Elasticity Score Research Articles

Multimodal Imaging under Artificial Intelligence Algorithm for the Diagnosis of Liver Cancer and Its Relationship with Expressions of EZH2 and p57.

Objective It aimed to explore the diagnostic efficacy of multimodal ultrasound images based on mask region with convolutional neural network (M-RCNN) segmentation algorithm for small liver cancer and analyze the expression of zeste gene enhancer homolog 2 (EZH2) and p57 (P57 Kip2) genes in cancer cells. Methods A total of 100 patients suspected of small liver cancer were randomly divided into Doppler group (color Doppler ultrasound examination), contrast group (contrast ultrasound examination), elastic group (ultrasound elastography examination), and multimodal group (combined examination of the three methods), with 25 patients in each group. Images were processed by the M-RCNN segmentation algorithm. The results of the pathological biopsy were used to evaluate the diagnostic efficacy of the four methods. The liver tissues were then extracted and divided into observation group 1 (lesion tissue specimen), observation group 2 (liver tissue around cancer lesion), and control group (normal liver tissue), and the expression activities of EZH2 and p57 genes in the three groups were analyzed. Results The accuracy of M-RCNN (97.23%) and average precision (AP) (71.90%) were higher than other methods (P < 0.05). Sensitivity (88.87%), specific degree of consistency (90.91%), accuracy (89.47%), and consistence (0.68) of the multimodal group were better than the other three groups (P < 0.05). Low and medium differentiated cancer tissues had an irregular shape, unclear boundary, uneven internal echo, unchanged/enhanced posterior echo, blood flow level 1∼2, elastic score 4∼5, and enhancement mode fast in and fast out. The positive expression rate of EZH2 in observation group 1 (75.95%) was higher than that in the other two groups, the positive expression rate of p57 in observation group 1 (80.79%) was lower than that in the other two groups, and the positive expression rate of p57 in the highly differentiated cancer foci (80.79%) was significantly lower than that in the middle and low differentiated cancer foci (P < 0.05). Conclusions M-RCNN segmentation algorithm had a better segmentation effect. Multimodal ultrasound had a good effect on the benign and malignant diagnosis of small liver cancer and had a high clinical application value. The high expression of EZH2 and the decreased expression of p57 can promote the occurrence of small hepatocellular carcinoma, and the deficiency of the P57 gene was related to the low differentiation of cancer cells.

Evaluation of Confounding Factors of Strain Sonoelastography in Patients With Thyroid Nodules

Thyroid nodule elastography has been exceedingly used for the differentiation of benign and malignant nodules. Determination of confounding factors of the results of sonoelastography in thyroid nodules when assessing the probability of malignancy is an issue of importance, and this matter needs further research. In this study, the contributing factors to the results of strain sonoelastography in cases of thyroid nodules were assessed in order to help the clinicians for better management and decision making. In this diagnostic study in Taleghani Hospital, Tehran, Iran, in 2018 and 2019, a total of 92 consecutive patients with thyroid nodules were assessed by grayscale ultrasound and strain sonoelastogaphy, and the contributing factors to the results of sonoelastography were determined according to low and high malignancy probability elasticity scores. The results in this study demonstrated that there were 57 cases (62%) with low probability scores and 35 patients (38%) with high probability scores according to strain sonoelastogaphy. The patient’s age and nodule grayscale characteristics such as shape, echogenicity, margin, composition, size, and calcification were not related to sonoelastography results (P&gt;0.05). This study showed that results of sonoelastography are not related to demographic factors and gray-scale sonographic features of the nodules.

