Thyroid nodules associated with Hashimoto thyroiditis: assessment with US.

Sonographic findings in 109 thyroid nodules in 104 patients with Hashimoto thyroiditis were retrospectively analyzed. Sixty patients underwent ultrasound (US)--guided fine-needle aspiration (FNA) biopsy (65 nodules, 24 palpable, 27 surgically confirmed), 14 of whom also underwent palpation-guided FNA (14 nodules, all palpable, all surgically confirmed). Forty-four patients (44 nodules, 25 palpable) underwent diagnostic US followed up with surgery. US-guided FNA helped differentiate between benign (n = 11) and malignant (n = 16) diseases (sensitivity, 100%). Two papillary carcinomas were falsely diagnosed as Hashimoto thyroiditis with palpation-guided FNA. Eight malignancies were not palpable, and correct diagnosis was obtained with US-guided FNA. Hyperechoic nodules were usually benign, and isoechoic nodules had a low frequency (13%) of malignancy. Most carcinomas were found in hypoechoic masses, and almost all lymphomas were found in markedly hypoechoic masses. Lymphoma was indistinguishable from pseudotumor in Hashimoto thyroiditis or adenomatous hyperplasia at US. US-guided FNA is helpful in making the histologic diagnosis in thyroid nodules associated with Hashimoto thyroiditis. US-guided FNA is clinically beneficial because it can help select patients who need surgery, avoiding unnecessary surgery for patients with nonneoplastic disorders.     

Diagnostic accuracy of fine-needle aspiration versus core-needle biopsy for the diagnosis of thyroid malignancy in a clinical cohort

Objectives

To retrospectively compare the accuracy of fine-needle aspiration (FNA) and core-needle biopsy (CNB) for the diagnosis of thyroid malignancy

Methods

We evaluated the results of FNA and CNB in 555 consecutive thyroid nodules with final diagnoses (malignancy 318, benign 237). All patients underwent FNA and CNB simultaneously for each nodule. We assessed the sensitivity, specificity and accuracy of FNA, CNB and FNA/CNB for the diagnosis of thyroid malignancy.

Results

The sensitivity of FNA, CNB and FNA/CNB for thyroid malignancy was 68.6%, 86.8% and 90.6%, specificity 100%, 99.2% and 99.2%, and accuracy 82.0%, 92.1% and 94.2%, respectively. The sensitivity and accuracy of CNB or FNA/CNB for thyroid malignancy were significantly higher than those of FNA (P?P?Conclusions Our clinical cohort data demonstrated that CNB was more accurate for the diagnosis of thyroid malignancy than FNA, and FNA/CNB was more accurate than CNB alone in small thyroid nodules. CNB will play a complementary role in optimal surgical decision-making and the management of thyroid nodules.

Key Points

? CNB was more accurate for the diagnosis of malignancy than FNA. ? Combined FNA/CNB was more accurate than CNB alone in small thyroid nodules. ? CNB should play at least a complementary role in managing thyroid nodules.     

MRI-guided abdominal biopsy in a 0.23-T open-configuration MRI system

The purpose of this study was to test the hypothesis that when ultrasound (US) guidance is not feasible, abdominal biopsies can be performed safely and accurately under magnetic resonance imaging (MRI) guidance in a low-field environment. MRI-guided abdominal biopsy was performed on 31 consecutive patients, in whom US-guided abdominal biopsy was not possible because the lesion was not visualized in US (n=27) or an US-guided procedure was not considered safe (n=4). The locations of the lesions were liver (n=14), pancreas (n=6), lymph node (n=4), retroperitoneal mass (n=3), adrenal gland (n=3) and spleen (n=1). The average size of the lesion was 2.2 cm (range 1–4 cm) in maximum diameter. All procedures were done by using a 0.23-T open-configuration C-arm-shaped MRI scanner with interventional optical tracking equipment and software. Fine-needle aspiration (FNA) biopsy was performed on all 31 patients; 18 patients underwent both FNA biopsy and cutting needle core biopsy. Procedures were evaluated for diagnostic sensitivity, specificity and accuracy as well as procedure time and complications. The FNA biopsy specimens were adequate for interpretation in 27 (87%) of 31 cases. Two of these proved to be false-negative findings during follow-up or subsequent biopsy. The final diagnosis was malignant in 15 and benign in 16 patients. The sensitivity, specificity and accuracy of FNA biopsy were 71, 100 and 81%, respectively. Of the 18 core-needle biopsies, one was determined false-negative owing to nonrepresentativeness. The sensitivity, specificity and accuracy of histological samples were 90, 100 and 94%, respectively. The needle time was 19 min on average and the mean room time was 1 h 48 min. No immediate or late complications occurred. MRI-guided abdominal biopsy can be performed safely and accurately in a low-field environment in patients for whom an US-guided procedure is not feasible.     

