Complications following US-guided core-needle biopsy for thyroid lesions: a retrospective study of 6,169 consecutive patients with 6,687 thyroid nodules.

OBJECTIVES: To present the various complications of ultrasound (US)-guided core needle biopsy (CNB) of thyroid lesions in a large patient series. METHODS: From January 2008 to March 2013, 6,169 patients underwent US-guided CNB of 6,687 thyroid nodules at a single institution. We assessed the number and types of major and minor complications, and evaluated the factors associated with complications. RESULTS: Overall, 53 complications were observed in 50 patients (0.81 %), including 4 major and 49 minor complications. The major complications were massive haematoma (n = 2), pseudoaneurysm (n = 1) and voice change leading to disability that lasted for more than 30 days (n = 1). The minor complications were small to moderate haematoma (n = 42), carotid injury (n = 2), voice change that recovered within 30 days (n = 3), tracheal puncture (n = 1) and dysphagia (n = 1). Oedema (n = 12), vertebral puncture (n = 3) and vasovagal reaction (n = 1) were recorded as side effects. The presence of a coprocedure was the only significant factor associated with complications after thyroid CNB (P = 0.023). CONCLUSIONS: US-guided CNB of thyroid lesions was found in a large population to be a safe procedure with a low complication rate. KEY POINTS: • The complication rate after US-guided CNB for thyroid lesions was 0.81 % (50/6,169). • The rate of major complications was 0.06 % (4/6,169). • Vascular injury was the most common complication (47/6,169; 0.76 %). • None of the patients experienced permanent problems resulting from complications.

Ultrasonography features of medullary thyroid cancer as predictors of its biological behavior.

Background Although there are many well-known prognostic predictors of medullary thyroid carcinoma (MTC), the ultrasonography (US) findings of MTC have not been sufficiently validated in this regard. Purpose To investigate the US findings of MTC and their relationship with the biological behavior of MTC. Material and Methods The US findings and clinical and pathology records of 123 MTC nodules from 108 patients were retrospectively analyzed at two tertiary referral hospitals. MTCs were classified according to US findings, i.e. MTC with benign (B-MTC) and malignant US findings (M-MTC). We then compared the clinical and pathology findings between the two groups. Results Eighty-two M-MTCs (66.7%) and 41 B-MTCs (33.3%) were identified. M-MTCs showed a significantly higher prevalence of lateral lymph node metastases as well as extrathyroidal and extranodal extension (all P < 0.05). M-MTCs larger than 1 cm showed a significantly higher prevalence of multifocality, recurrence, extrathyroidal and extranodal extension than B-MTCs larger than 1 cm in the largest dimension (all P < 0.05). Tumors > 1 cm were more likely to be B-MTC and one-third of all MTCs had benign US features. The common findings of B-MTC included a solid, ovoid to round shape, with a smooth margin, hypoechogenicity, and without calcification. Conclusion The biological behavior of M-MTCs results in poorer outcomes than that of B-MTCs.

Initial clinical experience with BRAF(V600E) mutation analysis of core-needle biopsy specimens from thyroid nodules.

OBJECTIVE: The accurate diagnosis of thyroid nodules is important for making management decisions. The purpose of this study was to evaluate the feasibility of core-needle biopsy with BRAF(V600E) mutation analysis (CNB + BRAF(V600E) ) and to compare the clinical usefulness of CNB + BRAF(V600E) and fine-needle aspiration with BRAF(V600E) mutation analysis (FNA + BRAF(V600E) ) in the diagnosis of thyroid malignancy. DESIGN, PATIENTS AND MEASUREMENTS: The results of BRAF(V600E) mutation analyses of 820 nodules from 820 patients (153 men, 667 women; mean age, 51·1 years), who underwent CNB + BRAF(V600E) (n = 256) or FNA + BRAF(V600E) (n = 564) between January 2011 and March 2012 were retrospectively evaluated. The feasibility of CNB + BRAF(V600E) was assessed by comparing its rate of detection of BRAF(V600E) mutations and positive predictive value with those of FNA + BRAF(V600E) . The clinical usefulness of CNB + BRAF(V600E) was determined by comparing rates of inconclusive results, the additional value of BRAF(V600E) mutation analysis, diagnostic surgery and diagnostic performance with those of FNA + BRAF(V600E) . RESULTS: CNB + BRAF(V600E) and FNA + BRAF(V600E) had similar rates of BRAF(V600E) mutation detection (66·3% vs 64·4%, P = 0·883) and positive predictive value (100·0% vs 96·6%, P = 0·135). CNB + BRAF(V600E) had a significantly higher diagnostic accuracy rate (95·7% vs 85·9%, P < 0·001), and significantly lower rates of inconclusive results (8·2% vs 51·8%, P < 0·001), and diagnostic surgery (8·9% vs 22·3%, P = 0·006), than FNA + BRAF(V600E) . CONCLUSIONS: The greater diagnostic performance of CNB + BRAF(V600E) and its lower rate of inconclusive results than FNA + BRAF(V600E) suggest that CNB + BRAF(V600E) can reduce rates of preventable diagnostic surgery.