REAL-TIME strain elastography: Applications in musculoskeletal system

BackgroundStrain or compression sonoelastography (CE) provides a colour-coded elastogram representing tissue elasticity by measuring tissue deformability after repeated probe compression. Elastographic ultrasound (EUS) is a valuable tool for screening diagnosis and follow-up of inflammatory, degenerative, benign and malignant neoplastic pathologies of skin, subcutaneous tissue, muscles, tendons, ligaments, fascia and nerves; help in targeted biopsy; monitor healing tendons after surgery or nerve stiffness changes during physiotherapy. ObjectivesTo assess stiffness of normal tendons, muscles and nerve. To diagnose cellulitis, fasciitis, abscess, tendinopathy, myositis, muscle/tendon rupture/contusion and differentiate between benign and malignant soft tissue tumours. To derive elastic score (ES) and strain ratio (SR) in cases and controls. To correlate B-mode findings with CE. Materials and methodsA prospective study on 50 healthy subjects between 25 and 30 years and 50 cases of diffuse and focal musculoskeletal pathologies was done using B-mode and CE over 2 years. Statistical analysis of distribution, mean, associations, sensitivity, specificity, area under Receiver Operating Characteristic curve (AUROC) for B-mode, ES, SR combined B-mode/CE and their comparison was done. ResultsSignificant association was noted between SR in muscles and tendons with sex. Significant correlation was noted between ES/SR with B-mode. CE and B-mode had 100% and 52.4% sensitivity respectively for diagnosing diffuse pathologies. For differentiating benign and malignant masses sensitivity, specificity, and diagnostic accuracy of B-mode was 71.43%, 86.36% and 82.76%; of SR was 71.43%, 90.91% and 86.21%; of Combined B-mode with CE was 100%, 90.91% and 93.1% respectively. Elastographic pattern had highest diagnostic accuracy and largest AUROC. ConclusionCE as a screening test had higher diagnostic accuracy, supporting need for standardizing it for clinical use in MSK. EUS being a widely available, fast and affordable modality, can aid follow up of chronic MSK pathologies, response to medication, physiotherapy and surgery and mitigate the need for MRI.

Sonoelastography of salivary glands for diagnosis and clinical evaluation in primary Sjögren's syndrome.

To explore the performance of sonoelastography (SE) in diagnosis and clinical evaluation of primary Sjögren's syndrome (pSS). SE examination of major salivary glands was conducted for 79 pSS patients, 39 disease controls and 15 healthy subjects. Elastographic images were determined with a qualitative 4-point scoring method. Receiver operating characteristic (ROC) curve was employed to evaluate the performance of the elasticity scoring method and the best cut-off value was determined. The associations between elasticity scores and disease characteristics were analysed to evaluate the clinical value of SE for pSS. Elasticity scores of parotid and submandibular glands in pSS group were significantly higher than those in the non-pSS group (p<0.001). The sum of the scores of all four glands provided the largest AUC-ROC (0.916, 95% CI 0.87-0.962), compared with that of bilateral parotid glands (0.857, 95% CI 0.794-0.919) and that of bilateral submandibular glands (0.783, 95% CI 0.704-0.863). The optimal cut-off value was 9 for combined evaluation of all four glands (81% sensitivity and 87% specificity, respectively). The elasticity scores of parotid glands in patients with disease duration >10 years experienced significant difference as compared to patients with disease duration ≤5 years and 5-10 years respectively (p=0.007, 0.009, respectively), whereas it presented no variations between the disease duration ≤5 years and 5-10 years (p=0.952). Sonoelastography, performed simultaneously with ultrasonography, is an additional tool for the assessment of the salivary glands in patients with pSS. The elasticity is closely associated with disease duration.

Application of neck ultrasound in the diagnosis of sarcoidosis

ObjectiveTo explore the significance of neck ultrasound (NUS) combined with contrast-enhanced ultrasound (CEUS) in the diagnosis of sarcoidosis.Methods88 patients with evidence of intrathoracic lymphadenopathy and suspected sarcoidosis with enlarged cervical lymph nodes underwent NUS, CEUS, fine-needle aspiration and core needle biopsy when technically feasible were retrospectively analyzed in this study. Seven characteristics such as enhanced mode (EM), resolution time, color Doppler flow imaging (CDFI), fading time, peaking state-uniformity, strengthen the area and symmetry were considered to perform the logistic regression model.ResultsOf 88 patients included in this study, sarcoidosis was accounted in 20 cases, tuberculosis in 23 cases, malignancy in 22 cases and inflammatory lymph node in 23 cases. There were statistically significant differences in symmetry, lymphatic hilum, homogeneity, CDFI pattern and elasticity score between the sarcoidosis and non-sarcoidosis groups via NUS. Similarly, we also acknowledged a statistically significant differences in EM, homogeneity, presence or absence of necrosis between the sarcoidosis and non-sarcoidosis groups via CEUS to further group the non-sarcoidosis into tuberculosis, malignancy or inflammatory disorder. The percentage correction of prediction was 90% (18/20).ConclusionNUS combined with CEUS has characteristic features in sarcoidosis with cervical lymph node involvement, which is helpful for its diagnosis and differential diagnosis. The binary classification model of NUS combined with CEUS features can help differentiate sarcoidosis from non-sarcoidosis groups.

