1
|
Zandi A, Shojaeian F, Abbasvandi F, Faranoush M, Anbiaee R, Hoseinpour P, Gilani A, Saghafi M, Zandi A, Hoseinyazdi M, Davari Z, Miraghaie SH, Tayebi M, Taheri MS, Ardestani SMS, Sheikhi Mobarakeh Z, Nikshoar MR, Enjavi MH, Kordehlachin Y, Mousavi-kiasary SMS, Mamdouh A, Akbari ME, Yunesian M, Abdolahad M. A human pilot study on positive electrostatic charge effects in solid tumors of the late-stage metastatic patients. Front Med (Lausanne) 2023; 10:1195026. [PMID: 37915327 PMCID: PMC10616960 DOI: 10.3389/fmed.2023.1195026] [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: 03/27/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023] Open
Abstract
Background Correlative interactions between electrical charges and cancer cells involve important unknown factors in cancer diagnosis and treatment. We previously reported the intrinsic suppressive effects of pure positive electrostatic charges (PEC) on the proliferation and metabolism of invasive cancer cells without any effect on normal cells in cell lines and animal models. The proposed mechanism was the suppression of pro-caspases 3 and 9 with an increase in Bax/Bcl2 ratio in exposed malignant cells and perturbation induced in the KRAS pathway of malignant cells by electrostatic charges due to the phosphate molecule electrostatic charge as the trigger of the pathway. This study aimed to examine PECs as a complementary treatment for patients with different types of solid metastatic tumors, who showed resistance to chemotherapy and radiotherapy. Methods In this study, solid metastatic tumors of the end-stage patients (n = 41) with various types of cancers were locally exposed to PEC for at least one course of 12 days. The patient's signs and symptoms, the changes in their tumor size, and serum markers were followed up from 30 days before positive electrostatic charge treating (PECT) until 6 months after the study. Results Entirely, 36 patients completed the related follow-ups. Significant reduction in tumor sizes and cancer-associated enzymes as well as improvement in cancer-related signs and symptoms and patients' lifestyles, without any side effects on other tissues or metabolisms of the body, were observed in more than 80% of the candidates. Conclusion PECT induced significant cancer remission in combination with other therapies. Therefore, this non-ionizing radiation would be a beneficial complementary therapy, with no observable side effects of ionizing radiotherapy, such as post-radiation inflammation.
Collapse
Affiliation(s)
- Ashkan Zandi
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
- Nano Electronic Centre of Excellence, Nanoelectronics and Thin Film Laboratory, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | - Fatemeh Shojaeian
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereshteh Abbasvandi
- Department of ATMP, Breast Cancer Research Centre, Motamed Cancer Institute, ACECR, Tehran, Iran
- Cancer Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Faranoush
- Pediatric Growth and Development Research Centre, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
- Cardio-Oncology Research Centre, Rajaie Cardiovascular Medical and Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Robab Anbiaee
- Department of Radiation Oncology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Hoseinpour
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
- SEPAS Pathology Laboratory, Tehran, Iran
| | - Ali Gilani
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | - Mohammad Saghafi
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | - Afsoon Zandi
- Department of Otolaryngology, Head and Neck Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meisam Hoseinyazdi
- Medical Imaging Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Davari
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | - Seyyed Hossein Miraghaie
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | - Mahtab Tayebi
- Department of ATMP, Breast Cancer Research Centre, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Morteza Sanei Taheri
