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Dong XY, Li QM, Xue WL, Sun JW, Zhou H, Han Y, Zhou XL, Hou XJ. Diagnostic performance of endorectal ultrasound combined with shear wave elastography for rectal tumors staging. Clin Hemorheol Microcirc 2023; 84:399-411. [PMID: 37334584 DOI: 10.3233/ch-231716] [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: 06/20/2023]
Abstract
OBJECTIVE This study aims to analyze the performance of endorectal ultrasound (ERUS) combined with shear wave elastography (SWE) for rectal tumor staging. METHODS Forty patients with rectal tumors who had surgery were enrolled. They underwent ERUS and SWE examinations before surgery. Pathological results were used as the gold standard for tumor staging. The stiffness values of the rectal tumor, peritumoral fat, distal normal intestinal wall, and distal perirectal fat were analyzed. The diagnostic accuracy of ERUS stage, tumor SWE stage, ERUS combined with tumor SWE stage, and ERUS combined with peritumoral fat SWE stage were compared and evaluated by receiver operating characteristic (ROC) curve to select the best staging index. RESULTS From T1 to T3 stage, the maximum elasticity (Emax) of the rectal tumor increased gradually (p < 0.05). The cut-off values of adenoma/T1 and T2, T2 and T3 tumors were 36.75 and 85.15kPa, respectively. The diagnostic coincidence rate of tumor SWE stage was higher than that of ERUS stage. Overall diagnostic accuracy of ERUS combined with peritumoral fat SWE Emax restaging was significantly higher than that of ERUS. CONCLUSIONS ERUS combined with peritumoral fat SWE Emax for tumor restaging can effectively distinguish between stage T2 and T3 rectal tumors, which provides an effective imaging basis for clinical decisions.
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Affiliation(s)
- Xue-Ying Dong
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qiang-Mei Li
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei-Li Xue
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jia-Wei Sun
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hang Zhou
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ye Han
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xian-Li Zhou
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiu-Juan Hou
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Endorectal ultrasound radiomics in locally advanced rectal cancer patients: despeckling and radiotherapy response prediction using machine learning. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3645-3659. [PMID: 35951085 DOI: 10.1007/s00261-022-03625-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE The current study aimed to evaluate the association of endorectal ultrasound (EUS) radiomics features at different denoising filters based on machine learning algorithms and to predict radiotherapy response in locally advanced rectal cancer (LARC) patients. METHODS The EUS images of forty-three LARC patients, as a predictive biomarker for predicting the treatment response of neoadjuvant chemoradiotherapy (NCRT), were investigated. For despeckling, the EUS images were preprocessed by traditional filters (bilateral, wiener, lee, frost, median, and wavelet filters). The rectal tumors were delineated by two readers separately, and radiomics features were extracted. The least absolute shrinkage and selection operator were used for feature selection. Classifiers including logistic regression (LR), K-nearest neighbor (KNN), support vector machine (SVM), random forest, naive Bayes, and decision tree were trained using stratified fivefold cross-validation for model development. The area under the curve (AUC) of the receiver operating characteristic curve followed by accuracy, precision, sensitivity, and specificity were obtained for model performance assessment. RESULTS The wavelet filter had the best results with means of AUC: 0.83, accuracy: 77.41%, precision: 82.15%, and sensitivity: 79.41%. LR and SVM by having AUC: 0.71 and 0.76; accuracy: 70.0% and 71.5%; precision: 75.0% and 73.0%; sensitivity: 69.8% and 80.2%; and specificity: 70.0% and 60.9% had the highest model's performance, respectively. CONCLUSION This study demonstrated that the EUS-based radiomics model could serve as pretreatment biomarkers in predicting pathologic features of rectal cancer. The wavelet filter and machine learning methods (LR and SVM) had good results on the EUS images of rectal cancer.
