[Evaluation of Extrathyroidal Extension of Papillary Thyroid Microcarcinoma With Three-Dimensional Tomographic Ultrasound Imaging].

Objective To evaluate extrathyroidal extension (ETE) in papillary thyroid microcarcinoma (PTMC) with three-dimensional tomographic ultrasound imaging (3D-TUI). Methods A total of 97 thyroid nodules of 79 patients with PTMC treated in PUMC Hospital from February 2016 to January 2018 were included in this study.Two ultrasound experts performed independent blinded assessment of the relationship between thyroid nodules and thyroid capsule by two-dimensional ultrasound (2D-US) and 3D-TUI.The results of 2D-US and 3D-TUI in evaluating ETE were compared with intraoperative findings and postoperative histological and pathological results. Results Among the 97 nodules,54 (55.7%) nodules had ETE.The diagnostic sensitivity (68.5% vs.37.0%;χ2=10.737,P=0.002),accuracy (74.5% vs.56.7%;χ2=6.686,P=0.015),and area under the receiver operating characteristic curve[0.761 (95%CI=0.677-0.845) vs.0.592 (95%CI=0.504-0.680);Z=3.500,P<0.001] of 3D-TUI were higher than those of 2D-US.However,3D-TUI and 2D-US showed no significant difference in the specificity (84.1% vs.81.4%;χ2=0.081,P=0.776),negative predictive value (67.9% vs.50.7%;χ2=3.645,P=0.066),or positive predictive value (84.1% vs.71.4%;χ2=1.663,P=0.240). Conclusion Compared with 2D-US,3D-TUI demonstrates increased diagnostic efficiency for ETE of PTMC.

Ultrasonographic Multimodality Diagnostic Model of Thyroid Nodules.

The aim of this study was to identify independent risk factors for thyroid cancer, establish an ultrasonographic multimodality diagnostic model for thyroid nodules, and explore the diagnostic value of the model. From November 2011 to February 2015, 307 patients with a total of 367 thyroid nodules underwent conventional ultrasound, contrast-enhanced ultrasound (CEUS), and ultrasound elastography examinations before surgery. A binary logistic regression analysis was performed to identify independent risk factors for thyroid cancer and to establish a multimodality diagnostic model for thyroid nodules. The diagnostic performance of conventional ultrasound, CEUS, ultrasound elastography, and the multimodality diagnostic model was assessed and compared. The following seven independent risk factors were included in the logistic regression models: age, irregular shape, hypoechoic pattern, marked hypoechoic pattern, irregular blood flow distribution, heterogeneous enhancement, and an elastic score of 3/4. The multimodality diagnostic model had a diagnostic accuracy of 86.9%, with a sensitivity of 93.5% and a specificity of 77.3%. The multimodality diagnostic model improved the diagnostic accuracy compared with that of conventional ultrasound, CEUS, and ultrasound elastography. Independent risk factors for thyroid cancer included age, irregular shape, hypoechoic pattern, marked hypoechoic pattern, irregular blood flow distribution, heterogeneous enhancement, and an elastic score of 3/4. The multimodality diagnostic model was demonstrated to be effective in the diagnosis of thyroid nodules.

[Clinical Features of Von-Hippel-Lindau Syndrome and Its Ultrasonographic Diagnosis of Abdominal Mass].

Objective To analyze the clinical features of Von-Hippel-Lindau(VHL)syndrome and explore the diagnostic value of abdominal ultrasound for this disease.Methods The clinical features including age at first diagnosis,symptoms,signs,affected organs,number of operations,and diagnostic examinations of 35 patients with VHL syndrome admitted to our center from January 1994 to December 2017 were retrospectively analyzed.The diagnostic value of abdominal ultrasound for VHL syndrome was analyzed.Results Pheochromocytoma(n=14)and nervous system hemangioblastoma(n=13)were the common firstly-identified tumors.Nervous system hemangioblastoma(n=21),pheochromocytoma(n=19),renal carcinoma(n=17),and pancreatic mass(n=15)were common tumors.The main surgical reasons were nervous system hemangioblastoma(n=22),pheochromocytoma(n=23)and renal carcinoma(n=13).Abdominal organ involvements were found in 33 patients,which were first detected by abdominal ultrasound in 20 patients and were found accidently during routine health checkups in 6 patients.The ultrasound results were accurate in 27 of 33 adrenal gland scans,13 of 16 pancreas scans,and 8 of 19 kidney scans.Conclusions When multiple tumors are detected in the kidney,adrenal gland,and pancreas by ultrasound,the possibility of VHL syndrome should be considered.When the clinical findings suggest the possibility of VHL syndrome,ultrasound can discover and diagnose the abdominal tumors and can also be used for the long-term follow-up of the tumors.Therefore,ultrasound is an important method in the screening and follow-up of patients with VHL syndrome.

