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Cesaro E, Saliba T, Simoni P. The use of shear-wave elastography for the assessment of muscle spasticity in patients with cerebral palsy, a systematic review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 38708803 DOI: 10.1002/jcu.23706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/25/2024] [Accepted: 03/31/2024] [Indexed: 05/07/2024]
Abstract
We explore the use of shear wave elastography (SWE) for assessing muscle stiffness and treatment response in cerebral palsy (CP) children by way of a systematic review. SWE offers real-time muscle stiffness measurements, showing significant differences between CP patients and controls. Studies suggest that SWE can be used to follow muscle stiffness post-botulinum toxin treatment, correlating with clinical improvement. However, methodological variations and small sample sizes prevent comparison between different studies. Standardized protocols could enhance SWE's clinical utility. In conclusion, SWE holds promise for CP management, though standardized methodologies and larger studies are needed to validate its efficacy and integration into clinical practice.
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Affiliation(s)
- Edoardo Cesaro
- Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Thomas Saliba
- Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Paolo Simoni
- Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
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2
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Fan J, Tao L, Zhan W, Li W, Kuang L, Zhao Y, Zhou W. Diagnostic value of qualitative and quantitative parameters of contrast-enhanced ultrasound for differentiating differentiated thyroid carcinomas from benign nodules. Front Endocrinol (Lausanne) 2024; 14:1240615. [PMID: 38250738 PMCID: PMC10797774 DOI: 10.3389/fendo.2023.1240615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/30/2023] [Indexed: 01/23/2024] Open
Abstract
Objective To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) of qualitative and quantitative parameters for differentiating differentiated thyroid cancers from benign nodules. Method A total of 290 thyroid nodules that were pathologically confirmed were enrolled in this study. The univariate analysis was performed for the clinical characteristics and CEUS qualitative and quantitative parameters of the inside and peripheral zone of nodules, including age, gender, nodule size, intensity of enhancement, homogeneity, wash-in and wash-out patterns, margin after CEUS, ring enhancement, peak intensity, sharpness, time to peak(TP), and area under the curve(AUC), and the meaningful indicators in the single-factor analysis were further included in multivariate logistic regression analysis. Results Multivariate analysis showed that there were significant differences in age (p=0.031), nodule size (p<0.001), heterogeneous enhancement (p<0.001), hypo-enhancement (p=0.001), unclear margin after CEUS(p=0.007), inside peak (p<0.001), and outside sharpness(p<0.001) between benign and malignant nodules. However, there were no significant differences in gender, ring enhancement, wash-in, wash-out, outside TP, outside AUC between benign and malignant thyroid nodules (P>0.05, for all). Conclusion CEUS might be useful in the differential diagnosis of differentiated thyroid cancers and benign nodules, which could provide a certain basis for clinical treatment.
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Affiliation(s)
- Jinfang Fan
- Department of Ultrasound, RuiJin Hospital, LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lingling Tao
- Department of Ultrasound, RuiJin Hospital, LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weiwei Li
- Department of Ultrasound, RuiJin Hospital, LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lijun Kuang
- Department of Ultrasound, RuiJin Hospital, LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yingyan Zhao
- Department of Ultrasound, RuiJin Hospital, LuWan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wei Zhou
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Bora Makal G, Aslan A. The Diagnostic Value of the American College of Radiology Thyroid Imaging Reporting and Data System Classification and Shear-Wave Elastography for the Differentiation of Thyroid Nodules. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1227-1234. [PMID: 33589354 DOI: 10.1016/j.ultrasmedbio.2021.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
This study aimed to determine the diagnostic accuracy of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) classification and shear-wave elastography (SWE) for the diagnosis of benign and malignant thyroid nodules. This retrospective study enrolled 141 patients (18-84 y of age) undergoing thyroidectomy between January 2015 and August 2020. All statistical analysis was based on pathologic results of patients. The cut-off value was found as category 4 for ACR TI-RADS classification and 5 m/s for shear-wave velocity (Vs) by the receiver operator characteristic curve analysis (area under the curve [AUC] = 0.684, p = 0.020 and AUC = 0.715, p = 0.005, respectively). SWE has higher diagnostic accuracy than the ACR TI-RADS classification system and can improve thyroid nodule discrimination in all sizes of the nodules. Also, the diagnostic performance decreases when the nodule diameter increases.
