Benign Outcome Research Articles

One-Year Mortality after Elective Colectomy for Benign Disease: Not a Benign Outcome

One-Year Mortality after Elective Colectomy for Benign Disease: Not a Benign Outcome

How to Differentiate Segmental Colitis Associated With Diverticulosis and Inflammatory Bowel Diseases.

The segmental colitis associated with diverticulosis," better known by its acronym "SCAD," is a chronic inflammatory process localized in the colonic area presenting diverticulosis, and therefore mainly in the sigmoid colon. By definition, both the rectum and the right colon are spared from any inflammation both endoscopically and from a histologic point of view. Recent data have hypothesized that SCAD may be an independent clinical entity within the inflammatory bowel disease set of diseases. Compared with inflammatory bowel disease, SCAD seems to have a more benign outcome, with low rate of complications.

P10.03: Isolated midline intracranial cysts in the region of the quadrigeminal cistern are associated with benign postnatal outcome

P10.03: Isolated midline intracranial cysts in the region of the quadrigeminal cistern are associated with benign postnatal outcome

Severe Varicella Pneumonia in an Immunocompetent Infant: A Case Report

Primary varicella infection (chickenpox) is a common and highly contagious infection caused by varicella-zoster virus (VZV) with a benign outcome during childhood. However, serious complications and death may occur in newborns, adults and in immunocompromised patients, and during pregnancy. VZV pneumonia is a common and life-threatening chickenpox-related complication, particularly in healthy adults. This complication occurs infrequently in children, is even more rarely in infants, and can result in fatal outcomes. We report a case of severe hypoxemic pneumonia occurring during the eruptive phase of varicella in a previously healthy 17-month-old infant, which was associated with a favorable clinical course. Based on the available data, we attempt to discuss the main aspects of diagnosis, treatment, prevention, and prognosis of this pulmonary complication of varicella.

Neutropenia as an Adverse Event following Vaccination: Results from Randomized Clinical Trials in Healthy Adults and Systematic Review.

BackgroundIn the context of early vaccine trials aimed at evaluating the safety profile of novel vaccines, abnormal haematological values, such as neutropenia, are often reported. It is therefore important to evaluate how these trials should be planned not to miss potentially important safety signals, but also to understand the implications and the clinical relevance.MethodologyWe report and discuss the results from five clinical trials (two with a new Shigella vaccine in the early stage of clinical development and three with licensed vaccines) where the absolute neutrophil counts (ANC) were evaluated before and after vaccination. Additionally, we have performed a systematic review of the literature on cases of neutropenia reported during vaccine trials to discuss our results in a more general context.Principal FindingsBoth in our clinical trials and in the literature review, several cases of neutropenia have been reported, in the first two weeks after vaccination. However, neutropenia was generally transient and had a benign clinical outcome, after vaccination with either multiple novel candidates or well-known licensed vaccines. Additionally, the vaccine recipients with neutropenia frequently had lower baseline ANC than non-neutropenic vaccinees. In many instances neutropenia occurred in subjects of African descent, known to have lower ANC compared to western populations.ConclusionsIt is important to include ANC and other haematological tests in early vaccine trials to identify potential safety signals. Post-vaccination neutropenia is not uncommon, generally transient and clinically benign, but many vaccine trials do not have a sampling schedule that allows its detection. Given ethnic variability in the level of circulating neutrophils, normal ranges taking into account ethnicity should be used for determination of trial inclusion/exclusion criteria and classification of neutropenia related adverse events.Trial registrationClinicalTrials.gov NCT02017899, NCT02034500, NCT01771367, NCT01765413, NCT02523287

Long-term effects of parotidectomy.

The present study investigated the long-term complications of parotidectomy, the differences in these complications in regard to the pathological diagnosis and type of surgery. The patients were questioned regarding the presence of facial paresis-paralysis, pain, loss of sensation, scarring, collapse, and mouth dryness in the area of operation. Complaints of pain (p=0.287), scarring (p=0.456), and mouth dryness (p=0.136) did not show statistically significant differences between the cases with benign or malignant pathological outcomes. However, complaints of loss of sensation (p<0.001), collapse in the area of operation (p=0.025), paresis-paralysis (p<0.001), and fear of repeated surgery (p=0.032) were present at significantly higher rates. Complaints of pain (p=0.258), scarring (p=0.665), mouth dryness (p=0.113) and fear of repeated surgery (p=0.053) did not show statistically significant differences between the cases who underwent superficial or total parotidectomy. However, complaints of loss of sensation (p=0.002), paresis (p<0.001), and collapse in the area of operation (p=0.019) were present at significantly higher rates. The type of tumor and surgical approach significantly affect the quality of life; however, parotidectomy generally does not lead to serious long-term complications that would disturb the patients.

