Dan-Dan Li

Treatment efficacy and safety of ultrasound-guided percutaneous bipolar radiofrequency ablation for benign thyroid nodules

OBJECTIVE To evaluate the therapeutic efficacy and safety of ultrasound-guided percutaneous bipolar radiofrequency ablation (BRFA) of benign thyroid nodules by comparison with a matched untreated control group. METHODS The therapeutic efficacy and safety in 35 patients who were subjected to a single session of ultrasound-guided percutaneous BRFA (Group A) for benign thyroid nodules were compared with those in 35 untreated patients (Group B) with benign nodules. The benign nature of all the nodules was confirmed by ultrasound-guided fine-needle aspiration biopsy (FNAB), and all the patients had normal thyroid functions. BRFA was performed with a bipolar electrode (CelonProSurge 150-T20) with an output power of 20 W. Nodule volume, thyroid function and clinical symptoms of all the patients were compared before treatment and during follow-up. RESULTS In Group A, the BRFA procedures were completed with a mean time of 10.02 ± 3.30 min (range, 5.47-16.03 min) and with a mean total energy deposition of 10.747 ± 3704 J (range, 5510-17.770 J). The procedures were tolerated well in all the patients without causing any major complications. At the 6-month follow-up, all of the nodule volume decreased significantly (from 8.81 ± 8.66 to 1.59 ± 1.55 ml, p < 0.001) in Group A, whereas the nodule volume increased from 6.90 ± 3.77 to 7.87 ± 3.95 ml in Group B (p < 0.001). All (100%) the 35 nodules in Group A had volume reduction ratios (VRRs) of >50%, among which 3 (8.57%) had VRRs >90%. In Group A, the clinical symptoms of the patients who had symptoms before BRFA disappeared, whereas in Group B, the patients had no resolution of clinical symptoms at the 6-month follow-up. CONCLUSION Ultrasound-guided percutaneous BRFA seems to be an effective and safe method for the treatment of benign thyroid nodules. It may gain a wide use in clinical practice. ADVANCES IN KNOWLEDGE Based on the comparable efficacy and clinical symptoms between the BRFA and untreated groups, the technique of BRFA can be used as an effective and safe method for the treatment of benign thyroid nodules.

Two-dimensional shear wave elastography of breast lesions: Comparison of two different systems

OBJECTIVE To evaluate the diagnostic performance of two different shear wave elastography (SWE) techniques in distinguishing malignant breast lesions from benign ones. MATERIALS AND METHODS From March 2016 to May 2016, a total of 153 breast lesions (mean diameter, 16.8 mm±10.5; range 4.1-90.0 mm) in 153 patients (mean age, 46.4 years±15.1; age range 20-86 years) were separately performed by two different SWE techniques (i.e. T-SWE, Aplio500, Toshiba Medical System, Tochigi, Japan; and S-SWE, the Aixplorer US system, SuperSonic Imagine, Provence, France). The maximum (Emax), mean (Emean) and standard deviation (ESD) of elasticity modulus values in T-SWE and S-SWE were analyzed. All the lesions were confirmed by ultrasound (US)-guided core needle biopsy (n = 26), surgery (n = 122), or both (n = 5), with pathological results as the gold standard. The areas under the receiver operating characteristic curves (AUROCs) were calculated. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) were calculated to assess the diagnostic performance between T-SWE and S-SWE. Operator consistency was also evaluated. RESULTS Among the 153 lesions, 41 (26.8%) were malignant and 112 (73.2%) were benign. Emax (T-SWE: 40.10±37.14 kPa vs. 118.78±34.41 kPa; S-SWE: 41.22±22.54 kPa vs. 134.77±60.51 kPa), Emean (T-SWE: 19.75±16.31 kPa vs. 52.93±25.75 kPa; S-SWE: 20.95±10.98 kPa vs. 55.95±22.42 kPa) and ESD (T-SWE: 9.00±8.55 kPa vs. 38.44±12.30 kPa; S-SWE: 8.17±6.14 kPa vs. 29.34±13.88 kPa) showed statistical differences in distinguishing malignant lesions from benign ones both in T-SWE and S-SWE (all p < 0.05). In T-SWE, the diagnostic performance of ESD was the highest (AUROC = 0.958), followed by Emax (AUROC = 0.909; p = 0.001 in comparison with ESD) and Emean (AUROC = 0.892; p < 0.001 in comparison with ESD), while in S-SWE, the diagnostic performance of Emax was the highest (AUROC = 0.967), followed by ESD (AUROC = 0.962, p > 0.05 in comparison with Emax) and Emean (AUROC = 0.930, p = 0.034 in comparison with Emax). AUROC-max (T-SWE: 0.909 vs. S-SWE 0.967), AUROC-mean (T-SWE: 0.892 vs. S-SWE 0.930) and AUROC-SD (T-SWE: 0.958 vs. S-SWE 0.962) showed no significant difference between T-SWE and S-SWE (all p > 0.05). The intra-class correlation coefficients (ICC) of the intra-operator consistency and inter-operator consistency respectively were 0.961 and 0.898 in T-SWE, while 0.954 and 0.897 in S-SWE. CONCLUSION T-SWE and S-SWE are equivalent for distinguishing the breast lesions. In T-SWE, ESD had the best diagnostic performance, while in S-SWE, Emax had the best diagnostic performance.

