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Şah Ünal FT, Gökçay Canpolat A, Elhan AH, Sevim S, Sak SD, Emral R, Demir Ö, Güllü S, Erdoğan MF, Çorapçıoğlu D, Şahin M. Cancer rates and characteristics of thyroid nodules with macrocalcification. Endocrine 2024; 84:1021-1029. [PMID: 38147262 DOI: 10.1007/s12020-023-03650-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/08/2023] [Indexed: 12/27/2023]
Abstract
AIMS The aim of this study was to determine the malignant potential of thyroid nodules with macrocalcifications and to evaluate the role of other sonographic findings in the diagnosis of malignancy in thyroid nodules besides macrocalcifications. METHODS The findings of 8250 patients who applied to our outpatient clinic and underwent thyroid ultrasonography(US) between 2008 and 2021 were retrospectively reviewed. We included a total of 296 patients with 296 macrocalcified nodules (macrocalcification group) and an age- and sex matched group of 300 patients (control group) with the cytopathologic and/or histopathologic data of fine-needle aspiration biopsy (FNAB) of thyroid nodules without calcification. Demographic characteristics of these patients, US characteristics of the nodules, and thyroid function tests were recorded. Cytopathological data of FNAB were classified according to BETHESDA. RESULTS The malignancy rate was 14.2% (42/296) in the macrocalcification group and 5.3% (16/300) in the control group (p < 0.001). There was no significant relationship between interrupted peripheral calcification and malignancy. Hypoechoic or markedly hypoechoic appearance, irregular border, solid structure, presence of accompanying pathological lymphadenopathy on sonographic examination and upper and middle zone localization were other sonographic features that increased the risk of malignancy of a nodule. The presence of autoimmunity was not found to be associated with the risk of malignancy. TSH and calcitonin levels of malignant nodules were higher than benign nodules. There was no significant difference between gender and malignancy. In the univariate analysis, it was found that the presence of macrocalcification increased the risk of malignancy 2.935 times. (OR:2.935, p < 0.001.95% CI for OR 1.611-5.349) In addition, being younger, being in the high TIRADS category, and being in the upper and middle zones were factors that increased the risk of malignancy. Gender, TSH level, nodule volume and structure were not associated with malignancy. However, after multivariate analysis, factors that significantly increased the risk of malignancy were younger age, higher TIRADS category, and nodule localization. CONCLUSION In our study, the malignancy rate was higher in the macrocalcification group than in the control group. However, no correlation was found after multivariate analysis. In the multivariate analysis, younger age, higher TIRADS category, and nodules located in the upper and middle zone were other factors associated with malignancy. There was no association between peripheral interrupted calcification and malignancy risk.
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Affiliation(s)
- Fatma Tuğçe Şah Ünal
- Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey.
| | - Asena Gökçay Canpolat
- Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Atilla Halil Elhan
- Ankara University Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
| | - Selim Sevim
- Ankara University Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Serpil Dizbay Sak
- Ankara University Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Rıfat Emral
- Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Özgür Demir
- Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Sevim Güllü
- Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Murat Faik Erdoğan
- Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Demet Çorapçıoğlu
- Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Mustafa Şahin
- Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
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Wang SR, Zhu PS, Li J, Chen M, Cao CL, Shi LN, Li WX. Study on diagnosing thyroid nodules of ACR TI-RADS 4-5 with multimodal ultrasound radiomics technology. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:274-283. [PMID: 38105371 DOI: 10.1002/jcu.23625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Explore the feasibility of using the multimodal ultrasound (US) radiomics technology to diagnose American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) 4-5 thyroid nodules. METHOD This study prospectively collected the clinical characteristics, conventional, and US elastography images of 100 patients diagnosed with ACR TI-RADS 4-5 nodules from May 2022 to 2023. Independent risk factors for malignant thyroid nodules were extracted and screened using methods such as the least absolute shrinkage and selection operator (LASSO) logistic regression (LR) model, and a multimodal US radiomics combined diagnostic model was established. Using a multifactorial LR analysis and a Rad-score rating, the predictive performance was validated and evaluated, and the final threshold range was determined to assess the clinical net benefit of the model. RESULTS In the training set, the US radiomics combined predictive model area under curve (AUC = 0.928) had higher diagnostic performance compared with clinical characteristics (AUC = 0.779), conventional US (AUC = 0.794), and US elastography model (AUC = 0.852). In the validation set, the multimodal US radiomics combined diagnostic model (AUC = 0.829) also had higher diagnostic performance compared with clinical characteristics (AUC = 0.799), conventional US (AUC = 0.802), and US elastography model (AUC = 0.718). CONCLUSION Multi-modal US radiomics technology can effectively diagnose thyroid nodules of ACR TI-RADS 4-5, and the combination of radiomics signature and conventional US features can further improve the diagnostic performance.