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.     

Effects of fine-needle aspiration on the US appearance of the breast.

Fine-needle aspiration (FNA) of normal breast tissue or benign lesions can cause changes that suggest malignancy at ultrasound (US) examination. Serial US studies showed that three of 17 patients developed signs mimicking malignancy following FNA of palpable breast lumps. A second group of 14 patients had US signs of malignancy in palpable lumps following recent FNA. Nine patients with benign lesions were unnecessarily worried, since the appearance was probably due to FNA. Diagnosis of malignancy was delayed in one of five patients because the US appearance was attributed to the FNA in the presence of false-negative cytologic findings. FNA of normal breast tissue or benign masses produced tissue changes in 18% of cases that altered the US appearance from normal or benign to possibly malignant. The changes took up to 4 months to subside. If US is clinically indicated, it should be performed before FNA.     

How to combine ultrasound and cytological information in decision making about thyroid nodules

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.     

Feasibility of MRI-guided large-core-needle biopsy of suspiscious breast lesions at 3 T

The feasibility of large-core-needle magnetic resonance imaging (MRI)-guided breast biopsy at 3 T was assessed. Thirty-one suspicious breast lesions shown only by MRI were detected in 30 patients. Biopsy procedures were performed in a closed-bore 3-T clinical MR system on a dedicated phased-array breast coil with a commercially available add-on stereotactic biopsy device. Tissue sampling was technically successful in 29/31 (94%) lesions. Median lesion size (n = 29) was 9 mm. Histopathological analysis showed 19 benign lesions (66%) and one inconclusive biopsy result (3%). At follow-up of these lesions, 15 lesions showed no malignancy, no information was available in three patients and two lesions turned out to be malignant (one lesion at surgical excision 1 month after biopsy and one lesion at a second biopsy because of a more malignant enhancement curve at 12-months follow-up MRI). Nine biopsy results showed a malignant lesion (31%) which were all surgically removed. No complications occurred. MRI-guided biopsy at 3 T is a safe and effective method for breast biopsy in lesions that are occult on mammography and ultrasound. Follow-up MRI at 6 months after the biopsy should be performed in case of a benign biopsy result.     

Role of combined grey scale US and US tissue elastography in differentiating solid thyroid nodules

Background

Ultrasonographic (US) examination is an accurate method for detecting thyroid nodules, but its use in differentiating between benign and malignant thyroid nodules is relatively low. US elastography has been applied to study the hardness/elasticity of nodules to differentiate malignant from benign lesions thus deviating a significant group of patients from unnecessary FNAB.

Objectives

The aim of the study is to evaluate the validity of combined grey scale US and tissue elastography in differentiating benign form malignant solid thyroid nodules.

Methods

The study included 46 selected patients with solid thyroid nodules according to our inclusion and exclusion criteria. The patients underwent surgery for compressive symptoms or suspicion of malignancy on FNA cytology. US features and tissue elastography were scored according to the Rago criteria (1).

Results

On US elastography: all the 31 cases with a final diagnosis of benign nodule had a score of 1–3, while 14 of 15 (94.1%) with a final diagnosis of carcinoma had a score of 4–5, with a sensitivity of 93.3%, a specificity of 100% and an accuracy of 97.8%. Combined US and elastography reveals that hypoechogenicity/score 4–5 was most predictive of malignancy with sensitivity 80% and specificity 100%; and accuracy 93.4%.

Conclusions

US elastography seems to have great potential as a new tool for differentiating solid thyroid nodules and for recommending FNAC. Combined grey scale US features and US elastography added no significant value when compared with US elastography alone. Further prospective studies are needed.     

