Recent advances of multimoda ultrasound in image-guided prostate-targeted biopsy

Prostate-targeted biopsy is usually the preferred method over systematic biopsy because it can effectively detect prostate cancer using only a few puncture cores with fewer complications.With the development of ultrasound,it has gained multimodal technological upgrades,such as the emergence of contrast-enhanced ultrasound,ultrasound elastography,and three-dimensional ultrasonography.Moreover,multimodal ultrasound has played an increasingly significant role in prostate-targeted biopsies.

Transrectal ultrasound examination of prostate cancer guided by fusion imaging of multiparametric MRI and TRUS:avoiding unnecessary mpMRI-guided targeted biopsy

The purpose of this study was to explore transrectal ultrasound(TRUS)findings of prostate cancer(PCa)guided by multiparametric magnetic resonance imaging(mpMRI)and to improve the Prostate Imaging Reporting and Data System(PI-RADS)system for avoiding unnecessary mpMRI-guided targeted biopsy(TB).From January 2018 to October 2019,fusion mpMRI and TRUS-guided biopsies were performed in 162 consecutive patients.The study included 188 suspicious lesions on mpMRI in 156 patients,all of whom underwent mpMRI-TRUS fusion imaging-guided TB and 12-core transperineal systematic biopsy(SB).Univariate analyses were performed to investigate the relationship between TRUS features and PCa.Then,logistic regression analysis with generalized estimating equations was performed to determine the independent predictors of PCa and obtain the fitted probability of PCa.The detection rates of PCa based on TB alone,SB alone,and combined SB and TB were 55.9%(105 of 188),52.6%(82 of 156),and 62.8%(98 of 156),respectively.The significant predictors of PCa on TRUS were hypoechogenicity(odds ratio[OR]:9.595,P=0.002),taller-than-wide shape(OR:3.539,P=0.022),asymmetric vascular structures(OR:3.728,P=0.031),close proximity to capsule(OR:3.473,P=0.040),and irregular margins(OR:3.843,P=0.041).We propose subgrouping PI-RADS score 3 into categories 3a,3b,3c,and 3d based on different numbers of TRUS predictors,as the creation of PI-RADS 3a(no suspicious ultrasound features)could avoid 16.7%of mpMRI-guided TBs.Risk stratification of PCa with mpMRI-TRUS fusion imaging-directed ultrasound features could avoid unnecessary mpMRI-TBs.

Thermal ablation and immunotherapy for hepatocellular carcinoma:Recent advances and future directions

Hepatocellular carcinoma(HCC)is one of most common cancers that cause death in the world.Thermal ablation(TA)is an important alternative treatment method for HCC patients who are not appropriate for surgery or liver transplantation.Particularly for small and early HCCs,TA can be considered as the first-line curative treatment.However,local and distant recurrence rates are still high even though the TA equipment and technology develop rapidly.Immunotherapy is a novel systemic treatment method to enhance the anti-tumor immune response of HCC patients,which has the potential to reduce the tumor recurrence and metastasis.The combination of local TA and systemic immunotherapy for HCCs may be an ideal treatment for enhancing the efficacy of TA and controlling the recurrence.Herein we summarize the latest progress in TA,immunotherapy,and their combination for the treatment of patients with HCC and discuss the limitations and future research directions of the combined therapy.

Multiparametric ultrasound for the assessment of testicular lesions with negative tumoral markers

The purpose of this study was to evaluate the diagnostic performance of multiparametric ultrasound(mpUS;grayscale US,color Doppler US,strain elastography,and contrast-enhanced US)in the assessment of testicular lesions with negative tumoral markers.MpUS imaging data,patient age,serum tumor markers,scrotal pain,cryptorchidism,and related clinical information were retrospectively collected for patients who underwent mpUS examination between January 2013 and December 2019.Histologic results or follow-up examinations were used as the reference standard.In total,83 lesions from 79 patients were included in the analysis.Fifty-six patients were finally diagnosed with benign tumors,and 23 patients were ultimately diagnosed with malignant tumors.Chi-square tests or Fisher's exact tests were used to assess the difference between the two groups.Stepwise multivariate logistic regression analysis showed that lesion diameter(odds ratio[OR]=1.072,P=0.005),vascularization on color Doppler US(OR=4.066,P=0.001),and hyperenhancement during the early phase(OR=6.465,P=0.047)were significant independent risk factors for malignancy;however,when compared with neoplastic lesions,pain(OR=0.136,P<0.001),absence of vascularization on color Doppler US(OR=1.680,P=0.042),and nonenhancement during the late phase(OR=3.461,P=0.031)were strongly associated with nonneoplastic lesions.MpUS features are useful for differentiating testicular lesions with negative tumoral markers and improving the preoperative diagnosis,which may avoid inappropriate radical orchiectomy.

Thermal ablation for papillary thyroid microcarcinoma: Some clarity amid controversies

The increasing incidence of papillary thyroid microcarcinoma(PTMC)has become a global challenge.Because of its indolent nature,active surveillance(AS)has been proposed as a treatment option in selected PTMC patients to prevent surgery-related complications.However,only a few patients with PTMC receive the AS approach because of the serious psychological burden following the“cancer”diagnosis and the uncertainty of the timing for metastatic dissemination.Ultrasound(US)-guided thermal ablation can bridge the gap in the treatment options of PTMC patients who wish for a minimally invasive management approach.However,it has acquired only marginal attention from the thyroid guideline societies because of concerns regarding incomplete elimination.The recently published guidelines from the European Thyroid Association-Cardiovascular and Interventional Radiological Society of Europe and the American Head Neck Society Endocrine Section-initiated global consensus provide the most definitive evidence and essential foundational experience to address the long-term controversy over USguided thermal ablation for low-risk PTMC patient management and facilitate the responsible global dissemination of minimally invasive strategies.

纳米药物的构型调控用于自噬增强铁死亡和肿瘤免疫治疗

设计合成了一种四足针尖状铁钯纳米颗粒(简称TFPs),分别通过诱导乳腺癌细胞自噬和巨噬细胞释放促炎因子,实现在光声成像引导下的乳腺肿瘤细胞铁死亡协同免疫治疗.首先,该新型TFPs具有优异的光学吸收和较高的光热转换效率,是良好的光声成像造影剂.其次,TFPs具有过氧化物酶/谷胱甘肽氧化酶模拟酶性能,能原位催化肿瘤区过表达过氧化氢,产生羟基自由基,并同时下调胞内谷胱甘肽水平,协同诱导细胞铁死亡.此外,其独特的针状形态可以进一步触发肿瘤细胞自噬,加快铁蛋白降解,释放铁离子,进而增效铁死亡;同时,特殊的尖状结构能触发巨噬细胞释放促炎细胞因子,增效放大免疫效应,在与PD-L1检查点抑制剂联合使用后,取得最强的抗肿瘤效果.这项工作不仅开发了一种高效的铁死亡诱导剂,也为在纳米尺度调控肿瘤细胞自噬/免疫功能提供了一种全新的策略.

Nanomaterials-Based Tumor Microenvironment Modulation for Magnifying Sonodynamic Therapy

CONSPECTUS:Sonodynamic therapy(SDT)is a noninvasive and more preferable therapeutic modality than photodynamic therapy(PDT)due to deeper tissue penetration,which utilizes sonosensitizers to produce reactive oxygen species(ROS)to kill tumor cells and arouse immune responses.However,it still suffers from low ROS production efficiency and insufficient systematic immune activation,which thus has attracted increasing attention and researchers to engage in this field.