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Affiliation(s)
- Si-Rui Wang
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Pei-Shan Zhu
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Jun Li
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Ming Chen
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Chun-Li Cao
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Li-Nan Shi
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Wen-Xiao Li
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
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Wang J, Dong C, Zhang YZ, Wang L, Yuan X, He M, Xu S, Zhou Q, Jiang J. A novel approach to quantify calcifications of thyroid nodules in US images based on deep learning: predicting the risk of cervical lymph node metastasis in papillary thyroid cancer patients. Eur Radiol 2023; 33:9347-9356. [PMID: 37436509 DOI: 10.1007/s00330-023-09909-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 04/23/2023] [Accepted: 05/15/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE Based on ultrasound (US) images, this study aimed to detect and quantify calcifications of thyroid nodules, which are regarded as one of the most important features in US diagnosis of thyroid cancer, and to further investigate the value of US calcifications in predicting the risk of lymph node metastasis (LNM) in papillary thyroid cancer (PTC). METHODS Based on the DeepLabv3+ networks, 2992 thyroid nodules in US images were used to train a model to detect thyroid nodules, of which 998 were used to train a model to detect and quantify calcifications. A total of 225 and 146 thyroid nodules obtained from two centers, respectively, were used to test the performance of these models. A logistic regression method was used to construct the predictive models for LNM in PTCs. RESULTS Calcifications detected by the network model and experienced radiologists had an agreement degree of above 90%. The novel quantitative parameters of US calcification defined in this study showed a significant difference between PTC patients with and without cervical LNM (p < 0.05). The calcification parameters were beneficial to predicting the LNM risk in PTC patients. The LNM prediction model using these calcification parameters combined with patient age and other US nodular features showed a higher specificity and accuracy than the calcification parameters alone. CONCLUSIONS Our models not only detect the calcifications automatically, but also have value in predicting cervical LNM risk of PTC patients, thereby making it possible to investigate the relationship between calcifications and highly invasive PTC in detail. CLINICAL RELEVANCE STATEMENT Due to the high association of US microcalcifications with thyroid cancers, our model will contribute to the differential diagnosis of thyroid nodules in daily practice. KEY POINTS • We developed an ML-based network model for automatically detecting and quantifying calcifications within thyroid nodules in US images. • Three novel parameters for quantifying US calcifications were defined and verified. • These US calcification parameters showed value in predicting the risk of cervical LNM in PTC patients.
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Affiliation(s)
- Juan Wang
- Department of Ultrasound, the Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Caixia Dong
- Institute of Artificial Intelligence, the Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Yao-Zhong Zhang
- The Institute of Medical Science, The University of Tokyo, Shirokanedai 4-6-1, Minato-ku, Tokyo, 108-8639, Japan
| | - Lirong Wang
- Department of Ultrasound, the Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Xin Yuan
- Department of Ultrasound, the Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Meiqing He
- Department of Ultrasound, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Songhua Xu
- Institute of Artificial Intelligence, the Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, 710004, China.
| | - Qi Zhou
- Department of Ultrasound, the Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, 710004, China.
| | - Jue Jiang
- Department of Ultrasound, the Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, 710004, China.
