Ultrasound and Photoacoustic Imaging of Breast Cancer: Clinical Systems, Challenges, and Future Outlook

Three-dimensional diffractive acoustic tomography

Acoustically probing biological tissues with light or sound, photoacoustic and ultrasound imaging can provide anatomical, functional, and/or molecular information at depths far beyond the optical diffusion limit. However, most photoacoustic and ultrasound imaging systems rely on linear-array transducers with elevational focusing and are limited to two-dimensional imaging with anisotropic resolutions. Here, we present three-dimensional diffractive acoustic tomography (3D-DAT), which uses an off-the-shelf linear-array transducer with single-slit acoustic diffraction. Without jeopardizing its accessibility by general users, 3D-DAT has achieved simultaneous 3D photoacoustic and ultrasound imaging with optimal imaging performance in deep tissues, providing near-isotropic resolutions, high imaging speed, and a large field-of-view, as well as enhanced quantitative accuracy and detection sensitivity. Moreover, powered by the fast focal line volumetric reconstruction, 3D-DAT has achieved 50-fold faster reconstruction times than traditional photoacoustic imaging reconstruction. Using 3D-DAT on small animal models, we mapped the distribution of the biliverdin-binding serpin complex in glassfrogs, tracked gold nanoparticle accumulation in a mouse tumor model, imaged genetically-encoded photoswitchable tumors, and investigated polyfluoroalkyl substances exposure on developing embryos. With its enhanced imaging performance and high accessibility, 3D-DAT may find broad applications in fundamental life sciences and biomedical research.

Multiple diffusion models-enhanced extremely limited-view reconstruction strategy for photoacoustic tomography boosted by multi-scale priors

Photoacoustic tomography (PAT) is an innovative biomedical imaging technology, which has the capacity to obtain high-resolution images of biological tissue. In the extremely limited-view cases, traditional reconstruction methods for photoacoustic tomography frequently result in severe artifacts and distortion. Therefore, multiple diffusion models-enhanced reconstruction strategy for PAT is proposed in this study. Boosted by the multi-scale priors of the sinograms obtained in the full view and the limited-view case of 240°, the alternating iteration method is adopted to generate data for missing views in the sinogram domain. The strategy refines the image information from global to local, which improves the stability of the reconstruction process and promotes high-quality PAT reconstruction. The blood vessel simulation dataset and the in vivo experimental dataset were utilized to assess the performance of the proposed method. When applied to the in vivo experimental dataset in the limited-view case of 60°, the proposed method demonstrates a significant enhancement in peak signal-to-noise ratio and structural similarity by 23.08 % and 7.14 %, respectively, concurrently reducing mean squared error by 108.91 % compared to the traditional method. The results indicate that the proposed approach achieves superior reconstruction quality in extremely limited-view cases, when compared to other methods. This innovative approach offers a promising pathway for extremely limited-view PAT reconstruction, with potential implications for expanding its utility in clinical diagnostics.

Machine learning radiomics based on intra and peri tumor PA/US images distinguish between luminal and non-luminal tumors in breast cancers

PURPOSE

This study aimed to evaluate a radiomics model using Photoacoustic/ultrasound (PA/US) imaging at intra and peri-tumoral area to differentiate Luminal and non-Luminal breast cancer (BC) and to determine the optimal peritumoral area for accurate classification.

MATERIALS AND METHODS

From February 2022 to April 2024, this study continuously collected 322 patients at Shenzhen People's Hospital, using standardized conditions for PA/US imaging of BC. Regions of interest were delineated using ITK-SNAP, with peritumoral regions of 2 mm, 4 mm, and 6 mm automatically expanded using code from the Pyradiomic package. Feature extraction was subsequently performed using Pyradiomics. The study employed Z-score normalization, Spearman correlation for feature correlation, and LASSO regression for feature selection, validated through 10-fold cross-validation. The radiomics model integrated intra and peri-tumoral area, evaluated by receiver operating characteristic curve(ROC), Calibration and Decision Curve Analysis(DCA).

