Minghua Yao

A Drug–Perfluorocarbon Nanoemulsion with an Ultrathin Silica Coating for the Synergistic Effect of Chemotherapy and Ablation by High‐Intensity Focused Ultrasound

The synergistic effect of chemotherapy and ablation using high-intensity focused ultrasound (HIFU) is realized with a newly developed drug-delivery system. The system comprises an ultrathin silica shell surrounding a poly(lactic-co-glycolic acid) nanoemulsion core containing the drug (CPT) and a perfluorocarbon (PFOB). This nanosystem presents many advantages in drug delivery, such as excellent structural stability, high drug-loading capacity, and rapid HIFU-mediated drug release.

Diagnostic Value of Virtual Touch Tissue Quantification for Breast Lesions with Different Size

Purpose. To evaluate diagnostic value of the virtual touch tissue quantification (VTTQ) for breast lesions with different sizes. Materials and Methods. Patients with 206 breast lesions were categorized into three groups according to lesion size (<10 mm, 10–20 mm, and >20 mm). Breast lesions were examined by conventional ultrasound and VTTQ, and shear wave velocity (SWV) of each lesion and adjacent normal breast tissue were measured. Diagnoses were confirmed by pathological examination after surgery. The receiver-operating characteristic curve (ROC) analyses were performed to evaluate the diagnostic value of SWV, and the area under curves (AUC) was compared among groups. Results. SWV of malignant lesions was much higher than that of benign lesions, whereas the difference was not obvious for lesions <10 mm (P = 0.15). There was statistical significant difference of AUC between lesions <10 mm and 10–20 mm (P < 0.05), as well as lesions <10 mm and >20 mm (P < 0.05). The sensitivity of lesions <10 mm was 33.33%, which was relatively low compared to other groups. Conclusion. According to our results, VTTQ is a promising method for breast lesions >10 mm, and further studies were warranted to improve sensitivity of VTTQ for breast lesions <10 mm.

A novel two-dimensional quantitative shear wave elastography to make differential diagnosis of breast lesions: Comprehensive evaluation and influencing factors

BACKGROUND Virtual touch imaging quantification (VTIQ), a form of shear wave elastography, may help in the diagnosis of breast lesions. OBJECTIVE We aimed to evaluate the diagnostic performance of combined VTIQ and conventional ultrasound (US), and assess the factors influencing VTIQ measurement. METHODS From September 2014 to December 2014, 162 patients with breast lesions were examined by US and VTIQ to assess shear wave speed (SWS) and morphological characteristics (lesion shape, orientation, margin and echo pattern). The sensitivity, specificity and accuracy of VTIQ, US and VTIQ+US for the diagnosis of breast lesions was evaluated in comparison to pathological results. Factors influencing deviations in SWS measurements were assessed by logistic regression. RESULTS The SWS cut-off between malignant and benign lesions was 3.73 m/s. The sensitivity, specificity and accuracy were: 98.07%, 55.96%, and 69.57% for US; 76.92%, 78.89% and 78.26% for VTIQ; and 98.07%, 84.40% and 88.82% for US+VTIQ. The two factors that influenced the SWS results were the lesion margin (odds ratio [OR], 16.363; 95% confidence interval [CI], 3.220-29.020) and vascularity (OR, 6.712; 95% CI, 1.358-9.072). CONCLUSIONS The lesion margin and vascularity could affect the measurement of SWS as well as the experience of examiner. However, VTIQ is still a reliable method that provides valuable information in the differential diagnosis of breast lesions, and may reduce unnecessary biopsies.

Conventional US combined with acoustic radiation force impulse (ARFI) elastography for prediction of triple-negative breast cancer and the risk of lymphatic metastasis

