Endoscopic ultrasonography-related diagnostic accuracy and clinical significance on small rectal neuroendocrine neoplasms

This research aimed to examine the diagnostic accuracy and clinical significance of endoscopic ultrasonography(EUS)in the context of small rectal neuroendocrine neoplasms(NENs).A total of 108 patients with rectal subepithelial lesions(SELs)with a diameter of<20 mm were included in the analysis.The diagnosis and depth assessment of EUS was compared to the histology findings.The prevalence of NENs in rectal SELs was 78.7%(85/108).The sensitivity of EUS in detecting rectal NENs was 98.9%(84/85),while the specificity was 52.2%(12/23).Overall,the diagnostic accuracy of EUS in identifying rectal NENs was 88.9%(96/108).The overall accuracy rate for EUS in assessing the depth of invasion in rectal NENs was 92.9%(78/84).Therefore,EUS demonstrates reasonable diagnostic accuracy in detecting small rectal NENs,with good sensitivity but inferior specificity.EUS may also assist physicians in assessing the depth of invasion in small rectal NENs before endoscopic excision.

Guidelines for diagnosis and treatment of advanced breast cancer in China(2022 edition)

Breast cancer is the most common cancer among women worldwide.It has been estimated that about 416000 new cases and over 117000 deaths of breast cancer occurred in China in 2020.Among the new cases of breast cancer diagnosed each year,3-10%have distant metastasis at the time of initial diagnosis.In addition,approxi-mately 30%of patients with early-stage breast cancer may eventually experience recurrence or metastases.The 5-year survival rate of patients with advanced breast cancer is only 20%with a median overall survival of 2-3 years.Although advanced breast cancer remains incurable at present,new therapeutic options and multidisci-plinary treatment could be utilized to alleviate symptoms,improve quality of life,and prolong patients’survival.The choice of treatment regimens for patients with advanced breast cancer is very important,and the optimal treatment strategy beyond the first-and second-line therapy is often lacking.Herein,the China Advanced Breast Cancer Guideline Panel discussed and summarized recent clinical evidence,updated the guidelines for the diag-nosis and treatment of advanced breast cancer based on the 2020 edition,and formulated the“Guidelines for diagnosis and treatment of advanced breast cancer in China(2022 edition)”for clinicians’reference.

Diagnostic accuracy of endoscopic ultrasonography for rectal neuroendocrine neoplasms

AIM: To investigate the diagnostic accuracy of endoscopic ultrasonography (EUS) for rectal neuroendocrine neoplasms (NENs) and the differential diagnosis of rectal NENs from other subepithelial lesions (SELs).

Expert consensus on diagnosis,treatment and fertility management of young breast cancer patients

Breast cancer in young females is a relatively common disease in China.Young breast cancer has aggressive clinical and pathological features.During the treatment of young females with breast cancer,issues involving the choice of surgical methods,early amenorrhea,and fertility protection may have physical,psychological,and social impacts.Thus,a multidisciplinary model of diagnosis and treatment is indispensable.The breast cancer expert committee of the National Cancer Quality Control Center organized experts in related fields in China to compile this consensus as to provide scientific and feasible solutions for rational diagnosis,treatment,and fertility management for young females with breast cancer.This consensus is based on the literature data,the views of relevant international guidelines,and the clinical practice experience of experts in different fields.

更多〉〉相关学者姜玉新严昆华扬张青萍陈敏华段云友刘东戴晴吴瑛蔡胜相关检索词乳腺癌 新辅助化疗 ultrasonography 免疫组化 导管 breast cancer 造影剂 胎儿 乳腺肿块 ultrasound 检出率 改良根治术 多普勒 保乳手术 免疫组织化学 磁共振成像 彩色 肿块 病理检查 准确率 自动乳腺全容积成像在乳腺癌术前测量评估中的应用

