The relationship between ultrasound microcalcifications and psammoma bodies in thyroid tumours: a single-institution retrospective study.

AIM: To investigate the diagnostic accuracy of ultrasound microcalcifications for the detection of malignancy in thyroid nodules and determine the validity of the concept that ultrasound microcalcification reflects the presence of psammoma body calcification in thyroid nodules. MATERIALS AND METHODS: The laboratory information system at University Hospital Galway, a tertiary referral hospital, was used to compile a list of patients who underwent thyroid lobectomy or complete thyroidectomy over a continuous 12-month period with both preoperative ultrasound and postoperative histology available (n=106) from January to December 2019. The haematoxylin and eosin-stained histology slides of each case were sourced and reviewed under light microscopy by a histopathologist to determine the presence of psammoma body calcification within both benign and malignant thyroid nodules. Two radiologists reviewed preoperative thyroid ultrasound images of each case independently and blindly, and reported on the presence of ultrasonographic microcalcification. RESULTS: There was a strong and significant relationship between the presence of preoperative ultrasound microcalcification and thyroid malignancy (p<0.001). Ultrasound microcalcification had a high specificity (93%) and positive predictive value (75%) for thyroid malignancy, with a diagnostic accuracy of 76%. Negative predictive value was high at 76.7%, while sensitivity was low at 42.8%. There was a strong and significant association between the presence of preoperative ultrasound microcalcification in thyroid nodules and the presence of pathological psammoma bodies on histology (p<0.001). DISCUSSION: Ultrasound microcalcification has a strong and significant association with malignancy in thyroid nodules. This study supported the theory that ultrasound microcalcification occurs secondary to the presence of psammoma bodies within thyroid nodules.

The Role of Endobronchial Ultrasound in Early-Stage Non-Small Cell Lung Cancer.

Aim The aim of this study is to assess the impact of EBUS on the concordance of clinical and pathological NSCLC staging in our center. Methods Data was collected retrospectively from the hospital database regarding patients who underwent surgical resection for early stage NSCLC between 2012 and 2017. Results A total of 251 patients were included. The mean age was 67 (±9), 55% (n=137) were male and 83% (n=209) were current/former smokers. In group A (n=154, 61%) clinical nodal stage (cN) was established from a combination of CT, PET CT and mediastinoscopy. Group B underwent additional EBUS (n=97, 39%). cN and pathological nodal staging (pN) were concordant in 78% (n=120) in group A versus 62% (n=60) in group B (p=0.009). Conclusion This study demonstrated higher rates of nodal discordance in patients who underwent EBUS which contrasts existing data that demonstrates improved concordance with EBUS. We describe these findings and potential explanations further in this study.

Asymptomatic primary fallopian tube cancer: an unusual cause of axillary lymphadenopathy.

Primary Fallopian tube malignancy is considered a rare disease and is often mistaken histologically and clinically for ovarian cancer. The etiology is poorly understood, and it typically presents at an advanced disease stage, as symptoms are often absent in the initial period. As a result, primary fallopian tube cancer is generally associated with a poor prognosis. We present the case of a 45-year-old female who presents with a 5-day history of left axillary swelling and a normal breast examination. Mammogram and biopsy of a lesion in the left breast revealed a fibroadenoma but no other abnormalities. Initial sampling of the axillary node was suspicious for a primary breast malignancy, but histology of the excised node refuted this. PET-CT showed an area of high uptake in the right pelvis, and a laparoscopy identified a tumor of the left fallopian tube which was subsequently excised and confirmed as a serous adenocarcinoma.

Imaging of the gastrointestinal complications of systemic chemotherapy.

Gastrointestinal complications of chemotherapy may be serious and potentially life-threatening. Familiarity with and awareness of the potential complications associated with various chemotherapeutic agents/regimens is paramount to enable accurate and timely diagnosis. In this article we review the radiological manifestations of the most notable gastrointestinal complications associated with chemotherapeutic administration.

Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lymphoma.