Predicting Pathological Complete Response After Neoadjuvant Chemotherapy in Advanced Breast Cancer by Ultrasound and Clinicopathological Features Using a Nomogram.

Background and AimsPrediction of pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) for breast cancer is critical for surgical planning and evaluation of NAC efficacy. The purpose of this project was to assess the efficiency of a novel nomogram based on ultrasound and clinicopathological features for predicting pCR after NAC.MethodsThis retrospective study included 282 patients with advanced breast cancer treated with NAC from two centers. Patients received breast ultrasound before NAC and after two cycles of NAC; and the ultrasound, clinicopathological features and feature changes after two cycles of NAC were recorded. A multivariate logistic regression model was combined with bootstrapping screened for informative features associated with pCR. Then, we constructed two nomograms: an initial-baseline nomogram and a two-cycle response nomogram. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were analyzed. The C-index was used to evaluate predictive accuracy.ResultsSixty (60/282, 21.28%) patients achieved pCR. Triple-negative breast cancer (TNBC) and HER2-amplified types were more likely to obtain pCR. Size shrinkage, posterior acoustic pattern, and elasticity score were identified as independent factors by multivariate logistic regression. In the validation cohort, the two-cycle response nomogram showed better discrimination than the initial-baseline nomogram, with the C-index reaching 0.79. The sensitivity, specificity, and NPV of the two-cycle response nomogram were 0.77, 0.77, and 0.92, respectively.ConclusionThe two-cycle response nomogram exhibited satisfactory efficiency, which means that the nomogram was a reliable method to predict pCR after NAC. Size shrinkage after two cycles of NAC was an important in dependent factor in predicting pCR.

Added Value of a New Strain Elastography Technique in Conventional Ultrasound for the Diagnosis of Breast Masses: A Prospective Multicenter Study

ObjectiveThis study aimed to explore the value of elasticity score (ES) and strain ratio (SR) combined with conventional ultrasound in distinguishing benign and malignant breast masses and reducing biopsy of BI-RADS (Breast Imaging Reporting and Data System) 4a lesions.MethodsThis prospective, multicenter study included 910 patients from nine different hospitals. The acquisition and analysis of conventional ultrasound and strain elastography (SE) were obtained by radiologists with more than 5 years of experience in breast ultrasound imaging. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under curve (AUC) of conventional ultrasound alone and combined tests with ES and/or SR were calculated and compared.ResultsThe optimal cutoff value of SR for differentiating benign from malignant masses was 2.27, with a sensitivity of 60.2% and a specificity of 84.8%. When combined with ES and SR, the AUC of the new BI-RADS classification increased from 0.733 to 0.824 (p < 0.001); the specificity increased from 48.1% to 68.5% (p < 0.001) without a decrease in the sensitivity (98.5% vs. 96.4%, p = 0.065); and the PPV increased from 52.2% to 63.7% (p < 0.001) without a loss in the NPV (98.2% vs. 97.1%, p = 0.327). All three combinations of conventional ultrasound, ES, and SR could reduce the biopsy rate of category 4a lesions without reducing the malignant rate of biopsy (from 100% to 68.3%, 34.9%, and 50.4%, respectively, all p < 0.001).ConclusionsSE can be used as a useful and non-invasive additional method to improve the diagnostic performance of conventional ultrasound by increasing AUC and specificity and reducing the unnecessary biopsy of BI-RADS 4a lesions.