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Chen C, Liu Y, Yao J, Wang K, Zhang M, Shi F, Tian Y, Gao L, Ying Y, Pan Q, Wang H, Wu J, Qi X, Wang Y, Xu D. Deep learning approaches for differentiating thyroid nodules with calcification: a two-center study. BMC Cancer 2023; 23:1139. [PMID: 37996814 PMCID: PMC10668439 DOI: 10.1186/s12885-023-11456-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/27/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Calcification is a common phenomenon in both benign and malignant thyroid nodules. However, the clinical significance of calcification remains unclear. Therefore, we explored a more objective method for distinguishing between benign and malignant thyroid calcified nodules. METHODS This retrospective study, conducted at two centers, involved a total of 631 thyroid nodules, all of which were pathologically confirmed. Ultrasound image sets were employed for analysis. The primary evaluation index was the area under the receiver-operator characteristic curve (AUROC). We compared the diagnostic performance of deep learning (DL) methods with that of radiologists and determined whether DL could enhance the diagnostic capabilities of radiologists. RESULTS The Xception classification model exhibited the highest performance, achieving an AUROC of up to 0.970, followed by the DenseNet169 model, which attained an AUROC of up to 0.959. Notably, both DL models outperformed radiologists (P < 0.05). The success of the Xception model can be attributed to its incorporation of deep separable convolution, which effectively reduces the model's parameter count. This feature enables the model to capture features more effectively during the feature extraction process, resulting in superior performance, particularly when dealing with limited data. CONCLUSIONS This study conclusively demonstrated that DL outperformed radiologists in differentiating between benign and malignant calcified thyroid nodules. Additionally, the diagnostic capabilities of radiologists could be enhanced with the aid of DL.
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Affiliation(s)
- Chen Chen
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Wenling Big Data and Artificial Intelligence Institute in Medicine, Taizhou, 317502, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Yuanzhen Liu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Wenling Big Data and Artificial Intelligence Institute in Medicine, Taizhou, 317502, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Jincao Yao
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, 310022, China
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, 310022, China
| | - Kai Wang
- Department of Ultrasound, The Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 317502, China
| | - Maoliang Zhang
- Department of Ultrasound, The Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 317502, China
| | - Fang Shi
- Capacity Building and Continuing Education Center of National Health Commission, Beijing, 100098, China
| | - Yuan Tian
- Capacity Building and Continuing Education Center of National Health Commission, Beijing, 100098, China
| | - Lu Gao
- Capacity Building and Continuing Education Center of National Health Commission, Beijing, 100098, China
| | - Yajun Ying
- Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Qianmeng Pan
- Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Hui Wang
- Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Jinxin Wu
- Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Xiaoqing Qi
- Department of Ultrasound, Hangzhou Ninth People's Hospital, Hangzhou, 311225, China
| | - Yifan Wang
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China.
- Wenling Big Data and Artificial Intelligence Institute in Medicine, Taizhou, 317502, China.
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China.
| | - Dong Xu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China.
- Wenling Big Data and Artificial Intelligence Institute in Medicine, Taizhou, 317502, China.
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China.
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Kim S, Shin JH, Ihn YK. Biopsy strategies for intermediate and high suspicion thyroid nodules with macrocalcifications. Curr Med Res Opin 2023; 39:179-186. [PMID: 36369696 DOI: 10.1080/03007995.2022.2146404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES (1) To find strategies to improve diagnostic performance of ultrasound-guided biopsy of intermediate and high suspicion thyroid nodules with macrocalcifications. (2) To find malignancy rates of nodules with macrocalcification. MATERIALS AND METHODS From 2018 to 2022, fine-needle aspiration biopsy (FNAB) and core needle biopsy (CNB) were retrospectively evaluated. Macrocalcifications were categorized into three types: intra-nodular, rim and entirely calcified. Diagnostic performance was compared between biopsy modes (FNAB vs. CNB) and FNAB techniques (to-and-fro vs. whirling). Multivariate logistic regression was performed to determine features associated with performance of FNAB. Malignancy rates were calculated according to macrocalcification types. RESULTS A total of 114 procedures (87 FNAB and 27 CNB) in 89 nodules per 86 patients (mean age, 64 years; 76 women) were performed. Overall, CNB performed better than FNAB (unsatisfactory rate: 3.7% vs. 33.3%, p = .005). For macrocalcification thicker than 2 mm, whirling FNAB technique demonstrated a comparable unsatisfactory rate with statistical trends toward significance (to-and-fro: 69.2% vs. whirling: 27.8%, p = .055). The entirely calcified nodule was associated with poor performance of FNAB (adjusted odds ratio 4.46 [95% CI: 1.19-16.67], p = .027). Overall malignancy was 22.5%, higher in intra-nodular macrocalcification than rim and entirely calcified types (68.4% vs. 21.1% vs. 10.5%, p = .025). CONCLUSION For the entirely calcified type, CNB should be considered first to improve diagnosis. For other types, FNAB can be performed, and whirling technique may be an alternative technique in thicker macrocalcification. Malignancy in intermediate and high suspicion nodules with macrocalcification have non-negligible rates.
