This study aims to explore the impact of different ROI delineation strategies on the axillary lymph nodes metastasis (ALNM) prediction model by analyzing two-dimensional ultrasound images of lymph nodes. In addition, we integrated clinical and pathological information to construct a comprehensive model, and based on this model, developed a nomogram for individualized assessment of the probability of ALNM. A total of 146 axillary lymph nodes were randomly divided into a training set and a testing set at a ratio of 8:2. Clinical and pathological features were selected using univariate and multivariate logistic regression analyses, followed by the construction of a clinical prediction model. Radiomic features were extracted from both the internal and surrounding regions of the two-dimensional ultrasound images of the axillary lymph nodes. The least absolute shrinkage and selection operator (LASSO) algorithm was then used to select and retain the optimal features, followed by the construction of a radiomic prediction model. A combined prediction model was developed by integrating the clinical and radiomic models, and a nomogram was created for the combined prediction model. The clinical status of axillary lymph nodes was an independent predictor for metastasis. The clinical prediction model based on the status of axillary lymph nodes achieved an AUC of 0.728 in the testing set. The radiomic prediction model based on the LASSO logistic regression algorithm with a 1 mm extended region had the highest AUC of 0.856 in the testing set. The combined prediction model integrating the clinical and optimal radiomic models achieved an AUC of 0.841 in the testing set, with a sensitivity of 77.4

OBJECTIVE:This study aimed to assess whether ultrasound inversion imaging enhances the specificity of Breast Imaging Reporting and Data System (BI-RADS) BI-RADS 4A masses, reducing unnecessary biopsies. METHOD:From July 2021 to March 2023, 425 pathologically confirmed breast masses were collected from the Second Affiliated Hospital of Anhui Medical University. Based on a five-point scale of inversion imaging criteria proposed in a previous study, the diagnostic performance of three classification algorithms, including BI-RADS, BI-RADS category after inversion imaging, and BI-RADS category after inversion imaging without calcification masses-via receiver operating characteristic (ROC) curve analysis. RESULTS:Among the 425 breast masses, 116 masses were classified as BI-RADS category 4A (82 benign, 34 malignant). After inversion imaging, 74 benign BI-RADS category 4A masses were correctly downgraded to BI-RADS category 3, avoiding biopsies. ROC curve values indicated that the specificity, sensitivity, and accuracy were 31.06%, 98.48%, and 72.94%, respectively, with BI-RADS, 72.05%, 95.83%, and 86.82%, respectively, with BI-RADS after inversion imaging, and 86.51%, 97.75%, and 93.09%, respectively, with BI-RADS category after inversion imaging without calcification masses. CONCLUSION:Ultrasound inversion imaging offers a feasible supplementary method to distinguish between benign and malignant breast masses, improving BI-RADS 4A specificity, especially for non-calcified masses.

This study aims to explore whether intratumoral and peritumoral ultrasound radiomics of ultrasound images can predict the low expression status of human epidermal growth factor receptor 2 (HER2) in HER2-negative breast cancer patients. HER2-negative breast cancer patients were recruited retrospectively and randomly divided into a training cohort (n = 303) and a test cohort (n = 130) at a ratio of 7:3. The region of interest within the breast ultrasound image was designated as the intratumoral region, and expansions of 3 mm, 5 mm, and 8 mm from this region were considered as the peritumoral regions for the extraction of ultrasound radiomic features. Feature extraction and selection were performed, and radiomics scores (Rad-score) were obtained in four ultrasound radiomics scenarios: intratumoral only, intratumoral + peritumoral 3 mm, intratumoral + peritumoral 5 mm, and intratumoral + peritumoral 8 mm. An optimal combined nomogram radiomic model incorporating clinical features was established and validated. Subsequently, the diagnostic performance of the radiomic models was evaluated. The results indicated that the intratumoral + peritumoral (5 mm) ultrasound radiomics exhibited the excellent diagnostic performance in evaluated the HER2 low expression. The nomogram combining intratumoral + peritumoral (5 mm) and clinical features showed superior diagnostic performance, achieving an area under the curve (AUC) of 0.911 and 0.869 in the training and test cohorts, respectively. The combination of intratumoral + peritumoral (5 mm) ultrasound radiomics and clinical features possesses the capability to accurately predict the low-expression status of HER2 in HER2-negative breast cancer patients.