The Tensile and Flexural Forces of Acropora Reef Waste Particulate-Enchanced Polyester Composites

Composite is a material that combines two or more materials that basically dissimilar chemical or physical properties from one another. In this research, we used Acropora coral reef waste particulate and Resin Polyester BQTN type 157 with Methyl ethyl ketone peroxide (MEKP) 1% as the hardener. The Hand Lay-Up molding technique is used in the process of making the material. The tensile and flexure test is done according to the ASTM D3090 and ASTM D790 – 03 standards. The purpose of this research is to discover the means to produce a composite enhanced by Acropora coral reef waste with polyester matrix and to learn the tensile and flexure strength from the Acropora coral reef waste particulate-enhanced polyester composites with mass fraction varieties of 10%, 20%, 30%, and 40%. The tensile test result of Acroporal coral reef waste particulate with polyester matrix yields average tensile strength at mass fraction variety of 40% with a score of 19,66 MPa, with an Modulus score of 636,75 MPa. The flexure test result of Acropora coral reef waste particulate with polyester matrix yields average flexure stress at mass fraction variety of 40% with a score of 112,56 MPa, with an average Elastic Modulus score of 3098,96 MPa.

English

BACKGROUND We wanted to evaluate the sensitivity and specificity of ultrasound elastography in the detection and characterization of various breast masses and study its role in differentiating benign vs malignant breast masses with fine needle aspirarion cytology (FNAC) and/or histopathological correlation of its findings. METHODS A total of 120 patients with breast lesions were prospectively evaluated using ultrasonography (USG) in the Department of Radiodiagnosis at Katihar Medical College, Katihar, Bihar. After procuring consent from the patients, B-mode and elastography examination of all the patients was carried out simultaneously, using the Philips EPIQ 5G ultrasound machine. The findings were noted in a proforma for observation and further comparisons. The usefulness of elastography, regarding prediction of the nature of the mass (benign/malignant), delineation of its exact extent, and correlation with clinical/cytological diagnosis was studied. RESULTS A sensitivity of 97.0% and specificity of 86.7% was observed when a cut off value of 3 was used for elasticity score. A specificity of 95.5% and a sensitivity of 93.3% was observed when a cut off of 3.8 was used for strain ratio (SR). In all cases, the extent of the pathology, the local or contiguous spread and vascular involvement, predicted by ultrasound elastography examination corroborated well with the cytological findings. The results of this study are in concordance with results of studies that have been conducted previously. CONCLUSIONS Ultrasound elastography is a simple and rapid method that can improve the sensitivity and specificity of ultrasonography of focal breast lesions and can decrease the rate of unnecessary biopsies. The diagnostic accuracy of combined ultrasound and elastography is quite high and thus improves the diagnostic confidence of the cases under evaluation. KEYWORDS Elastography, Ultrasound, Focal Breast Lesions

Elastosonography in the Characterization of Breast Masses in Black Women in Lomé (Togo)

Objective: study the contribution of elastosonography in the characterization of breast masses. Methods: a prospective and descriptive study took place over a period of 6 months from February to July 2020 in the department of radiology of the Sylvanus Olympio teaching hospital in Lome. Patients presenting a breast mass diagnosed by the conventional ultrasound were invited to take part in the study. Result: in total, fifty-four patients met our selection criteria, for an overall frequency of 2.9%. The average age of our patients was 24.2 years old with the 20-29 years age group being the most represented. The mean lesion size was 18.8mm with extremes of 5 and 35mm. The lesions classified as Birads 3 were the most prevalent (40.4%) and they all had an elasticity score of less than 3. 75% of the lesions classified as Birads 4 also had an elasticity score less than 3. All lesions classified as Birads 5 had an elasticity score greater than 4. We obtained a statistically significant relationship between the Birads classification and the elastographic score and also by differentiating the mammary masses into benign and malignant lesions by these two modalities. Conclusion: elastosonography is a diagnostic imaging method that allows rapid and easy evaluation of breast lesions and it provides a valuable addition to the ultrasound data in real-time. It provides complementary diagnostic information that could potentially assist in the characterization of breast lesions by B-mode ultrasound.

