[show abstract][hide abstract] ABSTRACT: Purpose: To analyze which sonographic features of thyroid nodules with macrocalcifications were predictable of thyroid malignancy. Materials and Methods: We reviewed sonographic findings of 854 macrocalcified thyroid nodules in patients who underwent fine needle aspiration biopsy between December 2009 and January 2011. There were 171 non-diagnostic aspirations, 34 nodules with category 3, 4, 5 based on Bethesda system, which were not confirmed by surgery, and these nodules were excluded from the analysis. Sonographic characteristics of the macrocalcifications including its thickness, interruption, and existence of soft tissue rim outside the macrocalcification were analyzed. Other sonographic characteristics of nodules such as shape, margin, composition, echo pattern, vascularity, and underlying parenchymal echogenicity were also evaluated. The correlation of sonographic features with cytopathologic results and the diagnostic performance of sonographic features for the prediction of malignancy were analyzed. Results: Among 649 nodules, 179 (27.6%) nodules were malignant and 470 (72.4%) nodules were benign. Among the features of the macrocalcification, interruption, irregular thickness, or the presence of soft tissue outside calcification rim were associated with malignancy (p<0.001). A high sensitivity and negative predictive values for the prediction of malignancy was found in sonographic characteristics of irregular thickness (92.2% and 91.0%, respectively) and the presence of soft tissue (88.5% and 88.8%, respectively). Conclusion: Sonographic characteristics of macrocalcification such as interruption, irregular thickness and the presence of soft tissue rim were associated with malignancy in thyroid nodules with macrocalcifications.
Yonsei medical journal 03/2014; 55(2):339-44. · 0.77 Impact Factor
[show abstract][hide abstract] ABSTRACT: The indications of repeat fine-needle aspiration (FNA) for thyroid nodules with benign results of the Bethesda system were investigated.
A total of 1,398 nodules were classified according to the Thyroid Imaging Reporting and Data System (TIRADS). TIRADS category 3 included nodules without solidity, hypoechogenicity or marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, and taller-than-wide shape on ultrasonography (US). Categories 4a, 4b, 4c, and 5 included nodules with one, two, three or four, or five suspicious US features, respectively. The malignancy risks, and odds ratio (OR) with 95 % confidence interval (CI) were calculated. Analyses were performed for all nodules, nodules >10 mm, and nodules ≤10 mm.
Of 1.398 nodules, 43 (3.1 %) were malignanct. The malignancy risks of benign nodules with categories 3, 4a, and 4b were 0.7, 1.2, and 0.7 %, respectively, whereas those for nodules with categories 4c and 5 were 9.8 and 22.2 %, respectively. The ORs of nodules with categories 4c and 5 were 19.4 (95 % CI 5.0-76.2) and 50.6 (95 % CI 10.4-245.0), respectively. In nodules >10 mm, the malignancy risks of categories 4c and 5 were 2.7 and 20 %, respectively, and the ORs were 10.7 (95 % CI 1.2-93.7) and 236.1 (95 % CI 12.6-4426.4), respectively. In nodules ≤ 10 mm, the malignancy risks of categories 4c and 5 were 12.6 and 22.6 %, respectively, and the ORs were 10.1 (95 % CI 1.3-78.0) and 18.9 (95 % CI 2.1-168.9), respectively.
Repeat US-guided FNA should be considered in benign thyroid nodules with three or more suspicious US features regardless of size.
