Predicting non-small-volume central lymph node metastases (>5 or ≥2 mm) preoperatively in cN0 papillary thyroid microcarcinoma without extrathyroidal extension.

The ability to identify patients with aggressive papillary thyroid microcarcinoma (PTMC) from the low-risk patients is critical to planning proper management of PTMC. Lymph node metastases showed association with recurrence and low survival rate, especially in patients with >5 or ≥2 mm metastatic lymph nodes. Therefore, this study aimed to investigate the preoperatively predictive factors of non-small-volume (metastatic lymph nodes >5 or ≥2 mm in size) central lymph node metastases (NSVCLNM) in PTMC patients. A total of 420 patients with clinically node-negative (cN0) PTMC without extrathyroidal extension underwent thyroidectomy plus central neck dissection (CND) between January 2013 and December 2015, were retrospectively analyzed. Of the 420 patients, 33 (7.9%) had NSVCLNM. The 5-year recurrence-free survival was significantly less in cN0 PTMC patients with NSVCLNM, when compared with patients without NSVCLNM (80.8% vs 100%, P < .001). Multivariate logistic regression revealed age ≤36 years (P < .001), male sex (P = .002), ultrasonic tumor sizes of >0.65 cm (P < .001), and ultrasonic multifocality (P = .039) were independent predictive factors of NSVCLNM. A prediction equation (Y = 1.714 × age + 1.361 × sex + 1.639 × tumor size + 0.842 × multifocality -5.196) was developed, with a sensitivity (69.7%) and a specificity (84.0%), respectively, at an optimal cutoff point of -2.418. In conclusion, if the predictive value was >-2.418 according to the equation, immediate surgery including CND rather than active surveillance might be considered for cN0 PTMC patients.

Anatomical localization of normal parathyroid glands before thyroidectomy through ultrasonography reduces postoperative hypoparathyroidism.

Postoperative hypoparathyroidism due to dysfunction of the parathyroid gland is the most common complication after thyroidectomy. Our objective was to introduce the method of anatomical localization of normal parathyroid glands before thyroidectomy through ultrasonography and to evaluate its efficiency. The study group included 52 patients subjected to anatomical localization of the parathyroid gland prethyroidectomy through ultrasonography. The control group included 52 sex- and age-matched patients without parathyroid gland localization. The proportion of parathyroid glands preserved in situ and postoperative hypoparathyroidism rates in the 2 groups were compared. The rates of normal parathyroid glands identified according to ultrasonography for left superior, left inferior, right superior, and right inferior glands were 78.8%, 90.4%, 57.7%, and 82.7%, respectively. The rate of parathyroid gland excised inadvertently was significantly decreased (P = .038) in the study group as compared with the control group. The rates of parathyroid gland preservation in situ were significantly improved in the left superior (P = .001), left inferior (P = .002), and right inferior glands (P = .005). Furthermore, the incidence of transient hypoparathyroidism decreased significantly (P = .028). Our study indicated that normal parathyroid glands were identified by ultrasonography, and the anatomical localization improved the rate of parathyroid gland preservation in situ and decreased the incidence of transient hypoparathyroidism.

[Sonographic features and diagnostic analysis of breast granulomatous diseases: a report of 32 cases].

OBJECTIVE: To evaluate the sonographic features of different pathological types of breast granulomatous diseases and analyze the feasibility of ultrasonic diagnosis. METHODS: A total of 32 patients with different pathological types of breast granulomatous diseases were recruited. Their clinical and sonographic findings were retrospectively reviewed. There were granulomatous mastitis (n = 12), breast xanthogranuloma (n = 5), lipogranuloma (n = 2), foreign body granuloma (n = 1) and nonspecific granulation hyperplasia (n = 12). RESULTS: Based on major sonographic appearances, they were divided into 4 patterns of tubular, mass, diffuse and cystic mass. In 12 patients with granulomatous mastitis and 12 patients with nonspecific granulation hyperplasia, the major sonographic appearance was of tubular pattern (n = 6, 5), followed by mass pattern (n = 4, 5) and diffuse pattern (n = 2, 2). Five patients with breast xanthogranuloma and 1 patient with foreign body granuloma all showed mass pattern. In 2 patients with lipogranuloma, one was of mass pattern and another cystic pattern. In patients with granulomatous mastitis and patients with nonspecific granulation hyperplasia, it showed a high diagnostic reliability of ultrasound. The ratio of inflammatory lesion as the first sonographic diagnosis was 10/12 and 8/12 respectively and ultrasonic BI-RADS 4b or above both only 1/12. However, the ratio of sonographic imaging in patients with xanthogranuloma and Lipogranuloma mimic breast cancer, in which ultrasonic score as breast imaging-reporting and data system (BI-RADS) 4b or above was 4/5 and 1/1 respectively. CONCLUSIONS: Ultrasound is valuable in evaluating the lesions in patients with granulomatous mastitis and nonspecific granulation hyperplasia. However a definite diagnosis is still dependent on histopathology.

