Accelerating acquisition of readout-segmented echo planar imaging (rs-EPI) with a simultaneous multislice (SMS) technique for diffusion-weighted (DW) breast MRI: Evaluation of image quality factors.

PURPOSE: This study aims to compare the image quality, apparent diffusion coefficient (ADC), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) values, and scan time between readout-segmented echo planar imaging (rs-EPI) and simultaneous multislice (SMS) rs-EPI sequences. METHODS: A total of 80 consecutive women who underwent breast diffusion-weighted imaging (DWI) were included, and two rs-EPI DWI sequences with and without SMS were acquired and compared. Qualitative analysis involved three radiologists independently scoring image quality and radiologist preference. For quantitative comparison, the radiologists independently measured the ADC values in patients, while SNR, CNR, and ADC values were measured on a phantom. RESULTS: The acquisition time was 5:47 min for rs-EPI and 3:20 min for SMS rs-EPI. In terms of image quality, scores were similar between rs-EPI and SMS rs-EPI sequences in the pooled data set, with the exception of skin-line distinction (p = 0.001) and background noise (p < 0.001). All radiologists considered SMS rs-EPI as equal or superior to rs-EPI in more than 70 % of cases. SMS rs-EPI demonstrated significantly higher ADC values than rs-EPI by all radiologists (p ≤ 0.002). For the phantom measurement, ADC (SMS: 1.26 ± 0.68 and RS: 1.26 ± 0.68, p = 0.198), SNR (SMS: 540.6 ± 342.1 and RS: 558.8 ± 523.2, p = 0.927), and CNR (SMS: 235.5 ± 38.9 and RS: 252.8 ± 108.0, p = 0.784) values did not significantly differ between the two sequences. CONCLUSION: SMS rs-EPI exhibited comparable image quality and similar ADC, SNR, and CNR values to rs-EPI while reducing the scan time by 42%.

Morphometry and Molecular Identification of Haemonchus Cobb, 1898 (Trichostrongylidae: Nematoda) Isolates from Small Ruminants in Tanzania Based on Mitochondrial cox 1 and rRNA-ITS genes.

The genus Haemonchus is the major abomasal parasite of ruminants responsible for substantial economic losses in tropical and temperate regions. This study was conducted to clarify the morphometry and molecular characterisation of Haemonchus species isolated from sheep in Babati district, Tanzania. A total of 486 trichostrongylid nematodes were recovered from five sheep. Of the total worms, 106 nematodes were distinguished by 37 males and 69 females. The asymmetrical length of dorsal ray and the distance of bulb at the apex of spicules were used for identification of males. In females, the linguiform vulvar flap was the most predominant with 33 out of 69 (48%) compared with knobbed morph type which was 25/69 (36%) and smooth morph type with 11/69 (16%). Partial cox1 sequence fragments of Haemonchus contortus isolates showed 98.8%, 99.3%, 99.7%, 99.5%, 99.3%, and 98.4% in male, smooth, knobbed, linguiform A, linguiform B, and linguiform C, respectively; with the average nucleotide divergence ranged from 1.03 to 2.35%. The amplified fragments of ITS-2 genes in knobbed, linguiform A, and smooth morphotypes revealed 99.4%, 98.5%, and 98.3%, respectively. Phylogenetic analysis was evaluated by employing Bayesian inference and maximum-likelihood, and the tree was distinctly separated into three clusters focusing on H. contortus in cluster I within the family Haemonchidae. Genetic drifting, mutation, and modification of the morphological features of the Haemonchus species described to have an impact on the development of drug resistance. Species identification is necessary to understand which species infect animal host. We recommend more studies on the parasites intensity and the strategies for controlling Haemonchus species in Tanzania.

Orientation of the ultrasound probe to identify the taller-than-wide sign of thyroid malignancy: a registry-based study with the Thyroid Imaging Network of Korea.