Annals of Surgical Oncology 02/2014; · 4.12 Impact Factor
[show abstract][hide abstract] ABSTRACT: Purpose: To assess the risk of malignancy of thyroid incidentalomas found on 18F-FDG PET/CT by US features and cytologic results, and to evaluate the clinical usage of a combination of US features and cytology for post-FNA management of thyroid incidentalomas on 18F-FDG PET/CT. Materials and Methods: From September 2006 to December 2008, 132 patients with 134 thyroid incidentalomas detected on 18F-FDG PET/CT who had undergone US and US-FNA were included in this study. We evaluated the malignancy rate of thyroid incidentalomas in different subgroups subdivided by US features and US-FNA cytology results. Several variables were compared between the benign and malignant group. Results: The risk of malignancy was 58.2 % (78/132) in thyroid incidentalomas on 18F-FDG PET/CT. Age, gender, and tumor size were not significantly different between the malignant and benign group. Malignancy rate of thyroid incidentalomas was significantly higher in the suspicious malignant (88.9 %) than in the probably benign group (11.3 %) on US (p < 0.001). Malignancy rates were high in thyroid nodules with "malignancy", "suspicious for malignancy", or "follicular neoplasm" on cytologic results, regardless of US features. However, malignancy rates of thyroid incidentalomas with "unsatisfactory" or "benign" results on cytology were higher in the suspicious malignant (75 %, 12.5 %, respectively) than in the probably benign (0 %) group on US. Conclusions: This study demonstrated that the risk of malignancy was high in thyroid incidentalomas on 18F-FDG PET/CT even without suspicious US features. However, there was no malignancy in nodules with no suspicious US features and benign cytology. Based on these results, we concluded that US may not replace FNA in the diagnosis of PET incidentalomas, and that a follow-up may be considered of thyroid incidentalomas with benign cytology and no suspicious US features.
Ultraschall in der Medizin 01/2014; · 4.12 Impact Factor
[show abstract][hide abstract] ABSTRACT: Heterogeneous echogenicity and micro-nodulations of diffuse thyroid disease on ultrasonography (US) might influence the diagnostic performance of pre-operative US staging, especially the detection of multi-focality. This study was designed to determine whether heterogeneous echogenicity of the thyroid parenchyma influences the diagnostic performance of US in the detection of multi-focality in papillary thyroid carcinoma. Between December 2010 and April 2011, 811 patients underwent pre-operative staging US for papillary thyroid carcinoma and surgery. Twelve radiologists performed the pre-operative US for T and N staging. Underlying parenchymal echogenicity and unilateral and bilateral multi-focality of the thyroid nodules were also evaluated. Patients were divided into two groups on the basis of the underlying echogenicity of the thyroid gland. To evaluate the diagnostic accuracy of US with respect to underlying echogenicity, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated and compared between the two groups. Among the 811 patients included, US revealed underlying heterogeneous echogenicity of the thyroid parenchyma in 204 (25.2%) and underlying homogeneous echogenicity of the thyroid parenchyma in 607 (74.8%). There were no significant differences between the two groups in the diagnostic performance of pre-operative staging US in predicting unilateral multi-focality and bilaterality. Underlying heterogeneous echogenicity in a thyroid gland with Hashimoto's thyroiditis does not significantly influence the detection of multi-focality in papillary thyroid cancer on pre-operative US staging.
Ultrasound in medicine & biology 01/2014; · 2.02 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background: Recently, it has been reported that the risk of thyroid malignancy increases with increasing concentrations of serum TSH. The aim of study was to determine whether or not serum TSH can be a predictor for thyroid malignancy, when considering the relevant US features and clinical risk factors. Methods: This retrospective study included 1200 euthyroid patients with 1269 thyroid nodules who underwent ultrasound-guided fine-needle aspiration biopsy between January and June 2009. Serum TSH, US feature, and clinical parameters were compared according to final diagnosis. Subgroup analyses were performed according to nodule size. Results: Serum TSH did not show a positive association with malignancy for all nodules and micronodule subgroup in multivariate analysis, although they showed significant association with thyroid malignancy for macronodule subgroup. For all nodules and the two subgroups, suspicious US features and younger age were significantly associated with malignancy in univariate and multivariate analyses. Conclusions: Our study suggests that TSH alone is not as useful as US features in deciding whether or not to perform FNA in patients with micronodules. Head Neck, 2014.
