A Novel Approach to Breast Tumor Detection: Enhanced Speckle Reduction and Hybrid Classification in Ultrasound Imaging

Breast cancer detection heavily relies on medical imaging, particularly ultrasound, for early diagnosis and effectivetreatment. This research addresses the challenges associated with computer-aided diagnosis (CAD) of breastcancer fromultrasound images. The primary challenge is accurately distinguishing between malignant and benigntumors, complicated by factors such as speckle noise, variable image quality, and the need for precise segmentationand classification. The main objective of the research paper is to develop an advanced methodology for breastultrasound image classification, focusing on speckle noise reduction, precise segmentation, feature extraction, andmachine learning-based classification. A unique approach is introduced that combines Enhanced Speckle ReducedAnisotropic Diffusion (SRAD) filters for speckle noise reduction, U-NET-based segmentation, Genetic Algorithm(GA)-based feature selection, and Random Forest and Bagging Tree classifiers, resulting in a novel and efficientmodel. To test and validate the hybrid model, rigorous experimentations were performed and results state thatthe proposed hybrid model achieved accuracy rate of 99.9%, outperforming other existing techniques, and alsosignificantly reducing computational time. This enhanced accuracy, along with improved sensitivity and specificity,makes the proposed hybrid model a valuable addition to CAD systems in breast cancer diagnosis, ultimatelyenhancing diagnostic accuracy in clinical applications.

Expect the unexpected:Brown tumor of the mandible as the first manifestation of primary hyperparathyroidism

Hyperparathyroidism(HPT)is a condition in which one or more parathyroid glands produce increased levels of parathyroid hormone(PTH),causing disturbances in calcium homeostasis.Most commonly HPT presents with asymptomatic hypercalcemia but the clinical spectrum may include disturbances reflecting the combined effects of increased PTH secretion and hypercalcemia.Brown tumors are rare,benign,tumor-like bone lesions,occurring in 1.5%to 4.5%of patients with HPT,as a complication of an uncontrolled disease pathway,and are nowadays rarely seen in clinical practice.The tumor can appear either as a solitary or multifocal lesion and usually presents as an asymptomatic swelling or a painful exophytic mass.Furthermore,it can cause a pathological fracture or skeletal pain and be radiologically described as a lytic bone lesion.The diagnosis of a brown tumor in HPT is typically confirmed by assessing the levels of serum calcium,phosphorus,and PTH.Although when present,brown tumor is quite pathognomonic for HPT,the histologic finding often suggests a giant cell tumor,while clinical presentation might suggest other more frequent pathologies such as metastatic tumors.Treatment of brown tumors frequently focuses on managing the underlying HPT,which can often lead to regression and resolution of the lesion,without the need for surgical intervention.However,in refractory cases or when dealing with large symptomatic lesions,surgical treatment may be necessary.

Complementary comments on metastatic liver lesions with exceptional and rare cases

Liver metastases can appear in different forms in magnetic resonance imaging.Contrary to popular belief,while radiologists report hypovascular or hypervascular metastatic lesions,exceptional examples may be detected in various tumors.The aim of this article is to improve this review by presenting rare and atypical examples of liver metastasis,as well as cases that might potentially be misdiagnosed as metastases during the process of differential diagnosis.

Endoscopic ultrasound-guided tissue acquisition for the diagnosis of focal liver lesion

In patients with liver tumors,the histopathology examination can assist in diagnosis,staging,prognosis,and therapeutic management strategy.Endoscopic ultrasound(EUS)-guided tissue acquisition using fine needle aspiration(FNA)or more newly fine needle biopsy(FNB)is a well-developed technique in order to evaluate and differentiate the liver masses.The goal of the EUS-FNA or EUS-FNB is to provide an accurate sample for a histopathology examination.Therefore,malignant tumors such as hepatocarcinoma,cholangiocarcinoma and liver metastasis or benign tumors such as liver adenoma,focal hyperplastic nodular tumors and cystic lesions can be accurately diagnosed using EUS-guided tissue acquisition.EUS-FNB using 19 or 22 Ga needle provide longer samples and a higher diagnostic accuracy in patients with liver masses when compared with EUS-FNA.Few data are available on the diagnostic accuracy of EUS-FNB when compared with percutaneously,ultrasound,computer tomography or transjugulary-guided liver biopsies.This review will discuss the EUS-guided tissue acquisition options in patients with liver tumors and its efficacy and safety in providing accurate samples.The results of the last studies comparing EUS-guided liver biopsy with other conventional techniques are presented.The EUS-guided tissue acquisition using FNB can be a suitable technique in suspected liver lesions in order to provide an accurate histopathology diagnosis,especially for those who require endoscopy.

