An-Hua Li

Objectives Sonochemotherapy, which uses microbubble (MB)-assisted ultrasound (US) to deliver chemotherapeutic agents, has the potential to enhance tumour chemotherapy. The combination of US and MB has been demonstrated to prolong the survival of patients with pancreatic cancer. This phase 2 clinical trial aimed to determine the clinical efficacy and safety of sonochemotherapy for inoperable pancreatic ductal adenocarcinoma by using US and MB. Methods Eighty-two patients with stage III or IV pancreatic cancer were recruited from July 2018 to March 2021 and followed up until September 2022. US treatment was performed with a modified diagnostic US scanner for 30 min after chemotherapeutic infusion. The primary endpoint was overall survival (OS), and the secondary endpoints were Eastern Cooperative Oncology Group (ECOG) status < 2, progression-free survival (PFS), disease control rate (DCR), and adverse events. Results Seventy-eight patients were randomly allocated (40 to chemotherapy and 38 to sonochemotherapy). The median OS was longer with sonochemotherapy than with chemotherapy (9.10 vs. 6.10 months; p = 0.037). The median PFS with sonochemotherapy was 5.50 months, compared with 3.50 months (p = 0.080) for chemotherapy. The time of ECOG status < 2 was longer with sonochemotherapy (7.20 months) than with chemotherapy (5.00 months; p = 0.029). The DCR was 73.68% for sonochemotherapy compared with 42.50% for the control (p = 0.005). The incidence of overall adverse events was balanced between the two groups. Conclusions The use of sonochemotherapy can extend the survival and well-being time of stage III or IV pancreatic cancer patients without any increase in serious adverse events. Trial registration ChineseClinicalTrials.gov ChiCTR2100044721 Clinical relevance statement This multicentre, randomised, controlled trial has proven that sonochemotherapy, namely, the combination of diagnostic ultrasound, microbubbles, and chemotherapy, could extend the overall survival of patients with end-stage pancreatic ductal adenocarcinoma from 6.10 to 9.10 months without increasing any serious adverse events. Key Points • This is the first multicentre, randomised, controlled trial of sonochemotherapy for clinical pancreatic cancer treatment using ultrasound and a commercial ultrasound contrast agent. • Sonochemotherapy extended the median overall survival from 6.10 (chemotherapy alone) to 9.10 months. • The disease control rate increased from 42.50% with chemotherapy to 73.68% with sonochemotherapy.

Objectives: The aim of this study was to investigate the detection efficacy of deep learning (DL) for automatic breast ultrasound (ABUS) and factors affecting its efficacy. Methods: Females who underwent ABUS and handheld ultrasound from May 2016 to June 2017 (N = 397) were enrolled and divided into training (n = 163 patients with breast cancer and 33 with benign lesions), test (n = 57) and control (n = 144) groups. A convolutional neural network was optimized to detect lesions in ABUS. The sensitivity and false positives (FPs) were evaluated and compared for different breast tissue compositions, lesion sizes, morphologies and echo patterns. Results: In the training set, with 688 lesion regions (LRs), the network achieved sensitivities of 93.8%, 97.2% and 100%, based on volume, lesion and patient, respectively, with 1.9 FPs per volume. In the test group with 247 LRs, the sensitivities were 92.7%, 94.5% and 96.5%, respectively, with 2.4 FPs per volume. The control group, with 900 volumes, showed 0.24 FPs per volume. The sensitivity was 98% for lesions > 1 cm3, but 87% for those ≤1 cm3 (p < 0.05). Similar sensitivities and FPs were observed for different breast tissue compositions (homogeneous, 97.5%, 2.1; heterogeneous, 93.6%, 2.1), lesion morphologies (mass, 96.3%, 2.1; non-mass, 95.8%, 2.0) and echo patterns (homogeneous, 96.1%, 2.1; heterogeneous 96.8%, 2.1). Conclusions: DL had high detection sensitivity with a low FP but was affected by lesion size. Advances in knowledge: DL is technically feasible for the automatic detection of lesions in ABUS.