BACKGROUND: The diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of lymphoma in patients with mediastinal lymphadenopathy is not well defined. METHODS: A retrospective review was performed of all patients with mediastinal lymphadenopathy referred for EBUS-TBNA between August 2005 and December 2006 in whom lymphoma was suspected based on prior history or clinical presentation. Mediastinal biopsy specimens were taken using a linear array ultrasonic bronchoscope (Olympus XBF-UC 160F) and a 22-gauge cytology needle (NA-202C Olympus) with on-site cytopathological support. The EBUS-TBNA result was compared with a reference standard of pathological tissue diagnosis or a composite of > or =6 months of clinical follow-up with radiographic imaging. RESULTS: Of 236 patients who underwent EBUS-TBNA, 25 were eligible for inclusion. Indications for EBUS-TBNA were suspected mediastinal recurrence of lymphoma (n = 13) and mediastinal lymphadenopathy of unknown cause (n = 12). Adequate lymph node sampling was accomplished in 24/25 patients (96%); there were no complications. EBUS-TBNA identified lymphoma in 10 patients and benign disease in 14 patients. There was one false negative EBUS-TBNA for lymphoma (lymphoma prevalence 11/25 (44%)). Follow-up over a median of 10.5 months (range 1-19) confirmed stable or regressive lymphadenopathy in all 14 patients without a lymphoma diagnosis, consistent with a benign diagnosis. Overall, EBUS-TBNA had a sensitivity of 90.9%, specificity of 100%, positive predictive value of 100% and negative predictive value of 92.9% for the diagnosis of lymphoma. CONCLUSIONS: EBUS-TBNA is an accurate, safe and useful tool in the investigation of suspected lymphoma with isolated mediastinal adenopathy, and may diminish the need for more invasive procedures such as mediastinoscopy.

Transjugular liver biopsy: assessment of safety and efficacy of the Quick-Core biopsy needle.

BACKGROUND: We assessed the safety and efficacy of transjugular liver biopsy with the Quick-Core biopsy needle. METHODS: Fifty consecutive patients with liver failure and contraindications to percutaneous liver biopsy were referred for transjugular liver biopsy. Eighteen (36%) patients had thrombocytopenia (platelet range = 44-92/microL, mean = 66/microL), 31 (62%) patients had elevated prothrombin times (international normalized ratio range = 1.3-3, mean = 1.6), and 19 (38%) patients had ascites. The Cook Quick-Core biopsy needle was used. RESULTS: Average procedure time was 30 min. Transjugular access to the hepatic veins was successful in 49 of 50 cases. A transfemoral approach was used in one patient. Tissue specimens were satisfactory for histologic diagnosis in all cases. Established cirrhosis was present in 37 (74%) patients. The mean number of cores was 2.2 (range = 1-3). The mean number of portal triads per core was 10.4 (range = 6-20). There were no procedure-related complications. CONCLUSION: Transjugular liver biopsy with the Quick-Core biopsy needle is safe and effective in patients in whom the percutaneous route is contraindicated by coagulopathy or ascites.

Osteosarcoma arising in a femur with melorheostosis and osteopathia striata.

Osteopathia striata is an asymptomatic autosomal dominant or sporadically inherited disorder that causes dense striations at sites of endochondral bone formation, with a predilection for the metaphyses of long bones. Melorheostosis is a mixed sclerosing dysplasia with disturbance of both endochondral and intramembranous ossification, in which disordered intramembranous ossification dominates. It presents typical radiological changes of cortical hyperostosis distributed along a sclerotome with variable associated cutaneous and clinical features. Overlap syndromes including one or more of these diseases are described. We report a 44-year-old man with both melorheostosis and osteopathia striata who presented with pain secondary to superimposed osteosarcoma. In reporting this case we discuss the relationship between sclerosing dysplasia and either coexisting or complicating sarcoma.

Clinical results of CT colonoscopy.

With increasing emphasis among the medical community on the early diagnosis and staging of colorectal cancer, interest has grown in CT colonography as a developing technique to challenge existing methods such as the barium enema and conventional colonoscopy. First introduced in 1994, CT colonography has experienced dramatic improvements in both hardware and software capabilities, resulting in shorter scanning times, greater user-friendliness and promising performance statistics. The recent development in multi-slice CT scanners has meant the ability to scan patients in a single breath hold, while innovations in image reconstruction and manipulation have optimised and yet greatly simplified study interpretation. Recent imaging protocols that use IV contrast to stage known or suspected colorectal cancer have been described. Current interest has focused on improving patient acceptance of the technique through the development of faecal tagging agents to avoid full bowel catharsis. This review summarises the development of CT colonography to date, evaluates its applications and performance in the detection and screening of colorectal polyps and looks at future directions of this exciting technique.

Trends in CT colonography.

CT colonography (virtual colonoscopy) is a safe, noninvasive method of examining the large bowel. Since its first description in 1994, the technique has undergone rapid development, stimulating considerable interest in its potential as both a diagnostic and screening tool. Diagnostic performance statistics have been encouraging, with predictive values rivaling those of barium enema and approaching those of endoscopic colonoscopy. Improvements are underway in methods of bowel preparation, scanning procedure, and image display. Increasing experience with the technique is reflected in better understanding and characterization of both two-dimensional and three-dimensional findings, resulting in improved study performance and interpretation. This review attempts to chart the development of CT colonography, with an emphasis on published results and current research interests. We propose potential directions for future study and means toward effective implementation of CT colonography in clinical practice.