Expression of p-STAT3 and vascular endothelial growth factor in MNNG-induced precancerous lesions and gastric tumors in rats

AIM: To investigate the dynamic expression of p-signal transducer and activator of transcription 3(STAT3) and vascular endothelial growth factor(VEGF) in the formation of gastric tumors induced by drinking water containing N-methyl-N'-nitro-N-nitrosoguanidine(MNNG) in Wistar rats.METHODS: One hundred and twenty Wistar rats were randomly divided into two groups(60 in each group): Control group and Model group. The rats in each group were then randomly divided into three groups(20 in each group): C/M15, C/M25 and C/M40(15, 25 and 40 represent the number of feeding weeks from termination). Rats in the control group received normal drinking water and rats in the model group received drinking water containing 100 μg/m L MNNG. Stomach tissues were collected at the end of the 15 th, 25 th and 40 th week, respectively, for microscopic measurement using hematoxylin and eosin staining. The expression of p-STAT3 and VEGF in different pathological types of gastric tissue, including normal, inflammation, atrophy, hyperplasia and gastric stromal tumor, was observed by immunohistochemistry and Western blot, and the corelation between p-STAT3 and VEGF was analyzed. RESULTS:(1) The expression of p-STAT3 in tissue with gastritis, atrophy, dysplasia and gastric stromal tumor were significantly increased in the model group compared with the control group(2.5 ± 1.0, 2.75 ±0.36, 6.2 ± 0.45, 5.67 ± 0.55 vs 0.75 ± 0.36, P = 0.026, 0.035, 0.001, 0.002, respectively); the expression of p-STAT3 in tissue with dysplasia was higher than that in samples with gastritis or atrophy(6.2 ± 0.45 vs 2.5 ± 1.0, P = 0.006; 6.2 ± 0.45 vs 2.75 ± 0.36, P = 0.005, respectively); however, the expression of p-STAT3 in gastritis and atrophy was not significantly different(P > 0.05);(2) the expression of VEGF in tissue with gastritis, atrophy, dysplasia and gastric stromal tumor was significantly increased in the model group compared with normal gastric mucosa; and the expression of VEGF in tissue with dysplasia was higher than that in tissue with inflammation and atrophy(10.8 ± 1.96 vs 7.62 ± 0.25, P = 0.029; 10.8 ± 1.96 vs 6.26 ± 0.76, P = 0.033, respectively); similarly, the expression of VEGF in tissue with gastritis and atrophy was not significantly different(P > 0.05); and(3) the expression of VEGF was positively correlated with p-STAT3. CONCLUSION: p-STAT3 plays an important role in gastric cancer formation by regulating the expression of VEGF to promote the progression of gastric tumor from gastritis.

Esophageal subepithelial lesion diagnosed as malignant gastrointestinal neuroectodermal tumor