Diagnostic Value of Elastography for Thyroid Nodules in Hashimoto's Thyroiditis.

Objective To evaluate the diagnostic performance of elastography in the diagnosis of thyroid nodules in the context of Hashimoto's thyroiditis(HT). Methods The study evaluated 43 thyroid nodules by conventional ultrasound (CU) and elastography in 38 patients co-existed with HT who were referred for operation. The patients underwent CU and elastography before operation. The sensitivity,specificity,positive and negative predictive values,and accuracy for CU,elastography,and combination of these two techniques were assessed by using histopathological results as the gold standard. Results Among these 43 thyroid nodules,pathology confirmed 29 (67.4%) malignant nodules and 14 (32.6%) benign ones. There were statistically significant differences between malignant and benign groups in features such as solid shape (96.6% vs. 64.0%;OR:15.6,95%CI:1.600-151.262,P=0.004),irregularity (90.0% vs. 42.9%;OR:11.6,95%CI:2.341-57.032,P=0.001),taller than wide shape (72.0% vs. 21.4%;OR:9.6,95% CI:2.117-43.753,P=0.002),microcalcification (69% vs. 28.6%;OR:5.6,95% CI:1.368-22.556,P=0.012) and irregular blood flow (90.0% vs. 28.6%;OR:17.3,95%CI:3.186-94.290,P=0.000). The diagnostic performance of elastography and CU was as follows:sensitivity (86.2 % vs.96.6%),specificity (71.4% vs.42.9%),positive predictive value (86.2% vs.77.8%),negative predictive value (71.4% vs.85.7%),and accuracy (81.4% vs.79.0%). The combination of these two techniques had a sensitivity of 93.1%,a specificity of 71.4%,a positive predictive value of 87.1%,a negative predictive value of 83.3%,and an accuracy of 86.0%. Conclusions Elastography has a higher specificity in the diagnosis of thyroid nodules in HT,while its sensitivity is slightly lower than that of CU. Combination of these two techniques can increase the specificity and accuracy.

Role of Superb Micro-Vascular Imaging in the Preoperative Evaluation of Thyroid Nodules: Comparison With Power Doppler Flow Imaging.

OBJECTIVES: To evaluate whether Superb Micro-Vascular Imaging (SMI; Toshiba Medical Systems Corporation, Tochigi, Japan) is superior to power Doppler flow imaging (PDFI) in depicting thyroid nodular vascularity and to primarily explore the diagnostic performance of vascularity on SMI integrated with grayscale sonographic features for diagnosis of malignant thyroid nodules. METHODS: Ninety-two resident patients with 113 nodules for surgery were included in the study. Thirty-four nodules were benign, and 79 nodules were malignant. Vascularity was classified as none, peripheral, mixed, and intranodular. Grayscale features, including calcifications, echogenicity, margins, shape, and internal components, were evaluated. The distribution of vascular patterns was compared between PDFI and SMI to determine the superior technique for diagnosing malignancy. A multivariate logistic regression analysis was used to evaluate the accuracy of SMI combined with grayscale sonography for thyroid malignancy. RESULTS: The 92 patients had a male-to-female ratio of 12:11 and a median age of 42 years (range, 20-75 years). Intranodular vascularity on SMI had 91.2% specificity and 75.9% sensitivity, which were superior to PDFI, at 82.3% and 41.8%, respectively (P < .01). We attribute this finding to the fact that peripheral vessels of many nodules on PDFI were actually intense small penetrating vessels around the lesion on SMI. A taller-than-wide shape, microcalcifications, and SMI intranodular vascularity were independent risk factors for thyroid malignancy. The area under the receiver operating characteristic curve for the logistic regression model was 0.92, which was higher than that for a single suspicious sonographic feature (P < .05). CONCLUSIONS: Intranodular vascularity on SMI is useful for determining thyroid carcinoma. Furthermore, a combination of SMI and grayscale features performs better than any single sonographic feature alone.

