Sonographic Features of the Follicular Variant of Papillary Thyroid Carcinoma

Objective. The purpose of this study was to evaluate the sonographic findings of the follicular variant of papillary thyroid carcinoma (FVPTC) and to assess the role of preoperative fine‐needle aspiration biopsy (FNAB). Methods. The sonographic findings of 27 thyroid nodules in 26 patients (2 male and 24 female; mean age, 45 years) with surgically proven FVPTC were reviewed retrospectively. Findings were categorized according to the echogenicity, margin, shape, and presence of microcalcifications. Malignant findings included marked hypoechogenicity, irregular or microlobulated margins, a taller‐than‐wide shape, and microcalcifications. Thyroid nodules with a single malignant finding as described above were classified as malignant. All patients underwent sonographically guided FNAB, and the sensitivity of the cytologic results was calculated. Results. Lesion sizes varied from 3 to 34 mm (mean, 15.2 mm), and lesions were most commonly solid (23 [85.2%]), hypoechoic (14 [51.9%]), and oval (17 [63%]) with well‐defined margins (14 [51.9%]) and no microcalcifications (23 [85.2%]). Eighteen lesions (66.7%) were correctly classified as malignant, whereas 9 (33.3%) were classified as benign on the basis of sonographic criteria. Twenty‐four samples were adequate for cytologic examination, and 3 were inadequate. Twenty‐one of 24 diagnostic cytologic results (87.5%) were suspicious for papillary carcinoma (5 of 21 [20.8%]) or malignant (16 of 21 [66.7%]), whereas 3 lesions (12.5%) had benign results. The sensitivity of FNAB was 77.8% (21 of 27). Conclusions. The follicular variant of papillary thyroid carcinoma tends to have relatively benign sonographic features, such as hypoechogenicity, well‐defined margins, an oval shape, and no microcalcifications, but most lesions were correctly classified as malignant by both sonography and FNAB. The possibility of FVPTC should be considered when thyroid nodules with a relatively benign sonographic appearance have suspicious or malignant FNAB results     

Hurthle cell neoplasms of the thyroid: sonographic appearance and histologic characteristics

OBJECTIVE: The purpose of this study was to determine the sonographic features of Hürthle cell neoplasms (HCNs) of the thyroid. METHODS: We retrospectively analyzed the sonographic appearance of 15 histologically proven HCNs in 15 patients aged 16 to 70 years (mean age, 44 years). Sonographic features that were reviewed included the size and echogenicity of the tumors, the presence of cystic areas or calcifications, and detectable blood flow on color Doppler imaging. Correlation of sonographic findings with pathologic results was performed. RESULTS: The tumors ranged from 0.4 to 7 cm in diameter, but most were less than 3 cm in diameter. Four (27%) of the 15 tumors were homogeneously hypoechoic. Two tumors (13%) were predominantly hypoechoic with isoechoic areas to thyroid parenchyma. Two (13%) neoplasms were isoechoic to thyroid parenchyma. Four (27%) tumors were predominantly isoechoic, containing hypoechoic areas, and 3 (20%) tumors were hyperechoic. Three neoplasms contained cystic components. None of the tumors contained calcifications. One tumor was avascular on Doppler examination. One neoplasm showed only peripheral blood flow. Thirteen tumors showed internal vascularity, 7 of them with peripheral blood flow. Twelve HCNs were benign, and 3 were malignant on pathologic examination. CONCLUSIONS: Hürthle cell neoplasms show a spectrum of sonographic appearances from predominantly hypoechoic to hyperechoic lesions and from peripheral blood flow with no internal flow to extensively vascularized lesions. Pathologic criteria differentiating benign and malignant HCNs (absence or presence of a capsular breach, vascular or extrathyroidal tissue invasion, nodal involvement, and distant metastasis) are beyond the resolution of sonography and fine-needle aspiration biopsy and require removal of the entire lesion. This precludes diagnosis and characterization of HCNs by sonography.     

