Suspiciously malignant findings on ultrasound after fine needle aspiration biopsy in a thyroid nodule with initially benign ultrasound and cytologic result: to repeat or to follow-up

Purpose

The purposes of this study were to evaluate the incidence of suspiciously malignant change on ultrasound (US) in thyroid nodules after initial benign US and cytologic results and to investigate the associated US characteristics and the management of these nodules.

Materials and methods

Among the patients who underwent thyroid fine needle aspiration biopsy (FNAB) from October 2003 to December 2004, 550 patients who had thyroid nodules with initial benign US and cytologic results were included. Reference standards were established by pathologic results, follow-up cytologic results or follow-up US. We evaluated the incidence of morphologic changes to suspiciously malignant US findings of these thyroid nodules after FNAB. We also evaluated the initial US features associated with the nodules showing suspiciously malignant findings on US after FNAB in these patients.

Results

Of 550 patients, 28 nodules (5.1%) showed morphologic changes into nodules with suspiciously malignant US findings on follow-up US. All thyroid nodules showing morphologic changes had mixed solid and cystic components (P<.001). Suspiciously malignant changes on US were associated with the percentage of the cystic portion, but all changed nodules were confirmed as benign.

Conclusion

Follow-up US should be recommended rather than to repeat FNAB for thyroid nodules with initial benign US and cytologic results even if they later develop suspiciously malignant US features after FNAB.     

Role of ultrasound in the preoperative staging of patients with breast cancer

The aim of this study was to evaluate the ability of axillary ultrasound (US) and US-guided fine-needle aspiration biopsy (FNAB) to detect axillary LN metastases. Between January 2001 and September 2003, axillary US was performed in 165 patients with cytologically or histologically proven breast cancer and clinically non-palpable axillary LNs. In patients with US suspicious LNs, US-guided FNAB was performed and patients with cytologically proven malignant LNs proceeded directly to the ALND. In 49/90 patients with US suspicious LNs, US-guided FNAB was performed. It was positive in 33/49 patients. Definitive histology report revealed LN metastases in 65/165 patients. The sensitivity, specificity, positive and negative predictive value of the US-FNAB, were 84, 91, 97 and 62%. Axillary US in a combination with US-FNAB is a valuable method in preoperative staging of patients with breast cancer. Almost 50% of patients with LN metastases can be spared the second operation. However, it is very much operator-dependent and equipment-dependent.     

超声TI-RADS分类与细针穿刺活检在诊断甲状腺恶性结节中的临床应用

目的探讨甲状腺影像报告和数据系统分类（TI-RADS）与细针穿刺活检（FNA）在诊断甲状腺恶性结节中的临床应用价值。 方法回顾性分析我院于2020年1月至2020年12月期间常规甲状腺超声检查中TI-RADS分类≥3类的585例患者的588个甲状腺结节,所有患者均接受甲状腺细针穿刺细胞学活检,其中266个甲状腺结节手术切除,以大体病理为金标准,评价超声TI-RADS分类与细针穿刺活检诊断甲状腺恶性结节的效能。 结果588个甲状腺结节细胞学病理诊断恶性243例、良性193例、性质不确定152例,超声TI-RADS 3、4、5类甲状腺恶性结节的阳性率分别为3.01%（4/133）、38.87%（110/283）、75.00%（129/172）;266个结节手术切除,大体病理诊断恶性211例、良性55例,细针穿刺活检诊断甲状腺恶性结节的敏感性、特异性、准确性分别为98.46%、93.02%、97.48%,阳性预测值为98.46%,阴性预测值为93.02%,阳性似然比为14.11,阴性似然比为0.017;穿刺感硬及有砂粒感诊断为甲状腺恶性结节的准确性明显高于穿刺感软及无砂粒感,差异有统计学意义（χ² = 70.206,65.083;P = 0.000,0.000）;超声TI-RADS分类及细针穿刺活检诊断甲状腺恶性结节的ROC曲线下面积分别为0.881及0.954。 结论超声TI-RADS分类结合细针穿刺活检对甲状腺恶性结节有较高的诊断价值,可更准确、更安全地判断甲状腺结节的良恶性,值得临床推广。     

Breast Microcalcifications: Diagnostic Outcomes According to Image-Guided Biopsy Method

Objective

To evaluate the diagnostic outcomes of ultrasonography-guided core needle biopsy (US-CNB), US-guided vacuum-assisted biopsy (US-VAB), and stereotactic-guided vacuum-assisted biopsy (S-VAB) for diagnosing suspicious breast microcalcification.

