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The Diagnostic Efficiency of Ultrasound in Characterization of Thyroid Nodules: How Many Criteria Are Needed?
S34
Ultrasound in Medicine and Biology
Conclusion: CEUS-guided biopsy in renal and adrenal tumors is a very accurate procedure. PEB should be performed always with CEUS guidance in patients with large tumors or those with liquid areas.
Sun, Aug 28, 2011 Hall I SS 18 10:30-12:00 Head and Neck 2 - Thyroid and Other Small Parts SS 18.01 Computerized Detection and Quantification of Microcalcifications in Thyroid Nodules K. Chen,1 C. Chen,1 M. Wu,1 M. Ho,1 H. Tai,1 Y. Chung,2 A. Chen,3 K. Chang4 1 Department of Surgery, National Taiwan University Hospital, Taipei/TW, 2Department of Surgery, Hsin Chu General Hospital, Hsin Chu City/TW, 3Graduate Institute of Industrial Engineering, National Taiwan University, Taipei/TW, 4Department of Surgery, Cheng Ching General Hospital, Taipei/TW Purpose: In order to improve the ultrasonographic diagnostic rates of thyroid cancers, we propose to evaluate the sonographic calcifications and echotexture by a computerized quantification method in a prospective setting. Material & Methods: A total of 227 participants with 258 nodules were evaluated. Among them, 2 nodules were excluded for suspicious aspiration cytology results without pathologic proof. Among the rest 256 nodules, the diagnosis of 181 nodules was verified by surgical pathology, and the diagnosis of 75 were based on FNA biopsy results There were 173 benign thyroid nodules and 83 malignant thyroid nodules, which included 74 papillary carcinomas. Patient clinical data were collected, and the conventional gray-scale ultrasound evaluation was restrospectively reviewed. Quantification of cystic components, echotexture and calcifications was automatically performed by a proprietary program. The calcification index (CI) and heterogeneity (HI) were calculated. Results: The CI and HI between benign and malignant nodules diagnosed by combined FNA biopsy and surgical pathology results (total number, 256) showed a significant difference (p,0.001, AUC 5 0.746; p,0.001, AUC 5 0.664). Furthermore, we excluded patients without surgical pathology results for further validation, and the CI and HI between benign and malignant nodules confirmed by pathology results (total number, 181) showed a significant difference (p,0.001; p,0.001). Conclusion: This new computer-aided diagnosis method to evaluate the sonographic calcifications and heterogeneity of thyroid nodules is a more sensitive and more objective method. SS 18.02 The Diagnostic Efficiency of Ultrasound in Characterization of Thyroid Nodules: How Many Criteria Are Needed? A. Ozel,1 S. M. Erturk,1 A. Ercan,1 B. Yilmaz,2 T. Basak,2 Z. Karpat,1 M. Basak1 1 Radiology, Sisli Etfal Research and Training Hospital, Istanbul/TR, 2 Pathology, Sisli Etfal Research and Training Hospital, Istanbul/TR Purpose: The purpose of this study was to define the criteria for use in differentiating benign from malignant nodules with the help of the receiver operating characteristic analysis and to increase the objective diagnostic accuracy of ultrasonography. Material & Methods: A total of 363 patients (307 women, 56 men) with 363 nodules (22 malignant and 341 benign) were included in the
Volume 37, Number 8S, 2011 study. The presence and absence of each US feature of the evaluated nodule – shape taller than wide, irregular margin, hypoechogenicity, microcalcification, intranodular vascularity – were scored 1 and 0, respectively. The total ultrasound score was obtained by summing up of each positive ultrasound findings for malignancy. The effect of the total US score in the discrimination of benign and malignant nodules was analysed using ROC analysis. Results: The cut-off values of US score for nodules larger and smaller than one centimeter were two (Az: 0.783) and three (Az: 0.935), respectively. For the nodules greater than one centimeter, the sensitivity, specificity, positive predictive value and negative predictive value, and accuracy were 62.5%, 91.5%, 30.3%, 97.7%, and 89,9%, respectively. For the nodules smaller or equal to one centimeter, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 83.3%, 94.9%, 62.5%, 98.2%, 93.8%, respectively. Conclusion: Using ultrasound, thyroid nodules can be characterized effectively. The number of the US features used in this distinction varies in respect to nodule size. SS 18.03 Retrospective