The Role of Ultrasound Elastography in Evaluation for Axillary Lymph Nodes of Patients with Breast Cancer

Abstract Background: Axillary lymph node status is the most reliable prognostic indicator for disease recurrence and patient survival in breast cancer. Axillary ultrasound is an important mean for detecting metastatic LNs, being non-invasive, avail-able & cheap. Aim of Study: To investigate the role of strain elastography combined with conventional ultrasound in the diagnosis of axillary lymph nodes in patients with breast cancer. Patients and Methods: 24 patients diagnosed with breast cancer with enlarged axillary lymph node were included in this study over the course of six months, they were examined bu B mode ultrasound and ultrasound elastography. Finally, findings of B-mode US and elastography were compared with pathological results (reference standard). ROC analysis was constructed to obtain best cutoff values for B-mode criteria, alasticity score and strain ratio. Results: Elastography score and strain ratio had a higher specifcity (83.3% vs. 33.3%) and a lower sensitivity (88.9% vs. 100%) than gray-scale ultrasonography. Of all the 6 benign axillary lymph nodes analysed in the present study, 2 were determined to be metastatic by gray-scale ultrasonography, while these diagnoses were corrected by RTE. As regards the semi-quantitative assessment; strain ratio, in our study there was a significant increase in mean strain ratio in the malignant nodes (1-8.3) than the benign ones (0.7-3.4) (p=0.005), with the best cutoff value 2.5 which yielded sensitivity of 88.89, specificity of 83.33,accuracy of 90%, PPV 94.1%, NPV 71.4%. Conclusion: Ultrasound elastography by its qualitative (elasticity score) and quantitative (strain ratio) evaluation has proved to useful in differentiation between benign and malig-nant nodes as a complementary to conventional ultrasound. Using elasticity score/strain ratio; 11 out of 18 pathologically proved malignant nodes, were diagnosed as malignant, 5 out of 6 benign nodes were diagnosed as benign.

Effect of Flock Age, Air Pressure and Litter Types on Carcass Traits and Meat Quality of Broiler Chicks

The present study was aimed to investigate the effect of flock age (younger breeder flock 33 WKS and older breeder flock 43 WKS), air pressure during incubation period (low, 100719 (LAP) and high, 101000 (HAP) Pascal) and the type of litter on carcass characteristics and meat quality of broiler chicks. A total number of 600 one day old chicks (Ross 308) hatched from eggs of two flocks in different age (each of 300 chicks)were randomly chosen divided into two sub experimental groups according the air pressure of incubation conditions (each of 150 chicks), each sub-group divided into three sub-sub experimental groups were raised on floor house provided with litters of wood shaving, plastic and sand, respectively. This study was design as 2×2×3 factorial arrangement experiment. The results obtained showed that, broiler chicks produced from older breeder flock recorded the higher significant (p>0.05) absolute and relative weights of eviscerated carcass, giblets, total edible parts, protein, ash percentages, odor, color, elasticity and overall score of meat quality compared with younger ones. However broiler chicks produced from eggs incubated at HAP shoed the higher absolute and relative weights of eviscerated carcass, giblets, total edible parts, percentages of protein, fat pH, TVN, TPA and odor of meat. Broilers chicks raised on plastic (PL) litter type showed the higher values of absolute and relative weights of eviscerated carcass total edible parts, percentages of protein and ash, meat sensory evaluation and recorded the lowest microbial count of APC bacteria in meat and cecal . According to the interaction between the studied factors, it could be concluded that the broiler chicks hatched from eggs of the flock at age of 43 WK, incubated at HAP and raised on plastic litter type (43 WKS × HAP ×PL) seemed to be adequate to achieve the favorable results.

Interobserver and intermethod variability in data interpretation of breast strain elastography in suspicious breast lesions

Background/aimStrain elastography has the disadvantage of being operator-dependent. Interobserver variability is observed during image acquisition and interpretation. This study aimed to analyze the interobserver and intermethod variability of strain elastography in image interpretation and evaluate the diagnostic performance combining elasticity score and strain ratio with ultrasonography.Materials and methodsA retrospective study was conducted on 70 breast lesions evaluated with B-mode ultrasonography and strain elastography. B-mode ultrasonography findings, elasticity scores, and strain ratio values were evaluated using static images by two radiologists. BI-RADS assessment of the lesions and the decision of both observers as to whether the biopsy was required using B-mode ultrasonography, and the combined ultrasonography+elasticity score, and the combined ultrasonography+elasticity score+strain ratio were compared with the histopathological results. Also, the interobserver agreement was analyzed for all the combinations.ResultsThere was very good agreement (weighted κ = 0.865) between the observers for the elasticity scores. Very good agreement was observed between the observers for BI-RADS assessments using the combined ultrasonography+elasticity score and the combined ultrasonography+elasticity score+strain ratio (weighted κ = 0.848, and 0.902, respectively). Area under the curve of B-mode ultrasonography, the combined B-mode ultrasonography+elasticity score, and the combined B-mode ultrasonography+elasticity score+strain ratio, were calculated as 0.859, 0.866, and 0.916 for observer 1, and 0.851, 0.829, and 0.916 for observer 2, respectively. There were no statistically significant differences between the observers’ diagnostic performances in any of the combinations (P = 0.703, 0.067, and 0.972, respectively). ConclusionIn the evaluation and further assessment of breast lesions, semiquantitative strain ratio calculation may help improve diagnostic accuracy by reducing interpretational variety, when used together with B-mode ultrasonography and elasticity scoring, especially for inexperienced individuals.