PURPOSE: Although the taller-than-wide (TTW) sign has been regarded as one of the most specific ultrasound (US) features of thyroid malignancy, uncertainty still exists regarding the US probe's orientation when evaluating it. This study investigated which US plane would be optimal to identify the TTW sign based on malignancy risk stratification using a registry-based imaging dataset. METHODS: A previous study by 17 academic radiologists retrospectively analyzed the US images of 5,601 thyroid nodules (≥1 cm, 1,089 malignant and 4,512 benign) collected in the webbased registry of Thyroid Imaging Network of Korea through the collaboration of 26 centers. The present study assessed the diagnostic performance of the TTW sign itself and fine needle aspiration (FNA) indications via a comparison of four international guidelines, depending on the orientation of the US probe (criterion 1, transverse plane; criterion 2, either transverse or longitudinal plane). RESULTS: Overall, the TTW sign was more frequent in malignant than in benign thyroid nodules (25.3% vs. 4.6%). However, the statistical differences between criteria 1 and 2 were negligible for sensitivity, specificity, and area under the curve (AUC) based on the size effect (all P<0.05, Cohen's d=0.19, 0.10, and 0.07, respectively). Moreover, the sensitivity, specificity, and AUC of the four FNA guidelines were similar between criteria 1 and 2 (all P>0.05, respectively). CONCLUSION: A longitudinal US probe orientation provided little additional diagnostic value over the transverse orientation in detecting the TTW sign of thyroid nodules.

Long-range charge carrier mobility in metal halide perovskite thin-films and single crystals via transient photo-conductivity.

Charge carrier mobility is a fundamental property of semiconductor materials that governs many electronic device characteristics. For metal halide perovskites, a wide range of charge carrier mobilities have been reported using different techniques. Mobilities are often estimated via transient methods assuming an initial charge carrier population after pulsed photoexcitation and measurement of photoconductivity via non-contact or contact techniques. For nanosecond to millisecond transient methods, early-time recombination and exciton-to-free-carrier ratio hinder accurate determination of free-carrier population after photoexcitation. By considering both effects, we estimate long-range charge carrier mobilities over a wide range of photoexcitation densities via transient photoconductivity measurements. We determine long-range mobilities for FA0.83Cs0.17Pb(I0.9Br0.1)3, (FA0.83MA0.17)0.95Cs0.05Pb(I0.9Br0.1)3 and CH3NH3PbI3-xClx polycrystalline films in the range of 0.3 to 6.7 cm2 V-1 s-1. We demonstrate how our data-processing technique can also reveal more precise mobility estimates from non-contact time-resolved microwave conductivity measurements. Importantly, our results indicate that the processing of polycrystalline films significantly affects their long-range mobility.

Ultrasonographic and cytologic assessments of follicular neoplasms of the thyroid: Predictive features differentiating follicular carcinoma from follicular adenoma.

BACKGROUND: The preoperative diagnosis of follicular neoplasm of the thyroid is challenging due to difficulties in the assessment of capsular invasion. This study aimed to identify ultrasonographic (US) and cytopathologic features that are characteristic of follicular adenoma and carcinoma to aid in their differential diagnosis. METHODS: A total of 98 surgically resected nodules diagnosed as follicular neoplasms between 2011 and 2012 were analyzed. US findings were reviewed according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS). Six cytologic features (high cellularity, abundant microfollicles, cell crowding/nuclear overlapping, isolated cells, homogeneous nuclei, abundant colloid) were reviewed quantitatively. The radiologic findings and quantification of cytologic features were correlated with final diagnoses. RESULTS: In total, 70 (71.4%) and 28 (28.6%) of the nodules were follicular adenomas and follicular carcinomas, respectively. US findings of a heterogeneous echogenicity, speculated/ill-defined margin, and presence of calcifications were significantly associated with follicular carcinoma (p<0.05). Calcifications had a predilection for pericapsular areas than for stromal areas in follicular carcinomas, whereas their location was more varied in follicular adenomas. No cytologic feature was significantly different between follicular adenomas and carcinomas. CONCLUSION: Distinct from follicular adenomas, follicular carcinomas are characterized by heterogeneous echogenicity, speculated/ill-defined margin, and presence of calcifications on US. Thus, US findings can be helpful to differentiate between these two follicular neoplasms.

Quantitative analysis of vascularity for thyroid nodules on ultrasound using superb microvascular imaging: Can nodular vascularity differentiate between malignant and benign thyroid nodules?