Study of Sonographic Appearance of Autoimmune Thyroiditis in a Tertiary Center S. Sundararajan Radiology, Madras Medical mission, Chennai/IN Purpose: The purpose of this work was to assess the validity of an ultrasonographic sign, micronodulation, in the diagnosis of Hashimoto thyroiditis. Material & Methods: Among 100 patients found to have ultrasonographic features of micronodulation, 40 patients had autoantibody test results available. Results: The positive predictive value for micronodulation in diagnosing Hashimoto thyroitis is 94.7%. The micronodules were 0.1 to 0.85 cm in size, hypoechoic, and surrounded by an echogenic rim. This corresponds to accentuated lobulation on the pathologic specimen. Fifty percent patients showed septations on USG indicating fibrosis and hence disease of some duration. Conclusion: Although micronodulation is highly diagnostic of Hashimoto thyroiditis, the ultrasonographic features of Hashimoto thyroiditis varied and were not specific for the disease. SS 18.04 Ultrasound Features of Malignancy in the Preoperative Diagnosis of Parathyroid Cancer: A Retrospective Analysis of Parathyroid Tumours Larger Than 15mm P. N. Patel,1 T. Nadia,2 K. Schulte,2 N. Mulholland,2 P. Sidhu2 1 Radiology, Kings College Hospital, London/UK, 2Kings College Hospital, London/UK Purpose: Nearly all reported parathyroid cancers are .15mm at presentation. The objective was to identify ultrasound criteria of malignancy in parathyroid lesions of .15mm in size. Material & Methods: A retrospective review of patients identified from a database from 2004-2009 was performed. Two trained observers categorized ultrasound findings using the pre-determined features: shape, calcification, pattern of vascularity, local infiltration and internal lesion gray-scale appearances. Results: 69 patients (mean age 54.3 years, range 19-79 years; male 5 16, female 5 53) fulfilled the criteria of a parathyroid lesion .15mm; 8/69 (11.6%) with parathyroid cancer and 61/69 (88.4%) with benign solitary parathyroid adenoma. A high positive predictive value (PPV) for cancer was identified for infiltration (PPV 100%) and calcification (PPV 100%), whilst a high negative predictive value (NPV) was found for the absence of suspicious vascularity (NPV 97.6%), a thick capsule (NPV 96.7) and inhomogeneity (NPV 100%).
Ultrasound in Medicine and Biology
Conclusion: CEUS-guided biopsy in renal and adrenal tumors is a very accurate procedure. PEB should be performed always with CEUS guidance in patients with large tumors or those with liquid areas.
Sun, Aug 28, 2011 Hall I SS 18 10:30-12:00 Head and Neck 2 - Thyroid and Other Small Parts SS 18.01 Computerized Detection and Quantification of Microcalcifications in Thyroid Nodules K. Chen,1 C. Chen,1 M. Wu,1 M. Ho,1 H. Tai,1 Y. Chung,2 A. Chen,3 K. Chang4 1 Department of Surgery, National Taiwan University Hospital, Taipei/TW, 2Department of Surgery, Hsin Chu General Hospital, Hsin Chu City/TW, 3Graduate Institute of Industrial Engineering, National Taiwan University, Taipei/TW, 4Department of Surgery, Cheng Ching General Hospital, Taipei/TW Purpose: In order to improve the ultrasonographic diagnostic rates of thyroid cancers, we propose to evaluate the sonographic calcifications and echotexture by a computerized quantification method in a prospective setting. Material & Methods: A total of 227 participants with 258 nodules were evaluated. Among them, 2 nodules were excluded for suspicious aspiration cytology results without pathologic proof. Among the rest 256 nodules, the diagnosis of 181 nodules was verified by surgical pathology, and the diagnosis of 75 were based on FNA biopsy results There were 173 benign thyroid nodules and 83 malignant thyroid nodules, which included 74 papillary carcinomas. Patient clinical data were collected, and the conventional gray-scale ultrasound evaluation was restrospectively reviewed. Quantification of cystic components, echotexture and calcifications was automatically performed by a proprietary program. The calcification index (CI) and heterogeneity (HI) were calculated. Results: The CI and HI between benign and malignant nodules diagnosed by combined FNA biopsy and surgical pathology results (total number, 256) showed a significant difference (p,0.001, AUC 5 0.746; p,0.001, AUC 5 0.664). Furthermore, we excluded patients without surgical pathology results for further validation, and the CI and HI between benign and malignant nodules confirmed by pathology