Jianghao Lu

Objectives: To compare the diagnostic performance of conventional ultrasonography (US) combined with contrast‐enhanced ultrasonography (CEUS) versus dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) in preoperatively predicting nipple‐areolar complex (NAC) involvement in breast cancer. Methods: From January 2020 to November 2024, patients with primary breast cancer confirmed by preoperative biopsy were consecutively enrolled in this study. All patients underwent CEUS and DCE‐MRI examinations before operation. NAC involvement status was determined by subareolar intraoperative biopsy and postoperative pathology. LASSO regression was used to screen the US and DCE‐MRI predictors most related to NAC involvement, and nomograms were constructed accordingly. The data were bootstrapped 500 times for internal verification, and a calibration curve was generated to verify the prediction ability. The area under the receiver operating characteristic curve (AUC) of the 2 models was compared using the DeLong test. Results: We prospectively included 126 primary breast cancer lesions from 124 women in this study: 26 lesions (20.6%) with NAC involvement and 100 lesions (79.4%) without NAC involvement. The AUC of the US‐CEUS model for diagnosing NAC involvement was significantly higher than that of the DCE‐MRI model (0.893 versus 0.817, p = .047). Conclusions: US combined with CEUS demonstrated significantly higher diagnostic performance than DCE‐MRI in the preoperative prediction of NAC involvement. This supports its role as a valuable complementary tool for identifying candidates for nipple‐sparing mastectomy (NSM), particularly in patients with contraindications to gadolinium‐based contrast agents or in settings where MRI is unavailable.

Nipple adenoma (NA) is a rare benign lesion of the lactiferous ducts, often mistaken for malignancy due to its diverse clinical and imaging presentations. We report the case of a 34-year-old female presenting with persistent bloody discharge and nipple erosion, for which multimodal ultrasound evaluation was pivotal in the differential diagnosis. Ultrasonography revealed a hypoechoic, well-defined nodule in the left nipple, with significant blood flow and a fast-in-fast-out contrast enhancement pattern, indicative of NA. Despite the presentation mimicking malignant processes, the benign nature of the lesion was confirmed postoperatively via histology and immunohistochemistry. This case underscores the value of a comprehensive ultrasound approach in diagnosing NA, emphasizing its ability to distinguish it from malignant lesions, and thus infer an appropriate treatment course. Maintaining a high index of suspicion coupled with tailored ultrasound techniques is recommended for accurate NA diagnosis, which remains a challenging yet critical task to avoid unnecessary aggressive interventions.

Purpose: We performed a systematic review and meta-analysis of studies that investigated the diagnostic performance of Superb Microvascular Imaging (SMI) in differentiating between benign and malignant breast tumors. Methods: Studies published between January 2010 and March 2022 were retrieved by online literature search conducted in PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Disc, China National Knowledge Infrastructure, Wanfang, and Vip databases. Pooled sensitivity, specificity, and diagnostic odd ratios were calculated using Stata software 15.0. Heterogeneity among the included studies was assessed using I² statistic and Q test. Meta-regression and subgroup analyses were conducted to investigate potential sources of heterogeneity. Influence analysis was conducted to determine the robustness of the pooled conclusions. Deeks’ funnel plot asymmetry test was performed to assess publication bias. A summary receiver operating characteristic curve (SROC) was constructed. Results: Twenty-three studies involving 2749 breast lesions were included in our meta-analysis. The pooled sensitivity and specificity were 0.80 (95% confidence interval [CI], 0.77–0.84, inconsistency index [I²] = 28.32%) and 0.84 (95% CI, 0.79–0.88, I² = 89.36%), respectively. The pooled diagnostic odds ratio was 19.95 (95% CI, 14.84–26.82). The area under the SROC (AUC) was 0.85 (95% CI, 0.81–0.87). Conclusion: SMI has a relatively high sensitivity, specificity, and accuracy for differentiating between benign and malignant breast lesions. It represents a promising supplementary technique for the diagnosis of breast neoplasms.