Background Ultrasonography (US) still has some limitations in the differentiation of benign and malignant breast masses. Therefore, we introduced new technologies such as S-Detect, microvascular flow imaging (MVFI), and strain elastography (SE) into the examination and compared the multimodal method with Breast Imaging Reporting and Data System (BI-RADS). Objectives This prospective study aimed to evaluate the value of multimodal diagnostic methods that add S-Detect, MFI, and SR to US in differentiating benign from malignant breast masses. Methods We recruited 186 patients with 189 masses between July 2021 and March 2022. The masses were examined using US, S-Detect, SR, and MFI before biopsy, and the benign and malignant differentiation value of each and their combination were assessed compared with surgical pathology results using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Subgroup analysis by lesion size was also performed. Results The respective optimal cutoff values of SR and MFI for differentiating benign from malignant masses were 3.15 and 2.45, respectively, and the sensitivity and specificity were 79.3% and 85.6% and 94.6% and 69.1%, respectively. The multimodal AUC (0.907), sensitivity (97.8%), accuracy (90.5%), PPV (84.9%), and NPV (97.6%) were larger than those of each modality ( p < 0.05), regardless of the mass size. Conclusions The diagnostic method of S-Detect combined with multimodal ultrasound can effectively improve the diagnostic efficiency of breast masses and is expected to become a routine examination for breast in future for better evaluation the benign and malignancy of breast masses.

Background To investigate whether combining the flipped classroom approach with Peyton’s four-step method can enhance teaching effectiveness in ultrasound (US) zoning of the thyroid and cervical lymph nodes for standardized residency training. Methods A total of 66 resident training students were randomly divided into a control group and an observation group. The control group received traditional teaching methods, including “see one, do one” learning, lecture-based learning (LBL), and case-based learning (CBL). The observation group was taught using Peyton’s four-step teaching method, the flipped classroom approach, and CBL. Assessments were conducted through skill operation and clinical case analysis. A questionnaire survey was used to evaluate student satisfaction. Assessment scores and questionnaire ratings between the two teaching methods were compared. Results 1) Assessment results demonstrated higher scores in skill operation and clinical case analysis for the observation group compared to the control group [(87.64 ± 3.72) vs. (80.48 ± 5.92) points, (87.94 ± 4.46) vs. (82.85 ± 4.24) points]. 2) The questionnaire survey indicated that resident trainees taught using Peyton’s four-step method showed greater improvement in learning interest [(4.61 ± 0.57) vs. (3.70 ± 0.85) points] and experienced reduced exam pressure compared to the control group [(4.52 ± 0.62) vs. (3.21 ± 0.70) points]. These differences were statistically significant (P < 0.05). Conclusion Peyton’s four-step approach combined with the flipped classroom method improved resident training students’ scores in skill operation and clinical case analysis for ultrasound zoning of the thyroid and cervical lymph nodes. It also stimulated learning interest and alleviated exam pressure, making it an effective teaching method for enhancing standardized US training outcomes in resident education.

Objective To validate the feasibility of ultrasound in assessing the curative effect of botulinum toxin type A (BTXA) in treating hypertrophic scar (HS). Methods Eight healthy New Zealand long-eared rabbits were utilized in the study. Four wounds, each measuring 1.0 cm in diameter, were created on both ears of each rabbit. Immediately after surgery, each of these wounds received an injection containing a distinct concentration of BTXA. On postoperative week 6, scar thickness, vascularity, and hardness were assessed based on high frequency ultrasound (HFUS), superb microvascular imaging (SMI), shear wave elastography (SWE), Masson staining, and immunohistochemical staining for CD31. Results All wounds healed well, and HSs formed after 6 weeks post-surgery. Scar thickness based on HFUS presented a significant decrease with increasing BTXA concentration (p < 0.05), aligning with the gross morphology. Simultaneously, scar stiffness, evaluated using SWE, showed a significant decrease in accordance with the variation of the collagen volume fraction, which refers to the ratio of the collagen positive area to the total area (p < 0.05). Although the vascularity index obtained by SMI did not exhibit a statistically significant change across different BTXA concentrations, this technique effectively illustrated the microvascular perfusion in HS. Immunohistochemical staining for CD31 revealed that BTXA inhibited angiogenesis. Conclusion HFUS and SWE displayed excellent performance in evaluating HS thickness and stiffness. SMI showed a good performance in reflecting microvascular signals in HS. These ultrasound techniques have great potential in assessing the therapeutic effect of BTXA in HS.

