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Objective: Large volume radiological text data have been accumulated since the incorporation of electronic health record (EHR) systems in clinical practice. We aimed to determine whether deep natural language processing algorithms could aid radiologists in improving thyroid cancer diagnosis. Methods: Sonographic EHR data were obtained from the EHR database. Pathological reports were used as the gold standard for diagnosing thyroid cancer. We developed thyroid cancer diagnosis based on natural language processing (THCaDxNLP) to interpret unstructured sonographic text reports for thyroid cancer diagnosis. We used the area under the receiver operating characteristic curve (AUROC) as the primary metric to measure the performance of the THCaDxNLP. We compared the performance of thyroid ultrasound radiologists aided with THCaDxNLP vs. those without THCaDxNLP using 5 independent test sets. Results: We obtained a total number of 788,129 sonographic radiological reports. The number of thyroid sonographic data points was 132,277, 18,400 of which were thyroid cancer patients. Among the 5 test sets, the numbers of patients per set were 439, 186, 82, 343, and 171. THCaDxNLP achieved high performance in identifying thyroid cancer patients (the AUROC ranged from 0.857–0.932). Thyroid ultrasound radiologists aided with THCaDxNLP achieved significantly higher performances than those without THCaDxNLP in terms of accuracy (93.8% vs. 87.2%; one-sided t-test, adjusted P = 0.003), precision (92.5% vs. 86.0%; P = 0.018), and F1 metric (94.2% vs. 86.4%; P = 0.007). Conclusions: THCaDxNLP achieved a high AUROC for the identification of thyroid cancer, and improved the accuracy, sensitivity, and precision of thyroid ultrasound radiologists. This warrants further investigation of THCaDxNLP in prospective clinical trials.

Background We compared the ultrasound features, superb microvascular imaging (SMI) and micro vessel density (MVD) of pleomorphic adenoma (PA), Warthin’s tumor (WT) and basal cell adenoma (BCA) to explore the clinic value of SMI in differential diagnosis of benign tumors of parotid gland. Methods The vascular distributions and grade by color doppler flow imaging (CDFI) and SMI, as well as vascular index (VI) of 249 parotid gland masses from 217 patients were analyzed. Results The internal echogenicity of BCA are more homogeneous in comparing with WT and PA(P P P P Conclusion SMI can provide low-velocity blood flow information, which is helpful for the differential diagnosis of common benign tumors of parotid gland, and is expected to be more widely used.

Purpose To investigate the capacity of Superb Microvascular Imaging (SMI) to detect microvascular details and to explore the different SMI features in various focal liver lesions (FLLs) and the correlation between SMI and microvessel density (MVD). Method: Eighty-three liver lesions were enrolled in our study, including 35 hepatocellular carcinomas (HCCs) and 48 non-HCCs. All patients underwent color Doppler flow imaging (CDFI) and SMI examination and were categorized into subgroups according to Adler semiquantitative grading (grade 0–3) or the microvascular morphologic patterns (pattern a-f). The correlation between SMI blood flow signal percentage and MVD was assessed. Results Compared with CDFI, SMI detected more high-level blood flow signals (grade 2–3) and more hypervascular supply patterns (pattern e-f) in HCCs (p p r = 0.675, p Conclusion SMI was superior to CDFI in detecting microvascular blood flow signals. More hypervascular supply patterns were depicted in HCC than in non-HCC, suggesting a promising diagnostic value for SMI in the differentiation between HCC and non-HCC. Meanwhile, we were the first to demonstrate that SMI blood flow signal percentage (VI) was correlated with MVD in malignant lesions.

BACKGROUND The aim of this study was to evaluate the clinical diagnostic value of superb microvascular imaging (SMI) in assessing vascular distribution, vascularity, and vessel morphology of parotid tumors (PTs). MATERIAL AND METHODS PT patients confirmed by postoperative histopathological detection and who underwent color Doppler flow imaging (CDFI), microvascular imaging (MVI), and SMI examination were recruited. PTs were classified into 3 groups: pleomorphic adenoma (PA), Warthin tumor (WT), and malignant PT (MT). The tumor vascular distribution, vascularity, and vessel morphology recorded by CDFI, MVI, and SMI were compared among PA, WT, and MT group. PT diagnosis was performed using histopathological detection. Fisher's exact test was used to compare the diagnostic sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy between SMI and MVI examination in PTs. RESULTS We enrolled 198 PTs consisting of 114 PAs, 56 WTs, and 28 MTs into our study. CDFI examination found no significant differences in vascular distribution and vascularity among the PA, WT, and WT groups. SMI examination found significant differences in vascular distribution and vascularity among the 3 groups. MVI found significant differences in vessel morphology, including uneven distribution of blood flow, arborization, and irregular blood flow among the PA, WT, and MT groups. SMI found significant differences in arborization and irregular blood flow, but none of the differences in uneven distribution of blood flow among the 3 groups were significant. The diagnostic sensitivity, specificity, and accuracy of SMI and MVI in PTs showed no significant differences. CONCLUSIONS SMI more accurately evaluated the vascular distribution and vascularity of PTs than CDFI. SMI might be a potential non-invasive diagnostic method for PTs in clinical practice.