- Department of Radiology, Shohada Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S. Mehdi Samimi Ardestani
- Department of Psychiatry, Behavioural Sciences Research Centre, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Sheikhi Mobarakeh
- Department of Quality of Life, Breast Cancer Research Centre, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Mohammad Reza Nikshoar
- Department of Gastroenterology Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Enjavi
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
- Nano Electronic Centre of Excellence, Nanoelectronics and Thin Film Laboratory, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | - Yasin Kordehlachin
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | - S. M. Sadegh Mousavi-kiasary
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | - Amir Mamdouh
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
| | | | - Masud Yunesian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Research Methodology and Data Analysis, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdolahad
- Nano Electronic Centre of Excellence, Nanobioelectronic Devices Laboratory, Cancer Electronics Research Group, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
- Nano Electronic Centre of Excellence, Nanoelectronics and Thin Film Laboratory, School of Electrical and Computer Engineering, Faculty of Engineering, University of Tehran, Tehran, Iran
- Imam-Khomeini Hospital, Tehran University of Medical Sciences, Cancer Institute, Tehran, Iran
- UT&TUMS Cancer Electrotechnique Research Centre, YAS Hospital, Tehran, Iran
| |
Collapse
|
2
|
Shehata RMA, El-Sharkawy MAM, Mahmoud OM, Kamel HM. Qualitative and quantitative strain and shear wave elastography paradigm in differentiation of breast lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00697-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Breast cancer is the most common life-threatening cancer in women worldwide. A high number of women are going through biopsy procedures for characterization of breast masses every day and yet 75% of the pathological results prove these masses to be benign. Ultrasound (US) elastography is a non-invasive technique that measures tissue stiffness. It is convenient for differentiating benign from malignant breast tumors. Our study aims to evaluate the role of qualitative ultrasound elastography scoring (ES), quantitative mass strain ratio (SR), and shear wave elasticity ratio (SWER) in differentiation between benign and malignant breast lesions.
Results
Among 51 female patients with 77 histopathologically proved breast lesions, 57 breast masses were malignant and 20 were benign. All patients were examined by B-mode ultrasound then strain and shear wave elastographic examinations using ultrasound machine (Logiq E9, GE Medical Systems) with 8.5–12 MHz high-frequency probes. Our study showed that ES best cut-off point > 3 with sensitivity, specificity, PPV, NPP, accuracy was 94.7%, 85%, 94.7%, 85%, 90.9%, respectively, and AUC = 0.926 at P < 0.001, mass SR the best cut-off point > 4.6 with sensitivity, specificity, PPV, NPP, accuracy was 96.5%, 80%, 93.2%, 88.9%, 92.2%, respectively, and AUC = 0.860 at P < 0.001, SWER the best cut-off value > 4.9 with sensitivity, specificity, PPV, NPP and accuracy was 91.2%, 80%, 92.9%, 76.2%, 93.5%, respectively, and AUC = 0.890 at P < 0.001. The mean mass strain ratio for malignant lesions is 10.1 ± 3.7 SD and for solid benign lesions 4.7 ± 4.3 SD (p value 0.001). The mean shear wave elasticity ratio for malignant lesions is 10.6 ± 5.4 SD and for benign (solid and cystic) lesions 3.6 ± 4.2 SD. Using ROC curve and Youden index, the difference in diagnostic performance between ES, SR and SWER was not significant in differentiation between benign and malignant breast lesions and also was non-significant difference when comparing them with conventional US alone.
Conclusion
ES, SR, and SWER have a high diagnostic performance in differentiating malignant from benign breast lesions with no statistically significant difference between them.
