ObjectiveTo systematically review the diagnostic value of ultrasound for breast cancer with axillary sentinel lymph nodes, so as to provide evidence for clinical decision-making. MethodsWe searched the databases including PubMed, EMbase, The Cochrane Library (Issue 12, 2013), CBM, CNKI, WanFang Data and VIP for studies about ultrasound in the diagnosis of breast cancer with axillary sentinel lymph nodes till December 31st, 2013. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and methodological quality of the included studies was evaluated. Meta-analysis was then conducted using Meta-Disc 1.4 software. ResultsA total of 12 studies involving 2 188 cases were included. The pooled results of meta-analysis showed that sensitivity and specificity were 0.75 (95%CI 0.72 to 0.77) and 0.91 (95%CI 0.89 to 0.92), respectively; positive likelihood ratio and negative likelihood ratio were 6.54 (95%CI 4.68 to 8.89) and 0.22 (95%CI 0.15 to 0.33), respectively; diagnostic odds ratio was 33.59 (95%CI 17.87 to 63.12); and the AUC was 0.934 3. ConclusionUltrasound is has relatively high value in diagnosis of breast cancer with axillary sentinel lymph nodes. However, due to the influence caused by the limited quality and various potential heterogeneity, more high quality RCTs with large sample size are needed to further verify the above conclusion.
ObjectiveTo investigate the clinical value of real-time elastosonography in diagnosis of thyroid nodules. MethodsThe clinical date of 168 patients with thyroid nodules, admitted to our hospital from June 2009 to December, were retrospectively analyzed with pathological findings as the reference standard． The findings on elastography were classified into five grades: grade 0 to Ⅳ. The nodules with grade less than Ⅱ were diagnosed as benign, otherwise more than Ⅲ were diagnosed as malignancy. ResultsThere were 208 nodules in 168 patients: nodular goiter was in 125 cases, thyroid adenoma in 36 cases, thyroid malignant tumor in 41 cases including 39 cases for thyroid papillary carcinoma, 1 case for thyroid medullary carcinoma, 1 case for thyroid non-Hodgkin lymphoma. Other nodules were in 6 cases, including diffuse toxic goiter in 1 case, local lymphocytic thyroiditis in 3 cases, and subacute granulomatous thyroiditis in 2 cases. There were 148 thyroid nodules in grade 0-Ⅱ and 60 nodules in grade Ⅲ-Ⅳ. According to the pathological findings, 97.3%(144/148) thyroid nodules of grade 0-Ⅱ were benign, however, 38.3% (23/60) of grade Ⅲ-Ⅳ were benign. Furthermore, 2.7% (4/148) thyroid nodules of grade 0-Ⅱ were malignancy, while 61.7% (37/60) of grade Ⅲ-Ⅳ were malignancy. The sensitivity， specificity, and accuracy of the real-time elastosonography in diagnosis of thyroid nodules was 90.2%(37/41), 86.2%(144/167), and 87.0%(181/208), respectively. ConclusionReal-time elastosonography can reflect the relative hardness of thyroid nodules and provide useful information for diagnosis, which is helpful in differentiating benign and malignant thyroid nodules.
Objective To investigate the value of contrast-enhanced ultrasonography in detection and diagnosis of small primary liver cancer. Methods SonoVue-enhanced ultrasonography were performed on 353 patients with 378 primary liver cancer, less than 3 cm in diameter. Enhancement patterns and enhancement phases of hepatic lesions on contrast-enhanced ultrasonography were analyzed and compared with the results of histopathology. Results In all hepatic tumors, 96.6% （365/378） lesions enhanced in the arterial phase. Among them, 317 (83.9%) tumors enhanced earlier than liver parenchyma and 48 (12.7%) tumors enhanced synchronously with liver parenchyma, and 342 (90.5%) tumors showed early wash-out in the portal and late phases. With regard to the enhancement pattern, 329 (87.0%) tumors presented whole-lesion enhancement, 35 (9.3%) to be mosaic enhancement and 14 (3.7%) to be rim-like enhancement. If taking the whole-lesion enhancement and mosaic enhancement in arterial phase as diagnotic standard for primary liver cancer on contrast-enhanced ultrasonography, the sensitivity was 92.9%(351/378), and if the earlier or synchronous enhancement of the tumor compared with liver parenchyma in arterial phase and the wash-out in portal phase were regarded as the stardand, the sensitivity was 87.3%(330/378). Conclusion Contrast-enhanced ultrasonography could display real-time enhancement patterns as well as the wash-out processes both in hepatic tumors and the liver parenchyma. It might be of clinical value in diagnosis of primary liver cancer based on the hemodynamics of hepatic tumors on contrast-enhanced ultrasonography.