Objective: Bosniak classification system provides a fine imaging evaluation for the malignant cystic renal masses. Superb microvascular imaging (SMI) is a new ultrasonic technique which apply advanced clutter suppression to reflect microflow information. The aim of this study was to evaluate the performance of ultrasound Bosniak classification aided by SMI in diagnosis of cystic renal masses. Methods: By comparing with contrast-enhanced ultrasound (CEUS) and pathology, we evaluated the sensitivity, specificity and accuracy of conventional ultrasound and SMI combination in the diagnosis of renal cystic masses. Results: Color Doppler Flow image (CDFI) and SMI had significant difference in evaluation the blood flow and Bosniak classification for cystic renal mass of IIf, III and IV (p = 0.020). SMI was consistent with CEUS for cystic renal mass Bosniak classification of IIf, III and IV. Although, CEUS had highest sensitivity of 97.4%, SMI had the highest area under curve in differential diagnosis malignance from benign masses [area under curve = 0.869 (0.743 – 0.995), p < 0.001]. Conclusion: SMI can display better in observing blood flow in septa and solid structures of renal cystic lesions compared with CDFI, thus, it can perform more accurate Bosniak classification for renal cystic mass. SMI and CEUS are consistent in Bosniak classification. Bosniak classification aided by SMI maybe an accurate non-invasive ultrasonic examination in distinguishing benign and malignant renal cystic lesions. Advances in knowledge: Conventional ultrasound had limited ability to distinguish malignance in Bosniak classifications IIf and III. SMI can display better in observing blood flow in septa and solid structures of renal cystic lesions compared with CDFI.

Gastric cancer remains a disease with a high mortality rate despite of multiple therapeutic strategies. So far, it is very important to develop new treatment approaches to improve current therapeutic efficacy in gastric cancer. Apurinic/apyrimidinic endonuclease (APE1) involves in DNA base excision repair (BER) during DNA damage pathway. APE1 was found to be associated with poor overall survival with gastric cancer patients. In the in vitro experiment, we tested APE1 inhibitor-AT101 could potently inhibit gastric cancer cell growth and further induce cancer cell apoptosis and autophagy through p53-dependent pathway. Downregulation of APE1 by AT101 has ability to suppress gastric cancer cell migration and renewal through inhibition of CD133, Nanog and LC3expression. Based on findings that Her-2 positive expression cases has poor prognosis from our dataset and TCGA database, we investigated the role of AT101 in synergetic efficacy with 5-FU treatment in Her-2 overexpression gastric cancer in vivo, indicating that AT101 is able to enhance 5-FU in the shrinkage of xenograft mice tumor and induction of cell apoptosis. In summary, the data obtained from our study showed APE1 is guided as a potential therapeutic target for gastric cancer. AT101 could be regarded as a potent inhibitor to promote chemotherapeutic sensitivity in patients with gastric cancer.

The DNA base excision repair gene APE1 involves in DNA damage repair pathway and overexpression in a variety of human cancers. Analyses of patients with non-small cell lung cancer (NSCLC) suggested that multiple factors associated with prognosis of NSCLC patients. Further investigation showed that APE1 expression was able to predict the progression-free survival and overall survival in patients with NSCLC and correlated with lymph node metastasis. Intriguingly, as a stratification of APE1-141 SNPs in APE1 positive expression, we also found APE1-141 GT/GG was identified as a marker for prediction of poor survival in NSCLC patients. In the in vitro experiments, the results showed that when APE1 expression was inhibited by siRNA or AT101 (an APE1 inhibitor), the migration and invasion of NSCLC cells were suppressed. Furthermore, Epithelial-Mesenchymal Transition (EMT) markers was tested to provide evidence that APE1 promoted NSCLC EMT through interaction with SirT1. Using NSCLC xenograft models, we confirmed that AT101 shrank tumor volumes and inhibited lymph node metastasis. In conclusion, APE1 could be a potential target for patients with NSCLC metastasis and AT101 is a potent inhibitor in further treatment of NSCLC patients.