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Affiliation(s)
- Sungmok Kim
- Department of Radiology, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Jae Ho Shin
- Department of Radiology, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Yon Kwon Ihn
- Department of Radiology, St. Vincent's Hospital, Suwon, Republic of Korea
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Li R, Liang Z, Wang X, Chen L. Role of echogenic foci in ultrasonographic risk stratification of thyroid nodules: Echogenic focus scoring in the American College of Radiology Thyroid Imaging Reporting and Data System. Front Oncol 2022; 12:929500. [PMID: 36106124 PMCID: PMC9465029 DOI: 10.3389/fonc.2022.929500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Although echogenic foci may raise malignancy rates in thyroid nodules, the association between peripheral calcification or macrocalcification and thyroid carcinoma is controversial. We evaluated the malignancy probability of various echogenic foci and explored whether the method of determining a thyroid nodule’s point score in the echogenic focus category of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) is reasonable. Methods We retrospectively evaluated 819 patients with 852 nodules. The patterns of echogenic foci on ultrasonography were classified into the following four categories: punctate echogenic foci, macrocalcification, peripheral calcification, and multiple different types of echogenic foci. The core needle biopsy results were divided into two groups: benign and malignant or suspicious for malignancy. Results Among the 852 nodules, 471 (55.3%) had echogenic foci on ultrasonography. Of these nodules, there was no significant statistical difference in the malignant or suspicious for malignancy rate between nodules with peripheral calcification and those with macrocalcification [40.0% (8/20) vs. 30.6% (11/36), respectively; p = 0.474]. The incidence of malignancy or suspicious for malignancy for nodules with peripheral calcification, macrocalcification, or multiple different types of echogenic foci was significantly lower than the incidence for punctate echogenic foci alone, with odds ratios of 0.265 [95% confidence interval (CI): 0.105–0.667; p = 0.005], 0.175 (95% CI: 0.083–0.368; p = 0.000), and 0.256 (95% CI: 0.136–0.482; p = 0.000), respectively. Conclusion We found no significant statistical difference in the risk of malignancy or suspicious for malignancy rate between peripheral calcification and macrocalcification in thyroid nodules. We observed that nodules with multiple different types of echogenic foci were not associated with higher malignant or suspicious for malignancy rates compared with nodules with punctate echogenic foci alone.
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Wang G, Nie F, Wang Y, Wang P, Wang L, Fan X, Ma Z. Value of Echogenic Foci in Diagnosing Papillary Thyroid Carcinoma and Predicting Aggressive Biological Behavior. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1237-1245. [PMID: 34415647 DOI: 10.1002/jum.15815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/17/2021] [Accepted: 07/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To assess the diagnostic value of echogenic foci in papillary thyroid carcinoma (PTC) and the relationship between echogenic foci and aggressiveness of PTC. METHODS From January 2018 to January 2021, a total of 950 patients diagnosed with thyroid nodules (n = 1113) in our hospital were retrospectively analyzed. Among the 1113 nodules, single PTC in 527 patients confirmed by surgery was studied for their aggressive biological behavior. The patterns of echogenic foci were classified as: no echogenic foci, sparse punctate echogenic foci, focal punctate echogenic foci, diffuse punctate echogenic foci, petal-like punctate echogenic foci, comet-tail artifacts, coarse echogenic foci, peripheral rim (eggshell echogenic foci), and mixed echogenic foci. The clinical and ultrasonographic characteristics were also analyzed. A univariate analysis was performed, and binary logistic regression was performed to screen independent risk factors. RESULTS For the differential diagnosis of PTC, age < 50 years, size <1.1 cm, hypoechoic or very hypoechoic, aspect ratio > 1, irregular shape, types II (punctate echogenic foci) and VI (mixed echogenic foci) were independent risk factors. For the aggressive biological behavior of PTC, male sex, age<42 years, size <1.0 cm, types IIb (focal punctate echogenic foci), IIc (diffuse punctate echogenic foci), and VI (mixed echogenic foci) were independent risk factors for predicting cervical lymph node metastasis of PTC. CONCLUSION Echogenic foci are useful in diagnosing PTC and predicting aggressiveness of PTC, which contribute to screening invasive PTC and avoiding overdiagnosis and overtreatment.
