|
1
|
Venkatayogi N, Sharma A, Ambinder EB, Myers KS, Oluyemi ET, Mullen LA, Bell MAL. Comparative Assessment of Real-Time and Offline Short-Lag Spatial Coherence Imaging of Ultrasound Breast Masses. ULTRASOUND IN MEDICINE & BIOLOGY 2025; 51:941-950. [PMID: 40074593 PMCID: PMC12010921 DOI: 10.1016/j.ultrasmedbio.2025.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 01/15/2025] [Accepted: 01/24/2025] [Indexed: 03/14/2025]
Abstract
OBJECTIVE To perform the first known investigation of differences between real-time and offline B-mode and short-lag spatial coherence (SLSC) images when evaluating fluid or solid content in 60 hypoechoic breast masses. METHODS Real-time and retrospective (i.e., offline) reader studies were conducted with three board-certified breast radiologists, followed by objective, reader-independent discrimination using generalized contrast-to-noise ratio (gCNR). RESULTS The content of 12 fluid, solid and mixed (i.e., containing fluid and solid components) masses were uncertain when reading real-time B-mode images. With real-time and offline SLSC images, 15 and 5, respectively, aggregated solid and mixed masses (and no fluid masses) were uncertain. Therefore, with real-time SLSC imaging, uncertainty about solid masses increased relative to offline SLSC imaging, while uncertainty about fluid masses decreased relative to real-time B-mode imaging. When assessing real-time SLSC reader results, 100% (11/11) of solid masses with uncertain content were correctly classified with a gCNR<0.73 threshold applied to real-time SLSC images. The areas under receiver operator characteristic curves characterizing gCNR as an objective metric to discriminate complicated cysts from solid masses were 0.963 and 0.998 with real-time and offline SLSC images, respectively, which are both considered excellent for diagnostic testing. CONCLUSION Results are promising to support real-time SLSC imaging and gCNR application to real-time SLSC images to enhance sensitivity and specificity, reduce reader variability, and mitigate uncertainty about fluid or solid content, particularly when distinguishing complicated cysts (which are benign) from hypoechoic solid masses (which could be cancerous).
Collapse
Affiliation(s)
- Nethra Venkatayogi
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Arunima Sharma
- Department of Electrical & Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Emily B Ambinder
- Department of Radiology & Radiological Science, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Kelly S Myers
- Department of Radiology & Radiological Science, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Eniola T Oluyemi
- Department of Radiology & Radiological Science, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Lisa A Mullen
- Department of Radiology & Radiological Science, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Muyinatu A Lediju Bell
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA; Department of Electrical & Computer Engineering, Johns Hopkins University, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
|
2
|
Parodi I, Palamà MEF, Di Lisa D, Pastorino L, Lagazzo A, Falleroni F, Aiello M, Fato MM, Scaglione S. Core-Shell Hydrogels with Tunable Stiffness for Breast Cancer Tissue Modelling in an Organ-on-Chip System. Gels 2025; 11:356. [PMID: 40422376 DOI: 10.3390/gels11050356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2025] [Revised: 05/06/2025] [Accepted: 05/07/2025] [Indexed: 05/28/2025] Open
Abstract
Breast cancer remains the most common malignancy in women, yet, many patients fail to achieve full remission despite significant advancements. This is largely due to tumour heterogeneity and the limitations of current experimental models in accurately replicating the complexity of in vivo tumour environment. In this study, we present a compartmentalised alginate hydrogel platform as an innovative in vitro tool for three-dimensional breast cancer cell culture. To mimic the heterogeneity of tumour tissues, we developed a core-shell structure (3.5% alginate core and 2% alginate shell) that mimic the stiffer, denser internal tumour matrix. The human triple-negative breast cancer cell line (MDA-MB-231) was embedded in core-shell alginate gels to assess viability, proliferation and hypoxic activity. Over one week, good cells proliferation and viability was observed, especially in the softer shell. Interestingly, cells within the stiffer core were more positive to hypoxic marker expression (HIF-1α) than those embedded in the shell, confirming the presence of a hypoxic niche, as observed in vivo. When cultured in the MIVO® milli fluidic organ-on-chip resembling the physiological fluid flow conditions, cancer cells viability became comparable between core and shell hydrogel area, emphasising the importance of the fluid flow in nutrients diffusion within three-dimensional matrixes. Cisplatin chemotherapy treatment further highlighted these differences: under static conditions, cancer cell death was prominent in the softer shell, whereas cells in the stiffer core remained resistant to cisplatin. Conversely, drug diffusion was more homogeneous in the core-shell structured treated in the organ-on-chip, leading to a uniform reduction in cell viability. These findings suggest that integrating a compartmentalised core-shell cell laden alginate model with the millifluidic organ on chip offers a more physiologically relevant experimental approach to deepening cancer cell behaviour and drug response.
Collapse
Affiliation(s)
- Ilaria Parodi
- Department of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, 16145 Genoa, Italy
- National Research Council of Italy, Institute of Electronic, Computer and Telecommunications Engineering (CNR-IEIIT), 16149 Genoa, Italy
| | | | - Donatella Di Lisa
- Department of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, 16145 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16131 Genoa, Italy
| | - Laura Pastorino
- Department of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, 16145 Genoa, Italy
| | - Alberto Lagazzo
- Department of Civil, Chemical and Environmental Engineering, University of Genoa, 16145 Genoa, Italy
| | | | - Maurizio Aiello
- National Research Council of Italy, Institute of Electronic, Computer and Telecommunications Engineering (CNR-IEIIT), 16149 Genoa, Italy
- React4life S.p.A., 16152 Genoa, Italy
| | - Marco Massimo Fato
- Department of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, 16145 Genoa, Italy
| | - Silvia Scaglione
- National Research Council of Italy, Institute of Electronic, Computer and Telecommunications Engineering (CNR-IEIIT), 16149 Genoa, Italy
- React4life S.p.A., 16152 Genoa, Italy
| |
Collapse
|
|
3
|
Angeli S, Neophytou C, Kalli M, Stylianopoulos T, Mpekris F. The mechanopathology of the tumor microenvironment: detection techniques, molecular mechanisms and therapeutic opportunities. Front Cell Dev Biol 2025; 13:1564626. [PMID: 40171226 PMCID: PMC11958720 DOI: 10.3389/fcell.2025.1564626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Accepted: 02/27/2025] [Indexed: 04/03/2025] Open
Abstract
The mechanical properties of the tumor microenvironment (TME) undergo significant changes during tumor growth, primarily driven by alterations in extracellular (ECM) stiffness and tumor viscoelasticity. These mechanical changes not only promote tumor progression but also hinder therapeutic efficacy by impairing drug delivery and activating mechanotransduction pathways that regulate crucial cellular processes such as migration, proliferation, and resistance to therapy. In this review, we examine the mechanisms through which tumor cells sense and transmit mechanical signals to maintain homeostasis in the biomechanically altered TME. We explore current computational modelling strategies for mechanotransduction pathways, highlighting the need for developing models that incorporate additional components of the mechanosignaling machinery. Furthermore, we review available methods for measuring the mechanical properties of tumors in clinical settings and strategies aiming at restoring the TME and blocking deregulated mechanotransduction pathways. Finally, we propose that proper characterization and a deeper understanding of the mechanical landscape of the TME, both at the tissue and cellular levels, are essential for developing therapeutic strategies that account for the influence of mechanical forces on treatment efficacy.
Collapse
Affiliation(s)
| | | | | | | | - Fotios Mpekris
- Cancer Biophysics Laboratory, Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia, Cyprus
| |
Collapse
|
|
4
|
Tan R, Liu J, Tang Q, Chen H, Zhang Z. Clinical Diagnostic Value of Shear-Wave Elastography in Detecting Malignant Nipple Retraction. J Comput Assist Tomogr 2025; 49:73-79. [PMID: 39143669 DOI: 10.1097/rct.0000000000001653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
OBJECTIVES In recent years, the use of shear-wave elastography (SWE) as a diagnostic tool for detecting malignant breast lesions has shown promising results. This study aims to determine the clinical diagnostic value of SWE in detecting malignant nipple retraction. METHODS Both US and SWE (Philips EPIQ7 system) were performed for 41 consecutive patients with nipple retraction (56 nipples). The mean, median, and maximum tissue elasticity values (in kilopascals) were determined for each nipple by using SWE. The sensitivity, specificity, and overall accuracy of each measurement was determined by using the surgical pathology results or clinical diagnosis as the gold standard. RESULTS Of the 56 retracted nipples, 32 were due to benign lesions, and 24 were due to malignant lesions. No significant differences in dimensions or echo features were found between the benign and malignant groups. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the color Doppler flow imaging (CDFI) pattern were 63.89% (23/36), 95% (19/20), 95.83 (23/24), 59.38 (19/32), and 75% (42/56), respectively; the corresponding values for median elasticity on SWE were 88.46% (23/26), 96.67% (29/30), 95.83 (23/24), 90.63 (29/32), and 92.85 (52/56), respectively. CONCLUSIONS The addition of SWE to conventional US could help differentiate benign from malignant lesions associated with nipple retraction.
Collapse
Affiliation(s)
- Rong Tan
- From the Department of Ultrasonography, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University (The First Hospital of Changsha)
| | - Jie Liu
- Department of Medical Record and Statistical Analysis, Hunan Provincial Maternal and Child Health Care Hospital
| | - Qi Tang
- From the Department of Ultrasonography, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University (The First Hospital of Changsha)
| | | | - Zhenhui Zhang
- Department of Obstetrics, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University (The First Hospital of Changsha), Changsha, Hunan, PR China
| |
Collapse
|
|
5
|
Lei YM, Liu C, Hu HM, Li N, Zhang N, Wang Q, Zeng SE, Ye HR, Zhang G. Combined use of super-resolution ultrasound imaging and shear-wave elastography for differential diagnosis of breast masses. Front Oncol 2024; 14:1497140. [PMID: 39759128 PMCID: PMC11695221 DOI: 10.3389/fonc.2024.1497140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 12/04/2024] [Indexed: 01/07/2025] Open
Abstract
Objectives Shear-wave elastography (SWE) provides valuable stiffness within breast masses, making it a useful supplement to conventional ultrasound imaging. Super-resolution ultrasound (SRUS) imaging enhances microvascular visualization, aiding in the differential diagnosis of breast masses. Current clinical ultrasound diagnosis of breast cancer primarily relies on gray-scale ultrasound. The combined diagnostic potential of tissue stiffness and microvascular characteristics, two critical tumor biomarkers, remains insufficiently explored. This study aims to evaluate the correlation between the elastic modulus, assessed using SWE, and microvascular characteristics captured through SRUS, in order to evaluate the effectiveness of combining these techniques in distinguishing between benign and malignant breast masses. Materials and methods In this single-center prospective study, 97 patients underwent SWE to obtain parameters including maximum elasticity (Emax), minimum elasticity (Emin), mean elasticity (Emean), standard deviation of elasticity (Esd), and elasticity ratio. SRUS was used to calculate the microvascular flow rate and microvessel density (MVD) within the breast masses. Spearman correlation analysis was used to explore correlations between Emax and MVD. Receiver operating characteristic curves and nomogram were employed to assess the diagnostic efficacy of combining SRUS with SWE, using pathological results as the gold standard. Results Emax, Emean, Esd, and MVD were significantly higher in malignant breast masses compared to benign ones (p < 0.001), while Emin was significantly lower in malignant masses (p < 0.05). In Spearman correlation analysis, Emax was significantly positively correlated with MVD (p < 0.01). The area under the curve for SRUS combined with SWE (0.924) was significantly higher than that for SWE (0.883) or SRUS (0.830) alone (p < 0.001), thus indicating improved diagnostic accuracy. The decision curve analysis of the nomogram indicated that SWE combined with SRUS model had a higher net benefit in predicting breast cancer. Conclusions The MVD of the breast mass shows a significant positive correlation with Emax. By integrating SRUS with SWE, this study proposes a novel diagnostic approach designed to improve specificity and accuracy in breast cancer detection, surpassing the limitations of current ultrasound-based methods. This approach shows promise for early breast cancer detection, with the potential to reduce the need for unnecessary biopsies and improve patient outcomes.
Collapse
Affiliation(s)
- Yu-Meng Lei
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Chen Liu
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
- Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Hai-Man Hu
- Department of Electrical and Electronic Engineering, Hubei University of Technology, Wuhan, China
| | - Nan Li
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Ning Zhang
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Qi Wang
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Shu-E Zeng
- Department of Medical Ultrasound, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Breast Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Clinical Research Center for Breast Cancer, Wuhan Clinical Research Center for Breast Cancer, Wuhan, China
| | - Hua-Rong Ye
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Ge Zhang
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
- Department of Cardiovascular Medicine, Wuhan Asia Heart Hospital, Wuhan, China
| |
Collapse
|
|
6
|
Shi J, Yang S, Niu Q, Zhao L, Jia C, Du L, Li F, Liu Y. Correlation of sonographic features with prognostic factors in ductal carcinoma in situ of the breast: an exploratory study using ultrasound and shear wave elastography. BMC Med Imaging 2024; 24:327. [PMID: 39627774 PMCID: PMC11613642 DOI: 10.1186/s12880-024-01494-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 11/06/2024] [Indexed: 12/08/2024] Open
Abstract
OBJECTIVE Ductal carcinoma in situ (DCIS) of the breast has a wide disease spectrum with risks of progression to invasive cancer linked to pathological factors. High-grade histology, large tumor volume, and comedonecrosis are adverse prognostic factors. This study explores the correlation between conventional ultrasound (Con-US) and shears wave elastography (SWE) features with DCIS prognostic factors and evaluates their predictive efficacy. METHODS A retrospective analysis was conducted on clinical data, Con-US, and SWE imaging features of 83 DCIS patients who underwent surgical resection between June 2018 and December 2022. Binary logistic regression analysis was performed to explore the relationship between sonogram indices and pathological prognostic factors. RESULTS The results revealed that microcalcification observed on Con-US was an independent risk factor for high-grade DCIS and comedonecrosis [odds ratio (OR): 5.316 and 4.512]. In SWE analysis, the Emax value was significantly different between the non-high-grade and high-grade DCIS groups(P = 0.006), with an Emax value greater than 75.03 kPa identified as an independent risk factor for high-grade DCIS [OR:1.022, the area under the curve (AUC): 0.682, 95% confidence interval (CI): 0.555-0.808]. Additionally, the Ecolor, Emax, Emean, and Emean SD values were statistically different between the groups with and without comedonecrosis (P = 0.049, 0.006, 0.012, 0.022), with an Emean value exceeding 30.45 kPa identified as an independent risk factor for comedonecrosis (OR:1.025, AUC:0.708, 95% CI:0.562-0.854). Furthermore, combining microcalcification on Con-US with specific SWE indicators demonstrated an improved predictive specificity for high-grade DCIS and comedonecrosis (0.902 and 0.889, respectively). No significant difference was found in other indexes on SWE. CONCLUSIONS The microcalcification signs on Con-US, Emax and Emean values on SWE analysis are associated with the high nuclear grade and comedonecrosis of DCIS, the combination of Con-US and SWE can improve the predictive specificity of DCIS-related prognostic factors.