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Luo Z, Yao X, Li M, Fang D, Fei Y, Cheng Z, Xu Y, Zhu B. Modulating tumor physical microenvironment for fueling CAR-T cell therapy. Adv Drug Deliv Rev 2022; 185:114301. [PMID: 35439570 DOI: 10.1016/j.addr.2022.114301] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 02/06/2023]
Abstract
Chimeric antigen receptor (CAR) T cell therapy has achieved unprecedented clinical success against hematologic malignancies. However, the transition of CAR-T cell therapies for solid tumors is limited by heterogenous antigen expression, immunosuppressive microenvironment (TME), immune adaptation of tumor cells and impeded CAR-T-cell infiltration/transportation. Recent studies increasingly reveal that tumor physical microenvironment could affect various aspects of tumor biology and impose profound impacts on the antitumor efficacy of CAR-T therapy. In this review, we discuss the critical roles of four physical cues in solid tumors for regulating the immune responses of CAR-T cells, which include solid stress, interstitial fluid pressure, stiffness and microarchitecture. We highlight new strategies exploiting these features to enhance the therapeutic potency of CAR-T cells in solid tumors by correlating with the state-of-the-art technologies in this field. A perspective on the future directions for developing new CAR-T therapies for solid tumor treatment is also provided.
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Intra- and Interobserver Variability of Shear Wave Elastography in Rectal Cancer. Cancers (Basel) 2022; 14:cancers14112633. [PMID: 35681613 PMCID: PMC9179262 DOI: 10.3390/cancers14112633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 01/17/2023] Open
Abstract
Simple Summary For a diagnostic tool to be important, there must be a high level of agreement between different observers. If not, the reliability of the measurement can not be considered valid. Previous studies have evaluated the reproducibility of tissue stiffness measurements of rectal tumors, but only on previously obtained images. Therefore, we aimed to investigate the issue in a clinical setting and found a high level of agreement between observers. Abstract Background: Endorectal ultrasound (ERUS) is an important tool when evaluating complex rectal adenomas and rectal cancer, and the accuracy is improved by adding elastography measurements. A high interobserver agreement is imperative in clinical practice. Therefore, the aim of this study was to evaluate interobserver agreement assessed on real-time images. Additionally, we investigated the intra- and interobserver agreement between experienced and inexperienced observers. Materials and methods: We prospectively included patients referred to an ERUS at the Department of Radiology with a complex rectal polyp or suspected rectal malignancy. Two operators independently scanned each patient in turn. Furthermore, four observers assessed previously obtained images using three different methods for placing the region of interest (ROI). Three months later, the four observers reassessed the images to assess intraobserver variability. Results: A total of 19 patients were included for live assessment. Agreement of tumor classification was substantial for T stage (kappa: 0.86) and fair for N stage (kappa: 0.73), with an absolute agreement for T and N stages of 84% and 89%, respectively. Agreement of SWE was good for Emean (ICC 0.94, 95% CI 0.86–0.98) and fair for Emax (ICC 0.85, 95% CI 0.66–0.94). Intra- and interobserver agreement between inexperienced and experienced observers showed good to excellent agreement with all ROI methods. Conclusion: Interobserver agreement is high in SWE when performed in a clinical setting. We found the best agreement using the mean value of several ROIs. Intra- and interobserver agreement was high regardless of operator experience.
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Abstract
Physicians have used palpation as a diagnostic examination to understand the elastic properties of pathology for a long time since they realized that tissue stiffness is closely related to its biological characteristics. US elastography provided new diagnostic information about elasticity comparing with the morphological feathers of traditional US, and thus expanded the scope of the application in clinic. US elastography is now widely used in the field of diagnosis and differential diagnosis of abnormality, evaluating the degree of fibrosis and assessment of treatment response for a range of diseases. The World Federation of Ultrasound Medicine and Biology divided elastographic techniques into strain elastography (SE), transient elastography and acoustic radiation force impulse (ARFI). The ARFI techniques can be further classified into point shear wave elastography (SWE), 2D SWE, and 3D SWE techniques. The SE measures the strain, while the shear wave-based techniques (including TE and ARFI techniques) measure the speed of shear waves in tissues. In this review, we discuss the various techniques separately based on their basic principles, clinical applications in various organs, and advantages and limitations and which might be most appropriate given that the majority of doctors have access to only one kind of machine.