[Application of fetal echocardiography in detection of fetal arrhythmia and its clinical significance].

OBJECTIVE: To investigate application of fetal echocardiography in diagnosis of fetal arrhythmia and its clinical significance. METHODS: Fetal echocardiography was performed on 725 fetuses for evaluation of fetal heart structures and arrhythmias. Two-dimensional, M-mode, Color M-mode and pulsed Doppler echocardiography were used. RESULTS: Ninety fetuses were documented with fetal arrhythmia, the commonest fetal arrhythmia encountered in 72 cases extrasystole was (65 atrial extrasystoles, 7 ventricular extrasystoles), followed by bradycardia in 9 cases, tachycardia in 6 cases, 2:1 atrioventricular block in 2 cases, atrial flutter in 1 case. There were 4 fetuses with arrhythmias and structural heart diseases: 2 fetuses were found died in uterus within two-week follow-up (1 with single ventricle and pulmonary stenosis, 1 with cardiac rhabdomyoma, fetal echocardiographic findings were confirmed at autopsy), another 2 cases (1 with mitral atresia and 1 with atrioventricular canal defect, autopsy confirmed the fetal echocardiographic diagnoses) received termination of pregnancy later. One 38-week fetus with atrial flutter underwent cesarean section, neonatal ECG confirmed the arrhythmia, and Cedilanid D induced successful conversion. All the other 85 fetuses were with intermittent arrhythmia, normal heart structures, and had no fetal hydrops. After receiving routine treatment, all of them had term deliveries and follow-up monitoring showed normal neonatal heart rhythms (auscultation). CONCLUSIONS: Fetal echocardiography is the main diagnostic tool for prenatal evaluation of fetal arrhythmias. The outcomes of the vast majority of fetal arrhythmias are benign, especially for fetuses with extrasystoles. Their arrhythmias are always well tolerated and disappear during the perinatal period. Fetuses with intermittent arrhythmias without structural heart malformations, fetal hydrops or heart failure, can be followed up with routine prenatal care without the need for special intervention.

Comparison study of harmonic imaging (HI) and fundamental imaging (FI) in fetal echocardiography.

OBJECTIVES: To directly compare the quality of harmonic imaging (HI) and fundamental imaging (FI) in fetal echocardiography and to determine any differences in image quality between the two modalities. METHODS: Fetal echocardiograms were performed with the use of FI and HI in 58 fetuses, image quality and visualization of left and right atria, left and right ventricles, mitral and tricuspid valves, aortic and pulmonary valves, left and right ventricular outflow tracts were evaluated and compared between FI and HI. RESULTS: Mean HI scores were higher than mean FI scores (2.73 +/- 0.43 vs 2.16 +/- 0.69, P < 0.001) for all the cardiovascular structures evaluated. Compared with FI, HI improved the image quality and visualization of fetal cardiac structures in subjects with both good (2.73 +/- 0.43 vs 2.88 +/- 0.32, P < 0.001) and suboptimal (1. 65 +/- 0.41 vs 2.58 +/- 0.47, P < 0.001) echocardiographic windows. The interobserver correlation coefficient for the grading scores was 0.74 (P < 0.001). CONCLUSIONS: harmonic imaging enhances and improves the image quality of fetal echocardiography; and has important potential role in cardiac imaging in the fetus.