Core needle biopsy could reduce diagnostic surgery in patients with anaplastic thyroid cancer or thyroid lymphoma.

OBJECTIVE: To evaluate the diagnostic performance of fine needle aspiration (FNA) and core needle biopsy (CNB) in patients with anaplastic thyroid cancer (ATC) or thyroid lymphoma (TL). METHODS: Between January 2000 and March 2012, 104 patients were diagnosed with ATC or TL by means of ultrasound (US)-guided FNA, CNB, or surgery. This study ultimately included 99 patients with ATC (n = 59) or TL (n = 40). We evaluated the sensitivity and positive predictive value of FNA and CNB for the diagnosis of ATC and TL, and compared the rates of diagnostic surgery between FNA and CNB. RESULTS: FNA was used in 83 patients, and CNB was used in 32 patients initially (n = 16), after FNA results (n = 8), or simultaneously with FNA (n = 8). CNB achieved sensitivity of 87.5 % (28/32) and positive predictive value of 100.0 % (28/28) for the diagnosis of ATC and TL. The respective values for FNA were 50.6 % (40/79) and 90.9 % (40/44). The rate of diagnostic surgery was significantly lower after CNB (4/32, 12.5 %) than after FNA (28/79, 35.4 %) (p = 0.020). CONCLUSIONS: CNB was able to reduce unnecessary diagnostic surgery in patients with ATC or TL by virtue of its superior diagnostic sensitivity and positive predictive value compared to FNA. KEY POINTS: • Diagnostic sensitivity and PPV for CNB were 87.5 % and 100.0 %, respectively. • The respective values for FNA were 50.6 % and 91.0 % for ATC and TL. • Diagnostic surgery rates were reduced after CNB compared to FNA (p = 0.020).

The Influence of Flush Methods on Transfemoral Catheter Cerebral Angiography: Continuous Flush versus Intermittent Flush.

PURPOSE: To evaluate the influence of different flush methods on transfemoral cerebral angiography (TFCA). MATERIALS AND METHODS: This single-blind randomized controlled trial included 50 patients who had undergone TFCA. Balanced block randomization was used to allocate participants into intermittent-flush (n = 25) and continuous-flush (n = 25) groups. Differences in procedure duration, amounts of contrast medium and heparinized saline used, heparin dose, blood loss, fluoroscopy time, radiation dose, and occurrence of new embolic signal (NES) on diffusion-weighted imaging (DWI) were compared between the two groups. RESULTS: The procedure duration was shorter in the continuous-flush group (mean 26.5 min ± 3.7) than in the intermittent-flush group (mean 29.6 min ± 2.8) (P = .004). Amounts of injected contrast medium (mean 20.2 mL ± 4.4 vs 57.1 mL ± 9.0), wasted heparinized saline (mean 19.8 mL ± 9.6 vs 92.3 mL ± 16.7), and aspirated blood (mean 4.7 mL ± 1.3 vs 13.2 mL ± 2.9) were lower in the continuous-flush group than in the intermittent-flush group (P < .001). The amount of injected (or infused) heparinized saline, heparin dose, fluoroscopy time, radiation dose, and occurrence of NES on DWI did not differ between the groups (P > .05). CONCLUSIONS: The use of continuous flushing during TFCA reduced the procedure time, amount of contrast medium needed, amount of wasted heparinized saline, and blood loss, but no difference in the occurrence of NES on DWI was noted between the groups.