ABSTRACT: This study aimed to investigate the utility of adding superb microvascular imaging (SMI) to B-mode ultrasound (US) for distinguishing between benign and malignant thyroid nodules and evaluate the usefulness of SMI quantification of nodular vascularity for diagnosing thyroid cancer.The malignancy likelihood was scored for 3 datasets before versus after additional color Doppler imaging or SMI using 4-scale visual analysis (i.e., B-mode US alone, B-mode US + color Doppler image, and B-mode US + SMI). Further, the SMI pixel count was measured in the region of interest, including the whole nodule, on the longitudinal view. It was compared between benign and malignant nodules and analyzed according to the US patterns of thyroid nodules based on the Korean thyroid imaging reporting and data system. We calculated the area under the receiver operating characteristic curve values, sensitivities, and specificities.There was no significant difference in the area under the receiver operating characteristic curve values among B-mode, B-mode + color Doppler, and B-mode + SMI. However, the SMI pixel count was significantly higher in malignant thyroid nodules than in benign ones. The optimal cut-off value for the SMI pixel count for predicting malignant thyroid nodules obtained using a receiver operating characteristic curve was 17 (40.54% in sensitivity, 91.3% in specificity). Analysis based on the US pattern of thyroid nodules revealed significant differences in the nodules with low-to-intermediate suspicious US features between malignant and benign nodules.Quantification analysis of vascularity using SMI can differentiate malignant thyroid nodules from benign ones.

Histopathological correlation of punctate echogenic foci on ultrasonography in papillary thyroid carcinoma.

PURPOSE: To investigate the pathological entities of punctate echogenic foci (PEF) by correlating PEF with histopathological features of papillary thyroid carcinoma (PTC). METHODS: This study included 121 consecutive patients who had undergone thyroidectomy for PTC. The inclusion criterion was entire tumor resection with a 3-mm thickness for histopathological examination. We assessed the presence and number (<5 or ≥5) of PEF defined as punctate hyperechoic foci within the solid component of nodules. All surgical tumor specimens were retrospectively reviewed for the presence of microcalcifications, including the psammomatous calcification, coarse microcalcification, and micro-ossification, and inspissated colloid. RESULTS: PEF were detected in 71 (58.7%) PTCs. Psammomatous calcifications, coarse microcalcifications, and inspissated colloids were more frequently found in PTCs with PEF than in those without (74.6%, 42.3%, and 46.5%, respectively, p ≤ 0.024). Any type of microcalcification was found in 90.1% of PTCs with PEF. Psammomatous calcifications, coarse microcalcifications, and inspissated colloids were independently associated with PEF (p ≤ 0.012). Psammomatous calcifications were found in all PTCs with a high number (≥5) of PEF. CONCLUSION: Microcalcifications were found in most PTCs with PEF and psammomatous calcification was the main pathological entity of PEF in PTC. Our study validates reliability of PEF as a predictor of microcalcifications in PTC.

Comparative Antimicrobial Activity of Hp404 Peptide and Its Analogs against Acinetobacter baumannii.

An amphipathic α-helical peptide, Hp1404, was isolated from the venomous gland of the scorpion Heterometrus petersii. Hp1404 exhibits antimicrobial activity against methicillin-resistant Staphylococcus aureus but is cytotoxic. In this study, we designed antimicrobial peptides by substituting amino acids at the 14 C-terminal residues of Hp1404 to reduce toxicity and improve antibacterial activity. The analog peptides, which had an amphipathic α-helical structure, were active against gram-positive and gram-negative bacteria, particularly multidrug-resistant Acinetobacter baumannii, and showed lower cytotoxicity than Hp1404. N-phenyl-1-naphthylamine uptake and DisC3-5 assays demonstrated that the peptides kill bacteria by effectively permeating the outer and cytoplasmic membranes. Additionally, the analog peptides inhibited biofilm formation largely than Hp1404 at low concentrations. These results suggest that the analog peptides of Hp1404 can be used as therapeutic agents against A. baumannii infection.

Comparison of the diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System for thyroid malignancy with three international guidelines.

