Selected
Abstracts
Early Evaluation of Relative
Changes in Tumor Stiffness by Shear Wave Elastography Predicts the Response to
Neoadjuvant Chemotherapy in Patients With Breast CancerJournal of Ultrasound in Medicine August 2016 35:1619-1627;Published
Online First June 14, 2016, doi:10.7863/ultra.15.08052
Sonographic-Pathologic
Correlation for Punctate Echogenic Reflectors in Papillary Thyroid Carcinoma: What
Are They?Journal of Ultrasound in
Medicine August 2016 35:1645-1652;Published Online First June
14, 2016, doi:10.7863/ultra.15.09048
Sonographic Characteristics and
Interval Changes of Subacute ThyroiditisJournal of Ultrasound in Medicine August 2016 35:1653-1659;Published
Online First June 14, 2016, doi:10.7863/ultra.15.09049
Impact of Image Orientation on
Measurements of Thyroid Nodule Stiffness Using Shear Wave ElastographyJournal of Ultrasound in Medicine August 2016 35:1661-1667;Published
Online First June 22, 2016, doi:10.7863/ultra.15.10016
Early Evaluation of Relative Changes in
Tumor Stiffness by Shear Wave Elastography Predicts the Response to Neoadjuvant
Chemotherapy in Patients With Breast Cancer
Objectives—Neoadjuvant chemotherapy plays an important role in
comprehensive therapy for breast cancer, but response prediction is imperfect.
Shear wave elastography (SWE) is a novel technique that can quantitatively
evaluate tissue stiffness. In this study, we sought to investigate the
application value of SWE for early prediction of the response to neoadjuvant
chemotherapy in patients with breast cancer.
Methods—We prospectively evaluated tumor stiffness in 62 patients with
breast cancer using SWE, which was performed at baseline and after the second
cycle of neoadjuvant chemotherapy. After chemotherapy, all of the patients
underwent surgery. We investigated the correlations between the relative
changes in tumor stiffness (Δ stiffness) after 2 cycles of chemotherapy and the
pathologic response to the therapy.
Results—Compared with baseline values, tumor stiffness after 2 cycles of
neoadjuvant chemotherapy was significantly decreased in responders (P < .001) but not in nonresponders (P = .172). The Δstiffness was significantly higher
in responders (−42.194%) than in nonresponders (−23.593%; P = .001). As determined at either the baseline or
after the second cycle of chemotherapy, tumor stiffness was significantly lower
in responders than in nonresponders (P = .033 and
.009, respectively). The Δ stiffness threshold for distinguishing between responders
and nonresponders was −36.1% (72.92% sensitivity and 85.71% specificity).
Furthermore, correlating Δ stiffness with clinical and pathologic
characteristics, we found that estrogen and progesterone receptor expression
showed statistically significant correlations with Δ stiffness (estrogen
receptor, P = .008; progesterone
receptor, P = .023).
Conclusions—Early evaluation of relative changes in tumor stiffness using
SWE could effectively predict the response to neoadjuvant chemotherapy in
patients with breast cancer and might indicate better therapeutic strategies on
a timelier basis.
o Received August
25, 2015.
o Revision received September 22, 2015.
o Accepted December
1, 2015.
Sonographic-Pathologic Correlation for
Punctate Echogenic Reflectors in Papillary Thyroid Carcinoma
What Are They?
Objectives—It is commonly held that punctate nonshadowing echogenic foci on
sonography, often termed microcalcifications, represent psammoma bodies. We
aimed to determine the validity of this supposition by correlating the presence
of punctate echogenic foci on sonography with their presence at histopathologic
examination.
Methods—We examined 51 nodules (surgically proven papillary thyroid carcinoma)
by sonography and histopathologic examination. On the latter, nodules were
examined for evidence of psammomatous calcifications, dystrophic
calcifications, and colloid. Two subspecialty-trained radiologists with 2 and
25 years of experience in sonography, respectively, reviewed the sonograms for
the presence and distribution of punctate echogenic foci.
Results—All nodules contained colloid at histologic examination. Twenty
of the papillary carcinomas lacked any calcification at pathologic examination.