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Affiliation(s)
- Guojuan Wang
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Fang Nie
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Yanfang Wang
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Peihua Wang
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Lan Wang
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xiao Fan
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Zhenxian Ma
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
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Hong MJ, Noh BJ, Na DG, Paik W. Histopathological correlation of punctate echogenic foci on ultrasonography in papillary thyroid carcinoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:49-57. [PMID: 34931709 DOI: 10.1002/jcu.23107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/13/2021] [Accepted: 10/26/2021] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Min Ji Hong
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Byeong-Joo Noh
- Department of Pathology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Wooyul Paik
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
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Zhao D, Jing Y, Lin X, Zhang B. The value of color Doppler ultrasound in the diagnosis of thyroid nodules: a systematic review and meta-analysis. Gland Surg 2021; 10:3369-3377. [PMID: 35070897 PMCID: PMC8749106 DOI: 10.21037/gs-21-752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/10/2021] [Indexed: 10/13/2023]
Abstract
BACKGROUND This study aimed to analyze the value of color Doppler ultrasound in the diagnosis of thyroid nodules. METHODS We searched the PubMed, Web of Science, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) on using color Doppler ultrasound, thyroid nodules, thyroid tumors, and Doppler ultrasound to diagnose the thyroid nodules. The outcome indicators in the articles had to include the numbers of true positives (TP), false positives (FP), false negatives (FN), and true negatives (TN). Subsequently, the Jadad tool was adopted to evaluate the quality of the included articles, and Review Manager 5.3 software was used to conduct a meta-analysis of the experimental data. RESULTS A total of eight suitable articles were selected. The results showed that the estimated sensitivity and specificity of color Doppler ultrasound for the diagnostic of thyroid nodules were 0.46-0.89 and 0.00-1.00, respectively. The pooled estimate of sensitivity for the different articles was 0.71 [95% confidence interval (CI): 0.46-0.89], and the pooled estimate of specificity was 0.77 (95% CI: 0.00-1.00). The area under the summary receiver operating characteristic (SROC) curve (AUC) was 0.917, which was larger than 0.9, signifying high diagnostic accuracy. This suggests that color doppler ultrasound can realize the clinical diagnosis of thyroid nodules. DISCUSSION In summary, the results of this study could provide a clinical data for the promotion and application of color Doppler ultrasound in the clinical diagnosis of thyroid nodules, as well as further reliable data for follow-up clinical research on the diagnosis and treatment of thyroid nodules.
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Affiliation(s)
- Danbo Zhao
- Ultrasonic Image Center, The First People’s Hospital of Wenling, Wenling, China
| | - Yi Jing
- Ultrasonic Image Center, The First People’s Hospital of Wenling, Wenling, China
| | - Xiaoyi Lin
- Ultrasonography Lab, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Bixia Zhang
- Ultrasonic Image Center, The First People’s Hospital of Wenling, Wenling, China
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Ha EJ, Chung SR, Na DG, Ahn HS, Chung J, Lee JY, Park JS, Yoo RE, Baek JH, Baek SM, Cho SW, Choi YJ, Hahn SY, Jung SL, Kim JH, Kim SK, Kim SJ, Lee CY, Lee HK, Lee JH, Lee YH, Lim HK, Shin JH, Sim JS, Sung JY, Yoon JH, Choi M. 2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean J Radiol 2021; 22:2094-2123. [PMID: 34719893 PMCID: PMC8628155 DOI: 10.3348/kjr.2021.0713] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1-2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.