Collapse
Affiliation(s)
- Jianan Shi
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Ultrasonography, School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shiyun Yang
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qinghua Niu
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Zhao
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Jia
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yang Liu
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
|
7
|
Xu S, Wang Q, Hong Z. The correlation between multi-mode ultrasonographic features of breast cancer and axillary lymph node metastasis. Front Oncol 2024; 14:1433872. [PMID: 39529837 PMCID: PMC11552536 DOI: 10.3389/fonc.2024.1433872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 10/14/2024] [Indexed: 11/16/2024] Open
Abstract
Objective This study aimed to explore the correlation between multi-mode ultrasonographic features of breast cancer and axillary lymph node metastasis. Method A total of 196 patients with surgically confirmed breast cancer between September 2019 and December 2023 were included. Data on preoperative B-mode ultrasound (US), color Doppler, and shear wave elastography (SWE) features of breast cancer masses were collected and analyzed to determine their correlation with axillary lymph node metastasis. The area under the receiver operating characteristic curve (AUC) of B-mode US, color Doppler, SWE, and the multi-mode predictive model for evaluating axillary lymph node metastasis were compared. Results Among the 196 patients, 70 had positive axillary lymph nodes, while 126 had negative axillary lymph nodes. There was no significant difference in the color features between the negative and positive axillary lymph node groups. Multifocality/multicentricity, architectural distortion, microcalcifications, and the "stiff rim" sign in SWE were identified as independent risk factors to predict axillary lymph node metastasis according to binary logistic regression analysis. The AUC of the predictive model based on these independent risk factors was 0.803 (95% CI: 0.739-0.867), which was significantly higher than that of B-mode US or SWE alone. Conclusion Multifocality/multicentricity, architectural distortion, microcalcifications, and the "stiff rim" sign in SWE were found to be valuable for predicting axillary lymph node metastasis in patients with breast cancer. The predictive model developed in this study, combining the multi-mode ultrasonographic features of breast cancer masses, could serve as a noninvasive and convenient method to predict axillary lymph node status. This approach could aid in clinical decision-making and individualized treatment to improve the prognosis of breast cancer patients.
Collapse
Affiliation(s)
| | | | - Zhe Hong
- Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| |
Collapse
|
|
8
|
Hu P, Zhao P, Qu Y, Maslov K, Chubiz J, Tuuli MG, Stout MJ, Wang LV. Quantification of Cervical Elasticity During Pregnancy Based on Transvaginal Ultrasound Imaging and Stress Measurement. IEEE Trans Biomed Eng 2024; 71:2948-2955. [PMID: 38771680 DOI: 10.1109/tbme.2024.3403799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
Strain elastography and shear wave elastography are commonly used to quantify cervical elasticity. However, the absence of stress information in strain elastography causes difficulty in inter-session elasticity comparison, and the robustness of shear wave elastography is compromised by cervical tissue's high inhomogeneity. OBJECTIVE To overcome these limitations, we develop a quantitative cervical elastography system by adding a stress sensor to a clinically used transvaginal ultrasound imaging system. METHODS We record the cervical deformation in B-mode images and measure the probe-surface stress through the sensor. Then we quantify the strain using a customized algorithm and estimate the cervical Young's modulus through stress-strain linear regression. RESULTS In phantom experiments, we demonstrate the system's high accuracy (alignment with the quasi-static compression method, p-value = 0.369 > 0.05), robustness (alignment between 60°- and 90°-contact measurements, p-value = 0.638 > 0.05), repeatability (consistency of single sonographers' measurements, coefficient of variation < 0.06), and reproducibility (alignment between two sonographers' measurements, Pearson correlation coefficient = 0.981). Applying it to pregnant participants, we observe significant cervical softening (p-value < 0.001): Young's modulus decreases 3.95% weekly and its geometric mean value during the first (11 to 13 weeks), second, and third trimesters are 13.07 kPa, 7.59 kPa, and 4.40 kPa, respectively. CONCLUSION The proposed system is accurate, robust, and safe, and enables longitudinal and inter-examiner comparisons. SIGNIFICANCE The system applies to different ultrasound machines with minor software updates, which allows for studies of cervical softening patterns in pregnancy for larger populations, facilitating insights into conditions such as preterm birth.
Collapse
|
|
9
|
Musaddaq T, Musaddaq B. Recent Advances in Image-Guided Tissue Sampling. Cureus 2024; 16:e71613. [PMID: 39553029 PMCID: PMC11566127 DOI: 10.7759/cureus.71613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2024] [Indexed: 11/19/2024] Open
Abstract
Recent advances in image-guided tissue sampling have enhanced diagnostic medicine, particularly in oncology. Traditional techniques, such as computed tomography (CT)-, ultrasound (US)-, and magnetic resonance imaging (MRI)-guided biopsies, remain the cornerstone of diagnostic interventions, each offering unique advantages based on tissue characteristics. CT-guided biopsies excel in deeper complex lesions, while US-guided biopsies provide real-time imaging ideal for superficial tissues. MRI-guided biopsies are invaluable for soft tissue evaluations. The emergence of fusion imaging, which combines modalities such as positron emission tomography (PET)/CT or MRI/US, has demonstrated enhanced diagnostic accuracy. Despite these advantages, image co-registration and cost are the main drawbacks. Emerging techniques such as molecular breast imaging (MBI) and shear wave elastography (SWE) have been evaluated, particularly for breast cancer; however, research suggests that US is likely to remain the most effective modality due to both its cost and ease of use. Innovations in biopsy navigation, including augmented reality, "hot needles," and robotic assistance, demonstrate promise in closing the gap between operator dependency and procedural consistency; however, further research is required. While liquid biopsies show promise in non-invasive early cancer detection, they are not yet ready to replace tissue biopsies. Collectively, these advancements indicate a future where image-guided tissue sampling is more targeted, less invasive, and diagnostically accurate, although cost and technology access remain challenges.
Collapse
Affiliation(s)
- Talal Musaddaq
- Radiology, Watford General Hospital, Watford, GBR
- Medicine, University of Cambridge, Cambridge, GBR
| | | |
Collapse
|
|
10
|
Su HZ, Hong LC, Su YM, Chen XS, Zhang ZB, Zhang XD. A Nomogram Based on Conventional Ultrasound Radiomics for Differentiating Between Radial Scar and Invasive Ductal Carcinoma of the Breast. Ultrasound Q 2024; 40:e00685. [PMID: 38889436 DOI: 10.1097/ruq.0000000000000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
ABSTRACT We aimed to develop and validate a nomogram based on conventional ultrasound (CUS) radiomics model to differentiate radial scar (RS) from invasive ductal carcinoma (IDC) of the breast. In total, 208 patients with histopathologically diagnosed RS or IDC of the breast were enrolled. They were randomly divided in a 7:3 ratio into a training cohort (n = 145) and a validation cohort (n = 63). Overall, 1316 radiomics features were extracted from CUS images. Then a radiomics score was constructed by filtering unstable features and using the maximum relevance minimum redundancy algorithm and the least absolute shrinkage and selection operator logistic regression algorithm. Two models were developed using data from the training cohort: one using clinical and CUS characteristics (Clin + CUS model) and one using clinical information, CUS characteristics, and the radiomics score (radiomics model). The usefulness of nomogram was assessed based on their differentiating ability and clinical utility. Nine features from CUS images were used to build the radiomics score. The radiomics nomogram showed a favorable predictive value for differentiating RS from IDC, with areas under the curve of 0.953 and 0.922 for the training and validation cohorts, respectively. Decision curve analysis indicated that this model outperformed the Clin + CUS model and the radiomics score in terms of clinical usefulness. The results of this study may provide a novel method for noninvasively distinguish RS from IDC.
Collapse
Affiliation(s)
- Huan-Zhong Su
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Long-Cheng Hong
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | | | - Xiao-Shuang Chen
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Zuo-Bing Zhang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xiao-Dong Zhang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| |
Collapse
|
|
11
|
Krishnan S, Kaur K, Bhartendu, Kundu P, Chowdhury N, Huda F, Syed A. Beware it's benign: A unique case of concomitant benign breast pathologies. Radiol Case Rep 2024; 19:3185-3190. [PMID: 38779195 PMCID: PMC11109307 DOI: 10.1016/j.radcr.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 05/25/2024] Open
Abstract
Complex sclerosing lesion (CSL)/radial scar of breast is a benign entity that can pose a diagnostic challenge due to resemblance to breast carcinoma on imaging. Hamartoma are uncommon benign tumors, composed of disorganized mixture of glandular, fibrous, and adipose tissues, which can exhibit classical imaging characteristics. Here we describe a case of concomitant CSL and hamartoma in left beast, of which CSL presented as suspicious mass on imaging but was ultimately confirmed to be benign on histopathology with 4 years of documented stability.
Collapse
Affiliation(s)
- Sweta Krishnan
- Department of Diagnostic and Intervention Radiology, AIIMS, Rishikesh, India
| | - Khushpreet Kaur
- Department of Diagnostic and Intervention Radiology, AIIMS, Rishikesh, India
| | - Bhartendu
- Department of Pathology, AIIMS, Rishikesh, India
| | - Pooja Kundu
- Department of Diagnostic and Intervention Radiology, AIIMS, Rishikesh, India
| | | | - Farhanul Huda
- Department of General Surgery, AIIMS, Rishikesh, India
| | - Anjum Syed
- Department of Diagnostic and Intervention Radiology, AIIMS, Rishikesh, India
| |
Collapse
|
|
12
|
Deeg J, Swoboda M, Egle D, Wieser V, Soleiman A, Ladenhauf V, Galijasevic M, Amort B, Gruber L. Shear-Wave Elastography Gradient Analysis of Newly Diagnosed Breast Tumours: A Critical Analysis. Diagnostics (Basel) 2024; 14:1657. [PMID: 39125533 PMCID: PMC11312263 DOI: 10.3390/diagnostics14151657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND A better understanding of the peritumoral stroma changes due to tumour invasion using non-invasive diagnostic methods may improve the differentiation between benign and malignant breast lesions. This study aimed to assess the correlation between breast lesion differentiation and intra- and peritumoral shear-wave elastography (SWE) gradients. METHODS A total of 135 patients with newly diagnosed breast lesions were included. Intratumoral, subsurface, and three consecutive peritumoral SWE value measurements (with three repetitions) were performed. Intratumoral, interface, and peritumoral gradients (Gradient 1 and Gradient 2) were calculated using averaged SWE values. Statistical analysis included descriptive statistics and an ordinary one-way ANOVA to compare overall and individual gradients among Breast Imaging-Reporting and Data System (BI-RADS) 2, 3, and 5 groups. RESULTS Malignant tumours showed higher average SWE velocity values at the tumour centre (BI-RADS 2/3: 4.1 ± 1.8 m/s vs. BI-RADS 5: 4.9 ± 2.0 m/s, p = 0.04) and the first peritumoral area (BI-RADS 2/3: 3.4 ± 1.8 m/s vs. BI-RADS 5: 4.3 ± 1.8 m/s, p = 0.003). No significant difference was found between intratumoral gradients (0.03 ± 0.32 m/s vs. 0.0 ± 0.28 m/s; p > 0.999) or gradients across the tumour-tissue interface (-0.17 ± 0.18 m/s vs. -0.13 ± 0.35 m/s; p = 0.202). However, the first peritumoral gradient (-0.16 ± 0.24 m/s vs. -0.35 ± 0.31 m/s; p < 0.0001) and the second peritumoral gradient (-0.11 ± 0.18 m/s vs. -0.22 ± 0.28 m/s; p = 0.037) were significantly steeper in malignant tumours. The AUC was best for PTG1 (0.7358) and PTG2 (0.7039). A threshold value for peritumoral SWI PT1 above 3.76 m/s and for PTG1 below -0.238 m/s·mm-1 indicated malignancy in 90.6% of cases. CONCLUSIONS Evaluating the peritumoral SWE gradient may improve the diagnostic pre-test probability, as malignant tumours showed a significantly steeper curve of the elasticity values in the peritumoral stroma compared to the linear regression with a relatively flat curve of benign lesions.
Collapse
Affiliation(s)
- Johannes Deeg
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (L.G.)
| | - Michael Swoboda
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (L.G.)
| | - Daniel Egle
- Department of Obstetrics and Gynaecology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (D.E.); (V.W.)
| | - Verena Wieser
- Department of Obstetrics and Gynaecology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (D.E.); (V.W.)
| | - Afschin Soleiman
- Institute for Pathology, INNPath, University Hospital Tirol Kliniken, Anichstraße 35, 6020 Innsbruck, Austria;
| | - Valentin Ladenhauf
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (L.G.)
| | - Malik Galijasevic
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (L.G.)
| | - Birgit Amort
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (L.G.)
| | - Leonhard Gruber
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (J.D.); (V.L.); (M.G.); (B.A.); (L.G.)
| |
Collapse
|
|
13
|
Li B, Dai S, Wang Q, Jing H, Shao H, Zhang L, Qin L, Qiao C, Wang Z, Cheng W. Investigation of correlation between shear wave elastography and lymphangiogenesis in invasive breast cancer and diagnosis of axillary lymph node metastasis. BMC Cancer 2024; 24:409. [PMID: 38566057 PMCID: PMC10986065 DOI: 10.1186/s12885-024-12115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Accurate evaluation of axillary lymph node metastasis (LNM) in breast cancer is very important. A large number of hyperplastic and dilated lymphangiogenesis cases can usually be found in the pericancerous tissue of breast cancer to promote the occurrence of tumor metastasis.Shear wave elastography (SWE) can be used as an important means for evaluating pericancerous stiffness. We determined the stiffness of the pericancerous by SWE to diagnose LNM and lymphangiogenesis in invasive breast cancer (IBC). METHODS Patients with clinical T1-T2 stage IBC who received surgical treatment in our hospital from June 2020 to December 2020 were retrospectively enrolled. A total of 299 patients were eventually included in the preliminary study, which included an investigation of clinicopathological features, ultrasonic characteristics, and SWE parameters. Multivariable logistic regression analysis was used to establish diagnostic model and evaluated its diagnostic performance of LNM. The correlation among SWE values, collagen volume fraction (CVF), and microlymphatic density (MLD) in primary breast cancer lesions was analyzed in another 97 patients. RESULTS The logistic regression model is Logit(P)=-1.878 + 0.992*LVI-2.010*posterior feature enhancement + 1.230*posterior feature shadowing + 0.102*posterior feature combined pattern + 0.009*Emax. The optimum cutoff value of the logistic regression model was 0.365, and the AUC (95% CI) was 0.697 (0.636-0.758); the sensitivity (70.7 vs. 54.3), positive predictive value (PPV) (54.0 vs. 50.8), negative predictive value (NPV) (76.9 vs. 69.7), and accuracy (65.2 vs. 61.9) were all higher than Emax. There was no correlation between the SWE parameters and MLD in primary breast cancer lesions. CONCLUSIONS The logistic regression model can help us to determine LNM, thus providing more imaging basis for the selection of preoperative treatment. The SWE parameter of the primary breast cancer lesion cannot reflect the peritumoral lymphangiogenesis, and we still need to find a new ultrasonic imaging method.