Collapse
|
3
|
Hersh AM, Weber-Levine C, Jiang K, Young L, Kerensky M, Routkevitch D, Tsehay Y, Perdomo-Pantoja A, Judy BF, Lubelski D, Theodore N, Manbachi A. Applications of elastography in operative neurosurgery: A systematic review. J Clin Neurosci 2022; 104:18-28. [PMID: 35933785 PMCID: PMC11023619 DOI: 10.1016/j.jocn.2022.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
Elastography is an imaging technology capable of measuring tissue stiffness and consistency. The technology has achieved widespread use in the workup and management of diseases of the liver, breast, thyroid, and prostate. Although elastography is increasingly being applied in neurosurgery, it has not yet achieved widespread adoption and many clinicians remain unfamiliar with the technology. Therefore, we sought to summarize the range of applications and elastography modalities available for neurosurgery, report its effectiveness in comparison with conventional imaging methods, and offer recommendations. All full-text English-language manuscripts on the use of elastography for neurosurgical procedures were screened using the PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science databases. Thirty-two studies were included with 990 patients, including 21 studies on intracranial tumors, 5 on hydrocephalus, 4 on epilepsy, 1 on spinal cord compression, and 1 on adolescent scoliosis. Twenty studies used ultrasound elastography (USE) whereas 12 used magnetic resonance elastography (MRE). MRE studies were mostly used in the preoperative setting for assessment of lesion stiffness, tumor-brain adherence, diagnostic workup, and operative planning. USE studies were performed intraoperatively to guide resection of lesions, determine residual microscopic abnormalities, assess the tumor-brain interface, and study mechanical properties of tumors. Elastography can assist with resection of brain tissue, detection of microscopic lesions, and workup of hydrocephalus, among other applications under investigation. Its sensitivity often exceeds that of conventional MRI and ultrasound for identifying abnormal tissue and lesion margins.
Collapse
Affiliation(s)
- Andrew M Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carly Weber-Levine
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kelly Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lisa Young
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Max Kerensky
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Denis Routkevitch
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yohannes Tsehay
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | | | - Brendan F Judy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Amir Manbachi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| |
Collapse
|
4
|
Mutala TM, Mwango GN, Aywak A, Cioni D, Neri E. Determining the elastography strain ratio cut off value for differentiating benign from malignant breast lesions: systematic review and meta-analysis. Cancer Imaging 2022; 22:12. [PMID: 35151365 PMCID: PMC8841096 DOI: 10.1186/s40644-022-00447-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/10/2022] [Indexed: 12/15/2022] Open
Abstract
Background Elastography is an addition to grey-scale ultrasonic examination that has gained substantial traction within the last decade. Strain ratio (SR) has been incorporated as a semiquantitative measure within strain elastography, thus a potential imaging biomarker. The World Federation for Ultrasound in Medicine and Biology (WFUMB) published guidelines in 2015 for breast elastography. These guidelines acknowledge the marked variance in SR cut-off values used in differentiating benign from malignant lesions. The objective of this review was to include more recent evidence and seek to determine the optimal strain ratio cut off value for differentiating between benign and malignant breast lesions. Methods Comprehensive search of MEDLINE and Web of Science electronic databases with additional searches via Google Scholar and handsearching set from January 2000 to May 2020 was carried out. For retrieved studies, screening for eligibility, data extraction and analysis was done as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Diagnostic Test Accuracy (PRISMA-DTA) Statement guidelines of 2018. Quality and risk of bias assessment of the studies were performed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Results A total of 424 articles, 412 from electronic database and 12 additional searches were retrieved and 65 studies were included in the narrative synthesis and subgroup analysis. The overall threshold effect indicated significant heterogeneity among the studies with Spearman correlation coefficient of Logit (TPR) vs Logit (FPR) at − 0.301, p-value = 0.015. A subgroup under machine model consisting seven studies with 783 patients and 844 lesions showed a favourable threshold, Spearman’s correlation coefficient,0.786 (p = 0.036). Conclusion From our review, currently the optimal breast SR cut-off point or value remains unresolved despite the WFUMB guidelines of 2015. Machine model as a possible contributor to cut-off value determination was suggested from this review which can be subjected to more industry and multi-center research determination. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-022-00447-5.
