Purpose To assess the feasibility of nuclear score combined with ultrasound features on indeterminate thyroid nodules in fine needle aspiration cytological diagnosis.Methods A consecutive cohort of 119 thyroid fine-needle aspiration(FNA)specimens with indeterminate diagnosis(TBSRTC cate-gory Ⅲ-Ⅴ)and available histopathologic follow-up was evalua-ted.Original sonographic images and cytological slides of each nodule were reviewed by two experienced sonographers and two experienced cytopathologists respectively,and evaluated jointly to obtain consensus.The identification of the optimal cut-off points of simplified nuclear score and ultrasound features score for the diagnosis of malignancy or low-risk neoplasm were evalu-ated using the receiver operating characteristic(ROC)curves and the assessment of the area under the ROC curve(AUC).The specificity,sensitivity,positive predictive value(PPV)and negative predictive value(NPV)of nuclear score and US score were evaluated from crosstabs based on Cut-off points and signif-icance were calculated.The diagnostic accuracy of simplified nuclear score combined with ultrasound features was estimated by Logistic regression and ROC curve analysis.Results Nucle-ar grooves,intra-nuclear inclusions and chromatin clearing were more common in malignancy/low-risk neoplasms(P = 0.001,0.013 and 0.001 respectively).A Cut-off point of≥2 for the simplified nuclear score was sensitive for defining malignancy/low-risk neoplasm,and the sensitivity was 99.1%.Nodule height greater than width,absent halo sign,irregular margin and absent intranodular vascularization were more common in malig-nancy/low-risk neoplasms(P = 0.003,0.007,0.003 and 0.004 respectively).When the Cut-off point was set as≥5,the PPV and specificity for defining malignancy/low-risk neoplasm were 95.9%and 78.6%respectively.ROC curve analysis showed that the diagnostic accuracy of nuclear score combined with US score(0.873,95%CI = 0.777-0.970)was higher than that of nuclear score alone(0.817,95%CI = 0.687-0.948,P =0.092)or US score alone(0.758,95%CI 0.637-0.879,P =0.047).But no significant difference was detec-ted between the combined score and the nuclear score.Conclu-sion The addition of simplified nuclear score and US score to FNA cytology can increase the diagnostic accuracy of cytology in indeterminate categories.

Objective: To investigate the diagnostic value of ultrasonography.in elderly patients with gastric tumors. Methods: A total of 42 elderly patients with gastric tumors confirmed by surgery pathology underwent oral contrast-enhanced ultrasonography and electronic gastroscopy.The diagnostic effect of oral contrast-enhanced ultrasonography and electronic gastroscopy were compared based on the gold standard of surgical pathology. Results: Of the 42 elderly patients with gastric tumors, 40 patients were diagnosed by oral contrast-enhanced ultrasonography and the surgical pathology(40/42, 95.2%), with Kappa value of 0.812.And 38 cases were diagnosed by electronic gastroscopy and the surgical pathology(38/42, 90.5%), with Kappa value of 0.718(P<0.05). Based on gold standard of surgical pathology results, the accuracies of T1, T2, T3 and T4 stage by oral contrast-enhanced ultrasonography were 95.0%(38/40), 95.0%(38/40), 100.0%(40/40)and 100.0%(40/40), respectively.The sensitivity and specificity of T3 and T4 stage for oral contrast-enhanced ultrasonography reached to 100.0%.The diagnostic accuracies of N0, N1-N3, M0 and M1 by oral contrast-enhanced ultrasonography were 95.0%(38/40), 95.0%(38/40), 100.0%(40/40)and 100.0%(40/40). Conclusions Oral contrast-enhanced ultrasonography is a simple, painless and non-invasive method for the diagnosis of gastric tumors in the elderly.And its qualitative coincidence rate of the tumors diagnosis is similar to that of gastroscopy.So it can be used as the first choice for the examination of gastric tumors in the elderly.Oral contrast-enhanced ultrasonography has a high diagnostic accuracy on TNM staging of gastric tumor.When combined with electronic gastroscopy, it may provide a more reliable basis for the choice of evaluation of treatment and prognosis in elderly patients with gastric tumor.

