Objective To probe the value of gastroduodenal water window in ultrasonic diagnosis of ampulla carcinoma. Methods Sixty-three patients were divided into the conventional ultrasonic examination group(including 35 patients) and the gastroduodenal water window ultrasonic examination group(including 28 patients), all being detected before and after drinking. The results of ultrasonic examination of the groups were divided into Ⅰ, Ⅱ and Ⅲ grades. The diagnostic accurate rates and the rates of Ⅰ, Ⅱ and Ⅲ grades of the ultrasonic examination of the groups were compared respectively. Results The diagnostic accurate rate of the gastroduodenal water window group after drinking was 96.43%(27/28), which was markedly higher than that of the same group before drinking and the conventional group which were 60.71%(17/28) and 54.29%(19/35) respectively. The rates of Ⅰ, Ⅱ and Ⅲ grades of the ultrasonic examination of the gastroduodenal water window group after drinking were also markedly higher than those of the same group before drinking and the conventional group respectively (all P 0.05). Conclusions The gastroduodenal water window ultrasonic examination can effectively raise the ultrasonic diagnostic rate of ampulla carcinoma. It is of significance in the clinic.

Objective To investigate the value of ultrasonography in diagnosis and preoperative TNM staging for neuroendocrine breast cancer(NEBC).Methods The ultrasonic characteristics of 12 NEBC and 104 invasive ductal carcinoma(IDC) confirmed by pathology,as well as the metastatic lymph nodes were analyzed retrospectively.The TNM-staging for NEBC by preoperative ultrasonography was evaluated according to pathology.And the relation between lesions size and Ki-67 was then analyzad.Results NEBC lesions mainly showed solid and heterogeneous hypoechoic(66.67％),irregular shape(66.67％),clear border (58.33 ％),posterior enhancement(58.33 ％) and internal blood flow(grade 0-Ⅰ) (66.67 ％).The detection rate of unclear border,irregular edge,hyperechoic halos and uneven internal echo was lower than IDC(P ＜ 0.05).Meanwhile,NEBC had a lower detection rate of calcification and internal blood flow(grade Ⅱ-Ⅲ)than IDC (P ＞0.05).And the detection rate of more round or oval lesions were higher in NEBC than that in IDC (P =0.001).According to pathology,the ultrasonic coincidence rate for T staging of NEBC and pathology was 75％,and for T1-staging was 100％,for T2-staging was 80％.The sensitivity,specificity,positive predictive value and negative predictive value of ultrasonic diagnosis on lymph node metastases was 66.67％,88.89％,66.67％ and 88.89％,respectively.There was a positive correlation between focal maximum diameter with Ki-67 (r=0.026,P=0.004).Conclusions It shows certain value of ultrasonography in diagnosis and preoperative TNM staging for NEBC.

Objective To probe the characteristics of the ultrasonography of the intrahepatic duct cystic tumor(IDCT).Methods The ultrasonography of 12 patients with IDCT was analysed.The results were compared with the operation and pathology.Two of them were intraductal papillary adenomas,six were papillary adenocarcinomas,two were biliary cystadenomas and two were biliary cystadenocarcinomas.Results The ultrasonic diagnostic rate was 75%(9/12).The bile ducts of 10 cases(83%) were cystically dilated.Seven cases(58%) with thick walls of bile ducts were all malignant.Six tumors(50%) with intraluminal papillate echoes could be malignant or benign.The tremellose echoes were detected in 7 cases(58%) and the common bile ducts of six cases were obstructed by the tremellose substance.Conclusions It is the important diagnostic basis of IDCT that the bile ducts in some liver lobal or segment are dilated without reasons,with the thick bile duct wall and the poor ultrasound penetration,especially when the bile ducts are full of tremellose substance and the papillomas are detected in the ducts.It is of significance in the clinic to raise the early diagnostic rate of IDCT by ultrasound.