PURPOSE To evaluate the combination of conventional ultrasound (US) and acoustic radiation force impulse (ARFI) elastography in predicting triple-negative breast cancer and the likelihood of lymphatic metastasis. MATERIALS AND METHODS A total of 178 women presenting from May 2013 to September 2015 with pathologically proven triple-negative (n = 60) or hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer (n = 118) were reviewed. Conventional US and ARFI imaging including Virtual touch tissue image (VTI) and Virtual Touch tissue Quantification (VTQ), were performed for each breast nodule. Parameters collected included patient age, lymph node involvement, histological grade, tumor subtype, appearance on conventional US, shear wave velocity (SWV) value, VTI score and the boundary on VTI. The ARFI findings were compared with the pathological findings. RESULTS Younger age (P < 0.001), higher histological grade (P < 0.001), lymphatic metastasis (P < 0.001), more nodes involved (P = 0.001), larger tumor size (P = 0.008), regular shape (P = 0.032), high VTI score (P = 0.006), unclear VTI boundary (P = 0.033), SWV ≥3.51 m/s (P = 0.015) were significantly associated with triple-negative breast cancer. High VTI score (P = 0.004) and a high SWV ≥4.15 m/s (P = 0.002) were significantly associated with lymphatic metastasis. CONCLUSION Conventional US combined with ARFI may be used to predict triple-negative breast cancer. Those cancers with higher SWV and the high VTI score have a higher likelihood of lymphatic metastasis.

Diagnostic value of contrast-enhanced ultrasound and shear-wave elastography for breast lesions of sub-centimeter

BACKGROUND Contrast-enhanced ultrasound (CEUS) and shear-wave elastography (SWE) are used for diagnostic purposes. OBJECTIVE Investigate the diagnostic value of CEUS and SWE for breast lesions of sub-centimeter diameter. METHODS Sixty-two patients (mean age: 49.3±12.1 years) with 66 lesions (mean diameter, 8.1±1.5 mm) were analyzed. Conventional ultrasound (US), CEUS and SWE were undertaken. Pathologic specimens were obtained through biopsy or surgery. Lesions were measured in kilopascals. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were analyzed. RESULTS For conventional US, the sensitivity was 92.31%, specificity 28.30%, PPV 24.00%, NPV 93.75%, and accuracy 40.90%, whereas those for SWE were 61.54%, 98.11%, 88.89%, 91.23%, and 90.91% (p = 0.000) and CEUS were 92.31%, 60.38%, 36.37%, 96.97%, and 66.67% (p = 0.001), respectively. For SWE + CEUS, the sensitivity was 61.54%, specificity 100.00%, PPV 100.00%, NPV 91.38%, and accuracy 92.42% (p = 0.000). There was a significant difference between US and CEUS (p = 0.004), but not for SWE or SWE + CEUS (p = 0.568; p = 0.205). For SWE + CEUS, there was a significant difference with SWE alone and CEUS alone (p = 0.000; p = 0.008). Between SWE and CEUS, the difference was significant (p = 0.031). CONCLUSIONS SWE and CEUS could help to differentiate between malignant and benign breast lesions <1 cm in diameter.

Comparison of Virtual Touch Tissue Quantification and Virtual Touch Tissue Imaging Quantification for diagnosis of solid breast tumors of different sizes

BACKGROUND Acoustic radiation force impulse imaging (ARFI) with Virtual Touch Tissue Quantification (VTQ) or Virtual Touch Tissue Imaging Quantification (VTIQ) measures shear wave velocity (SWV), which is proportional to tissue stiffness, a diagnostic parameter for malignancy. OBJECTIVE To compare the performance of VTQ and VTIQ in diagnosing solid breast tumors. METHODS Conventional ultrasound, VTQ and VTIQ were used to examine 246 solid breast tumors from 230 patients. Tumors were grouped according to size: <10 mm, 10-20 mm, >20 mm. Pathological diagnoses were via histological examination of biopsies. ROC curves were used to assess diagnostic performance and optimal cut-off points for VTQ and VTIQ. RESULTS For all sizes, SWVVTQ and SWVVTIQ were higher for malignant versus benign tumors (P < 0.05). SWVVTQ and SWVVTIQ were both higher for tumors≥10 mm (P < 0.05). Areas under the ROC curves (diagnostic performance index; 0.860-0.952) did not differ significantly between VTQ and VTIQ. Optimal cut-off values for SWVVTQ and SWVVTIQ were higher for tumors≥10 mm. CONCLUSION The diagnostic performance of VTQ and VTIQ was moderate to good for solid breast tumors. Although both methods have higher sensitivities in tumors≥10 mm, their overall diagnostic performance was similar for all sizes.