Asymptomatic primary biliary cirrhosis. A progress report on long-term follow-up and natural history.

Thirty-six patients presenting with asymptomatic primary biliary cirrhosis have been followed for a median period of 11.4 yr, extending by 5 yr a previously reported median follow-up study of 6 yr. Life table survival analysis indicates that the overall survival of this subgroup of patients with primary biliary cirrhosis continues to remain similar to that of the general population (p = 0.91). Over this period, 15 patients developed symptoms and 8 patients died, 6 from liver disease; 21 patients remained in an asymptomatic state. Portal granulomas on initial liver biopsy were the only finding that correlated with a normal survival and a continued asymptomatic state (p = 0.03). In contrast, associated autoimmune disorders (thyroiditis, sicca syndrome, CRST syndrome, Raynaud's phenomenon) correlated with decreased survival (p = 0.01). No other clinical, laboratory, or histologic features correlated with survival or the development of symptoms. This extended follow-up study (median 11.4 yr) indicates that many patients with asymptomatic primary biliary cirrhosis have a benign outcome. Although 42% developed signs or symptoms of progressive disease at variable times up to 14 yr from presentation, the group survival remained similar to the general population.

MicroRNA in situ hybridization for miR-211 detection as an ancillary test in melanoma diagnosis

Some melanocytic tumors can be histologically ambiguous causing diagnostic difficulty, which could lead to overtreatment of benign lesions with an unwarranted psychological distress or undertreatment of malignant cancers. Previously, we demonstrated that significantly decreased miR-211 expression in melanomas compared with melanocytic nevi could accurately discriminate malignant from benign tumors. Herein we show microRNA in situ hybridization for fluorescent detection of miR-211, suitable for paraffin-embedded tissues in 109 primary melanocytic tumors. miR-211 expression was significantly lower in melanomas vs nevi (P<0.0001), and receiver operating characteristic curve (area under the curve=0.862) accurately discriminated melanomas from nevi with 90% sensitivity and 86.2% specificity. Qualitatively, all dysplastic nevi expressed miR-211 at high (86%) and low (14%) levels, independent of the degree of nuclear atypia. All 35 melanocytic tumors with Spitz morphology expressed miR-211 independent of morphological classification, where clinical follow-up of these patients showed no recurrence at the site or metastasis in mean and median of 3 (ranging 2–5) years. Moreover, a decision tree learning analysis selected age and miR-211 miRNA in situ hybridization as the predictive variables for benign or malignant outcome in 88 patients correctly classified 92% (81 out of 88) of cases as proven by receiver operating characteristic curve (area under the curve=0.9029). These results support miR-211 as a leading miRNA candidate for melanoma diagnosis and miRNA in situ hybridization as a uniquely uncomplicated ancillary test.

Duplication within the KCNQ2 Gene in a Child with Benign Early-Onset Epileptic Encephalopathy

Introduction: Mutations in the KCNQ2 gene lead to autosomal dominant benign neonatal seizures or early-onset epileptic encephalopathy. We describe here a female patient with focal epileptic seizures starting from four months of age, carrying a heterozygous duplication of exons 9 – 17 of the KCNQ2 gene. Case Presentation: It is the second child of German non-consanguineous parents without any family history for seizures or epilepsy. After uneventful pregnancy, delivery and neonatal period, the patient developed focal seizures with impairment of awareness several times per week. Cranial MRI, screening for inborn disorders of metabolism or prenatal infections (TORCH) did not show pathogenic results. A panel analysis for epileptic encephalopathies (CeGaT) revealed a heterozygous duplication of exons 9 to 17 of the KCNQ2 gene which was classified as variant of unknown significance. With application of Levetiraetam (at least 40 mg/kg daily, blood level of ~10 μg/mL) absence of seizures except for febrile situations was achieved. After the 7th month, no more seizures were observed, even during infections, and Levetiraetam therapy could be gradually reduced and finally stopped. Psychomotor development of the patient is almost normal. Due to muscular hypotonia, she received physiotherapy, but the developmental milestones were all reached age-appropriately. Conclusion: The clinical interpretation of variants of unknown significance revealed through a panel analysis is often difficult, even with incorporation of data from large databases. So far, a partial KCNQ2 duplication, of exons 3 to 12, has been described only once in the literature in a patient with benign neonatal epilepsy. The reported disease course in our patient carrying another partial duplication of KCNQ2 suggests a benign outcome in this family as well.