目的评价运用自动乳腺全容积成像（ABVS）对乳腺癌术前大小测量的准确率.方法选取经手术病理证实的乳腺癌患者105例（118个病灶,其中导管原位癌病灶36个,非导管原位癌病灶82个）,术前均行常规超声、ABVS 检查,测量病灶最大径并与手术病理测量结果进行对比,比较常规超声与 ABVS 对两类病灶的检测情况.结果病理检查：病灶大小0.2~5.5（2.45±1.18）cm;ABVS 检查：病灶大小0.3~5.8（2.50±1.21）cm;常规超声检查：病灶大小0.8~5.2（2.16±1.12）cm.乳腺癌患者 ABVS 及常规超声检查结果与病理检查结果均呈显著正相关（r=0.906、0.990,均 P〈0.01）.ABVS 对导管原位癌病灶的检出率明显高于常规超声（P〈0.05）,而两种方法对非导管原位癌病灶检出率的差异无统计学意义（P 〉0.05）.结论 ABVS 对乳腺肿块的测量优于常规超声,尤其对于导管原位癌的测量有明显优势.

Hemolymphangioma: A rare differential diagnosis of cystic-solid or cystic tumors of the pancreas

We report a case of pancreatic hemolymphangioma. Hemolymphangioma is a malformation of both lymphatic vessels and blood vessels. The incidence of this disease in the pancreas is extremely rare. To the best of our knowledge, only seven cases have been reported worldwide (PubMed). A 39-year-old woman with a oneday history of abdominal pain was admitted to our hospital. There was no obvious precipitating factor. The preoperative examination, including ultrasonography and computed tomography, showed a cystic-solid tumor in the pancreas, and it was considered to be a mucinous cystadenoma or cystadenocarcinoma. Pancreaticbody-tail resection combined with splenectomy was performed. After the operation, the tumor was pathologically demonstrated to be a pancreatic hemolymphangioma. Although pancreatic hemolymphangioma is rare, we believe that it should be considered in the differential diagnosis of cystic-solid tumors of the pancreas, particularly when there is no sufficient evidence for diagnosing cystadenoma, cystadenocarcinoma or some other relatively common disease of the pancreas.

Breast non-mass-like lesions on contrast-enhanced ultrasonography: Feature analysis, breast image reporting and data system classification assessment

BACKGROUND Breast non-mass-like lesions(NMLs)account for 9.2%of all breast lesions.The specificity of the ultrasound diagnosis of NMLs is low,and it cannot be objectively classified according to the 5th Edition of the Breast Imaging Reporting and Data System(BI-RADS).Contrast-enhanced ultrasound(CEUS)can help to differentiate and classify breast lesions but there are few studies on NMLs alone.AIM To analyze the features of benign and malignant breast NMLs in grayscale ultrasonography(US),color Doppler flow imaging(CDFI)and CEUS,and to explore the efficacy of the combined diagnosis of NMLs and the effect of CEUS on the BI-RADS classification of NMLs.METHODS A total of 51 breast NMLs verified by pathology were analyzed in our hospital from January 2017 to April 2019.All lesions were examined by US,CDFI and CEUS,and their features from those examinations were analyzed.With pathology as the gold standard,binary logic regression was used to analyze the independent risk factors for malignant breast NMLs,and a regression equation was established to calculate the efficiency of combined diagnosis.Based on the regression equation,the combined diagnostic efficiency of US combined with CEUS(US+CEUS)was determined.The initial BI-RADS-US classification of NMLs was adjusted according to the independent risk factors identified by CEUS,and the diagnostic efficiency of CEUS combined with BI-RADS(CEUS+BI-RADS)was calculated based on the results.ROC curves were drawn to compare the diagnostic values of the three methods,including US,US+CEUS,and CEUS+BI-RADS,for benign and malignant NMLs.RESULTS Microcalcification,enhancement time,enhancement intensity,lesion scope,and peripheral blood vessels were significantly different between benign and malignant NMLs.Among these features,microcalcification,higher enhancement,and lesion scope were identified as independent risk factors for malignant breast NMLs.When US,US+CEUS,and CEUS+BI-RADS were used to identify the benign and malignant breast NMLs,their sensitivity rates were 82.6%,91.3%,and 87.0%,respectively;their specificity rates were 71.4%,89.2%,and 92.9%,respectively;their positive predictive values were 70.4%,87.5%,and 90.9%,respectively;their negative predictive values were 83.3%,92.6%,and 89.7%,respectively;their accuracy rates were 76.5%,90.2%,and 90.2%,respectively;and their corresponding areas under ROC curves were 0.752,0.877 and 0.903,respectively.Z tests showed that the area under the ROC curve of US was statistically smaller than that of US+CEUS and CEUS+BI-RADS,and there was no statistical difference between US+CEUS and CEUS+BI-RADS.CONCLUSION US combined with CEUS can improve diagnostic efficiency for NMLs.The adjustment of the BI-RADS classification according to the features of contrastenhanced US of NMLs enables the diagnostic results to be simple and intuitive,facilitates the management of NMLs,and effectively reduces the incidence of unnecessary biopsy.