RESULTS

We extracted and selected features from intratumoral and peritumoral PA/US images regions at 2 mm, 4 mm, and 6 mm. The comprehensive radiomics model, integrating these regions, demonstrated enhanced diagnostic performance, especially the 4 mm model which showed the highest area under the curve(AUC):0.898(0.78-1.00) and comparably high accuracy (0.900) and sensitivity (0.937). This model outperformed the standalone clinical model and combined clinical-radiomics model in distinguishing between Luminal and non-Luminal BC, as evidenced in the test set results.

CONCLUSION

This study developed a radiomics model integrating intratumoral and peritumoral at 4 mm region PA/US model, enhancing the differentiation of Luminal from non-Luminal BC. It demonstrated the diagnostic utility of peritumoral characteristics, reducing the need for invasive biopsies and aiding chemotherapy planning, while emphasizing the importance of optimizing tumor surrounding size for improved model accuracy.

Deep tissue photoacoustic imaging with light and sound

Photoacoustic computed tomography (PACT) can harvest diffusive photons to image the optical absorption contrast of molecules in a scattering medium, with ultrasonically-defined spatial resolution. PACT has been extensively used in preclinical research for imaging functional and molecular information in various animal models, with recent clinical translations. In this review, we aim to highlight the recent technical breakthroughs in PACT and the emerging preclinical and clinical applications in deep tissue imaging.

Investigating the Use of Traveltime and Reflection Tomography for Deep Learning-Based Sound-Speed Estimation in Ultrasound Computed Tomography

Ultrasound computed tomography (USCT) quantifies acoustic tissue properties such as the speed-of-sound (SOS). Although full-waveform inversion (FWI) is an effective method for accurate SOS reconstruction, it can be computationally challenging for large-scale problems. Deep learning-based image-to-image learned reconstruction (IILR) methods can offer computationally efficient alternatives. This study investigates the impact of the chosen input modalities on IILR methods for high-resolution SOS reconstruction in USCT. The selected modalities are traveltime tomography (TT) and reflection tomography (RT), which produce a low-resolution SOS map and a reflectivity map, respectively. These modalities have been chosen for their lower computational cost relative to FWI and their capacity to provide complementary information: TT offers a direct SOS measure, while RT reveals tissue boundary information. Systematic analyses were facilitated by employing a virtual USCT imaging system with anatomically realistic numerical breast phantoms (NBPs). Within this testbed, a supervised convolutional neural network (CNN) was trained to map dual-channel (TT and RT images) to a high-resolution SOS map. Single-input CNNs were trained separately using inputs from each modality alone (TT or RT) for comparison. The accuracy of the methods was systematically assessed using normalized root-mean-squared error (NRMSE), structural similarity index measure (SSIM), and peak signal-to-noise ratio (PSNR). For tumor detection performance, receiver operating characteristic (ROC) analysis was employed. The dual-channel IILR method was also tested on clinical human breast data. Ensemble average of the NRMSE, SSIM, and PSNR evaluated on this clinical dataset was 0.2355, 0.8845, and 28.33 dB, respectively.

Assessing Breast Cancer through Tumor Microenvironment Mapping of Collagen and Other Biomolecule Spectral Fingerprints─A Review

Breast cancer is a major challenge in the field of oncology, with around 2.3 million cases and around 670,000 deaths globally based on the GLOBOCAN 2022 data. Despite having advanced technologies, breast cancer remains the major type of cancer among women. This review highlights various collagen signatures and the role of different collagen types in breast tumor development, progression, and metastasis, along with the use of photoacoustic spectroscopy to offer insights into future cancer diagnostic applications without the need for surgery or other invasive techniques. Through mapping of the tumor microenvironment and spotlighting key components and their absorption wavelengths, we emphasize the need for extensive preclinical and clinical investigations.

The Use of Breast-specific Gamma Imaging as a Low-Cost Problem-Solving Strategy for Avoiding Biopsies in Patients With Inconclusive Imaging Findings on Mammography and Ultrasonography

OBJECTIVE

To evaluate the clinical performance and financial costs of breast-specific gamma imaging (BSGI) as a biopsy-reducing problem-solving strategy in patients with inconclusive diagnostic imaging findings.