Outcomes of type II endoleaks after endovascular abdominal aortic aneurysm (AAA) repair: a single-center, retrospective study

PurposeThis study aims to determine incidence and outcomes of type II endoleaks (T2E) after endovascular abdominal aortic aneurysm repair (EVAR). MethodsA retrospective review of procedural angiograms, computed tomography angiography, and medical records of 202 patients who underwent EVAR with the Gore Excluder stent graft was performed to determine presence and outcomes of T2E. ResultsMedian follow-up time for 163 patients meeting inclusion criteria [136 males (83%)] was 24.7 months (range=0.5–85.2 months). T2E occurred in 66/163 patients (40.5%). Aneurysm sac size was unchanged in 32/66 patients (48.5%), decreased in 22/66 (33.3%), and increased in 12/66 (18.2%). No aneurysm ruptures, conversion to open repair, or aneurysm-related deaths occurred. ConclusionT2E are a common occurrence after EVAR, often with benign outcome. However, routine surveillance should be performed, particularly in patients with persistent endoleak or sac growth.

Acinar cell cystadenoma of the pancreas: A retrospective analysis of ten-year experience from a single academic institution

Background/objectiveAcinar cell cystadenoma (ACA), also referred to as “acinar cystic transformation”, is a rare and newly recognized cystic lesion of the pancreas displaying apparent acinar cell differentiation with benign outcomes. We summarized our experience with the diagnosis, clinicopathologic feature, treatment and prognosis of ACA to provide a reference for the disposal of this uncommon condition. MethodsWe retrospectively analyzed the clinical data from eight patients with ACA treated in our hospital between March, 2005 and January, 2015. ResultsAmong eight patients, five of whom were female and the age at diagnosis ranged from 33 to 67 years (mean, 49.8 y). The most commonly clinical symptom was abdominal pain. Eight lesions were unifocal and either unilocular (n = 5) or multilocular (n = 3) with average size of 10.5 cm (range, 5.1–19.7 cm). All the patients were treated surgically and a definite diagnosis of ACA was obtained by the histopathological, histochemical and immunohistochemical tests. The length of stay range was from 11 to 17 days and there were no perioperative deaths. At a median follow-up of 57.3 months, all the patients were alive and there was no evidence of recurrence, distant metastasis or malignant transformation. ConclusionsAppropriately preoperative differential diagnosis of ACA remains challenging and the final result is usually gained by the histopathology and immunohistochemistry. Although the origin of ACA is still contradictory, surgery is actively advocated as the most effective method for relieving the symptoms and preventing the tumor from local extension or malignant transformation so as to obtain an optimal long-term survival.

Su1364 Genetic Fluid Analysis of Pancreatic Cysts Predicts a Benign Outcome in Long-Term Follow-Up

Su1364 Genetic Fluid Analysis of Pancreatic Cysts Predicts a Benign Outcome in Long-Term Follow-Up

Commentary on ‘Selective AAA sac Embolization During EVAR to Prevent Type II Endoleaks’

In this edition of the European Journal of Vascular and Endovascular Surgery, Mascoli and co-workers present their interesting strategy for embolization of the abdominal aortic aneurysm (AAA) sac during primary endovascular aortic repair (EVAR) in patients deemed at high risk of type II endoleaks. High risk is defined as at least six patent efferent AAA side branches and/or anAAA thrombus volume ratio<40%. During short-term follow up with standard (0 and 6 months) or contrast enhanced (12 months) ultrasound, the number of persistent type II endoleaks was significantly lower in a group of 26 embolized patients compared with 44 morphologically matched controls. Is this an inventive example of locking the stable door before the horse has bolted or do the authors see potential problems, which do not exist? Three major issues should be discussed: Is there any need to treat type II endoleaks at all? Is the suggested coiling technique efficient? Are there any, and maybe better, endovascular alternatives? To date there is no optimal threshold for the intervention of isolated type II endoleaks post-EVAR. In a recently published systematic review and meta-regression of 231 patients, the treatment of type II endoleaks did not lead to a reduced sac expansion rate or improved sac regression rate compared with conservative management. This is in line with the 1 year results of the current study. Moreover, no post-EVAR ruptures occurred.These benign outcomes of type II endoleaks have been duplicated by other researchers recently, with an incidence of <1% of post-EVAR ruptures in patients with persistent type II endoleak. Interestingly, Nolz and co-workers showed an association between type II endoleak and decreased surface movements of the proximal anchoring zones and distal limbs of endografts, which may lead to a more stable endograft position. The advancement of several coils into the aneurysm sac led to a disappointing 69% success rate at the pre-discharge duplex ultrasound. Although Mascoli and colleagues used bony landmarks of the pre-EVAR computed tomograms (CT), their embolization technique sometimes must have been a shot in the dark. It seems more reasonable to use a targeted