Prevalence of thyroid carcinoma in nodules with thy 3 cytology: the role of preoperative ultrasonography and strain elastography

BackgroundFine needle aspiration (FNA) cytology, the gold standard in assessing thyroid nodules, is limited by its inability to determine the true risk of malignancy in Thy 3 nodules. Most patients with Thy3 cytology undergo surgery to establish a histologic diagnosis. The aims of this study were to evaluate the prevalence of malignancy in Thy3 nodules, to examine the ultrasound (US) characteristics that are associated with a high cancer risk and to assess the role of real-time strain elastography.MethodsRetrospective cohort study of 99 nodules with Thy3 cytology in 99 patients who underwent thyroidectomy over a three-year period. Grayscale US, Doppler and real-time strain elastography data were evaluated.ResultsEighty-one nodules (81.82%) were benign, 18 (18.18%) were malignant, and almost all were papillary thyroid carcinoma (PTC). Univariable analysis revealed irregular margins (p = 0.02), ill-defined borders (p ≤ 0.001), a taller than wide shape (p ≤ 0.001) and the elasticity score (p = 0.02) as significant predictors of malignancy. Multivariable analysis showed that ill-defined borders and the elasticity score were significant and independent factors associated with malignancy. All soft nodules (elasticity scores 1–2) were benign (sensitivity 100%, specificity 33%, NPV 100%, and PPV 23%). There was a higher rate of malignancy in Thy3a nodules than in Thy3f nodules (42.86% versus 11.54%) (p ≤ 0.001).ConclusionsIrregular margins, ill-defined borders, a taller than wide shape and low elasticity were associated with malignancy. Elastography should be performed when evaluating Thy3 nodules.

Role of gray-scale ultrasound, Doppler, and ultrasound elastography in the evaluation of nodular goiter

Background Thyroid nodules are very common. Most nodules are benign, with less than 5% of them being malignant. High-resolution ultrasound (US) is sensitive in detection of thyroid nodules, enabling differentiation of solid and cystic lesions. Conventional US does not provide information regarding hardness of the nodule and this is often the role of Ultra Sound Elastography (USE). US elastography was developed to work out tissue stiffness and strain information noninvasively. Aim The aim was to judge of the accuracy of gray-scale US, Doppler, and US elastography in the diagnosing of nodular thyroid diseases. Patients and methods The study included 20 consecutive patients with a clinically diagnosed multinodular goiter presented to Otorhinolaryngology OutPatient Clinic. All patients have been subjected to detailed history taking, complete Oto Rhino Laryngology (ORL) head and neck examination, complete general examination, and routine investigations for general anesthesia. Radiological imaging using conventional US and real- time US, Doppler study of the whole thyroid gland by the same probe, and elastography. Suspicious nodules were subject to Fine Needle Aspiration Cytology (FNAC) and surgery was done by ORL surgeon in the ENT department. Results In this study, 20 cases were included from which 19 cases were benign and only one case was malignant. There was a high statistical significance in-between the US classification and elasticity score with P less than 0.001, and high statistical significance in-between Doppler signs and elasticity score with P less than 0.001. Conclusion US elastography may be a promising technique that combined with other US modalities is straightforward and rapid to perform and might help to spot thyroid nodules that are likely to be malignant.