Materials and Methods

We retrospectively reviewed 336 cases of suspicious breast microcalcification in patients who subsequently underwent image-guided biopsy. US-CNB was performed for US-visible microcalcifications associated with a mass (n = 28), US-VAB for US-visible microcalcifications without an associated mass (n = 59), and S-VAB for mammogram-only visible lesions (n = 249). Mammographic findings, biopsy failure rate, false-negative rate, and underestimation rate were analyzed. Histological diagnoses and the Breast Imaging Reporting and Data System (BI-RADS) categories were reported.

Results

Biopsy failure rates for US-CNB, US-VAB, and S-VAB were 7.1% (2/28), 0% (0/59), and 2.8% (7/249), respectively. Three false-negative cases were detected for US-CNB and two for S-VAB. The rates of biopsy-diagnosed ductal carcinoma in situ that were upgraded to invasive cancer at surgery were 41.7% (5/12), 12.9% (4/31), and 8.6% (3/35) for US-CNB, US-VAB, and S-VAB, respectively. Sonographically visible lesions were more likely to be malignant (66.2% [51/77] vs. 23.2% [46/198]; p < 0.001) or of higher BI-RADS category (61.0% [47/77] vs. 22.2% [44/198]; p < 0.001) than sonographically invisible lesions.

Conclusion

Ultrasonography-guided vacuum-assisted biopsy is more accurate than US-CNB when suspicious microcalcifications are detected on US. Calcifications with malignant pathology are significantly more visible on US than benign lesions.     

Causes of discordant or negative ultrasound of parathyroid glands in treatment naïve patients with primary hyperparathyroidism

Objectives

To describe causes of discordant or negative parathyroid ultrasound and to assess factors influencing them.

Materials and methods

Retrospective review of patients who underwent parathyroidectomy between 2000 and 2012 was done. Imaging findings were compared with operative findings and pathology to identify discrepant (n = 60; 32 negative, 28 incorrect) parathyroid ultrasounds.

Results

Fifty (83.3%) patients had parathyroid adenoma, of which 10 (16.6%) were ectopic and three were double adenomas; 8 (13.3%) had multigland hyperplasia and two had parathyroid carcinoma. Discrepant reports were due to incorrect localisation in 8 (13.3%); difficulty in differentiating thyroid from parathyroid lesion in 12 (20%); large and small size in two and three patients, respectively; overcall in 5 (8.3%) and satisfaction of search in 7 (11.7%) patients. There was significant correlation between presence of multi-nodular goitre and incorrect reports (χ² = 4.112, p = 0.04). Experience of ultrasound operators performing initial and second look ultrasound was significantly different (p < 0.0001). Second look ultrasound was concordant with surgical findings in 39(65%) patients; 21 (66%) patients with initially negative ultrasound and four out of five extra-mediastinal ectopic lesions. Ten patients with negative initial ultrasound had elongated parathyroid lesion. Scintigraphy was concordant in 44 (73.3%) patients and nine were ectopic.

Conclusion

Second look ultrasound performed by experienced operator for negative or discordant initial ultrasound of parathyroid is a useful strategy which will improve the accuracy of parathyroid ultrasound. Being able to differentiate thyroid from parathyroid lesion is a factor which will influence performance of parathyroid ultrasound.     

超声引导下穿刺活检的临床应用（423例资料的分析总结）

目的：开展超声引导下穿刺活检以用于临床诊断,方法：用超声引导下细针穿刺抽吸活检（ｆｉｎｅ－ｎｅｅｄｌｅａｓｐｉｒａｔｉｏｎ,ＦＮＡ）５６处病变和活检枪自动切割活检（ａｕｔｏｍａｔｉｃｃｏｒｅ－ｎｅｅｄｌｅｂｉｏｐｓｙ,ＡＣＮＢ）３７９处病变。１８个月内共检查４２３例４３５处病变,取材部位涉及除颅脑以外的全身深浅部各种脏器及软组织。结果：ＡＣＮＢ的取材质量,成功率（９８．７％）,显著高于ＦＮＡ（８９     

