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Triple-negative breast cancer is a complex type of breast cancer,the most common malignant tumor in women.Since the early image features of triple-negative breast cancer appear benign tumor with rapid growth,this cancer has progressed into the middle and late stages once diagnosed,which leads to high mortality.Therefore,the diagnosis of triple-negative breast cancer has always been a clinical difficulty.This article summarizes the role of ultrasound in the diagnosis and treatment of triple-negative breast cancer.The extracted multi-mode ultrasound features will facilitate the early detection of this cancer and improve the prognosis of these patients.

Background: The current deep learning diagnosis of breast masses is mainly reflected by the diagnosis of benign and malignant lesions. In China, breast masses are divided into four categories according to the treatment method: inflammatory masses, adenosis, benign tumors, and malignant tumors. These categorizations are important for guiding clinical treatment. In this study, we aimed to develop a convolutional neural network (CNN) for classification of these four breast mass types using ultrasound (US) images., Methods: Taking breast biopsy or pathological examinations as the reference standard, CNNs were used to establish models for the four-way classification of 3623 breast cancer patients from 13 centers. The patients were randomly divided into training and test groups (n = 1810 vs. n = 1813). Separate models were created for two-dimensional (2D) images only, 2D and color Doppler flow imaging (2D-CDFI), and 2D-CDFI and pulsed wave Doppler (2D-CDFI-PW) images. The performance of these three models was compared using sensitivity, specificity, area under receiver operating characteristic curve (AUC), positive (PPV) and negative predictive values (NPV), positive (LR+) and negative likelihood ratios (LR-), and the performance of the 2D model was further compared between masses of different sizes with above statistical indicators, between images from different hospitals with AUC, and with the performance of 37 radiologists., Results: The accuracies of the 2D, 2D-CDFI, and 2D-CDFI-PW models on the test set were 87.9%, 89.2%, and 88.7%, respectively. The AUCs for classification of benign tumors, malignant tumors, inflammatory masses, and adenosis were 0.90, 0.91, 0.90, and 0.89, respectively (95% confidence intervals [CIs], 0.87-0.91, 0.89-0.92, 0.87-0.91, and 0.86-0.90). The 2D-CDFI model showed better accuracy (89.2%) on the test set than the 2D (87.9%) and 2D-CDFI-PW (88.7%) models. The 2D model showed accuracy of 81.7% on breast masses ≤1 cm and 82.3% on breast masses >1 cm; there was a significant difference between the two groups (P < 0.001). The accuracy of the CNN classifications for the test set (89.2%) was significantly higher than that of all the radiologists (30%)., Conclusions: The CNN may have high accuracy for classification of US images of breast masses and perform significantly better than human radiologists., Trial Registration: Chictr.org, ChiCTR1900021375; http://www.chictr.org.cn/showproj.aspx?proj=33139., (Copyright © 2021 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.)

The purpose of this study was to evaluate the feasibility of delineating the substructure of the heart by using 64-slice spiral CT coronary angiography (CTA) in breast cancer patients who underwent left breast-conserving surgery, and to compare the dosimetric differences between the targets and organs at risk in the prone and supine positions in intensity-modulated radiation therapy (IMRT) planning. From January to December 2011, ten patients who underwent left breast-conserving surgery were enrolled in this study. CTA was performed in both the supine and prone positions during the simulation, and conventional scanning without CTA was performed at the same time. Image registration was performed for paired image series using a commercially available planning system. In a conventional image series, the clinical target volume (CTV) of the whole breast, planning target volume (PTV), bilateral lungs (L-Lung, R-Lung), spinal cord, contralateral breast (R-Breast), and heart were delineated. In the CTA image series, the left ventricular (LV) and left anterior descending coronary arteries (LAD) and the planning risk volume (LAD-PRV) of the LAD (LAD with a 1 cm margin) were outlined. For each patient, two separate IMRT plans were developed for the supine and prone positions. A total of 20 plans were generated. The following indicators were compared: Dmean and D95 for the PTV; Dmean, V5, and V20 for the left lung; Dmean, V10, V20, V25, V30, and V40 for the heart and its substructures (LAD-PRV, LV); Dmean and V5 for the right lung; and Dmax and Dmean for the right breast. Using CTA to delineate the substructures of the heart is simple and straightforward. Plans for both the prone and supine positions reached the prescribed dose for the PTV without significant differences. Dose distributions were acceptable for both the prone and supine positions. However, the LAD-PRV, LV, heart, and L-Lung received smaller doses in the prone position plans than in the supine position plans. The Dmean values reduced by 445.83 cGy (p = 0.043), 575.00 cGy (p = 0.003), 402.00 cGy (p = 0.039), and 553.33 cGy (p = 0.004) in the LAD-PRV, LV, heart, and L-Lung. In addition, the V25 lessened 12.54% (p = 0.042) and 8.70% (p = 0.019) in the LV and heart, while the V20 was decreased 8.57% (p = 0.042), 15.21% (p = 0.026), 12.59% (p = 0.011), and 10.62% (p = 0.006) in the LAD-PRV, LV, heart, and L-Lung, respectively. Similarly, the V10 and V30 were reduced by 28.31% (p = 0.029) and 5.54% (p = 0.034) in the heart, while the V5 was cut back 27.86% (p = 0.031) in the L-Lung. For most Asian women with average-sized breasts after breast conserving treatment (BCT), prone positioning during IMRT radiation will reduce the dose to the ipsilateral lung, heart, and substructures of the heart, which may reduce the incidence of cardiovascular events after radiotherapy more than radiation therapy performed in a supine position. Using CTA to delineate the substructures of the heart is easy and intuitive. It is cost-effective and highly recommended for breast cancer IMRT. However, the dose-volume limits of the heart substructures remain to be determined.