ROLE OF ULTRASONOGRAPHIC ELASTOGRAPHY IN THE DIFFERENTIAL DIAGNOSIS OF BREAST MASSES AND ITS CONTRIBUTION TO CLASSICAL ULTRASONOGRAPHIC EVALUATION

Introduction: India is experiencing an unprecedented rise in the number of breast cancer cases across all sections of society. Breast cancer is now the most common malignancy in women and the second leading cause of cancer- related mortality. Breast cancer is quite easily and effectively treated, provided it is detected in it's early stages. There is a drastic drop in the survival rates when women present with advanced stage of breast cancer, regardless of the setting. Unfortunately, women in resource-poor and developing countries, like India, generally present at a later stage of disease than women elsewhere, partly due to the absence of effective awareness programs and partly due to the lack of proper mass screening programs Aims And Objectives: The diagnostic performance of elastography in differentiating benign from malignant breast lesions. To assess whether elastography has the potential to reduce the need for breast biopsy /FNAC. Cut off value of Strain Ratio for benign versus malignant breast lesions. Further characterize BI-RADS 3 lesions using elastography Materials And Methods: The study was approved by the GSVM MEDICAL COLLEGE AND LLR HOSPITAL Ethics Committee. All patients that presented to the Radiology and Imaging Department of LLR HOSPITAL for diagnostic work up for breast pathology were included in the study. After obtaining a written and signed informed consent from all patients, they were subjected to conventional B-Mode ultrasonography followed by elastography. All diagnostic breast imaging was done with Samsung RS80A ultrasound machine using linear array transducer of frequency 5-12MHz.Observations &amp; Results: The elastography patterns for each lesion were assessed and documented in color scale. Color images were constructed automatically and displayed as a color-overlay on the B-mode image. The color pattern of each lesion was then evaluated on a scale of 1-5 according to the Tsukuba elasticity scoring system. Conclusion: Strain Ratio cutoff of 3.3 is a sensitive parameter to differentiate benign and malignant breast lesions. Elastography is a specic test for differentiating benign and malignant breast lesions. The combined use of elasticity score, strain ratio and B- Mode sonographyincreases the diagnostic performance in distinguishing benign from malignant breast masses.

A Model for Predicting Malignant Sub-pleural Solid Masses Using Grayscale Ultrasound and Ultrasound Elastography

This article aimed to establish a prediction model of grayscale sonography and ultrasound elastography for malignant sub-pleural solid masses and evaluate its diagnostic value. The study included 153 patients, including 89 patients with malignant tumors and 64 patients with benign diseases. Statistical differences between the malignant and benign groups were found in the factors of age, air bronchogram, borderline, shape and elasticity score (p < 0.05). Age, elasticity score and borderline were effective factors for predicting malignant sub-pleural solid masses, offering an area under the receiver operating characteristic curve (AUROC) value of 0.72 (95% confidence interval [CI] 0.64–0.80), 0.73 (95% CI 0.65–0.79) and 0.70 (95% CI 0.62–0.77), respectively. The AUROC value of the prediction model for malignant sub-pleural solid masses was 0.88 (95% CI 0.81–0.92), which indicates that the prediction model was able to improve the diagnostic accuracy and that it may prove a useful auxiliary diagnostic tool for malignant sub-pleural solid masses, especially in primary health care institutions in developing countries.

The diagnostic performance of conventional ultrasound and strain elastography in malignant soft tissue tumors.

To investigate the diagnostic value of conventional ultrasound (US) and strain elastography (SE) in malignant soft tissue tumors. A total of 83 soft tissue masses were included prospectively. US and SE imaging were performed at the same time. Two observers assessed the B mode, color Doppler, elastic scores (ES), strain ratio (SR), and SE size to B mode size (EI/B) ratio and compared the consistency of the data between the observers. According to the pathological diagnosis of resection, the cases were divided into malignant and nonmalignant groups. The diagnostic value of conventional US and SE in the prediction of malignant soft tissue tumors was assessed. The pathology results divided cases into 36 malignant lesions and 47 nonmalignant lesions. There was no statistically significant difference in gender, location, maximum diameter, echo, tail sign, cystic component, Doppler scores, or SR between the two groups (p > 0.05). However, significant differences between the two groups were found in age, depth, heterogeneity, edge, ES, and EI/B (p < 0.05). The biggest area under the receiver operating characteristics curve (0.934) was the combination model of age, heterogeneity, edge, ES, and EI/B, and the sensitivity and specificity were 0.861 and 0.957, respectively. Conventional US and SE are significant for the diagnosis of malignant soft tissue tumors, and SE can be used as a complementary technique to the characterization of STTs using conventional US.