Purpose To explore ultrasonic characteristics of complex fibroadenoma (CF) of breast and its differential diagnosis from invasive ductal carcinoma (IDC).Materials and Methods Sixty-one patients with CF and 81 patients with IDC from January 2010 to February 2016 in the Affiliated Union Hospital of Fujian Medical University were enrolled,and the CF and IDC were confirmed by pathology after operation.The preoperative sonographic findings of CF and IDC were retrospectively analyzed and compared.Results Fifty-nine cases with CF were detected by ultrasonography in 61 cases.Ultrasonic findings of 59 cases of CF showed as follows:79.7％ (47/59) of the CF cases with an aspect ratio ＜0.7;79.7％ (47/59) with blood flow signal of 0 to 1 level;72.9％ (43/59) with liquid dark area,including 67.8％ (40/59) with round or oval cystic fluid area showing local sievelike or diffused distribution;72.9％ (43/59) with irregular shape;61.0％ (36/59) with obscure boundary;61.0％ (36/59) with the largest diameter of tumor ＜2 cm;59.3％ (35/59) with calcifications,including 33.9％ (20/59) with coarse calcification,25.4％ (15/59) with microcalcification and 85.7％ (30/35) with distribution of calcified lesions along the linear high echo zone;54.2％ (32/59) with echo heterogenicity showing linear high echo and high echo in the middle and low echo.There were significant differences in the detection rates of internal regular fluid area,internal linear high echo or high echo area,and alcification distribution along the linear high echo between CF and IDC lesions (all P＜0.01).Compared with IDC,there were higher rates in CF for detecting lesions of largest diameter of tumor ＜2 cm,more regular shape,more clear border,poorer blood flow signal (P＜0.05),but there were lower rates in CF for detecting axillary lymph node enlargement,lesions with edge or spiculation and hyperechoic halo (P＜0.01).Conclusion Color Doppler ultrasonography is of great value in the diagnosis of CF and its differential diagnosis from IDC.

Objective To explore the atypical ultrasonic appearances of breast fibroadenoma and analyze the cause of mis diagnosis.Methods A total of 493 lesions in 485 patients of breast fibroadenoma detected by ultrasound examination andconfirmed by pathology were retrospectively analyzed.Atypical appearances were analyzed and misdiagnosis rate were cal-culated.Statistical methods were taken to compare the misdiagnosis rates in lesions with various atypical appearances andthose with none or single atypical appearance.Misdiagnosis rates in lesions with different sizes and pathological types wereanalyzed statically.Then misdiagnosing causes were analyzed.Results A total of 404 lesions were diagnosed correctly,in-cluding 99 lesions with atypical appearances,and the other 89 lesions were misdiagnosed,which showed atypical appear-ances.The misdiagnosis rate of lesions with ≥2 atypical features was higher than that with none or single atypical feature(x2 =256.40,P＜ 0.05).Large lesions (maximum diameter＞ 3 am) showed higher misdiagnosis rates than small ones(maximum diameter ≤3 cm,x2=6.73,P＜0.05),and complex fibroadenoma lesions also showed higher misdiagnosisrate than simple ones (x2 =188.01,P＜0.05).Conclusion The lesions with various atypical appearances,large size andcomplex fibroadenoma in pathology are easy to be misdiagnosed.

Objective To investigate the tumor chemical ablation and analgesic effects of compound lauromacrogol,and to explore a new method for ultrasound-guided tumor ablation.Methods 18 VX2 tumorbearing rabbits were randomly divided into saline group,ethanol group and compound lauromacrogol group,and the medicine was intratumoral injected guided by ultrasonography.After 4 times treatment,tumor contrast-enhanced ultrasonography,tumor growth inhibition rate and tumor tissue pathology were performed to evaluate the antitumor effects.The analgesic effect was evaluated using the pain model induced by formaldehyde test.Results Ultrasound-guided intratumoral injection of compound lauromacrogol showed significant antitumor effects with a tumor growth inhibition rate of 63.3 ％,which was higher than that of ethanol group.No apparent enhancement was found under contrast-enhanced ultrasonography,and pathology results confirmed wide necrosis.In saline,ethanol and compound lauromacrogol groups,the average accumulated points were 62.25 ± 9.79,21.00 ± 9.13 and 9.87 ± 3.10,respectively by formaldehyde test.Conclusions Ultrasound-guided chemical ablation using compound lauromacrogol showed complete antitumor and strong analgesic effects,which would be a new method for tumor ablation.

Objective To probe the ultrasonic diagnostic value in splenic lyrnphoma and classify the sonographic appearance of splenic lymphoma.Methods The clinical datas and ultrasonic appearances of 31 patients with splenic lymphoma were compared with the pathology.The ultrasonic images were classified.Results Among the 31cases,3 cases with splenic lymphoma and 5 cases with splenic infiltration of splenic lymphoma were correctly diagnosed by ultrasound.The diagnostic correct rate was 25.8%.The sonographic appearances of 31 cases were divided into four types.Homogeneous splenomegaly type(12.9%,4/31),showed homogeneous splenomegaly without mass in the spleen.Multiple nodule type(16.2%,5/31),showed multiple hypoechoic nodules diffused in the spleen.Solitary mass type(29.0%,9/31),showed solitary mass larger than 3 cm with or without necrosis in the spleen.Comples type(41.9%,13/31),showed splenomegaly,hypoechoic masses and nodulars of different sizes in the spleen.Conclusions The sonographic diagnosis of splenic lymphoma is valuable to the clinic.The ultrasound-guided splenic biopsy could be carry out if necessary.