A Preliminary Investigation of Normal Pancreas and Acute Pancreatitis Elasticity Using Virtual Touch Tissue Quantification (VTQ) Imaging

Background The aim of this study was to prospectively evaluate the use of elastometry in healthy volunteers and patients with acute pancreatitis using virtual touch tissue quantification (VTQ) imaging technology performed on the pancreas. Material/Methods We enrolled 210 healthy volunteers and 44 acute pancreatitis patients in the study between March 2012 and June 2013. Healthy subjects were divided into 3 groups: young (18–30 years), middle-aged (30–50 years), and elderly (>50 years). VTQ was performed on the pancreatic head and body regions to obtain shear wave velocity (SWV) measurements, which were used to evaluate the elasticity values of tissues. Results The pancreatic head SWV value in the whole healthy group was 1.18±0.23 m/s, and that in the pancreatic body was 1.21±0.20 m/s. In patients with acute pancreatitis, the mean SWV measurements at the head were 1.18±0.20 m/s, compared to 1.25±0.19 m/s in the pancreatic body. There was no statistically significant difference between whole healthy volunteers and the acute pancreatitis group. Conclusions VTQ is a new method that shows promise for the quantification of pancreatic elasticity, but further studies are warranted.

Combination of conventional ultrasonography and virtual touch tissue imaging quantification for differential diagnosis of breast lesions smaller than 10 mm

OBJECTIVE To determine the value of combining conventional ultrasonography with virtual touch tissue imaging quantification (VTIQ) for differential diagnosis of breast lesions smaller than 10 mm. METHODS A total of 98 breast lesions smaller than 10 mm were examined by conventional ultrasound and VTIQ using a Siemens ACUSON S3000 ultrasound machine. Pathologic diagnosis was established after surgery or fine needle biopsy. RESULTS Malignant lesions were characterized by taller-than-wide shape, poorly circumscribed margin, and marked hypoechogenicity. The mean VTIQ shear wave velocity (SWV) value of malignant lesions was 4.88±1.87 m/s (range, 1.75-9.34 m/s), significantly higher than that of benign lesions (2.68±1.02 m/s; range, 1.18-4.67 m/s). The optimal cutoff SWV value was 3.27 m/s, with sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 86.20%, 95.65%, 92.86%, 89.29%, and 94.29%, respectively. The combination of SWV >3.27 m/s plus the US feature of poorly circumscribed margin had the highest sensitivity (93.33%) and specificity (100%) for diagnosis of malignant breast lesions. CONCLUSION Features such as taller-than-wide shape, poorly circumscribed margin, and marked hypoechogenicity on conventional US, and SWV >3.27 m/s on VTIQ, are indicators of malignancy in breast lesions with diameter <10 mm. The combination of poorly circumscribed margin and SWV >3.27 m/s provides the highest specificity and diagnostic accuracy.

The clinical value of sonourethrography after bipolar transurethral plasmakinetic prostatectomy

Abstract The aim of this study was to assess the value of transrectal sonourethrography in the diagnosis of dysuria after bipolar transurethral plasmakinetic prostatectomy (TUPKP). Seventy-seven male patients with dysuria after TUPKP underwent transrectal sonourethrography. The clinical data were then compared with the surgical outcomes. The following pathologies were diagnosed: Bladder neck atresia (17/77), bladder orifice strictures (15/77), membranous urethral strictures (21/77), pars cavernosa urethral stricture (12/77), residual prostate gland (5/77), external urethral orifice stricture (2/77), calculi in the prostatic urethra (2/77), flap in the internal urethral orifice (2/77), and postoperative dysfunction of the bladder detrusor muscle (1/77). Transrectal sonourethrography is a reliable diagnostic method for numerous pathologies that occur in patients with dysuria after TUPKP and is a clinically useful tool.

Diagnostic Value of Different Systematic Prostate Biopsy Methods in the Detection of Prostate Cancer with Ultrasonographic Hypoechoic Lesions - A Comparative Study

Objective: To assess if a less extended biopsy in the transperineal approach is sufficient for detection of prostate cancer (PC) in patients with hypoechoic lesions. Methods: This was a prospective study of 167 consecutive patients with prostate hypoechoic lesion and who underwent transperineal ultrasound (TPUS)-guided 12-core and hypoechoic lesion core biopsy between January 2012 and February 2013. Results: PC was detected in 64.1% (107/167) of patients. The PC detection rate of the 12-core prostate biopsy scheme was the highest, but when including the hypoechoic lesion core, there was no difference between the 6- and 12-core schemes (all p > 0.05), irrespective of prostate volume or prostate-specific antigen levels (all p > 0.05). Conclusions: A more limited biopsy scheme could be sufficient for the detection of PC if the hypoechoic lesion is sampled.