Background We aimed to evaluate the added value of inversion imaging in differentiating between benign and malignant breast masses when combined with the Breast Imaging Reporting and Data System (BI-RADS). Methods A total of 364 patients with 367 breast masses (151 benign and 216 malignant) who underwent conventional ultrasound and inversion imaging prior to breast surgery were included. A 5-point inversion score (IS) scale was proposed based on the masses’ internal echogenicity and distribution characteristics in the inversion images. The combination of IS and BI-RADS was compared with BI-RADS alone to evaluate the value of inversion imaging for breast mass diagnosis. The diagnostic performance of the BI-RADS and its combination with IS for breast masses were analyzed using area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results The IS for malignant breast masses (3.96 ± 0.77) was significantly higher than benign masses (2.58 ± 0.98) ( P < 0.001). The sensitivity, specificity, accuracy, PPV, and NPV of BI-RADS were 86.1%, 81.5%, 84.2%, 86.9%, and 80.4%, respectively, and an AUC was 0.909. By compared with BI-RADS, 72 breast masses were downgraded from suspected malignancy to benign, and 6 masses were upgraded from benign to suspected malignancy. Thus, the specificity was increased from 81.5 to 84.8%, it allows 72 benign masses avoid biopsy. Conclusion The combination of inversion imaging with BI-RADS can effectively improve the diagnostic efficacy of breast masses, and inversion imaging could help benign masses avoid biopsy.

Objective:To compare the efficacy of either the 2017 American Society of Radiology thyroid imaging report and data system (ACR-TIRADS) or the Chinese ultrasound thyroid imaging report and data system (C-TIRADS) combined with two-dimensional shear wave elastography (2D-SWE) imaging technology in the differential diagnosis of benign and malignant thyroid nodules.Methods:Cases with thyroid nodules who underwent fine needle aspiration or surgery at four hospitals in Anhui province (the Second Affiliated Hospital of Anhui Medical University, Anhui Provincial Hospital, Anhui Provincial Cancer Hospital, and the Fourth Affiliated Hospital of Anhui Medical University) from February 2021 to January 2022 were collected and classified by trained senior sonographers based on the ACR-TIRADS (2017) and C-TIRADS, respectively. A total of 502 thyroid nodules with the data of conventional ultrasound and 2D-SWE were retrospectively analyzed. Using the fine needle aspiration or surgical pathological results as the gold standard, receiver operating characteristic (ROC) curve analysis was performed to compare the diagnostic efficacy of ACR-TIRADS, C-TIRADS, 2D-SWE technology, ACR-TIRADS combined with 2D-SWE, and C-TIRADS combined with 2D-SWE in thyroid nodules. The consistency of the two combined diagnostic methods was assessed by Kappa test.Results:The area under the ROC curve (AUC) of ACR-TIRADS combined with 2D-SWE and C-TIRADS combined with 2D-SWE (set cut-off value: C-TR4C) was 0.852 and 0.875, respectively, for the diagnosis of malignant thyroid nodules, with a corresponding sensitivity of 86.00% and 91.70%, specificity of 79.90% and 67.40%, and accuracy of 83.27% and 80.79%; the diagnostic efficacy of these two combinations was significantly better than that of ACR-TIRADS, C-TIRADS, or 2D-SWE technology alone (P＜0.05). The AUC of C-TIRADS was higher than that of ACR-TIRADS (Z=2.090, P=0.037). The Kappa value of ACR-TIRADS combined with 2D-SWE and C-TIRADS combined with 2D-SWE was 0.801 (P＜0.001).Conclusion:Either ACR-TIRADS or C-TIRADS combined with 2D-SWE technology can considerably improve the diagnostic efficacy for malignant thyroid nodules, with the latter having better diagnostic efficacy.

目的 探讨人工智能S-Detect技术联合BI-RADS分类及Adler分级法诊断乳腺肿块中的价值.方法 收集2019年9月-2021年7月在安徽医科大学第二附属医院超声诊断科行超声检查的121例乳腺肿块患者的超声图像资料,分析BI-RADS分类、S-Detect及Adler分级法诊断结果,根据S-Detect及Adler分级法诊断结果将每个肿块的分类进行联合诊断,以病理结果为金标准,比较BI-RADS分类、BI-RADS联合S-Detect技术、BI-RADS联合S-Detect技术及Adler分级法诊断乳腺肿块的灵敏度、特异度、准确度,采用受试者操作曲线(ROC)分析三种诊断方法的价值.结果 病理结果显示,121例乳腺肿块患者恶性65例,良性56例.BI-RADS分类、BI-RADS联合S-Detect技术、BI-RADS联合S-Detect技术及Adler分级法的AUC分别为0.644、0.663、0.823;BI-RADS分类诊断乳腺肿块的灵敏度为98.46％、特异度为30.36％、准确度为66.94％;BI-RADS联合S-Detect诊断乳腺肿块的灵敏度为96.92％,特异度为35.71％,准确度为68.60％;BI-RADS联合S-Detect及Adler分级法诊断乳腺肿块的灵敏度为98.46％,特异度为66.07％,准确度为83.47％.结论 人工智能S-Detect技术联合BI-RADS分类及Adler分级法可进一步提升对乳腺肿块的诊断效能,对临床干预与治疗具有重要的指导意义.