PURPOSE: This study compared the diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System (K-TIRADS) for thyroid malignancy with three international guidelines. METHODS: From June to September 2015, 5,708 thyroid nodules (≥1.0 cm) in 5,081 consecutive patients who underwent thyroid ultrasound (US) at 26 institutions were evaluated. The US features of the thyroid nodules were retrospectively reviewed and classified according to all four guidelines. In the modified K-TIRADS, the biopsy size threshold was changed to 2.0 cm for K-TIRADS 3 and 1.0 or 1.5 cm for K-TIRADS 4 (K-TIRADS1.0cm and K-TIRADS1.5cm, respectively). We compared the diagnostic performance and unnecessary fine-needle aspiration biopsy (FNAB) rates for thyroid malignancy between the modified K-TIRADS and three international guidelines. RESULTS: Of the 5,708 thyroid nodules, 4,597 (80.5%) were benign and 1,111 (19.5%) were malignant. The overall sensitivity was highest for the modified K-TIRADS1.0cm (91.0%), followed by the European (EU)-TIRADS (84.6%), American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME) (80.5%), American College of Radiology (ACR)-TIRADS (76.1%), and modified K-TIRADS1.5cm (76.1%). For large nodules (>2.0 cm), the sensitivity increased to 98.0% in both the modified K-TIRADS1.0cm and K-TIRADS1.5cm. For small nodules (≤2.0 cm), the unnecessary FNAB rate was lowest with the modified K-TIRADS1.5cm (17.6%), followed by the ACR-TIRADS (18.6%), AACE/ACE/AME (19.3%), EU-TIRADS (28.1%), and modified K-TIRADS1.0cm (31.2%). CONCLUSION: The modified K-TIRADS1.5cm can reduce the unnecessary FNAB rate for small nodules (1.0-2.0 cm), while maintaining high sensitivity for detecting malignancies >2.0 cm.

Time-Resolved Changes in Dielectric Constant of Metal Halide Perovskites under Illumination.

Despite their impressive performance as a solar absorber, much remains unknown on the fundamental properties of metal halide perovskites (MHPs). Their polar nature in particular is an intense area of study, and the relative permittivity (εr) is a parameter widely used to quantify polarization over a range of different time scales. In this report, we have exploited frequency-dependent time-resolved microwave conductivity (TRMC) to study how εr values of a range of MHPs change as a function of time, upon optical illumination. Further characterization of charge carriers and polarizability are conducted by femtosecond transient absorption and stimulated Raman spectroscopy. We find that changes in εr are roughly proportional to photogenerated carrier density but decay with a shorter time constant than conductance, suggesting that the presence of charge carriers alone does not determine polarization.

Publisher Correction: Deciphering photocarrier dynamics for tuneable high-performance perovskite-organic semiconductor heterojunction phototransistors.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Impact of Moisture on Mobility in Methylammonium Lead Iodide and Formamidinium Lead Iodide.

The greatest remaining barrier to the commercialization of perovskite solar cells is their instability to ambient environmental conditions. While most studies of the electronic stability of perovskites employ finished devices, we here exploit the contactless characterization technique time-resolved microwave conductivity to probe electronic properties in the absence of encapsulation and interface effects. By tracking the mobility of charge carriers in two archetypal perovskite compounds, methylammonium lead iodide (MAPbI3) and formamidinium lead iodide (FAPbI3) under various conditions, we are able to make decisive statements about the role of water in the electronic performance of perovskites. Overall, we observe a strong negative correlation between hydration and mobility in MAPbI3, but not in FAPbI3. We anticipate that the data presented herein will serve as a valuable resource in future stability studies in perovskite solar cells and, ultimately, lead to more stable devices.

Diagnostic Efficacy and Safety of Core Needle Biopsy as a First-Line Diagnostic Method for Thyroid Nodules: A Prospective Cohort Study.

Background: The diagnostic role of ultrasonography (US)-guided core needle biopsy (CNB) as a first-line diagnostic method for thyroid nodules remains controversial. This study was performed to determine the diagnostic efficacy and safety of CNB as a first-line diagnostic method for thyroid nodules. Methods: From February 2016 to January 2018, CNB was prospectively performed by an experienced radiologist in all consecutive patients with thyroid nodules indicated for fine-needle aspiration (FNA). Three patients refused this protocol. Finally, 212 consecutive patients with 248 thyroid nodules were enrolled in this prospective study. Combined CNB/FNA was selectively performed in 43 patients. The diagnostic efficacy of CNB was evaluated by the rate of inconclusive results (nondiagnostic or indeterminate results), and its feasibility was estimated by calculating the successful biopsy rate and by measuring the procedure time from the time of the initial skin puncture to the last withdrawal of the biopsy needle from the skin. The safety of the procedure was evaluated by the major and minor complication rates. A US evaluation was performed before and after manual self-compression to assess for hemorrhage at the biopsy site, and delayed complications were assessed 5-7 days after the biopsy. Any hemorrhage that did not require hospitalization was classified as a minor complication. Results: CNB was performed once (n = 125, 50.4%), twice (n = 122, 49.2%), or three times (n = 1, 0.4%) per nodule. The diagnostic results of CNB were as follows: nondiagnostic (0.8%), benign (63.3%), indeterminate (10.1%), follicular neoplasm (3.2%), suspected malignancy (2.4%), and malignancy (20.1%); the rate of inconclusive results was 10.9%. The successful biopsy rate of CNB was 100%, and the median procedure time was 102 seconds (interquartile range 51-181 seconds). There were no major or delayed complications. There were 6 cases (2.8%) of minor complications, which included 2 cases (0.9%) with symptomatic hematomas and 4 cases (1.9%) with asymptomatic small hematomas. Conclusion: The findings confirm that CNB is effective in reducing the rate of inconclusive results and it is safe. CNB may be used as an alternative first-line diagnostic method for thyroid nodules by an experienced operator.