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Affiliation(s)
- Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Chung
- Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Korea
| | - Seong Whi Cho
- Department of Radiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seul Kee Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Soo Jin Kim
- Department of Radiology, New Korea Hospital, Gimpo, Korea
| | - Chang Yoon Lee
- Department of Radiology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Ho Kyu Lee
- Department of Radiology, Jeju National University, Jeju, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam, Korea
| | - Jin Young Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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11
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Tessler FN. American Thyroid Association Nonclassifiable Thyroid Nodules: A New Perspective. Thyroid 2021; 31:1449-1450. [PMID: 34470461 DOI: 10.1089/thy.2021.0449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Franklin Neil Tessler
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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12
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Different sonographic features of peripheral thyroid nodule calcification and risk of malignancy: a prospective observational study. Pol J Radiol 2021; 86:e366-e371. [PMID: 34322186 PMCID: PMC8297479 DOI: 10.5114/pjr.2021.107450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/26/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the association of peripheral calcification, as well as its sonographic features, with thyroid nodule malignancy. Material and methods This study was prospectively conducted during 2015-2020 on patients diagnosed with thyroid nodule undergoing ultrasound-guided fine-needle aspiration in Shahid Beheshti teaching hospital or private offices in Babol, northern Iran. The ultrasonographic characteristics of the nodules, as well as the cytological findings, were recorded. Regression analysis was used to assess the relationship between sonographic results and malignancy. We also used receiver operator characteristics (ROC) analysis to estimate the ability of ultrasound to predict the characteristic features of malignancy, as estimated by the area under the curve (AUC). Results A total of 1857 thyroid nodules were finally included, of which 84 were peripherally calcified nodules. There was a significant positive association between the nodule malignancy and peripheral calcification (OR = 2.23, 95% CI: 1.13-4.35). In the nodules with peripheral calcification, significant positive associations were seen between malignancy and lobulated margin (OR = 3.85, 95% CI: 1.02-14.54) and solid composition (OR = 4.05, 95% CI: 0.99-16.53). The ROC analysis indicated that AUC for lobulated margin and solid composition was 63.8% and 66.5%, respectively, in predicting malignant thyroid nodules. Conclusion The findings showed that peripheral calcification on sonography can be a potential indicator of malignant thyroid nodules. Also, the presence of lobulated margin and/or solid composition, besides peripheral calcification, can be helpful in better distinguishing malignant from benign nodules.
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Shin HS, Na DG, Paik W, Yoon SJ, Gwon HY, Noh BJ, Kim WJ. Malignancy Risk Stratification of Thyroid Nodules with Macrocalcification and Rim Calcification Based on Ultrasound Patterns. Korean J Radiol 2021; 22:663-671. [PMID: 33660454 PMCID: PMC8005340 DOI: 10.3348/kjr.2020.0381] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/25/2020] [Accepted: 11/03/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To determine the association of macrocalcification and rim calcification with malignancy and to stratify the malignancy risk of thyroid nodules with macrocalcification and rim calcification based on ultrasound (US) patterns. Materials and Methods The study included a total of 3603 consecutive nodules (≥ 1 cm) with final diagnoses. The associations of macrocalcification and rim calcification with malignancy and malignancy risk of the nodules were assessed overall and in subgroups based on the US patterns of the nodules. The malignancy risk of the thyroid nodules was categorized as high (> 50%), intermediate (upper-intermediate: > 30%, ≤ 50%; lower-intermediate: > 10%, ≤ 30%), and low (≤ 10%). Results Macrocalcification was independently associated with malignancy in all nodules and solid hypoechoic (SH) nodules (p < 0.001). Rim calcification was not associated with malignancy in all nodules (p = 0.802); however, it was independently associated with malignancy in partially cystic or isoechoic and hyperechoic (PCIH) nodules (p = 0.010). The malignancy risks of nodules with macrocalcification were classified as upper-intermediate and high in SH nodules, and as low and lower-intermediate in PCIH nodules based on suspicious US features. The malignancy risks of nodules with rim calcification were stratified as low and lower-intermediate based on suspicious US features. Conclusion Macrocalcification increased the malignancy risk in all and SH nodules with or without suspicious US features, with low to high malignancy risks depending on the US patterns. Rim calcification increased the malignancy risk in PCIH nodules, with low and lower-intermediate malignancy risks based on suspicious US features. However, the role of rim calcification in risk stratification of thyroid nodules remains uncertain.