不同病理类型甲状腺癌颈部转移淋巴结的声像图分析

目的探讨不同病理类型甲状腺癌颈部转移淋巴结的声像图特征。方法分析75例甲状腺癌颈部转移淋巴结的声像图的特点,其中乳头状癌50例,滤泡癌8例,髓样癌10例,未分化癌7例。结果甲状腺乳头状癌颈部转移性淋巴结局部可见团状偏高回声,部分淋巴结内可见沙砾样的微小钙化点,局部或整体可出现囊性变;甲状腺髓样癌颈部转移性淋巴结皮髓质分界不清,部分转移性淋巴结内也可见沙砾样的微小钙化点,但未见囊性变;滤泡癌和未分化癌颈部转移性淋巴结纵横比缩小,近似球形,皮髓质分界不清,淋巴门结构消失,呈低回声,均未见微小钙化点和囊性变。结论不同病理类型的甲状腺癌颈部转移淋巴结具有不同的声像图特征,病变淋巴结的超声表现与其病理改变密切相关。     

Differentiation of Thyroid Nodules With Macrocalcifications

Objective. The purpose of this study was to determine which types of macrocalcifications are associated with thyroid carcinoma and to assess the role of other suspicious sonographic findings in thyroid nodules with macrocalcifications. Methods. Our Institutional Review Board approved this retrospective study, and informed consent was not required. We reviewed sonographic findings of thyroid nodules in 722 patients that underwent thyroid surgery in our institution between March 2006 and August 2006. Sonographic results were grouped into 3 types of macrocalcifications. Each lesion was evaluated on the basis of other suspicious sonographic criteria, including marked hypoechogenicity, irregular or microlobulated margins, and a taller‐than‐wide shape. Sensitivity and specificity based on sonographic criteria were calculated and compared among the subtypes of macrocalcifications. Results. One hundred seventy‐four nodules showed macrocalcifications; 116 were malignant, and 58 were benign. Among the macrocalcification categories, solitary calcifications were more common in benign thyroid lesions, whereas coarse calcifications not otherwise specified were more common in malignant lesions (P < .05). Although the risk of malignancy was 17.2% in cases with no suspicious sonographic findings, the risk of malignancy was up to 82.8% in cases with at least 1 of the sonographic criteria (P < .05). On the basis of the suspicious sonographic criteria, the overall sensitivity was 82.8%. There was no statistically significant difference in sensitivity among the macrocalcification subtypes (P > .05). Conclusions. Suspicious sonographic features such as marked hypoechogenicity, irregular or microlobulated margins, and a taller‐than‐wide shape can play important roles in differentiating benign and malignant thyroid nodules with macrocalcifications.     

Sonographic Differentiation of Thyroid Nodules With Eggshell Calcifications

Objective. The purpose of this study was to assess the role of known suspicious sonographic findings and to find other additional sonographic findings to differentiate benign and malignant thyroid nodules with “eggshell” calcifications. Methods. Our Institutional Review Board approved this retrospective study, and informed consent was not required. We reviewed sonographic findings of thyroid nodules in 795 patients who underwent thyroid surgery in our institution between August 2006 and February 2007. Ninety‐three thyroid nodules with eggshell calcifications in 92 patients were included in this study. Each lesion was evaluated for known suspicious sonographic criteria, including marked hypoechogenicity, irregular or microlobulated margins, and a taller‐than‐wide shape, as well as 2 additional sonographic findings: a hypoechoic halo and disruption of eggshell calcifications (halo and disrupted calcification rim). The sensitivity and specificity based on the sonographic criteria were calculated and compared among the 2 types of criteria. Results. Among the 93 thyroid nodules, 59 were malignant and 34 were benign. The halo and disrupted calcification rim showed higher sensitivity (62.7% and 76.3%, respectively) than any of the known suspicious sonographic criteria (40.7%, 35.6%, and 55.9%). The combination of both the halo and the disrupted calcification rim showed significantly higher sensitivity (93.2%) than the combination of the known suspicious sonographic criteria (78%; P < .05), although both had the same specificity (64.7%). Conclusions. In thyroid nodules with eggshell calcifications but no other calcifications, the findings of a peripheral halo and disruption of the eggshell calcifications may be more useful sonographic predictors of malignancy than hypoechogenicity, microlobulated margins, and a taller‐than‐wide shape.     

