Bing Ou

Comparison of ultrasound elastography, mammography and sonography in the diagnosis of solid breast lesions

The purpose of this study was to evaluate the value of ultrasound elastography (UE) in differentiating benign versus malignant lesions in the breast and compare it with conventional sonography and mammography.

Ultrasonic Elastography in Breast Cancer Diagnosis: Strain Ratio vs 5-point Scale

RATIONALE AND OBJECTIVESnThe aim of this study was to develop a more reliable ultrasonic elastographic diagnostic method than a five-point scoring system by analyzing the difference in stiffness between benign and malignant breast lesions.nnnMATERIALS AND METHODSnFrom January 2008 to April 2009, 559 solid lesions (415 benign, 144 malignant) in 437 consecutive patients (age range, 12-77 years) were examined using ultrasound elastography (UE). Final diagnosis was made on the basis of histopathologic findings. The strain ratios of the lesions were calculated. The area under the curve and cutoff point, both of which were obtained using receiver-operating characteristic curve analysis, were used to assess diagnostic performance. Diagnostic performance was further compared to that generated using a five-point scoring system with the z test. The sensitivity, specificity, and accuracy of these two evaluation systems were compared using McNemars test.nnnRESULTSnThe strain ratios of benign lesions (mean, 1.83 ± 1.22) and malignant lesions (mean, 8.38 ± 7.65) were significantly different (P < .00001). When a cutoff point of 3.05 was introduced, UE had 92.4% sensitivity, 91.1% specificity, and 91.4% accuracy. The area under the curve for strain ratio-based elastographic analysis was 0.944, and the area under the curve for the five-point scoring system was 0.885. The diagnostic performance of strain ratio-based elastographic analysis was better than that of the five-point scoring system with UE (P < .05).nnnCONCLUSIONSnStrain ratio-based elastographic analysis can provide a new, more reliable diagnostic tool in comparison to a five-point scoring system for UE.

Semi-quantitating Stiffness of Breast Solid Lesions in Ultrasonic Elastography

RATIONALE AND OBJECTIVESnTo explore whether strain ratio measurement could semi-quantitatively evaluate the stiffness of breast lesions.nnnMATERIALS AND METHODSnFrom January 2008 to May 2008, 148 patients with 254 solid lesions (183 benign, 71 malignant) in the breast were included in the study. Ultrasound sonography found the lesions and ultrasonic elastography obtained the strain images. By using the strain ratio measurement method together with the ultrasound machine, the strain index of the lesion was calculated. Different depths of breast tissue were selected as the reference. The strain indexes of malignant and benign solid lesions were calculated with the same level of breast tissue as the reference.nnnRESULTSnThe strain indexes of breast lesions were different compared to the same depth of breast tissue and the superior level of fat tissue (P = 0.000). The strain indexes of breast lesions were different compared to different depths of breast glandular tissues (P = 0.003). At the same level of the breast lesions, 212 lesions were glandular tissue, 11 were fat tissue, and 40 were both. In the lesion plane, six lesions had almost no glandular tissue and 20 had almost no superior fat tissue. Compared to the same depth of breast tissue, the strain indexes of benign lesions (range, 0.62-11.07) and malignant lesions (range, 3.12-39.28) were different (P = 0.000).nnnCONCLUSIONnUsing the strain ratio measurement, stiffness of breast lesions could be semi-quantitated with the same depth of breast tissue as the reference. This method may provide another diagnostic method in addition to the 5-point scoring system used with ultrasonic elastography in the future.

Could ultrasonic elastography help the diagnosis of breast cancer with the usage of sonographic BI-RADS classification?

OBJECTIVESnThe purpose was to evaluate whether BI-RADS (the Breast Imaging Recording and Data System) combined with UE (ultrasound elastography) could improve the differentiation and characterization of benign and malignant breast lesions by comparing with BI-RADS.nnnMETHODSnA total of 1080 patients with 1194 breast lesions were studied retrospectively at 8 different institutions from 3 geographic areas across China (North, South, and West) from June 2010 to March 2012. Each institutional ethic review board approved the study and all patients gave written informed consent. All the cases were examined by conventional US (ultrasonography) and UE prior to ultrasound-guided core biopsy. Performance of BI-RADS and BI-RADS combined with UE were compared in different size groups, age groups and area groups.nnnRESULTSnBI-RADS combined with UE cloud improve the accuracy by 13.2% compared to BI-RADS alone for all lesions, 23.2% for <10 mm lesions, 13.3% for ≥10-20 mm lesions, 6.3% for ≥20 mm lesions, 18.4% for <50 years group, 1.7% for ≥50 years group, 13.7% for northern area group, 17.7% for southern area group and 4.4% for western area group.nnnCONCLUSIONSnThe help which UE contributed to BI-RADS was greater for breast lesions <10mm and <50 years group.