超细支气管镜结合经皮肺穿技术在肺外周病变诊断中的价值

目的 评价超细支气管镜结合经皮肺穿技术在肺外周病变诊断中的价值.方法 269例肺外周病变患者均先进行超细支气管镜活检并刷检术,对无阳性结果,且病灶位于肺门、内带或中带的89例患者进行X线引导超细支气管镜肺活检并刷检术;对病灶位于中、外带的77例患者,经X线引导进行经皮肺穿刺针吸活检术;对于超细病灶紧贴胸壁的70例患者经B超引导进行经皮肺自动弹性穿刺切割活检术.结果 269例患者行超细支气管镜肺活检并刷检共276例次,获得诊断者82例,阳性率为30.5%(82/269);89例患者行X线引导超细支气管镜肺活检并刷检94例次,获得诊断者66例,阳性率为74.2%(66/89);77例患者行X线引导经皮肺针吸活检85例次,获得诊断者52例,阳性率为67.5%(52/77);70例患者行B超引导经皮肺自动弹性穿刺切割术79例次,获得诊断者49例,阳性率为70.0%(49/70).4种方法结合后的诊断率(92.6%)明显提高.结论 综合超细支气管镜检查结合经皮肺穿等介入诊断技术,可明显提高肺外周病变的阳性率,值得临床推广应用.     

Localization of parathyroid enlargement: experience with technetium-99m methoxyisobutylisonitrile and thallium-201 scintigraphy,ultrasonography and computed tomography

Technetium-99m methoxyisobutylisonitrile (MIBI), like thallium-201, has recently been introduced as a myocardial perfusion agent and is now also showing very promising results in parathyroid scintigrapy. The results of ²⁰¹Tl/^99mTc-pertechnetate and ^99mTc-MIBI/^99mTc-pertechnetate subtraction scintigraphy, ultrasonography and computed tomography are presented in a series of 43 patients operated on for hyperparathyroidism. All four imaging modalities were confirmed to be reliable, scintigraphy being the most accurate. Sensitivities ranged from 81% to 95%, that of ^99mTc-MIBI being the highest. Moreover this tracer, which has more favourable physical and also biochemical properties, yielded images of superior quality. This allowed localization of the lesion by visual inspection only in as many as 86% of the patients with positive ^99mTc-MIBI/^99mTc-pertechnetate subtraction scintigraphy. We believe that the higher sensitivity, superior image quality and lower cost of ^99mTc-MIBI imaging will make ^99mTc-MIBI the new radiopharmaceutical of choice for parathyroid scintigraphy (when one takes into account the stability of labelling with large activities it is possible to perform three or four cardiac studies together with one parathyroid scintigraphic examination using one lyophililzed vial).     

Parotid incidentaloma identified by combined 18F-fluorodeoxyglucose whole-body positron emission tomography and computed tomography: findings at grayscale and power Doppler ultrasonography and ultrasound-guided fine-needle aspiration biopsy or core-needle biopsy

Twelve parotid incidentalomas in 10 consecutive subjects (nine with a known malignancy elsewhere and one presumptively healthy subject) identified by combined ¹⁸F-fluorodeoxyglucose whole-body positron emission tomography and computed tomography (¹⁸F-FDG PET/CT) were investigated, with the aim of calculating maximum standardized uptake value (SUV_max) of each FDG-avid focus, and identifying corresponding sonographic and pathologic findings. The results of ultrasound-guided fine-needle aspiration biopsy (FNAB) (n = 9) and core-needle biopsy (CNB) (n = 3) were Warthin tumor in 10 cases, and pleomorphic adenoma and chronic inflammation in one each. SUV_max was 7.0–21.0 g/mL (average 13.7 g/mL) for Warthin tumor, 6.8 g/mL for pleomorphic adenoma, and 7.3 g/mL for chronic inflammation. Each FDG-avid focus corresponded to ovoid (n = 11) or lobulated (n = 1) hypoechoic mass on grayscale ultrasonography (US) and hypervascular mass, except one with chronic inflammation, on power Doppler (PD) US. Parotid incidentaloma identified by ¹⁸F-FDG PET/CT during workup of various malignancies elsewhere does not necessarily signify primary or metastatic malignancy, but indicates a high likelihood of benign lesions, particularly Warthin tumor. Such lesions should be evaluated thoroughly by US and ultrasound-guided FNAB or CNB if parotid disease would change the patient’s treatment plan.     