In the remaining 31 nodules with calcifications, 13 had psammomatous
calcifications only; 6 had both coarse and psammomatous calcifications; and 12
had only coarse calcifications. The presence of punctate echogenic foci on
sonography was 74% sensitive, was 46% to 53% specific, and had a positive
predictive value of only 45% to 48% for the presence of psammomatous
calcifications. The computed 2-tailed P value
indicated that the punctate echogenic foci-to-psammoma body correlation was not
statistically significant.
Conclusions—The sonographic signature commonly referred to as
“microcalcifications” may represent a variety of entities, including
psammomatous calcifications, dystrophic calcifications, and eosinophilic
colloid; for this reason, “punctate echogenic foci” would be a more accurate
term.
o Received September
15, 2015.
o Revision received September 30, 2015.
o Accepted October
30, 2015.
Sonographic Characteristics and Interval
Changes of Subacute Thyroiditis
Objectives—This study aimed to assess the sonographic characteristics and
interval changes of subacute thyroiditis using follow-up sonography.
Methods—From January 2008 to December 2014, 85 patients with clinically
suspected subacute thyroiditis underwent sonographic examinations by a single
radiologist. Subacute thyroiditis was confirmed on the basis of the clinical,
sonographic, and cytohistopathologic findings. On the initial and follow-up
sonograms, the individual sonographic findings and interval changes were retrospectively
investigated by the same radiologist. According to the sonographic
configuration, subacute thyroiditis lesions were categorized as nodular or
non-nodular. The interval changes in the lesions were classified as follows:
“disappeared,” “decreased,” “increased,” “eventually smaller,” “eventually
larger,” or “no interval change.”
Results—Subacute thyroiditis was confirmed in 64 of the 85 patients. In
these 64 patients, nodular (n = 39) and non-nodular (n = 35) lesions were
found; 10 patients had both nodular and non-nodular lesions. Of the 64
patients, 41 underwent sonographic follow-up. In both nodular and non-nodular
lesions, the common interval changes included disappeared, decreased, and
eventually smaller patterns. Although the increased pattern was found only in 4
nodular lesions, there was no significant difference in the interval changes
between nodular and non-nodular lesions. On follow-up sonography, a new lesion
was detected in 6 patients.
Conclusions—The prevalence rate of nodular subacute thyroiditis lesions on
sonography was high, and the interval changes in the lesions were variable.
o Received September
15, 2015.
o Revision received October 26, 2015.
o Accepted November
25, 2015.
Impact of Image Orientation on
Measurements of Thyroid Nodule Stiffness Using Shear Wave Elastography
Objectives—To assess the effect of orientation on the stiffness measurement
by shear wave elastography (SWE) within a thyroid nodule.
Methods—Forty-five patients with 50 thyroid nodules were enrolled in
this study. After a short sonographic examination, SWE images were acquired in
transverse and longitudinal orientations. Multiple elastograms of each nodule
were obtained in both orientations. Mean and maximum stiffness values were
recorded from each region of interest. The overall mean and maximum stiffness
values of each nodule were calculated for both orientations separately. The
concordance correlation coefficient was used to assess overall agreement
between measurements. A receiver operating characteristic curve analysis was
conducted to assess diagnostic performance for benign versus malignant nodules.
Results—The 45 patients included 6 men and 39 women (mean age, 53 years;
range, 23–84 years). The mean stiffness values ± SD were 19.1 ± 18.4 and 20.9 ±
21.5 kPa for transverse and longitudinal measurements, respectively, with a
small overall bias between the orientations (1.8 kPa; P = .09). Overall agreement was good (concordance
correlation coefficient, 0.93) although moderated somewhat after the stiffness
values were log transformed to reduce skewness (concordance correlation
coefficient, 0.76). Of the 50 nodules, 6 were classified as malignant. The area
under the curve based on the mean stiffness value from longitudinal images
tended to be better than for transverse images, but the difference was not
statistically significant (0.93 versus 0.83; P = .17).
Conclusions—Our study has shown that good diagnostic performance can be
achieved by using SWE in longitudinal and transverse orientations. Moderate to
good agreement in mean and maximum stiffness values for both orientations was
observed, with only a small bias. Diagnostic performance for benign and
malignant nodules was similar. The similar performance of both orientations
gives flexibility in imaging patients with Received October
13, 2015.
o Revision received November 9, 2015.
o Accepted November
25, 2015.
·
Copyright © 2016 by the
American Institute of Ultrasound in Medicine