Objective To evaluate the value of endorectal ultrasound(ERUS)combined with real-time elastography in the staging of advanced rectal cancer in elderly patients.Methods A total of 50 patients with advanced rectal cancer underwent endorectal ultrasound and real-time tissue elastography imaging at our hospital from Jun.2014 to Oct.2015.Their staging results were compared with postoperative pathology.Results The accuracy,sensitivity and specificity of ERUS in the staging of advanced rectal cancer(T3)were 90％ (45/50),93.5％ (43/46)and 50％ (2/4),respectively.The accuracy,sensitivity and specificity of real-time elastography in the staging of advanced rectal cancer(T3)were 84％(42/50),89.1％(41/46)and 25％(1/4),respectively.With the combination of the two techniques,the accuracy,sensitivity and specificity in the staging of advanced recta[cancer(T3)were 96％ (48/50),97.8％ (45/46)and 75％ (3/4),respectively.There was no significant difference in accuracy and sensitivity(x2 ＝4.000 and 3.100,P＝0.373 and 0.542)between the three approaches.Kappa values between each of the three approaches and surgical pathology were 0.531,0.252 and 0.728,respectively.Conclusions Real-time tissue elastography in the diagnosis and staging of advanced rectal cancer can be enhanced when used in combination with endorectal ultrasound.

Objective To evaluate the roles of cytomorphology and immunohistochemistry in distinguishing between basaloid squamous cell carcinoma ( BSC) and small cell carcinoma ( SCC) of lung. Methods The direct smears and/or liquid-based cytology preparation ( ThinPrep) of bronchial brushing/washing and fine-needle aspiration ( FNA ) specimens from 17 cases of biopsy-proven BSC of lung were retrospectively reviewed and compared with those from 17 cases of SCC.The cytomorphologic parameters analyzed included proportion of cohesive cell clusters, cell palisades/rosettes, adenoid cystic features, crushing artifact, nuclear maximum diameter, nuclear molding, scantiness of cytoplasm,“salt-and-pepper”nuclei, distinct nucleoli, spindly configuration, individual cell keratinization, necrosis, hyaline material, apoptosis and mitotic activity.Immunocytochemical/immunohistochemical study of 25 cases was performed. Ten FNA samples of basaloid squamous cell carcinoma were also analyzed for epidermal growth factor receptor mutations in exons 18, 19, 20 and 21 using amplification refractory mutation system.Results Most of the 17 BSC cases ( 15/17 ) showed a predominance of tightly cohesive tumor cell clusters.The proportion of isolated tumor cells was high in SCC ( more than 60% in 14 cases ) .The nuclear maximum diameter of BSC was slightly larger than that of SCC (9 to 11μm in BSC versus 7 to 9μm in SCC).“Salt-in-pepper” nuclei, nuclear molding and crushing artifact were detected in all SCC cases (15/17, 17/17 and 14/17, respectively).These features were only occasionally found in BSC group.Nucleoli were present in BSC and rarely ( 2/17 ) in SCC. Only 9 of 17 BSC cases showed individual cell keratinization. The differences in the above-mentioned cytomorphologic features were statistically significance (P<0.05).The results of immunohistochemistry performed on the cell block sections and immunocytochemistry performed on the ThinPrep slides were identical to that performed on the corresponding biopsy specimens.The tumor cells in BSC were consistently positive for CK5, p40 and p63.TTF1, chromogranin A, synaptophysin and CD56 were positive in most of SCC.One of SCC cases showed focal PAX5 expression.No EGFR mutations were detected in the 10 BSC cases studied.Conclusions Selected cytomorphologic features, including presence of cohesive cell clusters, larger nuclear size, distinct nucleoli, lack of crushing artifact, absence of nuclear molding and presence of individual cell keratinization, are helpful in diagnosing BSC on cytology specimens. Immunohistochemistry using a panel of TTF1, CK5, p40/p63 and chromogranin A/synaptophysin/CD56 provides further clues in differential diagnosis between BSC and SCC.EGFR mutation study is often negative in lung BSC.

