BACKGROUND:This study is to investigate the feasibility of using the 18F fluorodeoxyglucose (18F-FDG) positron emission tomography / computed tomography (PET/CT) metabolic parameters to predict the MSI status of gastric cancer (GC) patients. MATERIALS AND METHODS:Patients with GC who underwent 18F-FDG PET/CT before surgery from January 2021 to June 2022 were retrospectively analyzed. Calculate and record the 18F-FDG PET/CT metabolic parameters of primary gastric cancer lesions, including maximum, peak and average standardized uptake values (SUVmax, SUVpeak, and SUVmean), as well as metabolic tumor volume (MTV) and total lesion glycolysis (TLG). The status of MSI was determined by immunohistochemical assay. The differences of quantitative parameters between MSI and microsatellite stability (MSS) groups were evaluated, and the prediction performance of metabolic parameters was analyzed by using subject operating characteristic (ROC) analysis and area under ROC curve (AUC). RESULTS:62 patients (44 males and 18 females; age range 30-81 years-old, median age 65.5 years-old) were finally included. There were 20 patients in MSI group and 42 patients in MSS group. MTV30%, MTV40%, MTV50% and MTV60%, as well as TLG40% showed significant differences between the two groups (all P values <0.05), within which MTV40% demonstrated the highest AUC value [0.825, 95% confidence interval (CI): 0.703-0.947] in predicting MSI, the cutoff value was 44.1. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy value were 66.7%, 97.6%, 86.7%, 85.1%, and 85.5%, respectively. In multiple logistic regression analysis, MTV40% was an important predictor of MSI. CONCLUSION:18F-FDG PET/CT metabolic parameters could predict the preoperative GC MSI status, and MTV40%shows the highest predictive efficiency. 18F-FDG PET/CT imaging might be used as a non-invasive tool to guide the immunotherapy and individualized treatment of GC patients.

Background Since the Z0011 trial, the assessment of axillary lymph node status has been redirected from the previous assessment of the occurrence of lymph node metastasis alone to the assessment of the degree of lymph node loading. Our aim was to apply preoperative breast ultrasound and clinicopathological features to predict the diagnostic value of axillary lymph node load in early invasive breast cancer. Methods The 1247 lesions were divided into a high lymph node burden group and a limited lymph node burden group according to axillary lymph node status. Univariate and multifactorial analyses were used to predict the differences in clinicopathological characteristics and breast ultrasound characteristics between the two groups with high and limited lymph node burden. Pathological findings were used as the gold standard. Results Univariate analysis showed significant differences in ki-67, maximum diameter (MD), lesion distance from the nipple, lesion distance from the skin, MS, and some characteristic ultrasound features ( P < 0.05). In multifactorial analysis, the ultrasound features of breast tumors that were associated with a high lymph node burden at the axilla included MD (odds ratio [OR], 1.043; P < 0.001), shape (OR, 2.422; P = 0.0018), hyperechoic halo (OR, 2.546; P < 0.001), shadowing in posterior features (OR, 2.155; P = 0.007), and suspicious lymph nodes on axillary ultrasound (OR, 1.418; P = 0.031). The five risk factors were used to build the predictive model, and it achieved an area under the receiver operating characteristic (ROC) curve (AUC) of 0.702. Conclusion Breast ultrasound features and clinicopathological features are better predictors of high lymph node burden in early invasive breast cancer, and this prediction helps to develop more effective treatment plans.

Preoperative evaluation of axillary lymph node (ALN) status is an essential part of deciding the appropriate treatment. According to ACOSOG Z0011 trials, the new goal of the ALN status evaluation is tumor burden (low burden, < 3 positive ALNs; high burden, ≥ 3 positive ALNs), instead of metastasis or non-metastasis. We aimed to develop a radiomics nomogram integrating clinicopathologic features, ABUS imaging features and radiomics features from ABUS for predicting ALN tumor burden in early breast cancer. A total of 310 patients with breast cancer were enrolled. Radiomics score was generated from the ABUS images. Multivariate logistic regression analysis was used to develop the predicting model, we incorporated the radiomics score, ABUS imaging features and clinicopathologic features, and this was presented with a radiomics nomogram. Besides, we separately constructed an ABUS model to analyze the performance of ABUS imaging features in predicting ALN tumor burden. The performance of the models was assessed through discrimination, calibration curve, and decision curve. The radiomics score, which consisted of 13 selected features, showed moderate discriminative ability (AUC 0.794 and 0.789 in the training and test sets). The ABUS model, comprising diameter, hyperechoic halo, and retraction phenomenon, showed moderate predictive ability (AUC 0.772 and 0.736 in the training and test sets). The ABUS radiomics nomogram, integrating radiomics score with retraction phenomenon and US-reported ALN status, showed an accurate agreement between ALN tumor burden and pathological verification (AUC 0.876 and 0.851 in the training and test sets). The decision curves showed that ABUS radiomics nomogram was clinically useful and more excellent than US-reported ALN status by experienced radiologists. The ABUS radiomics nomogram, with non-invasive, individualized and precise assessment, may assist clinicians to determine the optimal treatment strategy and avoid overtreatment.