Collapse
|
5
|
Sakalecha AK, Parameshwar KBH, Savagave SG, Naik BR. The Role of Ultrasonography and Elastography in Differentiating Benign From Malignant Breast Masses With Pathologic Correlation. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793211073682] [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: Elastography has the potential in differentiating benign from malignant masses. The objectives of the study were to evaluate morphology of the breast masses with routine ultrasonography and elastography, to assess the role of elastography and conventional B-mode ultrasonography in differentiating benign from malignant breast masses and to correlate elastography and B-mode ultrasonography results with pathologic findings. Materials and Methods: This prospective observational study was conducted over a period of 18 months from January 2018 to June 2019 on 86 patients with 101 clinically palpable breast lumps who underwent B-mode ultrasonography and elastography of the breast. Baseline data, sonographic features, a modified color score, and mean strain ratio were recorded and compared with final diagnosis. Results: Sonography showed a sensitivity of 89.8%; specificity of 96.15%; positive predictive value (PPV) and negative predictive value (NPV) of 95.65% and 90.91%, respectively; and overall diagnostic accuracy of 93.07%. New modified dual color score showed sensitivity of 97.8%, specificity of 87.0%, PPV of 86.79%, and NPV of 87.08% with a diagnostic accuracy of 92.08%. The risk of missing a malignant case with the new modified dual color score was 2.1%. Mean strain ratio showed sensitivity of 100%; specificity of 98.11%; PPV and NPV of 97.96% and 100%, respectively; and diagnostic accuracy of 99.01%. Conclusion: This study demonstrates the promise of elastography in identifying possible breast malignancies, thus preventing unnecessary invasive procedures.
Collapse
Affiliation(s)
- Anil Kumar Sakalecha
- Department of Radiology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, India
| | - Keerthi B H Parameshwar
- Department of Radiology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, India
| | - Shivaprasad G. Savagave
- Department of Radiology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, India
| | - Bukke Ravindra Naik
- Department of Radiology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, India
| |
Collapse
|
6
|
Wei Q, Yan YJ, Wu GG, Ye XR, Jiang F, Liu J, Wang G, Wang Y, Wang Y, Pan ZP, Hu JH, Song J, Dietrich CF, Cui XW. Added Value of a New Strain Elastography Technique in Conventional Ultrasound for the Diagnosis of Breast Masses: A Prospective Multicenter Study. Front Oncol 2021; 11:779612. [PMID: 34858859 PMCID: PMC8631107 DOI: 10.3389/fonc.2021.779612] [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: 09/19/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to explore the value of elasticity score (ES) and strain ratio (SR) combined with conventional ultrasound in distinguishing benign and malignant breast masses and reducing biopsy of BI-RADS (Breast Imaging Reporting and Data System) 4a lesions. Methods This prospective, multicenter study included 910 patients from nine different hospitals. The acquisition and analysis of conventional ultrasound and strain elastography (SE) were obtained by radiologists with more than 5 years of experience in breast ultrasound imaging. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under curve (AUC) of conventional ultrasound alone and combined tests with ES and/or SR were calculated and compared. Results The optimal cutoff value of SR for differentiating benign from malignant masses was 2.27, with a sensitivity of 60.2% and a specificity of 84.8%. When combined with ES and SR, the AUC of the new BI-RADS classification increased from 0.733 to 0.824 (p < 0.001); the specificity increased from 48.1% to 68.5% (p < 0.001) without a decrease in the sensitivity (98.5% vs. 96.4%, p = 0.065); and the PPV increased from 52.2% to 63.7% (p < 0.001) without a loss in the NPV (98.2% vs. 97.1%, p = 0.327). All three combinations of conventional ultrasound, ES, and SR could reduce the biopsy rate of category 4a lesions without reducing the malignant rate of biopsy (from 100% to 68.3%, 34.9%, and 50.4%, respectively, all p < 0.001). Conclusions SE can be used as a useful and non-invasive additional method to improve the diagnostic performance of conventional ultrasound by increasing AUC and specificity and reducing the unnecessary biopsy of BI-RADS 4a lesions.