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Affiliation(s)
- Hwa Seon Shin
- Department of Radiology, Gyeongsang National University Hospital, Jinju, Korea
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
| | - Wooyul Paik
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - So Jin Yoon
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hye Yun Gwon
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Byeong Joo Noh
- Department of Pathology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Won Jun Kim
- Department of Endoclinology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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14
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ARSLAN A, KARASU R, KESKİN S, GÜNGÖR MN. The relationship between thyroid ultrasonography and cytopathology. TURKISH JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.46310/tjim.822949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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15
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Wang Z, Zhu X, Yu X, Guan H, Zhao L, Zhang Y, Li Y, Sang L, Han Y, Li Y, Shan Z, Teng W. The combination of ATA classification and FNA results can improve the diagnostic efficiency of malignant thyroid nodules. Endocr Connect 2020; 9:903-911. [PMID: 32810845 PMCID: PMC7583133 DOI: 10.1530/ec-20-0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE To determine the diagnostic efficiency of the ATA classification and ultrasound-guided fine-needle aspiration (FNA) results in identifying the risk factors of malignancy, we analyzed the thyroid nodules of patients who underwent thyroidectomy and compared preoperative ATA classifications with FNA results. METHODS We retrospectively analyzed 274 nodules of 196 patients who underwent ultrasonography, FNA and thyroidectomy. Histopathological findings of thyroid nodules were considered as the Au standard in the analysis of the diagnostic efficiency of the ATA classification and FNA results. Univariate analysis and binary multivariate logistic regression analysis were applied to identify the ultrasound features associated with malignancy. RESULTS The overall malignancy rate of 274 nodules was 41.6%. The areas under the ROC curves (AUCs) for the ATA classification and FNA results were 0.88 and 0.878, respectively (P < 0.001). The sensitivity and specificity of the ATA classification were 86 and 86.9%, whereas those of FNA results were 68.5 and 91.4%, respectively. The specificity (98.7%) and sensitivity (94.3%) increased after the combined use of the ATA classification and FNA results. Taller-than-wide shape, microcalcifications, hypoechogenicity and irregular margins were independent risk factors for malignancy. Microcalcifications had the highest OR (7.58), and taller-than-wide shape had the highest specificity in BSRTC I, II, III and IV cytology. CONCLUSION The diagnostic efficiency of the ATA classification and FNA results in identifying malignant nodules was high, and the use of both criteria improved the diagnostic accuracy. Taller-than-wide shape, microcalcifications, hypoechogenicity and irregular margins were independent risk factors for malignancy.
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Affiliation(s)
- Zhenzhen Wang
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiangying Zhu
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaohui Yu
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Haixia Guan
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Lei Zhao
- Department of Ultrasonography, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yixia Zhang
- Department of Ultrasonography, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yuge Li
- Department of Ultrasonography, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Liang Sang
- Department of Ultrasonography, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yuchen Han
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yushu Li
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Weiping Teng
- Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, China
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Joo L, Baek JH. Clinical significance of isolated macrocalcifications detected by ultrasonography. Ultrasonography 2020; 39:407-408. [PMID: 32814373 PMCID: PMC7515661 DOI: 10.14366/usg.20075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Leehi Joo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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17
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Sohn YM, Na DG, Paik W, Gwon HY, Noh BJ. Malignancy risk of thyroid nodules with nonshadowing echogenic foci. Ultrasonography 2020; 40:115-125. [PMID: 32594667 PMCID: PMC7758109 DOI: 10.14366/usg.20012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/19/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose This study was conducted to determine the malignancy risk and diagnostic value of various types of nonshadowing echogenic foci (NEF) in the risk stratification of thyroid nodules. Methods A total of 1,018 consecutive thyroid nodules (≥1 cm) with final diagnoses were included. The presence of NEF was determined and types of NEF were classified according to the presence of a comet tail artifact (CTA), location, and size through a prospective evaluation. The associations with malignancy, malignancy risk, and diagnostic value of various types of NEF were assessed. Results Intrasolid punctate NEF without CTA was the only type of NEF that was an independent predictor of malignancy (P<0.001). The malignancy risk of intrasolid punctate NEF without CTA was substantially higher in solid hypoechoic nodules than in isoechoic or nonsolid nodules (71.3% vs. 9.2%, P<0.001). In solid hypoechoic nodules, slightly increased sensitivity (70.8% vs. 67.9%) for malignancy and a similar malignancy risk (71.4% vs. 71.3%) were observed for intrasolid punctate NEF (with or without CTA) and intrasolid punctate NEF without CTA, respectively. NEF with CTA at the margin of the cystic component was not associated with malignancy or benignity in nonsolid nodules (P>0.05). Conclusion Intrasolid punctate NEF without CTA was the only independent predictor of malignancy. However, solid hypoechoic nodules with intrasolid punctate NEF should be classified as high-suspicion nodules regardless of coexisting CTA. Other types of NEF had no added value for detecting malignancy compared to intrasolid punctate NEF without CTA.