Collapse
Affiliation(s)
- Bo Li
- Department of Ultrasound, Harbin Medical University Cancer Hospital, 150 Haping Rd, Nangang District, 150081, Harbin, China
| | - Shaochun Dai
- Department of Ultrasound, Harbin Medical University Cancer Hospital, 150 Haping Rd, Nangang District, 150081, Harbin, China
| | - Qiucheng Wang
- Department of Ultrasound, Harbin Medical University Cancer Hospital, 150 Haping Rd, Nangang District, 150081, Harbin, China
| | - Hui Jing
- Department of Ultrasound, Harbin Medical University Cancer Hospital, 150 Haping Rd, Nangang District, 150081, Harbin, China
| | - Hua Shao
- Department of Ultrasound, Harbin Medical University Cancer Hospital, 150 Haping Rd, Nangang District, 150081, Harbin, China
| | - Lei Zhang
- Department of Ultrasound, Harbin Medical University Cancer Hospital, 150 Haping Rd, Nangang District, 150081, Harbin, China
| | - Ling Qin
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Cong Qiao
- Department of Pathology, Harbin Medical University, Harbin, China
| | - Zhuozhong Wang
- The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, 150 Haping Rd, Nangang District, 150081, Harbin, China.
| |
Collapse
|
|
14
|
Bosio G, Destrempes F, Yazdani L, Roy Cardinal MH, Cloutier G. Resonance, Velocity, Dispersion, and Attenuation of Ultrasound-Induced Shear Wave Propagation in Blood Clot In Vitro Models. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:535-551. [PMID: 38108551 DOI: 10.1002/jum.16387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/24/2023] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Improve the characterization of mechanical properties of blood clots. Parameters derived from shear wave (SW) velocity and SW amplitude spectra were determined for gel phantoms and in vitro blood clots. METHODS Homogeneous phantoms and phantoms with gel or blood clot inclusions of different diameters and mechanical properties were analyzed. SW amplitude spectra were used to observe resonant peaks. Parameters derived from those resonant peaks were related to mimicked blood clot properties. Three regions of interest were tested to analyze where resonances occurred the most. For blood experiments, 20 samples from different pigs were analyzed over time during a 110-minute coagulation period using the Young modulus, SW frequency dispersion, and SW attenuation. RESULTS The mechanical resonance was manifested by an increase in the number of SW spectral peaks as the inclusion diameter was reduced (P < .001). In blood clot inclusions, the Young modulus increased over time during coagulation (P < .001). Descriptive spectral parameters (frequency peak, bandwidth, and distance between resonant peaks) were linearly correlated with clot elasticity values (P < .001) with R2 = .77 for the frequency peak, .60 for the bandwidth, and .48 for the distance between peaks. The SW dispersion and SW attenuation reflecting the viscous behavior of blood clots decreased over time (P < .001), mainly in the early stage of coagulation (first minutes). CONCLUSION The confined soft inclusion configuration favored SW mechanical resonances potentially challenging the computation of spectral-based parameters, such as the SW attenuation. The impact of resonances can be reduced by properly selecting the region of interest for data analysis.
Collapse
Affiliation(s)
- Guillaume Bosio
- Institute of Biomedical Engineering, University of Montreal, Montreal, Quebec, Canada
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
| | - François Destrempes
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Ladan Yazdani
- Institute of Biomedical Engineering, University of Montreal, Montreal, Quebec, Canada
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Marie-Hélène Roy Cardinal
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Guy Cloutier
- Institute of Biomedical Engineering, University of Montreal, Montreal, Quebec, Canada
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montreal, Quebec, Canada
| |
Collapse
|
|
15
|
Eshaghinia SS, Taghvaeipour A, Aghdam MM, Rivaz H. On the soft tissue ultrasound elastography using FEM based inversion approach. Proc Inst Mech Eng H 2024; 238:271-287. [PMID: 38240143 DOI: 10.1177/09544119231224674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Abstract
Elastography is a medical imaging modality that enables visualization of tissue stiffness. It involves quasi-static or harmonic mechanical stimulation of the tissue to generate a displacement field which is used as input in an inversion algorithm to reconstruct tissue elastic modulus. This paper considers quasi-static stimulation and presents a novel inversion technique for elastic modulus reconstruction. The technique follows an inverse finite element framework. Reconstructed elastic modulus maps produced in this technique do not depend on the initial guess, while it is computationally less involved than iterative reconstruction approaches. The method was first evaluated using simulated data (in-silico) where modulus reconstruction's sensitivity to displacement noise and elastic modulus was assessed. To demonstrate the method's performance, displacement fields of two tissue mimicking phantoms determined using three different motion tracking techniques were used as input to the developed elastography method to reconstruct the distribution of relative elastic modulus of the inclusion to background tissue. In the next stage, the relative elastic modulus of three clinical cases pertaining to liver cancer patient were determined. The obtained results demonstrate reasonably high elastic modulus reconstruction accuracy in comparison with similar direct methods. Also it is associated with reduced computational cost in comparison with iterative techniques, which suffer from convergence and uniqueness issues, following the same formulation concept. Moreover, in comparison with other methods which need initial guess, the presented method does not require initial guess while it is easy to understand and implement.
Collapse
Affiliation(s)
- Seyed Shahab Eshaghinia
- Mechanical Engineering Department, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Afshin Taghvaeipour
- Mechanical Engineering Department, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Mohammad Mohammadi Aghdam
- Mechanical Engineering Department, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Hassan Rivaz
- Department of Electrical and Computer Engineering, Concordia University, Montreal, QC, Canada
| |
Collapse
|
|
16
|
Mierke CT. Phenotypic Heterogeneity, Bidirectionality, Universal Cues, Plasticity, Mechanics, and the Tumor Microenvironment Drive Cancer Metastasis. Biomolecules 2024; 14:184. [PMID: 38397421 PMCID: PMC10887446 DOI: 10.3390/biom14020184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
Tumor diseases become a huge problem when they embark on a path that advances to malignancy, such as the process of metastasis. Cancer metastasis has been thoroughly investigated from a biological perspective in the past, whereas it has still been less explored from a physical perspective. Until now, the intraluminal pathway of cancer metastasis has received the most attention, while the interaction of cancer cells with macrophages has received little attention. Apart from the biochemical characteristics, tumor treatments also rely on the tumor microenvironment, which is recognized to be immunosuppressive and, as has recently been found, mechanically stimulates cancer cells and thus alters their functions. The review article highlights the interaction of cancer cells with other cells in the vascular metastatic route and discusses the impact of this intercellular interplay on the mechanical characteristics and subsequently on the functionality of cancer cells. For instance, macrophages can guide cancer cells on their intravascular route of cancer metastasis, whereby they can help to circumvent the adverse conditions within blood or lymphatic vessels. Macrophages induce microchannel tunneling that can possibly avoid mechanical forces during extra- and intravasation and reduce the forces within the vascular lumen due to vascular flow. The review article highlights the vascular route of cancer metastasis and discusses the key players in this traditional route. Moreover, the effects of flows during the process of metastasis are presented, and the effects of the microenvironment, such as mechanical influences, are characterized. Finally, the increased knowledge of cancer metastasis opens up new perspectives for cancer treatment.
Collapse
Affiliation(s)
- Claudia Tanja Mierke
- Faculty of Physics and Earth System Science, Peter Debye Institute of Soft Matter Physics, Biological Physics Division, Leipzig University, 04103 Leipzig, Germany
| |
Collapse
|
|
17
|
Durcan C, Hossain M, Chagnon G, Perić D, Girard E. Mechanical experimentation of the gastrointestinal tract: a systematic review. Biomech Model Mechanobiol 2024; 23:23-59. [PMID: 37935880 PMCID: PMC10901955 DOI: 10.1007/s10237-023-01773-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/10/2023] [Indexed: 11/09/2023]
Abstract
The gastrointestinal (GI) organs of the human body are responsible for transporting and extracting nutrients from food and drink, as well as excreting solid waste. Biomechanical experimentation of the GI organs provides insight into the mechanisms involved in their normal physiological functions, as well as understanding of how diseases can cause disruption to these. Additionally, experimental findings form the basis of all finite element (FE) modelling of these organs, which have a wide array of applications within medicine and engineering. This systematic review summarises the experimental studies that are currently in the literature (n = 247) and outlines the areas in which experimentation is lacking, highlighting what is still required in order to more fully understand the mechanical behaviour of the GI organs. These include (i) more human data, allowing for more accurate modelling for applications within medicine, (ii) an increase in time-dependent studies, and (iii) more sophisticated in vivo testing methods which allow for both the layer- and direction-dependent characterisation of the GI organs. The findings of this review can also be used to identify experimental data for the readers' own constitutive or FE modelling as the experimental studies have been grouped in terms of organ (oesophagus, stomach, small intestine, large intestine or rectum), test condition (ex vivo or in vivo), number of directions studied (isotropic or anisotropic), species family (human, porcine, feline etc.), tissue condition (intact wall or layer-dependent) and the type of test performed (biaxial tension, inflation-extension, distension (pressure-diameter), etc.). Furthermore, the studies that investigated the time-dependent (viscoelastic) behaviour of the tissues have been presented.
Collapse
Affiliation(s)
- Ciara Durcan
- Zienkiewicz Centre for Modelling, Data and AI, Faculty of Science and Engineering, Swansea University, Swansea, SA1 8EN, UK
- Université Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000, Grenoble, France
| | - Mokarram Hossain
- Zienkiewicz Centre for Modelling, Data and AI, Faculty of Science and Engineering, Swansea University, Swansea, SA1 8EN, UK.
| | - Grégory Chagnon
- Université Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000, Grenoble, France
| | - Djordje Perić
- Zienkiewicz Centre for Modelling, Data and AI, Faculty of Science and Engineering, Swansea University, Swansea, SA1 8EN, UK
| | - Edouard Girard
- Université Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000, Grenoble, France
- Laboratoire d'Anatomie des Alpes Françaises, Université Grenoble Alpes, Grenoble, France
| |
Collapse
|
|
18
|
Xu J, Zhang L, Wen W, He Y, Wei T, Zheng Y, Pan X, Li Y, Wu Y, Dong F, Zhang H, Cheng W, Xu H, Zhang Y, Bao L, Zhang X, Tang S, Liao J, Luo H, Zhao H, Tian J, Peng Y. Evaluation of standard breast ultrasonography by adding two-dimensional and three-dimensional shear wave elastography: a prospective, multicenter trial. Eur Radiol 2024; 34:945-956. [PMID: 37644151 PMCID: PMC11322273 DOI: 10.1007/s00330-023-10057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/17/2023] [Accepted: 06/30/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To reduce the number of biopsies performed on benign breast lesions categorized as BI-RADS 4-5, we investigated the diagnostic performance of combined two-dimensional and three-dimensional shear wave elastography (2D + 3D SWE) with standard breast ultrasonography (US) for the BI-RADS assessment of breast lesions. METHODS A total of 897 breast lesions, categorized as BI-RADS 3-5, were subjected to standard breast US and supplemented by 2D SWE only and 2D + 3D SWE analysis. Based on the malignancy rate of less than 2% for BI-RADS 3, lesions assessed by standard breast US were reclassified with SWE assessment. RESULTS After standard breast US evaluation, 268 (46.1%) participants underwent benign biopsies in BI-RADS 4-5 lesions. By using separated cutoffs for upstaging BI-RADS 3 at 120 kPa and downstaging BI-RADS 4a at 90 kPa in 2D + 3D SWE reclassification, 123 (21.2%) participants underwent benign biopsy, resulting in a 54.1% reduction (123 versus 268). CONCLUSION Combining 2D + 3D SWE with standard breast US for reclassification of BI-RADS lesions may achieve a reduction in benign biopsies in BI-RADS 4-5 lesions without sacrificing sensitivity unacceptably. CLINICAL RELEVANCE STATEMENT Combining 2D + 3D SWE with US effectively reduces benign biopsies in breast lesions with categories 4-5, potentially improving diagnostic accuracy of BI-RADS assessment for patients with breast lesions. TRIAL REGISTRATION ChiCTR1900026556 KEY POINTS: • Reduce benign biopsy is necessary in breast lesions with BI-RADS 4-5 category. • A reduction of 54.1% on benign biopsies in BI-RADS 4-5 lesions was achieved using 2D + 3D SWE reclassification. • Adding 2D + 3D SWE to standard breast US improved the diagnostic performance of BI-RADS assessment on breast lesions: specificity increased from 54 to 79%, and PPV increased from 54 to 71%, with slight loss in sensitivity (97.2% versus 98.7%) and NPV (98.1% versus 98.7%).