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Hu J, Guo J, Pei Y, Hu P, Li M, Sack I, Li W. Rectal Tumor Stiffness Quantified by In Vivo Tomoelastography and Collagen Content Estimated by Histopathology Predict Tumor Aggressiveness. Front Oncol 2021; 11:701336. [PMID: 34485136 PMCID: PMC8415020 DOI: 10.3389/fonc.2021.701336] [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: 04/27/2021] [Accepted: 07/29/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose To investigate the significance of collagen in predicting the aggressiveness of rectal tumors in patients, examined in vivo based on tomoelastography quantified stiffness and ex vivo by histologically measured collagen volume fraction (CVF). Experimental Design 170 patients with suspected rectal cancer were prospectively enrolled and underwent preoperative magnetic resonance imaging (MRI) and rectal tomoelastography, a technique based on multifrequency magnetic resonance elastography. Histopathologic analysis identified eighty patients with rectal cancer who were divided into subgroups by tumor-node (TN) stage, prognostic stage, and risk level. Rectal tumor stiffness was correlated with histopathologic CVF. Area-under-the-curve (AUC) and contingency analysis were used to evaluate the performance of rectal stiffness in distinguishing tumor stages which was compared to standard clinical MRI. Results In vivo tomoelastography revealed that rectal tumor stiffened significantly with increased TN stage (p<0.05). Tumors with poorly differentiated status, perineural and lymphovascular invasion also displayed higher stiffness than well-to-moderately differentiated, noninvasive tumors (all p<0.05). Similar to in vivo stiffness, CVF indicated an abnormally high collagen content in tumors with perineural invasion and poor differentiation status. CVF was also positively correlated with stiffness (p<0.05). Most importantly, both stiffness (AUROC: 0.82) and CVF (AUROC: 0.89) demonstrated very good diagnostic accuracy in detecting rectal tumors that have high risk for progressing to an aggressive state with poorer prognosis. Conclusion In human rectal carcinomas, overexpression of collagen is correlated with increased tissue stiffness and high risk for tumor advancing more aggressively. In vivo tomoelastography quantifies rectal tumor stiffness which improves the diagnostic performance of standard MRI in the assessment of lymph nodes metastasis. Therefore, in vivo stiffness mapping by tomoelastography can predict rectal tumor aggressiveness and add diagnostic value to MRI.
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Affiliation(s)
- Jiaxi Hu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Jing Guo
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Yigang Pei
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Ping Hu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Mengsi Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Ingolf Sack
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wenzheng Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
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Can Ultrasound Elastography Discriminate between Rectal Adenoma and Cancer? A Systematic Review. Cancers (Basel) 2021; 13:cancers13164158. [PMID: 34439313 PMCID: PMC8391413 DOI: 10.3390/cancers13164158] [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: 06/21/2021] [Revised: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Rectal cancer is a common malignancy. Since the introduction of bowel-screening programs, the number of patients with advanced adenomas and early rectal cancer has increased. Despite improved diagnostics, the discrimination between rectal adenomas and early rectal cancer (i.e., pT1-T2) remains challenging. The purpose of this systematic review was to evaluate the diagnostic performance of endorectal ultrasound (ERUS) elastography in discriminating rectal adenomas from cancer. METHOD Using PRISMA guidelines, a systematic search was performed on PubMed, Embase, and MEDLINE databases. Studies evaluating the primary staging of rectal adenomas and cancer using ERUS elastography were included. RESULTS Six studies were identified; three evaluated the discrimination between adenomas and cancer; two evaluated adenomas and early rectal cancer (i.e., pT1-T2); one evaluated performance on different T categories. All studies reported increased diagnostic accuracy of ERUS elastography compared to ERUS. Sensitivity, specificity and accuracy ranged 0.93-1.00, 0.83-1.00 and 0.91-1.00, respectively, when discriminating adenomas from cancer. In the differentiation between adenomas and early rectal cancer, the sensitivity, specificity and accuracy were 0.82-1.00, 0.86-1.00 and 0.84-1.00, respectively. CONCLUSION Elastography increases the accuracy of ERUS and may provide valuable information on malignant transformation of rectal lesions.