Collapse
Affiliation(s)
- Qi Wei
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu-Jing Yan
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ge-Ge Wu
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi-Rong Ye
- Department of Medical Ultrasound, The Central Hospital of EDong Healthcare, Huangshi, China
| | - Fan Jiang
- Department of Medical Ultrasound, The Second Hospital of Anhui Medical University, Hefei, China
| | - Jie Liu
- Department of Medical Ultrasound, Yichang General Hospital, Renmin Hospital of Three Gorges University, Yichang, China
| | - Gang Wang
- Department of Medical Ultrasound, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Yi Wang
- Department of Medical Ultrasound, Macheng People's Hospital, Macheng, China
| | - Yu Wang
- Department of Medical Ultrasound, Xiangyang No. 1 People's Hospital, Affiliated Hospital of Hubei University of Medicine, Xiangyang, China
| | - Zhi-Ping Pan
- Department of Medical Ultrasound, Yixing Traditional Chinese Medicine Hospital, Yixing, China
| | - Jin-Hua Hu
- Department of Medical Ultrasound, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Juan Song
- Department of Medical Ultrasound, Xiangyang No. 1 People's Hospital, Affiliated Hospital of Hubei University of Medicine, Xiangyang, China
| | | | - Xin-Wu Cui
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
7
|
Kokubu Y, Yamada K, Tanabe M, Izumori A, Kato C, Horii R, Ohno S, Matsueda K. Evaluating the usefulness of breast strain elastography for intraductal lesions. J Med Ultrason (2001) 2021; 48:63-70. [PMID: 33389371 PMCID: PMC7882591 DOI: 10.1007/s10396-020-01070-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 10/23/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Strain elastography for imaging lesion stiffness is being used as a diagnostic aid in the malignant/benign discrimination of breast diseases. While acquiring elastography in addition to B-mode images has been reported to help avoid performing unnecessary biopsies, intraductal lesions are difficult to discriminate whether they are malignant or benign using elastography. An objective evaluation of strain in lesions was performed in this study by measuring the elasticity index (E-index) and elasticity ratio (E-ratio) of lesions as semi-quantitative numerical indicators of the color distribution of strain. We examined whether ductal carcinoma in situ (DCIS) and intraductal papilloma could be distinguished using these semi-quantitative numerical indicators. METHODS In this study, 170 ultrasonographically detected mass lesions in 162 cases (106 malignant lesions and 64 benign lesions)-in which tissue biopsy by core needle biopsy and vacuum-assisted biopsy, or surgically performed histopathological diagnosis, was performed-were selected as subjects from among 1978 consecutive cases (from January 2014 to December 2016) in which strain elastography images were acquired, in addition to standard B-mode breast ultrasonography, by measuring the E-index and E-ratio. RESULTS The cut-off values for E-index and E-ratio in the malignant/benign discrimination of breast lesions were determined to be optimal values at 3.5 and 4.2, respectively, based on receiver operating characteristic (ROC) curve analysis. E-index sensitivity, specificity, accuracy, and AUC value (area under the curve) were 85%, 86%, 85%, and 0.860, respectively, while those for E-ratio were 78%, 74%, 74%, and 0.780, respectively. E-index yielded superior results in all aspects of sensitivity, specificity, accuracy, and AUC values, compared to those of E-ratio. The mean E-index values for malignant tumors and benign tumors were 4.46 and 2.63, respectively, indicating a significant difference (P < 0.001). E-index values of 24 DCIS lesions and 25 intraductal papillomas were 3.88 and 3.35, respectively, which showed a considerably close value, while the false-negative rate for DCIS was 29.2%, and the false-positive rate for intraductal papilloma was as high as 32.0%. CONCLUSION E-index in strain elastography yielded better results than E-ratio in the malignant/benign discrimination of breast diseases. On the other hand, E-index has a high false-negative rate and false-positive rate for intraductal lesions, a factor which should be taken into account when making ultrasound diagnoses.