Mechanical thrombectomy in cardiac myxoma stroke: a case report and review of the literature.

Cardiac myxoma is the most common primary tumor of the heart. It is a rare cause of acute ischemic stroke and commonly not detected until after the stroke. There is no current guideline for the treatment of cardiac myxoma stroke and only a few cases of mechanical thrombectomy have been reported. We present a case of cardiac myxoma stroke in a 4-year-old boy treated with a stent-retrieval device and review the literature describing the safety and efficacy of mechanical thrombectomy in cardiac myxoma stroke. We also describe imaging features of the myxoma clot on susceptibility weighted images.

Imaging characteristics of sinonasal organized hematoma.

BACKGROUND: Sinonasal organized hematoma is a rare benign disease that may be mistaken for malignancy. PURPOSE: To define the imaging characteristics of sinonasal organized hematoma. MATERIAL AND METHODS: We retrospectively reviewed computed tomography (CT) images of eight patients (4 male patients, 4 female patients; mean age, 40 years; range, 9-83 years) with pathologically proven sinonasal organized hematomas; magnetic resonance imaging (MRI) was performed in one patient among them. The following lesions characteristics were analyzed: size, shape, location, expansile nature, density, signal intensity, internal structure, enhancement pattern, and surrounding bony wall change. RESULTS: The lesion sizes were in the range of 2-5.2 cm (mean, 3.55 cm), and the shapes were lobular, lumpy, or nodular. They were located in the nasal cavity (n = 1), maxillary sinuses (n = 2), or both nasal cavities and maxillary sinuses (n = 5). Expansile lesions with locally aggressive margins were observed in two cases. All lesions were hyperdense on precontrast CT scans; the smaller lesions showed even hyperdensity, whereas the larger lesions showed uneven density. The signal intensity was mixed on MRI, consisting of hemorrhage, fibrosis, and neovascularization. Papillary or frond-like enhancement was noted after contrast injection. All cases showed smooth erosion of the medial walls of the maxillary sinuses, and the epicenters were the secondary maxillary ostia. Two lesions showed erosion of the lateral walls of the maxillary sinuses and were expansile in nature. Non-hemorrhagic polyps accompanied the organized hematomas in three cases. CONCLUSION: Although sinonasal organized hematoma can be mistaken for a malignant tumor, the following characteristic imaging findings facilitate the diagnosis of an organized hematoma: erosion of the bony sinus walls, markedly heterogeneous signal intensity, and papillary or frond-like enhancement.

A focal marked hypoechogenicity within an isoechoic thyroid nodule: is it a focal malignancy or not?

BACKGROUND: A marked hypoechogenicity is a reliable criterion for a malignant nodule, whereas isoechogenicity is considered to be a benign ultrasonographic (US) finding. However, there have been no reports to demonstrate whether a focal marked hypoechogenicity within an isoechoic nodule is a focal malignancy. PURPOSE: To evaluate whether a focal marked hypoechogenicity within an isoechoic nodule on US examination is a focal malignancy and to correlate US histologic findings using surgical or core needle biopsy (CNB) specimens. MATERIAL AND METHODS: From January 2010 to August 2011, 28 consecutive patients (25 women, 3 men; mean age, 52.2 years) with 29 thyroid nodules, which showed a focal marked hypoechogenicity within an isoechoic nodule on US, underwent US-guided CNB for a suspicion of a focal malignancy. All nodules were confirmed by surgery (n = 6) or more than two consecutive US-guided biopsies (n = 23). We evaluated the risk of malignancy, and analyzed histological components which correlated with a focal marked hypoechogenic area within an isoechoic nodule on US. Statistical analysis was performed using the Mann-Whitney U test and Fisher's exact test. RESULTS: Of the 29 nodules, 25 were benign (86.2%) and four were malignant (13.8%). The peripheral location of focal marked hypoechogenicity within an isoechoic nodule was the only significant US finding that suggested malignancy (P = 0.03). All benign focal marked hypoechogenicities were histologically composed of severe fibrosis with a few follicular cells with varying frequencies of hemosiderin, calcification, infarction, and granulation tissue. CONCLUSION: Although a focal marked hypoechogenicity within an isoechoic nodule is usually benign, the peripheral location of a focal marked hypoechogenicity may be a malignancy. The histologic information obtained by CNB specimen may reduce the needs for repetitive fine needle aspirations or diagnostic surgery.

