Sonographic evaluation of thyroid nodule based on thyroid imaging reporting and data system classification and its correlation with fine needle aspiration cytology findings

Background: Thyroid nodules, common clinical occurrences, often require diagnostic assessment. Ultrasonography (USG) is primary non-invasive method for detection, with advancing technology enhancing detection capabilities. Fine needle aspiration cytology (FNAC) remains standard but poses risks and expenses. American college of radiology-thyroid image reporting and data system (ACR-TIRADS), introduced in 2017, offers a systematic scoring system based on ultrasound features. This study aims to evaluate USG guided by ACR-TIRADS for accurate nodule classification. Methods: A 1.5-year study at department of radio-diagnosis of BSMCH evaluated thyroid nodules using high-resolution USG based on ACR-TIRADS criteria, followed by FNAC for selected cases, comparing results for concordance. Results: Out of 47 thyroid nodules evaluated, 19.1% were malignant and 80% benign. ACR-TIRADS demonstrated sensitivity, specificity, and accuracy of 66.7%, 87.8%, and 82.9%, respectively. Higher ACR-TIRADS categories correlated with an increased risk of malignancy. Suspicious USG features such as hypo-echogenicity, taller-than-wide shape, lobulated margin, and punctate echogenic foci exhibited significant predictive value for malignancy, with varying levels of sensitivity and specificity. Overall, USG parameters demonstrated notable accuracy in identifying malignant nodules. Conclusions: ACR-TIRADS 2017 reliably predicts thyroid nodule malignancy, reducing unnecessary FNAC procedures, minimizing patient discomfort, and optimizing healthcare resources.

Role of ultrasonography in evaluation of right iliac fossa mass compared to CT scan

Background: With the demonstration of origin and nature of RIF mass by high-resolution ultrasound and multidetector CT scan, the patients presenting with clinically palpable mass in RIF need not to undergo time consuming, uncomfortable and unpalatable barium study. The objective is to evaluate the diagnostic precision of CT and ultrasonography in the diagnosis of right iliac fossa masses and to assess the effectiveness of USG in diagnosing various right iliac fossa masses in comparison with CT scan in terms of sensitivity, specificity, and predictive accuracy. Methods: The study was conducted on 35 patients presenting with right iliac fossa mass who were stable enough to undergo USG followed by CT scan. The time gap between these studies had kept to minimum to make the studies comparable. USG and CT scan was performed by 2 expert radiologists, who had been blinded of each other findings. Results: More than 50% cases were related to appendicular pathology. Ultrasound abdomen had a sensitivity and specificity of 88.9% and 94.11% in diagnosis of appendicular mass, 71.42% and 96.42% in diagnosis of appendicular abscess, 66.7% and 96.6% in diagnosis of ileo-caecal tuberculosis, 50% and 100% in diagnosis of carcinoma caecum respectively as compared to CT scan. Conclusions: USG is the most easily available bed side investigation and excellent screening test for RIF mass. However, CECT whole abdomen remains the gold standard investigation for etiological diagnosis of RIF mass.

Sonomammographic and sonoelastographic evaluation of benign and malignant breast lesions and its correlation with fine needle aspiration cytology

Background: Breast cancer affects 25.8% of women worldwide. Mammography and ultrasound have sensitivity, but invasive breast biopsies and aggressive biopsies are essential. Sonoelastography is a non-invasive imaging method that can measure tissue stiffness related to different pathologic conditions, such as cancer. Objective is to assess the diagnostic accuracy of sonomammography and sonoelastography in diagnosing breast lesions as benign or malignant in correlation with fine needle aspiration cytology (FNAC) as gold standard. Methods: This study was conducted on 52 female patients with breast mass and sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), kappa and p value of conventional gray scale ultrasound and ultrasonography (USG) elastography were calculated and compared with that of FNAC. Ultrasound was performed using grayscale and elastography mode on GE LOGIQ P9 ultrasound equipment with a 7-12 MHz linear-array transducer. All cases with breast lesions identified on ultrasound elastography underwent FNAC. Results: The sensitivity, specificity, PPV, NPV of sonoelastography were 78.5, 94.7, 84.6, 92.3 with kappa 0.75 and p value <0.0001. Similarly, sensitivity and specificity for strain ratio were 85.7 and 97.4, and that for size ratio were 85.7 and 100 respectively. These results are comparable to or better than results for conventional ultrasound. Conclusions: Breast elastography makes it easier to classify BIRADS 3 category lesions which are benign but still confused as malignant on conventional USG. BIRADS category 3 and 4 lesions with benign findings on sonoelastography can be downgraded to category 2 and 3 respectively thus reducing the number of false positive malignancy cases and biopsy.