results (total number, 181) showed a significant difference (p,0.001; p,0.001). Conclusion: This new computer-aided diagnosis method to evaluate the sonographic calcifications and heterogeneity of thyroid nodules is a more sensitive and more objective method. SS 18.02 The Diagnostic Efficiency of Ultrasound in Characterization of Thyroid Nodules: How Many Criteria Are Needed? A. Ozel,1 S. M. Erturk,1 A. Ercan,1 B. Yilmaz,2 T. Basak,2 Z. Karpat,1 M. Basak1 1 Radiology, Sisli Etfal Research and Training Hospital, Istanbul/TR, 2 Pathology, Sisli Etfal Research and Training Hospital, Istanbul/TR Purpose: The purpose of this study was to define the criteria for use in differentiating benign from malignant nodules with the help of the receiver operating characteristic analysis and to increase the objective diagnostic accuracy of ultrasonography. Material & Methods: A total of 363 patients (307 women, 56 men) with 363 nodules (22 malignant and 341 benign) were included in the
Volume 37, Number 8S, 2011 study. The presence and absence of each US feature of the evaluated nodule – shape taller than wide, irregular margin, hypoechogenicity, microcalcification, intranodular vascularity – were scored 1 and 0, respectively. The total ultrasound score was obtained by summing up of each positive ultrasound findings for malignancy. The effect of the total US score in the discrimination of benign and malignant nodules was analysed using ROC analysis. Results: The cut-off values of US score for nodules larger and smaller than one centimeter were two (Az: 0.783) and three (Az: 0.935), respectively. For the nodules greater than one centimeter, the sensitivity, specificity, positive predictive value and negative predictive value, and accuracy were 62.5%, 91.5%, 30.3%, 97.7%, and 89,9%, respectively. For the nodules smaller or equal to one centimeter, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 83.3%, 94.9%, 62.5%, 98.2%, 93.8%, respectively. Conclusion: Using ultrasound, thyroid nodules can be characterized effectively. The number of the US features used in this distinction varies in respect to nodule size. SS 18.03 Retrospective Study of Sonographic Appearance of Autoimmune Thyroiditis in a Tertiary Center S. Sundararajan Radiology, Madras Medical mission, Chennai/IN Purpose: The purpose of this work was to assess the validity of an ultrasonographic sign, micronodulation, in the diagnosis of Hashimoto thyroiditis. Material & Methods: Among 100 patients found to have ultrasonographic features of micronodulation, 40 patients had autoantibody test results available. Results: The positive predictive value for micronodulation in diagnosing Hashimoto thyroitis is 94.7%. The micronodules were 0.1 to 0.85 cm in size, hypoechoic, and surrounded by an echogenic rim. This corresponds to accentuated lobulation on the pathologic specimen. Fifty percent patients showed septations on USG indicating fibrosis and hence disease of some duration. Conclusion: Although micronodulation is highly diagnostic of Hashimoto thyroiditis, the ultrasonographic features of Hashimoto thyroiditis varied and were not specific for the disease. SS 18.04 Ultrasound Features of Malignancy in the Preoperative Diagnosis of Parathyroid Cancer: A Retrospective Analysis of Parathyroid Tumours Larger Than 15mm P. N. Patel,1 T. Nadia,2 K. Schulte,2 N. Mulholland,2 P. Sidhu2 1 Radiology, Kings College Hospital, London/UK, 2Kings College Hospital, London/UK Purpose: Nearly all reported parathyroid cancers are .15mm at presentation. The objective was to identify ultrasound criteria of malignancy in parathyroid lesions of .15mm in size. Material & Methods: A retrospective review of patients identified from a database from 2004-2009 was performed. Two trained observers categorized ultrasound findings using the pre-determined features: shape, calcification, pattern of vascularity, local infiltration and internal lesion gray-scale appearances. Results: 69 patients (mean age 54.3 years, range 19-79 years; male 5 16, female 5 53) fulfilled the criteria of a parathyroid lesion .15mm; 8/69 (11.6%) with parathyroid cancer and 61/69 (88.4%) with benign solitary parathyroid adenoma. A high positive predictive value (PPV) for cancer was identified for infiltration (PPV 100%) and calcification (PPV 100%), whilst a high negative predictive value (NPV) was found for the absence of suspicious vascularity (NPV 97.6%), a thick capsule (NPV 96.7) and inhomogeneity (NPV 100%).