Objective:To assess the value of preoperative percutaneous contrast-enhanced ultrasound (CEUS) in the diagnosis of axillary sentinel lymph node (SLN) metastasis in breast cancer and the value of enhancement mode in diagnosing axillary lymph node burden.Methods:Seventy-five breast cancer patients at the Breast Surgery Department of Harbin Medical University Cancer Hospital were enrolled from July 2020 to December 2021. Preoperative percutaneous CEUS was used to identify SLNs and record their enhancement pattern (divided into type Ⅰ uniform enhancement, type Ⅱ non-uniform enhancement, and type Ⅲ no enhancement). Pathological diagnosis was used as the gold standard. The value of enhancement pattern analysis in diagnosing axillary SLN metastasis and burden was then assessed by fourfold table.Results:The detection rate of CEUS for SLN in 75 breast cancer patients was 97.3% (73/75), and a total of 88 SLNs were detected. Among them, there are 40 type Ⅰlymph nodes, 42 type Ⅱ lymph nodes, and 6 type Ⅲ lymph nodes. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CEUS enhancement patterns in predicting SLN metastasis were 100%, 62.5%, 50%, 100%, and 72.7%, respectively. Twenty-four of 71 patients with stage T1/T2 breast cancer had sentinel lymph node metastasis, of whom 6 had high lymph node load and 18 had low lymph node load. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the enhancement patterns of CEUS in diagnosing SLN burden status were 100%, 56.9%, 60.6%, 17.6%, and 100%, respectively.Conclusion:Percutaneous CEUS is effective in identifying axillary SLNs, and CEUS enhancement patterns can help predict axillary SLN metastasis and burden.

Purpose: The purpose of this study was to evaluate the response to neoadjuvant chemotherapy (NAC) of different molecular subtypes of breast cancer using shear wave ultrasound elastography (SWE). Methods: Ninety-eight patients with final diagnoses of breast cancer prior to NAC were examined with SWE and B-mode ultrasound. These parameters were compared with the response evaluation criteria in solid tumors (RECIST) index and pathological diagnoses. Then, we recorded the area under the receiver operating characteristic (ROC) curve. Immunohistochemical markers, including estrogen receptor (ER), progesterone receptor (PR), Ki67 index, and human epidermal growth factor receptor 2 (HER2) score, were examined before neoadjuvant treatment. Then, the diagnostic efficacy of SWE in different molecular subtypes was evaluated. Results: One-way analysis of variance revealed that age, tumor margin, the change in tumor size after chemotherapy, and the average (Emean), minimum (Emin), and maximum (Emax) values from shear wave elastography ultrasound before chemotherapy were related to the RECIST index. Multivariate regression revealed that age, tumor margin, the change in tumor size after chemotherapy, and Emax were independently correlated with the RECIST index. According to the ROC curve, the area under the curve (AUC) of Emax was 0.773. The AUC of Emean, Emin, and the ratio between tumor tissue and normal tissue (EI) were 0.630, 0.617, and 0.510, respectively. The Emax, Emin, Emean, and EI before and after NAC were significantly different (p <= 0.05). There was statistical significance in Luminal B type and HER2 enriched type in correlation results of the Emax values and RECIST indexes of different molecular subtypes. However, there was no significant difference in the Luminal A type and Triple negative types. There was no significant difference in the Emax values before NAC between the pathologic complete response (pCR) group and the non-pCR group (p > 0.05).Conclusion: Emax can be used to predict the response to NAC in women with invasive breast cancer, especially those with the Luminal B type and HER2 enriched type, but it cannot be used to predict pCR to NAC.