Comparison of Ultrasound Features of Primary Metastatic Papillary Thyroid Carcinoma and Recurrent/Persistent Metastatic Cervical Lymph Nodes.

Objective To explore the ultrasound features and levels of cervical lymph node metastases in primary and recurrent/persistent papillary thyroid cancer (PTC).Methods We retrospectively analyzed the clinical data of 2181 patients who underwent cervical lymph nodes dissection for PTC from January 1st 2015 to January 1st 2016.Totally 418 PTC patients (with 622 lymph nodes) who met the inclusion criteria entered the final analysis.Patients who had not received any prior thyroid treatment (surgery with or without radioactive iodine) were categorized as the primary group (352 patients with 527 metastatic lymph nodes),and patients who had received prior treatment (thyroidectomy with or without radioactive iodine) for PTC were categorized as recurrent/persistent group (66 patients with 95 metastatic lymph nodes).Pathological results from lymph node dissections were used as the gold standards by means of level-to-level analysis.Results The mean of the minimum axis diameter of the lymph nodes in the primary group was (6.7±3.6)mm,and that of the recurrent/persistent group was (6.6±3.1)mm (U=0.180,P=0.857).The proportion of metastasis in the central area of primary group was 40.0%,which was significantly higher than that in the recurrent/persistent group (12.6%);the proportion of metastasis in the lateral area was 60.6% in the primary group,which was significantly lower than that in the recurrent/persistent group (87.4%)(χ2=26.288,P<0.001).In lateral metastatic lymph nodes,Ⅲ level was the most common place in both groups.Level Ⅴ metastatic lymph was rare in both primary group and recurrent/persistent group.Calcifications (63.1% vs. 48.2%;χ2=7.207,P=0.007) and peripheral vascularity (81.1% vs. 59.4%;χ2= 16.147, P<0.001) were more common in the recurrent/persistent group.The round shape,absence of an echogenic hilum,hyperechogenicity,and cystic aspects were not significantly different between these two groups (all P>0.05).Conclusions Primary metastatic lymph nodes often occur in the central area of lymph nodes,while lateral metastatic lymph nodes are more common in recurrent/persistent PTC.For metastatic lymph nodes,calcifications and peripheral vascularity are more common in recurrent/persistent PTC.

Discrepancy of Papillary Thyroid Carcinoma Sizes Measured by Ultrasonography and Pathology.

OBJECTIVE: To compare the size of papillary thyroid carcinoma on ultrasonography(US)and the actual size measured during histological examination and to discuss the potential causes of such discrepancy. METHODS: A total of 148 patients with histologically confirmed papillary thyroid carcinoma underwent thyroid surgery in our center from December 2012 to May 2013. Patients were stratified based on the size,morphology,margin,cystic component,and presence of Hashimoto's disease to compare the discrepancy of the US and pathalogical measurements. RESULTS: The mean sizes of the nodules measured by US and pathology were(1.58±0.94)cm and(1.33±0.84)cm,respectively(P=0.000). In 70.9%(105/148)of the nodules,the sizes measured by US were larger than those measured by pathology. In 17.6%(26/148)of the nodules,the sizes measured by US were smaller than those measured by pathology. In 1.1-1.4 cm size subgroup,the difference between mean ultrasound diameter and pathologic diameter was not significant [(1.21±0.11)cm vs.(1.11±0.32)cm,P=0.062]. In 0.1-1.0 cm size subgroup,the mean sizes of the nodules measured by US and pathology were(0.75±0.19)cm and(0.62±0.23)cm,respectively(P=0.000). In ≥1.5 cm size subgroup,the mean sizes of the nodules measured by US and pathology were(2.48±0.70)cm and(2.03±0.81)cm(P=0.000). CONCLUSIONS: There is a significant discrepancy between US and pathologic size measurements for papillary thyroid carcinoma. However,for nodules sized 1.1-1.4 cm,the ultrasound and pathologic measurements are more likely to be consistent.

Diagnostic value of contrast-enhanced ultrasound of thyroid nodules coexisting with Hashimoto's thyroiditis.