Collapse
Affiliation(s)
- Yumi Kokubu
- Department of Ultrasound, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Keiko Yamada
- Department of Ultrasound, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
- Department of Diagnostic Imaging, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Ayumi Izumori
- Department of Breast Surgery, Takamatsu Heiwa Hospital, Takamatsu, Japan
| | - Chieko Kato
- Department of Ultrasound, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Rie Horii
- Department of Pathology, Saitama Cancer Center, Saitama, Japan
- Department of Pathology, The Cancer Institute of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinji Ohno
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kiyoshi Matsueda
- Department of Ultrasound, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
- Department of Diagnostic Imaging, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| |
Collapse
|
8
|
Xie X, Zhang Q, Liu S, Ma Y, Liu Y, Xu M, Xu B. Value of quantitative sound touch elastography of tissues around breast lesions in the evaluation of malignancy. Clin Radiol 2020; 76:79.e21-79.e28. [PMID: 32948313 DOI: 10.1016/j.crad.2020.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022]
Abstract
AIM To assess the value of quantitative analysis of sound touch elastography of tissues around breast lesions to facilitate the evaluation of malignancy of the lesions. MATERIALS AND METHODS With the permission of the Ethics Committee, every patient signed informed consent forms before the study. One hundred and eighty-two solid breast lesions were analysed retrospectively. Postoperative histopathology proved that 63 lesions were malignant and 119 were benign. All lesions were examined by two-dimensional ultrasonography, colour Doppler ultrasonography and ultrasound elastography including sound touch elastography (STE) and strain elastography. Using pathological diagnosis as the reference, the correlation between each ultrasound marker and the malignancy of the solid breast masses was evaluated by chi-square test, and the logistic regression model was constructed to determine the best diagnostic model with multiple markers. RESULTS The areas under the receiver operating characteristic (ROC) curve (AUCs) of various elastography markers were compared and the markers with the largest AUC values, including quantitative, semi-quantitative, and distance markers were identified. Logistic regression analysis showed that the combination of accuracy of Breast Imaging Reporting and Data System (BI-RADS) classification + age + maximum elasticity value of the tissue around the lesion (EMax_shell) in predicting malignant lesions was higher than that of the other combinations. The prediction model verified that the sensitivity of diagnosis of the mammary lump was 94.12% and the specificity was 84.13%. CONCLUSIONS EMax_shell in the elasticity is the most valuable marker for the diagnosis of breast cancer, and age combined with EMax_shell can effectively improve the diagnostic efficacy of the BI-RADS classification in breast cancer.
Collapse
Affiliation(s)
- X Xie
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Q Zhang
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - S Liu
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Y Ma
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Y Liu
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - M Xu
- Department of Echocardiography, Changzhou First People's Hospital and The Third Affiliated Hospital of Soochow University, Changzhou, 213000, China.
| | - B Xu
- Department of Tumour Biotherapy, Changzhou First People's Hospital and The Third Affiliated Hospital of Soochow University, Changzhou, 213000, China
| |
Collapse
|
9
|
Sezgin G, Coskun M, Apaydin M, Akder Sari A. The role of rare breast cancers in the false negative strain elastography results. Radiol Med 2020; 126:349-355. [PMID: 32894448 DOI: 10.1007/s11547-020-01270-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Elastography was primarily used as an adjunctive method along with ultrasonography in differentiation between benign from malignant lesions. Occasionally, overlaps can occur which are caused by some rare invasive breast cancers. Our aim is to analyze the role of rare breast cancers in false negative strain elastography results and to assess the relation among false negative results and tumor size, lesion distance to skin, and tumor grade. METHODS Patients with BI-RADS 5 category underwent strain elastography and core biopsy. All those with confirmed invasive breast cancer were included. For each rare breast cancer, four usual invasive breast cancer cases were taken as a control group. The cut-off value of strain ratio was considered as 2.3. The true positive and the false negative groups were compared in terms of histological type (rare carcinomas and the others) and the other parameters. Pearson Chi-square and Fisher's exact test were used for statistical analyses. P values < 0.05 were considered statistically significant. RESULTS One hundred-thirteen patients were defined as true positive (70.6%), and 47 patients were defined as false negative (29.4%). Strain ratio values of the rare breast cancers were significantly lower than those of the other breast cancers (p = 0.012). There was no statistically significant difference between the groups with respect to tumor size, distance to skin, and tumor grade (p > 0.05). CONCLUSION The rare breast cancers are an important cause of false negativity in elastographic evaluation of invasive breast cancers. The results should be interpreted in combination with grayscale US findings.