Ultrasound Elastography of Breast Lesions in Chinese Women: A Multicenter Study in China

PURPOSEnThrough analysis, the elastograms characteristics of breast lesions of Chinese women, a suitable diagnostic standard of quasistatic ultrasound elastography (UE) for Chinese women was proposed.nnnMETHODSnFrom June 2010 to March 2012, 1036 consecutive female patients (mean age, 44 years old) with breast lesions were recruited into a multicenter retrospective study, which involved 8 centers across China. Each institutional ethic review board approved the study, and all the patients gave written informed consent. All breast lesions underwent ultrasound and UE examination. Two radiologists analyzed the elastograms and separated the elastograms into 10 types. A final diagnosis was made on the basis of histologic findings. The characteristics of the elastograms were analyzed. Receiver operating characteristic curves were plotted for evaluating the diagnostic performance. Sensitivity, specificity, and accuracy were calculated. Differences in sensitivity, specificity, and accuracy were tested by using the McNemar test.nnnRESULTSnThere were 1150 lesions (593 benign, 557 malignant). There was a highly significant correlation between the elastogram color distribution and the percentage of malignant lesions, with a value of 0.92 (2P < .0001). Through analysis the different malignant percentages in different elastogram types, UE diagnostic standard was proposed, which was correlated with the blue percentage in the elastogram. The specificity, sensitivity, and accuracy of UE were 86.4%, 80.8%, and 83.5%, respectively. The specificity and accuracy of UE were higher than with ultrasound. The area under the curve was 0.86.nnnCONCLUSIONnUE could give valuable assessment in the diagnosis of breast lesions. The proposed UE diagnostic standard was suitable for Chinese women.

Breast Contrast-Enhanced Ultrasound: Is a Scoring System Feasible? ----A Preliminary Study in China

Objectives Although many studies about breast contrast-enhanced ultrasound had been conducted, clear diagnostic criteria for evaluating enhancement patterns are still lacking. This study aims to identify significant indicators for breast contrast-enhanced ultrasound and to establish an initial scoring system. Materials and Methods Totally 839 patients were included in the study. This study was divided into two parts. 364 patients were included in part 1 while 475 in part 2. Conventional ultrasound and contrast-enhanced ultrasound were used to examine each lesion. Only the cases in part 2 were also examined by elastography. In part 1, Logistic regression analysis was performed to predict significant variables. A 5-point scoring system was developed based on the results. In part 2, the scoring system was used to evaluate all the breast lesions. To evaluate the diagnostic efficacy of the new scoring system, it was compared with the system established for elastography and conventional ultrasound (BI-RADS). Results Three independent variables, namely, lesion scope, margin, and shape were selected in the final step of the logistic regression analysis in part 1. In part 2, the area under the ROC (receiver operating characteristic) curve for the contrast-enhanced scoring system was 0.912. The difference in the diagnostic capabilities of the contrast-enhanced scoring system and elastography was not statistically significant (Pu200a=u200a0.17). The difference in the diagnostic capabilities of the contrast-enhanced scoring system and BI-RADS was statistically significant (P<0.001). Conclusions The contrast-enhanced patterns of benign and malignant breast tumors are different. The application of a 5-point scoring system for contrast-enhanced ultrasound is clinically promising.

Production and characterization of a novel long-acting Herceptin-targeted nanobubble contrast agent specific for Her-2-positive breast cancers.

BackgroundThere is an unmet need for specific and sensitive imaging techniques to assess the efficacy of breast cancer therapy, particularly Her-2-expressing cancers. Ultrasonic microbubbles are being developed for use as diagnostic and therapeutic tools. However, nanobubbles circulate longer, are smaller, and diffuse into extravascular tissue to specifically bind target molecules. Here, we characterize a novel Herceptin-conjugated nanobubble for use against Her-2-expressing tumors.MethodsPhospholipid-shelled nanobubbles conjugated with Herceptin (NBs-Her) were fabricated using a thin-film hydration method and characterized in vitro in breast cancer cell lines and in vivo in a mouse model.ResultsThe average size of the unconjugated nanobubbles (NBs-Blank) and NBs-Her was 447.1xa0±xa018.4 and 613.0xa0±xa025.4xa0nm, respectively. In cell culture, the NBs-Her adhered to Her-2-positive cells significantly better than to Her-2-negative cells (pxa0<xa00.05). In vivo, the peak intensity and the half-time to washout of the NBs-Her were significantly greater than those of the NBs-Blank (pxa0<xa00.05). In addition, contrast-enhanced ultrasound imaging quality was improved through the use of the NBs-Her. The nanobubbles were able to penetrate into tumor tissue to allow extravascular imaging, but did not penetrate normal skeletal muscle.ConclusionsThe Herceptin-conjugated nanobubble had many properties that made it useful for in vivo imaging, including longer circulation time and better tumor selectivity. This platform may be able to provide targeted delivery of therapeutic drugs or genes.

Ultrasound Elastography Combined With BI-RADS–US Classification System: Is It Helpful for the Diagnostic Performance of Conventional Ultrasonography?