Core needle biopsy can minimise the non-diagnostic results and need for diagnostic surgery in patients with calcified thyroid nodules.

PURPOSE: To evaluate the role of core needle biopsy (CNB) for calcified thyroid nodules. METHODS: Between October 2008 and July 2011, 264 patients underwent ultrasound-guided CNB for 272 calcified thyroid nodules at our institution. We retrospectively evaluated the incidence of technical failure, non-diagnostic readings, and the diagnostic performance of CNB, and analysed the relationship between the types of calcification and the CNB results. Finally, the incidence of diagnostic surgery was calculated. RESULTS: The incidence of technical failure was 1.1 % (3/275) and that of non-diagnostic results was 0.7 % (2/272). The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CNB were 94.7 %, 89.5 %, 100 %, 100 %, and 90.2 %, respectively. There were no significant differences according to the calcification subtype for either the non-diagnostic results or the incidence of technical failure (P > 0.99 and P > 0.99). CNB could prevent diagnostic surgery for 92.9 % (13/14) of the patients who showed more than two non-diagnostic results in previous FNA. CONCLUSIONS: CNB can minimise the non-diagnostic results as well as diagnostic surgery in patients with calcified thyroid nodules. Therefore, CNB may be used as a first-line diagnostic tool for calcified thyroid nodules rather than FNA. KEY POINTS: CNB results show the low incidence of technical failure (1.1 %, 3/275). • CNB results show the low non-diagnostic rate (0.7 %, 2/272). There were no significant differences according to the calcification subtype. CNB can prevent unnecessary diagnostic surgery in 92.9 % (13/14).

Thyroid nodules with initially non-diagnostic, fine-needle aspiration results: comparison of core-needle biopsy and repeated fine-needle aspiration.

OBJECTIVE: To evaluate the role of core-needle biopsy (CNB) by comparing the results of CNB and repeated fine-needle aspiration (FNA) for thyroid nodules with initially non-diagnostic FNA results. METHODS: From October 2008 to December 2011, 360 nodules - 180 consecutive repeated FNAs and 180 consecutive CNBs -- from 360 patients (83 men, 277 women; mean age, 54.4 years) with initially non-diagnostic FNA results were analyzed retrospectively. The incidence of non-diagnostic results, inconclusive results, diagnostic surgery, and diagnostic performance of repeated FNA and CNB were assessed, and factors affecting second non-diagnostic results were evaluated. RESULTS: CNB achieved a significantly lower non-diagnostic and inconclusive rate than repeated FNA (1.1 % versus 40.0 %, P < 0.001; 7.2 % versus 72.0 %, P < 0.001). All diagnostic performances with CNB were higher than repeated FNA. The diagnostic surgery rate was lower with CNB than with repeated FNA (3.6 % versus 16.7 %, P = 0.047). Multivariate logistic regression analysis showed that repeated FNA was the most important factor for second non-diagnostic results (OR = 56.06, P < 0.001), followed by nodules with rim calcification (OR = 7.46, P = 0.003). CONCLUSIONS: CNB is more useful than repeated FNA for reducing the number of non-diagnostic and inconclusive results and for preventing unnecessary diagnostic surgery for thyroid nodules with initially non-diagnostic FNA results. KEY POINTS: • Core-needle biopsy achieved a lower number of non-diagnostic and inconclusive results. • Core-needle biopsy achieved better diagnostic performance. • Use of core-needle biopsy could prevent unnecessary diagnostic surgery. • Repeated fine-needle aspiration was significantly associated with a second non-diagnosis.