目的 应用Logistic回归分析临床、病理及超声特征对乳腺导管内癌是否伴有微浸润的诊断价值,确定伴有微浸润危险因素.方法 回顾性分析导管内癌(DCIS)患者64例、导管内癌伴微浸润(DCISM) 80例,在9项临床、5项病理、10项超声特征方面进行单因素及多因素Logistic回归分析.结果 多因素分析临床资料均不是DCISM危险因素(P＞0.05),分子生物学HER2阳性、病理组织高级别、声像图边缘不光整、低回声、富血供是DCISM危险因素(P＜0.05).多因素分析诊断导管内癌是否伴有微浸润灵敏度82.5％、特异度92.2％、ROC曲线下面积0.941.结论 多因素分析对乳腺导管内癌是否伴有微浸润具有良好的诊断价值,分子生物学HER2阳性、病理组织高级别、声像图边缘不光整、低回声、富血供是DCISM危险因素.

目的 探讨2020甲状腺结节超声恶性危险分层中国指南(C-TIRADS)及其联合弹性成像技术对甲状腺结节的诊断价值.方法 回顾性分析经手术病理证实的117例甲状腺结节灰阶及弹性声像图特征,运用C-TIRADS对灰阶声像图进行分类评价,记录超声弹性评估结果,在C-TIRADS结果基础上综合弹性成像对甲状腺结节进行联合诊断.以病理结果为金标准,对比C-TIRADS及联合诊断对甲状腺结节诊断效能.结果 C-TIRADS及联合诊断对甲状腺结节诊断敏感性、特异性、准确性、AUC为82.2％、88.6％、84.6％、0.854及95.9％、86.4％、92.3％、0.911.联合诊断较C-TI-RADS单独运用敏感性、准确性、AUC上升,特异性略有下降(P<0.05).结论 C-TIRADS对甲状腺结节具有较好的诊断价值,在此基础上联合弹性成像可进一步提升超声诊断价值.

目的 旨在探讨应用MVFI测量的血管指数ⅥMV联合BI-RADS在乳腺肿块良恶性鉴别中的应用价值.方法 选取行乳腺超声检查并取得病理结果的130例患者(131个乳腺肿块),分为直径＜20 mm和≥20 mm两组,行二维灰阶超声检查获得BI-RADS分类,再进行血管指数ⅥMV检测.以病理结果为金标准,分析BI-RADS、ⅥMV和二者联合对乳腺肿块的诊断效能.结果 以病理为金标准,ⅥMV鉴别乳腺肿块良恶性的cutoff值为2.45;ⅥMV联合BI-RADS诊断乳腺肿块的AUC、准确度、灵敏度、阴性预测值均较单一BI-RADS有所提高,而特异度和阳性预测值也未明显降低,均在80％以上.结论 血管指数ⅥMV和BI-RADS联合可有效提高对乳腺肿块的诊断效能,可有效减少不必要的穿刺.

目的 探讨TI-RADS与S-Detect技术联合应用对甲状腺结节的诊断价值.方法 回顾性分析125个结节的超声图像,行TI-RADS分类,并获取S-Detect结果,将每枚结节TI-RADS分类根据S-De-tect结果进行联合诊断调整.以病理结果为金标准,比较TI-RADS及其联合S-Detect诊断甲状腺结节的效能.结果 较TI-RADS单独诊断:CUT OFF值设为4a类时联合诊断后AUC、特异度、准确度均有上升(P＜0.05),灵敏度改变无统计学意义(P＞0.05);CUT OFF值设为4b类时联合诊断后特异度上升(P＜0.05);AUC、准确度、灵敏度改变无统计学意义(P＞0.05).结论 TI-RADS与S-Detect技术联合可提高超声对于甲状腺结节的诊断价值,在减少非必要FNA、避免过度诊断方面有积极的作用.

