Objective To improve understanding of the varied, especially atypical mammographic appearances of breast infiltrating lobular carcinoma(ILC). Methods We retrospectively studied 28 ILC (27 patients) mammographic appearances and correlated with the clinical examination, ultrasonographic(US) findings.Results ①The most frequent mammographic finding was an uncalcified mass (13), followed by a mass with calcifications (5), architecture distortion was seen in 4 lesions, two lesions appeared indistinct calcifications. Pleomorphic microcalcifications, focal asymmetric density were 1 respectively, negative mammogram was in two cases. ②Eighteen lesions appeared a mass with or without calcifications on mammogram. Of them, 5 lesions appeared irregular shape. The mass with indistinct margins and spiculated borders were 9 and 6 lesions respectively. ③Seven lesions appeared subtle features, such as architecture distortion (4), indistinct calcifications (2) and focal asymmertric density (1). ④The sensitivity of mammographic detection was 86%(24/28), clinical examination was 64%(18/28), US was 85% (17/20). The sensitivity could be improved to 96%(27/28) by the use of integrated mammography, US, and clinical examination.Conclusion The irregular mass with indistinct or spiculated margins is the predominant mammographic sign in ILC. Atypical features, such as architectural distortion etc are frequently findings. The combination of mammography, ultrasonography and clinical examination is effective to detect ILC.

0.05,respectively. Chi-square test, Fisher′s exact method). Conclusion The mammographic features of mucinous breast carcinoma show differences in pure and mixed types of the tumor. The most common mammographic appearance of pure mucinous carcinomas with high volume of mucin is a mass with microlobulated margins. Pure type of carcinomas with small volume of mucin and mixed type carcinomas have more aggressive imaging characteristics.

Objective To analyze the mammographic features of ductal carcinoma in situ (DCIS) of the breast and the correlation between the mammographic and pathologic findings, and try to provide clinical criteria for selecting patients for appropriate local treatment. Methods A retrospective study was performed to analyze the mammographic features and to correlate the mammographic and pathologic findings in 29 consecutive cases of DCIS including 8 cases of DCIS associated with small invasive foci. Results (1)There were various features in mammograms of DCIS, including cluster microcalcifications (20 cases), ill defined mass with calcifications (3 cases), mass (4 cases), nipple retraction associated with big ductal dilatation (1 case), and normal mammogram (1 case). (2)The shape of the calcification cluster distributed as V shaped in 7 cases, round in 8 cases, irregular in 5 cases, and scattered as many small areas in one quadrant in 3 cases.(3)1 lesion appeared as strip from the deep aspect of the breast to the nipple, and 3 masses were round. (4)The comedo subtype (7/9) and the high grade nuclei of DCIS (6/9), correlating with poor prognosis, were more likely to be accompanied by linear and branching calcification. Noncomedo DCIS (11/12) and low grade nuclei (11/12) were more likely to be associated with granular and punctate calcification when microcalcification were seen on mammogram. There was statistically significant difference between the two groups with P =0.002 and P =0.009 respectively (Chi square test, Fisher′s exact method). Conclusion The mammographic findings of DCIS were characteristic. They were closely associated with the pathologic features that were correlated with the biomolecular findings. To some extent, the choice of treatment could be based on these mammographic findings.

ObjectiveTo analyze the MRI features of aggressive fibromatosis (AF) in order to improve its diagnostic accuracy.Method The clinical files and MRI appearances of 66 AF patients (primary 19 cases,recurrent 47 cases) were reviewed and compared with the postoperative pathological findings.ResultsThe median age of all patients was 31 years( range,11—60 years) with a male-to-female sex ratio of 1 ∶ 3.4.Eighty tumors were discovered.There were 5 superficial fibromatosis and 75 deep fibromatosis in which 2 lesions were intraabdominal,6 lesions in the abdominal wall and 67 lesions extraabdominal.The average long diameter of all lesions was ( 8.7 ± 5.4 ) cm,of superficial lesions ( 5.7 ±2.8) cm,of deep lesions ( 8.9 ± 5.5 ) cm.Of the 80 tumors,79 were displayed as space-occupying intramuscular lesions; 47(58.8％ ) were ovoid or lobulated and 22( 27.5％ ) were infiltrative in shape; 48 (60％) lesions had a well-defined margin,of which 4 formed a pseudocapsule as they enlarged by compressing normal tissue.To compare with the muscle signal intensity on MRI,75 lesions demonstrated isointensity,mild hyperintensity or hypointensity on T1 WI,heterogeneous high intensity on T2 WI,and avid heterogeneous enhancement after contrast administration.There was no necrosis or surrounding edema in all lesions.Tumors destroyed bone in 2 cases.ConclusionAggressive fibromatosis has characteristic features on MRI,and MRI is valuable in diagnosising AF and evaluating the extend of lesion and involvement of adjacent structures.