OBJECTIVE: To evaluate the value of contrast-enhanced ultrasound (CEUS) in diagnosing thyroid nodules coexisting with Hashimoto's thyroiditis (HT). METHODS: Totally 62 thyroid nodules in 48 HT patients were retrospectively analyzed. The CEUS characteristics were reviewed, and diagnostic value of enhancement pattern and peak intensity were calculated. RESULTS: Peak intensity (P=0.002) and enhancement pattern (P<0.001) differed significantly between malignant and benign thyroid nodules. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of heterogeneous enhancement were 97.6%, 85.7%, 93.0%, 94.7%, and 93.5%, respectively. Sensitivity, specificity, PPV, NPV and accuracy of low intensity at peak time were 85.4%, 52.4%, 77.8%, 64.7%, and 74.2%, respectively. CONCLUSIONS: Heterogeneous enhancement is effective in the diagnosis of malignant thyroid nodules coexisting with HT. CEUS can improve the diagnostic accuracy in distinguishing thyroid nodules with unknown malignancy under the conventional ultrasound.

Comparison of ultrasonic features between anaplastic thyroid carcinoma and papillary thyroid carcinoma.

OBJECTIVE: To explore the difference of the ultrasonic features between anaplastic thyroid carcinoma and papillary thyroid carcinoma. METHODS: The ultrasound data of 7 patients with histopathologically confirmed anaplastic thyroid carcinomas who were treated in PUMC Hospital from April 2001 to June 2014 were retrospectively studied. In addition, 21 sex-and age-matched patients with histopathologically confirmed papillary thyroid carcinomas during the same period were enrolled as the control group. The pathologic results were regarded as the gold standard. The ultrasonic features of anaplastic thyroid carcinoma and papillary thyroid carcinoma were analyzed and compared. RESULTS: Patients with anaplastic thyroid carcinoma were predominantly females (5/7,71.4%), with an average age of (64.9 ± 11.3) years. Large mass [(5.17 ± 1.26) cm vs. (1.85 ± 1.89)cm, P<0.001], anteroposterior-to-transverse diameter ratio less than 1(100.0% vs. 47.6%, P ＝ 0.03), and punctuate calcification (100.0% vs. 52.4%, P ＝ 0.03) were more frequently associated with anaplastic thyroid carcinoma than with papillary thyroid carcinoma. No significant difference was observed between the two groups in the shape, margin, cystic change, echogenicity, echotexture,vascularity,and envelope (all P>0.05). CONCLUSION: In elderly women with common malignant features on ultrasound, the thyroid nodules with a maximum diameter greater than 5 cm,anteroposterior-to-transverse diameter ratio less than 1,and microcalcifications are highly likely to be anaplastic thyroid carcinoma.

Ultrasonographic features of thyroid nodules accompanied by Hashimoto thyroiditis.

OBJECTIVE: To compare the ultrasound imaging characteristics of benign and malignant thyroid nodules on the background of Hashimoto's thyroiditis (HT). METHODS: Totally 120 consecutive patients with pathologically confirmed benign (n=60) or malignant (n=60) thyroid nodules in Peking Union Medical College Hospital since January 2013 were retrospectively analyzed, and their preoperative ultrasound images were reviewed. RESULTS: Sixty cases (100%) of the malignant nodules were papillary thyroid cancers. In the benign group, 33 cases (55.0%) had nodular changes of HT, 26 (43.3%) had nodular goiter, and one (16.7%) had adenoma. Compared with the benign ones,the malignant nodules were more likely to be solid (91.7% vs. 68.3%, P=0.001), hypoechoic (96.7% vs. 48.3%, P=0.000), ill defined (95.0% vs. 41.7%, P=0.000), irregular (96.7% vs. 43.4%, P=0.000), and more easily to have such characteristics as micro-calcification (71.7% vs. 30.0%, P=0.000), absence of regular halo (96.7% vs. 65.0%, P=0.000), taller-than-wide sign (46.7% vs. 13.3%, P=0.000), and locally increased or irregular blood flow (61.7% vs. 26.7%, P=0.000). CONCLUSIONS: Ultrasound has an ideal overall sensitivity in differentiating nodules on the background of HT. Solid structure, hypo-echogenicity, ill-defined margin, irregular shape, and absence of regular halo are good screening ultrasound markers. Except for the A/T≥1, the other variables have less satisfactory diagnostic specificity.