Consistency and percentage agreement of preoperative surface marking of subcutaneous foreign body by colour comet tail artefact with its intra-operative positional findings – A prospective study

Background: Exact surface localization of foreign body is vital prior to its surgical removal. Preoperative localization errors lead to excessive soft tissue exploration, prolonged surgery, increased morbidity and post-surgical complications. Sarkar KN, Mandal SK, Kabiraj P, Mallik R, Gupta DK, Sarkar M. Consistency and percentage agreement of preoperative surface marking of subcutaneous foreign body by colour comet tail artefact with its intra-operative positional findings - A prospective study. IAIM, 2016; 3(6): 32-41. Page 33 Aim: Determination of percentage agreement of preoperative surface marking of subcutaneous foreign body by colour comet tail artefact with its intra-operative positional findings. Materials and methods: Prospective observational study was conducted on 100 patients over duration of eight months from September 2015 to April 2016 at our institution. Preoperative surface marking of foreign body was done using Ultrasound machine PHILIPS HD7 (2.0.1) with 7 MHz linear transducer, Excel mark premium black stamp ink 2oz, Acco smooth steel wire paper clip, Trade mark 45 cm wooden measuring scale and Apsara glass marking pencil. Percentage agreement of preoperative surface marking of subcutaneous foreign body by colour comet tail artefact with its intraoperative positional findings was studied in 100 patients prospectively. All analysis was done by using IBM SSPS statistics 24 and MS Excel. Results: The color tail artifact technique showed percentage agreement of 93.5% for accurate surface marking of vertical line within ≤ 5 mm of actual location and percentage agreement of 92.5% for surface marking of horizontal line within ≤ 5 mm of actual location. Conclusions: Blind surgical procedures of foreign body removal have been replaced by real time ultrasound guided removal under strict sterile conditions in most of the affluent nations. However in developing nations and semi urban places where there is limited and underrated sterilization and disinfection technique, real time ultrasound procedures for foreign body removal remains a challenging option. This study shall suffice to the needs of developing nations and semi urban places with precise preoperative surface localization, advantages of minimal surgical exploration, minimal local tissue injury, reduced patient’s morbidity and no real time ultrasound associated nosocomial infection. The study shall also be helpful with special emphasis to those underserved villages where surgeons still rely on blind foreign body removal procedures, causing massive tissue exploration, increased hospital stay, increased cost of treatment, failure of removal and increased patients morbidity.

Prevalence of nonalcoholic fatty liver disease in coastal eastern India: a preliminary ultrasonographic survey.

Non-alcoholic fatty liver disease (NAFLD) is a common clinical condition which is fast assuming importance as a possible precursor of more serious liver disorders, including cirrhosis of the liver and hepatocellular carcinoma. There are no data in the published English literature on the prevalence of NAFLD in India. The present study was performed to assess a prevalence of NAFLD by ultrasonography in a general population in coastal eastern India. Asymptomatic, apparently healthy attendants accompanying the patients attending the Gastroenterology outpatient were subjected to abdominal ultrasonographic examination for the presence of fatty liver; individuals who gave a history of alcohol abuse were excluded from the study. The subjects of the study comprised 159 apparently healthy attendants, who underwent ultrasonography. Fatty liver was diagnosed by ultrasonography in 39 of these 159 persons (24.5%). Fatty liver was seen more commonly in males (26.9%) than in females (13.8%). Persons with ultrasonographic fatty liver had a higher body mass index (BMI) (mean 25.9 +/- 4.17 kg/m2) than persons without fatty liver (mean 22.1 +/- 3.27 kg/m2) (p<0.001). The estimated prevalence of NAFLD in an unselected apparently healthy and asymptomatic population as detected by ultrasonography in our study was found to be 24.5%. This is similar to the prevalence rate published from the west. However, contrary to figures from the west, males appeared to have a greater predilection for fatty liver than females in our study. NAFLD is perhaps as common in developing world as in the developed countries despite a lower prevalence of obesity. Indian males may have a greater genetic predisposition to developing NAFLD.

Cryptococcal lymphadenitis and meningitis in human immunodeficiency virus infection--a case report.

Cryptococcal meningitis (CM) is the commonest life threatening opportunistic fungal disease in Human Immunodeficiency Virus (HIV) infected individuals. But there are very little reports of lymphadenopathy along with cryptococcal meningitis, although cases of pulmonary, Intestinal, Bone marrow and retinal involvement have been described earlier. Here we report a case of cryptococcal meningitis associated with generalized lymphadenopathy and hepatosplenomegaly.

Fine needle aspiration as a primary diagnostic procedure of breast lumps.

Two hundred and sixty-seven patients from the ages between 17 to 70 years with breast lumps attending the Cytology Clinic of the Out-patients Department and Cytology Section of the Department of Pathology, M.K.C.G. Medical College, Berhampur (Orissa), were subjected to Fine-Needle Aspiration Cytology (FNAC). Sixty-four patients were discarded from study because of non-availability of biopsy specimens and unsuitable smears. When cytological results were compared with those of histological sections, 100 per cent correct diagnosis was made in chronic mastitis and lobular carcinoma, 94.24 per cent in infiltrating duct carcinoma and 84.60 percent in duct papilloma and with the maximum over diagnosis to the tune of 14.75 per cent was found in fibro-adenoma. An overall correct diagnosis was made in 88.67 percent of cases by FNAC.