PURPOSEnTo evaluate the additive diagnostic performance of ultrasound elastography (UE) to ultrasound (US) with the 2003 or 2013 Breast Imaging Reporting and Data System (BI-RADS)-US classification systems for the differentiation of benign and malignant breast lesions.nnnMETHODSnFrom June 2010 to December 2012, 738 women with 770 breast lesions were recruited into this retrospective study. Breast lesions were evaluated separately by US, UE, and both. US assessment was based on the 2003 or 2013 BI-RADS-US, and UE assessment was based on a previously reported 5-point scale. Diagnostic performance of US, UE, and both was compared.nnnRESULTSnBefore category 4 lesions were subdivided, the area under the receiver operating characteristic curve (AUC) for US, UE, and both were, respectively, 0.735, 0.877, 0.878 (Pxa0< .01). When subcategories of 4 lesions were considered, the AUC for US, UE, and both were, respectively, 0.865, 0.877, and 0.883 (P > .05). Adding UE to analysis of 4A lesions can decrease the percentages of malignancy to 2.56%.nnnCONCLUSIONnWhen the 2003 BI-RADS was considered, UE could give US some help in differentiating breast lesions. However, when the 2013 BI-RADS was considered, UE gave little help to US, although it reduced unnecessary biopsies of benign category 4A lesions.

Hydroxyapatite nanoparticles modified by branched polyethylenimine are effective non-viral vectors for siRNA transfection of hepatoma cells in vitro

Small interfering RNA (siRNA) technology is a powerful tool in biomedical research and holds great potential for RNA interference-based therapies for HIV, hepatitis and cancer. However, the absence of a safe and efficient method for the delivery of siRNA has become a bottleneck for their development. Nanocrystallized hydroxyapatite (nHAP) appears to be an optimal candidate non-viral gene vector for several reasons, including its good biocompatibility and ease of production, however, nHAP microemulsions cannot remain monodispersed for long periods of time. Due to their high surface energy, nHAP particles gradually aggregate into large ones that are difficult for the cell to take up. To overcome this we modified nHAP with polyethylenimine (PEI) to generate a compound (MnHAP) with a tight size-distribution of <200 nm. The positive surface potential of MnHAP inhibited particle aggregation and thus made it easier to conjugate more siRNA. The transfection efficiency of MnHAP/fluorescent FAM-labeled siRNA complex was tested using flow cytometry, and the transfected cells were observed using fluorescence microscopy. The cytotoxicity of MnHAP/siRNA complexes to the human liver cancer cell line BEL-7402 was assessed in vitro by a formazan dye assay. Our results show that the in vitro transfection efficiency of MnHAP/siRNA was equivalent to that of the commercially available transfection agent Lipofectamine® 2000, but with decreased cytotoxicity. The MnHAP nanoparticles were also able to deliver siRNA for silencing of glyceraldehyde-3-phosphate dehydrogenase (GAPDH) in BEL-7402 cells, which supports that MnHAP might be a promising non-viral vector for biomedical research and gene delivery.

What Help Could Ultrasound Elastography Give to the Diagnosis of Breast Papillary Lesions

On the basis of results of our previous studies and the findings of other scholars, the most common histologic type of false-positive diagnosis with strain elastography (SE) was papilloma. The objectives of our study were to evaluate whether SE could contribute to conventional ultrasound differentiation between benign and malignant papillary lesions and between papillary lesions and other common benign breast lesions. Data on 89 papillary lesions at our hospital, including 74 benign and 15 malignant papillary lesions, were included in our study. In addition, 198 non-papillary benign tumors were selected as the control group, including 126 fibroadenomas and 72 cases of fibrocystic mastopathy. All patients gave written informed consent. All patients with breast lesions underwent conventional ultrasound and SE examination. Breast Imaging Recording and Data System (BI-RADS) category and SE score were compared with respect to sensitivity, specificity and accuracy in differentiating between benign and malignant papillary lesions. We then explored the possibility of using BI-RADS combined with SE to differentiate papillary lesions from non-papillary benign tumors. For differentiating between benign and malignant papillary lesions, the area under the receiver operating characteristic curve (AUC) of BI-RADS was 0.568, whereas the AUC values of SE score, strain ratio and BI-RADS combined with SE were 0.517, 0.584 and 0.509, respectively (pxa0>xa00.05). For differentiating between papillary lesions and non-papillary benign lesions, the AUC of BI-RADS combined with SE was 0.835, which was higher than the values for BI-RADS (0.775) and SE (SE score: 0.648, strain ratio: 0.661) (pxa0<xa00.001). The specificity and accuracy of BI-RADS combined with SE were significantly higher than those for BI-RADS alone without a decrease in sensitivity (pxa0<xa00.05). SE could not improve the diagnostic efficiency of BI-RADS in differentiating between benign and malignant papillary lesions. However, BI-RADS combined with SE could improve the specificity of BI-RADS without decrease in sensitivity for differentiating breast papillary lesions from non-papillary benign lesions.