A 21-year-old male visited our hospital with a complaint of aggravating dysphagia and odynophagia for a few days.Esophagogastroduodenoscopy showed huge bulging mucosa with an intact surface causing luminal narrowing at 35 cm from the incisor teeth.Endoscopic ultrasonography showed an about 35 mm sized irregular margined in-homogenous hypoechoic lesion with an obscure layer of origin.Endoscopic ultrasonography fine needle aspiration revealed spindle cell proliferation without immunoreactivity for CD117,SMA,and cytokeratin.The patient underwent excision of the subepithelial lesion at the distal esophagus.On pathologic examination of the specimen,the tumor was composed of short fascicles of oval to spindle cells with eosinophilic and clear cytoplasm and vesicular nuclei.The tumor cells were positive for S-100 and SOX10and negative for CD117,SMA,HMB-45,melan-A,cytokeratin,and CD99.The split-apart signal was detected in EWSR1 on FISH,suggesting a malignant gastrointestinal neuroectodermal tumor.At the time of writing,the patient is on radiation therapy at the operated site of esophagus and doing well,with no recurrence for three months.Malignant gastrointestinal neuroectodermal tumor is a rare gastrointestinal tumor with features of clear cell sarcoma,without melanocytic differentiation,and shows a poor prognosis.This is the first reported case of malignant gastrointestinal neuroectodermal tumor arising as subepithelial lesion in the esophagus.

Tumor response assessment by the single-lesion measurement per organ in small cell lung cancer

Background： The criterion of two target lesions per organ in the Response Evaluation Criteria in Solid Tumors （RECIST） version I. 1 is an arbitrary one, being supported by no objective evidence. The optimal number of target lesions per organ still needs to be investigated. We compared tumor responses using the RECIST 1.1 （measuring two target lesions per organ） and modified RECIST I. 1 （measuring the single largest lesion in each organ） in patients with small cell lung cancer （SCLC）. Methods： We reviewed medical records of patients with SCLC who received first-line treatment between January 2004 and December 2014 and compared tumor responses according to the two criteria using computed tomography. Results： There were a total of 34 patients who had at least two target lesions in any organ according to the RECIST 1.1 during the study period. The differences in the percentage changes of the sum of tumor measurements between RECIST 1.1 and modified RECIST 1.1 were all within 13%. Seven patients showed complete response and fourteen showed partial response according to the RECIST I.I. The overall response rate was 61.8%. When assessing with the modified RECIST 1.1 instead of the RECIST 1.1, tumor responses showed perfect concordance between the two criteria （k= 1.0）. Conclusions： The modified RECIST 1.I showed perfect agreement with the original RECIST 1.I in the assessment of tumor response of SCLC. Our result suggests that it may be enough to measure the single largest target lesion per organ for evaluating tumor response.

Metastasia Lesion of Gestation Trophoblastic Tumor in Abdominopelvic Cavity Diagnosed by Sonographic and Doppler Imaging

Objective: The purpose of this study was to review clinical data of metastasia lesion of gestation trophoblastic tumor (GTT) in abdominopelvic cavity by color Doppler ultrasound. Subjects and Methods: A retrospective analysis of 13 cases of GTT in China was performed. Clinical appearances, serum human chorionic gonadotropin (hCG) levels, sonographic findings, Doppler waveforms, and patient outcomes were followed up. Color Doppler ultrasound was performed to diagnose the presence of GTT, detect metastasia lesion in abdominopelvic cavity, assess disease recurrence, and monitor the efficacy of chemotherapy. Results: Of the 13 patients with GTT, 4 had choriocarcinoma which 3 cases occurred after an abortion, 1 after a year of dilation and suction evacuation for the hydatidform mole. Metastasia lesion in abdominopelvic cavity was detected by color Doppler ultrasound in all cases of choriocarcinoma, among which the metastasia lesion were found at uterine fundus, near uterus, colon and cystic vascular space near the uterus, repectively. 9 cases with an invasive hydatidiforn mole (IHM) occurred after one to three months of dilation and suction evacuation for the hydatidform mole, consistant with the hCG levels markedly elevating. Metastasia lesion in abdominopelvic cavity was also detected by color Doppler ultrasound besides invasive lesion in uterine muscular layer in all cases of IHM, among which 3 cases showed metastasia lesion in cystic vascular space near the uterus, 2 cases were detected in side wall of pelvic cavity, while the rest were found in abdominal cavity, right kidney, colon and near uterus, respectively. Meanwhile, the image of metastasia lesion with IHM was similar to choriocarcinoma’s. And the reticular structure, the cystic vascular space and solid lesion may be showed by ultrasound. The metastasia lesion had abundant flow. Doppler waveforms showed resistive indices of 0.34 (SD 0.07) for metastasia lesion. There was the same lower-impedance as invasive lesion in uterine muscular layer. Except an IHM with the renal metastasia lesion having been followed, abnormal sonographic and Doppler findings in other metastasia disease all disappeared after surgical operation or chemotherapy were successful. Conclusions: Sonography and Doppler imaging were helpful in detecting metastasia lesion in abdominopelvic cavity, and in following the effectiveness of chemotherapy. And it should be taken full examination for GTT by Color Doppler ultrasound in order to avoid mistake.