AIM: To investigate the influence of GM-CSF on human vascular endothelial cells induced to form new blood vessels and the role of VEGF.METHODS: HUVECs were cultured by Matrigel to set up a stable angiogenesis system with the stimulating factors.The rhGM-CSF concentration-dependent and time-dependent effects and the role of VEGF165 were detected.CD34 was measured by immunochemical staining and numbers of vessel formation was calculated under microscopic observation.RESULTS: After treatment with rhGM-CSF at various concentrations and at different time points,the numbers of vessel formation increased in a dose-dependent and time-dependent manner.In the presence of VEGF165,the numbers of vessel formation increased evidently.CONCLUSION: HUVECs were induced to develop tubular structure in vitro cultured with Matrigel.GM-CSF promotes human vascular endothelial cells to form vessel-like structure in vitro in a dose-dependent and time-dependent manner.VEGF also in vitro promotes human vascular endothelial cells to form new vessel-like structure.

Objective To determine the value of dynamic contrast enhanced (DCE?MRI) in predicting treatment response before preoperative chemoradiotherapy in locally advanced rectal cancer. Methods A cohort of consecutive patients with histologically confirmed rectal adenocarcinoma treated with preoperative chemoradiotherapy followed by total mesorectal excision (TME) surgery was enrolled in a prospective, pilot trial. All enrolled patients were examined using DCE?MRI at two time points: 2 to 5 days before neoadjuvant chemoradiation, 1 to 4 days before surgery. The following perfusion parameters (Ktrans, Kep, Ve) were measured for tumor. The patients were classified into pathological complete response (pCR) and non?pCR group according to the pathological results after operation. Those perfusion parameters were compared between the pCR and the non?pCR group and between before and after CRT in pCR and the non?pCR group with the t test. Receiver?operating curves (ROC) were constructed to further investigate the predictive value of Ktrans, Kep, Ve before neoadjuvant chemoradiation and were used to determine a threshold value at which patents with pCR could be distinguished from patients without complete response. Results The final study population consisted of 38 patients. There were 12 patients with a pCR and 26 patients with non?pCR. Before neoadjuvant chemoradiation, the mean tumor Ktrans, Kep and Ve for pCR group were (1.25 ± 0.56)/min, (2.10 ± 1.61)/min and 0.73 ± 0.34, respectively, for non?pCR group they were (0.46 ± 0.39)/min, (1.15 ± 0.77)/min and 0.32±0.12, respectively. All perfusion parameters showed significant difference between those two groups(t values were 3.45,5.67 and 6.23 respectively, all P<0.05). After neoadjuvant chemoradiation, the mean tumor Ktrans, Kep and Ve for pCR group were (0.28 ± 0.13)/min, (0.62 ± 0.27)/min and 0.21 ± 0.13 respectively, for non?pCR group, they were (0.32±0.12)/min, (0.83±0.42)/min and 0.17±0.10, respectively. All perfusion parameters showed no difference between those two groups(P>0.05), as well as the changes before and after neoadjuvant chemoradiation in those groups(P>0.05). ROC analysis for Ktrans pre?treatment revealed that Ktrans had an AUC of 0.837 in predicting pCR. A Ktrans of 0.66/min was emerged as the optimal cut?off for distinguishing pCR from non?pCR and for Ktrans>0.66/min, the sensitivity and specificity for predicting pCR were 75.0% (9/12) and 96.2% (25/26). Kep and Ve showed an AUC of 0.655 and 0.654 in predicting pCR. Conclusions In locally advanced rectal cancer, DCE?MRI can aid in predicting treatment response before preoperative chemoradiotherapy. Ktrans may become a better predictor to classify which patients will benefit from neoadjuvant chemoradiation.

Objective To explore the efficacy of high-resolution MRI in the prediction of tumor complete response after neoadjuvant chemoradiation therapy for T3 rectal cancer.Methods The clinical data of 108 patients with T3 rectal cancer who were admitted to Shanghai Cancer Center of Fudan University from 2010 to 2012 were retrospectively analyzed.The TNM stage of tumor,extramural depth of tumor invasion (mrT3 stage),involvement of mesorectum and rectal fascia,tumor diameter and distance from anal edge to lower edge of tumor were the main items of evaluation using the high-resolution MRI.A total of 108 patients underwent surgical resection of tumor after neoadjuvant chemoradiation therapy.The tumor complete response after neoadjuvant chemoradiation therapy was evaluated by tumor node metastasis (TNM) stage and tumor regression grade (TRG).The categorical data and multivariate analysis were done by the single factor analysis of variance (ANOVA) and Logistic regression analysis.Results The positive response rate of the T3a,T3b and T3c in the patients were 61.5％ (16/26),36.9％ (24/65) and 11.8％ (2/17) after neoadjuvant chemoradiation therapy,respectively.The mrT3,mrN and tumor diameter were the potential factors affecting response of neoadjuvant chemoradiation therapy by the univariate analysis of pathological restaging (x2 =50.474,30.985,8.318,P ＜ 0.05).The mrT3 was an independent risk factor affecting response of neoadjuvant chemoradiation therapy by the multivariate analysis of pathological restaging (OR =4.473,95 ％ confidence interval:2.003-9.991,P ＜ 0.05).There was no significant difference between the mrT3 stage,N stage,involvement of mesorectum and rectal fascia,tumor diameter and distance from anal edge to lower edge of tumor before therapy and the response after neoadjuvant chemoradiation therapy based on the tumor regression grade(TRG) (x2 =6.264,6.159,2.949,2.189,6.335,P ＞ 0.05).Conclusion The mrT3 in patients undergoing high-resolution MRI before neoadjuvant chemoradiation therapy could predict the tumor complete response after neoadjuvant chemoradiation therapy for T3 rectal cancer.