[Diagnostic values of ultrasound and (18)F-fluoro-2-deoxy-D-glucose-positron emission tomography/computerized tomography for patients with suspected thyroid carcinoma and lymph node metastasis].

OBJECTIVE: To evaluate the diagnostic values of ultrasound (US) and (18)F-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET)/computerized tomography (CT) in diagnosing suspected thyroid carcinoma and lymph node metastasis. METHODS: The clinical data of 28 patients who had undergone total or subtotal thyroidectomy with or without neck dissection from December 2011 to December 2012 in PUMC Hospital and had undergone US and FDG PET/CT before surgery were retrospectively analyzed. In each patient, US and FDG PET/CT images were retrospectively reviewed to determine the presence of carcinoma with or without loco-regional metastasis by level-by-level analysis. The potential correlation between imaging results and histopathology were analyzed. RESULTS: There were 11 benign lesions,15 papillary carcinomas, one follicular carcinoma, and one medullary carcinoma. For thyroid carcinoma,the sensitivity and specificity were 88.2% and 63.6% for US and 76.5% and 54.5% for FDG PET/CT(P>0.05). For lymph node metastasis, the sensitivity was 68.0% for US and 60.0% for FDG PET/CT (P>0.05), and the specificity was 96.7% for US and FDG PET/CT.FDG PET/CT could provide more diagnostic information than US for patients with level 2 or 5 metastasis. CONCLUSIONS: Combination of US and FDG PET/CT is typically not needed for differentiating thyroid lesions.However, for patients with suspected lymph node metastasis of infrequently involved levels, the combination of US and FDG PET/CT may be a good choice.

[Ultrasonographic and general pathologic features assessment of small intestinal lymphoma].

OBJECTIVE: To study the ultrasonographic and morphologic features of intestinal lymphoma. METHODS: The ultrasonographic and morphologic features of 19 patients with intestinal lymphoma were retrospectively analyzed. RESULTS All the patients were confirmed as non-Hodgkin's lymphoma by endoscopy or pathology. Of these 19 cases,the involved locations included ileum(n=14),duodenum(n=3),and ileocecum(n=2). The main sonographic types included mass type(n=12),bowel wall thickening type(n=1),and nonspecific signs(n=6). The mass type was characterized by solid and cystic-solid hypoechoic(including marked hypoechoic)foci,with well-defined margin,and rich blood signals were visible in large masses. The bowel wall thickening type was characterized by the thicking of bowel walls,showing hypoechoic(including marked hypoechoic),along with posterior acoustic enhancement. The nonspecific signs included e.g. dilatation of intestine and mesenteric lymph node enlargement. Morphologically,the tumor was featured by intestinal mass in intestinal mucosa or the circumferential thickening of intestinal wall. CONCLUSION: Small intestinal lymphoma has typical ultrasonographic features,and ultrasonography can provide useful information in the diagnosis of small intestinal lymphoma.

[Usefulness of ultrasonography in the differential diagnosis of thyroidal follicular tumor].

OBJECTIVE: To evaluate the usefulness of ultrasonography in distinguishing follicular carcinoma from adenoma. METHODS: The ultrasound data of 37 patients with histopathologically confirmed follicular carcinomas who were treated in PUMC Hospital from January 2000 to November 2012 were retrospectively studied. In addition, 74 sex-and age-matched patients with histopathologically confirmed adenomas during the same period were enrolled as the control group. The pathologic results were regarded as the gold standard. RESULTS: Irregular shape (32.4% of follicular carcinoma vs 5.4% of adenoma), absence of thin halo (67.6% vs 36.5%), indistinct margin (21.6% vs 1.4%), hypoechoic appearance (64.9% vs 39.2%), punctuate calcification(40.5% vs 13.5%), absence of cystic change (78.4% vs 54.1%), and being complicated with other thyroid disease (56.8% vs 28.4%) were more frequently associated with follicular carcinoma than with benign adenoma (P<0.05). No significant difference in the echotexture and internal flow was observed between the two groups (P>0.05). CONCLUSION: Although follicular carcinoma and adenoma share many sonographic features, irregular shape, absence of thin halo, indistinct margin, hypoechoic appearance, punctuate calcification, absence of cystic change, and being complicated with other thyroid disease favor a follicular carcinoma diagnosis.