Objective To investigate the characteristics of ultrasonogram of eyes with silicon oil tamponade. Methods Forty-seven patients (47 eyes) who had undergone the operation of silicon-oil removing were examined by A-(to determine the length of ocular axis) and B-scan before and after the operation respectively. The length of ocular axis and cubage of vitreous chamber were detected and the characteristics of the ultrasonograms were observed according to the default parameters of ultrasonograph. Results The results of A-scan showed that the preoperative axial length was 1.465 times of the postoperative one in the eyes without lens, and 1.284 times in eyes with lens; after modified the parameter according to the acoustic velocity, the preoperative axial length was (0.78±0.34) mm longer than the postoperative one in the eyes without lens, and (0.56±0.32) mm in eyes with lens. The results of A-scan showed that the cubage of vitreous chamber enlarged obviously in eyes with silicon oil tamponade, and the acoustic features included complete filling and partial filling according to the amount of silicon oil. Several arc echoes at the posterior segment of eye were detected in the silicon-oil-filling eyes with retinal detachment. Conclusion In the silicon-oil-filling eyes with lengthened ocular axis, the characteristics of B-scan images are affected by acoustic velocity through silicon oil, the amount of silicon oil capacity and the emulsification of silicon oil. (Chin J Ocul Fundus Dis，2004，20：349-351)
Objective To evaluate the real-time contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of retroperitoneal occupying lesions. Methods Thirty patients with retroperitoneal occupying lesions, including 10 benign and 20 malignant lesions, were performed with CEUS, thus describing the perfusion of contrast agent, the entering style of contrast agent and the vascular morphous. And the entering styles were divided into two patterns: peripheral type or central type while the vascular morphous were divided into 4 levels: level 0, level 1, level 2 and level 3. All of these were compared between benign and malignant lesions. Compared the results of diagnosis malignant lesions by common ultrasonography with CEUS. Results 1/5 case of benign substantive lesions presented as contrast agent perfusion defect, and 11/20 cases of substantive malignant lesions presented as contrast agent perfusion defect. 14/20 of malignant lesions were central type; 9/10 of benign lesions were peripheral type (P=0.005 2). In benign lesions, level 0 had 7/10， level 1 had 2/10 and level 3 had 1/10. In malignant lesions, level 0 had 1/20, level 1 had 3/20, level 2 had 8/20 and level 3 had 8/20, too (P=0.000 5). The rate of missed diagnosis was 40.00% and the accuracy was 66.67% by common ultrasonography, while the rate of missed diagnosis was 10.00% and the accuracy was 86.67% by CEUS combined with the entering style of contrast agent and the vascular morphous. Conclusion The CEUS applies a new way to discriminate malignant from benign in retroperitoneal occupying lesions.
Objective To systematically evaluate the influence of PICC (peripherally inserted central catheter) ultrasound guidance on success rates and incidences of complications of elbow catheterization. Methods The Cochrane Library (Issue 3, 2012), Library of JBI evidence-based nursing center, MEDLINE, EMbase, CBM, VIP, CNKI and WanFang Data were searched for relevant studies to influence on success rates of puncture and catheterization and complications from upper arm placement of PICC ultrasound guidance as well as conventional PICC placement from inception to March, 2012. The data were extracted according to the inclusion and exclusion criteria by two reviewers, the quality of included studies was also evaluated. Meta-analysis was conducted using RevMan 5.1, or only descriptive analysis was conducted instead. Results Eleven randomized controlled trials, five clinical controlled trials and four cohort studies were included, involving 4 052 patients. The results of meta-analysis showed that, upper arm placement of PICC ultrasound guidance combined with modified Seldinger technique was associated with significantly higher one-time success rates of puncture and catheterization than conventional PICC placement below the elbow, with significant differences (OR=4.71, 95%CI 1.97 to 11.28, P=0.000 5; OR=8.63, 95%CI 1.92 to 38.82, P=0.005). Conventional elbow catheterization had a significantly higher incidence of phlebitis than catheterization on the elbow that under the guidance of PICC ultrasound and modified Seldinger technique (OR=0.13, 95%CI 0.08 to 0.21, Plt;0.000 01). Conclusion Elbow catheterization under the guidance of PICC ultrasound combined with modified Seldinger technique has an obvious advantage in improving the success rates of puncture and catheterization and reducing the incidence of complications, compared with conventional elbow catheterization.
Objective To evaluate the effect of endoscopic surgery combined with intraoperative color Doppler ultrasound on removing the injected breast augmentation agents and share our experiences. Methods Sixteen female who accepted the bilateral removal of injected breast augmentation agents through endoscopic surgery combined with intraoperative color Doppler ultrasound between 2008 and 2010 were enrolled in this study. The results, techniques, and advantages of management were analyzed retrospectively. Results One incision was made in 18 breasts, 2 in 4 breasts, 3 in 10 breasts. The length of incision was 0.5 to 1 cm. The mean operative time was 128.70 min per person. The average amount of bleeding was 52.67 ml per person. Complications such as postoperative bleeding, infection, poor drainage, or breast augmentation agents remain did not happened in all cases. No case was turned into normal operation. Female who accepted this operation were all satisfied with the appearance of incisions. During 1-3 months follow up, neither clinically palpable mass nor sensory disturbance in nipple or areola of breast was observed. Color Doppler ultrasound or magnetic resonance showed 16 cases had been cleared free of breast augmentation agents. Conclusion With the advantages of beauty, safe, minimal invasion, and partial resection of lesions at the same time, endoscopic surgery combined with intraoperative color Doppler ultrasound was an effective approach in the removal of injected breast augmentation agents.