Ultrasonographic criteria for fine needle aspiration of nonpalpable thyroid nodules 1–2 cm in diameter

Purpose

To investigate the ultrasonographic (US) characteristics for nonpalpable thyroid nodules 1–2 cm in diameter and to evaluate the guideline for fine needle aspiration (FNA) in terms of US findings.

Materials and methods

Between June 2005 and November 2006, FNA was performed in 919 thyroid nodules by radiologists. Of these nodules, 51 malignant nodules and 72 benign nodules were finally included. All 123 nodules were analyzed by 3 radiologists if there were the following US characteristics: marked hypoechogenecity, hypoechogenecity, isoechogenecity, hyperechogenecity, microcalcification, coarse calcification, rim calcification, spiculated margin, taller-than-wide shape, irregular shape, hypoechoic rim and honeycomb appearance. The maximum diameters of nodules and thickness of hypoechoic rim were measured. US characteristics relevant as predictors were identified using a Chi-square or Fisher's exact test and odds ratio. We compared the diagnostic efficacy of 3 US criteria for FNA indication.

Results

Microcalcification, taller-than-wide shape, marked hypoechogenecity, hypoechogenecity, coarse calcification, irregular shape and spiculated margin were significant characteristics of malignant nodules. Isoechogenecity, hypoechoic rim and honeycomb appearance was significant characteristics of benign nodules. Rim or arc calcification, hyperechogenecity and thickness of hypoechoic rim were insignificant. Among 3 US criteria for FNA indication, NFI showed the highest diagnostic efficacy, 98.0% in sensitivity, 75.0% in specificity and 150.0 in odds ratio.

Conclusion

As for nonpalpable thyroid nodules 1–2 cm in diameter, US characteristics are useful for differentiating between malignant and benign nodules. Malignant US characteristics and honeycombing appearance have significant value in selecting nodules for biopsy and reducing the frequency of the FNA procedure.     

Efficacy of thyroid ultrasound elastography in differential diagnosis of small thyroid nodules

Objective

To explore the efficacy of thyroid ultrasound (US) elastography in differential diagnosis of small thyroid nodules.

Methods

This HIPAA-compliant study was approved by the Institutional Review Board and all patients provided written informed consent. Thirty-five patients with 38 small thyroid nodules as seen on transverse ultrasound image formed our study population. An US examination and a separate thyroid elastography examination with pulsation from the carotid artery used as the compression source were performed before fine-needle aspiration. Baseband US data were acquired for off-line elastography processing, where a semi-quantitative index for each nodule was calculated. The Kruskal–Wallis nonparametric rank sum test was used to assess equality of population means among the different types of thyroid nodules. Maximum likelihood estimation of the curve parameters for a binomial receiver operating characteristic (ROC) curve was performed.

Results

Elasticity contrast index calculated with elastography was effective in distinguishing between small papillary thyroid carcinomas (PTMC, n = 8) and other lesions (n = 30) in small thyroid nodules (p = 0.0036). The area under the ROC curve for diagnosing PTMCs was 0.812 with a 95% confidence interval of 0.653–0.920. The cut-off value of ECI of 3.6 led to a sensitivity of 100% and a specificity of 60% for detecting PTMCs.

Conclusion

Noninvasive evaluation of small thyroid nodules is possible using thyroid US elastography with in vivo compression to pick out the most suspicious thyroid nodules for fine-needle aspiration (FNA) and avoid FNA in benign nodules.     

Risk of Thyroid Cancer in Euthyroid Asymptomatic Patients with Thyroid Nodules with an Emphasis on Family History of Thyroid Cancer

Objective

To determine the factors associated with thyroid cancer, focusing on first-degree family history and ultrasonography (US) features, in euthyroid asymptomatic patients with thyroid nodules.

Materials and Methods

This retrospective study included 1310 thyroid nodules of 1254 euthyroid asymptomatic patients who underwent US-guided fine-needle aspiration biopsy between November 2012 and August 2013. Nodule size and clinical risk factors–such as patient age, gender, first-degree family history of thyroid cancer, multiplicity on US and serum thyroid stimulating hormone (TSH) levels–were considered together with US features to compare benign and malignant nodules. Multiple logistic regression analysis was performed to assess the risk of thyroid malignancy according to clinical and US characteristics.