Integrin β4 promotes cell invasion and epithelial-mesenchymal transition through the modulation of Slug expression in hepatocellular carcinoma

Integrin β4 (ITGB4) is a transmembrane receptor involved in tumorigenesis and the invasiveness of many cancers. However, its role in hepatocellular carcinoma (HCC), one of the most prevalent human cancers worldwide, remains unclear. Here, we examined the involvement of ITGB4 in HCC and explored the underlying mechanisms. Real-time PCR and immunohistochemical analyses of tissues from 82 patients with HCC and four HCC cell lines showed higher ITGB4 levels in tumor than in adjacent non-tumor tissues and in HCC than in normal hepatic cells. Silencing of ITGB4 repressed cell proliferation, colony forming ability and cell invasiveness, whereas ectopic expression of ITGB4 promoted the proliferation and invasion of HCC cells and induced epithelial to mesenchymal transition (EMT) in parallel with the upregulation of Slug, as shown by transwell assays, WB and immunocytochemistry. Knockdown of Slug reduced cell viability inhibited invasion and reversed the effects of ITBG4 overexpression on promoting EMT, and AKT/Sox2-Nanog may also be involved. In a xenograft tumor model induced by injection of ITGB4-overexpressing cells into nude mice, ITGB4 promoted tumor growth and metastasis to the lungs. Taken together, our results indicate that ITGB4 plays a tumorigenic and pro-metastatic role mediated by Slug and suggest IGTB4 could be a prognostic indicator or a therapeutic target in patients with HCC.

Quantitative parameters of contrast-enhanced ultrasound in breast invasive ductal carcinoma: The correlation with pathological prognostic factors

PURPOSE To investigate the correlation between quantitative parameters on contrast-enhanced ultrasound (CEUS) and pathological prognostic factors in patients with breast invasive ductal carcinomas (IDCs). MATERIALS AND METHODS 102 patients with pathologically proven IDCs were retrospectively enrolled and all were preoperatively evaluated by CEUS. Quantitative analysis was conducted using the SonoLiver® software. On the parametric imaging, the data of rise time (RT), time to peak (TTP), mean transit time (mTT) and maximum intensity (IMAX) were recorded. Pathological prognostic factors, including histological grade, tumor diameter, lymph node status, estrogen receptor (ER), progesterone receptor (PR), C-erb-B2 and Ki-67 expression were evaluated. Correlation of enhancement parameters with pathological prognostic factors was analyzed. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance and operator consistency was evaluated. RESULTS The RTs and TTPs for lower grade IDCs (grade I or II) and higher histological grade IDCs (grade III) were 9.3 s±3.9 vs. 11.4 s±5.4 (p = 0.016), 11.6 s±6.1 vs. 14.7 s±7.7 (p = 0.028), respectively. The RTs for positive-C-erbB-2 expression and negative-C-erbB-2 expression IDCs were 10.1 s±4.5 vs. 11.9 s±6.0 (p = 0.047). The IMAX showed statistical difference between IDCs with negative-ER and those with positive-ER (p = 0.003), as well as IDCs with negative-PR and those with positive-PR (p = 0.019). The ROC analysis showed that, for the differentiation ER expression, the cut-off point for IMAX was 648.8% with an Az value of 0.718 (95% CI: 0.599-0.836), and the sensitivity and specificity were 63.6% and 70.2% respectively. The intra-operator consistency of the RT, TTP, mTT and IMAX were excellent with an overall ICC of 0.893, 0.858, 0.984 and 0.800, respectively (all p < 0.001). CONCLUSIONS Quantitative analysis of CEUS may be a useful and objective method in predicting pathological prognostic factors in breast IDCs.