[show abstract][hide abstract] ABSTRACT: Purpose: Thyroid ultrasonography (US) is a useful diagnostic tool in the evaluation of diffuse thyroid disease (DTD), whereas shearwave elastography is a dynamic technique that can provide information about tissue hardness by using acoustic shearwaves remotely induced by a focused ultrasonic beam. This study aims at investigating the role of conventional US and shearwave elastography in the diagnosis of asymptomatic patients with DTD. Materials and Methods: Fifty-seven patients who underwent both conventional US and shearwave elastography were included in this study. Interobserver variability of the three radiologists in assessment of underlying thyroid echogenicity on conventional US was analyzed. Diagnostic performances for diagnosing DTD on conventional US and shearwave elastography were calculated and compared. Results: Fair agreement was observed in the identification of DTD with conventional US (kappa value= 0.27). The area under the receiver operating characteristic curve (Az) were 0.52-0.585 on conventional US by three radiologists. The Az values when using the mean and maximum elasticity values as a diagnostic criteria for DTD were 0.619 and 0.59 on shearwave elastography. Patients with DTD showed higher mean [24.1±10 kilo-Pascals (kPa)] and maximum (36.4±13.3 kPa) elasticity values on shearwave elastography when compared to the normal group (23.4±10.8 kPa and 33.7±12.4 kPa, respectively), although without statistical significance (p=0.802 and p=0.452, respectively). Conclusion: Conventional US did not show reliable interobserver agreement in the diagnosis of DTD. Although not statistically significant, shearwave elastography may provide additional information in the diagnosis of DTD. Therefore, larger prospective studies are needed to define the values of shearwave elastography for diagnosing DTD.
Yonsei medical journal 01/2014; 55(1):247-53. · 0.77 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background
We hypothesized that a nomogram constructed of clinical and imaging variables could be applied to predicting the risk of malignancy in thyroid nodules diagnosed as AUS/FLUS.
This retrospectively designed study included 393 thyroid nodules in 392 patients (mean age: 49.06 ± 11.86 years) which were diagnosed as AUS/FLUS with US-FNA during the study period. Medical records, US images, and cytopathology results were reviewed and analyzed. The 393 thyroid nodules were divided into training and validation sets. Logistic regression analysis was performed to predict the probability of malignancy and nomograms were constructed using the training set and subsequently applied to the validation set.
Three sets of nomograms were separately constructed using clinical factors and (a) individual US features, (b) final assessment of US, and (c) the number of suspicious US features. All three sets of nomograms built were proven accurate and discriminative, with an area under the receiver operating characteristic curve (AUC) of 0.817 (95% confidence interval (CI): 0.757-0.877) when using clinical factors and individual US features, of 0.769 (95% CI: 0.705-0.833) when using final assessment, and of 0.779 (95% CI: 0.718-0.840) when using the number of suspicious US features. The AUC of each validation set was 0.754 (95% CI: 0.659-0.850), 0.757 (95% CI: 0.661-0.853), and 0.721 (95% CI: 0.621-0.820), respectively.
Nomograms constructed in our study using US can be utilized in predicting the probability of malignancy in thyroid nodules diagnosed as AUS/FLUS on US-FNA, and may help in selecting patients who are at high risk for malignancy.
[show abstract][hide abstract] ABSTRACT: The aim of the present study was to evaluate the clinical implications of the vascular index (VI) as a predicting factor for central and lateral lymph node metastasis (LNM) in patients with papillary thyroid microcarcinoma (PTMC). From January 2011 to October 2011, 588 patients (495 females, 93 males) who were diagnosed with PTMC were included. Clinicopathologic characteristics of patients and ultrasound (US) features of the lesions including VI were evaluated retrospectively. The VI was measured with QLAB 7.0 quantification software using preoperative Doppler US images. Univariate and multivariate analysis were used to assess predictive factors of LNM. From 588 patients, 140 patients (23.8 %) had central LNM and 26 patients (4.4 %) had lateral LNM on pathologic results. The presence of lateral LNM [odds ratio (OR) 5.46; 95 % confidence interval (CI) = 2.19-13.64], bilaterality (OR 2.16; 95 % CI 1.17-4.01), and increased tumor size (OR 1.15; 95 % CI 1.04-1.28) were significant independent factors for predicting central LNM. The presence of central LNM (OR 5.58; 95 % CI 2.22-14.04), upper third location of malignancy (OR 2.50; 95 % CI 1.01-6.21), and tumor size (OR 1.34; 95 % CI 1.03-1.73) were significant independent factors for predicting lateral LNM. However, the VI was not a significant predicting factor for both central and lateral LNM. Therefore, the VI of PTMC may not be useful for predicting central and lateral LNM in patients with PTMC.