Accuracy of high-resolution ultrasound (US) for gingival soft tissue thickness mesurement in edentulous patients prior to implant placement

Objectives:To evaluate and compare the accuracy of high-resolution ultrasound (US) with two different cone beam CT (CBCT) units and clinical assessment for measuring gingival soft tissue thickness in edentulous patients prior to implant placement.Methods and materials:The study consisted of 40 maxillary implant sites of 40 healthy patients (20 females, 20 males; mean age, 47.88 years). We prospectively evaluated labial/buccal gingival thickness in 40 implant regions (16 anterior and 24 posterior) by using limited field of view (FOV) CBCT images and US images in comparison to gold standard transgingival probing measurements. One-way analysis of variance (ANOVA) was used to compare mean measurements obtained from CBCT (Morita and Planmeca), US, and transgingival probing. Interclass correlation coefficient (ICC) estimates were calculated based on means with two-way mixed and absolute-agreement model. Bland Altman plot was used to describe agreement between clinical vs US and CBCT measurements by constructing limits of agreement. Statistical significance was set at p < 0.05.Results:There was no significant difference between methods used according to mean gingival thickness measurements obtained from the top (p = 0.519) and bottom (p = 0.346) of the alveolar process. US and CBCT measurements highly correlated with clinical measurements for both top and bottom alveolar process gingival thickness (p < 0.001). Distribution of differences between clinical measurements and both CBCT measurements showed statistically significant differences according to 0 (p < 0.05). Distribution of differences between clinical measurements and US measurements did not show statistically significant difference (p > 0.05).Conclusion:High-resolution US provided accurate information for the measurement of gingival soft tissue thickness in edentulous patients prior to implant placement.     

Vocal cord paralysis secondary to a benign parathyroid cyst: a case report with clinical,imaging and pathological findings (2008:6b)

Parathyroid cysts are uncommon entities. Symptomatic parathyroid cysts are extremely rare with approximately only 200 cases reported in the literature. Only ten cases have been reported with recurrent laryngeal nerve paralysis and none in the radiological literature. We present a case of parathyroid cyst and recurrent laryngeal nerve paralysis with illustrations of the clinical, radiological and pathological appearances as well as discussion on the management of this condition.     

超声联合MRI诊断孤立性血管环及预后分析

目的 探讨产前超声联合MRI对孤立性血管环的诊断及预后情况。方法 选取我院经产前超声心动图检查诊断为孤立性血管环的胎儿82例作为观察对象,其中13例进行胎儿心脏MRI检查,观察走行于血管环内的气管有无受压,并以Kappa法对超声检出气管受压及MRI检出气管受压间的一致性进行评定,并随访出生后情况。结果 82例孤立性血管环包括右位主动脉弓伴左锁骨下动脉迷走（RAA+ALSA组）63例（76.83%,63/82）,双主动脉弓（DAA组）16例（19.51%,16/82）,肺动脉吊带（PAS组）3例（3.66%,3/82）。产前超声诊断气管受压结果和MRI诊断结果一致性好（Kappa=0.83）。随访DAA组生后10例（62.50%,10/16）患儿出现呼吸道症状;RAA+ALSA组生后1例（1.67%,1/60）患儿出现呼吸道症状;PAS组胎儿生后均出现呼吸道症状。血管环胎儿染色体检查检出异常3例（5.56%,3/54）。结论 产前超声心动图检查可明确诊断血管环并进行分型,MRI对于评估血管环气管通畅性有很好的补充作用。不合并染色体异常的孤立性血管环预后良好。     

多种频率超声探头联合应用在急性阑尾炎诊断中的价值探讨

目的探讨凸阵腹部探头、高频线阵探头、多种频率超声探头联合在急性阑尾炎诊断中的临床价值。方法回顾性分析我院69例经术后病理证实为急性阑尾炎患者的超声声像图特征,术前这些患者分别采用单独应用凸阵腹部探头,单独应用高频线阵探头及多种频率超声探头联合应用的方法进行了超声检查。结果单独应用凸阵腹部探头检查超声诊断符合率为54%,单独应用高频线阵探头检查超声诊断符合率为65%,2种探头联合应用超声诊断符合率为93%,明显高于仅用一种超声探头进行诊断,比较差异有统计学意义(P<0.05)。结论多种频率超声探头联合应用对急性阑尾炎的诊断价值更高。     