Objective The study conducted a multicenter study in China to explore the learning curve of contrast enhanced ultrasound (CEUS) for sentinel lymph nodes (SLNs), the feasibility of using this technique for the localization of SLNs and lymphatic channels (LCs) and its diagnostic performance for lymph node metastasis. Method Nine hundred two patients with early invasive breast cancer from six tertiary class hospitals in China were enrolled between December 2016 and December 2019. Each patient received general ultrasound scanning and SLN-CEUS before surgery. The locations and sizes of LCs and SLNs were marked on the body surface based on observations from SLN-CEUS. These body surface markers were then compared with intraoperative blue staining in terms of their locations. The first 40 patients from each center were included in determining the learning curve of SLN-CEUS across sites. The remaining patients were used to investigate the diagnostic efficacy of this technique in comparison with intraoperative blue staining and pathology respectively. Result The ultrasound doctor can master SLN-CEUS after 25 cases, and the mean operating time is 22.5 min. The sensitivity, specificity, negative predictive value, and positive predictive value of SLN-CEUS in diagnosing lymph node metastases were 86.47, 89.81, 74.90, and 94.97% respectively. Conclusion Ultrasound doctors can master SLN-CEUS with a suitable learning curve. SLN-CEUS is a feasible and useful approach to locate SLNs and LCs before surgery and it is helpful for diagnosing LN metastases.

Ultrasound-mediated nanobubble destruction (UMND), which can utilize the physical energy of ultrasound irradiation to improve the transfer efficiency to target cells is becoming one of the most promising carriers for gene delivery. The purpose of this study was to establish cell-penetrating peptide (CPP)-loaded nanobubbles (CNBs) connected with long intergenic nonprotein coding RNA 00511-small interfering RNA (LINC00511-siRNA) and evaluate its feasibility for improving the chemosensitivity of triple-negative breast cancer in vitro. First, fluorescence imaging confirmed the loading of siLINC00511 on CNBs, and the CNBs-siLINC00511 were characterized by the Zetasizer Nano ZS90 analyzer and transmission electron microscopy. Next, cell counting kit 8 assay was used to detect the inhibitory activity of cisplatin on the proliferation of MDA-MB-231 cells, and the 50% inhibition concentration value before and after transfer was calculated. Finally, the silencing effect of siLINC00511 was evaluated in vitro using an apoptosis assay, transwell assay, real time-PCR and western blotting. UMND combined with CNBs could effectively transfer the siRNA to MDA-MB-231 cells, thus evidently reducing the expression of LINC00511. Furthermore, inhibitory activity of cisplatin on MDA-MB-231 cells was enhanced after downregulation of LINC00511 expression. Downregulation of LINC00511 alters expression of cell cycle-related (CDK 6) and apoptosis-related (Bcl-2 and Bax) proteins in MDA-MB-231 cells. These results suggested that siRNA-CNBs may be an ideal vector for the treatment of tumors, with high efficiency RNA interference under the combined action of UMND. It may provide a new therapeutic method for triple negative breast cancer.

在乳腺癌疾病研究中,前哨淋巴结定位及定性是研究重点.前哨淋巴结超声造影及活检在该方面的研究有所进展,能够准确判断腋窝分期,指导选择性的腋窝淋巴结清扫.本文着重以乳腺癌前哨淋巴结超声造影及活检技术的研究进展做一综述.

[目的]探讨声触诊组织量化成像(VTIQ)技术在乳腺癌前哨淋巴结(SLN)转移中的检出效能.[方法]回顾性分析2017年1月至2017年9月在哈尔滨医科大学附属肿瘤医院就诊的经病理证实的52例乳腺癌患者前哨淋巴结的图像资料.记录淋巴结的长轴及短轴长度、淋巴结最大皮质厚度、淋巴结长短径之比二维超声声像图特征及VTIQ测量的剪切波横向速度(SWV)平均值.[结果]对52例患者的55枚淋巴结进行了检测,术后病理显示前哨淋巴结53枚(除外2例非前哨淋巴结),其中转移性淋巴结19枚(35.8％),反应性增生淋巴结34枚(64.2％).淋巴结的长轴及短轴长度、淋巴结长短径之比诊断SLN是否转移无统计学意义(P＞0.05);淋巴结最大皮质厚度(良性与转移3.24±1.34mm与5.95±3.35mm)和SWV平均值(2.10±0.35mm与2.55±0.55m/s)诊断SLN是否转移有统计学意义(P＜0.05).淋巴结最大皮质厚度、SWV平均值及两者联合的ROC曲线,诊断前哨淋巴结转移的ROC曲线下面积分别为0.811、0.749和0.830;诊断转移的准确率分别为83.0％、69.8％和84.9％;敏感度分别为63.2％、68.4％和63.2％;特异性分别为94.1％、70.6％和97.1％;阳性预测值分别为85.7％、56.5％和92.3％;阴性预测值分别为82.1％、80.0％和82.5％.[结论]VTIQ技术对乳腺癌前哨淋巴结转移性癌有一定的诊断价值,结合常规超声应用可提高对前哨淋巴结转移的诊断效能.

