Multimodal ultrasonography evaluation in thyroid nodule characterization: what is the ideal algorithm?

AIMS: The aim of this study is to investigate the diagnostic performances of Ultrasonography (US), Shear-wave Elastography (SWE), and Superb Microvascular Imaging (SMI) findings in the diagnosis of malignant thyroid nodules (MTNs) and to determine the US algorithm with the best diagnostic performance. MATERIAL AND METHODS: Eighty-one nodules in 77 patients who had underwent multimodal US with biopsy results, were evaluated. Echogenicity, nodule components, contours, presence and type of calcification, and size were analyzed with US. Nodule stiffness and vascular index (VI) measurements were performed via SWE and SMI. The power of the US algorithm in predicting malignancy was evaluated. RESULTS: Hypoechogenicity, irregular contour, aspect ratio (anteroposterior (AP)/transvers diameter) >1, and >43.9 kPa were the characteristicshad significant efficacy in the diagnosis of MTNs. Sensitivity, specificity, and AUC values were respectively 100%, 48.5%, and 0.742 for hypoechogenicity; 80%, 90.1%, and 0.855 for irregular contour; 60%, 71.2%, and 0.656 for aspect ratio >1; 60%, 72.7%, and 0.671 for >43.9 kPa; and 93.3%, 90.9%, and 0.921 for the US algorithm. VI did not show significant efficacy in diagnosis. CONCLUSION: Some B-mode and SWE findings showed sufficient efficacy in differentiating benign and malign nodules on their own. However, diagnostic accuracy increased significantly when the US algorithm was applied.

Comparison of severity and complication rates of acute cholecystitis during pandemic and pre-pandemic periods?

BACKGROUND: Cancellations of surgeries for elective cases and late admissions of symptomatic cases during the pandemic period might have increased the number of cases of acute cholecystitis and its complications. PURPOSE: To compare the severity of acute cholecystitis and complication rates during the pandemic and pre-pandemic periods. MATERIAL AND METHODS: We evaluated the computed tomography (CT) findings observed for the diagnosis of complications for both acute simple and acute complicated cholecystitis during both the pandemic and pre-pandemic periods. Patients admitted to the hospital between March 2020 and December 2020 made up the study group and the corresponding appropriate patients from one year earlier were studied as the control group. In addition to the CT findings, clinical and laboratory findings, co-morbidities such as diabetes, as well as the admission time to hospital from the onset of the initial symptoms to hospital admission were also evaluated. RESULTS: A total of 88 patients were evaluated (54 in the study group, 34 in the control group; mean age = 64.3 ± 16.3 years). The male-to-female ratio was 51/37. The number of patients diagnosed with complicated cholecystitis were significantly higher in the study group (P = 0.03). Murphy finding and diabetes status were similar between the two groups (P = 0.086 and P = 0.308, respectively). Admission time to the hospital was significantly different for study and control groups in simple cholecystitis patients (P = 0.045); with no significant difference in cases of complicated cholecystitis (P = 0.499). CONCLUSION: Our study reveals the course of acute cholecystitis during the pandemic period was much more serious with higher complications.