Adaptive laboratory evolution and transcriptomics-guided engineering of Escherichia coli for increased isobutanol tolerance.

As a renewable energy from biomass, isobutanol is considered as a promising alternative to fossil fuels. To biotechnologically produce isobutanol, strain development using industrial microbial hosts, such as Escherichia coli, has been conducted by introducing a heterologous isobutanol synthetic pathway. However, the toxicity of produced isobutanol inhibits cell growth, thereby restricting improvements in isobutanol titer, yield, and productivity. Therefore, the development of robust microbial strains tolerant to isobutanol is required. In this study, isobutanol-tolerant mutants were isolated from two E. coli parental strains, E. coli BL21(DE3) and MG1655(DE3), through adaptive laboratory evolution (ALE) under high isobutanol concentrations. Subsequently, 16 putative genes responsible for isobutanol tolerance were identified by transcriptomic analysis. When overexpressed in E. coli, four genes (fadB, dppC, acs, and csiD) conferred isobutanol tolerance. A fermentation study with a reverse engineered isobutanol-producing E. coli JK209 strain showed that fadB or dppC overexpression improved isobutanol titers by 1.5 times, compared to the control strain. Through coupling adaptive evolution with transcriptomic analysis, new genetic targets utilizable were identified as the basis for the development of an isobutanol-tolerant strain. Thus, these new findings will be helpful not only for a fundamental understanding of microbial isobutanol tolerance but also for facilitating industrially feasible isobutanol production.

Thyroid nodules with initially nondiagnostic cytologic results: the role of core-needle biopsy.

PURPOSE: To evaluate the role of core-needle biopsy (CNB) in thyroid nodules with nondiagnostic results at previous fine-needle aspiration (FNA). MATERIALS AND METHODS: From October 2008 to July 2011, 155 nodules from 155 patients (37 men, 118 women) with a mean age of 51.8 years (age range, 22-76 years) with nondiagnostic results at previous FNA were reviewed retrospectively. The Bethesda system for reporting thyroid cytopathologic results was used to assign FNA and CNB findings. Malignant nodules (n = 37) were diagnosed after surgery. Benign nodules (n = 79) were diagnosed either after surgery, with benign findings after FNA and/or CNB that had been repeated at least twice, or after benign cytology findings at FNA or CNB with a stable size at follow-up. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ultrasonographically guided CNB were evaluated. RESULTS: At CNB, two nodules (1.3%) showed nondiagnostic results, and 135 nodules (87.1%) had conclusive diagnoses. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of core biopsies for the detection of malignancy were 94.6% (35 of 37), 100% (79 of 79), 100% (35 of 35), 97.5% (79 of 81), and 98.3% (114 of 116), respectively. For 28 nodules, nondiagnostic results were found after two or more FNA procedures; however, diagnostic surgery was performed in only one patient. CONCLUSION: CNB of the thyroid nodule demonstrates high rates of conclusive and accurate diagnoses in patients for whom previous FNA results were nondiagnostic, thereby reducing the need for unnecessary diagnostic surgery.

Single-session treatment of benign cystic thyroid nodules with ethanol versus radiofrequency ablation: a prospective randomized study.