Application of ^(18) F-FDG PET/CT Imaging in Diagnosing Bladder Tumor Metastasis Lesions

Bladder tumor is the most common malignant tumor in urinary system and always com- panied with lymph node metastasis. The accurate staging plays a significant role in treatment for bladder tumor and prognostic evaluation, and the distant metastasis predicts worse prognosis. The objective of this study was to assess the clinical significance of 18F-FDG PET/CT imaging in diagnosing bladder tumor metastasis lesions. A retrospective analysis of 60 patients with bladder tumor from October 2008 to May 2010 was done. The patients were stratified based on the imaging technique. Among all 60 cases, besides the primary lesion, 81 suspected lesions were spotted and 73 confirmed as metastasis, including 50 lymph node metastases, 22 distant metastases, and 1 bone metastasis. For PET/CT imaging, its sensitivity was 94.5%, specificity 87.5%, positive predictive value 98.6%, negative predictive value 63.6% and accuracy 93.8% respectively. For CT, its sensitivity was 82.2%, specificity 50%, positive predictive value 93.8%, negative predictive value 23.5% and accuracy 79% respectively. PET/CT im- aging was superior to CT in sensitivity, specificity and accuracy. In conclusion, 18F-FDG PET/CT imaging is more significant in diagnosing bladder tumor metastasis lesions.

基于瘤体及瘤周多参数MRI对乳腺病变良恶性诊断列线图预测模型的构建与评价

目的:建立基于瘤体及瘤周多参数MRI的乳腺病变良恶性鉴别诊断的列线图模型,并验证其预测效能。方法:纳入经病理学检查明确乳腺病变性质的100例患者作为研究对象,所有患者均行核磁共振(MRI)检查和病理检查,根据病理检查结果分为乳腺良性病变组(n=62)和乳腺恶性病变组(n=38)。收集患者临床资料、瘤体各参数、瘤周各参数以及乳腺病变良恶性情况。多因素Logistic回归分析筛选乳腺恶性病变的危险因素并构建列线图预测模型,采用受试者工作特征(ROC)曲线和Hosmer-Lemeshow拟合优度检验验证模型的预测效能及拟合优度;内部验证采用Bootstrap。结果:乳腺恶性病变组病灶直径、平均扩散峰度(MK)、MDp/t、瘤周与瘤体MKp/n高于乳腺良性病变组(均P<0.05);乳腺恶性病变组表观扩散系数(ADC)值、平均扩散率(MD)、非对称磁化转移率(MTRasym)、MKp/t、MDp/n低于乳腺良性病变组(均P<0.05)。多因素分析结果显示,病灶直径、MK、MDp/t、MKp/n升高,ADC值、MD、MTRasym、MKp/t、MDp/n降低是乳腺恶性病变的独立影响因素(均P<0.05)。基于上述独立影响因素构建乳腺恶性病变的列线图预测模型,曲线下面积(AUC)为0.827。Hosmer-Lemeshow拟合优度检验显示P值为0.004。采用Bootstrap法,生成的校准曲线拟合良好。结论:瘤体及瘤周多参数MRI对乳腺病变良恶性鉴别诊断具有重要预测价值,基于乳腺恶性病变的独立影响因素构建的列线图预测效果良好,能直观预测乳腺发生恶性病变的概率。