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Affiliation(s)
- Gül Bora Makal
- Yuksek Ihtisas University, Faculty of Medicine, Department of General Surgery, Ankara, Turkey.
| | - Aydın Aslan
- Yuksek Ihtisas University, Faculty of Medicine, Department of Radiology, Ankara, Turkey
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Huang S, Meng N, Pan M, Yu B, Liu J, Deng K, Hu M, Zhou H, Qin C. Diagnostic performances of the KWAK-TIRADS classification, elasticity score, and Bethesda System for Reporting Thyroid Cytopathology of TI-RADS category 4 thyroid nodules. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:1159-1168. [PMID: 32509090 PMCID: PMC7270670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To explore the value of the KWAK Thyroid Imaging Reporting and Data System (KWAK-TIRADS), elasticity score (ES), and Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in the diagnosis of suspicious thyroid nodules. MATERIALS AND METHODS The study included 392 cases of TI-RADS category 4 thyroid nodules that underwent thyroidectomy between January 2017 and October 2019. All patients underwent ultrasonography, ultrasound elastography, and fine-needle aspiration cytology (FNAC) before surgery. The nodules were classified into different categories based on the KWAK-TIRADS, ES, and BSRTC. Patients were divided into two groups based on postoperative pathological characteristics. The sensitivity (Se), specificity (Sp), and area under the receiver operating characteristic (ROC) curve were calculated. Student's t-test and Pearson chi-square test were used to compare diagnostic performance. RESULTS There were 159 patients in the benign group and 233 in the malignant group. The percentage of malignant nodules in KWAK-TIRADS categories 4a, 4b, and 4c were 44.3%, 64.8%, and 92.9%, respectively. The percentages of malignant nodules in ES 2, 3, 4, and 5 were 0%, 37.1%, 93.8%, and 100%, respectively. The percentage of malignant nodules in BSRTC levels I, II, III, IV, V and VI were 57.1%, 2.8%, 9.9%, 76.6%, 99.1%, and 100%, respectively. Among those methods, the BSRTC had better diagnostic efficiency than the KWAK-TIRADS and ES (Sp 81.1%, Se 93.6%, and AUC 0.918, P<0.01). Among the combined methods, KWAK-TIRADS+ES+BSRTC was more effective than KWAK-TIRADS+ES, KWAK-TIRADS+BSRTC, and ES+BSRTC (Sp 93.7%, Se 91.4%, and AUC 0.967, P<0.01). CONCLUSION The combination of KWAK-TIRADS, ES, and BSRTC can improve the accuracy of identifying category 4 thyroid nodules.
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Affiliation(s)
- Supeng Huang
- Department of Thyroid and Breast Surgery, The Affiliated Hospital of Hangzhou Normal UniversityHangzhou, China
| | - Ning Meng
- Department of Thyroid and Breast Surgery, The Affiliated Hospital of Hangzhou Normal UniversityHangzhou, China
| | - Mengting Pan
- Department of Ultrasound, The Affiliated Hospital of Hangzhou Normal UniversityHangzhou, China
| | - Bo Yu
- Department of Ultrasound, The Affiliated Hospital of Hangzhou Normal UniversityHangzhou, China
| | - Juan Liu
- Department of Pathology, The Affiliated Hospital of Hangzhou Normal UniversityHangzhou, China
| | - Kailin Deng
- Department of Pathology, The Affiliated Hospital of Hangzhou Normal UniversityHangzhou, China
| | - Mingrong Hu
- Department of Thyroid and Breast Surgery, The Affiliated Hospital of Hangzhou Normal UniversityHangzhou, China
| | - Hongwei Zhou
- Department of Thyroid and Breast Surgery, The Affiliated Hospital of Hangzhou Normal UniversityHangzhou, China
| | - Chao Qin
- Department of Thyroid and Breast Surgery, The Affiliated Hospital of Hangzhou Normal UniversityHangzhou, China
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Zhang J, Zhang X, Meng Y, Chen Y. Contrast-enhanced ultrasound for the differential diagnosis of thyroid nodules: An updated meta-analysis with comprehensive heterogeneity analysis. PLoS One 2020; 15:e0231775. [PMID: 32310968 PMCID: PMC7170259 DOI: 10.1371/journal.pone.0231775] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/31/2020] [Indexed: 12/16/2022] Open