PURPOSE: To compare volume reduction of single-session ethanol ablation (EA) and radiofrequency (RF) ablation for cystic thyroid nodule treatment. MATERIALS AND METHODS: All patients gave written informed consent to participate in this prospective institutional review board-approved study. From May 6, 2010, to August 8, 2011, in this single-institutional, noninferiority trial, 50 patients, each with a single cystic thyroid nodule, were randomly assigned to EA (25 patients; mean age for women, 45.7 years, and for men, 37.5 years) or RF ablation (25 patients; mean age for women, 45.1 years, and for men, 43.7 years) treatment. Internal fluid was aspirated prior to EA or RF ablation. Primary end point was the volume reduction ratio (percentage) at 6-month follow-up; the noninferiority margin was chosen as -8% (EA minus RF ablation). Secondary end points included therapeutic success rate, improvement of symptoms and cosmetic problems, and number of major complications. Analysis was performed primarily in intention-to-treat manner. A one-sided 95% confidence interval (CI) for the mean difference in volume reduction ratio 6 months after treatment was calculated to test for noninferiority. Subsequent superiority comparison of EA with RF ablation on a condition of establishment of the noninferiority of EA to RF ablation was preplanned and used two-sided 95% CI of the outcome difference. RESULTS: The mean volume reduction was 96.9% in EA and 93.3% in RF ablation (n = 21 for each) (difference, 3.6%; lower bound of the one-sided 95% CI of the difference, 1.2%), thus demonstrating the noninferiority of EA to RF ablation. Two-sided 95% CI of the outcome difference was 0.7% to 6.5%, demonstrating significant superiority of EA to RF ablation. All patients demonstrated therapeutic success (P > .99). Mean symptom and cosmetic scores showed no significant difference in either group (P = .806 and P = .682, respectively). There were no major complications (P > .99). CONCLUSION: EA may be the first-line treatment modality for cystic thyroid nodules, which has comparable therapeutic efficacy to, but is less expensive than, RF ablation.

Radiofrequency ablation of benign non-functioning thyroid nodules: 4-year follow-up results for 111 patients.

OBJECTIVES: To evaluate the clinical outcomes and safety of radiofrequency (RF) ablation for benign non-functioning thyroid nodules over a 4-year follow-up. METHODS: We evaluated 126 benign non-functioning thyroid nodules of 111 patients treated with RF ablation and followed-up more than 3 years. RF ablation was performed using the Cool-Tip RF system and an internally cooled electrode. Nodule volume and cosmetic and symptom scores were evaluated before treatment and during follow-up. Complications and factors related to efficacy were evaluated. RESULTS: The mean follow-up duration was 49.4 ± 13.6 months. Thyroid nodule volume decreased significantly, from 9.8 ± 8.5 ml before ablation to 0.9 ± 3.3 ml (P < 0.001) at final evaluation: a mean volume reduction of 93.4 ± 11.7 %. The mean cosmetic (P < 0.001) and symptom scores (P < 0.001) improved significantly. Factors related to efficacy were initial solidity and volume. The overall recurrence rate was 5.6 % (7/126). The overall complication rate was 3.6 % (4/111). CONCLUSIONS: RF ablation was effective in shrinking benign thyroid nodules and in controlling nodule-related problems over a 4-year follow-up. There were no life-threatening complications or sequelae. Therefore, RF ablation can be used as a non-surgical treatment for patients with benign non-functioning thyroid nodules.

Symptomatic benign thyroid nodules: efficacy of additional radiofrequency ablation treatment session--prospective randomized study.

PURPOSE: To prospectively evaluate the efficacy of additional radiofrequency (RF) ablation by comparing the results of one and two sessions. MATERIALS AND METHODS: All patients gave written informed consent to participate in this institutional review board-approved prospective study. From September 2007 to February 2008, 30 patients with benign predominantly solid thyroid nodules causing pressure symptoms and/or cosmetic problems were randomly assigned to undergo single-session (group 1, n = 15) or two-session (group 2, n = 15) RF ablation. RF ablation was performed by using an 18-gauge internally cooled electrode with ultrasonographic guidance. Nodule volume and cosmetic and symptom scores were evaluated before ablation and at 1, 3, and 6 months after initial ablation, and quantitative comparisons of these were performed by using the Mann-Whitney and Wilcoxon signed rank tests; the Spearman rank test was used for correlation between nodule volume reduction and applied energy. RESULTS: At 6-month follow-up, there was significant nodule volume reduction, from 13.3 mL ± 12.9 (standard deviation) to 3.8 mL ± 4.4 in group 1 (P = .001), and from 13.0 mL ± 6.8 to 3.0 mL ± 2.2 in group 2 (P = .001). Each group showed significant improvement in cosmetic (P < .0001) and symptom (P = .001) scores. However, there was no significant difference in volume reduction, cosmetic score, and symptom score between two groups (P = .078, P > .99, and P = .259, respectively). In group 1, three of four patients who had a pretreatment nodule volume larger than 20 mL underwent additional RF ablation because of unresolved clinical problems after the first session. CONCLUSION: Single-session RF ablation showed significant volume reduction and satisfactory clinical response in most patients. Therefore, additional RF ablation should be limited to patients with a large nodule (>20 mL) or unresolved clinical problems.