This study is to evaluate the value of superb microvascular imaging (SMI) in assessing renal tumour vascularity and in differentiating benign from malignant renal tumours.Patients with pathologically confirmed renal mass who underwent colour Doppler flow imaging (CDFI) and SMI examination between October 2016 and March 2017 were retrospectively analysed. Patients were classified into benign renal mass group and malignant tumour group according to their pathological results. The vascularity, vascular distribution and vessel morphology obtained from the two scanning methods were analysed and compared between the two groups.53 patients with renal tumour were enrolled into the study, including 11 cases of benign renal tumours and 42 cases of malignant ones. SMI showed significant difference in vascularity between the two groups; CDFI showed no statistical difference. Compared with CDFI, SMI showed significantly higher grade in malignant tumour (p0.001), and no significant difference (p = 0.421) in benign mass. According to CDFI, there is no statistical difference in vascular distribution and vessel morphology (p = 0.432, p = 0.122) between the two groups, while SMI method showed significant difference (p0.05) between the two groups. SMI was significantly more sensitive and accurate than CDFI.Comparing with CDFI, SMI could effectively detect vascularity, vascular characteristics and distribution and annular blood flow in renal tumour. SMI appears more sensitive and precise in distinguishing benign renal mass from malignant tumour. Advances in knowledge: SMI seems potentially valuable in evaluating renal tumour vascularity and in differentiating benign from malignant renal tumours.

Ultrasound-guided biopsy technique with the large-core needle has widely been applied in the diagnosis of adult abdominopelvic cavity, thyroid, and neck tumors. There are few reports on ultrasound-guided biopsy using large-core needle in pediatric abdominopelvic cavity tumors. This study was to evaluate the ultrasound features and the diagnostic value of ultrasound-guided core needle biopsy for pediatric neuroblastic tumors. The pediatric patients with neuroblastic tumor that underwent ultrasound examination and ultrasound-guided core needle biopsy from January 2009 to November 2015 were reviewed. A minimum of two cores in each case was obtained. The biopsy results were confirmed by subsequent surgical histopathology. The ultrasound features and the diagnostic accuracy of ultrasound-guided core needle biopsy were evaluated. Eighty-three patients were enrolled into the study. Conventional ultrasound examination showed irregular hypoechoic or mixed echo masses and calcification and liquefied necrosis. The diagnostic accuracy of ultrasound-guided core needle biopsy was 96.4% (80/83). Three cases were misdiagnosed because of inadequate tissue sample. No serious complication, infection, or needle track seeding occurred. Ultrasound-guided core needle biopsy seems to be an accurate, minimally invasive, and safe diagnostic method of pediatric neuroblastic tumor.

To assess the diagnostic value of elastosonography for thyroid microcarcinoma (TMC), particularly with regard to elasticity score (ES) and strain ratio (SR).Conventional ultrasound and elastosonography were performed for 487 thyroid micronodules before surgery. We set the histology as the reference standard. The ES and SR values, as well as their diagnostic threshold and efficiency, were compared and analyzed by the receiver-operating characteristic (ROC) curve. Additional comparisons between TMC patients with and without extracapsular extension were also performed.Statistically significant differences (P0.05) in both ES and SR values were detected among the TMC and benign groups. The area under the ROC curve of SR was significantly greater than that of ES (0.956 and 0.844, respectively; P0.05). Using ES⩾3 and SR⩾3.65 as diagnostic threshold values, the diagnostic sensitivity, specificity, and accuracy of ES for differentiating benign and malignant nodules were 79.9%, 72.3%, and 80.5%, respectively, whereas those of SR were 86.6%, 85.3%, and 89.4%, respectively. The maximum diameter, microcalcification status, aspect ratio, bilateral cervical lymph node metastasis, and SR values of nodules with extracapsular extension (A1 subgroup) were greater than those of nodules without extracapsular extension (A2 subgroup).Elasticity imaging technology not only can help differentiate between benign and malignant thyroid micronodules but also allow SR values to provide accurate and objective information on tissue hardness and to predict TMC extracapsular extension or even bilateral cervical lymph node metastasis.