METHODS

A retrospective analysis of all patients for whom BSGI was utilized for inconclusive imaging findings following complete diagnostic mammographic and sonographic evaluation between January 2013 and December 2018 was performed. Positive BSGI findings were correlated and biopsied with either US or stereotactic technique with confirmation by clip location and pathology. After a negative BSGI result, patients were followed for a minimum of 24 months or considered lost to follow-up and excluded (22 patients). Results of further imaging studies, biopsies, and pathology results were analyzed. Net savings of avoided biopsies were calculated based on average Medicare charges.

RESULTS

Four hundred and forty female patients from 30 to 95 years (mean 55 years) of age were included in our study. BSGI demonstrated a negative predictive value (NPV) of 98.4% (314/319) and a positive predictive value for biopsy of 35.5% (43/121). The overall sensitivity was 89.6% (43/48), and the specificity was 80.1% (314/392). In total, 78 false positive but only 5 false negative BSGI findings were identified. Six hundred and twenty-one inconclusive imaging findings were analyzed with BSGI and a total of 309 biopsies were avoided. Estimated net financial savings from avoided biopsies were $646 897.

CONCLUSION

In the management of patients with inconclusive imaging findings on mammography or ultrasonography, BSGI is a problem-solving imaging modality with high NPV that helps avoid costs of image-guided biopsies.

Downregulation of CIAPIN1 regulates the proliferation, migration and glycolysis of breast cancer cells via inhibition of STAT3 pathway

Cytokine-induced apoptosis inhibitor 1 (CIAPIN1) is a protein that regulates apoptosis and programmed cell death. This research aims to evaluate its potential role in inhibiting breast cancer cell proliferation, migration, and glycolysis and uncover its underlying molecular mechanism. We collected breast cancer tissue samples from eight patients between January 2019 and June 2023 in our Hospital to analyse CIAPIN1 expression. We transfected human breast cancer cell lines (MCF7, MDA-MB-231, MDA-MB-453, and MDA-MB-468) with siRNA of CIAPIN1. Finally, we determined protein expression using RT-qPCR and Western blotting. CIAPIN1 expression was elevated in both breast cancer tissue and serum. Overexpression of CIAPIN1 detected in the breast cancer cell lines MCF7 and MDA-MB-468. In addition, CIAPIN1 overexpression increased cell proliferation and migration rate. CIAPIN1 downregulation suppressed cell proliferation while elevated cellular apoptosis, reactive oxygen species (ROS) production and oxidative stress in breast cancer cells. Moreover, CIAPIN1 inhibition remarkably suppressed pyruvate, lactate and adenosine triphosphate (ATP) production and reduced the pyruvate kinase M2 (PKM2) protein expression and phosphorylation of signal transducer and activator of transcription 3 (STAT3) in breast cancer cells. Downregulation of CIAPIN1 suppresses cell proliferation, migration and glycolysis capacity in breast cancer cells by inhibiting the STAT3/PKM2 pathway.

Deep learning combined with attention mechanisms to assist radiologists in enhancing breast cancer diagnosis: a study on photoacoustic imaging

Accurate prediction of breast cancer (BC) is essential for effective treatment planning and improving patient outcomes. This study proposes a novel deep learning (DL) approach using photoacoustic (PA) imaging to enhance BC prediction accuracy. We enrolled 334 patients with breast lesions from Shenzhen People's Hospital between January 2022 and January 2024. Our method employs a ResNet50-based model combined with attention mechanisms to analyze photoacoustic ultrasound (PA-US) images. Experiments demonstrated that the PAUS-ResAM50 model achieved superior performance, with an AUC of 0.917 (95% CI: 0.884 -0.951), sensitivity of 0.750, accuracy of 0.854, and specificity of 0.920 in the training set. In the testing set, the model maintained high performance with an AUC of 0.870 (95% CI: 0.778-0.962), sensitivity of 0.786, specificity of 0.872, and accuracy of 0.836. Our model significantly outperformed other models, including PAUS-ResNet50, BMUS-ResAM50, and BMUS-ResNet50, as validated by the DeLong test (p < 0.05 for all comparisons). Additionally, the PAUS-ResAM50 model improved radiologists' diagnostic specificity without reducing sensitivity, highlighting its potential for clinical application. In conclusion, the PAUS-ResAM50 model demonstrates substantial promise for optimizing BC diagnosis and aiding radiologists in early detection of BC.