Background: This study aimed to describe the technique and outcomes of hemostasis for ultrasound-guided lauromacrogol injection for active bleeding after renal biopsy.Methods: Data from patients with active bleeding after renal biopsy between January 2018 and December 2020 were retrospectively collected. Patients who still had active bleeding after 30 min of compression were then injected with lauromacrogol under ultrasound guidance. The patient’s symptoms before and after operation were collected to assess whether they had severe complications. Changes in hemoglobin and serum creatinine values were collected.Results: Data from a total of 15 patients with active bleeding after renal biopsy were collected, including data of 6 men and 9 women. After the operation, there were 11 cases of mild back pain; 1 case of chills, cold sweats, and back pain; 1 case of cold sweats and blood pressure reduction, and 2 cases with no obvious symptoms. No severe complications occurred in this study, and active bleeding was stopped in all patients. After the operation, compared with before the operation, there was no statistically significant difference in the hemoglobin value and serum creatinine value (p = 0.10 > 0.05, p = 0.78 > 0.05).Conclusion: Ultrasound-guided lauromacrogol injection is a relatively simple, safe and feasible method, which could be helpful in treating active bleeding in the immediate post-procedure period after renal biopsy.

Objectives The aim of this study was to explore a modified model to simplify the diagnostic process for American College of Radiology Breast Imaging Reporting and Data System category 3 to 5 breast lesions and evaluate the model's diagnostic efficacy. Methods A retrospective review was conducted of breast lesions examined by B-mode ultrasound (US) and contrast-enhanced ultrasound (CEUS) and diagnosed by histopathologic examination from October 2016 to August 2019. The US characteristics of a combined model (US + CEUS model) with relatively high diagnostic value were selected by a lasso regression analysis to establish a modified model. Two nomograms were developed. The results were internally validated by bootstrap resampling. Results Overall, 206 breast lesions in 198 patients, 136 benign and 70 malignant, were included. Ultrasound characteristics included in the modified model were shape, margin, microcalcification, enhanced intensity, enhanced scope, and enhanced time. For the US + CEUS model and modified model, sensitivities were 94.3% and 93.3%; specificities were 85.9% and 81.4%; accuracies were 89.3% and 88.7% and areas under the curve were 0.957 and 0.944, respectively. No statistically significant differences were seen in the diagnostic efficacies of the models (P= .097). Bootstrap-corrected sensitivities, specificities. and accuracies of the models were consistent with these results. Bootstrap-corrected areas under the curve for the US + CEUS model and the modified model were 0.955 and 0.940, respectively. Conclusions The modified model with fewer indicators conveniently and effectively diagnosed the malignancy of Breast Imaging Reporting and Data System category 3 to 5 breast lesions without reducing diagnostic efficacy.

Purpose: A meta-analysis was conducted to evaluate the diagnostic performance of contrast-enhanced ultrasonography using the contrast agent SonoVue to differentiate benign from malignant breast lesions. Method: A comprehensive search of the literature was performed using the Embase, PubMed, and Web of Science databases to retrieve studies published before February 2020. Data were extracted, and pooled sensitivity, specificity, and diagnostic odds ratios were calculated with meta-analysis software. Heterogeneity was evaluated via the Q test and I² statistic. Meta-regression and subgroup analyses were applied to evaluate potential sources of heterogeneity. Publication bias was assessed using the Deeks’ funnel plot asymmetry test. A summary receiver operating characteristic curve (SROC) was constructed. Results: A total of 27 studies including 5378 breast lesions subjected to CEUS examination with SonoVue were included in the meta-analysis. The pooled sensitivity and specificity values were 0.90 (95% confidence interval [CI], 0.88–0.91; inconsistency index [ I²] = 75.7%) and 0.83 (95% CI, 0.82–0.85; I² = 91.0%), respectively. The pooled diagnostic odds ratio was 48.35% (95% CI, 31.22–74.89; I² = 77.6%). The area under the summary receiver operating characteristic curve (AUC) was 0.9354. Meta-regression analysis revealed the region of patient residence and dose of contrast agent as potential sources of heterogeneity (P < .01). Subgroup analysis showed a higher area under the summary receiver operating characteristic curve for European and higher contrast agent dose subgroups (P < .05). Conclusion: Contrast-enhanced ultrasonography with SonoVue displays high sensitivity, specificity, and accuracy when differentiating benign from malignant breast lesions. Despite its current limitations, this technique presents a promising tool for diagnosing breast lesions in clinical practice.