超声人工智能联合TI-RADS分类在甲状腺结节鉴别诊断中的辅助价值

目的:探讨超声人工智能联合美国放射学会甲状腺影像与报告系统(TI-RADS)分类在甲状腺结节良恶性鉴别诊断中的价值。方法:回顾性分析860例(共920个结节)行甲状腺手术的患者,术前均行超声检查,并与术后组织病理学结果对照,比较人工智能、TI-RADS分类及两者联合诊断的效能,采用Kappa检验分析不同诊断方式的一致性。结果:人工智能、TI-RADS及联合检查诊断甲状腺恶性结节的准确率分别为78.80%(725/920)、80.98%(745/920)及85.00%(782/920);敏感度76.36%(252/330)、80.61%(266/330)及86.36%(285/330);特异度分别为80.17%(473/590)、81.19%(479/590)及84.24%(497/590)。ROC曲线分析人工智能、TI-RADS分类及联合诊断甲状腺恶性结节的AUC分别为0.783、0.792及0.853(Z=1.465,P=0.143)。结论:人工智能与TI-RADS分类对甲状腺结节均具有较高的诊断效能,联合诊断能更有效地鉴别甲状腺结节的良恶性。     

Management of infracentimetric thyroid nodules with respect to ultrasonographic features

An assumed indolent course of thyroid microcarcinomas and concerns about the cost-effectiveness of treatment raise management issues. As various studies have reported controversial results, management remains unclear. The purpose of this study was to examine the use of ultrasonography (US) in detecting malignancies in a series of 589 infracentimetric nodules. Results of fine-needle aspiration biopsies (FNAB) revealed 503 nodules with adequate cytology. Of these, 473 (94%) were benign, 13 (2.6%) were suspicious for malignancy, 13 (2.6%) were malignant, and 4 (0.8%) were follicular neoplasms. Hypoechogenicity and accompanying lymphadenopathy were the independently significant features in detecting malignancies. Certain combinations of US features increase the significance and predictive value for malignant cytology particularly in the presence of lymphadenopathy. When the postoperative histological results of ten patients with a final diagnosis of papillary carcinoma were evaluated for extent of disease, seven (70%) had one or more of the findings of multifocality, metastatic lymph nodes, or extracapsular involvement, thus proving their clinical significance. Our results indicate that thyroid microcarcinomas should be taken seriously if there are possible signs of malignancy on US. With respect to the high benign nature of the micronodules (94%), the number of interventional procedures should be lowered by making assessments based on a combination of US features including lymphadenopathy.     

CT透视引导下细针抽吸活检并T.B.O快速染色诊断胸部疾病的价值

目的：研究CT透视引导下细针抽吸活检结合床边T．B．O快速染色对胸部疑难疾病的诊断价值。方法：回顾分析胸部疑难疾病48例，所有病例均运用CT透视引导细针抽吸，常规进行床边T．B．O快速染色判断，并与涂片及或细胞团切片H．E染色诊断(必要时免疫细胞化学辅助诊断)、最后诊断对照分析。结果：CT导引下穿刺成功率100％。均并行床边T．B．O快速染色后标本判断。本组48例中，恶性病变42例，良性病变6例，床边T．B．O染色判断良、恶性准确率98％(47/48)，总的诊断准确率92％(44/48)。穿刺次数1—2次，无假阳性、无严重并发症发生。结论：CT透视引导下细针抽吸活检准确、安全，床边T．B．O快速染色简单易行，二者结合诊断准确率高，对胸部疑难疾病尤其是胸部小病灶或靠近大血管病灶的诊断具有重大价值。     