Pancreatic cancer screening in patients with presumed branch-duct intraductal papillary mucinous neoplasms

Because delayed diagnosis is one of the causes of poor prognosis in pancreatic ductal adenocarcinoma(PDAC), early detection is a key for overall improvement of prognosis. Towards this end, periodic screening is recommended for individuals considered high-risk for PDAC. Advances in diagnostic imaging modalities have increased the frequency of incidental findings of pancreatic cysts,including the intraductal papillary mucinous neoplasm(IPMN)-a major risk factor of PDAC, having 1% annual prevalence of concomitance with IPMN.Proper retainment of patients with IPMN and regular follow-up by routine imaging examination will likely improve early detection and better prognosis of PDAC. Unfortunately, current guidelines only address management of PDAC derived from IPMN and overlook PDAC concomitant with IPMN. Screening of patients with IPMN, by endoscopic ultrasonography(currently the most reliable modality for detecting small PDAC), may facilitate early detection of both IPMNderived and-concomitant PDAC. Prospective studies to evaluate the usefulness of endoscopic ultrasonography in screening of IPMN-concomitant PDAC will also help in determining the optimal surveillance strategy for more widespread applications.

Morphologic and texture features in classifying the malignant and benign breast nodules in ultrasonography

Objective To develop a computer-aided diagnosis(CAD)system with automatic contouring and morphologic and textural analysis to aid on the classification of breast nodules on ultrasound images.Methods A modified Level Set method was proposed to automatically segment the breast nodules(46malignant and 60benign nodules).Following,16morphologic features and 17texture features from the extracted contour were calculated and principal component analysis(PCA)was applied to find the optimal feature vector dimensions.Fuzzy C-means classifier was utilized to identify the breast nodule as benign or malignant with selected principal vectors.Results The performance of morphologic features was 78.30%for accuracy,67.39%for sensitivity and 86.67%for specificity,while the latter was 72.64%,58.70%and 83.33%,respectively.After the combination of the two features,the result was exactly the same with the morphologic performance.Conclusion This system performs well in classifying the malignant breast nodule from the benign breast nodule.

Early prediction of pathological outcomes to neoadjuvant chemotherapy in breast cancer patients using automated breast ultrasound

Objective： Early assessment of response to neoadjuvant chemotherapy （NAC） for breast cancer allows therapy to be individualized. The optimal assessment method has not been established. We investigated the accuracy of automated breast ultrasound （ABUS） to predict pathological outcomes after NAC. Methods： A total of 290 breast cancer patients were eligible for this study. Tumor response after 2 cycles of chemotherapy was assessed using the product change of two largest perpendicular diameters （PC） or the longest diameter change （LDC）. PC and LDC were analyzed on the axial and the coronal planes respectively. Receiver operating characteristic （ROC） curves were used to evaluate overall performance of the prediction methods. Youden＇s indexes were calculated to select the optimal cut-off value for each method. Sensitivity, specificity, positive and negative predictive values （PPV and NPV） and the area under the ROC curve （AUC） were calculated accordingly.Results： ypT0/is was achieved in 42 patients （14.5%） while ypT0 was achieved in 30 patients （10.3%） after NAC. All four prediction methods （PC on axial planes, LDC on axial planes, PC on coronal planes and LDC on coronal planes） displayed high AUCs （all〉0.82）, with the highest of 0.89 [95% confidence interval （95% CI）, 0.83-0.95] when mid-treatment ＆BUS was used to predict final pathological complete remission （pCR）. High sensitivities （85.7%-88.1%） were observed across all four prediction methods while high specificities （81.5%-85.1%） were observed in two methods used PC. The optimal cut-off values defined by our data replicate the WHO and the RECIST criteria. Lower AUCs were observed when mid-treatment ABUS was used to predict poor pathological outcomes. Conclusions：ABUS is a useful tool in early evaluation of pCR after NAC while less reliable when predicting poor pathological outcomes.