Abstract
The diagnostic accuracy of contrast-enhanced ultrasound (CEUS) for distinguishing malignant thyroid nodules from benign thyroid nodules remains controversial. This meta-analysis was performed to evaluate the overall diagnostic value of CEUS for the characterization of thyroid nodules. Relevant studies were identified by searching PubMed, Embase and the Cochrane Library until August 1th 2019 to assess the overall diagnostic accuracy of CEUS. 37 eligible studies were included in the present meta-analysis. The pooled sensitivity, specificity, positive likelihood rate, negative likelihood rate and diagnostic odds ratio of CEUS were 0.87, 0.83, 5.38, 0.17 and 38.94, respectively, with the AUC of 0.9263. Subgroup analysis showed the heterogeneity was greatly reduced in small nodules group (≤ 1 cm) (I2 = 0.0%), while heterogeneity was still observed in the group of variable sizes group (I2 = 69.5%). However, meta-regression analysis revealed that only diagnostic criterion was the major source of heterogeneity (p = 0.0259). The risk of publication bias was negligible (p = 0.35). CEUS exhibited high accuracy for the identification of thyroid nodules and might provide additional perfusion information for the current US imaging reporting systems.
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Affiliation(s)
- Juanjuan Zhang
- Department of Ultrasound, Huaihe Hospital of Henan University, Henan, China
| | - Xiuting Zhang
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanna Meng
- Department of Ultrasound, Huaihe Hospital of Henan University, Henan, China
| | - Yinghong Chen
- Department of Ultrasound, Huaihe Hospital of Henan University, Henan, China
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Luo W, Zhang Y, Yuan J, Yang X, Pang L, Ding L, Zhang P, Liu L, Zhou X. Differential diagnosis of thyroid nodules through a combination of multiple ultrasonography techniques: A decision-tree model. Exp Ther Med 2020; 19:3675-3683. [PMID: 32346431 PMCID: PMC7185151 DOI: 10.3892/etm.2020.8621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 12/18/2019] [Indexed: 12/25/2022] Open
Abstract
The present study aimed to establish a decision tree (DT) model by combining the parameters of conventional gray-scale ultrasonography (US), elastosonography (ES), color Doppler US (CDUS) and contrast-enhanced US (CEUS) for the differential diagnosis of thyroid nodules. A single-center, retrospective study of 321 thyroid nodules was conducted. For 222 nodules, parameters of conventional gray-scale US, CDUS, ES and CEUS were evaluated using univariate logistic regression. Factors for with P<0.10 were further assessed using multivariate logistic regression. Significant factors (P<0.05) were used to establish a DT. The diagnostic accuracy of this DT was then evaluated by its application to the other 99 nodules. After univariate logistic analysis, factors including gender, number of nodules and diffuse disease were excluded, due to P>0.10. The results of multivariate logistic analysis determined that the following factors were required for the DT: Extent of blood flow determined by CDUS (P=0.002), area ratio determined by ES (P=0.033), peak phase patterns determined by CEUS (P<0.001) and micro-calcification determined by conventional gray-scale US (P=0.015). When compared to the pathological or cytological results of 99 nodules, the resulting DT had a sensitivity of 98.6%, specificity of 80.1%, positive predictive value of 93.5% and negative predictive value of 95.5%. These results suggested that a DT combining conventional gray-scale US, ES, CDUS and CEUS may be helpful for differentiating between types of thyroid nodules.