Objective To study the application value of fine-needle aspiration (FNA) and Core-needle biopsy (CNB) in diagnosis of the benign and malignancy thyroid neoplasm. Methods We conducted a retrospective analysis between July 2015 and September 2017 on 279 patients with total of 296 lesions in our hospital. 141 patients had a total of 148 lesions which excepted 42 lesions of suspected malignancy and 5 lesions of dissatisfaction. Totally 101 lesions were examined by FNA for pathological examination. CNB and pathological examination carryed out in the rest of 138 patients with 148 lesions which excepted 41 lesions of suspected malignancy and 2 lesions of dissatisfaction (totally, 105 lesions). Results FNA prompted 55 lesions of malignant and 46 lesions of benign, a total of 101 lesions. Respectively, FNA diagnostic sensitivity, specificity and diagnostic accuracy were 83.02％, 87.50％, 85.15％. CNB prompted 67 lesions of malignant and 38 lesions of benign, a total of 105 lesions. Respectively, CNB disgnostic sensitivity, specificity and diagnostic accuracy were 93.84％, 85.00％, 90.48％. FNA diagnosis accuracy rate (86.84％) in diameter less than 1.0 centimeter nodules was higher than CNB accuracy (79.41％). The CNB (86.84％) diagnosis accuracy rate in diameter not less than 1.0 centimeter lesions were higher than FNA (84.13％). Conclusion FNA and CNB cannot replace each other in the diagnosis of thyroid nodules, the two should complement each other. The diagnostic accuracy of FNA for thyroid nodules with a diameter less than 1 cm is higher.

Advancements in cancer treatment have resulted in sufficient survival length for patients to experience treatment-related cardiac complications. In particular, chemotherapy-induced cardiac dysfunction significantly compromises the quality of life and increased mortality rates in cancer patients. It should be emphasized to identify subclinical and left ventricular dysfunction early. At present, there is still lack of accuracy methods to assess for cardiotoxicity. Echocardiography is a readily available noninvasive tool to measure cardiac function. This article will discuss the role of echocardiography in the diagnosis of cardiotoxicity, particularly the recently advanced echocardiographic techniques for assessing subclinical cardiotoxicity.

Objective:In order to improve diagnostic accuracy, we study the characteristics of two dimensional ultrasound and shear wave elastography in the diagnosis of false negative or false positive thyroid nodules by shear wave elastography.Method:One hundred and eighty-nine nodules in 189 consecutive patients who had been determined by surgical operation and pathology. Conventional ultrasound features and SWE elasticity imaging characteristics and properties of the final postoperative pathology were recorded. A comparative study between true and false results of quantitative SWE elasticity imaging, and the corresponding conventional ultrasound nodule characteristics were compared.Result:Postoperative pathology showed 189 nodules, 74(39.2%) were benign and 115(60.8%) were malignant. The sensitivity, specificity of conventional ultrasound in the diagnosis of thyroid nodules were 56.5% and 81.1% respectively, and those of SWE were 60.9% and 85.1%. The false positive rate of shear wave elastography in diagnosing benign nodules and the false negative rate of malignant nodules were 14.9% and 39.1%, respectively. The false negative rate was higher than the false positive rate. A vertical growth (P< 0.01) and smaller diameter of the masses were significantly associated with false SWE findings (P< 0.01).Conclusion:The SWE imaging has important significance for differentiating benign and malignant thyroid nodules, but false results are inevitable, which requires clinicians conjunction with other test results to prevent errors judgment when reviewing the SWE imaging.