[show abstract][hide abstract] ABSTRACT: The aim of this study was to compare the diagnostic performance of gray-scale ultrasound (US), elastography and a combination of gray-scale ultrasound and elastography (US-E) in differentiating benign and malignant thyroid nodules with respect to the level of physician experience. Three hundred fifty-eight patients with 367 thyroid nodules who underwent both gray-scale US and elastography, from November 2011 to January 2012, were included in this study. The diagnostic performance of US performed by experienced and less experienced physicians was compared. Comparisons of the diagnostic performance of US, elastography and US-E were evaluated for each group separately. Of 367 nodules, 121 were malignant and 246 were benign. When we compared the diagnostic performance of the experienced and less experienced physician groups, specificity was statistically higher in the experienced physician group for both US alone (p = 0.001) and US-E (p = 0.048). However, the experienced and less experienced physician groups did not differ significantly on other measures of diagnostic performance, regardless of modality. For the experienced physicians, the specificity and positive predictive value US were 88.0% and 76.8%, respectively; both of them were significantly higher than the corresponding values for US-E. For the less experienced physicians, specificity was significantly higher on elastography (93.8%) than on US (71.4%) (p < 0.001). However, diagnostic performance did not differ significantly between US and US-E for the less experienced physicians. Experienced physicians had superior specificity compared with less experienced physicians. The diagnostic performance of elastography and US-E was inferior compared with that of US alone, irrespective of the level of experience of the physician.
Ultrasound in medicine & biology 12/2013; · 2.02 Impact Factor
[show abstract][hide abstract] ABSTRACT: Objectives- To analyze sonographic findings suggesting central lymph node metastasis of papillary thyroid carcinoma and to evaluate the influence of associated chronic lymphocytic thyroiditis on the diagnostic performance of sonography for predicting central lymph node metastasis. Methods- A total of 124 patients (101 female and 23 male; mean age, 47.5 years; range, 21-74 years) underwent sonographically guided fine-needle aspiration in central lymph nodes from January 2008 to July 2011. Sonographic features of size, shape, margin, thickening of the cortex, cortical echogenicity, presence of a hilum, cystic changes, calcification, and vascularity of enlarged lymph nodes were analyzed before fine-needle aspiration and classified into 2 categories (probably benign and suspicious). Sonographic findings were correlated with the pathologic diagnosis and associated chronic lymphocytic thyroiditis. Receiver operating characteristic curve analysis was performed to assess the diagnostic performance of sonography for predicting central lymph node metastasis according to the associated thyroiditis. Results- Fifty-one lymph nodes (39.5%) were malignant, and 73 (60.5%) were benign. On univariate analysis, size, shape, margin, cortical thickening, cortical echogenicity, cystic changes, calcification, and vascularity were significantly different between the benign and metastatic nodes (P < .05). On multivariate analysis, eccentric cortical thickening (odds ratio, 26.59; 95% confidence interval [CI], 3.26-216.66) and hyper echogenicity of the cortex (odds ratio, 18.46; 95% CI, 2.44-139.64) were significantly associated with malignant nodes (P < .05). The area under the curve values for sonography for predicting metastasis were 0.756 (95% CI, 0.618-0.894) in chronic lymphocytic thyroiditis-positive patients and 0.971 (95% CI, 0.938-1.000) in negative patients. Conclusions- Eccentric cortical thickening and cortical hyperechogenicity were the sonographic findings predictive of central lymph node metastasis from papillary thyroid carcinoma. The diagnostic performance of sonography for predicting metastasis was superior in chronic lymphocytic thyroiditis-negative patients than in positive patients.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2013; 32(12):2145-51. · 1.40 Impact Factor
[show abstract][hide abstract] ABSTRACT: Heterogeneous echogenicity of the thyroid gland has been associated with diffuse thyroid disease and benign and malignant nodules can coexist with diffuse thyroid disease. Underlying heterogeneous echogenicity might make it difficult to differentiate between benign and malignant nodules on US. Thus, the aim of this study was to evaluate the influence of underlying thyroid echogenicity on diagnosis of thyroid malignancies using US.