Objective:To assess the value of S-Detect combined with calcification characteristics in the diagnosis of benign and malignant thyroid nodules.Methods:Ninety-four patients with 94 thyroid nodules were examined by conventional ultrasonography and S-Detect technique at the Second Affiliated Hospital of Anhui Medical University from July 2019 to February 2020, and the diagnostic efficacy of conventional ultrasound, S-Detect,and S-Detect combined with calcification characteristics were analyzed according to the postoperative pathological results.Results:As confirmed by surgical pathology, of 94 thyroid nodules in 94 patients, 37 were benign and 57 were malignant. The sensitivity, specificity, and accuracy of conventional ultrasound, S-Detect, and S-Detect combined with calcification characteristics in the differential diagnosis of benign and malignant thyroid nodules were 91.2%, 91.8%, and 91.4%, 96.4%, 81.1%, and 90.4%, and 98.2%, 81.8%, and 92.5%, respectively. The areas under the ROC curves of conventional ultrasound, S-Detect, and S-Detect combined with calcification characteristics were 0.879, 0.864, and 0.890, respectively, with the value of S-Detect combined with calcification characteristics being significantly higher than those of conventional ultrasound and S-Detect (Z=2.020, P=0.043; Z=2.231, P= 0.026).Conclusions:The combination of S-Detect and calcification characteristics can improve the diagnostic efficiency for thyroid nodules.

目的 探讨C-TIRADS分类方法联合人工智能S-Detect技术对甲状腺结节的诊断价值.方法 采用C-TIRADS分类方法和S-Detect技术对98例患者(共98个甲状腺结节)进行评估,以术后病理结果作为金标准,对比分析采用C-TIRADS分类方法、S-Detect技术以及两者联合对甲状腺结节的诊断效能.结果 经手术病理证实,98例患者共98个甲状腺结节中,良性40个、恶性58个.超声医师采用C-TIRADS分类方法联合S-Detect技术诊断甲状腺结节良恶性的灵敏度为95.2％、特异度为82.5％、准确率为91.8％,其诊断效能优于单独应用常规超声和 S-Detect 技术(P＜0.05).结论 C-TIRADS分类方法兼顾分类的准确性及临床易用性,适应目前我国甲状腺结节诊治流程,与S-Detect技术联合使用可提高甲状腺结节的诊断效能.

目的：探讨超声引导下 EnCor 真空辅助活检系统在乳腺良性肿块切除中的应用及注意事项。方法回顾性分析320例患者的445个良性肿块运用 EnCor 真空辅助活检系统病例资料。结果445个肿块中433个完全切除，12个可见残留肿块，长径3～6 mm。320例患者术后均未发生感染。320例患者中局部血肿发生 1 0例，发生率3．13％，3个月后复查均消失。320例患者术侧乳腺形态未见改变，皮肤切口处瘢痕隐蔽。结论EnCor 真空辅助活检系统在乳腺良性肿块的切除上具有创伤小、并发症少的优点，在超声引导下可减少进针次数、减少组织损伤，可取得满意的临床治疗效果。

Objective To evaluate the distinction of various bladder volumes on transabdominal ultrasound measurement of the curve distance of the inferior edge of the placenta with internal cervical os. Methods 136 pregnant women by normal single births 18-27 weeks were studied. The curve distance was measured transabdominally using ultrasound in different bladder volumes,among 0-50 ml,50-150 ml and 150-250 ml. According to the volumes,the objects were marked as d1 group,d2 group and d3 group in turn. Meanwhile,depending on the placental coverage area,the subjects were divided into three kinds,the anterior,the posterior and the sidewall. Results For the same woman,there was distance variations in different bladder volumes by measurements of transabdominal ultrasound( P < 0. 01) ,while distance variations was no relation to the placental coverage area( P > 0. 05) . With increasing bladder volume,there was an obvious trend of decreasing the distance. The 95 confidence interval for mean( upper bound) of the distance variations was 31. 67 mm and 50. 70 mm in d2 and d3 group bladder volumel,comparing the d1 group. Conclusion Transabdominal ultrasound measurement of the distance of the inferior edge of the placenta with internal cervical os is dependent on bladder volume,which should be paid attention to the work of ultrasound diagnosis.

目的 通过超声观察比较不同位置胎盘迁移的差异,预测妊娠末期前置胎盘的转归情况.方法 观察128例孕18～24周非高龄孕妇胎盘覆盖的区域,将其分为前壁组(A组)、后壁组(B组)、侧壁组(C组)及混合壁组(D组),并将其中56例胎盘前置状态的孕妇分为完全性、部分性、边缘性、低置状态4组.每隔4周重复超声检查1次,直至妊娠38～40周.结果 A、B、C、D 4组间胎盘迁移速率进行比较,结果显示A组与B组差异有统计学意义(P<0.05),其他组间差异均无统计学意义.妊娠中期前置状态的胎盘至妊娠晚期均有不同程度的转归,16例低置状态胎盘中有15例转归至正常位置,而12例完全性前置状态胎盘中只有1例转至正常位置.结论 中孕期胎盘附着位置不同,胎盘迁移程度也不同.