彩色多普勒超声对甲状腺乳头状癌颈部淋巴结囊性转移的诊断价值

目的探讨甲状腺乳头状癌颈部淋巴结囊性转移的超声表现。方法对经病理证实为甲状腺乳头状癌颈部淋巴结囊性转移的18例患者,44枚囊性转移性淋巴结进行高频彩色多普勒超声检查,观察其二维声像图,结节、分隔内部的血流情况。结果囊性转移性淋巴结二维声像图表现为完全囊性变和部分囊性变两种类型,42枚为部分囊性变,2枚为完全囊性变。其中38枚囊性变区透声差,39枚囊壁较厚且毛糙,23枚有壁结节,18枚内部有粗细不均分隔,19枚内部见点状高回声,40枚囊性转移性淋巴结实性成分内见点状、条状血流信号。结论彩色多普勒超声是诊断甲状腺乳头状癌颈部淋巴结囊性转移的一项重要检查方法,颈部淋巴结囊性变对于甲状腺乳头状癌转移的诊断有较高的特异性。     

颈部淋巴结内囊性变在甲状腺乳头状癌转移诊断中的作用

目的:观察高分辨率超声仪在诊断甲状腺乳头状癌颈部淋巴结转移中的作用,并评价颈部淋巴结内囊性变作为甲状腺乳头状癌转移的特征性改变及其特异性和敏感性。方法:回顾性分析87例颈部淋巴结异常的患者,所有患者均曾行灰阶及彩色多普勒检查、超声引导细针穿刺活检和/或术后组织病理学检查。结果:所有患者超声显示淋巴结异常,在69%甲状腺乳头状癌患者的转移淋巴结中可见囊性变。而在非甲状腺乳头状癌患者的转移淋巴结中仅有2例可见此现象。颈部淋巴结内部出现囊性变作为甲状腺乳头状癌转移的超声特征性改变,其敏感度为69%,特异度为96.6%,阳性预测值为90.9%,阴性预测值为83.6%,准确度为87.4%。结论:颈部淋巴结内出现囊性变高度提示甲状腺乳头状癌转移。     

Sonographic Findings of the Diffuse Sclerosing Variant of Papillary Carcinoma of the Thyroid

Objective. The purpose of this series was to describe the sonographic findings of the diffuse sclerosing variant of papillary carcinoma (DSVPC) of the thyroid. Methods. The sonographic findings of 8 patients with DSVPC of the thyroid were retrospectively analyzed. The following sonographic features of DSVPC of the thyroid were analyzed: extent of disease, echogenicity, microcalcifications, and cervical metastatic lymphatic nodes. Results. Three of 8 cases were unilateral, and 5 were bilateral. All 8 cases showed diffuse involvement of at least 1 entire thyroid lobe. Five of 8 cases showed hyperechogenicity, and 3 showed hypoechogenicity. Seven of 8 cases showed diffuse scattered microcalcifications, and 1 showed locally distributed microcalcifications. All 8 cases showed cervical metastatic lymph nodes. Conclusions. The sonographic findings of DSVPC of the thyroid are characteristic, and sonography is a useful imaging tool in diagnosis of DSVPC of the thyroid.     