Deciphering photocarrier dynamics for tuneable high-performance perovskite-organic semiconductor heterojunction phototransistors.

Looking beyond energy harvesting, metal-halide perovskites offer great opportunities to revolutionise large-area photodetection technologies due to their high absorption coefficients, long diffusion lengths, low trap densities and simple processability. However, successful extraction of photocarriers from perovskites and their conversion to electrical signals remain challenging due to the interdependency of photogain and dark current density. Here we report hybrid hetero-phototransistors by integrating perovskites with organic semiconductor transistor channels to form either "straddling-gap" type-I or "staggered-gap" type-II heterojunctions. Our results show that gradual transforming from type-II to type-I heterojunctions leads to increasing and tuneable photoresponsivity with high photogain. Importantly, with a preferential edge-on molecular orientation, the type-I heterostructure results in efficient photocarrier cycling through the channel. Additionally, we propose the use of a photo-inverter circuitry to assess the phototransistors' functionality and amplification. Our study provides important insights into photocarrier dynamics and can help realise advanced device designs with "on-demand" optoelectronic properties.

Safety and Efficacy of Radiofrequency Ablation for Nonfunctioning Benign Thyroid Nodules in Children and Adolescents in 14 Patients over a 10-Year Period.

PURPOSE: To evaluate the efficacy and safety of radiofrequency (RF) ablation for nonfunctioning benign thyroid nodules in children and adolescents. MATERIALS AND METHODS: Fourteen pediatric patients (10 female, 4 male; mean age 15.7 ± 2.3 years, range 12-19 years) with nonfunctioning benign thyroid nodules (mean longest diameter 3.7 ± 1.1 cm, range 2.0-5.6 cm) treated with the use of RF ablation from 2005 to 2015 were evaluated. The inclusion criteria for RF ablation therapy were (i) age <20 years, (ii) benign cytological confirmation by ≥2 separate fine-needle aspiration or core needle biopsies, (iii) pressure symptoms or cosmetic problems caused by thyroid nodules, (iv) absence of any suspicious feature as determined with the use of ultrasound (US), (v) normal serum levels of thyroid hormone and thyrotropin, and (vi) follow-up of >6 months. RF ablation was performed with the use of an RF generator and an 18-gauge internally cooled electrode. RF ablation was performed under local anesthesia without conscious sedation or general anesthesia. Changes in nodules on follow-up US, changes in symptomatic and cosmetic scores, and complications arising during or after RF ablation were evaluated. RESULTS: Mean follow-up period was 36.9 ± 21.7 months (range 6-69 months). At last follow-up visits, mean longest nodule diameter and volume had decreased significantly (3.7 ± 1.1 cm vs 1.4 ± 0.9 cm and 14.6 ± 13.3 mL vs 1.7 ± 4.4 mL; P < 0.001). Both cosmetic and compressive symptoms significantly improved (3.8 ± 0.6 vs 1.4 ± 0.6 and 3.4 ± 1.0 vs 0.1 ± 0.4; P < 0.001). The mean number of ablation sessions was 2.1 ± 1.2 (range 1-5 sessions) and no major complication was encountered during or after RF ablation. CONCLUSIONS: RF ablation might be a safe and effective treatment modality for nonfunctioning benign thyroid nodules in children and adolescents.

Impact of Nodule Size on Malignancy Risk Differs according to the Ultrasonography Pattern of Thyroid Nodules.