Challenges and advances in two-dimensional photoacoustic computed tomography: a review

Significance

Photoacoustic computed tomography (PACT), a hybrid imaging modality combining optical excitation with acoustic detection, has rapidly emerged as a prominent biomedical imaging technique.

Aim

We review the challenges and advances of PACT, including (1) limited view, (2) anisotropy resolution, (3) spatial aliasing, (4) acoustic heterogeneity (speed of sound mismatch), and (5) fluence correction of spectral unmixing.

Approach

We performed a comprehensive literature review to summarize the key challenges in PACT toward practical applications and discuss various solutions.

Results

There is a wide range of contributions from both industry and academic spaces. Various approaches, including emerging deep learning methods, are proposed to improve the performance of PACT further.

Conclusions

We outline contemporary technologies aimed at tackling the challenges in PACT applications.

Photoacoustic Imaging Radiomics to Identify Breast Cancer in BI-RADS 4 or 5 Lesions

OBJECTIVES

To develop a nomogram based on photoacoustic imaging (PAI) radiomics and BI-RADs to identify breast cancer (BC) in BI-RADS 4 or 5 lesions detected by ultrasound (US).

METHODS

In this retrospective study, 119 females with 119 breast lesions at US and PAI examination were included (January 2022 to December 2022). Patients were divided into the training set (n = 83) or testing set (n = 36) to develop a nomogram to identify BC in BI-RADS 4 or 5 lesions. Relevant factors at clinic, BI-RADS category, and PAI were reviewed. Univariate and multivariate regression was used to evaluate factors for associations with BC. To evaluate the diagnostic performance of nomogram, the area under the curve (AUC) of receiver operating characteristic curve, accuracy, specificity and sensitivity was employed.

RESULTS

The nomogram that included BI-RADS category and PAI radiomics score demonstrated a high AUC of 0.925 (95%CI: 0.8467-0.9712) in the training set and 0.926 (95%CI: 0.846-1.000) in the test set. The nomogram also showed significantly better discrimination than the radiomics score (P = .048) or BI-RADS category (P = .009) in the training set. These significant differences were demonstrated in the testing set, outperform the radiomics score (P = .038) and BI-RADS category (P = .013).

CONCLUSIONS

The nomogram developed with BI-RADS and PAI radiomics score can effectively identify BC in BI-RADS 4 or 5 lesions. This technique has the potential to further improve early diagnostic accuracy for BC.

Duchenne and Becker muscular dystrophy: Cellular mechanisms, image analysis, and computational models: A review

The muscle is the principal tissue that is capable to transform potential energy into kinetic energy. This process is due to the transformation of chemical energy into mechanical energy to enhance the movements and all the daily activities. However, muscular tissues can be affected by some pathologies associated with genetic alterations that affect the expression of proteins. As the muscle is a highly organized structure in which most of the signaling pathways and proteins are related to one another, pathologies may overlap. Duchenne muscular dystrophy (DMD) is one of the most severe muscle pathologies triggering degeneration and muscle necrosis. Several mathematical models have been developed to predict muscle response to different scenarios and pathologies. The aim of this review is to describe DMD and Becker muscular dystrophy in terms of cellular behavior and molecular disorders and to present an overview of the computational models implemented to understand muscle behavior with the aim of improving regenerative therapy.