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Affiliation(s)
- Wen Luo
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Yunfei Zhang
- Research Institution of Bone Tumor, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, P.R. China
| | - Jiani Yuan
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Xiao Yang
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Lina Pang
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Lei Ding
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Peidi Zhang
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Liwen Liu
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Xiaodong Zhou
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
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A Prospective Intervention Trial on Tailored Radiofrequency Ablation of Uterine Myomas. ACTA ACUST UNITED AC 2020; 56:medicina56030122. [PMID: 32178351 PMCID: PMC7143923 DOI: 10.3390/medicina56030122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 01/20/2023]
Abstract
Background and Objective: Investigating the use of radiofrequency myolysis (RFM) for the treatment of fibroids through less invasive access by combining transvaginal ultrasound, hysteroscopy and laparoscopy. Materials and Methods: Fifty-four premenopausal women with 106 symptomatic uterine myomas. Patients underwent RFM in three ways: Vaginal Ultrasound-guided RFM (VU-RFM), Laparoscopic RFM (L-RFM) and Hysteroscopic-RFM (H-RFM). The mean patient age was 43 years; 52 symptomatic uterine myomas were subserosal, 44 intramural and 10 submucosal. The outcomes evaluated at 1 and 12 months after RFM were myoma size (volume-diameter), "Uterine Fibroid Symptom and Quality of Life (UFS-QOL)" questionnaire and a 10-point Visual Analogue Scale (VAS). The therapy was completed with a single ablation in all patients, no complication was registered. The average number of fibroids treated per intervention was two with the use of different accesses: 64/106 VU-RFMs (60.4%), 32/106 L-RFMs (30.2%) and 10/106 H-RFMs (9.4%). Results: Volume and diameter of fibroids were significantly reduced by, respectively, 51.3% and 20.1% in the first 30 days post-intervention (p < 0.001) up to a maximum of 73.5% and 37.1% after the second follow-up visit at 12 months (p < 0.001). A similar trend was shown in terms of disability with a progressive and significant reduction of symptoms (menorrhagia, dysmenorrhea, dyspareunia and pollakiuria) demonstrated by percentage variation of UFS-QOL Symptom Severity and VAS scores to -74.3% and -45.3% as well as -84.9% and -74.3%, respectively, at 1 and 12 months after RFM (p < 0.001). An overall improvement in the quality of life was also demonstrated by a significant increase in the UFS-QOL total score of +38.2% in the first 30 days post-intervention up to +44.9% after the second follow-up visit at 12 months (p < 0.001). The overall average surgery time of the RFM for each patient was 48 minutes, and the time to treat each fibroid by Vaginal Ultrasound-guided RFM (23 min) was found to be significantly less than those of laparoscopy or hysteroscopy (respectively 35 and 34 min) (p < 0.05). An electromagnetic virtual needle tracking system (VNTS) was successfully tested during the RFM procedures, and real-time contrast-enhanced ultrasound (CEUS) has proven to be effective in determining the duration of myolysis through the identification of eventual residual areas of enhancement within the fibroids. Conclusion: Radiofrequency can be considered a minimally invasive and safe procedure for the treatment of uterine myomas through the customization and possible combination of transvaginal, laparoscopic or hysteroscopic accesses. The standardization of the ablation technique with pre-intervention biopsy and new technologies such as VNTS and CEUS spares healthy uterine tissue and may change the future management of symptomatic uterine fibroids.
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Xi X, Gao L, Wu Q, Fang S, Xu J, Liu R, Yang X, Zhu S, Zhao R, Lai X, Zhang X, Zhang B, Jiang Y. Differentiation of Thyroid Nodules Difficult to Diagnose With Contrast-Enhanced Ultrasonography and Real-Time Elastography. Front Oncol 2020; 10:112. [PMID: 32175270 PMCID: PMC7056834 DOI: 10.3389/fonc.2020.00112] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/21/2020] [Indexed: 02/06/2023] Open
Abstract
According to the 2015 American Thyroid Association (ATA), referred risk stratification and thyroid nodules with intermediate- and low-suspicion patterns are difficult to diagnose. The objective of this study is to evaluate the diagnostic performance of contrast-enhanced ultrasonography (CEUS) and elastosonography (ES) for the differentiation of these thyroid nodules. From November 2011 to June 2016, a total of 163 thyroid nodules with intermediate- and low-suspicion patterns in 150 consecutive patients at our hospital were studied before surgery. With surgical pathology as the standard, the diagnostic value of CEUS and ES was analyzed. There were 29 (17.8%) malignant lesions and 134 (82.2%) benign lesions. The enhancement patterns of CEUS, the echogenicity, and the elastography were significantly different between malignant and benign lesions (P < 0.05). Heterogenous enhancement was more common in malignant nodules, and the sensitivity, specificity, positive predictive value, negative predictive value, and odds ratio were 51.7, 88.1, 48.4, 89.4, and 10.1%, respectively. The diagnostic accuracy of CEUS was better than the conventional ultrasound [area under the curve (AUC), 0.729 vs. 0.616, P = 0.021]. The enhancement patterns of CEUS were helpful in the differential diagnosis of thyroid nodules with intermediate and low suspicion.