Collapse
Affiliation(s)
- Jinshun Xu
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
- Department of Ultrasound Medicine & Laboratory of Translational Research in Ultrasound Theranostics, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Lei Zhang
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wen Wen
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yushuang He
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Tianci Wei
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yanling Zheng
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaofang Pan
- Health Medical Department, Dalian Municipal Central Hospital, Dalian, China
| | - Yuhong Li
- Department of Ultrasound, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Yiyun Wu
- Department of Ultrasound, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Fenglin Dong
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Heqing Zhang
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hongchun Xu
- Department of Ultrasound, Shengjing-Dalian Hospital, Chinese Medical Sciences University, Dalian, China
| | - Yingchun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Lingyun Bao
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinguo Zhang
- Department of Ultrasound, Shaoyang Central Hospital, Shaoyang, China
| | - Shichu Tang
- Department of Ultrasound, Hunan Provincial Tumor Hospital, Changsha, China
| | - Jintang Liao
- Department of Ultrasound, Xiangya Hospital of Central South University, Changsha, China
| | - Honghao Luo
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Haina Zhao
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Jiawei Tian
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Yulan Peng
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China.
| |
Collapse
|
|
19
|
Xin Y, Li K, Huang M, Liang C, Siemann D, Wu L, Tan Y, Tang X. Biophysics in tumor growth and progression: from single mechano-sensitive molecules to mechanomedicine. Oncogene 2023; 42:3457-3490. [PMID: 37864030 PMCID: PMC10656290 DOI: 10.1038/s41388-023-02844-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 10/22/2023]
Abstract
Evidence from physical sciences in oncology increasingly suggests that the interplay between the biophysical tumor microenvironment and genetic regulation has significant impact on tumor progression. Especially, tumor cells and the associated stromal cells not only alter their own cytoskeleton and physical properties but also remodel the microenvironment with anomalous physical properties. Together, these altered mechano-omics of tumor tissues and their constituents fundamentally shift the mechanotransduction paradigms in tumorous and stromal cells and activate oncogenic signaling within the neoplastic niche to facilitate tumor progression. However, current findings on tumor biophysics are limited, scattered, and often contradictory in multiple contexts. Systematic understanding of how biophysical cues influence tumor pathophysiology is still lacking. This review discusses recent different schools of findings in tumor biophysics that have arisen from multi-scale mechanobiology and the cutting-edge technologies. These findings range from the molecular and cellular to the whole tissue level and feature functional crosstalk between mechanotransduction and oncogenic signaling. We highlight the potential of these anomalous physical alterations as new therapeutic targets for cancer mechanomedicine. This framework reconciles opposing opinions in the field, proposes new directions for future cancer research, and conceptualizes novel mechanomedicine landscape to overcome the inherent shortcomings of conventional cancer diagnosis and therapies.
Collapse
Grants
- R35 GM150812 NIGMS NIH HHS
- This work was financially supported by National Natural Science Foundation of China (Project no. 11972316, Y.T.), Shenzhen Science and Technology Innovation Commission (Project no. JCYJ20200109142001798, SGDX2020110309520303, and JCYJ20220531091002006, Y.T.), General Research Fund of Hong Kong Research Grant Council (PolyU 15214320, Y. T.), Health and Medical Research Fund (HMRF18191421, Y.T.), Hong Kong Polytechnic University (1-CD75, 1-ZE2M, and 1-ZVY1, Y.T.), the Cancer Pilot Research Award from UF Health Cancer Center (X. T.), the National Institute of General Medical Sciences of the National Institutes of Health under award number R35GM150812 (X. T.), the National Science Foundation under grant number 2308574 (X. T.), the Air Force Office of Scientific Research under award number FA9550-23-1-0393 (X. T.), the University Scholar Program (X. T.), UF Research Opportunity Seed Fund (X. T.), the Gatorade Award (X. T.), and the National Science Foundation REU Site at UF: Engineering for Healthcare (Douglas Spearot and Malisa Sarntinoranont). We are deeply grateful for the insightful discussions with and generous support from all members of Tang (UF)’s and Tan (PolyU)’s laboratories and all staff members of the MAE/BME/ECE/Health Cancer Center at UF and BME at PolyU.
- National Natural Science Foundation of China (National Science Foundation of China)
- Shenzhen Science and Technology Innovation Commission
Collapse
Affiliation(s)
- Ying Xin
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Keming Li
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Miao Huang
- Department of Mechanical and Aerospace Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA
| | - Chenyu Liang
- Department of Mechanical and Aerospace Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA
| | - Dietmar Siemann
- UF Health Cancer Center, University of Florida, Gainesville, FL, USA
| | - Lizi Wu
- UF Health Cancer Center, University of Florida, Gainesville, FL, USA
| | - Youhua Tan
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China.
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Xin Tang
- Department of Mechanical and Aerospace Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA.
- UF Health Cancer Center, University of Florida, Gainesville, FL, USA.
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, USA.
| |
Collapse
|
|
20
|
Wang X, He Y, Wang L. Diagnostic value of shear wave elastography combined with super microvascular imaging for BI-RADS 3-5 nodules. Front Oncol 2023; 13:1192630. [PMID: 37731632 PMCID: PMC10508847 DOI: 10.3389/fonc.2023.1192630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
Background To investigate the diagnostic value of shear wave elastography (SWE) and super microvascular imaging (SMI) integrated with the traditional ultrasound breast imaging reporting and data system (BI-RADS) classification in differentiating between benign and malignant breast nodules. Methods For analysis, 88 patients with 110 breast nodules assessed as BI-RADS 3-5 by conventional ultrasound were selected. SWE and SMI evaluations were conducted separately, and all nodules were verified as benign or malignant ones by pathology. Receiver operating characteristic (ROC) curves were plotted after obtaining quantitative parameters of different shear waves of nodules, including maximum (Emax), mean (Emean), minimum (Emin) Young's modulus, modulus standard deviation (SD), and modulus ratio (Eratio). The best cut-off value, specificity, sensitivity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing malignant nodules employing Emax were obtained, and the diagnostic value of combining Emax and BI-RADS classification was compared. SMI graded nodule based on the Alder blood flow grading standard, whereas the BI-RADS classification was based on microvascular morphology. We assessed the diagnostic value of SMI for breast nodules and investigated the diagnostic efficacy of SWE combined with SMI in differentiating benign and malignant breast nodules with BI-RADS classification 3-5. Results The adjusted the BI-RADS classification using SMI and SWE technologies promoted the sensitivity, specificity, and accuracy of discriminating benign and malignant breast nodules (P < 0.05). The combination of traditional ultrasound BI-RADS classification with SWE and SMI technologies offered high sensitivity, specificity, accuracy, PPV, and NPV for identifying benign and malignant breast lesions. Moreover, combining SWE and SMI technologies with the adjusted BI-RADS classificationhad the best diagnostic efficacy for distinguishing benign and malignant breast nodules with BI-RADS 3-5. Conclusion The combination of SWE and SMI with the adjusted BI-RADS classification is a promising diagnostic method for differentiating benign and malignant breast nodules.
Collapse
Affiliation(s)
| | | | - Liangyu Wang
- Department of Ultrasound, Shantou Central Hospital, Shantou, Guangdong, China
| |
Collapse
|
|
21
|
Sforza M, Kul Z, Saghir R, Saghir N, Okhiria R, Okhiria T, Sidhu M. Predicting the expansion of the lower pole of the breast following smooth breast implant augmentation: A novel shear wave elastography study. J Plast Reconstr Aesthet Surg 2023; 84:574-581. [PMID: 37441854 DOI: 10.1016/j.bjps.2023.06.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES This study aimed to educate and demonstrate how the use of shear wave elastography (SWE) can be used to determine the elasticity of patient tissues preoperatively, which can then be used to predict the level of lower pole expansion postoperatively, following breast augmentation surgery. MATERIALS AND METHODS This study evaluated 60 breasts in 30 patients that were divided in 3 equal groups (n = 20) according to their predefined elastography criteria measured via SWE (loose, moderate, and tight tissue elasticity). All measurements were taken under maximum stretch between the inferior border of the nipple alveolar complex (NAC) and inframammary fold (IMF) using a measuring tape in millimetres (mm). The follow-up appointments for routine assessments and measurements were done at 3, 6, 12, 18, and 24 months. RESULTS The study engaged 38 patients over 4 years, but only 10 patients in each group attended all the appointments. Statistical analysis showed the elastic skin types (loose, moderate, and tight) had significantly different rates of lower pole expansion, and the rate of expansion increased significantly after 6 months postoperatively, whereas prior to 6 months, the rates were comparable (p < 0.05). DISCUSSION The results showed that increasingly elastic skin types have a greater rate of lower pole expansion. This is important for the operating surgeon to be aware of as looser skin types will be more prone to lower pole expansion, and thus, a higher surgical IMF suture may be advised to manage patient expectations. CONCLUSION This study can be used as a guideline for surgeons, which will allow for a more predictable surgical planning system that will ultimately lead to fewer revisions and risks for patients worldwide.
Collapse
Affiliation(s)
- Marcos Sforza
- Department of Surgery and Interventional Sciences, University College of London, London, UK; Royal College of Surgeons of England, UK.
| | | | | | | | | | | | | |
Collapse
|
|
22
|
Gruber L, Deeg J, Egle D, Soleiman A, Ladenhauf V, Luger A, Amort B, Daniaux M. Peritumoural Strain Elastography of Newly Diagnosed Breast Tumours: Does Maximum Peritumoural Halo Depth Correlate with Tumour Differentiation and Grade? Diagnostics (Basel) 2023; 13:2064. [PMID: 37370959 DOI: 10.3390/diagnostics13122064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
To evaluate the diagnostic utility of the maximum ultrasound strain elastography (SE) halo depth in newly diagnosed and histologically confirmed breast lesions, a retrospective study approval was granted by the local Ethical Review Board. Overall, the maximum strain elastography peritumoural halos (SEPHmax)-the maximum distance between the SE stiffening area and the B-mode lesion size-in 428 cases with newly diagnosed breast lesions were retrospectively analysed alongside patient age, affected quadrant, tumour echogenicity, size, acoustic shadowing, and vascularity. Statistical analysis included an ordinary one-way ANOVA to compare the SEPHmax between BI-RADS 2, 3, and 5 groups and between tumour grades 1, 2, and 3. A binary regression analysis was used to determine the correlation between tumour malignancy and the above-mentioned demographic and imaging factors. SEPHmax was significantly higher in BI-RADS 5 tumours (5.5 ± 3.9 mm) compared to BI-RADS 3 (0.9 ± 1.7 mm, p < 0.0001) and 2 (0.6 ± 1.4 mm, p < 0.0001). The receiver operating characteristic area under the curve was 0.933 for the detection of BI-RADS 5 lesions. Furthermore, tumour grades 2 (5.6 ± 3.6 mm, p = 0.001) and 3 (6.8 ± 4.2 mm, p < 0.0001) exhibited significantly higher SEPHmax than grade 1 tumours (4.0 ± 3.9 mm). Similarly, St. Gallen Ki67-stratified low-risk (p = 0.005) and intermediate-risk (p = 0.013) tumours showed smaller SEPHmax than high-risk tumours. Multivariate analysis revealed a significant correlation between malignant differentiation and SEPHmax (standardized regression coefficient 3.17 [95% confidence interval (CI) 2.42-3.92], p < 0.0001), low tumour echogenicity (1.68 [95% CI 0.41-3.00], p = 0.03), and higher patient age (0.89 [95% CI 0.52-1.26], p < 0.0001). High SEPHmax is a strong predictor for tumour malignancy and a higher tumour grade and can be used to improve tumour characterisation before histopathological evaluation. It may also enable radiologists to identify lesions warranting observation rather than immediate biopsy.
Collapse
Affiliation(s)
- Leonhard Gruber
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Johannes Deeg
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynaecology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Afschin Soleiman
- Institute for Pathology, INNPath, University Hospital Tirol Kliniken, Anichstraße 35, 6020 Innsbruck, Austria
| | - Valentin Ladenhauf
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Anna Luger
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Birgit Amort
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Martin Daniaux
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| |
Collapse
|
|
23
|
Kim HJ, Kim HH, Choi WJ, Chae EY, Shin HJ, Cha JH. Correlation of shear-wave elastography parameters with the molecular subtype and axillary lymph node status in breast cancer. Clin Imaging 2023; 101:190-199. [PMID: 37418896 DOI: 10.1016/j.clinimag.2023.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/18/2023] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE To examine correlations between shear-wave elastography (SWE) parameters with molecular subtype and axillary lymph node (LN) status of breast cancer. METHODS We retrospectively analyzed 545 consecutive women (mean age, 52.7 ± 10.7 years; range, 26-83) with breast cancer who underwent preoperative breast ultrasound with SWE between December 2019 and January 2021. SWE parameters (Emax, Emean, and Eratio) and the histopathologic information from surgical specimens including histologic type, histologic grade, size of invasive cancer, hormone receptor and HER2 status, Ki-67 proliferation index, and axillary LN status were analyzed. The relationships between SWE parameters and histopathologic findings were analyzed using an independent sample t-test, one-way ANOVA test with Tukey's post hoc test, and logistic regression analyses. RESULTS Higher stiffness values of SWE were associated with larger lesion size (>20 mm) on ultrasound, high histologic grade, larger invasive cancer size (>20 mm), high Ki-67, and axillary LN metastasis. Emax and Emean were the lowest in the luminal A-like subtype, and all three parameters were the highest in the triple-negative subtype. Lower value of Emax was independently associated with the luminal A-like subtype (P = 0.04). Higher value of Emean was independently associated with axillary LN metastasis for tumors ≤ 20 mm (P = 0.03). CONCLUSION Increases in the tumor stiffness values on SWE were significantly associated with aggressive histopathologic features of breast cancer. Lower stiffness values were associated with the luminal A-like subtype, and tumors with higher stiffness values were associated with axillary LN metastasis in small breast cancers.
Collapse
Affiliation(s)
- Hee Jeong Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Hak Hee Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
| | - Woo Jung Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Eun Young Chae
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Hee Jung Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Joo Hee Cha
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| |
Collapse
|
|
24
|
Zhang X, Zheng Y, Li J, Zhang B. Application of the shear wave elastography in the assessment of carotid body tumors: A preliminary study. Front Oncol 2023; 12:1053236. [PMID: 36686815 PMCID: PMC9853190 DOI: 10.3389/fonc.2022.1053236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023] Open
Abstract
Objectives To evaluate the elasticity of carotid body tumors (CBTs) by two-dimensional shear wave elastography (SWE). Methods 22 pathologically or clinically confirmed CBTs in 16 patients were scanned by SWE. The maximum elasticity value (Emax) and its standard deviation (SDmax) in kPa and m/s for CBTs were obtained by placing a round ROI (2-3 mm) on the stiffest region of the CBTs. Elasticity value was compared between hard and soft groups at manual palpation, benign and malignant groups and among three Shamblin types. The area under the receiver operating characteristic curve (AUC) analysis was performed to evaluate the performance of SWE in the malignancy prediction of CBTs. Sensitivity, specificity and accuracy were calculated. The cut-off value was obtained by using the Youden index. Results There were 19 benign CBTs and 3 malignant CBTs. Emax (kPa and m/s) and SDmax (kPa) were significantly higher in the hard group than in the soft group at manual palpation (P<0.05); The distribution of Emax in kPa and m/s and SDmax in kPa were different in the three Shamblin types (P<0.05), Emax (kPa and m/s)increased from shambling I to Shambling II and Shambling III; Emax (kPa and m/s) were significantly higher in the malignant CBTs than in the benign ones (P<0.05). Emax in kPa and m/s had the similar AUC value (AUC=0.947, P=1.0000) for the prediction of malignant CBTs. Emax in kPa with the cut-off 124.9kPa showed a sensitivity of 100.0%, specificity of 94.7%, and an accuracy of 95.5% (Z=8.500, P<0.0001); Emax in m/s with the cut-off 5.9m/s showed a sensitivity of 100.0%, specificity of 89.5% and an accuracy of 90.9% for the prediction of malignant CBTs (Z=9.143, P<0.0001). Conclusions Quantitative analysis of SWE obtained the good performance in the elasticity assessment of CBTs.