Potential of right to left ventricular volume ratio measured on chest CT for the prediction of pulmonary hypertension: correlation with pulmonary arterial systolic pressure estimated by echocardiography.

OBJECTIVES: To investigate the correlation of right ventricular (RV) to left ventricular (LV) volume ratio measured by chest CT with pulmonary arterial systolic pressure (PASP) estimated by echocardiography. METHODS: 104 patients (72.47 ± 13.64 years; 39 male) who had undergone chest CT and echocardiography were divided into two groups (hypertensive and normotensive) based upon an echocardiography-derived PASP of 25 mmHg. RV to LV volume ratios (RV(V)/LV(V)) were calculated. RV(V)/LV(V) was then correlated with PASP using regression analysis. The Area Under the Curve (AUC) for predicting pulmonary hypertension on chest CT was calculated. RESULTS: In the hypertensive group, the mean PASP was 46.29 ± 14.42 mmHg (29-98 mmHg) and there was strong correlation between the RV(V)/LV(V) and PASP (R = 0.82, p < 0.001). The intraobserver and interobserver correlation coefficients for RV(V)/LV(V) were 0.990 and 0.892. RV(V)/LV(V) was 1.01 ± 0.44 (0.51-2.77) in the hypertensive and 0.72 ± 0.14 (0.52-1.11) in the normotensive group (P <0.05). With 0.9 as the cutoff for RV(V)/LV(V), sensitivity and specificity for predicting pulmonary hypertension over 40 mmHg were 79.5 % and 90 %, respectively. The AUC for predicting pulmonary hypertension was 0.87 CONCLUSION: RV/LV volume ratios on chest CT correlate well with PASP estimated by echocardiography and can be used to predict pulmonary hypertension over 40 mmHg with high sensitivity and specificity.

Cystic versus predominantly cystic thyroid nodules: efficacy of ethanol ablation and analysis of related factors.

OBJECTIVES: To compare the efficacy of ethanol ablation (EA) of cystic and predominantly cystic thyroid nodules, and to evaluate factors affecting efficacy. METHODS: From October 2008 to December 2010, a total of 217 thyroid nodules were treated with EA. Nodule volumes, symptoms and cosmetic scores were evaluated before and after EA. EA efficacy in treating cystic and predominantly cystic nodules was compared; and factors related to EA efficacy in each type, including initial volume, solid component, vascularity, fluid nature, ethanol retention time and number of EA sessions, were evaluated. RESULTS: Mean nodule volume decreased from 15.7 ± 18.1 ml to 3.0 ± 7.9 ml (mean volume reduction, 85.2 ± 16.1%) and the therapeutic success rate was 90.3% at last follow-up. EA was significantly more effective in cystic than predominantly cystic nodules. Independent predictors of EA efficacy for all nodules included initial volume, solid component and vascularity. Initial volume and vascularity were independent predictors of EA efficacy in predominantly cystic nodules, but no factor was independently related to efficacy in cystic nodules. CONCLUSIONS: EA is effective in both cystic and predominantly cystic nodules, especially the former. EA is less effective in large or vascular predominantly cystic nodules, but is effective in cystic nodules regardless of related factors. KEY POINTS: • Ethanol ablation under ultrasound guidance is increasingly used for cystic thyroid nodules. • EA seems effective for cystic and predominantly cystic nodules, especially cystic nodules. • The effectiveness of EA was reduced in large or vascular predominantly cystic nodules.

Hepatic resection versus radiofrequency ablation for very early stage hepatocellular carcinoma: a Markov model analysis.