Current status of ultrasound-guided surgery in the treatment of breast cancer

The primary goal of breast-conserving surgery(BCS) is to obtain tumour-free resection margins. Margins positive or focally positive for tumour cells are associated with a high risk of local recurrence, and in the case of tumour-positive margins, re-excision or even mastectomy are sometimes needed to achieve definite clear margins. Unfortunately, tumour-involved margins and re-excisions after lumpectomy are still reported in up to 40% of patients and additionally, unnecessary large excision volumes are described. A secondary goal of BCS is the cosmetic outcome and one of the main determinants of worse cosmetic outcome is a large excision volume. Up to 30% of unsatisfied cosm-etic outcome is reported. Therefore, the search for better surgical techniques to improve margin status, excision volume and consequently, cosmetic outcome has continued. Nowadays, the most commonly used localization methods for BCS of non-palpable breast cancers are wire-guided localization(WGL) and radioguided localization(RGL). WGL and RGL are invasive procedures that need to be performed pre-operatively with technical and scheduling difficulties. For palpable breast cancer, tumour excision is usually guided by tactile skills of the surgeon performing "blind" surgery. One of the surgical techniques pursuing the aims of radicality and small excision volumes includes intraoperative ultrasound(IOUS). The best evidence available demonstrates benefits of IOUS with a significantly high proportion of negative margins compared with other localization techniques in palpable and non-palpable breast cancer. Additionally, IOUS is non-invasive, easy to learn and can centralize the tumour in the excised specimen with low amount of healthy breast tissuebeing excised. This could lead to better cosmetic results of BCS. Despite the advantages of IOUS, only a small amount of surgeons are performing this technique. This review aims to highlight the position of ultrasoundguided surgery for malignant breast tumours in the search for better oncological and cosmetic outcomes.

Combined molybdenum target X-ray and magnetic resonance imaging examinations improve breast cancer diagnostic efficacy

BACKGROUND Early-stage breast cancer patients often lack specific clinical manifestations,making diagnosis difficult.Molybdenum target X-ray and magnetic resonance imaging(MRI)examinations both have their own advantages.Thus,a combined examination methodology may improve early breast cancer diagnoses.AIM To explore the combined diagnostic efficacy of molybdenum target X-ray and MRI examinations in breast cancer.METHODS Patients diagnosed with breast cancer at our hospital from March 2019 to April 2021 were recruited,as were the same number of patients during the same period with benign breast tumors.Both groups underwent molybdenum target X-ray and MRI examinations,and diagnoses were given based on each exam.The single(i.e.,X-ray or MRI)and combined(i.e.,using both methods)diagnoses were counted,and the MRI-related examination parameters(e.g.,T-wave peak,peak and early enhancement rates,and apparent diffusion coefficient)were compared between the groups.RESULTS In total,63 breast cancer patients and 63 benign breast tumor patients were recruited.MRI detected 53 breast cancer cases and 61 benign breast tumor cases.Molybdenum target X-ray detected 50 breast cancer cases and 60 benign breast tumor cases.The combined methodology detected 61 breast cancer cases and 61 benign breast tumor cases.The sensitivity(96.83%)and accuracy(96.83%)of the combined methodology were higher than single-method MRI(84.13%and 90.48%,respectively)and molybdenum target X-ray(79.37%and 87.30%,respectively)(P<0.05).The combined methodology specificity(96.83%)did not differ from singlemethod MRI(96.83%)or molybdenum target X-ray(95.24%)(P>0.05).The Twave peak(169.43±32.05)and apparent diffusion coefficient(1.01±0.23)were lower in the breast cancer group than in the benign tumor group(228.86±46.51 and 1.41±0.35,respectively).However,the peak enhancement rate(1.08±0.24)and early enhancement rate(1.07±0.26)were significantly higher in the breast cancer group than in the benign tumor group(0.83±0.19 and 0.75±0.19,respectively)(P<0.05).CONCLUSION Combined molybdenum target X-ray and MRI examinations for diagnosing breast cancer improved the diagnostic sensitivity and accuracy,minimizing the missedand misdiagnoses risks and promoting timely treatment intervention.