自身免疫性胰腺炎患者少见的影像表现

自身免疫性胰腺炎(autoimmune pancreatitis,AIP)是一种特殊类型的胰腺炎症,其常见的影像学特征已被影像科医师熟知,成为诊断AIP的影像学依据。然而在临床工作中我们也发现,除了常见的影像表现,AIP还可出现主胰管扩张、胰腺囊性病变、胰腺周围血管受累、胰腺钙化与胰管结石、类固醇治疗后短期内显著胰腺萎缩、合并恶性肿瘤等少见的影像表现。为进一步提高对AIP影像表现的认识,本文介绍这些AIP少见的CT和MRI表现。

可溶性肿瘤坏死因子样凋亡弱诱导因子在斑秃病人血清及皮损中的表达及临床意义

目的检测可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)在斑秃病人血清及皮损中的表达水平,并探讨其在斑秃发病过程中的作用及临床意义。方法以2017年10月至2018年11月在首都医科大学附属北京友谊医院确诊并治疗的斑秃病人70例为斑秃组,依据病情分为轻症组(44例)、重症组(26例)。同期该院因色素痣或皮肤良性肿瘤进行头皮手术的人群65例作为对照组。比较各组sTWEAK及相关细胞因子白细胞介素(IL)-4、IL-12、γ干扰素(IFN-γ)蛋白及mRNA表达水平;采用Pearson法分析两指标间相关性。多元线性回归分析各指标与sTWEAK或脱发严重度工具(SALT)评分的关系。结果斑秃组血清及皮损中sTWEAK表达水平[(196.73±32.48)ng/L,(2.35±0.62)ng/L]高于对照组[(121.75±19.62)ng/L,(1.49±0.45)ng/L](P<0.05)。斑秃组血清及皮损中细胞因子IL-12、IFN-γ表达水平高于对照组(P<0.05),IL-4表达水平比较差异无统计学意义(P>0.05)。斑秃病人血清及皮损中sTWEAK表达水平与IL-12及IFN-γ呈正相关,与IL-4表达水平无明显相关性。轻症组血清及皮损中sTWEAK[(173.25±26.84)ng/L,(2.04±0.57)ng/L]、IL-12及IFN-γ表达水平低于重症组[(236.47±42.02)ng/L,(2.87±0.70)ng/L](P<0.05);轻症组、重症组血清及皮损中IL-4表达水平差异无统计学意义(P>0.05);斑秃病人血清、皮损处sTWEAK、IL-12、IFN-γ与SALT评分均呈正相关(P<0.05)。多元线性回归分析显示,IL-12、IFN-γ与血清和皮损处sTWEAK呈显著正相关;血清及皮损处sTWEAK、IL-12、IFN-γ与SALT评分存在正相关性(P<0.05)。结论斑秃病人血清及皮损中sTWEAK表达水平增加,与IL-12及IFN-γ呈正相关,sTWEAK、IL-12及IFN-γ均与斑秃病情严重程度密切相关,sTWEAK可能参与斑秃炎症反应过程。