Objectives The purpose of this study was to evaluate the diagnostic performance of automated breast ultrasound (ABUS) for breast cancer by comparing it to handheld ultrasound (HHUS) and mammography (MG). Methods A multicenter cross-sectional study was conducted between February 2016 and March 2017 in five tertiary hospitals in China, and 1922 women aged 30–69 years old were recruited. Women aged 30–39 years (group A) underwent ABUS and HHUS, and women aged 40–69 (group B) underwent additional MG. Images were interpreted using the Breast Imaging Reporting and Data System (BI-RADS). All BI-RADS 4 and 5 cases were confirmed pathologically. Sensitivities and specificities of all modalities were compared. Results There were 83 cancers in 677 women in group A and 321 cancers in 1245 women in group B. In the whole study population, the sensitivities of ABUS and HHUS were 92.8% (375/404) and 96.3% (389/404), and the specificities were 93.0% (1411/1518) and 89.6% (1360/1518), respectively. ABUS had a significantly higher specificity to HHUS (p < 0.01), while HHUS had higher sensitivity (p = 0.01). In group B, the sensitivities of ABUS, HHUS, and MG were 93.5% (300/321), 96.6% (310/321), and 87.9% (282/321). The specificities were 93.0% (859/924), 89.9% (831/924), and 91.6% (846/924). ABUS had significantly higher sensitivity (p = 0.02) and comparable specificity compared with MG (p = 0.14). Conclusion ABUS increased sensitivity and had similar specificity compared with mammography in the diagnosis of breast cancer. Additionally, ABUS has comparable performance to HHUS in women aged 30–69 years old. ABUS or HHUS is a suitable modality for breast cancer diagnosis. Key Points • In breast cancer diagnosis settings, automated breast ultrasound has a higher cancer detection rate, sensitivity, and specificity than mammography, especially in women with dense breasts. • Compared with handheld ultrasound, automated breast ultrasound has higher specificity, lower sensitivity, and comparable diagnostic performance. • Automated breast ultrasound is a suitable modality for breast cancer diagnosis, and may have a potential indication for its further use in the breast cancer early detection.

Purpose As an adjunct to mammography, ultrasound can improve the detection of breast cancer in women with dense breasts. We aimed to evaluate the diagnostic performance of automated breast ultrasound system (ABUS) and handheld ultrasound (HHUS) in Chinese women with dense breasts, both in combination with mammography and separately. Methods This is a cross-sectional multicenter clinical research study. Nine hundred and thirty-seven women with dense breasts underwent ABUS, HHUS, and mammography at one of five tertiary-care hospitals. The diagnostic performance of ABUS and HHUS was evaluated in combination with mammography, or separately in women with mammography-negative dense breasts. The agreement between ABUS and HHUS in breast cancer detection was also assessed. Results The sensitivity of the combination of ABUS or HHUS with mammography was 99.1% (219/221), and the specificities were 86.9% (622/716) and 84.9% (608/716), respectively. The area under the curve was 0.93 for ABUS combined with mammography and 0.92 for that of HHUS combined with mammography. Statistically significant agreement between ABUS and HHUS in breast cancer detection was observed (percent agreement = 0.94, κ = 0.85). The incremental cancer detection rate in mammography-negative dense breasts was 42.8 per 1000 ultrasound examinations. Conclusions Both ABUS and HHUS as adjuncts to mammography can significantly improve the breast cancer detection rate in women with dense breasts, and there is a strong correlation between them. Given the high prevalence of dense breasts and the multiple advantages of ABUS over HHUS, such as less operator dependence and reproducibility, ABUS showed great potential for use in breast cancer early detection, especially in resource-limited areas.

Background: Accurate preoperative pathologic diagnosis is very important for making appropriate therapeutic decisions for patients with rectal lesions. This study aimed (I) to determine diagnostic value and safety of endoscopic forceps biopsy (EFB) and transrectal ultrasound (TRUS)-guided core needle biopsy (CNB), and (II) to analyze the risk factors for their histopathologic discrepancies, with a particular focus in identifying the indicators for re-biopsy using TRUS-guided CNB after EFB. Methods: We retrospectively reviewed the records of 102 patients who received EFB and TRUS-guided CNB before surgery. The histopathologic concordance and risk factors for underdiagnosis by EFB and TRUS-guided CNB were analyzed. Results: Compared with postoperative pathology, the histopathologic discrepancy rate of EFB and TRUS-guided CNB was 51.0% (52/102 lesions) and 8.8% (9/102 lesions), respectively. The kappa value for consistency with postoperative pathology findings was 0.420 for EFB and 0.876 for TRUS-guided CNB. The multivariate analyses and receiver operating characteristic (ROC) curve indicated that lesions thickness ≥13.5 mm [OR 1.080 (95% CI: 1.021–1.142), P=0.007] and flat/depressed shape [OR 0.206 (95% CI: 0.076–0.564), P=0.002] were significantly associated with histopathologic discrepancies in EFB. Conclusions: EFB was of limited clinical value in identifying the preoperative diagnosis of rectal lesions. Lesions thickness and flat/depressed shape at EFB were independent risk factors for pathologic discrepancies. TRUS-guided CNB may serve as a safe and effective supplement to routine EFB.