A total of 1,373 patients who underwent US-guided fine needle aspiration of 1,449 thyroid nodules from June 2009 to August 2009 were included. The diagnostic performance of US assessment for thyroid nodules was calculated and compared according to underlying thyroid echogenicity. The diagnostic ce of US assessments in the diagnosis of thyroid malignancy according to the underlying parenchymal echogenicity was compared using a logistic regression with the GEE (generalized estimating equation) method. Each US feature of malignant and benign thyroid nodules was analyzed according to underlying echogenicity to evaluate which feature affected the final diagnosis.
Among the 1,449 nodules, 325 (22.4%) were malignant and 1,124 (77.6%) were benign. Thyroid glands with heterogeneous echogenicity showed significantly lower specificity, PPV, and accuracy compared to thyroid glands with homogeneous echogenicity, 76.3% to 83.7%, 48.7% to 60.9%, and 77.6% to 84.4%, respectively (P = 0.009, 0.02 and 0.005, respectively).In benign thyroid nodules, microlobulated or irregular margins were more frequently seen in thyroid glands with heterogeneous echogenicity than in those with homogenous echogenicity (P < 0.001).
Heterogeneous echogenicity of the thyroid gland significantly lowers the specificity, PPV, and accuracy of US in the differentiation of thyroid nodules. Therefore, caution is required during evaluation of thyroid nodules detected in thyroid parenchyma showing heterogeneous echogenicity.
BMC Cancer 11/2013; 13(1):550. · 3.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: Purpose: To investigate the ultrasonographic (US) features of anaplastic thyroid cancer (ATC) and the diagnostic performance of US-guided fine needle aspiration biopsy (FNAB) therein. Materials and Methods: Eighteen cases of ATC diagnosed between January 2001 and May 2011 were included. FNAB was performed in all cases. Initial FNAB results were divided into three groups: 1) the cytological ATC group, cytological diagnosis of ATC; 2) the underestimated group, cytological diagnoses of malignancy other than ATC; and 3) the false negative group, cytological diagnoses of atypical, benign and non-diagnostic lesions. We retrospectively reviewed US findings and compared treatment modalities between each group. Results: Among the 18 patients, there were nine in the initially cytological ATC group, four in the underestimated group and five in the false negative group. The most common US features of ATC were a solid (64.7%) and irregular shaped (88.2%) mass with lymph node involvement (76.4%). However, except for lymph node involvement (p=0.003), US findings for each group were not statistically different. The initial cytological diagnostic accuracy of ATC was 50% (9/18). Surgery was performed less in the ATC group (11%) and the false negative group (20%) than the underestimated group (75%). Conclusion: The US features of ATC were not especially different from other types of aggressive thyroid cancer. A correct diagnosis of ATC by initial US-FNAB was made in 50% of the patients, which is significant in that therapeutic surgery can be undertaken in lower numbers if correctly diagnosed.
Yonsei medical journal 11/2013; 54(6):1400-6. · 0.77 Impact Factor
[show abstract][hide abstract] ABSTRACT: The goal of this study is to compare the overall quality of film mammograms taken according to the Korean standards with the American College of Radiology (ACR) standard for clinical image evaluation and to identify means of improving mammography quality in Korea.
