Objectives The aims of this study were to investigate the correlation between osteopontin expression and microcalcification seen on sonograms of human papillary thyroid carcinoma and to explore the mechanism of microcalcification in these tumors. Methods Real-time reverse transcription–polymerase chain reaction and immunohistochemistry were used to determine expression levels and locations of osteopontin in 56 pathologically verified papillary thyroid carcinoma nodules. Osteopontin expression correlated with microcalcification and other sonographic signs recorded preoperatively. Results Osteopontin expression in the papillary thyroid carcinoma group was significantly enhanced compared with the control group for both messenger RNA and protein levels (P < .05). Osteopontin expression was significantly related to microcalcification and lymph node metastasis (P < .05), as shown on sonography. Conclusions Our results suggest a possible role for osteopontin in the formation of microcalcification in papillary thyroid carcinoma; the sonographic signs can reflect the pathologic and biological behavior of these tumors.
This study compares the accuracy and safety of pedicle screw placement using a 3D navigation template with the free-hand fluoroscopy technique in scoliotic patients. Fifteen scoliotic patients were recruited and divided into a template group (eight cases) and a free-hand group (seven cases). All patients received posterior corrective surgeries, and the pedicle screw was placed using a 3D navigation template or a free-hand technique. After surgery, the positions of the pedicle screws were evaluated using CT. A total of 264 pedicle screws were implanted in 15 patients. Both the two techniques were found to achieve satisfactory safety of screw insertion in scoliotic patients (89.9% vs. 90.5%). In the thoracic region, the 3D navigation template was able to achieve a much higher accuracy of screw than the free-hand technique (75.3% vs. 60.4%). In the two groups, the accuracy rates on the convex side were slightly higher than on the concave side, while no significance was seen. In terms of rotational vertebrae, no significant differences were seen in Grades I or II vertebrae between the two groups. In conclusion, the 3D navigation template technique significantly increased the accuracy of thoracic pedicle screw placement, which held great potential for extensively clinical application.
Abstract Background Distant metastases stemming from a papillary thyroid carcinoma (PTC) are quite rare. Here we report an exceptional case of PTC presenting with cervical lymphatic and uterine metastases. This is the first case report of a PTC with uterine involvement. Case presentation A 60-year-old Chinese woman came to our hospital complaining of discomfort in the throat that she had been experiencing for about half a month. PTC and cervical lymphatic metastasis were diagnosed after ultrasound examinations. A massive heterogeneous mass was found beside the uterus during the pre-operative checkup and a diagnosis of ovarian carcinoma was suspected after a thorough case discussion. However, it proved to be a metastasis from the PTC as determined by pathological and immunohistochemical examinations after the operation. The patient declined further treatments. She was followed for 22 months with no sign of recurrence detected. Conclusions In this report, an unusual case of PTC was presented. The patient had not only regional lymphatic metastasis, but also had a massive metastasis in the uterine corpus, which was initially misdiagnosed as ovarian carcinoma. This case is of interest because of its rarity and exceptionally good prognosis. The reason for the misdiagnosis was attributed to overlooking the possibility of a distant metastasis coming from a PTC. This case raises the issue that completing an iodine-131 scan before operating on patients with PTC may be warranted.
Objective
To explore the correlation between quantitative parameters of blood perfusion with contrast-enhanced ultrasound (CEUS) and microvessel density (MVD), microvessel area (MVA) in papillary thyroid carcinoma (PTC). And to investigate the value of CEUS in evaluating the angiogenesis in PTC before operation.
Methods
Totally 69 cases of patients with papillary thyroid carcinoma were selected from April 2014 to October 2016 in the Affiliated Hospital of Qingdao University. The CEUS characteristics of 69 patients with papillary thyroid carcinoma confirmed by pathology were retrospectively analyzed. The patients were divided into three groups according to maximum diameter of lesions ( 2.0 cm group), and two groups according to pathologic reports (neck lymph node metastatic and nonmetastatic groups). The blood perfusion parameters between or among different groups were evaluated by ″t″test or one-way ANOVA. Immunohistochemical staining were performed to evaluate the MVD, MVA in the surgical specimens, and the correlation of quantitative parameters with MVD, MVA were assessed by Spearman.
