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Objective:To investigate the value of CT tumor-thyroid marginal contact range (MCR) for predicting capsular invasion and cervical lymph node metastasis in papillary thyroid carcinoma (PTC) with a diameter>1.0 cm and papillary thyroid microcarcinomas (PTMC) with a diameter ≤ 1.0 cm, and to evaluate the diagnostic efficacy of direct CT signs for lymph node metastasis.Methods:The CT data of 148 patients with PTC (>1.0 cm) and 193 patients with PTMC confirmed by surgery and pathology were retrospectively analyzed from January 2017 to April 2020 at Hangzhou First People′s Hospital. MCR was evaluated based on CT images and classified as<1/4 tumor circumference or ≥1/4 tumor circumference. Direct CT signs of cervical lymph nodes were observed, including cystic change, microcalcification, hyperenhancement, short/long diameter≥0.5, clustered lymph nodes or central area turbidity. The difference in the distribution of MCR between PTC (>1.0 cm) and PTMC was compared using the χ 2 test, and the efficiency of MCR and direct CT signs for diagnosing capsular invasion and lymph node metastasis was calculated using the pathological results as the gold standard. Results:In 148 PTC (>1.0 cm) and 193 PTMC patients, the pathological results showed capsular invasion in 88.5% (131/148) and 57.0% (110/193), and lymph node metastasis in 71.6% (106/148) and 44.0% (85/193), respectively. In PTC (>1.0 cm) patients, MCR≥1/4 tumor circumference was more common in patients with capsular invasion (χ2=22.211, P<0.001) and lymph node metastasis (χ2=4.746, P=0.029), and the corresponding sensitivity and specificity for predicting capsular invasion and lymph node metastasis were 84.7% (111/131) and 64.7% (11/17), 83.0% (88/106) and 33.3% (14/42), respectively. In PTMC patients, MCR≥1/4 tumor circumference was more common in patients with capsular invasion (χ2=66.066, P<0.001) and lymph node metastasis (χ2=5.343, P=0.021), and its sensitivity and specificity for predicting capsular invasion and lymph node metastasis were 87.3% (96/110) and 69.9% (58/83), 71.8% (61/85) and 44.4% (48/108), respectively. The sensitivity and specificity of direct CT signs for diagnosing lymph node metastasis in PTC (>1.0 cm) and PTMC were 89.6% and 73.8%, 69.4% and 76.9%, respectively. Conclusions:Both direct CT signs and MCR ≥ 1/4 tumor circumference can predict cervical lymph node metastasis in PTC patients, and the former had higher sensitivity and specificity. MCR≥1/4 tumor circumference has high efficiency for predicting capsular invasion in PTC patients.
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Objective:To investigate the predictive value of lymph node size for ipsilateral central lymph node metastasis (ICLNM) of papillary thyroid microcarcinoma (PTMC) in CT examination.Methods:The CT data of 229 patients with single PTMC admitted to the Department of Oncology, Hangzhou First People’s Hospital, Affiliated to Zhejiang University School of Medicine from Jan. 2018 to Jun. 2019 were retrospectively analyzed. All cases were confirmed by surgery and pathology. The ipsilateral central lymph nodes were divided into <0.2 cm group, 0.2-0.4 cm group and ≥0.4 cm group according to their maximun diameters, and the distribution difference of positive and negative ICLNM among the three groups were observed and analyzed by χ 2 test. Results:In 229 PTMCs, the proportion of positive and negative ICLNM were 29.69% (68/229) and 70.31% (108/155) , respectively. Positive ICLNM in <0.2 cm group, 0.2-0.4 cm group and ≥0.4 cm group accounted for 11.43% (16/140) , 64.29% (36/56) and 81.82% (27/33) , respectively. When 0.2 cm and 0.4 cm were used as the threshold to determine positive ICLNM, the values of χ 2 and P between groups were 87.663 and <0.001. The sensitivity and specificity of diagnosing lymph node metastasis were 79.75% (63/79) and 82.67% (124/150) , 34.18% (27/79) and 96% (144/150) , respectively. The proportions of high enhancement, calcification and cystic degeneration were 3.2% (5/155) , 0.7% (1/155) and 0 (0/155) , respectively. Conclusions:In CT examination of patients with PTMC, the diameter of lymph nodes less than 0.2 cm highly indicates negative ICLNM. The proportion of positive ICLNM increased with increasing lymph node diameter, and the diameter of lymph nodes less than 0.4 cm highly indicates positive ICLNM.