Comparison of Virtual Touch Tissue Imaging & Quantification (VTIQ) and Toshiba shear wave elastography (T-SWE) in diagnosis of thyroid nodules: Initial experience

OBJECTIVE The aim of this study was to compare the diagnostic performance of two different 2D shear wave speed imaging techniques of Virtual Touch Tissue Imaging & Quantification (VTIQ) and Toshiba shear wave elastography (T-SWE) in predicting malignant thyroid nodules (TNs). MATERIALS AND METHODS 75 TNs in 75 patients which were subject to both VTIQ and T-SWE examinations were enrolled and analyzed. Shear wave speed (SWS) values on VTIQ and T-SWE were computed (SWS_max, min, mean and median). Area under the receiver operating characteristic (AUROC) curve was obtained to assess the diagnostic performance. RESULTS The AUROC for VTIQ was the highest with SWS_min whereas for T-SWE was SWS_max (0.774 versus 0.851; p > 0.05). The AUROC, sensitivity and negative predictive value (NPV) corresponding to SWS_max for VTIQ were significantly lower than those for T-SWE (0.717 versus 0.851, 61.5% versus 92.3% and 78.7% versus 94.3%; all p < 0.05). However, no significant differences were found between AUROC with SWS_min, SWS_mean, or SWS_median for VTIQ and SWS_max for T-SWE (all p > 0.05). CONCLUSION In general, VTIQ is equal to T-SWE for diagnosis of TNs. In the clinical practice, the selection of SWS_max should be avoided in VTIQ whereas should be selected in T-SWE.

Virtual Touch Tissue Imaging and Quantification in the Evaluation of Thyroid Nodules.

To investigate the diagnostic performance of a 2‐dimensional shear wave elastographic technique (Virtual Touch tissue imaging and quantification [VTIQ]; Siemens Medical Solutions, Mountain View, CA) for predicting thyroid malignancy.

Thyroid imaging reporting and data system in assessment of cytological Bethesda Category III thyroid nodules

OBJECTIVE To assess the usefulness of thyroid imaging reporting and data system (TI-RADS) for cytological Bethesda Category III thyroid nodules (TNs). METHODS This retrospective study included 121 patients with 121 TNs classified as Bethesda Category III at fine needle aspiration (FNA) cytology and thereafter underwent surgery. The TNs were classified according to US TI-RADS category and the malignancy risk of each category was calculated. RESULTS Surgical pathology confirmed 43 (35.5%) malignant and 78 (64.5%) benign TNs. The malignancy risks of categories 3, 4a, 4b, 4c, and 5 TNs were 0%, 4.0%, 12.5%, 62.2%, and 100%, respectively. For those >10 mm (n = 55), the malignancy risks were 0%, 6.2%, 12.5%, 73.3%, and 100%, respectively, whereas for those ≤10 mm (n = 66), the risks were 0%, 0%, 12.5%, 56.7%, and 100%, respectively. CONCLUSION Bethesda Category III TNs without suspicious US features or those ≤10 mm with only one suspicious US feature can be followed up with US.