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Endoscopic Ultrasound Elastography in the Assessment of Rectal Tumors: How Well Does It Work in Clinical Practice? Diagnostics (Basel) 2021; 11:diagnostics11071180. [PMID: 34209811 PMCID: PMC8305995 DOI: 10.3390/diagnostics11071180] [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: 05/17/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022] Open
Abstract
Endorectal ultrasound applications in the evaluation of rectal tumors could be a useful tool in achieving proper staging of rectal cancer. The purpose of this study was to compare the efficacy of rectal tumor staging by flexible endoscopic ultrasound (EUS) with real-time elastography (RTE) using the gold standard post-surgery histological analysis of the resected tissue as the control. The second aim of our research was to establish cutoff values for the EUS-RTE strain ratio corresponding to stages by independently comparing the stiffness values obtained with histology and EUS-RTE staging in order to minimize observation bias. We evaluated the records of 130 patients with a rectal tumor confirmed by biopsy. EUS was used in 70 patients, EUS-RTE-in the other 60. We found no statistically significant differences in staging accuracy when comparing EUS to EUS-RTE. Through a correspondence method between staging assessment and the EUS-RTE stain ratio, we identified cutoff intervals for T2, T3, and T4 staging that were nonoverlapping and proved to be statistically significant in terms of EUS-RTE values (significantly different ascending values from one interval to the other). We found that EUS-RTE offers slightly better, although not statistically significant sensitivity and specificity for T and N stage predictions compared to 2D EUS. Our results showed that EUS-RTE offers slightly higher sensitivity and specificity compared to EUS. Reliable cutoff intervals were found for strain rate elastography, previously available only for shear wave elastography (SWE) which is currently unavailable on any EUS system. Thus, these commonly available EUS-RTE systems can serve as a complementary tool in the staging of rectal tumors.
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Zhao JY, Gao X, Zhuang H, Wu YT, Luo Y, Jing JG, Zhang Y. Using shear wave elasticity in normal terminal ileum of a healthy southwest Chinese population: a pilot study of reference elasticity ranges. Quant Imaging Med Surg 2021; 11:2677-2687. [PMID: 34079733 DOI: 10.21037/qims-20-877] [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] [Indexed: 02/05/2023]
Abstract
Background Elastography has not been widely applied to the gastrointestinal tract. The bowel wall's normal elasticity values are still unknown and are necessary for studies of gastrointestinal diseases. This study explores the feasibility of using shear wave elastography (SWE) to measure the terminal ileum wall stiffness in healthy subjects and establish the corresponding normal ranges of elasticity values. Methods This observational study recruited 139 healthy adult volunteers from April to July 2020. All examinations were performed in the anterior terminal ileum wall. Shear wave velocity (SWV) and Young's modulus (E) values were measured in the midline on longitudinal sections and replicated different operators' obtained data. Also, bowel wall thickness (BWT) and depth were recorded. Subgroups were classified according to the volunteers' gender, age, body mass index (BMI), BWT, and depth. The intra-class correlation coefficient was calculated to analyze inter- and intra-operator consistency, and independent t-tests and one-way analysis of variance were used to explore the differences in variables. Results The inter- and intra-operator agreements were good to excellent by different operators and in the replicated measurements (intra-operator consistency: 0.963; inter-operator consistency: 0.842). In all volunteers, the mean SWV was 1.08±0.25 m/s, the mean E value was 3.84±1.84 kPa, and the median BWT was 2 mm. SWV and E did not show significant differences according to gender (P=0.589), age (P=0.738), BMI (P=0.678), depth (P=0.375), or BWT (P=0.410). BWT did not show significant differences according to age (P=0.142), BMI (P=0.863), or depth (P=0.368). Conclusions SWE can be used in terminal ileum wall stiffness measurements with good reliability, and the SWE values do not appear to vary significantly according to different physiological factors. The corresponding elasticity ranges of the terminal ileum in normal adults were acquired.
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Affiliation(s)
- Jie-Ying Zhao
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Xin Gao
- Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, China
| | - Hua Zhuang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Yu-Ting Wu
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Yuan Luo
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Ji-Gang Jing
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Zhang
- Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, China
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Ma L, Zhu Q, Zhang Y, Li J, Jiang Y, Xu D, Zeng X, Hou Y, Liu H. Esophagus involvement in systemic sclerosis: ultrasound parameters and association with clinical manifestations. Arthritis Res Ther 2021; 23:122. [PMID: 33882993 PMCID: PMC8059267 DOI: 10.1186/s13075-021-02505-y] [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: 01/29/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background The esophagus involvement in systemic sclerosis (SSc) is very common yet underestimated due to the lack of suitable screening tools. This study aims to explore the usefulness of ultrasound (US) in the assessment of esophagus involvement and to identify its relationship with clinical and CT manifestations. Methods We performed transabdominal esophageal US in 38 SSc patients and 38 controls. US parameters including the abdominal esophagus length, esophagus wall thickness, shear-wave elastography, gastro-esophageal (His) angle, and reflux were compared. Relationships between distinguishable US parameters and clinical/CT parameters, such as gastro-esophageal reflux disease questionnaire (GERDQ), modified Rodnan skin score (mRSS), interstitial lung disease (ILD) score, the largest esophagus diameter (Dmax), and esophagus dilation percentage (%Eop), were evaluated. Results Abdominal esophagus length was shorter in the SSc group than the control group (2.69 cm vs 3.06 cm, P = 0.018), whereas His angle and the angle change before and after drinking water were larger in the SSc group than the control group (121° vs 108°, P < 0.001; 7.97° vs 2.92°, P = 0.025). Reflux was more frequently seen in the SSc group than the control group (7/38 vs 0/38; P = 0.017). As for correlation with clinical and CT parameters, His angle was higher in patients with GERDQ ≥ 8 than GERDQ < 8 (116.5° vs 125.6°, P = 0.035). Patients with reflux showed higher ILD score than patients without (15.8 vs 9.6, P = 0.043). Furthermore, abdominal esophagus length was negatively correlated with %Eop and Dmax (r = − 0.573, P < 0.001; r = − 0.476, P = 0.003). Conclusion US parameters of the esophagus can distinguish SSc patients from controls, as well as have correlations with clinical and CT characteristics. Our pilot study first shows that US can be used as a noninvasive and convenient method to evaluate the esophagus involvement in SSc.