Compressed Sensing for Biomedical Photoacoustic Imaging: A Review

Photoacoustic imaging (PAI) is a rapidly developing emerging non-invasive biomedical imaging technique that combines the strong contrast from optical absorption imaging and the high resolution from acoustic imaging. Abnormal biological tissues (such as tumors and inflammation) generate different levels of thermal expansion after absorbing optical energy, producing distinct acoustic signals from normal tissues. This technique can detect small tissue lesions in biological tissues and has demonstrated significant potential for applications in tumor research, melanoma detection, and cardiovascular disease diagnosis. During the process of collecting photoacoustic signals in a PAI system, various factors can influence the signals, such as absorption, scattering, and attenuation in biological tissues. A single ultrasound transducer cannot provide sufficient information to reconstruct high-precision photoacoustic images. To obtain more accurate and clear image reconstruction results, PAI systems typically use a large number of ultrasound transducers to collect multi-channel signals from different angles and positions, thereby acquiring more information about the photoacoustic signals. Therefore, to reconstruct high-quality photoacoustic images, PAI systems require a significant number of measurement signals, which can result in substantial hardware and time costs. Compressed sensing is an algorithm that breaks through the Nyquist sampling theorem and can reconstruct the original signal with a small number of measurement signals. PAI based on compressed sensing has made breakthroughs over the past decade, enabling the reconstruction of low artifacts and high-quality images with a small number of photoacoustic measurement signals, improving time efficiency, and reducing hardware costs. This article provides a detailed introduction to PAI based on compressed sensing, such as the physical transmission model-based compressed sensing method, two-stage reconstruction-based compressed sensing method, and single-pixel camera-based compressed sensing method. Challenges and future perspectives of compressed sensing-based PAI are also discussed.

Dual-modal Photoacoustic and Ultrasound Imaging: from preclinical to clinical applications

Photoacoustic imaging is a novel biomedical imaging modality that has emerged over the recent decades. Due to the conversion of optical energy into the acoustic wave, photoacoustic imaging offers high-resolution imaging in depth beyond the optical diffusion limit. Photoacoustic imaging is frequently used in conjunction with ultrasound as a hybrid modality. The combination enables the acquisition of both optical and acoustic contrasts of tissue, providing functional, structural, molecular, and vascular information within the same field of view. In this review, we first described the principles of various photoacoustic and ultrasound imaging techniques and then classified the dual-modal imaging systems based on their preclinical and clinical imaging applications. The advantages of dual-modal imaging were thoroughly analyzed. Finally, the review ends with a critical discussion of existing developments and a look toward the future.

Review of Deep Learning Approaches for Interleaved Photoacoustic and Ultrasound (PAUS) Imaging

Photoacoustic (PA) imaging provides optical contrast at relatively large depths within the human body, compared to other optical methods, at ultrasound (US) spatial resolution. By integrating real-time PA and US (PAUS) modalities, PAUS imaging has the potential to become a routine clinical modality bringing the molecular sensitivity of optics to medical US imaging. For applications where the full capabilities of clinical US scanners must be maintained in PAUS, conventional limited view and bandwidth transducers must be used. This approach, however, cannot provide high-quality maps of PA sources, especially vascular structures. Deep learning (DL) using data-driven modeling with minimal human design has been very effective in medical imaging, medical data analysis, and disease diagnosis, and has the potential to overcome many of the technical limitations of current PAUS imaging systems. The primary purpose of this article is to summarize the background and current status of DL applications in PAUS imaging. It also looks beyond current approaches to identify remaining challenges and opportunities for robust translation of PAUS technologies to the clinic.

DLGAP5 Regulates the Proliferation, Migration, Invasion, and Cell Cycle of Breast Cancer Cells via the JAK2/STAT3 Signaling Axis