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Affiliation(s)
- Xuehua Xi
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China
| | - Luying Gao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qiong Wu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Department of Ultrasound, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shibao Fang
- Department of Ultrasound, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingzhu Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruyu Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiao Yang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shenling Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruina Zhao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xingjian Lai
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoyan Zhang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Bo Zhang
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China.,Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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9
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Zhao H, Liu X, Lei B, Cheng P, Li J, Wu Y, Ma Z, Wei F, Su H. Diagnostic performance of thyroid imaging reporting and data system (TI-RADS) alone and in combination with contrast-enhanced ultrasonography for the characterization of thyroid nodules. Clin Hemorheol Microcirc 2019; 72:95-106. [PMID: 30320563 DOI: 10.3233/ch-180457] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Huaqun Zhao
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Xueling Liu
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Bei Lei
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Ping Cheng
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Jian Li
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Yedong Wu
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Zhen Ma
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Fang Wei
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Hongyue Su
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
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10
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Gay S, Schiaffino S, Santamorena G, Massa B, Ansaldo G, Turtulici G, Giusti M, At The Policlinico San Martino Genoa TT. Role of Strain Elastography and Shear-Wave Elastography in a Multiparametric Clinical Approach to Indeterminate Cytology Thyroid Nodules. Med Sci Monit 2018; 24:6273-6279. [PMID: 30194820 PMCID: PMC6140375 DOI: 10.12659/msm.909870] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background In thyroid nodules with indeterminate cytology, further clinical assessment aimed at ruling out malignancy is often mandatory. Ancillary imaging techniques and genetic mutation analysis can improve the risk stratification of such lesions, thereby facilitating the clinician’s decision to undertaken surgery or simple follow-up. The aim of this study was to evaluate the diagnostic performance of shear-wave elastography (SW), strain elastography (ELX 2/1), conventional ultrasound (US), contrast-enhanced ultrasound (CEUS), and BRAF V600E mutation analysis in the aforementioned lesions. Material/Methods We enrolled 81 patients, each with 1 indeterminate-cytology thyroid nodule. Thyroid function, thyroperoxidase antibodies and calcitonin were known in each case. SW, ELX 2/1, US, CEUS, and BRAF mutation analysis were subsequently performed, followed by a second FNAB. If the lesion was not downgraded to benign, surgery was recommended and histological reports collected. Results There were 28 nodules (34%) that proved benign on the second FNAB; 38 nodules (47%) underwent surgery (17 benign, 21 malignant), and 15 nodules (19%) refused surgery. The only techniques related to histological outcome were US (AUC=0,766), ELX 2/1 (AUC=0.701), and BRAF analysis (AUC=0.762). ELX 2/1 and SW reports were not correlated with each other (P=0.45). A scoring system taking into account all the variables considered performed better than the single variables alone (AUC=0.831). Conclusions In indeterminate-cytology thyroid lesions, repeating FNAB can avoid unnecessary surgery. ELX 2/1 seems to perform better than SW in distinguishing malignancy; these techniques could, however, be complementary in describing such lesions. A multiparametric approach appears the most accurate in predicting nodule histology.