Objective To evaluate the urine cytology silver staining combined with ultrasonography（USG）in the detection of bladder transitional cell carcinoma （TCC） recurrence after transurethral resection of bladder tumor（TURBT）in terms of sensitivity and specificity. Methods Cystoscopy was used as “gold standard”. Urine cytology combined with USG or cystoscopy was measured separately and blindly. AgNORs protein stained by silver were used in cytology with Kappa of inter-observers 0.81. For the USG, the patients were scanned with trans-rectal probe with Kappa of inter-observers 0.76. The results of urine cytology combined with USG （Positive when urine cytology and/or USG positive. Negative when both urine cytology and USG negative） were compared with “gold standard”. Results The 148 consecutive superficial TCC patients with TURBT one year previously were included in this study. Fifty seven recurrenced cases were detected. Recurrence rate was 38.51%. The sensitivity and specificity of urine cytology silver stain were 89.47% （95% CI 0.82 to 0.98） and 87.91% （95% CI 0.81 to 0.95）. Area under ROC curve was 82.22%. The sensitivity and specificity of USG were 57.90% （95% CI 0.45 to 0.71 ） and 90. 11% （ 95% CI 0.84 to 0.96）. Area under ROC curve was 73.13% . The sensitivity was improved to 94. 74% （95% CI 0.89 to 1.00） when cytology combined with USG. But specificity decreased to 84. 62% （95% CI 0.77 to 0.92 ）. Area under ROC curve was improved to 98.28%. Conclusions Urine cytology silver stain combined with USG improves the high sensitivity for follow-up TCC patients after TURBT. The non-invasive protocol is suggested.
Objective To discuss the diagnostic and differential diagnostic value of ultrasonography for primary testicular lymphoma (PTL) by studying the ultrasonographical image characteristics. Methods Thirty-one patients with PTL confirmed by postoperative histopathology between 2005 and 2015 were chosen to be the study subjects. We retrospectively analyzed their ultrasonographical features and clinical data. Results Most PTL patients were elderly men, and the initial symptom was mainly painless testis enlargement. Thirty-nine testicles were involved in the primary testicular lymphoma, including 23 unilateral and 8 bilateral. In the 31 patients, 22 had diffuse lesions and 9 nodal. Ultrasonography showed that most tumors were hypoechoic lesions, and part of them were hyperechoic linearly. The lesions had abundant blood flow signals with a low resistance index. Conclusions In elderly patients with painless testicular enlargement, the possibility of primary testicular lymphoma must be fist considered. Manifestations of primary testicular lymphoma have some distinctive characteristics, and combined with clinical history, they are helpful for the diagnosis and differential diagnosis of PTL.
ObjectiveTo observe the application value of RetCam Ⅲ in the diagnosis of retinoblastoma (RB). MethodsThe clinical data of 125 eyes from 94 patients with RB were retrospectively analyzed. According to the International Intraocular Retinoblastoma Classification, the results of binocular indirect ophthalmoscope and RetCam Ⅲ was compared. The consistency between RetCam Ⅲ and binocular indirect ophthalmoscope was analyzed by Kappa test. The detectable rates of tumor between binocular indirect ophthalmoscope, RetCam Ⅲand B scan ultrasound were comparatively analyzed. ResultsBy binocular indirect ophthalmoscope, there were 18 eyes (14.4%) in stage A, 15 eyes (12.0%) in stage B, 10 eyes (8.0%) in stage C, 28 eyes (22.4%) in stage D, and 54 eyes (43.2%) in stage E. Using RetCam Ⅲ, the classification was 18 eyes (14.4%) in stage A, 16 eyes (12.8%) in stage B, 11 eyes (8.8%) in stage C, 27 eyes (21.6%) in stage D, and 53 eyes (42.4%) in stage E. The RB classification of RetCam Ⅲ was quite consistent with binocular indirect ophthalmoscope (Weighted Kappa Coefficient=0.979 8, 95% confidence interval=0.960 1-0.999 5). A total of 150 tumors from stage A-D were observed by binocular indirect ophthalmoscope. In which, 147 tumors (98.0%) were found by RetCam Ⅲ, 122 tumors (81.3%) were found by B scan ultrasound. No serious complication was found in these patients. ConclusionsRetCam Ⅲ can detect RB of different stage in clinic. It is quite consistent with binocular indirect ophthalmoscope.