甲状腺细针穿刺细胞学联合BRAF基因检测的诊断价值

目的 评价甲状腺细针穿刺细胞学(FNAB)联合BRAF V600E基因检测对甲状腺结节良恶性鉴别的诊断价值.方法 总结经手术病理证实的64个甲状腺结节术前超声引导下细针穿刺细胞学检查和BRAF V600E基因检测的资料,以手术后组织病理学结果作为甲状腺结节性质的诊断金标准,分析FNAB、BRAF V600E基因检测以及两者联合诊断的价值.结果 62例患者64个结节(2例双侧)接受手术处理,其中共有44个结节检测到BRAF V600E突变,43个结节术后病理为甲状腺乳头状癌,1个术后病理为结节性甲状腺肿.在44个检测到BRAF V600E突变结节中,FNAB诊断恶性28个,良性6个,无法确定性质10个.在20个未检测到BRAF V600E突变结节中,FNAB诊断恶性5个,良性3,无法确定性质12个,术后病理14个甲状腺乳头状癌,4个结节性甲状腺肿,1个亚急性甲状腺炎,1个甲状腺腺瘤.共57个甲状腺乳头状癌中,检查到BRAF V600E基因突变有43个,突变率为75.4％.与手术病理金标准比较,FNAB判断甲状腺结节良恶性的灵敏度、特异度、阳性预测值、阴性预测值、正确率分别是78.9％、85.7％、97.8％、33.3％、79.7％;BRAF V600E基因检测判断甲状腺结节良恶性的灵敏度、特异度、阳性预测值、阴性预测值、正确率分别是75.4％、85.7％、97.7％、30.0％、76.6％;FNAB联合BRAF V600E基因检测判断甲状腺结节良恶性的灵敏度、特异度、阳性预测值、阴性预测值、正确率分别是94.7％、71.4％、96.4％、62.5％、92.2％.采用McNemar配对资料x2检验比较FNAB、FNAB联合BRAF基因检测两种诊断方法的差别,P＜0.001,两者差异有显著统计学意义.结论 对FNAB无法明确性质的甲状腺结节,辅助联合BRAF V600E基因检测,可以提高甲状腺结节良恶性诊断的准确性.     

四维盆底超声在电刺激联合生物反馈结合盆底肌锻炼治疗压力性尿失禁疗效评估中的价值

目的:探讨四维盆底超声在电刺激联合生物反馈盆底肌锻炼治疗压力性尿失禁(SUI)疗效评估中的价值.方法:选择60例SUI患者,电刺激联合生物反馈盆底肌锻炼3个月后分析治疗效果;并于治疗前后采用经会阴四维盆底超声记录患者肛提肌裂孔面积、裂孔左右径、肛提肌厚度、膀胱颈移动度、膀胱尿道后角及尿道内口漏斗形成率.结果:治疗后,肛...     

经皮肝穿刺酒精消融术中的X线导向与X线联合B超导向的对比研究

目的探讨在经皮肝穿酒精消融术（PEI）中单纯使用x线导向与x线联合B超导向技术（简称联合导向组）的临床使用价值,比较两者导向手段的优缺点。方法选取40例肝脏恶性肿瘤的患者随机分为两组：其中单纯X线组20例;联合导向组20例。均进行经皮肝穿酒精消融术,术后第1天均行cT平扫了解病灶的消融药物分布情况。结果单纯x线组中目标病灶穿刺命中率低且病灶消融药物分布欠均匀,非目标区域出现消融药物概率低：联合导向组中目标病灶穿刺命中率高且病灶消融药物分布均匀,非目标区域出现消融药物概率也低。结论经皮肝穿酒精消融介入治疗术中联合导向的优势明显优于单纯X线导向,建议有条件的单位尽量使用联合导向。     

Meier-Gorlin syndrome with prenatal ultrasound findings and successful growth hormone therapy: Six years follow-up of a rare case

Meire-Gorlin syndrome (MGS) is a rare autosomal recessive disorder characterized by a triad of short stature, microtia, and absent or hypoplastic patella. We report a 5-year-old male affected with the subtype MGS1, secondary to c.c2292t mutation of ORC1 gene. Our patient''s features included a triangular face, micrognathia, and delayed motor development. To the edge of our knowledge, this is the first diagnosed Iranian MGS patient and sixth case in the middle east. MGS1 subtype has never shown improvement to growth hormone therapy, therefore underlying molecular defect was suggested to be responsible for patients’ short stature rather than growth hormone deficiency. However, our patients’ growth velocity was improved by growth hormone. We recommend more studies to specify the role of ORC1 gene in this syndrome. In addition, this case report describes the prenatal investigations and sonographic examinations of MGS1 for the first time.