Exploring full-blown psychotic experiences in ‘non-need for care’ populations: Findings from the UNIQUE Study

BackgroundPeople displaying persistent, full-blown psychotic experiences without a need-for-care in the general population are an ideal group to investigate to differentiate those factors that are linked to distress and dysfunction from those that are merely associated with benign anomalous experiences. The UNIQUE study investigated the cognitive and social processes predicted by cognitive models of psychosis to differentiate between benign and pathological outcomes of psychotic experiences (PEs).MethodTwo hundred and fifty-nine individuals were recruited (84 clinical participants with PEs; 92 non-clinical participants with PEs; 83 controls without PEs) from urban (South-East London) and rural (North Wales) UK sites. The three groups were compared on clinical and psychological measures, on reasoning tasks, and on their appraisals of experimental tasks inducing anomalous experiences (of thought interference symptoms and auditory hallucinations).ResultsThe clinical picture demonstrated a distinctive pattern of similarities and differences on PEs between the clinical and non-clinical groups, while their demographic and psychological profiles were markedly different. As predicted, the clinical group showed a ‘jump-to-conclusions’ reasoning style, and endorsed more threatening appraisals ratings of the experimentally-induced anomalous experiences than the non-clinical group, who did not differ from the controls.ConclusionsThe results of this study identified a number of specific factors that may be protective against transition to psychosis in individuals with persistent PEs. They also provide robust experimental evidence for the key role of appraisals in determining outcome, as postulated by cognitive models of psychosis.FundingMedical research Council, UK.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Influence of integrated molecular pathology test results on real-world management decisions for patients with pancreatic cysts: analysis of data from a national registry cohort.

BackgroundIntegrated molecular pathology (IMP) approaches based on DNA mutational profiling accurately determine pancreatic cyst malignancy risk in patients lacking definitive diagnoses following endoscopic ultrasound imaging with fine-needle aspiration of fluid for cytology. In such cases, IMP ‘low-risk’ and ‘high-risk’ diagnoses reliably predict benign and malignant disease, respectively, and provide improved risk stratification for malignancy than a model of the 2012 International Consensus Guideline (ICG) recommendations. Our objective was to determine if initial adjunctive IMP testing influenced future real-world pancreatic cyst management decisions for intervention or surveillance relative to ICG recommendations, and if this benefitted patient outcomes.MethodsAnalysis of data from the previously described National Pancreatic Cyst Registry. Associations between real-world decisions (intervention vs. surveillance), ICG model recommendations (surgery vs. surveillance) and IMP diagnoses (high-risk vs. low-risk) were evaluated using 2 × 2 tables. Kaplan Meier and hazard ratio analyses were used to assess time to malignancy. Odds ratios (OR) for surgery decision were determined using logistic regression.ResultsOf 491 patients, 206 received clinical intervention at follow-up (183 surgery, 4 chemotherapy, 19 presumed by malignant cytology). Overall, 13 % (66/491) of patients had a malignant outcome and 87 % (425/491) had a benign outcome at 2.9 years’ follow-up. When ICG and IMP were concordant for surveillance/surgery recommendations, 83 % and 88 % actually underwent surveillance or surgery, respectively. However, when discordant, IMP diagnoses were predictive of real-world decisions, with 88 % of patients having an intervention when ICG recommended surveillance but IMP indicated high risk, and 55 % undergoing surveillance when ICG recommended surgery but IMP indicated low risk. These IMP-associated management decisions benefitted patient outcomes in these subgroups, as 57 % had malignant and 99 % had benign outcomes at a median 2.9 years’ follow-up. IMP was also more predictive of real-world decisions than ICG by multivariate analysis: OR 11.4 (95 % CI 6.0 − 23.7) versus 3.7 (2.4 − 5.8), respectively.ConclusionsDNA-based IMP diagnoses were predictive of real-world management decisions. Importantly, when ICG and IMP were discordant, IMP influence benefitted patients by increasing confidence in surveillance and surgery decisions and reducing the number of unnecessary surgeries in patients with benign disease.