The aim of this study was to discover new biomarkers to detect breast cancer (BC), which is an aggressive cancer with a high mortality rate. In this study, bioinformatic analyses (differential analysis, weighted gene co-expression network analysis, and machine learning) were performed to identify potential candidate genes for BC to study their molecular mechanisms. Furthermore, Quantitative Real-time PCR and immunohistochemistry assays were used to examine the protein and mRNA expression levels of a particular candidate gene (DLGAP5). And the effects of DLGAP5 on cell proliferation, migration, invasion, and cell cycle were further assessed using the Cell Counting Kit-8 assay, colony formation, Transwell, wound healing, and flow cytometry assays. Moreover, the changes in the JAK2/STAT3 signaling-pathway-related proteins were detected by Western Blot. A total of 44 overlapping genes were obtained by differential analysis and weighted gene co-expression network analysis, of which 25 genes were found in the most tightly connected cluster. Finally, NEK2, CKS2, UHRF1, DLGAP5, and FAM83D were considered as potential biomarkers of BC. Moreover, DLGAP5 was highly expressed in BC. The down-regulation of DLGAP5 may inhibit the proliferation, migration, invasion, and cell cycle of BC cells, and the opposite was true for DLGAP5 overexpression. Correspondingly, silencing or overexpression of the DLGAP5 gene inhibited or activated the JAK2/STAT3 signaling pathway, respectively. DLGAP5, as a potential biomarker of BC, may impact the cell proliferation, migration, invasion, cell cycle, and BC development by modulating the JAK2/STAT3 signaling pathway.

A Forward Model Incorporating Elevation-Focused Transducer Properties for 3-D Full-Waveform Inversion in Ultrasound Computed Tomography

Ultrasound computed tomography (USCT) is an emerging medical imaging modality that holds great promise for improving human health. Full-waveform inversion (FWI)-based image reconstruction methods account for the relevant wave physics to produce high spatial resolution images of the acoustic properties of the breast tissues. A practical USCT design employs a circular ring-array comprised of elevation-focused ultrasonic transducers, and volumetric imaging is achieved by translating the ring-array orthogonally to the imaging plane. In commonly deployed slice-by-slice (SBS) reconstruction approaches, the 3-D volume is reconstructed by stacking together 2-D images reconstructed for each position of the ring-array. A limitation of the SBS reconstruction approach is that it does not account for 3-D wave propagation physics and the focusing properties of the transducers, which can result in significant image artifacts and inaccuracies. To perform 3-D image reconstruction when elevation-focused transducers are employed, a numerical description of the focusing properties of the transducers should be included in the forward model. To address this, a 3-D computational model of an elevation-focused transducer is developed to enable 3-D FWI-based reconstruction methods to be deployed in ring-array-based USCT. The focusing is achieved by applying a spatially varying temporal delay to the ultrasound pulse (emitter mode) and recorded signal (receiver mode). The proposed numerical transducer model is quantitatively validated and employed in computer simulation studies that demonstrate its use in image reconstruction for ring-array USCT.

Niche preclinical and clinical applications of photoacoustic imaging with endogenous contrast

In the past decade, photoacoustic (PA) imaging has attracted a great deal of popularity as an emergent diagnostic technology owing to its successful demonstration in both preclinical and clinical arenas by various academic and industrial research groups. Such steady growth of PA imaging can mainly be attributed to its salient features, including being non-ionizing, cost-effective, easily deployable, and having sufficient axial, lateral, and temporal resolutions for resolving various tissue characteristics and assessing the therapeutic efficacy. In addition, PA imaging can easily be integrated with the ultrasound imaging systems, the combination of which confers the ability to co-register and cross-reference various features in the structural, functional, and molecular imaging regimes. PA imaging relies on either an endogenous source of contrast (e.g., hemoglobin) or those of an exogenous nature such as nano-sized tunable optical absorbers or dyes that may boost imaging contrast beyond that provided by the endogenous sources. In this review, we discuss the applications of PA imaging with endogenous contrast as they pertain to clinically relevant niches, including tissue characterization, cancer diagnostics/therapies (termed as theranostics), cardiovascular applications, and surgical applications. We believe that PA imaging's role as a facile indicator of several disease-relevant states will continue to expand and evolve as it is adopted by an increasing number of research laboratories and clinics worldwide.