超声误诊为乳腺癌临床特征与风险预测模型构建

目的分析超声误诊为乳腺癌临床特征,并构建误诊风险预测模型。方法选取2021年1月至2023年12月行超声检查的乳腺肿块患者602例,按照误诊情况分为误诊组和诊断准确组,分析超声误诊为乳腺癌病例特征,并构建误诊风险预测模型。结果共有30例误诊为乳腺癌,误诊率为4.98%。诊断准确组与误诊组在病灶最大径、触诊、合并良性病灶、合并炎性病变、超声图像边缘、血流信号明显、腋下淋巴结回声、微钙化、病灶结构复杂多样方面比较差异有统计学意义(P<0.01)。经二元Logistic回归分析显示,病灶最大径(≥5 cm)、合并良性病灶、合并炎性病变、超声图像边缘(模糊)、血流信号明显、腋下淋巴结回声、微钙化、病灶结构复杂多样是超声误诊为乳腺癌的危险因素(P<0.05,P<0.01)。超声误诊为乳腺癌风险预测模型:2.623×病灶最大径(≥5 cm)+1.422×合并良性病灶+1.616×合并炎性病变+1.574×超声图像边缘(模糊)+1.134×血流信号明显+1.518×腋下淋巴结回声+2.027×微钙化+1.541×病灶结构复杂多样。Hosmer-Lemeshow拟合度检验显示,该模型拟合优度较好(χ^(2)=3.487,P=0.900);受试者工作特征曲线分析显示,预测模型预测超声误诊为乳腺癌风险的曲线下面积为0.921,约登指数为0.698,敏感度、特异度分别为83.3%、86.5%,95%CI为0.872,0.969,实际应用准确性为96.2%(579/602)。结论超声误诊为乳腺癌和多种因素有关,基于病灶最大径、合并良性病灶、合并炎性病变、超声图像边缘模糊、血流信号明显、腋下淋巴结回声、微钙化和病灶结构复杂多样危险因子构建的超声误诊为乳腺癌风险预测模型预测准确性较好。

幽门螺杆菌感染对胃黏膜上皮细胞病变的研究进展

通过系统阐述幽门螺杆菌在不同机制下通过诱导通路活性与胃黏膜上皮细胞病变的联系,从而探讨延缓胃黏膜上皮细胞恶性病变的新方法。通过对比胃黏膜上皮细胞病变过程中影响通路的不同发病机制,从而研究影响胃黏膜上皮细胞恶性病变的相关活性通路。大量研究证明,幽门螺杆菌感染通过细胞毒素相关基因A(CagA)依赖性和非依赖性机制引发诱导不同通路发挥作用。同时,在CagA依赖/非依赖性作用条件下,幽门螺杆菌可以通过作用于p53肿瘤抑制因子,从而促进胃黏膜上皮细胞发生恶变,是胃癌的重要致病原因之一。通过对胃黏膜上皮细胞与幽门螺杆菌相关作用的深入研究,找出延缓胃黏膜病变进展的作用机制,为临床上治疗幽门螺杆菌感染所致的一系列胃肠道疾病提供新思路。

中药干预肿瘤及胃癌前病变上皮间质转化的研究进展

上皮间质转化(EMT)是指上皮细胞失去极性,转变为间质样细胞的过程。在肿瘤及胃癌前病变治疗中,EMT已成为近年来研究热点。本文中查阅近年来相关文献,综述中药干预肿瘤及胃癌前病变的实验研究,以推动中药治疗肿瘤及胃癌前病变研究进展。

多模态磁共振技术在脑内环形强化病变中的诊断价值

目的总结脑内环形强化病变的神经影像学特点,探讨多模态磁共振技术在脑内环形强化病变中的诊断价值。方法回顾分析2015年1月—2023年1月中南大学湘雅三医院就诊的67例脑内环形强化病变患者多模态磁共振特点、影像学诊断、临床确诊报告及预后等相关临床资料。结果67例脑内环形强化病变患者中,胶质瘤26例,转移瘤20例,脑脓肿7例,脱髓鞘病变5例,淋巴瘤3例,其他病变6例。常规MRI序列(T1WI、T2WI、FIAIR和增强)尽管能清晰显示脑内环形强化灶的部位、形态、灶周水肿程度等特点,但定性诊断困难。结合其他多模态磁共振序列(MRS、DWI、PWI等)的影像学特点,并构建影像学鉴别诊断流程图,57例患者得出了较明确的影像学诊断,其中54例患者的影像学诊断与最终临床诊断相符。结论多模态磁共振技术(MRS、DWI、PWI等)通过解析脑内环形强化病变的病理生理特点,结合程序性鉴别诊断分析,显著提高了影像学诊断的准确率。