Cystic Thyroid Nodules After Aspiration Mimicking Malignancy

Objective. The purpose of our study was to provide sonographic findings of cystic nodules, which can mimic malignancies, after fine‐needle aspiration (FNA) and to determine the differential points from malignancies. Methods. We retrospectively reviewed the sonographic findings of 33 lesions in 32 patients who had FNA for predominantly cystic nodules or cysts and showed suspicious findings during sonographic follow‐up, as well as findings of 47 surgically confirmed papillary thyroid carcinomas (PTCs) in 45 consecutive patients. We evaluated the size, shape, presence of shadowing and a halo, margin, echogenicity, and presence of echogenic dots for each nodule. The final diagnosis of cystic nodules was confirmed by FNA, surgery, or follow‐up sonography. Results. Of the 33 cystic lesions, 31 (94%) were adequate with benign results, and 2 (6%) were inadequate specimens at the initial FNA. There were no malignancies in the cystic nodules at follow‐up. The average interval between the initial FNA and suspicious sonographic findings was 26 months (range, 1–92 months). The average size of the suspicious nodules was 0.8 cm (range, 0.3–1.8 cm). Cystic nodules after aspiration were similar to PTCs in their sonographic findings, but the former frequently showed shadowing and a halo (85% versus 21%; P < .0001). With further follow‐up, 29 lesions (88%) showed additional decreases in size. Conclusions. Benign cystic nodules after aspiration can have suspicious malignant features. However, shadowing and a halo associated with malignant features are characteristic findings of cystic nodule shrinkage. Awareness of these findings and correlation with the FNA history can aid in preventing unnecessary FNA.     

Tall Cell Variant of Papillary Thyroid Carcinoma

We retrospectively reviewed the clinical and sonographic features of 8 patients with 10 tall cell variants of papillary thyroid carcinoma. The mean age of the patients was 57 years (range, 34–72 years). The tumor sizes varied. Of the 8 patients, 5 had symptomatic masses, and 3 had incidentalomas. Three patients had recurrences and 1 died of pulmonary metastasis within a mean time of 30 months. The tall cell variants often appeared as microlobulated markedly hypoechoic nodules with microcalcifications and extrathyroidal extension on sonography and were always associated with lymph node metastasis. The tall cell variant of papillary thyroid carcinoma should be included in the differential diagnosis of an aggressive thyroid tumor with symptoms and cervical nodal metastasis.     

甲状腺滤泡型乳头状癌的超声表现与病理对照研究

目的：探讨甲状腺滤泡型乳头状癌（FVPTC）的超声表现及其与病理改变的关系。方法回顾性分析38例经手术和病理证实的FVPTC 患者的超声表现,并进行病理对照研究。结果38例FVPTC的超声表现可分为3种类型：（1）Ⅰ型8例（21%）,具备甲状腺乳头状癌的典型超声表现,结节形态不规则,边界不清,内部可呈极低回声,可见微小钙化;（2）Ⅱ型15例（39.5%）,表现为边界较清晰的等回声或低回声结节,其形态不规则,边缘可见成角或分叶,微小钙化较少见;（3）Ⅲ型15例（39.5%）,声像图表现形似腺瘤,结节边界清晰且边缘光整,内部为均匀中等回声。结合38例FVPTC的超声表现,其镜下结构特征也可相应分为3类：（1）Ⅰ型8例,病灶无明显包膜,形态不规则,呈浸润性生长;（2）Ⅱ型15例,病灶有包膜,形态不规则,病灶对包膜侵犯明显,局部突破包膜,周边可见卫星病灶;（3）Ⅲ型15例,病灶有较为完整的包膜,形态规则,病灶对包膜无明显侵犯或累及程度和范围很小。依据病灶有无包膜情况,病理诊断Ⅰ型为非包膜内型FVPTC（8/38,21%）,Ⅱ、Ⅲ型为包膜内型FVPTC（30/38,79%）,以上两者的形态、边界、声晕、纵横比、内部回声、微小钙化等超声特征的显示率不同,差异有统计学意义（P＜0.05）,而肿瘤大小、淋巴结累及等超声特征,差异没有统计学意义（P＞0.05）。结论 FVPTC 的超声表现兼具滤泡性肿瘤和普通乳头状癌的特点,其超声表现的不同与其病理亚型密切相关。     

滤泡型甲状腺乳头状癌的声像图与病理基础对照研究

目的深入地认识滤泡型甲状腺乳头状癌（胛c）的超声表现,减少滤泡型PTC的误诊率。方法回顾性分析我院39个经病理证实为滤泡型PTC的术前超声图像指标（形态、边界、声晕、内部回声、钙化及肿瘤的血管分布状况）,并与指标相应的组织病理学进行对比分析。结果39个滤泡型PTC超声表现：形态光整33个、边界清楚30个、周边见声晕29个、实性低回声结节27个,砂粒样钙化17个,混合血管型20个;病理结果：瘤体几乎为滤泡细胞,且间质少（82．0％）,可见包膜（25．6％）及砂粒体（30．8％）;与病理结果对比,超声误诊率为71．8％。结论滤泡型PTC的病理基础决定了其超声多表现为：实性低回声、边界清、形态规则、可伴砂粒样钙化。     