Results
(1) Peak Intensity (Peak), area under the curve (AUC), MVD and MVA of thyroid carcinoma were lower than the surrounding normal thyroid tissue (14.95±4.96 vs 22.67±6.11, 970.01±263.20 vs 1798.35±563.67, 118.91±31.32 vs 206.27±39.58, 8.58±2.68 vs 18.47±3.13), and the differences were statistically significant (t=-8.700, -11.061, -14.377 and -20.532, all P 0.05).
Conclusions
The values of Peak and AUC calculated from CEUS were correlated to MVD and MVA. CEUS may be used to evaluated the angiogenesis of PTC before operation. And CEUS is helpful for prediction of prognosis of PTC.
Key words:
Thyroid neoplasms; Ultrasonography; Microvessels
To evaluate the differential diagnostic potential of lesion stiffness assessed by the sonoelastographic strain index ratio (SR) for thyroid nodules coexist with Hashimoto thyroiditis (HT).A total of 50 focal thyroid nodules from 36 patients with HT (mean age 38.4 years; range 19-77) scheduled for fine-needle aspiration or thyroid surgery were included. After a routine conventional ultrasound evaluation, real-time ultrasound elastography examinations were performed. Strain and area ratios of each lesion were calculated within the same machine. Histological diagnosis was used as the reference standard. The elastography images were scored according to the Asteria elasticity score. The area under the curve (AUC) and cut-off point were obtained by receiver operating curve (ROC). Sensitivity, specificity and accuracy were compared.A total of 38 nodules were benign and 12 were malignant on pathology. The mean strain ratios of benign and malignant lesions were 2.89 and 7.83 respectively. When a cut-off point of 5.03 was used, SR had a sensitivity of 75.0%, a specificity of 92.1% and an accuracy of 84.0%. The AUC values were 0.836. The diagnostic accuracy of the SR was superior to that of elastographic score.Real-time elastography is a promising tool for differential diagnosis of thyroid nodules coexist with HT, and SR measurement could be an effective predictor. The best cut-off point for benign and malignant nodules in patients with HT was 5.03.
Objective
To investigate the influencing factors of strain ratio(SR) value in differential diagnosis of benign and malignant thyroid nodules by using real-time tissue elastosonography (RTE).
Methods
One hundred and seventy-one patients with a total of 171 thyroid nodules were analyzed retrospectively.Their images, including 2D ultrasound, color Doppler flow imaging (CDFI) and RTE were reviewed and conventional ultrasonic features(including the maximum diameter, composition, shape, magin, calcification, intranodular blood flow, depth) and SR value were recorded. Receiver-operating characteristic (ROC) curve was employed to assess the diagnostic efficiency of SR value in differentiating malignant nodules from benign ones. Firstly, the correlation between the aforementioned factors and SR value was assessed by using malignant lesions as the research subjects. And then, the multiple linear regressions (MLR) was employed to evaluate the influence of particular features which turned out to be an important disturbing factor affecting SR value of the lesion in the first step of analysis and pathological type in all nodules (benign and malignant) on SR value.
Results
With a cut-off point of SR value 3.67, the sensitivity and specificity of SR value in differential diagnosis of benign and malignant thyroid nodules was 85.6% and 81.1%, respectively, and the area under ROC curve was 0.891. Correlation between the maximum diameter and calcification and SR value was significant(r=0.345 and 0.261 respectively, P<0.05). However, there was no significant correlation between other features(5 factors) and SR value(P≥0.05). MLR indicated that the maximum diameter, calcification and the type of pathology of the nodule were associated with SR value (P<0.05). Among them, pathological nature was the most significant impact factor with a standardized coefficient 0.494).