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Objective:To investiqate the clinical and CT features of anaplastic thyroid carcinoma.Methods:The clinical and CT data of 23 anaplastic thyroid carcinoma patients were retrospectively analyzed, mainly including gender, age, chief complaint, and CT signs such as tumor size, distribution status, morphology, calcification, necrosis, peripheral invasion, lymph node metastasis and lung metastasis.Results:Among 23 cases of ATC, the ratio of male to female was 7∶16. 21 cases (91.3%) had hoarseness or cervical mass, 8 cases (34.8%) had rapid enlargement of tumor size, 6 cases (26.1%) with lesion in unilateral lobe, 8 cases (34.8%) in unilateral lobe + isthmus, 9 cases (39.1%) in bilateral lobe + isthmus, diameter of tumors was (6.1 ± 1.7) cm, 20 cases (87.0%) had irregular shape of tumors. 16 cases (69.6%) with rough calcification, 17 cases (73.9%) with extensive necrosis, 15 cases (65.2%) with tracheoesophageal groove extension, 18 cases (78.3%) with cervical lymph node metastasis, 8 cases (34.8%) with lung metastasis, 16 cases (69.6%) with trachea invasion, 7 cases (30.4%) with common carotid artery invasion, and 10 cases (43.5%) with internal jugular vein invasion.Conclusions:The clinical features include elderly women patients, big tumors size, rapid enlargement of tumor size, CT signs include irregular shape, coarse calcification, extensive necrosis, tracheoesophageal groove extension, cervical lymph node metastasis, lung metastasis and invasion of trachea, common carotid artery and internal jugular vein. These features have great value in the diagnosis of ATC and evaluation of peripheral structure invasion, cervical lymph node metastasis and distant metastasis.
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Objective:To investigate the value of CT enhancement degree in diagnosing cervical lymph node metastasis of papillary thyroid carcinoma (PTC) .Methods:CT data of 535 neck lymph nodes with pathological diagnosis in 251 cases were retrospectively analyzed. The ratio and difference between the density of CT enhancement and plain scan were calculated. Mann-Whitney test was used to analyze the distribution of ratio and difference in lymph node metastasis group and non-metastasis group. The optimal thresholds of ratio and difference in the two groups were obtained by receiver operating characteristic (ROC) curve analysis.Results:535 cervical lymph nodes including 271 in metastatic group and 264 in non-metastatic group. The ratios of two groups were 2.30 (2.04, 2.76) and 1.66 (1.51, 1.81) ( Z=-16.94, P<0.05) respectively, and the differences were 58 (49, 76) Hu and 31 (22, 36) Hu ( Z=-18.045, P<0.05) respectively. When the ROC area under curve of ratio and difference between the two groups were 0.923 and 0.951 respectively, the optimal thresholds were 1.93 and 39.5Hu respectively. The sensitivity and specificity of diagnosing lymph node metastasis were 84.9% and 87.1%、91.5% and 86.0%respectively.The sensitivity and specificity of combination of the two diagnosing lymph node metastasis were 82.3% and 91.7%. Conclusions:The ratio of enhancement and plain scan density ≥1.93 and the difference ≥39.5Hu have a high diagnostic efficiency for cervical lymph node metastasis of PTC. The specificity of the two is similar, but the latter has higher sensitivity. The combination of the two can significantly improve the specificity, thereby reducing unnecessary surgical trauma.