Background: To assess the accuracy of ultrasound-guided 16G or 18G core needle biopsy (CNB) for ultrasound-visible breast lesions, and to analyze the effects of lesion features., Methods: Between July 2005 and July 2012, 4,453 ultrasound-detected breast lesions underwent ultrasound-guided CNB and were retrospectively reviewed. Surgical excision was performed for 955 lesions (566 with 16G CNB and 389 with 18G CNB) which constitute the basis of the study. Histological findings were compared between the ultrasound-guided CNB and the surgical excision to determine sensitivity, false-negative rate, agreement rate, and underestimation rate, according to different lesion features., Results: Final pathological results were malignant in 84.1% (invasive carcinoma, ductal carcinoma in situ, lymphoma, and metastases), high-risk in 8.4% (atypical lesions, papillary lesions, and phyllodes tumors), and benign in 7.5%. False-negative rates were 1.4% for 16G and 18G CNB. Agreement rates between histological findings of CNB and surgery were 92.4% for 16G and 92.8% for 18G CNB. Overall underestimate rates (high-risk CNB becoming malignant on surgery and ductal carcinoma in situ becoming invasive carcinoma) were 47.4% for 16G and 48.9% for 18G CNB. Agreements were better for mass lesions (16G: 92.7%; 18G: 93.7%) than for non-mass lesions (16G, 85.7%; 18G, 78.3%) (P <0.01). For mass lesions with a diameter ≤10 mm, the agreement rates (16G, 83.3%; 18G, 86.7%) were lower (P <0.01)., Conclusions: Ultrasound-guided 16G and 18G CNB are accurate for evaluating ultrasound-visible breast mass lesions with a diameter >10 mm.

Objective: To evaluate the underestimation of papillary breast lesions diagnosed at ultrasound-guided breast biopsy., Methods: Totally 4453 ultrasound-guided visible breast lesions that were identified in the Department of Ultrasound, Chinese PLA General Hospital, from April 2005 to April 2012 were retrospectively reviewed. Of 207 papillary lesions that were detected by histologic findings of ultrasound-guided core needle biopsy(US-CNB), 90 underwent surgical excision, 110 were followed up for at least one year, and 7 were lost to follow-up. The histological findings of the US-CNB and the findings of surgical excision were compared to analyze the underestimation rates according to the Breast Imaging Reporting and Data System(BI-RADS)categories of American College of Radiology(ACR)and biopsy methods., Results: Of the 90 papillary lesions underwent surgical excision, 29(32.2%)were underestimated, and 22 malignant lesions were underestimated(24.4%). Of the 23 papillomata with atypical ductal hyperplasia(IDP+ADH), 11(47.8%)were upgraded to malignant. Of the 137 benign intraductal papilloma(IDP)with concordance imaging-histologic findings, 8 lesions were underestimated(5.8%), whereas 10 out of 25(40.0%)IDP with diacordant imaging-histologic findings were underestimated. In total, 17.9% understimation were biopsied by 18G core needle biopsy(CNB)(P=0.017)and 16.0% by 16G CNB(P=0.023), which were significantly higher than vacuum-assisted biopsy(VAB)., Conclusions: VAB is more accurate than 16G or 18G CNB in detecting papillary breast lesions. For high underestimations of IDP+ADH and IDP with discordant imaging-histologic findings, VAB or surgical excisions should be performed.

The aim of this study was to investigate the application of ultrasonic gas-filled liposomes in enhancing transfer for breast cancer-related antisense oligonucleotides in vitro. An antisense oligodeoxynucleotide (AS-ODN) sequence, HA2741, modified with luciferase reporter plasmid, was used in evaluating the enhancing effect of gas-filled liposomes for gene transfer in breast cancer cells. Some important factors on HA 2741 transfection efficiency, such as wave intensity, ultrasound duration, gas-filled liposome concentration, and HA2741 concentration, were tested, respectively. Transfection efficiency was detected by fluorescence microscopy. Cell viability was verified by propidium iodide assay. Reverse-transcriptase polymerase chain reaction and immunocytochemistry were used to detect the inhibitory effect of HA2741 on HER-2 expression. All the four factors (wave intensity, ultrasound duration, gas-filled liposome concentration, and HA2741 concentration) showed a positive effect on AS-ODN transfection efficiency. However, these factors had a negative effect on cell viability. Considering all the factors investigated, the maximum transfection efficiency with minimum cell viability achieved under 2% gas-filled liposome mixed with 80 nmol/L HA2741 for 30-second ultrasound exposure at -3.0 dB wave intensity, which gave an overall transfection efficiency exceeding 90% and a cell viability near 90%. Under controlled conditions, ultrasound-mediated AS-ODN transfer, enhanced by gas-filled liposomes, may represent an effective, safe avenue for cancer-related gene delivery.