Four hundred and sixty eight sets of film mammograms were evaluated with respect to the Korean and ACR standards for clinical image evaluation. The pass and failure rates of mammograms were compared by medical facility types. Average scores in each category of the two standards were evaluated. Receiver operating characteristic curve analysis was used to identify an optimal Korean standard pass mark by taking the ACR standard as the reference standard.
93.6% (438/468) of mammograms passed the Korean standard, whereas only 80.1% (375/468) passed the ACR standard (p < 0.001). Non-radiologic private clinics had the lowest pass rate (88.1%: Korean standard, 71.8%: ACR standard) and the lowest total score (76.0) by the Korean standard. Average scores of positioning were lowest (19.3/29 by the Korean standard and 3.7/5 by the ACR standard). A cutoff score of 77.0 for the Korean standard was found to correspond to a pass level when the ACR standard was applied.
We suggest that tighter regulations, such as, raising the Korean pass mark, subtracting more for severe deficiencies, or considering a very low scores in even a single category as failure, are needed to improve the quality of mammography in Korea.
Korean journal of radiology: official journal of the Korean Radiological Society 09/2013; 14(5):701-10. · 1.32 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background Recommendation for subcentimeter thyroid nodules that need fine-needle aspiration biopsy is renewed in the revised American Thyroid Association (ATA) guidelines published in 2009. We applied these recommendations to analyze the diagnostic performance of the ATA guidelines and compared it to that of other modified guidelines. Methods We evaluated 1054 nodules with a size of 6 mm to 10 mm in 991 patients. A total of 713 nodules were included in the study population by excluding nodules with insufficient results for deciding whether they had a benign or malignant cytology. Frequencies of ultrasonographic features in benign and malignant nodules were compared, and odds ratios of suspicious ultrasonographic features were obtained with univariate and multivariate analysis. Seven modified guidelines were made based on the revised ATA guidelines and from multivariate analysis results. Diagnostic performances of the guidelines were compared by sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the receiver operating characteristic curve (Az) value. Results In addition to hypoechogenicity, infiltrative margin, microcalcification, and taller than wide shape that were suggested by the ATA guidelines, solid composition and macrocalcification were significantly associated with malignancy on multivariate analysis (p value = 0.001 and 0.003, respectively). Increased vascularity, however, was not significantly associated with malignant nodules (odds ratio 0.729, p value = 0.212). Among the eight guidelines, the ATA guidelines showed the lowest diagnostic performance (Az value = 0.616). Excluding increased vascularity and including solid composition with or without macrocalcification to the suspicious ultrasonographic features of the ATA guidelines improved sensitivity (96.6 % vs 97.0 %), specificity (26.6 % vs 42.9 %), PPV (48.3 % vs 54.7 %), and NPV (91.7 % vs 95.2 %), thereby resulting in the highest Az value (Az value = 0.699, p value < 0.001). Conclusions This study suggests that excluding increased vascularity and adding solid composition to the suspicious ultrasonographic features of the ATA guidelines would significantly improve the diagnostic performance in subcentimeter nodules for the identification of malignant lesions.