Objective: To test whether the impact of thyroid-nodule size on the malignancy risk differs according to the ultrasonography (US) patterns of nodules. Materials and Methods: This study is a post hoc analysis using data from the Thyroid Imaging Reporting and Data System (TIRADS) multicenter retrospective study which included 2000 consecutive thyroid nodules (≥ 1 cm) with final diagnoses. A total of 2000 consecutive thyroid nodules from 1802 patients (1387 women and 613 men; mean age, 51.2 ± 12.2 years) were enrolled in this study. The malignancy risk of the nodules was assessed according to the nodule size and US patterns (Korean-TIRADS). Results: Overall, the malignancy risk did not increase as nodules enlarged. In high-suspicion nodules, the malignancy rate had no association with nodule size (p = 0.467), whereas in intermediate- or low-suspicion nodules there was a trend toward an increasing malignancy risk as the nodule size increased (p = 0.004 and 0.002, respectively). The malignancy rate of large nodules (≥ 3 cm) was higher than that of small nodules (< 3 cm) in intermediate-suspicion nodules (40.3% vs. 22.6%, respectively; p = 0.001) and low-suspicion nodules (11.3% vs. 7.0%, respectively; p = 0.035). There was a trend toward a decreasing risk and proportion of papillary carcinoma and an increasing risk and proportion of follicular carcinoma or other malignant tumors as nodule size increased (p < 0.001, respectively). Conclusion: The impact of nodule size on the malignancy risk differed according to the US pattern. A large nodule size (≥ 3 cm) showed a higher malignancy risk than smaller nodules in intermediate- and low-suspicion nodules.

Mechanisms driving the antibacterial and antibiofilm properties of Hp1404 and its analogue peptides against multidrug-resistant Pseudomonas aeruginosa.

Hp1404, identified from the venom of the scorpion Heterometrus petersii, displays antimicrobial activity with cytotoxicity. Several synthetic peptides were designed based on the parent peptide Hp1404 to reduce cytotoxicity and improve activity (deletion of glycine and phenylalanine, substitution with leucine and lysine). The analogue peptides generated comprised 12 amino acids and displayed amphipathic α-helical structures, with higher hydrophobic moments and net positive charge than those of the Hp1404. The analogues showed less hemolytic and toxic effects toward mammalian cells than the Hp1404, especially Hp1404-T1e, which exhibited particularly potent antibacterial and antibiofilm activities against multidrug-resistant Pseudomonas aeruginosa (MRPA) strains. The analogue peptide Hp1404-T1e was more stable against salt and trypsin than the Hp1404. Hp1404's mechanism of action involves binding to lipopolysaccharide (LPS), thereby killing bacteria through membrane disruption. Hp1404-T1e kills bacteria more rapidly than Hp1404 and not only seems to bind more strongly to LPS but may also be able to enter bacterial cells and interact with their DNA. Additionally, Hp1404-T1e can effectively kill bacteria in vivo. The results of this study indicate that Hp1404-T1e not only displays antimicrobial activity, but is also functional in physiological conditions, confirming its potential use as an effective therapeutic agent against MRPA.

Agreement between MRI and pathologic analyses for determination of tumor size and correlation with immunohistochemical factors of invasive breast carcinoma.

Background There may be discordance between tumor size determined by magnetic resonance imaging (MRI) and that observed during pathologic analyses. Purpose To evaluate MRI-pathology concordance of tumor size in patients with invasive breast carcinoma. Material and Methods Data from 307 invasive breast carcinomas were analyzed retrospectively. Preoperative breast MRI was reviewed for size, lesion type, morphology, and dynamic contrast-enhanced tumor kinetics. MRI tumor size was compared with tumor size measurements from the pathologic analysis. Concordance was defined as a difference in diameter of ≤ 0.5 cm. MRI-pathology concordance was compared according to clinical and histopathologic features. Results The mean tumor size on MRI was 2.48 ± 1.41 cm. Tumor measurements determined by MRI were not significantly different from those recorded in the pathologic reports (2.56 ± 1.61 cm, P = 0.199). MRI-pathology concordance was found in 229/307 (74.6%) cases; the size was overestimated in 36 (11.7%) tumors and underestimated in 42 (13.7%). On univariate analysis, MRI-pathology discordance was associated with larger tumor size ( P < 0.001), estrogen receptor (ER) negativity ( P = 0.006), and lymphovascular invasion ( P = 0.003). Human epidermal growth factor receptor 2 positive molecular subtype showed worse correlation between the tumor size measured by MRI and pathology compared with luminal A and luminal B subtypes ( P = 0.008 and 0.007). On multivariate analysis, tumor size and ER status significantly influenced MRI-pathology concordance ( P < 0.05). Conclusion ER negativity and larger tumor size were strongly associated with MRI-pathology discordance in invasive breast carcinomas. Awareness of these factors might improve surgical planning.