Prospective Study of Color Doppler Ultrasonography in the Diagnosis of Breast Disease.

One hundred and four cases of breast disease were examined by color Doppler ultrasonography (CDUS). Malignant lesions were rich in blood blow signal and 56% of +++-++++grade while benign lesions had little blood flow signal

Malignant sweat gland tumor of breast arising in pre-existing benign tumor: A case report

BACKGROUND Sweat glands belong to skin appendages.Sweat gland tumors are uncommon,especially when they occur as malignant tumors in the breast.We report a case of malignant sweat gland tumor of the breast,including imaging and pathological findings.CASE SUMMARY A 47-year-old woman visited our hospital with a non-tender palpable lesion in her left breast.The lesion had not shown changes for 10 years.However,it recently increased in size.Sonography showed a well circumscribed cystic lesion with internal debris and fluid-fluid level.Magnetic resonance imaging showed a well circumscribed oval mass with T1 hyper-intensity compared to muscle and T2 high signal intensity.There was a small enhancing mural component in the inner wall of the mass.The tumor was resected.Its pathologic result was a malignant transformation of benign sweat gland tumor such as hidradenoma.The lesion was treated with excision and radiation therapy.At 1-year follow up,there was no local recurrence or metastasis in the patient.CONCLUSION In the case of a rapid growing cystic mass in the nipple and subareola,it is necessary to distinguish it from a malignant sweat gland tumor.

THE MAMMOGRAPHIC CALCIFICATIONS IN BREAST CANCER

Objective: This study was performed to exam the relativeship between mammographic calcifications and breast cancer. Methods: All of the 184 patients with breast diseases underwent mammography before either an open biopsy or a mastectomy. The presence, morphology, and distribution of calcifications visualized on mammograms for breast cancer were compared with the controls who remained cancer free. Statistical comparisons were made by using the x 2 test. Results: Of the 184 patients with breast diaeases, 93 malignant and 91 benign lesions were histologically confirmed. Calcifications were visualized on mammograms in 60 (64%)of 93 breast cancers and 26(28%)of 91 non breast cancers. The estimated odds ratio (OR) of breast cancer was 4.5 in women with calcifications seen on mammo grams, compared with those having none ( P < 0.01). Of the 60 breast carcinomas having mammographic calcifi cations, 28 (47%) were infiltrating ductal carcinomas. There were only 8 (24%) cases with infiltrating ductal cancers in the group of without calcifications seen on the mammograms ( P <0.05). Conclusion: Our finding sug gests that mammographic calcification appears to be a risk factor for breast cancer. The granular and linear cast type calcification provide clues to the presence of breast cancer, especially when the carcinomas without associated masses were seen on mammograms.

COMPARISON OF INFRARED LIGHTSCANNING AND MAMMOGRAPHY IN BREAST CANCER DETECTION

Purpose: This study is in an attempt to assess the diagnostic accuracy of infrared lightscanning by comparing with that of mammograpby- Methods: A total of 104 patients had been examined by both mammography and infrared lightscanning before surgery.All Patients were divided into two groups: cancer and non cancer. The diagnostic accuracy of these two modalities were calculated. Results: Of 104 Patients, 43 had breast cancer and 61 had benign lesions, the sensitivity and specificity for mammography were 84% and 83%, 82% and 77% for infrared lightscanning. The predictive values of positivity for mammograpby and lightscanning were 80% and 70%, the negative Predictive value for these two modalities were both 87%. Conclusion: Infrared lightscanning,being of assistance to mammography, could enhance sensitivity and predictive values of positivity in detecting breast cancer, especially, in mammographically dense breast.