Collapse
Affiliation(s)
- Gulten Sezgin
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Basin Sitesi Mah. Hasan Tahsin Cad No: 143, Karabaglar, 35150, Izmir, Turkey.
| | - Mehmet Coskun
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Basin Sitesi Mah. Hasan Tahsin Cad No: 143, Karabaglar, 35150, Izmir, Turkey
| | - Melda Apaydin
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Basin Sitesi Mah. Hasan Tahsin Cad No: 143, Karabaglar, 35150, Izmir, Turkey
| | - Aysegul Akder Sari
- Department of Pathology, Izmir Katip Celebi University Faculty of Medicine, 35150, Izmir, Turkey
| |
Collapse
|
10
|
Rosen D, Jiang J. Modeling Uncertainty of Strain Ratio Measurements in Ultrasound Breast Strain Elastography: A Factorial Experiment. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:258-268. [PMID: 31545719 PMCID: PMC8011866 DOI: 10.1109/tuffc.2019.2942821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Strain elastography (SE) is a technique in which images of localized tissue strains are used to detect the relative stiffness of tissues. The application of SE in differentiating malignant breast lesions from benign ones has been broadly investigated. The strain ratio (SR) between the background and the breast tumor has been used and its results have been mixed. Due to the complex nature of tissue elasticity and how it relates to the strain fields measured in SE, the exact reason is not known. In this study, we apply a novel design-of-experiments-based metamodeling approach to mechanical simulation of SE in the human breast. To our knowledge, such a study has not been reported in the ultrasound SE literature. More specifically, we first conduct a screening study to identify the biomechanical factors/simulation inputs that most strongly determine SR. We then apply a response surface experimental design to these factors to produce a metamodel of SR as a function of said factors. Results from the screening study suggest that the SR measurements are primarily influenced by three factors: the initial shear modulus of the lesion, the elastic nonlinearity of the lesion, and the precompression applied during acquisition. In order to investigate the implications of these results, stochastic inputs for these three factors associated with the malignant and benign cases were applied to the resulting response surface. The resulting optimal cutoffs, sensitivity, and specificity were generally in line with a majority (>60%) of 19 clinical trials in the literature.
Collapse
|
11
|
Yang T, Niu J, Dang Y, Zhou Y, Cao Y, Zeng M, Lv M. An Innovative Ultrasound Strain Elastographic Method for the Differential Diagnosis of Breast Tumors. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:56-67. [PMID: 30301575 DOI: 10.1016/j.ultrasmedbio.2018.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/24/2018] [Accepted: 08/29/2018] [Indexed: 06/08/2023]
Abstract
In this monocentric perspective study examining 64 lesions (19 benign and 45 malignant), we tested an innovative ultrasound elastographic method for diagnosing breast tumors. A new region of control and a new index designating the strain ratio (SR) were used. A traditional ultrasound elastographic method was used as the control. The results indicated that the SR ratios of the benign and malignant groups were 0.25 ± 0.22 and 1.10 ± 1.53, respectively, and this difference was statistically significant. The area under the receiver operating characteristic curve of the SR ratio method was 0.95, the cutoff point was 0.37 and the sensitivity and specificity were 95.56% and 94.74%, respectively. The two receiver operating characteristic curves of the traditional method and the SR of the proposed method were significantly different, at a p value of 0.02. Compared with that of the traditional method, the SR obtained with the new method had a larger area under the receiver operating characteristic curve, sensitivity, specificity and objectivity.