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Affiliation(s)
- Li Ma
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Qingli Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Yan Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Jianchu Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Dong Xu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Yong Hou
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
| | - He Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
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Cong Y, Fan Z, Dai Y, Zhang Z, Yan K. Application Value of Shear Wave Elastography in the Evaluation of Tumor Downstaging for Locally Advanced Rectal Cancer After Neoadjuvant Chemoradiotherapy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:81-89. [PMID: 32648968 DOI: 10.1002/jum.15378] [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: 03/17/2020] [Revised: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The aim of this study was to assess the application value of shear wave elastography in the evaluation of tumor downstaging for locally advanced rectal cancer after neoadjuvant chemoradiotherapy. METHODS A retrospective analysis was conducted using data from patients with locally advanced rectal cancer treated in our hospital who received endorectal ultrasound (ERUS) and shear wave elastographic examinations before and after chemoradiotherapy. The cases were grouped according to the postoperative pathologic tumor-staging scores. The lesions were divided into 2 groups: 1 showing and the other not showing tumor downstaging. The efficacy of ERUS in diagnosis of tumor downstaging was calculated. The differences in the mean and maximum values of the Young modulus of the lesions before and after chemoradiotherapy between the groups were calculated and compared. Receiver operating characteristic curves were constructed by using the differences in the 2 kinds of values of the Young modulus. RESULTS The mean and maximum values of the Young modulus before and after chemoradiotherapy were significantly different (P < .05). The differences in the mean and maximum values of the Young modulus of rectal lesions between groups were statistically significant (P < .05). The results of the receiver operating characteristic curve showed that a difference in the mean value at 34.7 kPa was the optimal diagnostic threshold. Compared with ERUS, this standard showed a significant difference in diagnosis of tumor downstaging (P < .05). CONCLUSIONS Shear wave elastography is an effective ultrasound elastographic technique to assist ERUS in evaluating lesions after chemoradiotherapy in rectal cancer. It can improve the diagnostic efficacy of tumor downstaging and provide effective imaging conclusions for clinical decision making.
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Affiliation(s)
- Yue Cong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Zhihui Fan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Ying Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Zhongyi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, 100142, China
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O'Connell E, Galvin R, McNamara DA, Burke JP. The utility of preoperative radiological evaluation of early rectal neoplasia: a systematic review and meta-analysis. Colorectal Dis 2020; 22:1076-1084. [PMID: 32052545 DOI: 10.1111/codi.15015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 02/05/2020] [Indexed: 12/12/2022]
Abstract
AIM The diagnostic role for preoperative imaging of clinically benign rectal adenomas is unclear. The objective of this systematic review and meta-analysis was to examine the diagnostic accuracy of preoperative imaging in distinguishing benign adenomas from rectal cancer. METHOD A systematic search was performed for all studies published that correlated staging of clinically benign rectal adenomas with endorectal ultrasound (ERUS) or MRI and histology. Imaging was compared with postoperative histology and data on the numbers of true positives, false positives, true negatives and false negatives were extracted. Summary estimates of sensitivity and specificity with 95% CIs were calculated using a bivariate random effects model. The QUADAS2 tool was used to determine the methodological quality of included studies. RESULTS Eleven studies describing 1511 patients were retrieved. A total of 1134 patients underwent local excision and 377 had a formal proctectomy. A benign rectal adenoma was diagnosed in 840 and 214 had a T1 rectal cancer. For confirming benign adenomas, the pooled sensitivity of ERUS was 0.81 (95% CI 0.69-0.89) and specificity was 0.85 (95% CI 0.68-0.93). For detecting occult T1 tumours, the pooled sensitivity of ERUS was 0.50 (95% CI 0.33-0.66) and specificity was 0.89 (95% CI 0.82-0.94). Quantitative analysis of MRI could not be performed due to insufficient studies. CONCLUSION This study demonstrates the limited accuracy of preoperative ERUS in distinguishing benign adenomas from T1 rectal cancer. Preoperative imaging must be interpreted with caution to prevent over-staging and unnecessary proctectomy. We propose that clinically benign lesions may undergo local excision, with subsequent management based on final histology.