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Objective:To explore the predictive value of various ultrasonic signs for papillary thyroid microcarcinoma (PTMC) .Methods:The ultrasonic data of of 603 micronodular goiter (MNG) in 396 cases and 640 PTMC in 539 cases, which were confirmed by pathology from Jan. 2013 to Dec. 2016, were retrospectively analyzed. According to the different inspection time, all nodules were divided into model group (2013-2014 years) and test group (2015-2016 years) . The tumor morphology, internal echo, microcalcification, and aspect ratio (A/T) were observed. Chi-square test and multivariate Logistic regression analysis were used to analyze the distribution differences of the four ultrasound features in PTMC and MNG, and their diagnostic value was evaluated.Results:There were statistical difference between model group and test group in ultrasonic signs including tumors shape, internal echo, microcalcification and aspect ratio according single factor analysis (chi square value was 283.540 and 298.119, 63.130 and 87.400, 26.342 and 50.152, 169.918 and 181.405; P<0.05) ;Multivariable Logistic regression analysis showed that irregular shape, hypoecho, A/T>1 and microcalcification were more common in PTMC ( P< 0.05) . OR values were 18.410 and 19.231, 2.560 and 6.380, 9.379 and 6.724, 3.102 and 8.830, and AUC prediction probability values were 0.916 and 0.911 respectively. Conclusions:Irregular shape, internal hypoechoic, microcalcification and A/T>1 are stable important ultrasonographic signs in predicting PTMC. Comprehensive analysis of various ultrasonic signs can improve the diagnostic efficiency.
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Objective To investigate the diagnostic value of lymph node size and distribution in ipsilateral central lymph node metastasis (ICLNM) of single papillary thyroid carcinoma (PTC) in CT examination.Method The CT data of 278 single PTC with diameter ＞ 1.0 cm confirmed by operation and pathology were retrospectively analyzed.According to the ipsilateral central lymph node diameter,these cases were divided into ＜ 0.2 cm group,0.2-0.4 cm group and ≥0.4 cm group,and the distribution difference of ICLNM positive and negative between the three groups were analyzed.Then according to the lymph node distribution,0.2 to 0.4 cm group were divided into turbidity group (≥ 3) and non-turbidity group (1-2),and ≥0.4 cm group were divided into cluster group (≥ 3) and non-cluster group (1-2).The differences betweeen turbidity group and non-turbidity group,cluster group and non-cluster group were analyzed.Results In 278 PTC,the proportion of ICLNM positive and negative was 65.8％(183/278) and 34.2％(95/278),respectively.ICLNM positive in ＜0.2 cm group,0.2-0.4 cm group and ≥0.4 cm group accounted for 37.3％ (31/83),68％ (66/97) and 87.8％ (86/98),respectively.x2 value and P value in between groups and within groups were 51.082 and 0,16.956 and 0,49.955 and 0,11.022 and 0.001,respectively.ICLNM positive in turbidity group and non-turbidity group accounted for 74.0％ (57/77) and 45％ (9/20),respectively.x2 value and P value were 6.151 and 0.013,respectively.ICLNM positive in cluster group and and non-cluster group accounted for 92.6％(50/54) and 82％(36/44),respectively.x2 value and P value were 2.619 and 0.106,respectively.Conclusions Among CT examination of patients with PTC,with the increase of the diameter and number of lymph nodes in central group,the positive proportion of ICLNM positive increases.For the 0.2-0.4 cm group,the turbidity phenomenon suggests that the possibility of metastasis is greater.The accurate identification of these signs can help surgeons take a more thorough surgical treatment and have great significance to reduce postoperative recurrence.
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Objective To investigate the diagnostic value of CT signs of ipsilateral central lymph node metastasis (ICLNM) in single papillary thyroid carcinoma (PTC) by multivariate regression analysis.Methods The CT data of 302 single PTC with diameter ＞1.0 cm confirmed by operation and pathology were retrospectively analyzed.The optimal thresholds of lymph node metastasis diameter were obtained by receiver operating characteristic (ROC) curve analysis.And multivariate regression analysis was used to analyze the relation between lymph node size,degree of enhancement,calcification or cystic degeneration,central turbidity,positive lateral cervical lymph nodes and the ICLNM positivity.Results In 302 PTC,the proportion of ICLNM positive and negative was 63.6％ (192/302) and 36.4％ (110/302),respectively.According to the ROC curve,with the increase of lymph node diameter,the sensitivity of diagnosing lymph node metastasis decreased and the specificity increased.When the threshold was 0.4 cm,Youden index was the largest (0.358),and the sensitivity and specificity was 50.5％ and 80.3％,respectively.Multivariate analysis showed that the diameter≥0.4 cm,high enhancement,central turbidity and lateral cervical lymph nodes positivity were the independent risk factors of ICLNM,and the OR values were 4.189[95％ CI (2.037-8.617)],3.875 [(95％ CI (1.561-9.617)],4.054[(95％CI (2.230-7.371)] and 8.735 [(95％ CI (1.093-69.831)],respectively.Calcification or cystic degeneration was not statistically significant in ICLNM.Conclusions The diameter ≥0.4 cm,high enhancement,central turbidity and lateral cervical lymph nodes positivity are the independent risk factors of ICLNM.Although calcification or cystic degeneration is not the independent risk factor,it has high accuracy for ICLNM positivity.The accurate identification of these signs can help surgeons to take a more thorough surgical treatment and has great significance to reduce postoperative recurrence.