Collapse
Affiliation(s)
- Xiaoyan Zhang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuehong Zheng
- Department of Vascular Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianchu Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Jianchu Li, ; Bo Zhang,
| | - Bo Zhang
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China,*Correspondence: Jianchu Li, ; Bo Zhang,
| |
Collapse
|
|
25
|
He H, Wu X, Jiang M, Xu Z, Zhang X, Pan J, Fu X, Luo Y, Chen J. Diagnostic accuracy of contrast-enhanced ultrasound synchronized with shear wave elastography in the differential diagnosis of benign and malignant breast lesions: a diagnostic test. Gland Surg 2023; 12:54-66. [PMID: 36761482 PMCID: PMC9906099 DOI: 10.21037/gs-22-684] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023]
Abstract
Background Breast cancer (BC) is one of the most common malignancies affecting women. Timely and accurate diagnosis is crucial for treatment and prognosis. Some studies have found that elastography combined with microperfusion characteristics, which are mostly described by contrast-enhanced ultrasound (CEUS), could help in the diagnosis of breast lesions. This study aimed to assess the diagnostic performance of CEUS synchronized with shear wave elastography (SWE) in discriminating between benign and malignant breast lesions by using real-time contrast elastography images to analyze shell elasticity and contrast intensity. Methods A total of 26 pathologically confirmed breast lesions in 26 patients were retrospectively reviewed. Each patient underwent conventional B-mode ultrasound, CEUS, and then SWE data was obtained from a frame of image that was almost identical to the B-mode and CEUS images when acquiring time to peak (TTP). Breast lesions were evaluated based on the Breast Imaging Reporting and Data System (BI-RADS) and quantitative characteristics that describe the stiffness and intensity of contrast of the 1.0-3.0 mm shell region. Quantitative aspects of the inner lesions and shell on the elastogram included the maximum (Emax), mean (Emean), and minimum (Emin) Young's moduli. Quantitative enhanced features included maximum (Imax) and mean (Imean) intensity. We took postoperative pathological results as the gold standard. Receiver operating characteristic (ROC) curves were used to compare the diagnostic efficacy of the 2 examination modalities, either alone or in combination. Results The age of the patients ranged from 23 to 76 years, with a 42.5-year average age. In all breast lesions, 19 were benign and 7 were malignant. SWE synchronized with CEUS can effectively improve the diagnostic performance of breast lesions, and Emean + Imean and Emax + Emean + Imean of shell at 1.0 mm both had the highest area under the curve (AUC) of 0.86 [95% confidence interval (CI): 0.67, 0.96], with the sensitivity and specificity of 71.43% and 89.47%, respectively. Conclusions The combination of CEUS and SWE has a better diagnostic value in differentiating benign and malignant breast lesions compared to separate techniques.
Collapse
Affiliation(s)
- Huiling He
- Department of Ultrasound Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Xiaojin Wu
- Zhejiang University School of Medicine, Hangzhou, China
| | - Meijuan Jiang
- Zhejiang University School of Medicine, Hangzhou, China
| | - Zhikang Xu
- Zhejiang University School of Medicine, Hangzhou, China
| | - Xuanxuan Zhang
- Department of Ultrasound Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Jianlian Pan
- Department of Clinical and Research, Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Xinyu Fu
- Department of Ultrasound Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Yunkai Luo
- Department of Ultrasound Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Jian Chen
- Department of Ultrasound Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| |
Collapse
|
|
26
|
Li J, Liu Y, Li Y, Li S, Wang J, Zhu Y, Lu H. Comparison of diagnostic potential of shear wave elastography between breast mass lesions and non-mass-like lesions. Eur J Radiol 2023; 158:110609. [PMID: 36423364 DOI: 10.1016/j.ejrad.2022.110609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/17/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Shear wave elastography (SWE) can improve the specificity of B-mode ultrasound (US) without reducing the sensitivity for breast cancer diagnosis. Existing research on SWE includes both mass lesions and non‑mass‑like (NML) lesions or only NML lesions; however, there are no studies comparing the diagnostic potential of SWE in the detection of mass and NML lesions in the same trial. OBJECTIVE This study aimed to compare the diagnostic performance of SWE in detecting mass lesions and NML lesions and determine the different individualised thresholds of the SWE parameters according to the lesion type. METHODS This Study included 623 breast lesions of 562 consecutive women, who were scheduled for conventional US and SWE between January 2021 and December 2021. The diagnostic performances of conventional US and each quantitative SWE parameter (maximum elastic modulus [Emax], mean elastic modulus [Emean], and elastic modulus standard deviation [Esd]) were assessed. Histological diagnosis for all Breast Imaging Reporting and Database System (BI-RADS) category 4/5 patients and some BI-RADS category 3 patients and the follow-up results of other BI-RADS category 3 patients were used as the reference standard. RESULTS In this study, 281 benign lesions and 342 malignant lesions were identified. The diagnostic performance of conventional US and SWE was better in the mass lesion group than in the NML lesion group. Every SWE parameter had a different threshold in each group, and the thresholds of the SWE parameters were higher in the mass lesion group than in the NML lesion group. In the mass lesion group, Esd had the highest Az value, whereas in the NML lesion group, Emax had the highest Az value. In both the mass and NML lesion groups, the diagnostic specificity of the combination of conventional US and SWE was significantly higher than that of conventional US alone (P < 0.05), without a significantly decrease in the diagnosticsensitivity. CONCLUSIONS SWE could increase the confidence of breast ultrasound diagnosis, especially for NML lesions. NML lesions had lower thresholds of SWE parameters than did the mass lesions.
Collapse
Affiliation(s)
- Junnan Li
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Yacong Liu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Yanbo Li
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Shuang Li
- Department of Bone and Tissue Oncology, Tianjin Hospital, Tianjin University, Tianjin, PR China
| | - Jiahui Wang
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Ying Zhu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Hong Lu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China.
| |
Collapse
|
|
27
|
Orguc S, Açar ÇR. Correlation of Shear-Wave Elastography and Apparent Diffusion Coefficient Values in Breast Cancer and Their Relationship with the Prognostic Factors. Diagnostics (Basel) 2022; 12:diagnostics12123021. [PMID: 36553027 PMCID: PMC9776617 DOI: 10.3390/diagnostics12123021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Diffusion-weighted imaging and elastography are widely accepted methods in the evaluation of breast masses, however, there is very limited data comparing the two methods. The apparent diffusion coefficient is a measure of the diffusion of water molecules obtained by diffusion-weighted imaging as a part of breast MRI. Breast elastography is an adjunct to conventional ultrasonography, which provides a noninvasive evaluation of the stiffness of the lesion. Theoretically, increased tissue density and stiffness are related to each other. The purpose of this study is to compare MRI ADC values of the breast masses with quantitative elastography based on ultrasound shear wave measurements and to investigate their possible relation with the prognostic factors and molecular subtypes. Methods: We retrospectively evaluated histopathologically proven 147 breast lesions. The molecular classification of malignant lesions was made according to the prognostic factors. Shear wave elastography was measured in kiloPascal (kPa) units which is a quantitative measure of tissue stiffness. DWI was obtained using a 1.5-T MRI system. Results: ADC values were strongly inversely correlated with elasticity (r = −0.662, p < 0.01) according to Pearson Correlation. In our study, the cut-off value of ADC was 1.00 × 10−3 cm2/s to achieve a sensitivity of 84.6% and specificity of 75.4%, and the cut-off value of elasticity was 105.5 kPa to achieve the sensitivity of 96.3% and specificity 76.9% to discriminate between the malignant and benign breast lesions. The status of prognostic factors was not correlated with the ADC values and elasticity. Conclusions: Elasticity and ADC values are correlated. Both cannot predict the status of prognostic factors and differentiate between molecular subtypes.
Collapse
|
|
28
|
Zhong X, Chen L, Long H, Zheng R, Su L, Duan Y, Xie X, Lin M. The "stiff rim" sign of hepatocellular carcinoma on shear wave elastography: correlation with pathological features and potential prognostic value. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:4115-4125. [PMID: 35962810 DOI: 10.1007/s00261-022-03628-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/01/2022] [Accepted: 07/13/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To explore the pathologic basis, the influencing factors and potential prognostic value of the stiff rim sign in two-dimensional shear wave elastography (2D-SWE) of hepatocellular carcinoma (HCC). METHODS HCC patients who underwent tumor 2D-SWE examination before resection were prospectively enrolled. The stiff rim sign was defined as increased stiffness in the peritumoral region. Interobserver and intraobserver variability of the stiff rim sign was assessed. The correlation between the stiff rim sign and pathological characteristics was analyzed. Multivariate analysis was performed to examine clinical and radiological factors influencing the appearance of stiff rim sign. The Kaplan-Meier method was used to analyze the relationship between recurrence-free survival (RFS) and the stiff rim sign. RESULTS The stiff rim sign on 2D-SWE was present in 44.7% of HCC lesions. Interobserver agreement and intraobserver agreement for the stiff rim sign were substantial (κ = 0.772) and almost perfect (κ = 0.895), respectively. Pathologically, the stiff rim sign was associated with capsule status, capsule integrity, capsule thickness, proportion of peritumoral fibrous tissue, and peritumoral fibrous arrangement. Multivariate analysis showed that tumor size was an independent clinical predictor for the appearance of stiff rim sign (OR 1.201, p = 0.008). Kaplan-Meier analysis showed RFS was significantly poorer in the stiff rim sign (+) group than the stiff rim sign (-) group in solitary tumors smaller than 5 cm (p = 0.007) and solitary tumors with intratumoral stiffness less than 33.7 kPa (p = 0.007). CONCLUSION The stiff rim sign on 2D-SWE was mainly correlated with peritumoral fibrous tissue status and was a poor prognostic indicator for HCC.
Collapse
Affiliation(s)
- Xian Zhong
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Lili Chen
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Haiyi Long
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Ruiying Zheng
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Liya Su
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Yu Duan
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Xiaoyan Xie
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Guangzhou, 510080, China
| | - Manxia Lin
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Second Road, Guangzhou, 510080, China.
| |
Collapse
|
|
29
|
Prospective analysis of breast masses using the combined score for quantitative ultrasonography parameters. Sci Rep 2022; 12:16205. [PMID: 36171328 PMCID: PMC9519555 DOI: 10.1038/s41598-022-19971-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 09/07/2022] [Indexed: 11/09/2022] Open
Abstract
To investigate the diagnostic value of combined SWE, SMI, and B-mode US scores for distinguishing between benign and malignant masses. A total of 450 breast masses that underwent US-guided core needle biopsies were prospectively enrolled. The breast masses were assessed based on the BI-RADS and quantitative SWE and SMI parameters. The SWEmax, SWEratio, and SMIVI cutoff value were determined using Youden’s index by comparison to the pathological results. The BI-RADS categories were scored on a scale from 1 to 5, and SWEmax, SWEratio, and SMIVI were dichotomized based on each cutoff values (0 or 1). The combined scores (1 to 8) were calculated as the sum of the BI-RADS score and the quantitative scores and compared to the pathologic results using AUROC analysis. The cutoff values were 52.25 kPa for SWEmax, 5.03 for SWEratio, and 2.15% for SMIVI. In AUROC, the combined scores showed significantly better diagnostic performance compared to BI-RADS alone (p < 0.001). The combined score showed significantly increased than BI-RADS alone in specificity (p < 0.001) and accuracy (p < 0.001), but a sensitivity decreased without significance (p = 0.082). When a combined score cutoff value of 4 was used, the false negative rate was 2.7%. Using the combined score, 76.4% of the C4a lesions were considered benign also pathologically diagnosed as benign. The combined scores showed improved diagnostic performance in differentiating between benign and malignant breast masses, which could be helpful for determining a breast biopsy eligibility.
Collapse
|
|
30
|
Value of shear wave elastography during second-look breast ultrasonography for suspicious lesions on magnetic resonance imaging. J Med Ultrason (2001) 2022; 49:719-730. [DOI: 10.1007/s10396-022-01253-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
|
|
31
|
Massimini M, Gloria A, Romanucci M, Della Salda L, Di Francesco L, Contri A. Strain and Shear-Wave Elastography and Their Relationship to Histopathological Features of Canine Mammary Nodular Lesions. Vet Sci 2022; 9:vetsci9090506. [PMID: 36136722 PMCID: PMC9500971 DOI: 10.3390/vetsci9090506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Mammary gland tumours have a significant impact on the health of dogs, requiring diagnostic tools to support clinicians to develop appropriate therapeutic strategies. Sonoelastography is an emerging technology that is able to define the stiffness of the tissue and has promising applications in the evaluation of mammary gland lesions. In the present study, strain elastography (STE) and shear-wave (SWE) elastography were compared in 38 mammary nodular lesions for their ability to define the histopathological features of canine mammary lesions. Among the techniques, SWE showed better repeatability (intraclass correlation coefficient: 0.876), whereas STE was found to be only acceptable (intraclass correlation coefficient: 0.456). Mammary nodular lesions showed a wide range of tissue stiffening with a similar mean value for STE and SWE in benign (4 ± 0.3 and 115.4 ± 12.6 kPa, respectively) and malignant lesions (3.8 ± 0.1 and 115.5 ± 4.5 kPa, respectively). A significant correlation was found between lesion fibrosis and STE (STE-I: r = 0.513, p < 0.001; STE-R: r = 0.591, p < 0.001) or SWE-S (r = 0.769; p < 0.001). In conclusion, SWE was reliable and correlated with fibrosis and was similar for both benign and malignant lesions, suggesting that other collateral diagnostic techniques should be considered in conjunction with SWE to characterize mammary nodular lesions in dogs.