Objective To explore the applicative value of contrast enhanced ultrasound (CEUS) through rectumin the T-staging of rectal cancer.Methods 24 cases with rectal cancer were examined preoperatively by endorectal ultrasound (ERUS) and CEUS during May 2012 to November 2013 in our hospital.The characteristics of contrast enhanced ultrasound imaging in early and late phase of the rectal cancers were studied,and the imaging distribution and enhancement mode were observed.The preoperative staging diagnosis was conducted by consulting T staging criteria.The diagnostic results were compared with the postoperative pathologic diagnosis.Results The contrast enhanced time in rectal cancer began at 14-35s.The early tumor showed uneven nodular,ribbon or ring in high enhancement.At the advanced late,angiographic tumor showed homogeneous enhancement and continued to be observed during the whole time.Normal rectal wall ultrasonography showed spotty low enhancement or no enhancement.The overall accuracy of ERUS in T-staging was 66.7％ (16/24) and the overall accuracy of CEUS was 83.3％ (20/24) respectively.There was a significant difference in the overall accuracy between ERUS and CEUS (P＝0.018).The sensitivity,accuracy and positive predictive value of CEUS were 100.0％ (2/2),100.0％ (2/2),100.0％ (2/2) inT1 stage,83.3％ (10/12),83.3％ (10/12),100.0％ (10/10) in T2 stage,100.0％ (8/8),88.9％ (8/9),88.9％(8/9) in T3 stage,and 100.0％ (2/2),100.0％(2/2),100.0％ (2/2) in T4 stage,respectively.Conclusions As compared toroutine transrectal ultrasound,transrectal contrast enhanced ultrasound imaging on rectal cancer shows the typical sonographic characteristic imaging on microvascular focus size and borders,on characteristic infiltration zone.Therefore,contrast enhanced ultrasound improves the diagnostic accuracy of preoperative T-staging in rectal cancer surgery.

Objective To analyze ultrasonic elastography (UE) score of breast carcinoma and to explore the correlation between UE and pathological collagen content in stroma.Methods UE scores of 60 breast carcinoma before operation were retrospectively studied.The correlation between the UE scores and the pathological collagen content grading in stroma after operation were analyzed.Results UE score of 60 breast carcinoma were (4.07 ± 0.78) scores,the diagnosis coincidence rate of UE score was 80.0％ (48/60).Positive correlation existed between UE score and the pathological collagen content grading in stroma of breast carcinoma (r =0.440,P =0.015).Conclusion UE score of breast carcinoma is related to the pathological collagen content in stroma,and it can evaluate collagen content in stroma of breast masses in some degree.

To explore the value of local anesthesia under ultrasonic guidance for establishing puncture path of superficial tumor.A total of 144 patients with superficial tumor received local pre-puncture anesthesia under ultrasonic guidance so that all lesions were targeted.Transient aggregation of narcotics was applied for raised (n =12) or superficial (n =15) skin lesions.The clarity of scanning acoustic window was enhanced,the puncture distance of tumor broadened and the mass of axial changed to obtain a longer lymph node cortex.The damage of blood vessels occurred easily due to tumor closeness to large blood vessel or shortened puncture path in 17 cases.Anesthetic drug was injected between tumor and blood vessels to enlarge the thickness for visualizing the puncture needle tract clearly.And puncture was accomplished under the guidance of color Doppler.Therefore a puncture path can be created effectively with local anesthesia by ultrasonic guidance.

The aim of this study is to evaluate the application of untrasound-guided local anesthesia in alleviation of pain after percutaneous liver biopsy.The clinical results of 1417 cases of percutuneous liver biopsy were retrospectively analyzed.In 896 patients under ultrasound-guided local anesthesia 51 felt pain after liver biopsy,while in 521 patients whose local anesthesia without ultrasound guidance,143 felt pain (5.7% vs.27.4%,X~2=118.63,P＜0.01).The results indicate ultrasound-guided local anesthesia can effectively alleviate pain after percutaneous liver biopsy.