Role of core needle biopsy as a first-line diagnostic tool for thyroid nodules: a retrospective cohort study.

PURPOSE: The purpose of this study was to evaluate the diagnostic efficacy of fine-needle aspiration (FNA), core needle biopsy (CNB), and combined FNA/CNB for the first-line diagnosis of thyroid nodules. METHODS: A total of 782 consecutive nodules that underwent simultaneous FNA and CNB were analyzed in this study. We compared the rate of inconclusive results and the diagnostic values for malignancy among FNA, CNB, and combined FNA/CNB. RESULTS: CNB showed a lower rate (10.2%) of inconclusive results than FNA (23.7%) (P<0.001). Combined FNA/CNB showed a lower rate (6.5%) of inconclusive results than FNA (all nodules, P<0.001; macronodules, P<0.001; and micronodules, P<0.001, respectively) or CNB (all nodules, P<0.001; macronodules, P<0.001; and micronodules, P=0.003, respectively). Combined FNA/ CNB and CNB showed significantly higher sensitivity, accuracy, and diagnostic performance for malignancy as defined by criterion 1 (Bethesda category VI) or criterion 2 (Bethesda categories IV/V/VI) than FNA (P<0.001). However, there was no significant difference in the sensitivity, accuracy, or diagnostic performance between combined FNA/CNB and CNB (with criterion 1, P=0.063, P=0.063, and P=0.412, respectively; with criterion 2, P=0.500, P=0.500, and P=0.348, respectively). CONCLUSION: CNB was found to be more effective than FNA for the diagnosis of thyroid nodules, and its sensitivity and diagnostic performance for malignancy were similar to those of combined FNA/CNB. CNB has the potential to be an effective alternative first-line diagnostic tool for thyroid nodules when performed by an experienced operator.

Cytology-Ultrasonography Risk-Stratification Scoring System Based on Fine-Needle Aspiration Cytology and the Korean-Thyroid Imaging Reporting and Data System.

BACKGROUND: The malignancy risk of a cytology diagnosis may depend on the ultrasonography (US) patterns of thyroid nodules, and management should be determined by the combined malignancy risk of fine-needle aspiration (FNA) cytology and US patterns. This study was performed to develop a clinically applicable cytology-ultrasonography (CU) scoring system for malignancy risk stratification based on FNA cytology and US patterns, according to the Korean-Thyroid Imaging Reporting and Data System (K-TIRADS). METHODS: This retrospective Institutional Review Board-approved study included 1651 thyroid nodules (≥1 cm) with final diagnoses. The malignancy risk was assessed of the combined results of FNA cytology and the K-TIRADS for the development of the CU system. The interaction between FNA cytology and US pattern (K-TIRADS) in the malignancy risk of nodules was investigated by using a binominal test. RESULTS: The malignancy risk of nodules could be stratified into four CU scores (very low risk, <3%; low risk, ≥3%, <30%; high risk, ≥30%, <90%; very high risk, ≥90%). In nodules with non-diagnostic, benign, and atypia of undetermined significance/follicular lesion of undetermined significance cytology results, low-suspicion US pattern (K-TIRADS 3) significantly decreased the malignancy risk of nodules (p = 0.003, 0.013, and 0.027, respectively), and a high-suspicion US pattern (K-TIRADS 5) significantly increased the malignancy risk of nodules (p ≤ 0.001). A Bethesda 1 or 4 cytology result did not significantly change the malignancy risk of any K-TIRADS (p ≥ 0.518 and p ≥ 0.137, respectively). A Bethesda 2 cytology result decreased and a Bethesda 5 or 6 cytology result increased the malignancy risk of K-TIRADS 3, 4, and 5 (p ≤ 0.001). A Bethesda 3 cytology result increased the malignancy risk of K-TIRADS 3 and 4 (p < 0.001 and p = 0.024, respectively). CONCLUSION: The malignancy risk of thyroid nodules can be stratified by the CU risk-stratification system, based on FNA cytology and the K-TIRADS. The proposed CU scoring system may be helpful in the management of thyroid nodules after FNA.