甲状腺包膜内乳头状癌的超声表现

目的:探讨甲状腺包膜内乳头状癌的超声表现。方法:回顾分析经手术病理证实的95例甲状腺包膜内乳头状癌患者共计97个病灶(经典型68个,滤泡型29个)的彩色超声声像图资料,根据甲状腺超声影像学报告及数据系统(thyroidimaging reporting and data system,TI-RADS)将甲状腺病灶分为良性、良性可能、不确定性、恶性可能及恶性5级。结果:经典型甲状腺包膜内乳头状癌提示恶性的超声表现有微小钙化(41%)及边缘针刺状(15%);滤泡型甲状腺包膜内乳头状癌提示恶性的超声表现有微小钙化(14%)。经典型与滤泡型甲状腺包膜内乳头状癌超声分级为良性、良性可能、不确定性、恶性可能及恶性的比例依次为10%、16%、31%、28%、15%及48%、21%、17%、14%、0。结论:甲状腺包膜内乳头状癌尤其是滤泡型甲状腺包膜内乳头状癌的超声分级多为良性、良性可能或不确定性,少数为恶性及恶性可能。     

甲状腺癌的高频声像图中钙化的意义

目的：评估甲状腺癌高频声像图中钙化的意义。方法：对２７１例甲状腺结节的高频声像图进行回顾性分析, 将其中的钙化分为三种类型： （１） 微钙化; （２） 粗钙化; （３） 弧形钙化。结果： １４４例恶性组中, 检出钙化６２例 （４３．０６％ ）, 其中微钙化４６ 例, 粗钙化１６ 例, 有微钙化的甲状腺癌中３７例为乳头状癌。１２７例良性组中, 检出钙化１１例（８．６７％ ）, 微钙化５ 例, 粗钙化５例, 弧形钙化１ 例。两组钙化率有显著性差异。但粗钙化与微钙化在两组中无显著性差异。钙化在甲状腺癌诊断中的敏感性和特异性分别为４３．０６％ 及９１．３３％ 。结论： 高频声像图中的钙化是诊断甲状腺癌的一个特异性指标。钙化的形状对甲状腺结节的良恶性鉴别帮助不大,而微钙化是乳头状癌的一个特征性表现。     

高频彩色超声对仅表现为微钙化的甲状腺乳头状癌的诊断价值

目的探讨仅表现为微钙化的甲状腺乳头状癌的高频超声诊断价值。方法收集经手术病理证实的19例仅表现为微钙化的甲状腺乳头状癌患者的声像图资料,回顾分析其高频超声及血流多普勒表现特点,总结仅表现为微钙化的甲状腺乳头状癌的超声诊断特征。结果 19例仅表现为微钙化的甲状腺乳头状癌超声表现分为局灶微钙化型和弥漫微钙化型。2例局灶微钙化型二维超声表现为"正常"甲状腺局部见簇状微钙化,彩色多普勒血流成像示局灶微钙化区血流信号无明显异常,无颈部淋巴结转移。17例弥漫微钙化型二维超声表现为甲状腺一侧叶大部或跨叶腺体内弥漫分布微钙化,未见具体结节;其中10例病变腺体回声不均匀性减低;彩色多普勒血流成像示受累腺体内血流信号均不同程度增多;14例弥漫微钙化型甲状腺乳头状癌伴一侧或双侧颈部淋巴结转移。结论高频超声检查可以检出"正常"甲状腺局部呈簇状分布的微钙化或肿大的甲状腺内呈弥漫分布的微钙化,这对仅表现为微钙化而没有具体结节的甲状腺乳头状癌具有重要的诊断价值。     

Sonographic Features of Follicular Variant Papillary Thyroid Carcinomas in Comparison With Conventional Papillary Thyroid Carcinomas