Results

Although all of the clinical factors and US findings were significantly different between patients with benign and malignant nodules, a solitary lesion on US (p = 0.041–0.043), US features and male gender (p < 0.001) were significant independent risk factors for thyroid malignancy in a multivariate analysis. Patient age, a first-degree family history of thyroid cancer and high normal serum TSH levels did not independently significantly increase the risk of thyroid cancer. However, multicollinearity existed between US assessment and patient age, first-degree family history of thyroid cancer and serum TSH values.

Conclusion

Ultrasonography findings should be the primary criterion used to decide the management of euthyroid asymptomatic patients with thyroid nodules. The concept of first-degree family history as a risk factor for thyroid malignancy should be further studied in asymptomatic patients.     

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.     

Combined use of fine-needle aspiration biopsy,MIBI scans and frozen section biopsy offers the best diagnostic accuracy in the assessment of the hypofunctioning solitary thyroid nodule

Purpose The probability of malignancy is increased in hypofunctioning solitary thyroid nodules (HFNs). Fine-needle aspiration biopsy (FNA), ^99mTc-methoxyisobutylisonitrile (MIBI) and frozen section biopsy (FS) have limited independent diagnostic accuracy for the differential diagnosis of HFNs. The goal of this study was to assess the accuracy of the three independent diagnostic methods in distinguishing between benign and malignant disease.Methods A total of 130 patients with an HFN on the ^99mTc-pertechnetate scan were included in this study. FNA, MIBI scans, FS, thyroidectomy and histological analysis of surgical specimens for final diagnosis were performed in all patients.Results Of the 130 patients, 80 (61.54%) had benign lesions and 50 (38.46%), malignant lesions. FNA was diagnostic in 78/130 (60%) patients and non-diagnostic in 52/130 (40%) patients. None of the patients with a negative MIBI scan had a final histological diagnosis of malignancy, and MIBI scans were negative in 38.46% of patients with non-diagnostic FNA results. FS was diagnostic in 104/130 (80%) patients and non-diagnostic in 26/130 (20%) patients. Sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios were 81.3%, 97.8%, 96%, 88%, 36.95 and 0.19 respectively for FNA; 100%, 61.3%, 61.7%, 100%, 2.58 and 0 respectively for MIBI; and 80.5%, 100%, 100%, 89%, 0 and 0.2 respectively for FS. Use of both MIBI scans and FS in patients with non-diagnostic FNA rendered a specificity and sensitivity of 100%.Conclusion MIBI scans exclude malignancy in a significant proportion of patients with non-diagnostic FNAs (38% in this study). Cystic nodules with a positive MIBI scan should be further investigated even when the FNA result indicates a benign lesion. Combined use of FNA, MIBI and FS offers the best diagnostic accuracy.     

Ultrasound-guided core-needle biopsy of the testis for focal indeterminate intratesticular lesions

The aim of this study was to evaluate ultrasound (US)-guided core-needle testicular biopsy. Twelve biopsies were performed in eleven patients, under US guidance using disposable 16- or 18-gauge needles, between April 2003 and October 2006. Details were entered on a database and records reviewed 9 months to 3 years after biopsy. Final diagnoses were based on histology of the biopsy, open surgical resection where performed, and interval follow-up. Biopsies were well tolerated and no complications were encountered apart from a single minor testicular haemorrhage. Benign histology was demonstrated on the core-needle samples of six patients and US follow-up was compatible with these diagnoses. Of five patients whose core-needle biopsies yielded malignancy, two patients had primary testicular tumours; both have been treated successfully with orchiectomy and chemotherapy. Three patients with haematological malignancies had successful chemotherapy without orchiectomy; one of these three underwent post-chemotherapy biopsy demonstrating resolution. There are four main clinical scenarios when core-needle testicular biopsy is performed in our institution: (1) lesions with equivocal malignant US features, (2) discrepancy between radiological and clinical findings, (3) suspected malignant process where orchiectomy is unnecessary, e.g. lymphoma, (4) atrophic testes, where it is frequently difficult to differentiate malignancy from the heterogeneous echo pattern.     