能谱CT虚拟平扫与真实平扫诊断儿童骨骼肌肿瘤或肿瘤样病变的对比研究

目的比较骨骼肌肿瘤/肿瘤样病变患儿行能谱CT虚拟平扫(virtual non-contrast,VNC)和真实平扫(true non-contrast,TNC)的影像特征以及影像质量,探讨能谱CT VNC用于儿童骨骼肌肿瘤/肿瘤样病变诊断的准确性与可行性。方法回顾性分析湖南省儿童医院放射科2020年1月至2021年12月行能谱CT平扫及双期增强扫描的43例骨骼肌肿瘤/肿瘤样病变患儿影像学资料,经后处理获得动脉期VNC图像(VNCa)与静脉期VNC图像(VNCv)。分别在TNC、VNCa与VNCv图像上测得病灶最大层面及同层面正常骨骼肌及脂肪的CT值与标准差(standard deviation,SD),计算信噪比(signal noise ratio,SNR)及对比噪声比(contrast noise ration,CNR),比较三种图像的图像质量和诊断效能。结果三种图像中骨骼肌病灶与骨骼肌的CT值差异均无统计学意义(骨骼肌病灶:F=2.139,P=0.122;骨骼肌:F=0.663,P=0.517)。VNCv比TNC的SNR值高,差异有统计学意义(P<0.01)。TNC图像与VNC图像中骨骼肌肿瘤/肿瘤样病变的病灶CT征象差异无统计学意义(P>0.05)。两名观察者对三种图像的主观评分结果一致性好(TNC:κ=0.554;VNCa:κ=0.501;VNCv:κ=0.628)。正常骨骼肌VNCa、VNCv与TNC图像CT值一致性良好(平均差值:VNCa=1.330 HU,VNCv=0.518 HU),骨骼肌病灶VNCv与TNC图像CT值一致性好(平均差值=-3.870 HU)。结论能谱CT VNC技术对儿童骨骼肌肿瘤/肿瘤样病变的诊断具有与TNC相似的图像质量和诊断价值,可减少一期常规平扫次数、降低辐射剂量。

高频超声引导下粗针穿刺活检及肿瘤标志物检测在乳腺肿块良恶性鉴别诊断中的价值研究

目的 探讨高频超声引导下粗针穿刺活检及肿瘤标志物检测在乳腺肿块良恶性鉴别诊断中的价值。方法 选择140例乳腺肿块患者作为研究对象,经手术术后病理检查确诊乳腺癌72例、乳腺良性病变68例,所有患者术前均接受高频超声检查、高频超声引导下粗针穿刺活检及肿瘤标志物[癌胚抗原(CEA)、糖类抗原199(CA199)、糖类抗原125(CA125)]检测。比较不同检查方法 (高频超声、高频超声引导下粗针穿刺活检)对乳腺癌的诊断效能,乳腺癌和乳腺良性病变患者的肿瘤标志物(CEA、CA199、CA125)水平,不同高频超声引导下粗针穿刺活检结果患者的超声表现特征及肿瘤标志物水平。结果 高频超声引导下粗针穿刺活检将4例乳腺癌误诊为乳腺良性病变,将1例乳腺纤维瘤和2例纤维样囊肿误诊为乳腺癌。高频超声引导下粗针穿刺活检诊断乳腺癌的灵敏度、特异度及准确率分别为94.44%、95.59%、95.00%,均明显高于高频超声的68.06%、79.41%、73.57%(P<0.05)。乳腺癌患者CEA、CA199、CA125水平分别为(4.55±1.22)ng/ml、(31.86±9.56)U/ml、(26.12±6.18)U/ml,均明显高于乳腺良性病变患者的(1.68±0.52)ng/ml、(12.10±4.33)U/ml、(11.54±4.83)U/ml(P<0.05)。高频超声引导下粗针穿刺活检良性与恶性患者的肿块最大直径、形态、边界、内部回声、淋巴结肿大、钙化、血流信号等超声特征比较差异有统计学意义(P<0.05)。高频超声引导下粗针穿刺活检良性患者的CEA、CA199、CA125水平分别为(1.74±0.55)ng/ml、(12.43±4.40)U/ml、(11.62±4.88)U/ml,均低于恶性患者的(4.53±1.26)ng/ml、(31.88±9.68)U/ml、(26.25±6.20)U/ml(P<0.05)。结论 高频超声引导下粗针穿刺活检能够较好的鉴别诊断乳腺癌与乳腺良性病变,其诊断效能明显优于单纯高频超声,穿刺活检结果与肿瘤标志物、超声表现特征存在明显关系,能够为乳腺肿块治疗提供指导依据。