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Affiliation(s)
- E O'Connell
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - R Galvin
- School of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - D A McNamara
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - J P Burke
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Preoperative prediction of tumour deposits in rectal cancer by an artificial neural network-based US radiomics model. Eur Radiol 2019; 30:1969-1979. [PMID: 31828415 DOI: 10.1007/s00330-019-06558-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/21/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop a machine learning-based ultrasound (US) radiomics model for predicting tumour deposits (TDs) preoperatively. METHODS From December 2015 to December 2017, 127 patients with rectal cancer were prospectively enrolled and divided into training and validation sets. Endorectal ultrasound (ERUS) and shear-wave elastography (SWE) examinations were conducted for each patient. A total of 4176 US radiomics features were extracted for each patient. After the reduction and selection of US radiomics features , a predictive model using an artificial neural network (ANN) was constructed in the training set. Furthermore, two models (one incorporating clinical information and one based on MRI radiomics) were developed. These models were validated by assessing their diagnostic performance and comparing the areas under the curve (AUCs) in the validation set. RESULTS The training and validation sets included 29 (33.3%) and 11 (27.5%) patients with TDs, respectively. A US radiomics ANN model was constructed. The model for predicting TDs showed an accuracy of 75.0% in the validation cohort. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and AUC were 72.7%, 75.9%, 53.3%, 88.0% and 0.743, respectively. For the model incorporating clinical information, the AUC improved to 0.795. Although the AUC of the US radiomics model was improved compared with that of the MRI radiomics model (0.916 vs. 0.872) in the 90 patients with both ultrasound and MRI data (which included both the training and validation sets), the difference was nonsignificant (p = 0.384). CONCLUSIONS US radiomics may be a potential model to accurately predict TDs before therapy. KEY POINTS • We prospectively developed an artificial neural network model for predicting tumour deposits based on US radiomics that had an accuracy of 75.0%. • The area under the curve of the US radiomics model was improved than that of the MRI radiomics model (0.916 vs. 0.872), but the difference was not significant (p = 0.384). • The US radiomics-based model may potentially predict TDs accurately before therapy, but this model needs further validation with larger samples.
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Fan Z, Cong Y, Zhang Z, Li R, Wang S, Yan K. Shear Wave Elastography in Rectal Cancer Staging, Compared with Endorectal Ultrasonography and Magnetic Resonance Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1586-1593. [PMID: 31085029 DOI: 10.1016/j.ultrasmedbio.2019.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 03/01/2019] [Accepted: 03/08/2019] [Indexed: 06/09/2023]
Abstract
The goal of the study described here was to investigate the value of shear wave elastography (SWE) in pre-operative staging of rectal cancer. Fifty-five patients with rectal cancer underwent pre-operative conventional endorectal ultrasonography (ERUS), SWE and enhanced magnetic resonance imaging (MRI) examinations. Pathologic results were used as the gold standard for cancer staging. The concordance rate with pathologic stage by ERUS and MRI and the stiffness values measured by SWE for tumors in different stages were compared. The concordance rates for cancer staging were 72.7% and 70.9% for conventional ERUS and enhanced MRI, respectively; the difference was not significant (p > 0.05). SWE indicated that the mean and maximum stiffness values of the tumors increased with advance in stage. The differences in stiffness values between T1 and T2, T1 and T3-4, as well as T2 and T3-4, were all statistically significant (p < 0.001). When the maximum stiffness values of 65.0 and 90.7 kPa are used for the diagnosis of T1, T2 and local advanced rectal cancer, the concordance rate of cancer staging was 85.5%, which was slightly higher than those of ERUS and MRI, although the difference was not statistically significant (p > 0.05). SWE is useful in judging the depth of invasion of rectal tumors. The value of tumor stiffness can provide a quantifiable indicator for pre-operative diagnosis of cancer staging and can be used as a supplement to conventional ERUS. Further studies with larger sample sizes are needed.