Collapse
Affiliation(s)
- Marcella Massimini
- Faculty of Veterinary Medicine, University of Teramo, Loc. Piano d’Accio, 64100 Teramo, Italy
| | - Alessia Gloria
- Faculty of Veterinary Medicine, University of Teramo, Loc. Piano d’Accio, 64100 Teramo, Italy
- Correspondence: (A.G.); (L.D.S.)
| | - Mariarita Romanucci
- Faculty of Veterinary Medicine, University of Teramo, Loc. Piano d’Accio, 64100 Teramo, Italy
| | - Leonardo Della Salda
- Faculty of Veterinary Medicine, University of Teramo, Loc. Piano d’Accio, 64100 Teramo, Italy
- Correspondence: (A.G.); (L.D.S.)
| | - Lucia Di Francesco
- Faculty of Veterinary Medicine, University of Teramo, Loc. Piano d’Accio, 64100 Teramo, Italy
| | - Alberto Contri
- Faculty of Biosciences and Technologies for Agriculture Food and Environment, University of Teramo, Via Balzarini 1, 64100 Teramo, Italy
| |
Collapse
|
|
32
|
Tumsatan P, Uscharapong M, Srinakarin J, Nanagara R, Khunkitti W. Role of shear wave elastography ultrasound in patients with systemic sclerosis. J Ultrasound 2022; 25:635-643. [PMID: 35060098 PMCID: PMC9402835 DOI: 10.1007/s40477-021-00637-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE A study of shear wave elastography (SWE) for evaluation of skin stiffness in systemic sclerosis (SSc) patients. The purpose of this study was to measure the skin stiffness and thickness in patients with scleroderma using shear wave elastography. METHODS Prospective data collections of skin stiffness and thickness using SWE in SSc and control groups. RESULTS Skin stiffness and thickness were done in 29 patients with SSc and a 29 control population using SWE on bilateral forearms. The SSc patients had thicker skin and higher stiffnesses than the control group. The mean of skin thickness and stiffness using SWE of SSc are 1.74 mm and 47.32 kPa while normal subjects were 1.5 mm and 19.5 kPa. Mean differences were 0.023 mm (95% CI 0.15-0.3, p < 0.001) and 27.82 kPa (95% CI 22.63-33.01, p < 0.001). The dorsal forearms tend to have a higher SWE than the volar forearms in SSc. No statistically significant differences between gender, age or dominancy of skin stiffness were found. SWE has a good correlation with clinical manual palpation of forearms (mRSS) with Spearman rho's of 0.550 (p = 0.002) and 0.508 (p = 0.005) of dominant and non-dominant forearms. CONCLUSION The application of SWE can be used for evaluation of skin involvement in scleroderma patients with good correlations with the mRSS that was used in the current patients. Furthermore, SWE is a safe technique for either diagnosis or follow up.
Collapse
Affiliation(s)
- Panaya Tumsatan
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen District, Khon Kaen, 40002, Thailand.
| | - Meenut Uscharapong
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen District, Khon Kaen, 40002, Thailand
| | - Jiraporn Srinakarin
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen District, Khon Kaen, 40002, Thailand
| | - Ratanavadee Nanagara
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen District, Khon Kaen, 40002, Thailand
| | - Watcharee Khunkitti
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Khon Kaen University, Khon Kaen, 40002, Thailand
| |
Collapse
|
|
33
|
Cui YY, He NA, Ye XJ, Hu L, Xie L, Zhong W, Zhang CX. Evaluation of Tissue Stiffness Around Lesions by Sound Touch Shear Wave Elastography in Breast Malignancy Diagnosis. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1672-1680. [PMID: 35672199 DOI: 10.1016/j.ultrasmedbio.2022.04.219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/09/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
The aim of the study described here was to assess the evaluation of tissue stiffness around lesions by sound touch shear wave elastography (STE) in breast malignancy diagnosis. This was an institutional ethics committee-approved, single-center study. A total of 90 women with breast masses examined with conventional ultrasound and STE were eligible for enrollment from December 2020 to July 2021. The maximum and mean elastic values of masses, Emax and Emean, were determined. Shell function was used to measure the maximum and mean elastic values of tissues around masses in annular shells 0.5, 1.0, 1.5 and 2.0 mm wide, recorded as corresponding Emax-shell and Emean-shell. All parameters were analyzed and compared with histopathologic results. Receiver operating characteristic curves were constructed to assess diagnostic performance. Logistic regression analysis was conducted to determine the best diagnostic model. Collagen fiber content of tissues around breast lesions was evaluated using Masson staining and ImageJ software. Ninety women with breast masses were included in this study; 50 had benign (mean diameter 15.84 ± 4.39 mm) and 40 had malignant (mean diameter 17.40 ± 5.42 mm) masses. The diagnostic value of Emax-shell-2.0 was the highest (area under the curve = 0.930) with a sensitivity of 87.5% and specificity of 88%. According to stepwise logistic regression analysis, Emax-shell-2.0 and age were independent predictors of malignancy. Emax-shell-2.0 was also found to be highly correlated with the collagen fiber content of tissue in the malignant group (r = 0.877). Tissue stiffness around lesions measured by STE is a useful metric in identifying malignant breast masses by reflecting collagen fiber content, and Emax-shell-2.0 performs best.
Collapse
Affiliation(s)
- Ya-Yun Cui
- Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Nian-An He
- Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Xian-Jun Ye
- Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Lei Hu
- Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Li Xie
- Department of Ultrasound, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Wen Zhong
- Department of Pathology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Chao-Xue Zhang
- Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
| |
Collapse
|
|
34
|
Morin M, Salomoni SE, Stafford RE, Hall LM, Hodges PW. Validation of shear wave elastography as a noninvasive measure of pelvic floor muscle stiffness. Neurourol Urodyn 2022; 41:1620-1628. [PMID: 35842828 DOI: 10.1002/nau.25010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To investigate the validity of shear wave elastography (SWE) as a measure of stiffness of the puborectalis muscle by examining: (1) the relationship between puborectalis muscle stiffness and pelvic floor muscle (PFM) activation at different intensities; and (2) the relationship between puborectalis stiffness and pelvic floor morphometry during contractions at different intensities. METHODS Fifteen healthy asymptomatic women performed 6-s isometric PFM contractions at different intensities (0, 10%, 20%, 30%, 50%, 75%, and 100% of maximal voluntary contraction) guided by intravaginal electromyography (EMG). Stiffness of the puborectalis muscle was measured using SWE by calculating the average shear modulus in regions of interest that contained puborectalis muscle fibers parallel to the transducer. Pelvic floor morphometry was assessed in the mid-sagittal plane using transperineal B-mode ultrasound imaging. Shear modulus, EMG (root mean square amplitude) and pelvic floor morphometry parameters were normalized to the value recorded during maximal voluntary contraction. To assess the relationship between stiffness and pelvic floor activation/morphometry, coefficient of determination (r2 ) was calculated for each participant and a group average was computed. RESULTS Shear modulus and EMG were highly correlated (average r2 ; left 0.90 ± 0.08, right 0.87 ± 0.15). Shear modulus also strongly correlated with bladder neck position (x-axis horizontal coordinates relative to the pubic symphysis), anorectal rectal angle and position, levator plate angle, and antero-posterior diameter of the levator hiatus (average r2 : range 0.62-0.78). CONCLUSIONS These findings support the validity of SWE to assess puborectalis muscle stiffness in females. Stiffness measures were strongly associated with PFM EMG and pelvic floor morphometry and may be used to indirectly assess the level of activation of the puborectalis muscle without the use of more invasive techniques. By overcoming limitations of current assessment tools, this promising noninvasive and real-time technique could enable important breakthrough in the pathophysiology and management of pelvic floor disorders.
Collapse
Affiliation(s)
- Mélanie Morin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Center of the Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, Québec, Canada
| | - Sauro E Salomoni
- School of Health and Rehabilitation Sciences, Center for Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Ryan E Stafford
- School of Health and Rehabilitation Sciences, Center for Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Leanne M Hall
- School of Health and Rehabilitation Sciences, Center for Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, Center for Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
|
35
|
Mahadevan GSV, Chakkalakkoombil SV, Kayal S, Dharanipragada K, Toi PC, Ananthakrishnan R. Evaluation of change in tumor stiffness measured by acoustic radiation force impulse imaging for early prediction of response to neoadjuvant chemotherapy in breast cancer. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:666-674. [PMID: 35353384 DOI: 10.1002/jcu.23201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/16/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES In this study, the role of change in tumor stiffness between pre- and post-two cycles of neoadjuvant chemotherapy (NACT) measured by Acoustic Radiation Force Impulse (ARFI) imaging for predicting the response to NACT in breast cancer was analyzed. METHODS Fifty-two adult women with biopsy-proven locally advanced breast cancer and early-stage breast cancer who received NACT followed by either modified radical mastectomy or breast conservation surgery were included in the study. Tumor stiffness represented by shear wave velocity (SWV) in meter per second by ARFI imaging was measured before and after two cycles of NACT. Participants were categorized into responders and nonresponders based on pathological response assessment from the postoperative specimen. The association of change in tumor stiffness between pre- and post-two cycles of NACT with final pathological response status was assessed. RESULTS The mean change in SWV before and after completion of two cycles of NACT was 0.42 ± 0.16 and 0.17 ± 0.11 m/s in responders and nonresponders, respectively, and this difference was proven to be statistically significant (p < 0.001) suggesting that tumors that exhibit a larger reduction in tumor stiffness, respond better. An SWV reduction cut-off of 0.295 m/s between baseline and post-two cycles of NACT was also arrived at, which can discriminate between responders and nonresponders with a sensitivity and specificity of 88% and 83%, respectively. CONCLUSION Difference in tumor stiffness measured by ARFI imaging before and after two cycles of chemotherapy can be used as a reliable early predictor of response to chemotherapy in breast cancer.
Collapse
Affiliation(s)
| | | | - Smita Kayal
- Department of Medical Oncology, JIPMER, Pondicherry, India
| | | | - Pampa Ch Toi
- Department of Pathology, JIPMER, Pondicherry, India
| | | |
Collapse
|
|
36
|
Sneider A, Kiemen A, Kim JH, Wu PH, Habibi M, White M, Phillip JM, Gu L, Wirtz D. Deep learning identification of stiffness markers in breast cancer. Biomaterials 2022; 285:121540. [PMID: 35537336 PMCID: PMC9873266 DOI: 10.1016/j.biomaterials.2022.121540] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 02/07/2023]
Abstract
While essential to our understanding of solid tumor progression, the study of cell and tissue mechanics has yet to find traction in the clinic. Determining tissue stiffness, a mechanical property known to promote a malignant phenotype in vitro and in vivo, is not part of the standard algorithm for the diagnosis and treatment of breast cancer. Instead, clinicians routinely use mammograms to identify malignant lesions and radiographically dense breast tissue is associated with an increased risk of developing cancer. Whether breast density is related to tumor tissue stiffness, and what cellular and non-cellular components of the tumor contribute the most to its stiffness are not well understood. Through training of a deep learning network and mechanical measurements of fresh patient tissue, we create a bridge in understanding between clinical and mechanical markers. The automatic identification of cellular and extracellular features from hematoxylin and eosin (H&E)-stained slides reveals that global and local breast tissue stiffness best correlate with the percentage of straight collagen. Importantly, the percentage of dense breast tissue does not directly correlate with tissue stiffness or straight collagen content.
Collapse
Affiliation(s)
- Alexandra Sneider
- Department of Chemical and Biomolecular Engineering, Johns Hopkins Physical Sciences-Oncology Center, Institute for NanoBioTechnology, Johns Hopkins University, 3400 N Charles St, Baltimore, MD, 21218, USA
| | - Ashley Kiemen
- Department of Chemical and Biomolecular Engineering, Johns Hopkins Physical Sciences-Oncology Center, Institute for NanoBioTechnology, Johns Hopkins University, 3400 N Charles St, Baltimore, MD, 21218, USA
| | - Joo Ho Kim
- Department of Materials Science and Engineering, Institute for NanoBioTechnology, Johns Hopkins University, 3400 N Charles St, Baltimore, MD, 21218, USA
| | - Pei-Hsun Wu
- Department of Chemical and Biomolecular Engineering, Johns Hopkins Physical Sciences-Oncology Center, Institute for NanoBioTechnology, Johns Hopkins University, 3400 N Charles St, Baltimore, MD, 21218, USA
| | - Mehran Habibi
- Johns Hopkins Breast Center, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave, Baltimore, MD, 21224, USA
| | - Marissa White
- Department of Pathology, Johns Hopkins School of Medicine, 401 N Broadway, Baltimore, MD, 21231, USA
| | - Jude M. Phillip
- Department of Chemical and Biomolecular Engineering, Johns Hopkins Physical Sciences-Oncology Center, Institute for NanoBioTechnology, Johns Hopkins University, 3400 N Charles St, Baltimore, MD, 21218, USA,Department of Biomedical Engineering, Johns Hopkins University, 3400 N Charles St, Baltimore, MD, 21218, USA
| | - Luo Gu
- Department of Materials Science and Engineering, Institute for NanoBioTechnology, Johns Hopkins University, 3400 N Charles St, Baltimore, MD, 21218, USA
| | - Denis Wirtz
- Department of Chemical and Biomolecular Engineering, Johns Hopkins Physical Sciences-Oncology Center, Institute for NanoBioTechnology, Johns Hopkins University, 3400 N Charles St, Baltimore, MD, 21218, USA,Department of Pathology, Johns Hopkins School of Medicine, 401 N Broadway, Baltimore, MD, 21231, USA,Department of Oncology, Johns Hopkins School of Medicine, 1800 Orleans St, Baltimore, MD, 21205, USA,Corresponding author. Department of Chemical and Biomolecular Engineering, Johns Hopkins Physical Sciences-Oncology Center, and Institute for NanoBioTechnology, Johns Hopkins University, 3400 N Charles St, Baltimore, MD, 21218, USA., (D. Wirtz)
| |
Collapse
|
|
37
|
The Benefit of Superb Microvascular Imaging and Shear Wave Elastography in Differentiating Metastatic Axillary Lymphadenopathy from Lymphadenitis. Clin Breast Cancer 2022; 22:515-520. [DOI: 10.1016/j.clbc.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/11/2022] [Accepted: 03/09/2022] [Indexed: 11/20/2022]
|
|
38
|
Gubarkova EV, Sovetsky AA, Vorontsov DA, Buday PA, Sirotkina MA, Plekhanov AA, Kuznetsov SS, Matveyev AL, Matveev LA, Gamayunov SV, Vorontsov AY, Zaitsev VY, Gladkova ND. Compression optical coherence elastography versus strain ultrasound elastography for breast cancer detection and differentiation: pilot study. BIOMEDICAL OPTICS EXPRESS 2022; 13:2859-2881. [PMID: 35774307 PMCID: PMC9203088 DOI: 10.1364/boe.451059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 05/20/2023]
Abstract
The aims of this study are (i) to compare ultrasound strain elastography (US-SE) and compression optical coherence elastography (C-OCE) in characterization of elastically linear phantoms, (ii) to evaluate factors that can cause discrepancy between the results of the two elastographic techniques in application to real tissues, and (iii) to compare the results of US-SE and C-OCE in the differentiation of benign and malignant breast lesions. On 22 patients, we first used standard US-SE for in vivo assessment of breast cancer before and then after the lesion excision C-OCE was applied for intraoperative visualization of margins of the tumors and assessment of their type/grade using fresh lumpectomy specimens. For verification, the tumor grades and subtypes were determined histologically. We show that in comparison to US-SE, quantitative C-OCE has novel capabilities due to its ability to locally control stress applied to the tissue and obtain local stress-strain curves. For US-SE, we demonstrate examples of malignant tumors that were erroneously classified as benign and vice versa. For C-OCE, all lesions are correctly classified in agreement with the histology. The revealed discrepancies between the strain ratio given by US-SE and ratio of tangent Young's moduli obtained for the same samples by C-OCE are explained. Overall, C-OCE enables significantly improved specificity in breast lesion differentiation and ability to precisely visualize margins of malignant tumors compared. Such results confirm high potential of C-OCE as a high-speed and accurate method for intraoperative assessment of breast tumors and detection of their margins.