Collapse
Affiliation(s)
- Tian Yang
- Ultrasound Department, International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Jianmei Niu
- Ultrasound Department, International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Yuanyuan Dang
- Ultrasound Department, International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Yun Zhou
- Ultrasound Department, International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Yunyun Cao
- Ultrasound Department, International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Min Zeng
- Ultrasound Department, International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Mingli Lv
- Ultrasound Department, International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China.
| |
Collapse
|
12
|
Martínez-Payá JJ, Del Baño-Aledo ME, Ríos-Díaz J, Fornés-Ferrer V, Vázquez-Costa JF. Sonoelastography for the Assessment of Muscle Changes in Amyotrophic Lateral Sclerosis: Results of a Pilot Study. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2540-2547. [PMID: 30279033 DOI: 10.1016/j.ultrasmedbio.2018.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/31/2018] [Accepted: 08/12/2018] [Indexed: 06/08/2023]
Abstract
The purpose of this study was to assess the sonoelastographic features of four different muscles in patients with amyotrophic lateral sclerosis compared with healthy controls and to evaluate the relationship of these features to muscle strength and other ultrasonographic variables. Fourteen patients with amyotrophic lateral sclerosis and 20 controls were examined using strain sonoelastography scanning. The RGB channel fraction ratio was analyzed with ImageJ software (Version 1.48). Two main sonoelastographic patterns could be distinguished in the controls: a clear predominance of the blue channel (hard areas) and a more heterogeneous pattern with predominance of the green channel (intermediate stiffness). These patterns were also observed in patients, although a higher green channel score was observed in mildly impaired muscles, whereas a higher blue channel score was observed in the most severely impaired muscle. Sonoelastography may be a good complementary biomarker in the detection and monitoring of muscle changes in amyotrophic lateral sclerosis.
Collapse
Affiliation(s)
- Jacinto J Martínez-Payá
- ECOFISTEM Research Group, Health Sciences Department, Facultad de Ciencias de la Salud, Universidad Católica de Murcia, Guadalupe (Murcia), Spain
| | | | - José Ríos-Díaz
- Centro de Ciencias de la Salud San Rafael, Universidad Antonio de Nebrija, Madrid, Spain; Fundación San Juan de Dios, Madrid, Spain.
| | | | - Juan F Vázquez-Costa
- Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Neuromuscular and Ataxias Research Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| |
Collapse
|
13
|
Jha A. Ultrasonographic Elasticity Contrast Index of Palpable Breast Lumps. JNMA J Nepal Med Assoc 2018; 56:787-790. [PMID: 30387470 PMCID: PMC8827552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
INTRODUCTION Elastrography used in addition to grey scale sonography increases its specificity. Elasticity contrast index (ECI) is based on strain elastrography and being a quantitative parameter, maybe more easy to obtain and reproducible while researches has been done in ECI in thyroid lesions, this is the first study, to the best of our knowledge to evaluate in breast lesions. This study was done to evaluate the diagnostic accuracy of Elasticity Contrast Index (ECI) in differentiating benign from malignant lesions of breast and to determine its cutoff value. METHODS This is a descriptive cross-sectional study done at tertiary health care centre, which involved retrospective evaluation of data collected from September 2016 to March 2017. Conventional sonography was done followed by elastography on commercially available ultrasound machine. ECI was calculated in thyroid protocol available in the unit. Histopathological diagnosis was obtained for all the lesions and taken as gold standard. RESULTS A total of 89 breast lumps were evaluated, of which was 61 (69.3%) were benign and 27 (30.7%) malignant on histopathology. Independent t test revealed the average ECI value of benign lesions was 2.48 and malignant 5.1. Receiver operating curve showed ECI value of 3.25 as the cutoff, above which the lesions were malignant. CONCLUSIONS ECI is a quantitative elastography technique which can be easily used as an adjunct during breast sonography and can increase its specificity for diagnosing a lesion as malignant. This could reduce the number of false positive biopsies.
Collapse
Affiliation(s)
- Anamika Jha
- Department of Radiology & Imaging, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| |
Collapse
|