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ABSTRACT: To determine the false-negative rate and to evaluate the clinical, radiologic or histologic features of false-negative results at ultrasound (US)-guided 14-gauge core needle biopsy (CNB).
A total of 3,724 masses from 3,308 women who had undergone US-guided 14-gauge CNB and who had a rebiopsy or at least 2 years' follow-up were included. The histology of CNB was correlated with the rebiopsy or long-term imaging follow-up. In cases of missed cancer, the time interval between CNB and rebiopsy, the reasons for rebiopsy, and the procedural or lesion characteristics were analysed.
Of 1,706 benign CNBs, 50 additional malignancies were found at excision (false-negative rate, 2.5% of 1,982 with a final diagnosis of malignancy). Of 50 false negatives, 41 were found immediately of which 28 had rebiopsy because of imaging-histological discordance. Regarding the frequency of malignancy according to the reasons for rebiopsy, suspicious imaging finding (24%) showed significantly higher frequency than suspicious clinical findings or request (1%). Regarding the characteristics except invasiveness, no significant differences in false-negative rates were found.
Most false negatives were found immediately and imaging-histological discordance was the most important clue. Careful correlation of clinical, radiological and histological results as well as appropriate follow-up is essential.
European Radiology 10/2009; 20(4):782-9. · 3.22 Impact Factor
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ABSTRACT: This study was designed to investigate the role of BRAFV600E mutation status in cytology specimens and ultrasonography (US) when planning surgery for thyroid nodules with cytologic results suspicious for papillary thyroid carcinoma (PTC).
From July 2008 to November 2008, 91 consecutive patients with cytologic results of suspicious for PTC underwent thyroidectomy. Before surgery, all patients received US-guided fine needle aspiration biopsy (US-FNAB) solely for the purpose of BRAFV600E mutation analysis of thyroid nodules suspicious for PTC on cytology. BRAFV600E mutations were tested by direct sequencing. We investigated the role of BRAFV600E mutation and US in planning the thyroid surgery.
Of 91 nodules suspicious for PTC, 42 (46.2%) were positive for the BRAFV600E mutation and confirmed to be PTC by histopathology. The positive predictive values of BRAFV600E mutation was 100%. Of the 49 nodules without the BRAFV600E mutation, 42 (85.7%) proved to be PTC. Thirty-nine of 42 (92.9%) PTCs were suspicious for malignant features on US. Two of seven (28.6%) benign lesions showed probably benign features. The sensitivity, positive predictive value, and accuracy of US in thyroid nodules without BRAFV600E mutations was 92.9% (39/42), 88.6% (39/44), and 83.7% (41/49), respectively.
The BRAFV600E mutation is a useful molecular marker for preoperative diagnosis of PTC and an indicator for therapeutic thyroid surgery in the nodule with cytologic results suspicious for PTC. In thyroid nodules without the BRAFV600E mutation, suspicious malignant features on US may help in planning the extent of thyroid surgery.
Annals of Surgical Oncology 08/2009; 16(11):3125-31. · 4.17 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the combined role of ultrasound (US) and frozen section (FS) in the surgical management of thyroid nodules that are suspicious for papillary thyroid carcinoma (PTC) on US-guided fine-needle aspiration biopsy (US-FNAB).
Between 2006 and 2008, 217 patients with thyroid nodules classified as suspicious for PTC on US-FNAB underwent intraoperative FS and surgery. A thyroid nodule with any suspicious US findings of marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, or taller than wider in shape was defined as positive and that without was defined as negative. FSs were classified as malignant, indeterminate, defer, and benign. We compared the results of US groupings, FS, and final histopathologic diagnosis.
Twenty-one (52.5%) of 40 patients with a negative US revealed malignancy. In contrast, 168 (94.9%) of 177 patients with a positive US had malignancy. Fourteen (50%) of 28 patients with benign pathology on FS had malignancy, and 166 (97.6%) of 170 patients with malignancy on FS proved malignancy on histopathology. Of 40 patients with negative US, 13 (92.9%) of 14 with malignancy on FS proved malignancy.
The malignancy rate of thyroid nodules read as "suspicious for PTC" on US-FNAB was 87.1%. When a thyroid nodule with "suspicious for PTC" on US-FNAB has suspicious malignant US features, FS may be unnecessary due to a very high risk of malignancy (94.9%). In contrast, when a thyroid nodule read as "suspicious for PTC" on US-FNAB has no suspicious malignant US features, FS can help surgeons determine the extent of surgery.
World Journal of Surgery 04/2009; 33(5):950-7. · 2.36 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the role of sonographic-cytological correlation in determining which nodules should be reaspirated to reduce the false-negative rate of fine-needle aspiration biopsy (FNAB). A retrospective cohort study was performed on a database of 568 patients with 672 focal thyroid nodules. An independent two-sample t-test was used to compare the risk of malignancy according to clinical factors. We evaluated the risk stratification of malignancy according to US groupings and cytological results. Additionally, we calculated the false-negative rate of FNAB and investigated the cytological results of repeat aspiration. The malignancy rate (92.2-98.5%) was high in thyroid nodules designated "malignant" or "suspicious for papillary carcinoma" on FNAB, regardless of US features. In contrast, when focal thyroid nodules had "benign" readings on FNAB, the malignancy rate was lower for the "probably benign" US features (2.9%) than for the suspicious nodules (56.6%). The false-negative rate of FNAB was 5.8%. Repeat aspiration revealed "suspicious for malignancy" or "malignancy" results in 15 (93.8%) of 16 thyroid cancers with "benign" results on initial aspirate. This study demonstrated repeat FNAB should be performed on focal thyroid nodules with suspicious US features even when initial FNAB results are benign.