Collapse
Affiliation(s)
| | | | | | - Pavel A. Buday
- Nizhny Novgorod Regional Oncologic Hospital, Nizhny Novgorod, Russia
| | | | | | | | | | - Lev A. Matveev
- Institute of Applied Physics RAS, Nizhny Novgorod, Russia
| | | | | | - Vladimir Y. Zaitsev
- Institute of Applied Physics RAS, Nizhny Novgorod, Russia
- Equally contributed
| | - Natalia D. Gladkova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
- Equally contributed
| |
Collapse
|
|
39
|
Aybar MD, Turna O. Evaluation of Different Types of Breast Lesions With Apparent Diffusion Coefficient and Shear Wave Elastography Values: Comparison of Shear Wave Elastography and Apparent Diffusion Coefficient in Breast Lesions. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221091245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The aim of this study was to compare the stiffness of different histological types of breast lesions by obtaining shear wave elastography (SWE) and apparent diffusion coefficient (ADC) values, and to determine the contribution of these two methods to the diagnosis. Materials and Methods: In total, 70 patients with biopsy-proven breast lesions were included in the study. The mean SWE values of breast lesions were recorded and ADC values of these lesions were calculated. Receiver operating characteristic (ROC) curve analyses and the diagnostic accuracies of SWE-ADC values were determined. Results: The mean SWE values were 45.47 ± 25.11 kPa and 3.51 ± 1.04 m/s in benign group, and 161.11 ± 219.34 kPa and 5.96 ± 1.06 m/s in malignant group, respectively. The mean ADC values were 1.38 ± 0.32 (×10–3 mm2/s) in benign group and 0.96 ± 0.22 (×10–3 mm2/s) in malignant group, respectively. When the diagnostic performances of both imaging modalities on mass stiffness are evaluated, statistically significant negative correlations were found between SWE lesion values and ADC lesion values. Conclusion: Evaluation of tissue elasticity has recently been used frequently in the diagnosis of breast diseases. SWE-ADC values, which are negatively correlated in the diagnosis of breast masses, may prove to be a powerful alternative diagnostic tool that can be used interchangeably, as appropriate.
Collapse
Affiliation(s)
- M. Devran Aybar
- Medical Imaging Techniques, Istanbul Gelişim University, Istanbul, Turkey
| | - Onder Turna
- Mehmet Akif Ersoy Training and Research Hospital Radiology Department, Istanbul, Turkey
| |
Collapse
|
|
40
|
Luo C, Lu L, Zhang W, Li X, Zhou P, Ran Z. The Value of Shear Wave Elastography in the Diagnosis of Breast Cancer Axillary Lymph Node Metastasis and Its Correlation With Molecular Classification of Breast Masses. Front Oncol 2022; 12:846568. [PMID: 35372023 PMCID: PMC8968036 DOI: 10.3389/fonc.2022.846568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the diagnostic value of shear wave elastography examination (SWE) on axillary node metastasis (ANM) in breast cancer, this study aimed to evaluate the correlation between the SWE features and different molecular types of breast cancer, and to check the elastic modulus differences among the molecular types. METHODS Breast cancer patients from November 2020 to December 2021 were subjected to both conventional ultrasonic examination (CUE) and SWE before ultrasound-guided percutaneous biopsy or axillary lymph node dissection (ALND). We used the pathological results as the gold standard to draw the receiver operating characteristic (ROC) curve. RESULTS SWE outperforms CUE, but their conjunctive use is the best option. No significant correlation was found between the elastic modulus values and the molecular types of breast cancer. CONCLUSION SWE can be used as an routine auxiliary method of CUE for ANM.
Collapse
Affiliation(s)
- Changyun Luo
- Regular Physical Examination Centre, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Li Lu
- Ultrasonography Department, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Weifu Zhang
- Public Health Section, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Xiangqi Li
- Breast Surgery, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Ping Zhou
- Liyang People’s Hospital, Liyang, China
| | - Zhangshen Ran
- Regular Physical Examination Centre, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| |
Collapse
|
|
41
|
Liu C, Zhou J, Chang C, Zhi W. Feasibility of Shear Wave Elastography Imaging for Evaluating the Biological Behavior of Breast Cancer. Front Oncol 2022; 11:820102. [PMID: 35155209 PMCID: PMC8830494 DOI: 10.3389/fonc.2021.820102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/30/2021] [Indexed: 12/27/2022] Open
Abstract
Objective To explore the feasibility of shear wave elastography (SWE) parameters for assessing the biological behavior of breast cancer. Materials and Methods In this prospective study, 224 breast cancer lesions in 216 female patients were examined by B-mode ultrasound and shear wave elastography in sequence. The maximum size (Smax) of the lesion was measured by B-mode ultrasound, and then shear wave elastography was performed on this section to obtain relevant parameters, including maximum elasticity (Emax), mean elasticity (Emean), standard deviation of elasticity (SD), and the area ratio of shear wave elastography to B-mode ultrasound (AR). The relationship between SWE parameters and pathological type, histopathological classification, histological grade, lymphovascular invasion status (LVI), axillary lymph node status (ALN), and immunohistochemistry of breast cancer lesions was performed according to postoperative pathology. Results In the univariate analysis, the pathological type and histopathological classification of breast cancer were not significantly associated with SWE parameters; with an increase in the histological grade of invasive ductal carcinoma (IDC), SD (p = 0.016) and Smax (p = 0.000) values increased. In the ALN-positive group, Smax (p = 0.004) was significantly greater than in the ALN-negative group; Smax (p = 0.003), Emax (p = 0.034), and SD (p = 0.045) were significantly higher in the LVI-positive group than in the LVI-negative group; SD (p = 0.043, p = 0.047) and Smax (p = 0.000, p = 0.000) were significantly lower in the ER+ and PR+ groups than in the ER- and PR- groups, respectively; AR (p = 0.032) was significantly higher in the ER+ groups than in the ER- groups, and Smax (p = 0.002) of the HER2+ group showed higher values than that of the HER2- group; Smax (p = 0.000), SD (p = 0.006), and Emax (p = 0.004) of the Ki-67 high-expression group showed significantly higher values than those of the Ki-67 low-expression group. In the multivariate analysis, Ki-67 was an independent factor of Smax (p = 0.005), Emax (p = 0.004), and SD (p = 0.006); ER was an independent influencing factor of Smax (p = 0.000) and AR (p = 0.032). LVI independently influences Smax (p = 0.006). Conclusions The SWE parameters Emax, SD, and AR can be used to evaluate the biological behavior of breast cancer.
Collapse
Affiliation(s)
- Chaoxu Liu
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jin Zhou
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Cai Chang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenxiang Zhi
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| |
Collapse
|
|
42
|
Li B, Zhao X, Wang Q, Jing H, Shao H, Zhang L, Cheng W. Prediction of high nodal burden in invasive breast cancer by quantitative shear wave elastography. Quant Imaging Med Surg 2022; 12:1336-1347. [PMID: 35111628 DOI: 10.21037/qims-21-580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Axillary imaging has been earmarked to forecast high nodal burden [≥3 metastatic axillary lymph nodes (ALN)] instead of lymph node metastasis since the Z0011 trial period. We aimed to ascertain the possibility of utilising quantitative shear wave elastography (SWE) to forecast high nodal burden in invasive breast cancer (IBC). METHODS In our hospital, 324 patients with clinical T1-T2N0 IBC who underwent surgery from June 2020 to October 2020 were analyzed retrospectively. A total of 273 patients (84.3%) were categorized as having a limited nodal burden, while 51 patients (15.7%) had a high nodal burden. The two groups were compared in terms of clinicopathological traits, ultrasonic features, and SWE values. The diagnostic performance for prediction of high nodal burden with the optimal cutoff values was drawn by SWE value. RESULTS The optimal cutoff values for forecasting high nodal burden were as demonstrated: 119.52 kPa for tumor Emax, 97.31 kPa for tumor Emean, 19.38 for tumor Esd, 26.22 kPa for ALN Emax, 19.79 kPa for ALN Emean, 2.32 for ALN Eratio, 3.34 for ALN Esd. Combined with the ratings of sensitivity and specificity, ALN Emax could be chosen as the optimal index if the best diagnostic achievement was contemplated (AUC: 0.856; 95% CI: 0.802-0.909). CONCLUSIONS An Emax cutoff 26.22 kPa of ALN, 72% of women with a high nodal burden of axillary disease would be detected, but if used for clinical decision making, 13% of women with a limited nodal burden disease would be potentially over treated. This data can allow us to appropriately ascertain this subgroup and can be used as one of the therapeutic implementation resources for patient decision support.
Collapse
Affiliation(s)
- Bo Li
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xin Zhao
- Department of Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qiucheng Wang
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hui Jing
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hua Shao
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Lei Zhang
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| |
Collapse
|
|
43
|
Huang S, Ye X, Yang K, Tian H, Ding Z, Chen J, Xu J, Dong F. The significance of dual-mode elastography in the diagnosis of breast lesions by physicians with different levels of experience. Quant Imaging Med Surg 2022; 12:1438-1449. [PMID: 35111637 PMCID: PMC8739147 DOI: 10.21037/qims-21-636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/08/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aimed to assess the diagnostic value of dual-mode elastography for benign and malignant breast lesions and determine whether this technique can improve the diagnostic ability of physicians with different levels of experience. METHODS One hundred and eighty-three breast lesions were analyzed retrospectively, and the following values were calculated for the lesions with various shells: shear modulus (G), Young's modulus (E), shear wave velocity (Cs), and strain ratio (SR). A random forest algorithm was used to select the optimal modes for elastography. A receiver operating characteristic curve was used to assess the diagnostic efficacy for benign and malignant breast lesions. Sensitivity and specificity values were calculated to evaluate any improvements in the diagnostic efficacy of physicians with different levels of experience (junior, intermediate-level, and senior) in the evaluation of malignant breast lesions using dual-mode elastography. RESULTS The best-performing mode of shear wave elastography (SWE) in the diagnosis of breast lesions was the A'min 1.0 (Cs) mode (minimum shear wave velocity of the area of interest and 1.0 mm around the area of interest), and the best-performing mode of strain elastography (SE) was the B/A' 0.5 (ratio of fat to the elasticity of the area of interest and 0.5 mm around the area of interest). When the two methods were used in series, results showed high specificity (98%), positive likelihood ratio (PLR) (21.2), and positive predictive value (PPV) (95%). Series means that if SE and SWE were malignant, the result in series was malignant, and that if either SE or SWE was benign, the result in series was benign. When the methods were used in parallel, the results showed high sensitivity (91%), negative likelihood ratio (NLR) (0.15), and negative predictive value (NPV) (89%). Parallel means that if SE and SWE were benign, the result in parallel was benign, and that if either SE or SWE was malignant, the result in parallel was malignant. When conventional ultrasound was combined with dual-mode elastography, the intermediate-level and junior physicians' diagnoses of breast lesions showed a higher sensitivity, specificity, and area under the curve than conventional ultrasound diagnosis alone. CONCLUSIONS Dual-mode elastography is effective in the diagnosis of breast lesions. The sensitivity and specificity values in this study show that diagnoses made by junior and intermediate-level physicians improve when dual-mode elastography is used, although diagnoses made by senior physicians do not improve significantly.
Collapse
Affiliation(s)
| | | | - Keen Yang
- Department of Ultrasound, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | | | | | - Jing Chen
- Department of Ultrasound, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | | | | |
Collapse
|
|
44
|
Mao YJ, Lim HJ, Ni M, Yan WH, Wong DWC, Cheung JCW. Breast Tumour Classification Using Ultrasound Elastography with Machine Learning: A Systematic Scoping Review. Cancers (Basel) 2022; 14:367. [PMID: 35053531 PMCID: PMC8773731 DOI: 10.3390/cancers14020367] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/21/2022] Open
Abstract
Ultrasound elastography can quantify stiffness distribution of tissue lesions and complements conventional B-mode ultrasound for breast cancer screening. Recently, the development of computer-aided diagnosis has improved the reliability of the system, whilst the inception of machine learning, such as deep learning, has further extended its power by facilitating automated segmentation and tumour classification. The objective of this review was to summarize application of the machine learning model to ultrasound elastography systems for breast tumour classification. Review databases included PubMed, Web of Science, CINAHL, and EMBASE. Thirteen (n = 13) articles were eligible for review. Shear-wave elastography was investigated in six articles, whereas seven studies focused on strain elastography (5 freehand and 2 Acoustic Radiation Force). Traditional computer vision workflow was common in strain elastography with separated image segmentation, feature extraction, and classifier functions using different algorithm-based methods, neural networks or support vector machines (SVM). Shear-wave elastography often adopts the deep learning model, convolutional neural network (CNN), that integrates functional tasks. All of the reviewed articles achieved sensitivity ³ 80%, while only half of them attained acceptable specificity ³ 95%. Deep learning models did not necessarily perform better than traditional computer vision workflow. Nevertheless, there were inconsistencies and insufficiencies in reporting and calculation, such as the testing dataset, cross-validation, and methods to avoid overfitting. Most of the studies did not report loss or hyperparameters. Future studies may consider using the deep network with an attention layer to locate the targeted object automatically and online training to facilitate efficient re-training for sequential data.