Initial Experience With Ultrasound Elastography for Diagnosis of Major Salivary Gland Lesions

The aim of this study was to evaluate the usefulness of ultrasound elastography, including conventional strain elastography, acoustic radiation force impulse (ARFI)‐induced strain elastography, and point shear wave elastography (SWE) for diagnosis of major salivary gland lesions.

Ablative safety margin depicted by fusion imaging with post-treatment contrast-enhanced ultrasound and pre-treatment CECT/CEMRI after radiofrequency ablation for liver cancers

OBJECTIVE To evaluate the value of fusion imaging with post-treatment contrast-enhanced ultrasound (CEUS) and pre-treatment contrast-enhanced CT/MRI (CECT/CEMRI) in evaluating ablative safety margin after percutaneous ultrasound (US)-guided radiofrequency ablation (RFA) for liver cancers. METHODS 34 consecutive patients with 47 liver lesions who had undergone RFA were included. Fusion imaging with post-treatment CEUS and pre-treatment CECT/CEMRI was carried out to evaluate local treatment response and ablative safety margin within 1-3 days after RFA. The minimal ablative safety margins of the ablation zones were recorded. The complete response (CR) rate was calculated with reference to CECT/CEMRI results 1 month after RFA. The local tumour progression (LTP) was also recorded. RESULTS Of the 47 ablation zones, 47 (100%) were clearly depicted with CEUS-CECT/CEMRI fusion imaging, 36 (76.6%) with US-CECT/CEMRI fusion imaging and 21 (44.7%) with conventional US (both p < 0.001). The minimal ablative safety margins were great than or equal to 5 mm in 28 ablation zones, between 0 and 5 mm in 15, and less than 0 mm in 4. For the four lesions without enough ablative safety margin, three were referred to follow-up because CEUS showed larger ablation zones than pre-treatment lesions and the remaining lesion was subject to additional RFA 5 days after the first RFA. The CR rate was 95.7% (45/47) with reference to CECT/CEMRI results 1 month after RFA. During 2 to 34 months follow-up, LTP was found in two (4.4%) of 45 lesions with CR. Insufficient ablative safety margin was more commonly found in those lesions with LTP than those without LTP (1/4 vs 1/43, p < 0.001). CONCLUSION Fusion imaging with post-treatment CEUS and pre-treatment CECT/CEMRI can depict the ablative safety margin accurately after RFA. Inadequate ablative safety margin is associated with LTP. Depiction of ablative safety margin by fusion imaging after ablation might be considered as a routine procedure to assess the treatment response of RFA. Advances in knowledge: Fusion imaging with post-treatment CEUS and pre-treatment CECT/CEMRI is an effective method to evaluate the ablative safety margin early after RFA. Therefore, it should be recommended to be used as a routine procedure after RFA for liver cancers.

A Risk Model based on Ultrasound, Ultrasound Elastography, and Histologic Parameters for Predicting Axillary Lymph Node Metastasis in Breast Invasive Ductal Carcinoma

To develop a risk model for predicting axillary lymph node metastasis (LNM) in patients with breast invasive ductal carcinoma (IDCs) using ultrasound (US), US elastography of virtual touch tissue imaging (VTI) and virtual touch tissue imaging & quantification (VTIQ), and histologic parameters. This study included 162 breast IDCs in 162 patients. Univariate and multivariate analyses were used to identify the risk factors and a risk model was created. The results found that 64 (39.5%) of 162 patients had axillary LNMs. The risk score (RS) for axillary LNM was defined as following: RS = 1.3 × (if lesion size ≥20 mm) + 2.6 × (if taller than wide shape) + 2.2 × (if VTI score ≥5) + 3.9 × (if histological grade III) + 1.9 × (if positive C-erbB-2). The rating system was divided into 6 stages (i.e. Stage I, Stage II, Stage III, Stage IV, Stage V, and Stage VI) and the associated risk rates in terms of axillary LNM were 0% (0/19), 6.1% (2/33), 7.7% (3/39), 65.5% (19/29), 92.3% (24/26), and 100% (16/16), respectively. The risk model for axillary LNM established in the study may facilitate subsequent treatment planning and management in patients with breast IDCs.