超声乳腺影像报告和数据系统联合患者年龄鉴别良性与交界性/恶性乳腺叶状肿瘤

目的观察超声乳腺影像报告和数据系统(BI-RADS)联合患者年龄鉴别良性与交界性/恶性乳腺叶状肿瘤(PTB)的价值。方法回顾性分析74例经乳腺超声检查及术后病理证实的PTB女性患者共76个病灶,包括良性57个、交界性14个及恶性5个,比较3种病变患者年龄及其超声BI-RADS分类,观察以单一年龄、超声BI-RADS及其联合鉴别诊断价值。结果良性、交界性及恶性PTB之间,患者年龄及超声BI-RADS分类差异均有统计学意义(P=0.026、0.015)。以44.5岁、超声BI-RADS 4B类及其联合鉴别良性与交界性/恶性PTB的敏感度分别为94.74%、36.84%及73.68%,特异度分别为56.36%、87.27%及72.73%,曲线下面积分别为0.769、0.649及0.780。结论超声BI-RADS分类联合患者年龄有助于鉴别良性与交界性/恶性PTB。

Case Report:Granular Cell Tumor In Breast

Granular cell tumor(GCT)of the breast is an unusual neoplasm,tipically benign,it represents between 5-6% of all GCT cases.These tumors are more common in middle-aged premenopausal women with a greater predilection African American race[1].Nevertheless,there are also cases described in men[2-4].Almost all of them are favorable,the malignant cases are uncommon(only 1-3%).Sometimes it could be clinically and radiologically confused with a malignant breast tumor;so it's very important to make a differential diagnosis.The choice therapy is an extensive local extirpation with free margins[5],without the need for adjuvant chemotherapy or radiotherapy.Our case is a 61-year-old woman with a GCT,and three years ago a history of breast carcinoma in the same breast.

多模态超声诊断甲状腺肿瘤

超声是诊断甲状腺疾病首选的影像学工具。基于常规超声的甲状腺影像报告和数据系统的建立在甲状腺肿瘤诊断中发挥着举足轻重的作用。近年来,弹性成像、超微血流成像、超声造影及人工智能等新技术广泛应用于甲状腺疾病超声诊断。多模态超声技术的应用大幅度提升了甲状腺恶性肿瘤的诊断准确度,为甲状腺癌患者个体化诊疗方案的制订提供了理论依据。

经皮超声造影引导下穿刺活检诊断腋窝转移性淋巴结假阴性的风险模型构建与评估

目的:构建经皮超声造影引导下细针穿刺活检(pCEUS-FNAC)诊断乳腺癌腋窝转移性淋巴结假阴性的预测模型,探讨该模型在降低pCEUS-FNAC假阴性率的临床可行性及实用性。方法:回顾性收集2020年10月—2023年1月在我院术前行p CEUS-FNAC的浸润性乳腺癌伴腋窝淋巴结转移患者261例,以腋窝淋巴结手术病理结果为金标准,将病例分为腋窝淋巴结p CEUS-FNAC阳性组和pCEUS-FNAC阴性组,对比分析两组病例临床病理特征、超声征象的差异,采用单因素分析及多因素Logistic回归分析确定pCEUS-FNAC假阴性的危险因素。根据筛选出的危险因素建立列线图预测模型,通过受试者工作特征(ROC)曲线、校准曲线对、临床决策曲线分析(DCA)对模型进行评价。结果:pCEUS-FNAC诊断乳腺癌腋窝转移性淋巴结假阴性率为14.6%。多因素回归分析结果显示,肿瘤d_(最大径)>5 cm、呈多灶、pCEUSⅠ/Ⅱ型为pCEUS-FNAC假阴性的独立危险因素(P<0.05)。基于以上危险因素构建的预测模型在训练集和测试集ROC曲线下面积分别为0.790(0.687~0.893)、0.803(0.653~0.954),Hosmer-Lemeshow拟合优度检验分别为P=0.548、P=0.397,DCA显示模型曲线远离两条极端线。结论:乳腺癌d_(最大径)>5 cm、呈多灶、腋窝淋巴结pCEUSⅠ/Ⅱ型为pCEUS-FNAC假阴性的危险因素,据此构建的预测模型具有较好的区分度和校准度,并展现出良好的临床实用价值。