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Affiliation(s)
- Stefano Gay
- Endocrine Unit, Policlinico San Martino, Genoa, Italy
| | | | | | - Barbara Massa
- Cyto-Histopathological Unit, Policlinico San Martino, Genova, Italy
| | | | - Giovanni Turtulici
- Interventional Radiology Unit, Ospedale Evangelico Internazionale, Genoa, Italy
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11
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Zhan J, Ding H. Application of contrast-enhanced ultrasound for evaluation of thyroid nodules. Ultrasonography 2018; 37:288-297. [PMID: 30213158 PMCID: PMC6177690 DOI: 10.14366/usg.18019] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/03/2018] [Indexed: 12/14/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is widely used to evaluate tumor microcirculation, which is useful in the differential diagnosis between benignity and malignancy. In the last 10 years, the applicability of CEUS to thyroid nodules has greatly improved due to technological refinements and the development of second-generation contrast agents. In this review, we summarize the applications of CEUS for thyroid nodules, focusing on the imaging findings of malignant and benign nodules in the existing literature and the use of those findings to predict malignancies, with an additional brief description of the utilization of CEUS for other thyroid-related diseases.
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Affiliation(s)
- Jia Zhan
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Hong Ding
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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12
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Giusti M, Massa B, Balestra M, Calamaro P, Gay S, Schiaffino S, Turtulici G, Zupo S, Monti E, Ansaldo G. Retrospective cytological evaluation of indeterminate thyroid nodules according to the British Thyroid Association 2014 classification and comparison of clinical evaluation and outcomes. J Zhejiang Univ Sci B 2018; 18:555-566. [PMID: 28681580 DOI: 10.1631/jzus.b1600075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The cytology of 130 indeterminate nodules (Thy 3) was retrospectively reviewed according to the British Thyroid Association 2014 classification. Nodules were divided into Thy 3a (atypical features) and Thy 3f (follicular lesion) categories. Histology was available as a reference for 97 nodules. Pre-surgical evaluations comprised biochemical tests, color-Doppler ultrasonography (US), semi-quantitative elastography-US (USE), contrast-enhanced US (CEUS), and mutation analysis from cytological slides. Thyroid malignancy was the final diagnosis for 19% of surgically-treated nodules. No statistically significant difference in the risk of malignancy was found between Thy 3a (26%) and Thy 3f (14%) nodules. Histology of the Thy 3a and Thy 3f nodules showed a higher incidence of Hurtle cell adenomas in Thy 3f (29%) than in Thy 3a (3%) nodules (P=0.01). The only pre-surgical difference concerned the BRAF V600E mutation, which was positive in some Thy 3a but not in any Thy 3f nodules (P=0.04). Receiver-operating characteristic (ROC) analysis was used to obtain cut-off values from US (score), USE (ELX 2/1 strain index), and CEUS (time-to-peak index and peak index) data. The cut-off values were similar for Thy 3a and Thy 3f nodules. Data showed that malignancy can be suspected if the US score is >2, ELX 1/2 strain index >1, time-to-peak index >1, and peak index <1. In a sub-group of 24 revised nodules (12 Thy 3a and 12 Thy 3f) with histology as a reference, the diagnostic power of cumulative pre-surgical analysis by means of US, USE, and CEUS showed high positive and negative predictive values (83% and 100%, respectively) for the presence of malignancy in Thy 3a and Thy 3f nodules. In conclusion, in our series of revised Thy 3 nodules, malignancy was low and displayed no significant differences between Thy 3a and Thy 3f categories. The use of cut-offs based on histology as a reference could reduce surgery. Our data support the conviction that, in mutation-negative Thy 3a and Thy 3f nodules, observation should be the first choice when not all instrumental results are suspect.