Objective To study changes in the expression levels of OX-62, OX-6 and CD86 of mononuclear cells and the related chemotatic factor macrophage inflammatory protein-1α (MIP-1α) in the livers of rats with Walker-256 tumors treated with radiofrequency ablation (RFA) and to elucidate the influence of RFA on differentiation and migration of liver dendritic cells(DCs).Methods Walker-256 liver tumors were induced in 60 SpragueDawley rats by implanting tumor particles. These rats were randomly divided equally into three groups from which liver tissue around the local area of the tumor was sampled at 7 d and 14 d after RFA. The mononuclear liver cells were separated with Ficoll density gradient centrifugation. The expression levels of OX-62, OX-6 and CD86 in the mononuclear cells were analyzed with flow cytometry. The expression level of MIP-1α in the liver tissue was detected by enzyme-linked immunosorbent assay (ELISA). Results The average expression of OX-6 in the control rats was 15.29 ±4.59% and those 7 d and 14 d after RFA were 34.20±11.62% and 39.18±9.14% respectively. The difference between the two RFA groups and the control group was statistically significant. The average expression rate of OX-62 in the control rats was 18.91±4.58% and those 7 d and 14 d after RFA were 24.49±4.45% and 22.77 ± 3.50% respectively. The difference between the 7 d group and the control group was significant. The average expression rate of CD86 in the control rats was 66.29±17.69% and those 7 d and 14 d after RFA were 55.29±10.69% and 55.93±12.64% respectively. These differences between both RFA groups and the controls group were not significant. The average expression level of MIP-1 α around the tumors was 232.92±54.58 pg/ml in the controls and 499.38±15.14 pg/ml and 495.90±9.94 pg/ml 7d and 14 d after RFA respectively. These differences from the controls were both statistically significant. Conclusion The expression of MIP-1α around the tumors was elevated after RFA, which could promote the migration of DCs. The changes in the expression of OX-62, OX-6 and CD86 also could reflect increased DC differentiation, which could improve local antigen-presenting capacity to a certain extent and recovery of host anti-tumor immune response.

BACKROUND:Previous studies have confirmed that radiofrequency ablation(RFA)has not only efficiently killed tumor cells,but also improved immune suppression of organism.Antigen presenting cells play an important role during anti-tumor immune reaction.Dendritic cells are most powerful antigen presenting cells.OBJECTIVE:To study the influence of RFA on OX-62,OX-6 and CD86 expression of rat peripheral blood mononuclear cells.DESIGN,TIME AND SETTING:The randomized controlled animal observation was performed at the School of Oncology of Peking University from June 2005 to March 2006.MATERIALS:A total of 12 Sprague Dawley rats were equally and randomly assigned into control and 1 -week radiofrequency groups.METHODS:2 mL peripheral blood was extracted from rats of the control group following rats were sacrificed.The left lobe of rat liver was exposed,inserted with acicular electrodes at tilted position.The acicular electrodes were spread out.The action time was 4 minutes.After RFA,the rats were given anti-infective therapy.2 mL peripheral blood was taken out after they were put to death 1 week after RFA.MAIN OUTCOME MEASURES:The following parameters were measured:pathomorphological observation on the liver of normal rats after RFA;OX-62,OX-6 and CD86 expression of peripheral blood mononuclear cells before and after RFA.RESULTS:Pathologyical examination after RFA showed the characteristic that coagulation necrosis and cellular degeneration and granulation tissue forming appeared from target center to peripheral of the target.Positive expression rate of OX-62 in rat peripheral blood in the 1-week radiofrequency group[(0.70±0.16)%]was significantly higher than in the control group [(0.34±0.08)%,P ＜0.05].No significant difference in positive expression rate of OX-6 and CD86 in the peripheral blood mononuclear cells between both groups(P＞0.05).CONCLUSION:RFA can promote the increased number of precursor Dendritic cells in rat peripheral blood,which may be contributed to improve the ability to angtigen presentation during immune response.Dai Wei-de,Doctor,Associate chief physician,Department of Ultrasound,Beijing Hospital of Ministry of Public Health,Beijing 100730,China dai.weide@126.com