0.05). A Kappa value was 0.435 for overall final assessment. There were moderate agreement in category Ⅰ and Ⅴ (K=0.511 and 0.671), and slight agreement in category Ⅱ (0.373), Ⅲ (0.179), and Ⅳ (0.276). The positive value of different categories assessed by two groups were as follows: category Ⅰ (12.5% vs 22.5%), Ⅱ(3.7% vs 12.5%), Ⅲ(20.83% vs 19.61%), Ⅳ(68.63% vs 60.34%), and Ⅴ(100% vs 89.91%). Twenty three lesions(7.49%)were misdiagnosed by both groups. Conclusion BI-RADS is useful in mammographic diagnoses of breast lesion with symptoms. The misdiagnoses can be reduced combined with the clinical examination and reasonable additional imaging evaluation. For symptomatic breast lesions, the assessing threshold of category Ⅱ or Ⅲ should be improved, and category Ⅳ should be reduced. But BI-RADS has its limitation. We propose that corresponded classification should be drawn according to every application’s condition.

OBJECTIVETo investigate the occurrence and associated factors for posttraumatic stress disorder (PTSD) in rescuers and firefighters.

METHODSThe PTSD of 264 rescuers and firefighters who had participated in rescue was evaluated using the self-designed fireman general situation questionnaire and PTSD Checklist-Civilian Version (PCL-C). The factors associated with the occurrence of PTSD were also analyzed.

RESULTSThe incidence rate of PTSD in the subjects was 8.3%. The PTSD rate of special service corps (12%) was significantly higher than that of other subjects (P<0.05). The incidence of PTSD was highest in the rescuers and firefighters above the third rank, but without significant differences (P>0.05). The PTSD rate of married rescuers and firefighters was significantly higher than that of unmarried subjects (P<0.05). The PTSD rate of subjects addicted to drinking was significantly higher than that of non-drinking subjects (P<0.05). Subjects with more frequent attendance were more susceptible to PTSD compared with those with less attendance.

CONCLUSIONThe incidence rate of PTSD is high in rescuers and firefighters who have attended rescues. It is necessary to implement both short-term and long-term counseling programs for stress management and intervention in order to reduce the psychological trauma after rescue and improve the mental health of rescuers and firefighters.

Objective To assess the value of contrast enhanced mammography (CESM) in the detection of breast cancer. Methods A total of 145 patients who were suspected of breast abnormalities by clinical examination or ultrasound were prospectively collected. All patients underwent bilateral breast CESM and MRI examinations. Breast CESM and MRI examination were completed in the same week. The pathological specimens were analyzed and the maximum diameters of pathological lesions were measured. The lesions were observed on low energy(LE), CESM and MRI images, and then the maximum diameters of lesions on the above images were measured. Using pathology results as the gold standard, the diagnostic efficacy of LE, CESM and MRI were analyzed by ROC curve, and Z test was used to compare the areas under the ROC curves among different imaging methods. Bland-Altman method was used to analyze the consistency of the maximum diameters of the lesions obtained with different imaging methods. Results One hundred and fifty three lesions were found in 145 patients, in which 36 were benign and 117 were malignant. The LE, CESM and MRI showed 140, 151 and 149 lesions respectively, and the qualitative diagnostic errors were 25, 8 and 11, respectively. The areas under ROC curves of LE, CESM and MRI were 0.87, 0.96 and 0.97 respectively. There was significant difference of the area under ROC curve between CESM and LE, so did the MRI and LE (P<0.05), but there was not significant difference between CESM and MRI (P=0.51). The sensitivity, specificity and accuracy in the diagnosis of malignant breast lesions were 88.98%, 65.71% and 83.66% for LE, while they were 95.80%, 91.18% and 94.77% for CESM, 94.17%, 87.88%and 92.81%for MRI. The average difference of diameters between LE, CESM, MRI and pathologic size was-1.7, 1.1 and 0.3 mm, respectively, with 95%consistency interval range of-18.6 to 15.1,-9.8 to 12.1,-10.6 to 11.2 mm, respectively. There was best consistency between the pathological size and the size on MRI. Conclusion CESM can significantly improve the diagnostic efficacy of breast lesions, which is comparable with MRI.