Objective. The purpose of this study was to compare the sonographic features as well as the results of fine-needle aspiration biopsy (FNAB) of follicular variant papillary thyroid carcinoma (FVPTCs) and conventional papillary thyroid carcinoma (PTCs). Methods. Forty patients with 44 FVPTCs and 59 patients with 74 conventional PTCs were enrolled in this study. The sonographic features, sonographic gradings, and FNAB results were compared between the two groups. Results. The mean nodule size of FVPTCs was larger than that of conventional PTCs (17.70 versus 10.53 mm; P < .001). Sonographic features of an ovoid-to-round shape (95% versus 73%), isoechogenicity (52% versus 8%), and a hypoechoic halo (25% versus 3%) were more frequent in FVPTCs than conventional PTCs (P < .001). Sonographic features of a taller-than-wide shape (5% versus 22%), a spiculated margin (7% versus 32%), marked hypoechogenicity (5% versus 38%), and microcalcification (7% versus 24%) were rarer in FVPTCs than conventional PTCs (P < .05). The incidence of a sonographically malignant grade was also lower in FVPTCs (48%) than conventional PTCs (81%; P < .001). A diagnosis of PTC on FNAB of FVPTCs was less common than that of conventional PTCs (28% versus 56%; P = .0393); however, a diagnosis of an indeterminate cytologic type such as atypical cells or follicular lesions in FVPTCs was higher than that in conventional PTCs (46% versus 19%; P = .0418). Conclusions. Follicular variant papillary thyroid carcinomas show a relatively larger size, more benign sonographic features, a lower incidence of a sonographically malignant grade, and a lower diagnostic rate of PTC on FNAB compared with conventional PTCs.     

Can Color Doppler Sonography Aid in the Prediction of Malignancy of Thyroid Nodules?

OBJECTIVE: To determine whether color Doppler interrogation of a thyroid nodule can aid in the prediction of malignancy. METHODS: We obtained color Doppler images of thyroid nodules undergoing sonographically guided fine-needle aspiration. The color Doppler appearance of each nodule was graded from 0 for no visible flow through 4 for extensive internal flow. The size, sonographic appearance, results of fine-needle aspiration, and surgical pathologic findings, if available, were recorded for each nodule. RESULTS: There were 254 nodules sampled, of which 32 were malignant (all confirmed at surgery) and 177 were benign. Fourteen (43.8%) of the 32 malignant nodules were color type 4, compared with only 26 (14.7%) of the 177 benign nodules (P = .0004, Fisher exact test). Thirteen (40.1%) of the 32 malignant nodules were solid, as were 18 (10.2%) of the 177 benign nodules (P = .006, Fisher exact test). Among solid nodules, the prevalence of malignancy was greater when the nodule was hypervascular (13 [41.9%] of 31) than when the color type was less than 4 (11 [14.7%] of 77; P = .004, Fisher exact test). CONCLUSIONS: Solid hypervascular thyroid nodules have a high likelihood of malignancy (nearly 42% in our series). The color characteristics of a thyroid nodule, however, cannot be used to exclude malignancy, because 14% of solid nonhypervascular nodules were malignant.     

Cystic appearance of cervical lymph nodes is characteristic of metastatic papillary thyroid carcinoma

PURPOSE: The usefulness of high-resolution sonography in diagnosing cervical lymph node metastases from papillary thyroid carcinoma was investigated. The accuracy of a particular sign, cystic change within a node, in establishing the diagnosis was assessed. METHODS: The sonographic findings in 63 patients with enlarged cervical lymph nodes were retrospectively reviewed. The patients had undergone high-resolution gray-scale and color Doppler sonography followed by ultrasound-guided fine-needle aspiration (FNA) in all patients and surgical excision in 27 patients. RESULTS: Abnormal sonographic features were present in the lymph nodes of all 63 patients. In 14 (70%) of 20 patients with papillary thyroid carcinoma, sonography depicted cystic changes. This pattern was not found in any of the other 43 patients, in whom FNA revealed either metastasis from another malignancy (22 patients) or benign reactive lymphadenopathy (21 patients). Among the 63 patients, there were 43 true-negative, 14 true-positive, 6 false-negative, and no false-positive results in the diagnosis of metastatic papillary thyroid carcinoma using the presence or absence of an intranodal cystic area on sonography. These results yielded a 70% sensitivity, 100% specificity, 100% positive predictive value, 88% negative predictive value, and 90% overall accuracy for this criterion. CONCLUSIONS: Cystic changes within a cervical lymph node are highly suggestive of metastatic papillary thyroid carcinoma.     