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Affiliation(s)
- Yu-Mee Sohn
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Wooyul Paik
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hye Yun Gwon
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Byeong-Joo Noh
- Department of Pathology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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Peng Q, Zhang Q, Chen S, Niu C. Petal-Like Calcifications in Thyroid Nodules on Ultrasonography: A Rare Morphologic Characteristic of Calcification Associated With Aggressive Biological Behavior. Front Endocrinol (Lausanne) 2020; 11:271. [PMID: 32528405 PMCID: PMC7256483 DOI: 10.3389/fendo.2020.00271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/14/2020] [Indexed: 01/18/2023] Open
Abstract
This study investigated a rare ultrasonographically detected thyroid petal-like calcification and its relationship with thyroid carcinoma and biological behavior. We described the clinical and ultrasonographical features of thyroid nodules with petal-like calcifications in 18 patients undergoing thyroid surgery and cervical lymph node dissection. All of the thyroid nodules with petal-like calcifications were papillary thyroid carcinomas (PTCs). Of the 18 patients, 13 (72.2%) had cervical central lymph node metastasis, and five (27.8%) had cervical lateral lymph node metastasis. Petal-like calcifications occurred in malignant thyroid nodules with a high incidence of lymph node metastasis, which may be a specific ultrasonographic feature associated with the aggressive biological behavior of PTC.
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19
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Reply to “Regarding Peripheral Thyroid Nodule Calcifications on Sonography”. AJR Am J Roentgenol 2019; 213:W294. [DOI: 10.2214/ajr.19.22500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Regarding Peripheral Thyroid Nodule Calcifications on Sonography. AJR Am J Roentgenol 2019; 213:W293. [PMID: 31755765 DOI: 10.2214/ajr.19.21837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Paik W, Na DG, Gwon HY, Kim J. CT features of thyroid nodules with isolated macrocalcifications detected by ultrasonography. Ultrasonography 2019; 39:130-136. [PMID: 31962383 PMCID: PMC7065983 DOI: 10.14366/usg.19045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/23/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose A thyroid nodule with an isolated macrocalcification is visualized as a calcified nodule with complete posterior shadowing on ultrasonography (US). This study aimed to determine the computed tomography (CT) features of isolated macrocalcifications detected using US. Methods This study included 20 patients who had thyroid nodules with isolated macroalcifications and underwent neck CT or chest CT. The patients were enrolled from a sample of 82 patients with isolated macrocalcifications detected by US drawn from 7,142 consecutive patients who underwent thyroid biopsy at two institutions. We evaluated the CT features of nodules with isolated macrocalcifications and categorized them as central or rim calcifications. We assessed the nodule size and the frequency of nondiagnostic fine-needle aspiration (FNA) results and malignant tumors according to the CT features of isolated macrocalcifications. Results CT scans showed central calcifications in 18 (90.0%) and rim calcifications in two (10.0%) of the 20 nodules with isolated macrocalcifications. Among the 18 nodules with central isolated macrocalcifications, complete compact calcification was found in six nodules and partial coarse calcification in 12 nodules. In 18 nodules with central isolated macrocalcifications, the nondiagnostic FNA rate and frequency of malignant tumors were not significantly different between complete and partial central calcifications (P=0.620 and P=0.999, respectively). Malignant tumors were only found in nodules with central isolated macrocalcifications. Conclusion The majority of nodules with isolated macrocalcifications showed central calcifications on CT. Thyroid nodules with isolated macrocalcifications detected by US should not be classified as having a type of rim or peripheral calcification.
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Affiliation(s)
- Wooyul Paik
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.,Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea
| | - Hye Yun Gwon
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Jinna Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
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