Background: The malignant probability of Breast Imaging Reporting and Data System (BI-RADS) 4 breast lesions is 3-94%, which is a very large span, and thus leads to a high rate of unnecessary biopsy. Therefore, the differential diagnosis of benign and malignant BI-RADS 4 breast lesions has become extremely important. Thus, in this paper, we investigated the diagnostic value of conventional ultrasonography (US), contrast-enhanced ultrasound (CEUS) and shear wave elastography (SWE) for BI-RADS 4 breast lesions, and tried to figure out a multi-mode ultrasonic method for them. Methods: From March 2016 to May 2017, 118 breast lesions that were categorized as BI-RADS 4 lesions by US were studied with CEUS and SWE. All the lesions were confirmed by pathology via surgery or vacuum-assisted biopsy. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of US, CEUS and SWE were analyzed. Then the diagnostic efficacies of US, CEUS, SWE and the combination of these modalities were compared. Logistic regression analysis was performed to identify the independent risk factors. A multi-mode method to evaluate BI-RADS 4 lesions based on the logistic regression was developed.Results: Of the 118 BI-RADS 4 lesions, 74 lesions (62.7%) were benign and 44 lesions (37.3%) were malignant. The diagnostic sensitivity and specificity for US, US + CEUS, US + SWE, US + CEUS + SWE were 88.6% and 75.7%, 86.4% and 94.6%, 88.6% and 90.5%, 97.7% and 93.2%, respectively. The area under the ROC curve (AUC) of US + SWE + CEUS was significantly higher than that of US (P<0.0001), US + CEUS (P=0.020), but there was no significant difference between the AUC of US + SWE + CEUS and the AUC of US + SWE. Conclusions: US + CEUS + SWE and US + SWE could significantly improve the diagnostic efficiency and accuracy of US in the diagnosis of BI-RADS 4 breast lesions.

BackgroundTo address the neglect of depression in multimorbidity measurement and the lack of focus on rural population in previous literature about China, this paper aimed to estimate the prevalence of multimorbidity (including depressive disorders) among the country’s rural and urban population.MethodsWe used a cross-sectional design and data from a nationally representative survey conducted in 2015–2016 among Chinese people aged 45 years or older involving 19 656 participants. Multimorbidity was measured with a cut-off point of having two or more among 14 chronic illnesses. In that 13 of them were based on self-reported physician diagnosis. In addition, depressive disorders were assessed with the 10-item Centre for Epidemiologic Studies Depression Scale. The weighted prevalence of multimorbidity was calculated, with a non-response adjustment. Multivariate logistic regression was applied to analyse the relation between covariates and multimorbidity.FindingsMultimorbidity was highly prevalent (54.3%) among the studied population. Contrary to previous studies, we found the prevalence of multimorbidity to be higher among the rural dwellers (58.3%) than among the urban population (50.4%). After adjustment for covariates, rural residents had 7.5% higher odds (95% CI of OR (1.003 to 1.151)) of having multimorbidity than their urban counterparts. Above 70% of patients with any of the 14 chronic illnesses above 45 years old had multimorbidity, while 80.6%–97.9% of chronic patients had multimorbidity.InterpretationFuture health system development in China should transform from preventing and controlling non-communicable diseases as individual diseases to addressing people’s comprehensive health needs under multimorbidity. The rural population should be prioritised as they suffered more from multimorbidity than the urban population.

Osteosarcoma (OS) is the most common primary malignant bone sarcoma mainly affecting adolescents and young adults, which often progresses to pulmonary metastasis and leads to the death of OS patients. OS is characterized as a highly heterogeneous cancer type and the underlying pathologic mechanisms triggering tumor progress and metastasis are incompletely recognized. Surgery combined with neoadjuvant and postoperative chemotherapy has elevated 5-year survival to over 70% for patients with localized OS tumors, as opposed to only 20% of patients with recurrence and/or metastasis. Therefore, novel therapeutic strategies are needed to overcome the drawbacks of conventional treatments. Immunotherapy is gaining momentum for the treatment of OS with an increasing number of FDA-approved therapies for malignancies resistant to conventional therapies. Here, we review the OS tumor microenvironment and appraise the promising immunotherapies available in the management of OS.

Objective: To construct a prediction model for more precise evaluation of prognosis which will allow personalized treatment recommendations for adjuvant therapy in patients following resection of ESCC. Background: Marked heterogeneity of patient prognosis and limited evidence regarding survival benefit of various adjuvant therapy regimens pose challenges in the clinical treatment of ESCC. Methods: Based on comprehensive clinical data obtained from 4129 consecutive patients with resected ESCC in a high-risk region in China, we identified predictors for overall survival through a 2-phase selection based on Cox proportional hazard regression and minimization of Akaike information criterion. The model was internally validated using bootstrapping and externally validated in 1815 patients from a non-high-risk region in China.Results: The final model incorporates 9 variables: age, sex, primary site, T stage, N stage, number of lymph nodes harvested, tumor size, adjuvant treatment, and hemoglobin level. A significant interaction was also observed between N stage and adjuvant treatment. N1+ stage patients were likely to benefit from addition of adjuvant therapy as opposed to surgery alone, but adjuvant therapy did not improve overall survival for N0 stage patients. The C-index of the model was 0.729 in the training cohort, 0.723 after bootstrapping, and 0.695 in the external validation cohort. This model outperformed the seventh edition American Joint Committee on Cancer staging system in prognostic prediction and risk stratification. Conclusions: The prediction model constructed in this study may facilitate precise prediction of survival and inform decision-making about adjuvant therapy according to N stage.

The aim of this study was to evaluate whether ultrasound‐guided 7‐gauge vacuum‐assisted core biopsy is sufficient for the diagnosis and treatment of intraductal papilloma and to evaluate the lesion characteristics and histologic features affecting the excision rate of papilloma with vacuum‐assisted core biopsy. Between March 2008 and October 2016, 2816 patients underwent US‐guided, 7‐gauge vacuum‐assisted core biopsy (VACB). In them, 101 (3.6%) were demonstrated to have intraductal papilloma by pathology. The accurate diagnostic rate and excision rate of intraductal papilloma after vacuum‐assisted core biopsy were evaluated by open surgical biopsy or follow‐up US. The lesion characteristics and histologic features were analyzed to identify factors affecting the excision rate of papilloma after VACB. Of the 101 intraductal papillomas, 83 (82.2%) cases were benign papilloma. Two cases were intraductal papilloma accompanied by invasive carcinoma. Sixteen (15.8%) cases were with signs of atypical hyperplasia. In them, one intraductal papilloma accompanied by severe atypical hyperplasia underwent further surgery, and it was demonstrated to have intraductal papilloma accompanied by invasive carcinoma. The accurate diagnostic rate of intraductal papillomas by 7‐gauge VACB was 99.0% (100/101). There was no recurrence or malignant transformation in 85.1% (86/101) intraductal papillomas after 7‐gauge vacuum‐assisted core biopsy. Intraductal papilloma with largest diameter <1 cm, with clear margin, without branch involvement or calcification had a significantly higher excision rate. Seven‐gauge VACB is an effective method for the diagnosis of intraductal papilloma of the breast. If histopathological examination confirms a benign character of the lesion, surgery may be avoided but regular follow‐up is recommended. If histopathological examination confirms a papilloma with moderate to severe atypical hyperplasia, it was strongly recommended for surgical excision. Lesion characteristics and histologic features could affect the excision rate of intraductal papillomas with VACB.