Risk of malignancy in solid breast nodules according to their sonographic features.

OBJECTIVE: The purpose of this study was to assess the risk of malignancy for each type of sonographic feature in solid breast nodules. METHODS: The study included 304 patients from the Department of Gynecology and Obstetrics of the Federal University of Goiás who had solid breast nodules. A medical trainee, working under the supervision of a preceptor, obtained the sonographic images of the breast, and the features were recorded in a questionnaire. Each sonographic feature was analyzed and compared with the anatomic and pathologic findings after the lesion was excised. RESULTS: Of the 304 patients included in the study, 292 (96%) had a conclusive diagnosis. Among these women, 216 (74%) had benign tumors and 76 (26%) had malignant tumors. The odds ratio of malignancy in breast nodules, as calculated by multivariate analysis, was as follows: lesions without circumscribed margins, 17.02 (95% confidence interval, 5.28-54.90); lesions with heterogeneous echo texture, 7.70 (2.99-19.84); lesions with thickened Cooper ligaments, 15.61 (1.08-225.10); nodules whose anteroposterior dimension was larger than their width, 3.29 (1.09-9.96); those with an anterior echogenic rim, 2.59 (0.80-8.40); and those with posterior shadowing, 1.57 (0.62-4.01). Among the 133 cases that had all the sonographic features of a benign lesion, 3 nodules (2.3%) had a histologic diagnosis of malignant. CONCLUSIONS: Sonography is a diagnostic method that can help establish the differentiation between benign and malignant solid tumors. A lack of circumscribed margins, heterogeneous echo patterns, thickened Cooper ligaments, and an increased anteroposterior dimension can indicate a higher probability of malignancy in solid breast nodules.     

Sonographic findings in the surgical bed after thyroidectomy: comparison of recurrent tumors and nonrecurrent lesions.

OBJECTIVE: The purpose of this study was to assess the sonographic findings of recurrent tumors and nonrecurrent lesions mimicking recurrent tumors in the surgical bed after thyroidectomy for thyroid cancer. METHODS: Fifty-eight patients who underwent sonography and sonographically guided fine-needle aspiration for evaluation of abnormal lesions in the surgical bed after thyroidectomy were included in this retrospective study. We compared the sonographic findings of recurrent tumors and nonrecurrent lesions, including lesion size, shape, margins, and echogenicity, presence or absence of microcalcification, and vascular flow signals. The reference standard was repeated sonographically guided fine-needle aspiration, surgery, or follow-up for at least 1 year. RESULTS: Of 59 lesions in 58 patients, 20 were confirmed as recurrent tumors, and 36 were confirmed as nonrecurrent lesions in the surgical bed; 3 patients were lost to follow-up. On sonographic examination, the recurrent tumors diagnosed in 20 patients were oval in 70%, had well-defined margins in 100%, were hypoechoic in 70%, and had microcalcification in 10%. The average size was 0.7 cm (range, 0.4-2.1 cm). There was no statistical difference in sonographic findings between recurrent tumors and nonrecurrent lesions (P > .05). The 36 nonrecurrent lesions included remnant thyroidal tissue (n = 8), postoperative fibrosis (n = 7), suture granuloma (n = 7), strap muscle with a nodular contour (n = 4), reactive lymph nodes (n = 4), cysts (n = 3), tracheal cartilage (n = 2), and fat necrosis (n = 1). CONCLUSIONS: For lesions located in the surgical bed in patients after thyroidectomy, the distinction between recurrent thyroid cancer and nonrecurrent benign lesions cannot be made on the basis of the sonographic features. Fine-needle aspiration is helpful in determining the histologic nature of such lesions.