Ultrasound Risk Assessment Combined with Molecular Markers of Galectin-3, c-MET, HBME-1 and CK19 for Diagnosis of Malignant and Benign Thyroid Nodules.

To investigate the effect of ultrasound combined with expression of Galectin-3, c-Met, HBME-1 and CK19 in differentiating malignant from benign thyroid nodules. Forty-six patients with thyroid nodules were studied with ultrasound and immunohistochemical staining of excised thyroid nodules. The data were classified and compared. The immunohistochemical staining revealed 8 benign and 41 malignant thyroid lesions. In ultrasound risk assessment, the malignancy risk was low in four nodules, medium in five and high in 37 with lymphatic metastasis in 26. A significant (P < 0.05) association existed in the expression of Galectin-3 with nodule boundary and lymphatic metastasis, in HBME-1 with nodule micro-calcification and in c-Met with nodule micro-calcification and lymphatic metastasis. CK19 expression was not significantly (P > 0.05) associated with any of ultrasound features of nodule. Galectin-3, c-Met, HBME-1 and CK19 were significantly (P < 0.05) different in malignant and benign thyroid lesions, with a significant (P < 0.01) tendency in all the molecular markers in predicting the malignant from benign lesions. The ultrasound characteristics could significantly (P < 0.001) predict malignant nodules with a significant (P < 0.05) prediction tendency. The scores of Galectin-3, c-Met and CK19 significantly (P < 0.05) increased with increase of ultrasound malignancy risk degree. In malignant and benign lesions differentiated by ultrasound, no significant (P > 0.05) difference existed in HBME-1 expression, however, with ultrasound malignancy risk increase, the score of HBME-1 expression increased significantly (P = 0.03). Galectin-3, c-Met, HBME-1 and CK19 have significantly greater expressions in thyroid malignant than benign lesions and their expression increases with increase of ultrasound malignancy risk. The combination of both ultrasound and molecular markers can be used to differentiate malignant and benign thyroid lesions.

The value of virtual touch tissue image (VTI) and virtual touch tissue quantification (VTQ) in the differential diagnosis of thyroid nodules.

OBJECTIVES: To explore the value of virtual touch tissue image (VTI) and virtual touch tissue quantification (VTQ) in the differential diagnosis of thyroid nodules. METHODS: One-hundred and seven patients with 113 thyroid nodules were performed conventional ultrasound and acoustic radiation force impulse (ARFI) elastography. The stiffness of the nodules on virtual touch tissue image (VTI) was graded, and the area ratios (AR) of nodules on VTI images versus on B-mode images were calculated. Shear wave velocity (SWV) within the thyroid nodules were measured using virtual touch tissue quantification (VTQ) technique. The pathological diagnosis as the gold standard draws the receiver-operating characteristic curve (ROC) to find the cut-off point of VTI grades, AR and SWV to predict thyroid cancer. RESULTS: The difference in VTI grades of malignant and benign nodules was statistically significant (P<0.05), as well as in AR and SWV. There was no significant difference in the AR of nodules or the SWV of nodules in benign group or in malignant group. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of VTI grades, AR, and SWV in the differential diagnosis of thyroid nodules were calculated. There was no significant difference in diagnostic accuracy among the three methods. CONCLUSION: VTI grades, AR of nodules on VTI images versus on B-mode images and SWV within the nodules can help the differential diagnosis of thyroid nodules.

The value of acoustic radiation force impulse (ARFI) in the differential diagnosis of thyroid nodules.

OBJECTIVES: The aim of this study was to investigate the value of shear wave velocity value (SWV) and shear wave velocity ratio (SWR) in differentiating between malignant and benign thyroid nodules using virtual touch tissue quantification (VTQ) of acoustic radiation force impulse (ARFI) technology. METHODS: The SWV and SWR were analyzed in 155 thyroid nodules in 155 patients (93 benign and 62 malignant) and eighty normal thyroid glands. The diagnostic performance of SWV and SWR were compared. RESULTS: The mean value of SWV of malignant nodules differed significantly from those of the benign nodules (6.34 ± 2.58 m/s vs. 2.15 ± 0.59 m/s, P<0.05) and the normal thyroid (1.96 ± 0.31 m/s, P<0.05). There was no statistically significant difference between the mean value of SWV of benign nodules and normal thyroid (P>0.05). The mean value of SWR of malignant nodules differed significantly from those of the benign nodules (2.99 ± 1.45 vs. 1.07 ± 0.34, P<0.05). The sensitivity, specificity, positive predictive values, negative predictive values and accuracy of SWV in differentiating between malignant and benign nodules were 96.80%, 95.70%, 93.75%, 97.80% and 96.13% respectively based on the cutoff point as 2.84 m/s. Those of SWR were 91.90%, 81.70%, 77.03%, 93.83% and 85.83% based on the cutoff point as 1.32. The diagnostic accuracy rate of SWV was statistically higher than that of SWR (P<0.05). CONCLUSION: VTQ of ARFI technology provides the quantitative information of thyroid tissue elasticity and has high accuracy rate in differentiating between malignant and benign nodules. It is a useful complement for conventional ultrasonography.

[Diagnosis and treatment of pharyngoesophageal diverticulum].

OBJECTIVE: To investigate the diagnosis, differential diagnosis and the treatment of Zenker diverticulum (pharyngo esophagus diverticulum) in thyroid operation. METHODS: Seven cases suffering from thyroid masses diagnosed Zenker diverticulum in thyroid operation between July 2001 and December 2011 were reviewed. RESULTS: Zenker diverticula in the patients were resected. Only one case was complicated with the formation of false capsular bag, infection and fistula postoperatively, but cured with draining eventually. CONCLUSIONS: Zenker diverticulum may exist in some patients with thyroid mass. Resection of diverticulum may be performed in thyroid operation, with a good prognosis.