The incidence of recurrent laryngeal nerve (RLN) injury has increased due to RLN lymph node dissection. The aim of this study was to evaluate the ability of intraoperative ultrasonography (IU) to detect RLN nodal metastases in esophageal cancer patients. Sixty patients with esophageal cancer underwent IU, computed tomography (CT), and endoscopic ultrasonography (EUS) to assess for RLN nodal metastasis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared. The sensitivities of IU, CT, and EUS in diagnosing right RLN nodal metastases were 71.4, 14.3, and 30.0%, respectively, and a significant difference among these three examinations was observed (χ2 = 10.077, P = .006). The specificities of IU, CT, and EUS for diagnosing right RLN nodal metastasis were 67.4, 97.8, and 95.0%, respectively, and a significant difference was observed (χ2 = 21.725, P < .001). No significant differences in either PPV or NPV were observed when diagnosing right RLN nodal metastases. For diagnosis of left RLN lymph nodal metastases, the sensitivities of IU, CT, and EUS were 91.7, 16.7, and 40.0% respectively. There was a significant difference among these diagnostic sensitivities (χ2 = 14.067, P = .001). The specificities of IU, CT, and EUS for diagnosis of left RLN nodal metastases were 79.2, 100, and 82.5%, respectively and a significant difference was observed (χ2 = 10.819, P = .004). No significant differences were observed in PPV or NPV for these examinations when diagnosing left RLN nodal metastases. Intraoperative ultrasonography showed superior sensitivity compared with preoperative CT or EUS in detecting RLN lymph node metastasis in patients with thoracic esophageal cancer.

Objective: This study investigated the feasibility of using strain elastography (SE) and real time shear wave elastography (RT-SWE) to evaluate early tumor response to cytotoxic chemotherapy in a murine xenograft breast cancer tumor model. Methods: MCF-7 breast cancer-bearing nude mice were treated with either cisplatin 2 mg kg–1 plus paclitaxel 10 mg kg–1 (treatment group) or sterile saline (control group) once daily for 5 days. The tumor elasticity was measured by SE or RT-SWE before and after therapy. Tumor cell density was assessed by hematoxylin and eosin staining, and the ratio of collagen fibers in the tumor was evaluated by Van Gieson staining. The correlation between tumor elasticity, as determined by SE and SWE, as well as the pathological tumor responses were analyzed. Results: Chemotherapy significantly attenuated tumor growth compared to the control treatment (p < 0.05). Chemotherapy also significantly increased tumor stiffness (p < 0.05) and significantly decreased (p < 0.05) tumor cell density compared with the control. Moreover, chemotherapy significantly increased the ratio of collagen fibers (p < 0.05). Tumor stiffness was positively correlated with the ratio of collagen fibers but negatively correlated with tumor cell density. Conclusion: The study suggests that ultrasound elastography by SE and SWE is a feasible tool for assessing early responses of breast cancer to chemotherapy in our murine xenograft model. Advances in knowledge: This study showed that the tumor elasticity determined by ultrasound elastography could be a feasible imaging biomarker for assessing very early therapeutic responses to chemotherapy.

To determine the diagnostic yield of ultrasound-guided core needle biopsy (US-CNB) in cervical lymphadenopathy and identify the factors influencing the diagnostic accuracy of US-CNB.

Objective:This study aimed to investigate the use of contrast-enhanced ultrasonography and time–intensity curves (CEUS-TIC) to assess angiogenesis in cervical cancer.Methods:Sixty patients who were scheduled to undergo radical surgery for biopsy-proven cervical cancers underwent CEUS. Surgical tissue sections from 32 patients who did not receive neoadjuvant chemotherapy were analysed with CD34 staining to estimate intratumoral microvessel density (MVD). CEUS images were analysed for maximum intensity (IMAX), rise time (RT), time to peak (TTP), and mean transit time (mTT).Results:Cervical lesions had a higher IMAX and shorter RT and TTP (P< 0.001) than reference regions. There was a linear association between the IMAX of the cervical lesion and the mean intratumoral MVD (r = 0.624, P< 0.001). There were no significant differences in CEUS variables according to histological type, grade, and stage.Conclusion:Quantitative CEUS variables have potential use for monitoring perfusion changes in tumors after nonsu...

Patients with late-stage cancer commonly have distant lymph node metastasis; however, poor health often contraindicates surgical treatment. Although the quality of life and overall survival for these patients are low, there is neither a consensus nor a guide for treatment. Ablation technique and surrounding tissue damage are two possible reasons for limited study of radiofrequency ablation in patients with superficial distant lymph node metastasis. Here, we report two patients treated successfully with ultrasound-guided radiofrequency ablation for superficial distant lymph node metastasis. In these patients, deionized water was injected to the surrounding tissues of the lymph node to decrease heat injury. Results from these patients suggest that radiofrequency ablation may play an important role in the treatment of patients with distant lymph node metastasis.