score 4 and 3.10 m/s. Gender, hypoechoic, taller than wide, VTI elastography score ≥ 4, and SWV > 3.10 m/s had been found to be independent risk factors for predicting PTMC.Conclusion. ARFI elastography can provide elasticity information of PTMC quantitatively (VTQ) and directly reflects the overall elastic properties (VTI). Gender, hypoechogenicity, taller than wide, VTI elastography score ≥ 4, and SWV > 3.10 m/s are independent risk factors for predicting PTMC. ARFI elastography seems to be a new tool for the diagnosis of PTMC.

To investigate the correlation between enhancement patterns of intrahepatic cholangiocarcinoma (ICC) on contrast-enhanced ultrasound (CEUS) and pathological findings.The CEUS enhancement patterns of 40 pathologically proven ICC lesions were retrospectively analysed. Pathologically, the degree of tumour cell and fibrosis distribution in the lesion was semi-quantitatively evaluated.4 enhancement patterns were observed in the arterial phase for 32 mass-forming ICCs: peripheral rim-like hyperenhancement (n=19); heterogeneous hyperenhancement (n=6); homogeneous hyperenhancement (n=3); and heterogeneous hypo-enhancement (n=4). Among the four enhancement patterns, the differences in tumour cell distribution were statistically significant (p0.05). The hyperenhancing area on CEUS corresponded to more tumour cells for mass-forming ICCs. Heterogeneous hyperenhancement (n=2) and heterogeneous hypo-enhancement (n=2) were observed in the arterial phase for four periductal infiltrating ICCs. In this subtype, fibrosis was more commonly found in the lesions. Heterogeneous hyperenhancement (n=1) and homogeneous hyperenhancement (n=3) were observed in the arterial phase for four intraductal growing ICCs. This subtype tended to have abundant tumour cells.The CEUS findings of ICC relate to the degree of carcinoma cell proliferation at pathological examination. Hyperenhancing areas in the tumour always indicated increased density of cancer cells.

To investigate the diagnostic performance of combined use of conventional ultrasound (US) and elastography, including conventional strain elastography such as elasticity imaging (EI) and acoustic radiation force impulse (ARFI) elastography, and to evaluate their usefulness in recommending fine-needle aspiration (FNA). A total of 556 pathologically proven thyroid nodules were evaluated by US, EI, and ARFI examinations in this study. Three blinded readers scored the likelihood of malignancy for 4 datasets (ie, US alone, US and EI, US and virtual touch tissue imaging [VTI], and US and virtual touch tissue quantification [VTQ]). The diagnostic performances of 4 datasets in differentiating malignant from benign thyroid nodules were evaluated. The decision-making changes for FNA recommendation in the indeterminate nodules or the probably benign nodules on conventional US were evaluated after review of elastography. The diagnostic performance in terms of area under the ROC curve did not show any change after adding EI, VTI, or VTQ for analysis; and no differences were found among different readers; however, the specificity and positive predictive value (PPV) improved significantly after adding VTI or VTQ for analysis in the senior reader. For the indeterminate nodules on US that were pathologically benign, VTQ made correct decision-making changes from FNA biopsy to follow-up in a mean of 82.6% nodules, which was significantly higher than those achieved by EI (46.8%) and VTI (54.4%) (both P

OBJECTION: To investigate the safety and treatment response of radioimmunotherapy (RIT) in combination with radiofrequency ablation (RFA) for the treatment of VX2 tumor on rabbit. MATERIALS AND METHODS: A total of 36 rabbits bearing VX2 tumor on the thigh were randomly assigned into 3 groups (group I: 1-2 cm; group II: 2-3 cm; group III: 3-4 cm) and 4 subgroups (A: as control, just puncture the tumor using the RFA electrode without power output; B: RFA alone; C: 131I-chTNT intratumoral injection alone; D: RFA+131I-chTNT intratumoral injection 3 days later). The variation of blood assay, weight and survival among different groups and subgroups were used to assess the treatment safety. Ultrasound (US) was used to monitor and assess the tumor response after treatment. RESULTS: According to the results of the weight and the blood assay among different groups, subgroups, and at two time points (one day before and the 16th day after treatment), no damages to the liver, kidney function and myelosuppression resulting from the treatment were found. No significant differences in survivals among the four subgroups (p = 0.087) were found. In addition, 131I-chTNT did not show significant inhibition effect on VX2 tumor progression according to US measurements. CONCLUSION: 131I-chTNT intratumoral injection alone or in combination with RFA is relatively safe for rabbit without significant toxicity and shows no significant effect on the survival. The treatment response is not as satisfactory as anticipated.

Schwannomas occurring in the gallbladder are extremely rare. Preoperative diagnosis of gallbladder schwannomas appears to be very difficult because they are normally asymptomatic and are often found incidentally. Until now, only five cases have been reported in the literature. To our knowledge, the contrast-enhanced ultrasound (CEUS) features of gallbladder schwannomas have not been reported before in other studies. We treated a 55-year-old male patient with gallbladder schwannoma in China. He had no symptoms, and the lesion was incidentally found by conventional ultrasound (US) when performing a health examination. The patient had normal liver function; moreover, serum carcinoembryonic antigen and alpha-fetoprotein were within the normal ranges. The lesion showed no blood flow signals on color Doppler US, and the wall beneath the lesion was intact on CEUS. The lesion was believed to be a benign entity; in addition, gallbladder adenomyomatosis was suspected. A laparoscopic cholecystectomy was performed to remove the mass. Pathological examination revealed that the tumor was mainly composed of spindle-shaped cells; neither atypical cells nor signs of malignancy were found. Immunohistochemical staining showed a strong positive S-100 protein reaction. Vimentin and CD56 staining were also positive, whereas CD34 and CD117 were negative. Finally, the lesion was diagnosed as schwannoma. Herein, we report the case; the associated literature is also reviewed.