Thyroid: official journal of the American Thyroid Association 05/2013; · 2.60 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Pulmonary actinomycosis is a chronic pulmonary infection caused by Actinomyces. Both improving oral hygiene and early application of antibiotics to the case of suspicious pulmonary infections result in changes in incidences and presentations of pulmonary actinomycosis. However, there are little reports dealt with the recent clinical characteristics of pulmonary actinomycosis. This study aimed to review the characteristics of pulmonary actinomycosis occurred during the first decade of 21st century. METHODS: This retrospective study was performed on 94 subjects with pulmonary actinomycosis diagnosed pathologically from January 2000 to December 2010 in 13 hospitals in Korea. RESULTS: The data of the study showed that pulmonary actinomycosis occurs frequently in middle to old-aged males (mean age; 57.7 years old) and that the most common symptoms are cough, hemoptysis, and sputum production. Various radiologic features such as the consolidation with central low attenuation (74. 5%) and no regional predominance were also observed. Most of patients recovered completely with medical and/or surgical treatment, reaching approximately 98% cure rate. CONCLUSIONS: The results demonstrate that pulmonary actinomycosis is one of the cautious pulmonary diseases. More importantly, in cases of persistent hemoptysis or for differential diagnosis from lung malignancy, our data have revealed that surgical resection appears to be a useful intervention and that radiologic diagnosis may not provide decisive information. These findings indicate that it is important for the clinicians to include pulmonary actinomycosis as one of differential diagnoses for refractory pulmonary abnormal lesions to the current usual management.
[show abstract][hide abstract] ABSTRACT: Background. To evaluate optimal indication of thyroglobulin (Tg) measurement in fine-needle aspiration (FNA) for detecting lateral metastatic lymph nodes (LNs) in patients with papillary thyroid carcinoma. Methods. We performed a retrospective study of 241 LNs of 220 patients who underwent ultrasound-guided FNA (US-FNA) with Tg in FNA washout fluid (FNA-Tg) measurements for suspicious LNs. Results. On multivariate analysis, hyperechogenicity, cystic change, presence of calcifications, and peripheral vascularity were independent factors predictive of LN. After adding FNA-Tg, sensitivity and accuracy were significantly increased when the LN had one or two suspicious US features. However, sensitivity and accuracy were not significantly increased when the LN had multiple suspicious US features. Conclusion. Additional FNA-Tg can help diagnose a metastatic LN with one or two suspicious US features. However, additional FNA-Tg is not beneficial in LNs with highly suspicious US features, where FNA alone is sufficient for diagnosis of metastasis. Head Neck, 2013.
[show abstract][hide abstract] ABSTRACT: The purpose of this pictorial essay is to show the limitations of sonography and complementary usefulness of specimen radiography in detecting microcalcifications of the diffuse sclerosing variant of papillary thyroid carcinoma, which mostly manifests as diffusely scattered microcalcifications in the thyroid gland.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 02/2013; 32(2):347-54. · 1.40 Impact Factor
[show abstract][hide abstract] ABSTRACT: The objective of this retrospective study was to develop and validate a simple diagnostic prediction model by using ultrasound (US) features of thyroid nodules obtained from multicenter retrospective data.
Patient data were collected from 20 different institutions and the data included 2000 thyroid nodules from 1796 patients. For developing a diagnostic prediction model to estimate the malignant risk of thyroid nodules using suspicious malignant US features, we developed a training model in a subset of 1402 nodules from 1260 patients. Several suspicious malignant US features were evaluated to create the prediction model using a scoring tool. The scores for such US features were estimated by calculating odds ratios, and the risk score of malignancy for each thyroid nodule was defined as the sum of these individual scores. Later, we verified the usefulness of developed scoring system by applying into the remaining 598 nodules from 536 patients.
Among 2000 tumors, 1268 were benign and 732 were malignant. In our multiple regression analysis models, the following US features were statistically significant for malignant nodules when using the training data set: hypoechogenicity, marked hypoechogenicity, non-parallel orientation, microlobulated or spiculated margin, ill-defined margins, and microcalcifications. The malignancy rate was 7.3% in thyroid nodules that did not have suspicious-malignant features on US. Area under the receiver operating characteristic (ROC) curve was 0.867, which shows that the US risk score help predict thyroid malignancy well. In the test data set, the malignancy rates were 6.2% in thyroid nodules without malignant features on US. Area under the ROC curve of the test set was 0.872 when using the prediction model.
The predictor model using suspicious malignant US features may be helpful in risk stratification of thyroid nodules.
Korean journal of radiology: official journal of the Korean Radiological Society 01/2013; 14(1):110-7. · 1.32 Impact Factor