UNLABELLED: No adequate randomized trials have been reported for a comparison between hepatic resection (HR) versus radiofrequency ablation (RFA) for the treatment of patients with very early stage hepatocellular carcinoma (HCC), defined as an asymptomatic solitary HCC <2 cm. For compensated cirrhotic patients with very early stage HCC, a Markov model was created to simulate a randomized trial between HR (group I) versus primary percutaneous RFA followed by HR for cases of initial local failure (group II) versus percutaneous RFA monotherapy (group III); each arm was allocated with a hypothetical cohort of 10,000 patients. The primary endpoint was overall survival. The estimates of the variables were extracted from published articles after a systematic review. In the parameter estimations, we assumed the best scenario for HR and the worst scenario for RFA. The mean expected survival was 7.577 years, 7.564 years, and 7.356 years for group I, group II, and group III, respectively. One-way sensitivity analysis demonstrated that group II was the preferred strategy if the perioperative mortality rate was greater than 1.0%, if the probability of local recurrence following an initial complete ablation was <1.9% or if the positive microscopic resection margin rate was >0.3%. The 95% confidence intervals for the difference in overall survival were -0.18-0.18 years between group I and II, 0.06-0.36 years between group I and III, and 0.13-0.30 years between group II and III, respectively. CONCLUSION: Primary percutaneous RFA followed by HR for cases of initial local failure was nearly identical to HR for the overall survival of compensated cirrhotic patients with very early stage HCC.

Clinical significance of vagus nerve variation in radiofrequency ablation of thyroid nodules.

OBJECTIVES: To evaluate the types and incidence of vagus nerve variations and to assess factors related to the vulnerability of vagus nerves during the radiofrequency (RF) ablation of thyroid nodules. METHODS: Bilateral vagus nerves of 304 consecutive patients who underwent ultrasound of the neck were assessed. Two radiologists evaluated vagus nerve type (types 1-4; lateral/anterior/medial/posterior), the shortest distance between the thyroid gland and vagus nerve, and thyroid contour. Vagus nerve vulnerability was defined as a vagus nerve located within 2 mm of the thyroid gland through the ex vivo experiments, and factors associated with vulnerability were assessed. RESULTS: We were unable to find one vagus nerve. Of the 607 vagus nerves, 467 (76.9%) were type 1, 128 (21.1%) were type 2, 10 (1.6%) were type 3, and 2 (0.3%) were type 4, with 81 (13.3%) being vulnerable. Univariate analysis showed that sex, location, thyroid contour and type were significantly associated with vagus nerve vulnerability. Multivariate analysis showed that bulging contour caused by thyroid nodules (P = 0.001), vagus nerve types 2/4 (P < 0.001) and type 3 (P < 0.001) were independent predictors. CONCLUSION: The operator should pay attention to anatomical variations and the resulting vagus nerve injury during RF ablation of bulging thyroid nodules.

Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies.

UNLABELLED: According to the American Association for the Study of Liver Diseases guidelines, percutaneous ethanol injection (PEI) is a safe and highly effective treatment for small hepatocellular carcinomas (HCC) and should be the standard against which any new therapy is compared. The primary purpose of this study was to identify survival benefit of any percutaneous ablation therapy as compared with PEI in the treatment of patients with unresectable HCC. The secondary endpoints were initial tumor response, local tumor progression, and complications. Randomized controlled trials that compared pecutaneous ablative therapies with PEI were included. MEDLINE, the Cochrane Library, CANCERLIT, and manual search from 1978 to July 2008 were used. To control the potential heterogeneity, the random effects model of DerSimonian and Laird was used for a meta-analysis. Egger's test was performed to test a potential publication bias. We identified seven randomized controlled trials (RCTs), but only four RCTs including 652 patients that compared radiofrequency ablation (RFA) with PEI met the inclusion criteria to perform a meta-analysis assessing 3-year survival. A meta-analysis of the four RCTs demonstrated a significant improvement in 3-year survival favoring RFA over PEI (odds ratio 0.477, 95% confidence interval 0.340-0.670; P < 0.001). Heterogeneity among the four trials was not significant (Q = 4.586; P= 0.205). Egger's test revealed that the publication bias was not significant (P = 0.647). However, the number of patients included in the analysis was insufficient for a robust meta-analysis of initial tumor response. The definition of local tumor progression or major complication was not unified among the trials included in the meta-analysis. CONCLUSION: RFA demonstrated significantly improved 3-year survival status for patients with HCC, when compared to PEI.