Conformable ultrasound breast patch for deep tissue scanning and imaging

Ultrasound is widely used for tissue imaging such as breast cancer diagnosis; however, fundamental challenges limit its integration with wearable technologies, namely, imaging over large-area curvilinear organs. We introduced a wearable, conformable ultrasound breast patch (cUSBr-Patch) that enables standardized and reproducible image acquisition over the entire breast with less reliance on operator training and applied transducer compression. A nature-inspired honeycomb-shaped patch combined with a phased array is guided by an easy-to-operate tracker that provides for large-area, deep scanning, and multiangle breast imaging capability. The in vitro studies and clinical trials reveal that the array using a piezoelectric crystal [Yb/Bi-Pb(In1/2Nb1/2)O3-Pb(Mg1/3Nb2/3)O3-PbTiO3] (Yb/Bi-PIN-PMN-PT) exhibits a sufficient contrast resolution (~3 dB) and axial/lateral resolutions of 0.25/1.0 mm at 30 mm depth, allowing the observation of small cysts (~0.3 cm) in the breast. This research develops a first-of-its-kind ultrasound technology for breast tissue scanning and imaging that offers a noninvasive method for tracking real-time dynamic changes of soft tissue.

Review on ultrasound-guided photoacoustic imaging for complementary analyses of biological systems in vivo

Photoacoustic imaging has been developed as a new biomedical molecular imaging modality. Due to its similarity to conventional ultrasound imaging in terms of signal detection and image generation, dual-modal photoacoustic and ultrasound imaging has been applied to visualize physiological and morphological information in biological systems in vivo. By complementing each other, dual-modal photoacoustic and ultrasound imaging showed synergistic advances in photoacoustic imaging with the guidance of ultrasound images. In this review, we introduce our recent progresses in dual-modal photoacoustic and ultrasound imaging systems at various scales of study, from preclinical small animals to clinical humans. A summary of the works reveals various strategies for combining the structural information of ultrasound images with the molecular information of photoacoustic images.

Evaluation of Cholesterol Thickness of Blood Vessels Using Photoacoustic Technology

One of the primary indicators of plaque vulnerability is the lipid composition of atherosclerotic plaques. Therefore, the medical industry requires a method to evaluate necrotic nuclei in atherosclerosis imaging with sensitivity. In this regard, photoacoustic imaging is a plaque detection method that provides chemical information on lipids and cholesterol thickness in the arterial walls of the patient. This aspect aims to increase the low-frequency axial resolution by developing a new photoacoustic-based system. A photoacoustic system has been developed to detect the cholesterol thickness of the blood vessels to observe the progression of plaque in the heart's blood vessels. The application of the coherent photoacoustic discontinuous correlation tomography technique, which is based on a novel signal processing, significantly increased the cholesterol oleate's sensitivity to plaque necrosis. By enhancing the quality of thickness detection, the system for measuring the thickness of cholesterol in blood vessels has been reduced to approximately 23 microns. The results show that the phase spectrum peaked at 100 Hz at 58.66 degrees, and at 400 Hz, the phase spectrum was 46.37 degrees. The minimum amplitude is 1.95 at 100 Hz and 17.67 at 400 Hz. In conclusion, it can be stated that photoacoustic imaging as a method based on new technologies is of great importance in medical research, which is based on the use of nonionizing radiation to perform diagnostic processes and measure different types of body tissues.

Optical Light Sources and Wavelengths within the Visible and Near-Infrared Range Using Photoacoustic Effects for Biomedical Applications

The photoacoustic (PA) effect occurs when sound waves are generated by light according to the thermodynamic and optical properties of the materials; they are absorption spectroscopic techniques that can be applied to characterize materials that absorb pulse or continuous wave (CW)-modulated electromagnetic radiation. In addition, the wavelengths and properties of the incident light significantly impact the signal-to-ratio and contrast with photoacoustic signals. In this paper, we reviewed how absorption spectroscopic research results have been used in applying actual photoacoustic effects, focusing on light sources of each wavelength. In addition, the characteristics and compositions of the light sources used for the applications were investigated and organized based on the absorption spectrum of the target materials. Therefore, we expect that this study will help researchers (who desire to study photoacoustic effects) to more efficiently approach the appropriate conditions or environments for selecting the target materials and light sources.