Objective To investigate ultrasonic findings of pure invasive micropapillary carcinoma (PIMPC) of breast. Methods A total of 18 patients with surgically confirmed PIMPC and 40 patients with surgically confirmed invasive ductal carcinoma (IDC) treated between January 2010 and August 2015 in Affiliated Union Hospital of Fujian Medical University, who had undergone preoperative ultrasound examination, were included in the study. To compared with the postoperative pathological examination, the value of ultrasonography in the diagnosis of axillary lymph node metastasis was discussed.Ultrasound findings of PIMPC and pathological results were compared. Results Ultrasound analysis of PIMPC masses identified predominantly hypoechoic lesions and irregular shape 100% (18/18), obscure lesion boundaries 88.9% (16/18), spiculated or angular margins 83.3% (15/18), combined microcalcifications 83.3% (15/18), with posterior acoustic enhancement or normal 88.9% (16/18), dcrab claws changes 77.7% (14/18),witout hyperechoic halo72.2% (13/18) and with 0- Ⅰ grade flow signals 55.6% (10/18). Compared to the IDC, the PIMPC had lower proportions in long speculation, hyperechoic halo, aspect ratio ≥ 0.7, posterior echo attenuation, Ⅱ- Ⅲ grade blood flow signals (P < 0.05), while their lesions in the maximal tumor size,shape, boundary, edge bur, microcalcification has no significance (P>0.05). The rate of lymph node metastasis of PIMPC was 72.2% (13/18), which was significantly higher than that of IDC 45.0% (18/40) (t=3.697,P=0.05). 13 cases were pathologically confirmed lymph nodes metastasis in 18 cases, and among them, the ultrasound indicated abnormal 46.2% (6/13), and showed abnormal cortex and medulla structure 30.8% (4/13), eccentric lymph door 30.8% (4/13), poor blood flow signals 38.5% (5/13). The sensitivity, specificity,positive predictive value, negative predictive value and accuracy of PIMPC lymph node metastasis by preoperative ultrasound were respectively 46.2%, 60.0%, 75.0%, 30.0%, 50.0%. Ultrasound performance of PIMPC has a certain relationship with its special pathological characteristics. Sonography findings were compared with pathological results: Microscopically, PIMPC cell arranged as pseudo-papillary or tubuloalveolar structures floating in empty spaces; PIMPC with 0-Ⅰ grade flow signals were seen that the small amount of new blood vessels of the tumor were mainly found in the pellucid zone around the cell clusters under the microscope, while IDC with Ⅱ - Ⅲ grade blood flow signals were found that more regenerated blood vessels were distributed in the collagen fibers. PIMPC witout hyperechoic halo were noticed that under the microscope, there were no fibrous tissue clusters in the edge of the tumor, meanwhile, IDC with hyperechoic halo were discovered that fibrous tissue was seen at the edge of the mass of the lens. Conclusions Ultrasound performance of PIMPC has a close relationship with its special pathological characteristics. To be familiar with ultrasound characteristic of PIMPC is significant for improving its ultrasound detection rate.

ObjectiveTo probe the value of transrectum ultrasound (TRUS) in evaluating the effect of new adjuvant therapy (NAT) in treating middle-low level rectal cancer (MLLRC).MethodsTRUS was used to examine 82 cases of MLLRC before and after NAT.All cases were pathologically confirmed.The results of TRUS before and after NAT were compared.ResultsThe diagnostic rate of TRUS in MLLRC was 97.6％(80/82).The up to down range and thickness of foci of 80 cases which were detected by TRUS before NAT showed different degree diminution after NAT( P ＜0.05).The number of lymph node around rectum decreased obviously ( P ＜0.05).Only the lymph nodes of 5 cases of all lymph nodes detected by TRUS before and after NAT showed dot flow signal.ConclusionsTRUS can clearly showed the MLLRC foci,internal flow signal and lymph nodes around rectum.This is of important value in evaluating the effect of NAT,choosing the therapeutic schedule and avoiding over therapy.

Objective To probe the characteristic ultrasonic appearances of hepatic adenoma.Methods The appearances of color Doppler flow imaging(CDFI)and contrast-enhanced ultrasound(CEUS)in 10 cases of hepatic adenoma were analyzed.Results Rich blood flow signals were found in all the hepatic adenoma lesions on CDFI.Large blood flow signals were detected in the periphery of all tumors.On CEUS,peritumoral feeding vessels displayed in early arterial phase and homogeneous enhancement in arterial phase was observed in all the 4 cases.The tumor capsule was enhanced continuously in all cases.One case with isoechoic enhancement in delayed phase was found the contrast agent wash out in portal phase.The other 3 cases showed the‘fast-in and slow-out'appearance.which was iso-echoic enhancement in portal phase and slightly hyperechoic enhancement in delayed phase.Conclusions The rich blood flow signals,early displaying of peritumoral feeding vessels,homogeneous enhancement in the arterial phase and continuously enhanced tumor capsule on CEUS are the distinctive appearances of hepatic adenoma.