Determination of Autosomal Dominant or Recessive Methionine Adenosyltransferase I/III Deficiencies Based on Clinical and Molecular Studies.

Methionine adenosyltransferase (MAT) I/III deficiency can be inherited as autosomal dominant (AD) or as recessive (AR) traits in which mono- or biallelic MAT1A mutations have been identified, respectively. Although most patients have benign clinical outcomes, some with the AR form have neurological deficits. Here we describe 16 Korean patients with MAT I/III deficiency from 15 unrelated families identified by newborn screening. Ten probands had the AD MAT I/III deficiency, while six had AR MAT I/III deficiency. Plasma methionine (145.7 μmol/L versus 733.2 μmol/L, P < 0.05) and homocysteine levels (12.3 μmol/L versus 18.6 μmol/L, P < 0.05) were lower in the AD type than in AR type. In addition to the only reported AD MAT1A mutation, p.Arg264His, we identified two novel AD mutations, p.Arg249Gln and p.Gly280Arg. In the AR type, four previously reported and two novel mutations, p.Arg163Trp and p.Tyr335*, were identified. No exonic deletions were found by quantitative genomic polymerase chain reaction (PCR). Three-dimensional structural prediction programs indicated that the AD-type mutations were located on the dimer interface or in the substrate binding site, hindering MAT I/III dimerization or substrate binding, respectively, whereas the AR mutations were distant from the interface or substrate binding site. These results indicate that the AD or AR MAT I/III deficiency is correlated with clinical findings, substrate levels and structural features of the mutant proteins, which is important for the neurological management and genetic counseling of the patients.

Incidence and outcomes of cerebrovascular events complicating catheter ablation for atrial fibrillation.

Cerebrovascular complications are relatively uncommon, but severe adverse events are associated with catheter ablation of atrial fibrillation (AF). This study aimed to investigate the incidence, risk factors, and hospital outcomes of cerebrovascular events complicating AF ablation. Cerebrovascular complications occurring during the procedure or hospitalization after AF ablation were assessed. Cerebrovascular events occurred in 9 of 1946 consecutive procedures (0.46%). Seven patients (0.36% per procedure) were diagnosed with ischaemic stroke and two patients (0.1% per procedure) with intracranial haemorrhage (ICH). Six events (6/9, 66.7%) occurred during the ablation and the remainders within 24 h after the ablation. Multivariable analysis revealed that previous ischaemic stroke [odds ratio (OR) 10.549; 95% confidence interval (CI) 2.551-43.625, P = 0.001] and mechanical valve replacement (OR 3.261; 95% CI 1.337-7.953, P = 0.009) were independent predictors. In a separate model, CHA2DS2-VASc score ≥3 (OR 7.992; 95% CI 2.046-31.215, P = 0.003) and mechanical valve replacement (OR 4.104; 95% CI 1.644-10.245, P = 0.002) were significantly associated with cerebrovascular complications. All patients survived to discharge except the two cases with ICH. Cerebrovascular complications related to catheter ablation of AF are relatively infrequent and typically occur early either during the procedure or within the first 24 h after AF ablation. Previous ischaemic stroke, mechanical valve replacement, and CHA2DS2-VASc score ≥3 are independent predictors of such complications. The majority of these events are ischaemic stroke with a benign clinical outcome, while ICH may correlate with poor prognosis.

Is there an Upgrading to Malignancy at Surgery of Mucocele-Like Lesions Diagnosed on Percutaneous Breast Biopsy?

Management of pure mucocele-like lesion (MLL) diagnosed on percutaneous breast biopsy (PBB) is controversial. To assess surgical upgrade rate and clinical outcome of pure MLL obtained as sole diagnosis on PBB. Patients diagnosed with a MLL as the most advanced lesion on PBB from April 1997 to December 2010 were reviewed for radiologic presentation, biopsy technique, and pathologic and clinical outcomes. Of the 21,340 image-guided PBB performed during the study period, 50 women with 51 MLL (0.24%) were identified. Mean age was 53.1 ± 7.7 years. Radiologic findings were mostly microcalcifications (n = 47, 92.2%). Stereotactic PBB was performed for 49 lesions (96.1%). Surgery was performed shortly after biopsy in 35 women, with benign final pathology in 33, and upgrade to ductal carcinoma in situ (DCIS) in two patients (2/35, 5.7%). Mean follow-up was 4.2 ± 2.5 years (3.7 ± 2.1 years for surgical patients; 5.9 ± 2.9 years for follow-up only patients); three women were lost to follow-up (3/50). Three invasive cancers (3/47, 6.4%) were diagnosed 1.2, 1.2, and 2.8 years after biopsy: two in surgical patients, and one in a follow-up only patient. No cancer occurred at the same site as the original MLL. Pure MLL lesion of the breast is a rare entity and is mostly associated with a benign outcome. We observed an upgrade to DCIS slightly superior to 5%, but no invasive cancer. It is therefore unclear if these lesions should be excised or clinically and radiologically followed up when such lesions are found at PBB.