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Affiliation(s)
- Massimo Giusti
- Endocrinology Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | - Barbara Massa
- Cytopathology and Pathology Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | | | - Paola Calamaro
- Cytopathology and Pathology Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | - Stefano Gay
- Endocrinology Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | | | | | - Simonetta Zupo
- Molecular Diagnostic Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | - Eleonora Monti
- Endocrinology Unit, San Martino University Hospital, I-16100 Genoa, Italy
| | - Gianluca Ansaldo
- Endocrinology Surgery Unit, San Martino University Hospital, I-16100 Genoa, Italy
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Zhou X, Zhou P, Hu Z, Tian SM, Zhao Y, Liu W, Jin Q. Diagnostic Efficiency of Quantitative Contrast-Enhanced Ultrasound Indicators for Discriminating Benign From Malignant Solid Thyroid Nodules. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:425-437. [PMID: 28880412 DOI: 10.1002/jum.14347] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 05/08/2017] [Accepted: 05/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES We aimed to determine the most efficient quantitative parameters to establish a contrast-enhanced ultrasound (US) assessment system for distinguishing between benign and malignant thyroid nodules. METHODS A total of 167 patients with thyroid solitary nodules had the diagnosis confirmed by surgery or fine-needle aspiration. Quantitative contrast-enhanced US indicators (time to peak, time from peak to one-half, ascend slope, descend slope, peak intensity, and area under the curve [AUC]) were gathered in nodule and perinodule areas. Univariate and multivariate logistic regression analyses were performed. Receiver operating characteristic curves were generated. Sensitivities, specificities, and positive and negative predictive values were calculated to identify the best cutoff value. RESULTS The univariate logistic regression model showed that the peak intensity, ascend slope, descend slope, and AUC were significant indicators for discriminating benign from malignant nodules under contrast-enhanced US (P < .0001). For thyroid nodules, low peak intensity, ascend slope, and AUC and high descend slope values were significant indicators of malignancy. However, in perinodule areas, high peak intensity, ascend slope, and AUC and low descend slope values were significantly associated with malignancies. The cutoff values for the nodule peak intensity, ascend slope, descend slope, and AUC were 20.75, 0.91, -0.2, and 1818.23, respectively. The cutoff values for the ratios of the nodule versus perinodule peak intensity, ascend slope, descend slope, and AUC were 0.90, 0.95, 0.96, and 0.96. The nodule-to-perinodule peak intensity ratio showed the best diagnostic efficiency, with 80.41% sensitivity and 80.00% specificity. CONCLUSIONS Quantitative contrast-enhanced US indicators help discriminate benign from malignant thyroid nodules. The nodule-to-perinodule peak intensity ratio showed the best diagnostic efficiency.
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Affiliation(s)
- Xiaohui Zhou
- Department of Ultrasound, Third Xiangya Hospital, Central South University, Changsha, China
| | - Ping Zhou
- Department of Ultrasound, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zheyu Hu
- Department of Clinical Research and Teaching, First Hospital of Changsha City, Changsha, China
| | - Shuang Ming Tian
- Department of Ultrasound, Third Xiangya Hospital, Central South University, Changsha, China
| | - Yongfeng Zhao
- Department of Ultrasound, Third Xiangya Hospital, Central South University, Changsha, China
| | - Wengang Liu
- Department of Ultrasound, Third Xiangya Hospital, Central South University, Changsha, China
| | - Qiuzi Jin
- Department of Ultrasound, Third Xiangya Hospital, Central South University, Changsha, China
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14
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Jingjing LMD, Liping LMD, Yanjing ZMD, Yufang Z, Yanhong HMD, Tingting LMD, Xiaochun ,HMD. Analysis of Characteristics Microvessel Density of Thyroid Malignant and Benign Nodules on Contrast-Enhanced Ultrasonography. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2018. [DOI: 10.37015/audt.2018.180819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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15
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Zhang Y, Luo YK, Zhang MB, Li J, Li J, Tang J. Diagnostic Accuracy of Contrast-Enhanced Ultrasound Enhancement Patterns for Thyroid Nodules. Med Sci Monit 2016; 22:4755-4764. [PMID: 27916971 PMCID: PMC5154710 DOI: 10.12659/msm.899834] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background The aim of this study was to investigate the accuracy of contrast-enhanced ultrasound (CEUS) enhancement patterns in the assessment of thyroid nodules. Material/Methods A total of 158 patients with suspected thyroid cancer underwent conventional ultrasound (US) and CEUS examinations. The contrast enhancement patterns of the lesions, including the peripheries of the lesions, were assessed by CEUS scans. The relationship between the size of the lesions and the degree of enhancement was also studied. US- and/or CEUS-guided biopsy was used to obtain specimens for histopathological diagnosis. Results The final data included 148 patients with 157 lesions. Seventy-five patients had 82 malignant lesions and 73 patients had 75 benign lesions. Peripheral ring enhancement was seen in 40 lesions. The differences of enhancement patterns and peripheral rings between benign and malignant nodules were significant (p=0.000, 0.000). The diagnostic sensitivity, specificity, and accuracy for malignant were 88%, 65.33%, and 88.32%, respectively, for CEUS, whereas they were 98.33%, 42.67%, and 71.97%, respectively, for TC by conventional US. The misdiagnosis rate by conventional US was 57.33% and 34.67% by CEUS (p=0.005). With regard to the size of lesions, a significant difference was found between low-enhancement, iso-enhancement, high-enhancement, iso-enhancement with no-enhancement area and no-enhancement (p=0.000). Conclusions In patients with suspicious US characteristics, CEUS had high specificity and contributed to establishing the diagnosis. Therefore, CEUS could avoid unnecessary biopsy.