[Sonographic evaluation of metastatic cervical lymph nodes].

Cervical nodal metastases are common in patients with head and neck cancers. Early assessment is important for treatment planning and prognosis. Ultrasound has been widely used in the evaluation of neck lymph nodes, with common parameters including location, size, shape, boundary, hilus, echogenicity, vascular pattern, and resistance index. The diagnostic accuracy has been dramatically improved along with the introduction of new techniques including contrast-enhanced ultrasound, elastography, and ultrasound-guided fine needle aspiration biopsy. Neck ultrasound has became an important tool in preoperative assessment and postoperative follow-up for patients with head and neck cancers.

Parathyroid disorder and concomitant thyroid cancer in patients with multiple endocrine neoplasia type 1: A retrospective cohort study.

ABSTRACT: This study aimed to determine the rates and characteristics of parathyroid disorder and thyroid cancer in patients with multiple endocrine neoplasia type 1 vs sporadic primary hyperparathyroidism (SPHP) undergoing parathyroidectomy.Patients with multiple endocrine neoplasia type 1-associated primary hyperparathyroidism (MPHP) or SPHP who underwent initial or reoperative parathyroid exploration from 1999 to 2019 were identified via a clinical database. The data for MPHP patients (n = 15) were compared to those of a selected 2:1 age- and sex-matched SPHP cohort (n = 30) who all underwent thyroidectomy for concurrent thyroid nodules.Compared with that of the SPHP group, the parathyroid hormone level of the MPHP group was much higher (470.67 ±â€Š490.74 pg/mL vs 217.77 ±â€Š165.60 pg/mL, P = .001). Multiglandular parathyroid disease (6/15 [40%] vs 3/30 [10%], P = .026) and more hyperplasia (7/15 [46.7%] vs 5/30 [16.7%], P = .039) were found in the MPHP group, and more parathyroid lesions presented as a round shape (long/short meridian < 2) by ultrasound (16/20 [80%] vs 8/31 [25.8%], P < .001). Regarding thyroid nodules, there was no difference in the rate of histologic thyroid cancer, but more thyroid cancer was found in the last 5 years among the MPHP cases (5/9 [55.6%] vs 3/18 [16.7%], P = .052).Multiglandular parathyroid disease and hyperplasia were more frequent in the MPHP cohort than in the SPHP cohort, and the parathyroid lesions usually presented with a round shape on ultrasonography. More concurrent thyroid cancer was found in MPHP than SPHP patients over the previous 5 years.

Exploring the diagnostic value of photoacoustic imaging for breast cancer: the identification of regional photoacoustic signal differences of breast tumors.

We examined 14 benign and 26 malignant breast nodules by a handheld dual-modal PA/US imaging system and analyzed the data using the quantitative and semi-quantitative method. The PA signal spatial density and PA scores of different regions of the benign and malignant nodules were compared, and the diagnostic performances of two diagnostic methods based on PA parameters were evaluated. For both quantitative and semi-quantitative results, significant differences in the distributions of PA signals in different regions of benign and malignant breast lesions were identified. The PA parameters showed good performance in diagnosing breast cancer, indicating the potential of PAI in clinical utilization.

Ultrasound is helpful to differentiate Bethesda class III thyroid nodules: A PRISMA-compliant systematic review and meta-analysis.