European Radiology 04/2009; 19(8):1923-31. · 3.22 Impact Factor
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ABSTRACT: Preoperative prediction of lateral lymph node metastasis (LNM) is important to prevent recurrence; however, there are few published data in predicting factors of lateral LNM before surgery. The present study investigated the factors affecting LNM in patients with papillary thyroid microcarcinoma (PTMC).
A retrospective cohort study was conducted with data obtained from 671 patients with PTMC between 2004 and 2006. We reviewed the clinical, ultrasound (US), and pathology records of patients and analyzed the association between lateral LNM and clinical factors, US features of PTMC, and pathologic features.
The rate of lateral LNM was 3.7% in 671 PTMCs. We found a statistically significant association between lateral LNM and US features of PTMC (upper pole location, contact of >25% with the adjacent capsule, and presence of calcifications), and pathologic features (central LNM) in multivariate analysis (P < .05). The odds ratios of statistically significant factors were 4.7 (95% confidence interval [95% CI], 1.8-12.6), 10.8 (95% CI, 3.3-34.6), 4.8 (95% CI, 1.6-13.7), and 6.9 (95% CI, 2.4-20) at upper pole location, contact of >25% with the adjacent capsule, presence of calcifications on US, and pathologic central LNM, respectively.
In patients with PTMC, independent factors in predicting lateral LNM were US features of PTMC (upper pole location, >25% contact with the adjacent capsule, and presence of calcifications) and pathologic features (central LNM). When these US features are detected on preoperative US, lateral neck nodes should be meticulously evaluated by a multimodal approach.
Annals of Surgical Oncology 02/2009; 16(5):1348-55. · 4.17 Impact Factor
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ABSTRACT: The aim of this study was to compare the diagnostic accuracy and image quality of microcalcifications in zoomed digital contact mammography with digital magnification mammography. Three radiologists with different levels of experience in mammography reviewed 120 microcalcification clusters in 111 patients with a full-field digital mammography system relying on digital magnification mammogram (MAG) images and zoomed images from contact mammography (ZOOM) using commercially available zooming systems on monitors. Each radiologist estimated the probability of malignancy and rated the image quality and confidence rate. Performance was evaluated by sensitivity, specificity, positive predictive value, negative predictive value, and receiver operating characteristic (ROC) analysis. All three radiologists rated MAG images higher than ZOOM images for sensitivity with statistical significance (average value, 92% vs. 87%, P<0.05) and performance by ROC analysis improved with MAG imaging. The confidence rate for diagnosis decision and the assessment of lesion characteristics were also better in MAG images than in ZOOM images with statistical significance (P<0.0001). Digital magnification mammography can enhance diagnostic performance when characterizing microcalcifications. Images zoomed from digital contact mammography cannot serve as an alternative to direct magnification digital mammography.
European Radiology 08/2008; 19(2):310-7. · 3.22 Impact Factor
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ABSTRACT: This study was conducted to assess the accuracy of US-guided directional vacuum-assisted removal (US-DVAR) in evaluating nonmalignant papillary breast lesions. This retrospective study was approved by the institutional review board at our institution; patient consent was not required. We reviewed the clinical and pathology findings from a total of 39 papillary lesions diagnosed at vacuum-assisted removal in 37 patients (age range, 26-60 years; mean age, 44.5 years). Over the follow-up period, we evaluated whether any histologic upgrade occurred and whether or not residual lesions were detected on follow-up imaging. US-DVAR of 39 lesions yielded tissue that was classified as benign in 35 and atypical in 4. Of the 35 lesions that were diagnosed as histologically benign at US-DVAR, 2 were surgically excised. Both of them yielded benign results. Of the 33 benign lesions that were not surgically excised, 28 (85%) were not seen at radiographic follow-up. Of the four lesions diagnosed as atypical at US-DVAR that were surgically excised, all the four were benign. None proved to be malignant. The upgrade rate was 0.0% (95% confidence interval, 0-9%). Among our patients, diagnosis by US-DVAR of benign papillary lesions proved to be accurate, and benign papillary lesions at US-DVAR did not need to be surgically excised for accurate diagnosis.
European Radiology 05/2008; 18(9):1774-83. · 3.22 Impact Factor
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ABSTRACT: OBJECTIVE:: To investigate the capability of preoperative evaluations in predicting the precise anatomic origin of intracanalicular tumors. STUDY DESIGN:: We conducted a retrospective case review. SETTING:: Tertiary referral center. PATIENTS:: A total of 11 patients (8 men and 3 women, 26-70 years old) with intracanalicular tumors who were treated surgically were included. INTERVENTIONS:: Pure-tone average, auditory brainstem response, caloric test, and temporal magnetic resonance imaging were done in all 11 patients. Electroneuronography has only been performed since 2003, and only 3 patients were evaluated. MAIN OUTCOME MEASURE:: Preoperative symptoms, pure-tone average, auditory brainstem response, caloric test, electroneuronography, and magnetic resonance imaging were compared between patients with facial nerve schwannomas and patients with vestibular schwannomas. RESULTS:: Postoperatively, facial nerve schwannomas were diagnosed pathologically in 2 (18%) of 11 patients. There were not any clues suggesting facial nerve schwannoma in preoperative evaluations. CONCLUSION:: A facial nerve schwannoma may be misdiagnosed as a vestibular schwannoma, especially when the tumor is confined to the internal auditory canal. There are no useful preoperative evaluation tools in predicting the precise nerve origin of intracanalicular tumors. These emphasize the need to fully inform the patient preoperatively.
Ontology & Neurotology 07/2007; · 1.90 Impact Factor