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Affiliation(s)
- Yan Zhang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China (mainland)
| | - Yu-Kun Luo
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China (mainland)
| | - Ming-Bo Zhang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China (mainland)
| | - Jie Li
- Department of Pathology, Chinese People's Liberation Army General Hospital, Beijing, China (mainland)
| | - Junlai Li
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China (mainland)
| | - Jie Tang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China (mainland)
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Monti E, Bovero M, Mortara L, Pera G, Zupo S, Gugiatti E, Dono M, Massa B, Ansaldo GL, Massimo G. BRAF Mutations in an Italian Regional Population: Implications for the Therapy of Thyroid Cancer. Int J Endocrinol 2015; 2015:138734. [PMID: 26693224 PMCID: PMC4674605 DOI: 10.1155/2015/138734] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/27/2015] [Accepted: 10/28/2015] [Indexed: 01/21/2023] Open
Abstract
Background. Molecular diagnostics has offered new techniques for searching for mutations in thyroid indeterminate lesions. The study's aim was to evaluate the BRAF mutations' incidence in an Italian regional population. Subjects and Methods. 70 Caucasian patients born in Liguria with indeterminate or suspicious cytological diagnoses. Results. A BRAF gene mutation was successfully analyzed in 56/70 patients. The mutation was BRAF V600E in 12/56 cases (21%) and BRAF K601E in 2/56 (4%). Of the BRAF mutated samples on cytological diagnosis (14/56 cases), 2/14 cases (14%) were benign on final histology and 12/14 (86%) were malignant. All BRAF-mutated cases on cytology that were found to be benign on histological examination carried the K601E mutation. Of the nonmutated BRAF cases (42/56, 75%) which were later found to be malignant on definitive histology, 5 cases were follicular carcinomas (36%), 3 cases were incidentally found to be papillary microcarcinomas (22%), 2 were cases papillary carcinomas (14%), 1 was case follicular variant of papillary carcinoma (7%), 1 was case medullary carcinoma (7%), 1 case was Hurtle cell tumor (7%), and 1 case was combined cell carcinoma and papillary oncocytic carcinoma (7%). Conclusions. The presence of the BRAF V600E mutation may suggest a more aggressive surgical approach. BRAF K601E mutation did not correlate with malignancy indexes.
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Affiliation(s)
- Eleonora Monti
- Department of Internal Medicine, Endocrinology Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
- *Eleonora Monti:
| | - Michela Bovero
- Department of Internal Medicine, Endocrinology Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
| | - Lorenzo Mortara
- Department of Internal Medicine, Endocrinology Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
| | - Giorgia Pera
- Department of Internal Medicine, Endocrinology Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
| | - Simonetta Zupo
- Department of Pathology, Molecular Diagnostic Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
| | - Elena Gugiatti
- Department of Pathology, Molecular Diagnostic Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
| | - Mariella Dono
- Department of Pathology, Molecular Diagnostic Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
| | - Barbara Massa
- Department of Pathology, Molecular Diagnostic Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
| | - Gian Luca Ansaldo
- Department of Surgery, Endocrinology Surgery Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
| | - Giusti Massimo
- Department of Internal Medicine, Endocrinology Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
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