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Affiliation(s)
- Zhihui Fan
- Department of Ultrasound, Key Laboratory of the Ministry of Education for Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yue Cong
- Department of Ultrasound, Key Laboratory of the Ministry of Education for Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhongyi Zhang
- Department of Ultrasound, Key Laboratory of the Ministry of Education for Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, China
| | - Rongjie Li
- Department of Ultrasound, Key Laboratory of the Ministry of Education for Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, China
| | - Song Wang
- Department of Ultrasound, Key Laboratory of the Ministry of Education for Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, China
| | - Kun Yan
- Department of Ultrasound, Key Laboratory of the Ministry of Education for Carcinogenesis and Translational Research, Peking University Cancer Hospital & Institute, Beijing, China.
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Li T, Lu M, Li Y, Li J, Hu Z, Li X, Cheng X, Jiang J, Tan B. Quantitative Elastography of Rectal Lesions: The Value ofShear Wave Elastography in Identifying Benign and Malignant Rectal Lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:85-92. [PMID: 30342780 DOI: 10.1016/j.ultrasmedbio.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/01/2018] [Accepted: 09/11/2018] [Indexed: 06/08/2023]
Abstract
We evaluate the value of shear wave elastography (SWE) in diagnosing benign and malignant rectal lesions. A total of 96 lesions were reviewed in this study; endorectal ultrasound (ERUS) and SWE examinations were performed before surgery in all cases. Elasticity parameters including mean elastographic index (Emean), maximum elastographic index (Emax) and minimum elastographic index (Emin) were analyzed. Correlations between elastographic parameters and histopathological results were studied. Inter-observer and intra-observer agreement was analyzed. Of the 96 rectal lesions, 72 were malignant and 24 were benign. Compared with ERUS, ERUS + SWE had higher sensitivity (93.0% vs. 88.9%), specificity (83.3% vs. 79.2%), positive predictive value (94.4% vs. 92.7%), negative predictive value (80.0% vs. 70.4%) and overall accuracy (90.6% vs. 86.4%). In receiver operating characteristic curve analysis, Emean and Emax had larger areas under the curve: 0.92 and 0.91, respectively. The optimal cutoff value was 61.3 kPa for Emean (sensitivity = 88.9%, specificity = 87.5%) and 63.4 kPa for Emax (sensitivity = 94.4%, specificity = 83.3%). We obtained κ values of 0.83 (95% confidence interval [CI]: 0.72-0.95) for ERUS and 0.90 (95% CI: 0.81-0.99) for ERUS + SWE of differential diagnosis in two observers. The intra-class correlation coefficients for intra-observer variability of stiffness (Emean) in malignant lesions, benign lesions, surrounding normal rectal wall in malignant lesions and surrounding normal rectal wall in benign lesions were 0.91 (95% CI: 0.86-0.94), 0.94 (95% CI: 0.88-0.97), 0.92 (95% CI: 0.88-0.95) and 0.89 (95% CI: 0.77-0.95), respectively. SWE is a promising tool that yields valuable quantitative data additional to that provided by ERUS examination in rectal lesions. The cutoff value 61.3 kPa for Emean may serve as a complementary tool in diagnosis of rectal lesions.
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Affiliation(s)
- Tingting Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Man Lu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Yuan Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Juan Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ziyue Hu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; North Sichuan Medical College, Nanchong, China
| | - Xu Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xueqing Cheng
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jingzhen Jiang
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; North Sichuan Medical College, Nanchong, China
| | - Bo Tan
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Chen LD, Liang JY, Wu H, Wang Z, Li SR, Li W, Zhang XH, Chen JH, Ye JN, Li X, Xie XY, Lu MD, Kuang M, Xu JB, Wang W. Multiparametric radiomics improve prediction of lymph node metastasis of rectal cancer compared with conventional radiomics. Life Sci 2018; 208:55-63. [DOI: 10.1016/j.lfs.2018.07.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/01/2018] [Accepted: 07/05/2018] [Indexed: 02/07/2023]
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