Thyroid Nodules Detected on CT: A Retrospective Audit Study and Analysis of Differences in Reporting Practices Across Radiology Subspecialties

Thyroid nodules (TNs) are common incidental findings  on imaging and TN reporting practices are variable among radiologists, leading to unnecessary or inadequate investigations. We aimed to document current literature adherence for TN reporting practices on thoracic CTs and assess the variability in TN reporting across radiology subspecialties. This is a 2-parts retrospective study. First part was an audit study including all adult patients with thoracic CTs in January 2020. Patients with prior thyroidectomy and/or lack of TN were excluded. A local committee was created for literature review and elaboration of a local TN management algorithm. The algorithm was shared with the thoracic radiology team. Imaging and medical records were reviewed and adequate adherence was assessed in the pre- and post-intervention cohorts. Second part included all adult patients who underwent neck or cervical spine CT imaging in the same timeframe and with same inclusion/exclusion criteria as the pre-intervention thoracic cohort. In the pre-intervention cohort 802 participants were screened and 137 patients included. TNs were reported in “body” and “conclusion” of the report in 51% and 7% of the time respectively. Thyroid US was recommended in 10% of the patients and inadequately recommended 3% of the time. Overall adequate adherence was 86%. In the post-intervention cohort 962 participants were screened and 167 patients included. Thyroid US was recommended in 7% of the patients and no inadequate US recommendation was made. Overall adequate adherence in the post-intervention cohort was 93%, increased by 7% (P= 0.039). The musculoskeletal and neuroradiology cohorts reported more TNs in “conclusion” (P= 0.013 and P< 0.0001) and recommended more thyroid US (P = 0.033 and P= 0.0018) compared to the preintervention thoracic cohort. No significant difference in overall adequate adherence between subspecialties (P= 0.48 and P= 0.51). Improvement in adequate TN reporting on thoracic CT by 7% while reducing inadequate thyroid US recommendations from 3% to none. Significant reporting trends were also noted across radiology subspecialties.     

Comparison of British Thyroid Association,American College of Radiology TIRADS and Artificial Intelligence TIRADS with histological correlation: diagnostic performance for predicting thyroid malignancy and unnecessary fine needle aspiration rate

Objectives:To compare diagnostic performance of British Thyroid Association (BTA), American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and Artificial Intelligence TIRADS (AI-TIRADS) for thyroid nodule malignancy. To determine comparative unnecessary fine needle aspiration (FNA) rates.Methods:218 thyroid nodules with definitive histology obtained during 2017 were included. Ultrasound images were reviewed retrospectively in consensus by two subspecialist radiologists, blinded to histopathology, and nodules assigned a BTA, ACR-TIRADS and AI-TIRADS grade. Nodule laterality and size were recorded to allow accurate histopathological correlation and determine which nodules met criteria for FNA.Results:77 (35.3%) nodules were malignant. Deeming ultrasound Grade 4–5 as test-positive and 1–2 as test-negative, sensitivity and specificity for BTA was 98.28 and 42.55%, for ACR-TIRADS: 95.24 and 40.57% and for AI-TIRADS: 93.44 and 45.71%. FNA was indicated in 101 (71.6%), 67 (47.5%) and 65 (46.1%) benign nodules utilising BTA, ACR-TIRADS and AI-TIRADS respectively. The unnecessary FNA rate was significantly higher with BTA (46.3%) compared to ACR-TIRADS (30.7%) and AI-TIRADS (29.8%) p < 0.001.Conclusion:BTA, ACR-TIRADS and AI-TIRADS had similar diagnostic performance for predicting thyroid nodule malignancy with sensitivity >93% for all systems when considering ultrasound Grade 4–5 as malignant and Grade 1–2 as benign. ACR-TIRADS and AI-TIRADS both had a significantly lower rate of recommended FNA in benign nodules compared to BTA.Advances in knowledge:BTA, ACR-TIRADS and AI-TIRADS have comparable diagnostic performance with high sensitivity but relatively low specificity for predicting thyroid nodule malignancy in this cohort using histology as gold-standard. Using Grade 1–2 as benign and 4–5 as malignant there were more false negatives with TIRADS but this improved when taking other features into account while BTA had a significantly higher rate of unnecessary FNA.     