Collapse
Affiliation(s)
- Ye-Jiao Mao
- Department of Bioengineering, Imperial College, London SW7 2AZ, UK;
| | - Hyo-Jung Lim
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Ming Ni
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China;
- Department of Orthopaedics, Pudong New Area People’s Hospital Affiliated to Shanghai University of Medicine and Health Science, Shanghai 201299, China
| | - Wai-Hin Yan
- Department of Economics, The Chinese University of Hong Kong, Hong Kong 999077, China;
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong 999077, China
| |
Collapse
|
|
45
|
Yu JF, Zhang S, Yin HH, Zhou BG, Pu YY, Fang Y, Du D, Zhang Y, Xu HX. Two-dimensional shear wave elastography with two different systems for the diagnosis of breast lesions. Clin Hemorheol Microcirc 2022; 82:53-62. [PMID: 35599476 DOI: 10.3233/ch-221471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Two-dimensional (2D) - shear wave elastography (SWE) has made promising advances in the diagnostic of breast lesions. However, few studies have assessed whether the diagnostic effectiveness of different platforms employing 2D-SWE is equal or different. OBJECTIVE To compare the diagnostic effectiveness of 2D-SWE techniques from two different systems in differentiating malignant breast lesions from benign ones. METHODS A total of 84 breast lesions were retrospectively analyzed by experienced radiologists using 2D-SWE on two ultrasound systems, i.e. system-1 (LOGIQ E9 system, GE Healthcare, Wauwatosa, WI, USA), and system-2 (Aixplorer US system, SuperSonic Imagine, Aix-en-Provence, France). Qualitative and quantitative parameters including color sign, the maximum elasticity modulus values (E-max), the mean elasticity modulus values (E-mean) and standard deviation (E-sd) of elasticity modulus values in two 2D-SWE systems were analyzed. The diagnostic performance between system-1 and system-2 were evaluated in terms of the areas under the receiver operating characteristic curves (AUROCs). RESULTS Among the 84 lesions in this study, 66 (78.6%) were benign and 18 (21.4%) were malignant. E-max in system-1 showed the best diagnostic performance with a cut-off value of 174.5 kPa with the associated sensitivity and specificity of 100.0% and 80.3% respectively. Meanwhile, E-sd in system-2 displayed the best diagnostic performance with a cut-off value of 12.7 kPa, with the associated sensitivity and specificity of 94.4% and 80.3% respectively. The diagnostic performance of the two 2D-SWE systems was not statistically different according to receiver operating characteristic curve (ROC) analysis of E-max, E-mean, and E-sd. CONCLUSION For identifying breast lesions, system-1 and system-2 appear to be similar in diagnostic performance. However, different cut-off values for different parameters might be selected to obtain the best diagnostic performance for the two 2D-SWE systems.
Collapse
Affiliation(s)
- Ji-Feng Yu
- Department of Medical Ultrasound, Shanghai Tenth Hospital, School of Clinical Medicine of Nanjing Medical University, Shanghai, P.R. China
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
| | - Shen Zhang
- Department of Medical Ultrasound, Shanghai Tenth Hospital, School of Clinical Medicine of Nanjing Medical University, Shanghai, P.R. China
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
| | - Hao-Hao Yin
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
| | - Bang-Guo Zhou
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
| | - Yin-Ying Pu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
| | - Yan Fang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
| | - Dou Du
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
| | - Yan Zhang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth Hospital, School of Clinical Medicine of Nanjing Medical University, Shanghai, P.R. China
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital; Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University. Shanghai, P.R. China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment; National Clinical Research Center for Interventional Medicine, Shanghai, P.R. China
| |
Collapse
|
|
46
|
A Cross-Machine Comparison of Shear-Wave Speed Measurements Using 2D Shear-Wave Elastography in the Normal Female Breast. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11209391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Quantitative measures of radiation-induced breast stiffness are required to support clinical studies of novel breast radiotherapy regimens and exploration of personalised therapy, however, variation between shear-wave elastography (SWE) machines may limit the usefulness of shear-wave speed (cs) for this purpose. Mean cs measured in four healthy volunteers’ breasts and a phantom using 2D-SWE machines Acuson S2000 (Siemens Medical Solutions) and Aixplorer (Supersonic Imagine) were compared. Shear-wave speed was measured in the skin region, subcutaneous adipose tissue and parenchyma. cs estimates were on average 2.3% greater when using the Aixplorer compared to S2000 in vitro. In vivo, cs estimates were on average 43.7%, 36.3% and 49.9% significantly greater (p << 0.01) when using the Aixplorer compared to S2000, for skin region, subcutaneous adipose tissue and parenchyma, respectively. In conclusion, despite relatively small differences between machines observed in vitro, large differences in absolute measures of shear wave speed measured were observed in vivo, which may prevent pooling of cross-machine data in clinical studies of the breast.
Collapse
|
|
47
|
Cantisani V, David E, Barr RG, Radzina M, de Soccio V, Elia D, De Felice C, Pediconi F, Gigli S, Occhiato R, Messineo D, Fresilli D, Ballesio L, D'Ambrosio F. US-Elastography for Breast Lesion Characterization: Prospective Comparison of US BIRADS, Strain Elastography and Shear wave Elastography. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:533-540. [PMID: 32330993 DOI: 10.1055/a-1134-4937] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of strain elastography (SE) and 2 D shear wave elastography (SWE) and SE/SWE combination in comparison with conventional multiparametric ultrasound (US) with respect to improving BI-RADS classification results and differentiating benign and malignant breast lesions using a qualitative and quantitative assessment. MATERIALS AND METHODS In this prospective study, 130 histologically proven breast masses were evaluated with baseline US, color Doppler ultrasound (CDUS), SE and SWE (Toshiba Aplio 500 with a 7-15 MHz wide-band linear transducer). Each lesion was classified according to the BIRADS lexicon by evaluating the size, the B-mode and color Doppler features, the SE qualitative (point color scale) and SE semi-quantitative (strain ratio) methods, and quantitative SWE. Histological results were compared with BIRADS, strain ratio (SR) and shear wave elastography (SWE) all performed by one investigator blinded to the clinical examination and mammographic results at the time of the US examination. The area under the ROC curve (AUC) was calculated to evaluate the diagnostic performance of B-mode US, SE, SWE, and their combination. RESULTS Histological examination revealed 47 benign and 83 malignant breast lesions. The accuracy of SR was statistically significantly higher than SWE (sensitivity, specificity and AUC were 89.2 %, 76.6 % and 0.83 for SR and 72.3 %, 66.0 % and 0.69 for SWE, respectively, p = 0.003) but not higher than B-mode US (B-mode US sensitivity, specificity and AUC were 85.5 %, 78.8 %, 0.821, respectively, p = 1.000). CONCLUSION Our experience suggests that conventional US in combination with both SE and SWE is a valid tool that can be useful in the clinical setting, can improve BIRADS category assessment and may help in the differentiation of benign from malignant breast lesions, with SE having higher accuracy than SWE.
Collapse
Affiliation(s)
- Vito Cantisani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Emanuele David
- Radiological Sciences, Radiology Unit, Papardo-Hospital, Messina, Italy, Messina, Italy
| | - Richard G Barr
- Radiology, Northeastern Ohio Medical University, Youngstown, United States
| | - Maija Radzina
- Radiology Department, Pauls Stradins Clinical University Hospital, Riga Stradins University, Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Valeria de Soccio
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Daniela Elia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Carlo De Felice
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | | | - Rossella Occhiato
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Daniela Messineo
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Daniele Fresilli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Laura Ballesio
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Ferdinando D'Ambrosio
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| |
Collapse
|
|
48
|
Swan KZ, Nielsen VE, Bonnema SJ. Evaluation of thyroid nodules by shear wave elastography: a review of current knowledge. J Endocrinol Invest 2021; 44:2043-2056. [PMID: 33864241 DOI: 10.1007/s40618-021-01570-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/04/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Shear wave elastography (SWE), as a tool for diagnosing thyroid malignancy, has gathered considerable attention during the past decade. Diverging results exist regarding the diagnostic performance of thyroid SWE. METHODS A comprehensive literature review of thyroid SWE was conducted using the terms "Thyroid" and "shear wave elastography" in PubMed. RESULTS The majority of studies found SWE promising for differentiating malignant and benign thyroid nodules on a group level, whereas results are less convincing on the individual level due to huge overlap in elasticity indices. Further, there is lack of consensus on the optimum outcome reflecting nodule elasticity and the cut-off point predicting thyroid malignancy. While heterogeneity between studies hinders a clinically meaningful meta-analysis, the results are discussed in a clinical perspective with regard to applicability in clinical practice as well as methodological advantages and pitfalls of this technology. CONCLUSION Technological as well as biological hindrances seem to exist for SWE to be clinically reliable in assessing benign and malignant thyroid nodules. Structural heterogeneity of thyroid nodules in combination with operator-dependent factors such as pre-compression and selection of scanning plane are likely explanations for these findings. Standardization and consensus on the SWE acquisition process applied in future studies are needed for SWE to be considered a clinically reliable diagnostic tool for detection of thyroid cancer.
Collapse
Affiliation(s)
- K Z Swan
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Faculty of Health, Aarhus University , Aarhus, Denmark.
| | - V E Nielsen
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - S J Bonnema
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
|
49
|
Kim JY, Kim JJ, Hwangbo L, Suh HB, Lee JW, Lee NK, Choo KS, Kim S. Tumor stiffness measured by shear-wave elastography: association with disease-free survival in women with early-stage breast cancer. Br J Radiol 2021; 94:20210584. [PMID: 34558307 DOI: 10.1259/bjr.20210584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine whether shear-wave elastography (SWE)-measured tumor stiffness is associated with disease-free survival in females with early-stage invasive breast cancer. METHODS This retrospective study included 202 consecutive females (mean age, 52.9 years; range, 25-84 years) with newly diagnosed T1-two breast cancer who underwent preoperative SWE between April 2015 and January 2016. Tumor stiffness was assessed and quantitative SWE features of each breast lesion were obtained by a breast radiologist. Cox proportional hazard models were used to identify associations between SWE features and disease-free survival after adjusting for clinicopathologic factors. RESULTS Fifteen (7.4%) patients exhibited recurrence after a median follow-up of 56 months. Mean (Emean), minimum, and maximum elasticity values were higher in females with recurrence than in those without recurrence (184.4, 138.3, and 210.5 kPa vs 134.9, 101.7, and 159.8 kPa, respectively; p = 0.005, p = 0.005, and p = 0.012, respectively). Receiver operating characteristics curve analysis for prediction of recurrence showed that Emean yielded the largest area under the curve (0.717) among the quantitative SWE parameters, and the optimal cut-off value was 121.7 kPa. Multivariable Cox proportional hazards analysis revealed that higher Emean (>121.7 kPa) [adjusted hazard ratio (HR), 10.01; 95% CI: 1.31-76.33; p = 0.026] and lymphovascular invasion (adjusted HR, 7.72; 95% CI: 1.74-34.26; p = 0.007) were associated with worse disease-free survival outcomes. CONCLUSION Higher SWE-measured Emean was associated with worse disease-free survival in females with early-stage invasive breast cancer. ADVANCES IN KNOWLEDGE Tumor stiffness assessed with shear-wave elastography might serve as a quantitative imaging biomarker of disease-free survival in females with T1-two breast cancer.
Collapse
Affiliation(s)
- Jin You Kim
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Jin Joo Kim
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Lee Hwangbo
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Hie Bum Suh
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Ji Won Lee
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Nam Kyung Lee
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Suk Kim
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| |
Collapse
|
|
50
|
Seyedpour SM, Nabati M, Lambers L, Nafisi S, Tautenhahn HM, Sack I, Reichenbach JR, Ricken T. Application of Magnetic Resonance Imaging in Liver Biomechanics: A Systematic Review. Front Physiol 2021; 12:733393. [PMID: 34630152 PMCID: PMC8493836 DOI: 10.3389/fphys.2021.733393] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/25/2021] [Indexed: 12/15/2022] Open
Abstract
MRI-based biomechanical studies can provide a deep understanding of the mechanisms governing liver function, its mechanical performance but also liver diseases. In addition, comprehensive modeling of the liver can help improve liver disease treatment. Furthermore, such studies demonstrate the beginning of an engineering-level approach to how the liver disease affects material properties and liver function. Aimed at researchers in the field of MRI-based liver simulation, research articles pertinent to MRI-based liver modeling were identified, reviewed, and summarized systematically. Various MRI applications for liver biomechanics are highlighted, and the limitations of different viscoelastic models used in magnetic resonance elastography are addressed. The clinical application of the simulations and the diseases studied are also discussed. Based on the developed questionnaire, the papers' quality was assessed, and of the 46 reviewed papers, 32 papers were determined to be of high-quality. Due to the lack of the suitable material models for different liver diseases studied by magnetic resonance elastography, researchers may consider the effect of liver diseases on constitutive models. In the future, research groups may incorporate various aspects of machine learning (ML) into constitutive models and MRI data extraction to further refine the study methodology. Moreover, researchers should strive for further reproducibility and rigorous model validation and verification.
Collapse
Affiliation(s)
- Seyed M. Seyedpour
- Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
- Biomechanics Lab, Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
| | - Mehdi Nabati
- Department of Mechanical Engineering, Faculty of Engineering, Boğaziçi University, Istanbul, Turkey
| | - Lena Lambers
- Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
- Biomechanics Lab, Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
| | - Sara Nafisi
- Faculty of Pharmacy, Istinye University, Istanbul, Turkey
| | - Hans-Michael Tautenhahn
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - Ingolf Sack
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Charité Mitte, Berlin, Germany
| | - Jürgen R. Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
- Center of Medical Optics and Photonics, Friedrich Schiller University, Jena, Germany
- Michael Stifel Center for Data-driven and Simulation Science Jena, Friedrich Schiller University, Jena, Germany
| | - Tim Ricken
- Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
- Biomechanics Lab, Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
| |
Collapse
|