Severe diffuse brain injury. Justifiability of decompressive craniectomy

Objective: To study the possibility of improvement of response to treatment of injured persons with severe diffuse brain injury (SDBI) through the intracranial pressure (ICP) monitoring and active correction of intracranial hypertension (ICH) with the use of decompressive craniectomy (DC). Material and methods: A prospective analysis of response to treatment of 57 injured persons with SDBI was carried out. The first period of research (2000 – 2005): 34 patients. The second period (2006 – 2012): 23 patients. The main criterion of enrolment to the research is a severe brain injury (8 points or less according GSC scale). L.F. Marshall classification of diffuse injury to brain was used. ICP measurement during the second period was carried using the parenchymal sensors on the monitor Brain Pressure Monitor REF HDM 26.1/FV500 Spiegelberg (Germany). Results: Augmentation of signs of axial and lateral dislocation with the transition from type I to type IV of SDBI of the brain is related to the increased rate of detection and intensity of ICH. ICH was discovered among 25% of patients with type II of SDBI, and among 57% with type III and 80% with type IV of SDBI. Average ICP in the group of injured persons with type II of SDBI constituted (14.4±6.6) mm Hg, with type III – (30±20.6) mm Hg, with type IV – (37.6±14.1) mm Hg. As long as the rate of ICH detection increases, the necessity to use more aggressive treatment methods increases as well, including the DC. DC was not used for type I and type II of SDBI. During the first period, DC was carried out only for 15.4% of injured persons with the injury of type IV. During the second period, DC was carried out for 42.9% of injured persons with type III and for 100 injured persons with type IV of SDBI. The average ICP in the group of injured persons with SDBI, who were subjected to DC, constituted (41±18.6) mm Hg prior to the operation and (20.1±18) mm Hg after the operation. DC fulfillment resulted in ICP reduction by a mean of 46.6%. Lethality during the first observation period constituted 52.9%, and during the second one – 39.1% (χ 2 =10.9; р<0.004). During the first period of research the benign outcome (good recovery + moderate disability according to the Glasgow outcome scale) was achieved among 17.7% of injured persons, and during the second period - among 26% (р<0.05). Conclusions: SDBI types according to L.F. Marshall classification that are determined on the basis of primary CT of brain, correlate with the ICH rate and intensity, lethality rate, and they must be taken into consideration when determining the treatment policy.

Value of contrast-enhanced ultrasound in the evaluation of neoadjuvant chemotherapy for breast cancer

Objective To explore the application value of contrast-enhanced ultrasound(CEUS) in evaluating the effect of neoadjuvant chemotherapy(NAC) on breast cancer. Methods Image features of 80 breast cancer patients with neoadjuvant chemotherapy were observed and analyzed by CEUS. In the process, the changes of primary foci before and after neoadjuvant chemotherapy and the changes of qualitative and quantitative indexes of blood perfusion were evaluated. The correlation between qualitative change and pathological response was also studied. Results The change of focus size measured by CEUS was higher than that of conventional ultrasound before and after neoadjuvant chemotherapy(P 0.05). All the qualitative observation indexes of the ultrasound contrast after NAC revealed obviously benign conversion(P<0.05). Among them, the pathological response was closely related to the changes of the enhancement degree, the distribution of the contrast agent, the order of the contrast and the contrast mode. After NAC, the perfusion parameters of the lesions showed slowly crawl and slowly retreat, low enhancement and the diminished total amount of microcirculation perfusion. Conclusions Before and after neoadjuvant chemotherapy, the changes of the lesion size deteted by CEUS were more close to the pathological evaluation than those detected by conventional ultrasound. The benign outcome of qualitative and quantitative indexes of the CEUS was more obvious than the changes of the lesion size, which had practical value for guiding the neoadjuvant chemotherapy for breast cancer, especially the CEUS indexes related to pathological assessment. Key words: Ultrasonography; Microbubbles; Breast neoplasms; Neoadjuvant chemotherapy; Treatment outcome