Diagnostic and Predictive Values of Strain Ratios in the Regions of Interests in Reference Tissue for Breast Tumor.

PurposeTo investigate the diagnostic and predictive value of strain ratios in the regions of interests (ROIs) in reference tissue for breast tumor.Patients and MethodsA total of 707 lesions in 665 consecutive patients were examined with B-mode Breast Imaging-Reporting and Data System (BI-RADS) and Ultrasonic elastography (UE). Elasticity score (ES) and strain ratio (SR) in each lesion were calculated. Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of BI-RADS, ES, SR1, SR2, BI-RADS combined with ES (BI-RADS+ES), BI-RADS combined with SR1 (BI-RADS+SR1), and BI-RADS combined with SR2 (BI-RADS+SR2). The sensitivity, specificity, and areas under the ROC curves (Az) were obtained. Scatter plots were generated to demonstrate the correlation between SR1 and SR2. Kruskal-Walls H-test, Mann–Whitney U-test and one-way ANOVA were performed to evaluate SRs and tumor-related variables. Multiple linear regression analysis was carried out to determine variables independently associated with SRs.ResultsBI-RADS had high sensitivity and low specificity in the diagnosis of breast tumor. The specificity of BI-BADS combined with ES or SR was even higher. The Az value of BI-RADS+ES or BI-RADS+SRs was higher than that of BI-RADS (P < 0.001). The Az value of ES was higher than those of SR1 and SR2 (P < 0.001), and those of SR1 and SR2 were similar. SR1 and SR2 were highly positively correlated. There was no statistical difference between Az values of BI-RADS+ES, BI-RADS+SR1, and BI-RADS+SR2. Indistinct margin, high histologic grade, histological type, and negative human epidermal growth factor receptor (Her-2) were associated with SR1 and SR2. Progesterone receptor (PR) status and molecular subtype were associated with SR2. Histologic grade and tumor margin were significantly associated with SR1, and tumor margin was associated with SR2.ConclusionSRs in different ROIs in the reference tissue at the same depth showed no different diagnostic value for breast tumor. Both SR1 and SR2 could be useful in assessing the biological characteristics of invasive breast carcinoma.

Role and importance of elastography in the diagnosis of differentiated thyroid carcinomas regarding the clinical, echosonographic, biochumoral and cytological examination and correlation of these results with definitive histopathological finding: A retrospective study

Background/Aim. Thyroid nodules represent a common problem in medicine. Ultrasound examination of the thyroid glands is a common method for the initial diagnosis of thyroid neoplasia enabling the selection of nodules that should undergo fine needle aspiration biopsy (FNAB). It is a noninvasive method that has a great potential in discovering suspicious lesions, enabling timely actions for further diagnostics and potential treatment. However, it is still not clear enough how the quantitative data collected from Ultrasound elastography correlate with those obtained by other diagnostic tools used for detecting thyroid nodules. The aim of this study was to estimate the importance of ultrasound elastography in diagnostics of differentiated thyroid carcinomas but also to estimate the importance of other diagnostic procedures as well. Methods. The research was performed on patients initially referred to the Clinic of Endocrinology in Military Medical Academy, Belgrade to evaluate the status of thyroid nodules. The da-ta from ultrasound elastography was then correlated with those from other diagnostic procedures including clinical examination, echosonography, cytological and histopathological analyses. Results. Statistically significant difference between the group of patients with follicular adenoma and the group of patients with differentiated thyroid carcinoma was detected for consistency, nodules immovability, thyroglobulin (Tg) levels, presence of calcifications in the nodules and the elastographic score. Fixed nodules and those with firmer consistency were significantly more common in the group of patients with malignant lesions, in which Tg levels were higher. The elastography score 3-4 showed a high predictive value for the detection of thyroid carcinoma, unlike the elasticity score. Conclusion. Ultrasound elastography represents a new non-invasive method that has a very significant, high predictive value for the detection of thyroid carcinoma, especially in correlation with other diagnostic procedures.