Conclusions
SR value can be used to evaluate the hardness of thyroid nodules semi-quantitatively.Its value mainly depends on the pathological nature of the nodules. The maximum diameter and calcification are also the influencing factors of SR value.However, the composition, shape, margin, intranodular blood flow and depth have no obvious effect on SR value.
Key words:
Elasticity imaging techniques; Thyroid nodule; Strain ratio
To observe the clinical effects of treating retinal vein occlusion by argon ion Laser and medicine,72 case with retinal vein occlusion were analyzed respectively.
Ultrasonography-guided fine-needle aspiration biopsy is the common choice for diagnosis of the suspected thyroid nodule. An algorithm(s) that finds the malignant potential of a nodule preoperatively, to overcome unnecessary diagnostic methods, does not exist. The objective of the study was to correlate thyroid nodule sizes measured by ultrasonography and risk of malignancy assessed by cytologic and histologic examinations. Data regarding fine-needle aspiration cytology and the results of histologic examinations of surgical specimens of 260 nodules were collected and analyzed. The macro or multiple calcifications, the complex echo pattern, and posterior region homogeneity were considered suspicious in ultrasonography. Bethesda system for classification of thyroid nodules was used for cytopathology. Histopathology performed as per the 2004 World Health Organization classification system. The benefit score analysis was performed for determination of clinical usefulness. Twenty-eight of 49 malignant nodules and 46 of 68 malignant nodules detected through ultrasound following fine-needle aspiration cytopathology and histopathology were <2 cm in size. A correlation was found for malignancy rate detected by ultrasonography-guided fine-needle aspiration cytology and those of the surgical specimen (r = 0.945, P = .015, R 2 = 0.894). Ultrasonography-guided fine-needle aspiration cytology had 0.994 sensitivities, 0.721 accuracies, and 0.08 to 0.945 diagnostic confidence for the detection of malignant nodules. Nodule size less than 2 mm (P = .011) was associated with the malignancy potential of thyroid nodules. Ultrasonography-guided fine-needle aspiration cytology had 19 (7%) results as a false negative and 1 (1%) results were false positive. Ultrasound-guided fine-needle aspiration cytopathology reported oversize of thyroid nodule than original but can predict the risk of malignancy. Level of Evidence: III.
Objective To explore the value of virtual touch tissue quantification (VTQ) elastography and its influencing factors in identifying benign and malignant thyroid nodules.Methods A retrospective analysis was conducted in 210 cases of 240 thyroid nodules.Their images,including 2D ultrasound,color Doppler flow imaging (CDFI) and VTQ elastography,were reviewed,and the scanning view,the maximum diameter of the nodule,inside blood flow,calcifications and its depth beneath the skin were recorded.The value of shear wave velocity(SWV) in identifying benign and malignant thyroid nodules was calculated using receiver operating characteristic (ROC) curve.The influences of the maximum diameter of the nodules,calcifications,internal blood flow,the depth beneath skin and scanning views as well as type of pathology on the value of SWV were analyzed using multiple linear regressions (MLR).Results The sensitivity and specificity of VTQ in differential diagnosis of benign and malignant thyroid nodules was 74.8％ and 73.4％,respectively,and the area under ROC curve was 0.799.MLR indicated that the maximum diameter of the nodule,the type of pathology and internal blood flow were correlated with the SWV value (P ＜0.05),of which,the type of pathology was the important factor (standardized coefficient was-0.312).Microcalcifications,the depth of the nodules located and the scanning surface were not significantly related to SWV value (P ＞0.05).Conclusions VTQ can quantitatively provide the information on the hardness of thyroid tissue,which is of a definite value in the differential diagnosis of the nodules.The pathology of the nodule,its internal blood flow and maximum diameter are the factors that affect the value of SWV,and not its depth,scanning views and microcalcifications.
Key words:
Ultrasonography; Thyroid nodules; Virtual touch tissue quantification
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