Research on the Multi-Element Synthetic Aperture Focusing Technique in Breast Ultrasound Imaging, Based on the Ring Array

As a widely clinical detection method, ultrasonography (US) has been applied to the diagnosis of breast cancer. In this paper, the multi-element synthetic aperture focusing (M-SAF) is applied to the ring array of breast ultrasonography (US) imaging, which addresses the problem of low imaging quality due to the single active element for each emission and the reception in the synthetic aperture focusing. In order to determine the optimal sub-aperture size, the formula is derived for calculating the internal sound pressure of the ring array with a 200 mm diameter, and the sound pressure distribution is analyzed. The ring array with 1024 elements (1024 ring array) is established in COMSOL Multiphysics 5.6, and the optimal sub-aperture size is 16 elements, according to the sound field beam simulation and the directivity research. Based on the existing experimental conditions, the ring array with 256 elements (256 ring array) is simulated and verified by experiments. The simulation has a spatial resolution evaluation in the k-Wave toolbox, and the experiment uses nylon rope and breast model imaging. The results show that if the sub-aperture size has four elements, the imaging quality is the highest. Specifically, the spatial resolution is the best, and the sound pressure amplitude and signal-to-noise ratio (SNR) are maintained at a high level in the reconstructed image. The optimal sub-aperture theory is verified by the two kinds of ring arrays, which also provide a theoretical basis for the application of the multi-element synthetic aperture focusing technology (M-SAF) in ring arrays.

An Improved Nomogram to Reduce False-Positive Biopsy Rates of Breast Imaging Reporting and Data System Ultrasonography Category 4A Lesions

BACKGROUND

The NCCN clinical guidelines recommended core needle biopsy for breast lesions classified as Breast Imaging Reporting and Data System (BI-RADS) 4, while category 4A lesions are only 2-10% likely to be malignant. Thus, a large number of biopsies of BI-RADS 4A lesions were ultimately determined to be benign, and those unnecessary biopsies may incur additional costs and pains. However, it is important to emphasize that the current risk prediction model focuses primarily on the details and complex risk features of US or MG findings, which may be difficult to apply in order to benefit from the model. To stratify and manage BI-RADS 4A lesions effectively and efficiently, a more effective and practical predictive model must be developed.

METHODS

We retrospectively analyzed 465 patients with BI-RADS ultrasonography (US) category 4A lesions, diagnosed between January 2019 and July 2019 in Tianjin Medical University Cancer Institute and Hospital and National Clinical Research Center for Cancer. Univariate and multivariate logistic regression analyses were conducted to identify risk factors. To stratify and predict the malignancy of BI-RADS 4A lesions, a nomogram combining the risk factors was constructed based on the multivariate logistic regression results. In order to determine the predictive performance of our predictive model, we used the concordance index (C-index), calibration curve, and receiver operating characteristic (ROC), and the decision curve analysis (DCA) to assess the clinical benefits.

RESULTS

Based on our analysis, 16.3% (76 out of 465) of patients were pathologically diagnosed with malignant lesions, while 83.6% (389 out of 465) were diagnosed with benign lesions. According to univariate and multivariate logistic regression analysis, age (OR = 3.414, 95%CI:1.849-6.303), nipple discharge (OR = .326, 95%CI:0.157-.835), palpable lesions (OR = 1.907, 95%CI:1.004-3.621), uncircumscribed margin (US) (OR = 1.732, 95%CI:1.033-2.905), calcification (mammography, MG) (OR = 2.384, 95%CI:1.366-4.161), BI-RADS(MG) (OR = 5.345, 95%CI:2.934-9.736) were incorporated into the predictive nomogram (C-index = .773). There was good agreement between the predicted risk and the observed probability of recurrence. Furthermore, we determined that 153 was the best cutoff score for distinguishing between patients in the low- and high-risk groups. Malignant lesions were significantly more prevalent in high-risk patients than in low-risk patients.

CONCLUSION

Based on clinical, US, and MG features, we present a predictive nomogram to reliably predict the malignancy risk of BI-RADS(US) 4A lesions, which may assist clinicians in the selection of patients at low risk of malignancy and reduce the number of false-positive biopsies.