^(18)F-FDG PET/CT代谢参数辅助评估弥漫大B细胞淋巴瘤化疗疗效

目的探讨^(18)F-FDG PET/CT代谢参数与弥漫大B细胞淋巴瘤(DLBCL)化疗疗效的相关性。方法回顾性总结2021年2月至2023年2月本院确诊DLBCL患者共78例,采用R-CHOP化疗方案。治疗前采用^(18)F-FDG PET/CT测量代谢参数包括标准摄取值的最大值(SUVmax)、峰值(SUVpeak)和平均值(SUVmean)、肿瘤代谢体积(MTV)和糖酵解总量(TLG),解剖学参数包括肿瘤位置、最大直径和AnnArbor分期。治疗4个疗程(21 d为1个疗程)后复查PET/CT,根据Lugano修订淋巴瘤疗效评价标准分为有效组62例和无效组16例,比较两组PET/CT参数。结果与无效组比较,有效组年龄和最大直径较小,改良国际预后指数(NCCN-IPI)和乳酸脱氢酶(LDH)水平较低,Ⅲ~Ⅳ期和骨髓侵犯较少;SUVmax、MTV和TLG值降低(P<0.05)。Spearman检验显示,SUVmax、MTV和TLG值与最大直径、NCCNIPI、LDH和AnnArbor分期呈显著正相关(P<0.05)。ROC计算SUVmax、MTV和TLG值预测DLBCL患者化疗疗效的AUC为0.741、0.886和0.869(P<0.001),MTV和TLG明显优于SUVmax(P<0.001),但MTV和TLG无明显差异(P>0.05)。结论^(18)F-FDG PET/CT作为DLBCL临床分期、疗效评估和预后随访的重要方法,代谢参数MTV和TLG值与化疗疗效密切相关。

循环肿瘤细胞联合血清整合素β1对病理性乳头溢液患者乳管内恶性病变的诊断价值

目的探讨循环肿瘤细胞(CTCs)联合整合素β1(ITGβ1)对病理性乳头溢液(PND)患者乳管内恶性病变的诊断价值。方法回顾性分析2022年1月至2023年9月北京市通州区妇幼保健院及首都医科大学附属北京朝阳医院收治的212例PND患者的临床资料,根据乳管病理检查结果将研究对象分为良性病变组(187例)和恶性病变组(25例)。采用差异富集-荧光免疫染色原位杂交技术(SE-iFISH)检测PND患者CTCs数量,采用酶联免疫吸附试验检测PND患者血清ITGβ1水平。采用多因素logistic回归分析PND患者发生乳管内恶性病变的影响因素。通过受试者工作特征(ROC)曲线分析CTCs数量、血清ITGβ1水平对PND患者乳管内恶性病变的诊断效能。结果两组年龄、体质量指数(BMI)、月经状态、溢液类型、乳腺肿块比较差异有统计学意义(P<0.05)。恶性病变组CTCs数量多于良性病变组,血清ITGβ1水平高于良性病变组,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,年龄>50岁、BMI>24 kg/m^(2)、血样溢液、较多的CTCs数量、较高的血清ITGβ1水平是PND患者发生乳管内恶性病变的独立危险因素(P<0.05)。CTCs数量、血清ITGβ1水平均具有诊断PND患者乳管内恶性病变的应用价值(P<0.05),且两项指标联合检测的诊断效能更优[AUC(95%CI)=0.961(0.925~0.983),P<0.001],灵敏度和特异度分别为96.00%、84.49%。结论CTCs数量、血清ITGβ1水平在乳管内恶性病变的PND患者体内显著升高,二者联合对PND患者乳管内恶性病变具有较好的诊断价值。