Value of dual-phase,contrast-enhanced CT combined with ultrasound for the diagnosis of metastasis to central lymph nodes in patients with papillary thyroid cancer

AimsTo evaluate the diagnostic performance of computed tomography combined with ultrasound (CT/US) in metastatic central lymph nodes (CLNs) compared with US in patients with papillary thyroid cancer (PTC).Material and methodsSix-hundred patients with surgically proven PTC who underwent both US and CT examination before CLN dissection were evaluated retrospectively. All cases were divided into four subgroups according to the tumor size and number. Diagnostic performances of US, CT and CT/US were evaluated.ResultsAmong 600 patients with CLN dissection, CT/US showed higher sensitivity (89.10%) and accuracy (83.00%) than US alone (76.06%, 76.50%). In the subgroup of solitary non-microcarcinomas, the AUC of CT/US was significantly higher than that for US alone (0.827 vs. 0.722, P < 0.05). For the subgroup of solitary or multiple microcarcinomas, the performance efficiency of CT had no obvious advantage over that of US (0.698 vs. 0.740, 0.798 vs. 0.802, P > 0.05). For the subgroup of multiple non-microcarcinomas, CT, US and US/CT had high diagnostic efficacy (AUC > 0.8, Accuracy >80%. P > 0.05), and there was no significant difference between them.ConclusionsIn the subgroup of solitary non-microcarcinoma, CT combined with US provided better diagnostic efficacy, and for those cases, complementary CT examination was recommended. In other subgroups, the diagnostic efficacy of US/CT was similar to that of US alone, and there was no significant benefit from additional CT examination.     

Prostate biopsy after ano-rectal resection: value of CT-guided trans-gluteal biopsy

We describe our single-institutional experience with computed tomography (CT)-guided percutaneous transgluteal biopsy of the prostate in patients in whom transrectal ultrasound-guided biopsy is precluded by prior ano-rectal resection. Between March 1995 and April 2007, 22 patients had 34 prostate biopsies (mean age 68; mean PSA 29 ng/ml; mean follow-up 6.1 years). The charts of patients who had transgluteal biopsy were reviewed for demographic, complications and pathology. Ninety-five percent (21/22) of primary biopsies were diagnostic. Of the 21 diagnostic biopsies, 11 were positive for prostate cancer and ten were definitive benign samples. Seventy-three percent (8/11) of the patients had progressive PSA elevation that mandated 11 further prostate biopsies. Six patients had a second biopsy, one patient had a third and one patient had a fourth biopsy. Among patients who had serial biopsies, 38% (3/8) had prostate cancer. No complications or death occurred. A malignant biopsy was not significantly associated with core number (P = 0.58) or a high PSA level (P = 0.15). CT-guided transgluteal biopsy of the prostate is safe and effective.     

Differentiating benign from malignant solid breast lesions: Combined utility of conventional ultrasound and contrast-enhanced ultrasound in comparison with magnetic resonance imaging

Objective

To prospectively evaluate the diagnostic efficacy of conventional ultrasound (US), contrast-enhanced US (CEUS), the combined use of two modalities, and magnetic resonance imaging (MRI) in the differentiation of focal solid breast lesions.

Materials and methods

61 patients with BI-RADS category 3–5 breast lesions detected at conventional US underwent CEUS and MRI. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of conventional US, CEUS, combination of two modalities and MRI for discrimination between benign and malignant breast lesions.

Results

Tissue specimens of 61 breast lesions were obtained either from surgical resection (n = 46) or from needle biopsy (n = 15). Histopathologic diagnosis revealed 28 benign and 33 malignant lesions. The diagnostic performance of conventional US and CEUS in differentiating benign from malignant breast lesions showed no significant difference (P = 0.741). The combination of two modalities significantly improved the diagnostic accuracy compared with either conventional US or CEUS alone (P = 0.031 and P = 0.012, respectively). The area under the ROC curve (A_z) value for the combined use of two modalities for discrimination between benign and malignant breast lesions was 0.94, and that for MRI was 0.91, whereas no statistical difference was found between them (P = 0.296).

Conclusion

The combined use of conventional US and CEUS has a better diagnostic performance than either method alone and displays good agreement with MRI in the differentiation capability for benign and malignant breast lesions.