BACKGROUND: Fine-needle aspiration (FNA) is the most dependable tool to triage thyroid nodules for medical or surgical management. However, Bethesda class III cytology, namely "follicular lesion of undetermined significance" (FLUS) or "atypia of undetermined significance" (AUS), is a major limitation of the US-FNA in assessing thyroid nodules. As the most important imaging method, ultrasound (US) has a high efficacy in diagnosing thyroid nodules. This meta-analysis aimed to assess the role of US in evaluating Bethesda class III thyroid nodules. METHODS: With keywords "Undetermined Significance," "Bethesda Category III," "Bethesda system," "Cytological Subcategory," "AUS/FLUS," "Atypia of Undetermined Significance," and "Ultrasound/US," papers in PubMed, Cochrane Library, Medline, Web of Science, Embase, and Google Scholar from inception to December 2016 were searched. A meta-analysis of these trials was then performed for evaluating the diagnostic value of thyroid ultrasound in Bethesda Category III thyroid nodules. RESULTS: Fourteen studies including 2405 nodules were analyzed. According to the criteria for US diagnosis of thyroid nodules in each article, with any one of suspicious features as indictors of malignancy, US had a pooled sensitivity of 0.75 (95% CI 0.72-0.78) and a pooled specificity of 0.48 (95% CI 0.45-0.50) in evaluating Bethesda Class III Nodules. The pooled diagnostic odds ratio was 10.92 (95% CI 6.04-19.74). The overall area under the curve was 0.84 and the Q* index was 0.77. With any 2 or 3 of US suspicious features as indictors of malignancy, the sensitivity and specificity were 0.77 (95% CI 0.71-0.83) and 0.54 (95% CI 0.51-0.58), 0.66 (95% CI 0.59-0.73) and 0.71 (95% CI 0.68-0.74), respectively. CONCLUSIONS: US was helpful for differentiating benign and malignant Bethesda class III thyroid nodules, with the more suspicious features, the more likely to be malignant.

"Onion Skin-liked Sign" in Thyroid Ultrasonography: A Characteristic Feature of Benign Thyroid Nodules.

BACKGROUND: Some ultrasonographic (US) signs overlap between benign and malignant nodules. The purpose of this study was to raise a special US sign of benign thyroid nodules, termed the "onion skin-liked sign." METHODS: Twenty-seven patients with 27 nodules who shrank naturally and the "onion skin-liked sign" appeared on the final US images were enrolled in the study. The ultrasound characters and risk stratifications at the start and end of observation were compared. Then, thirty goiters with fibrosis and thirty papillary thyroid carcinomas (PTC) were randomly selected from the database of our hospital, matched the sizes of 27 nodules at the end point of observation. The differences of "onion skin-liked sign" between the two groups were analyzed. RESULTS: The average duration of follow-up of 27 nodules was 24.0 ± 12.2 months (range, 12-65 months). At the end of the follow-up, the size of the nodules decreased on average by 1.26 ± 0.82 cm (range, 0.3-3.4 cm) and calcification was found in 21 nodules, compared with only 2 nodules with calcification at the start of the follow-up. In addition, only negligible or no blood flow signal could be detected at the periphery of all the nodules and 100% (27/27) were high suspicion at the end of observation. In matched groups, all PTC showed high suspicion of malignancy, 18/30 (60%) goiters with fibrosis were high suspicion and 11/30 (37%) were intermediate suspicion. Twenty-two patients in the group of nodular fibrosis presented "onion skin-liked sign," which was not shown in any patient of PTC group. The sensitivity, specificity, positive predictive value, and negative predictive value of "onion skin-liked sign" in predicting nodular goiter with fibrosis were 73.3%, 100%, 100%, and 78.9%, respectively. CONCLUSIONS: The "onion skin-liked sign" was a characteristic US feature of benign thyroid nodules detected in the follow-up of thyroid nodules. It is useful to differentiate PTCs and nodular goiters with fibrosis.

High Risk of Lateral Nodal Metastasis in Lateral Solitary Solid Papillary Thyroid Cancer.

We explored the relationship between ultrasonic intra-thyroidal location and neck node metastasis pattern in solitary solid papillary thyroid cancer (PTC). Data on 186 patients were retrospectively reviewed. The association between several characteristics and neck node metastasis pattern were analyzed. Among the 186 thyroid nodules, age ≥45 y (p = 0.005), mass size ≥2 cm (p = 0.001), presence of calcifications (p < 0.001) and lateral nodal metastasis (p = 0.001) were significantly related to central nodal metastasis in multivariate analysis. Mass size ≥2 cm (p = 0.046) and central nodal metastasis (p = 0.002) were significantly related to lateral nodal metastasis in multivariate analysis. Location of an intra-thyroidal solitary solid PTC located non-adjacent to the trachea (lateral) was significantly related to lateral nodal metastasis (p = 0.043) compared with location of an intra-thyroidal solitary solid PTC adjacent to the trachea (medial or isthmus). Lateral lesions have a high risk of lateral nodal metastasis in solitary solid PTC.