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Objective To explore the value of ultrasound gray scale ratio (UGSR) in the diagnosis and differential diagnosis of papillary thyroid carcinoma(PTC) with different sizes.Methods A retrospective study was made in 702 patients with 1107 nodules which were confirmed by surgery in the Department of Oncology or fineneedle aspiration of HangZhou First people's Hospital,Zhejiang University of medical school from Jan.2016 to Oct.2017.All the thyroid nodules were divided into three groups:D≤ 1 cm group,1＜D≤2 cm group and ＞2 cm group according to their sizes.The UGSR of the PTC and NG were obtained through the RAD info system.Their differences were analyzed and ROC was established to confirm the optimal threshold in the differential diagnosis between PTC and NG among the groups.Results There were 483 PTC and 624 NG in this study.The UGSR of D≤ 1 cm group,1＜D≤2 cm group and ＞2 cm group of PTC and NG were (0.48±0.12) vs (0.76±0.22)(t=33.21,P=0.00);(0.52±0.17) vs(0.80±0.21)(t=1.30,P=0.00) and (0.63±0.20) vs(0.89±0.24)(t=3.58,P=0.00) respectively.The area under the ROC of UGSR in the differentiation of PTC and NG in the three groups were 0.873,0.840 and 0.811 respectively.The Youden indexes were greatest (0.631,0.536 and 0.535 respectively),when the cut-offs of the UGSR were 0.682,0.652 and 0.831 respectively.The sensitivity and specificity to diagnose PTC were 94.8％ and 68.0％,75.0％ and 78.6％,80.3％ and 73.2％ respectively in the three groups.Conclusions The best UGSR value of PTC was variant in thyroid nodule with different size.Recognition of these differences accurately could improve the pre-operative diagnostic accuracy of PTC.Also the method is simple to operate and easy to apply.
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Objective To investigate the diagnostic value of computed tomography (CT) histogram analysis for thyroid malignant solitary coarse calcification nodules (MSCN).Methods A total of 89 thyroid solitary coarse calcification nodules (coarse calcification ≥5 mm,no definite soft tissue around calcification) confirmed either by surgery or histopathological examination in 86 patients enrolled in this study from Jan.2009 to Dec.2015 were evaluated,including 33 MSCN from 32 patients and 56 benign solitary coarse calcification nodules (BSCN) from 56 patients.Overall,27 cut-off values were calculated by N (4 ≤ N ≤ 30) times of 50 Hounsfield units (HU) in the range of 200 HU to 1500 HU,and each cut-off value and the differences in the corresponding area percentages in the CT histogram were recorded for MSCN and BSCN.The optimal cut-off value and the corresponding area percentage were established by receiver operating characteristic (ROC) curve analysis.Results In the 24 groups with an ROC area under the curve (AUC) of more than 0.7,at a cut-off value of 1150 HU and at an area percentage of no less than 98.4％,the ROC AUC reached a maximum of 0.86,and the accuracy,sensitivity,and specificity were 70.8％,93.9％,and 57.1％,respectively.At a cut-off value of 450 HU and at an area percentage of no less than 46.3％,the accuracy,sensitivity,and specificity were 76.4％,48.5％,and 92.9％,respectively.At a cut-off value of 550 HU and at an area percentage of no less than 81.5％,the accuracy,sensitivity,and specificity were 75.3％,33.3％,and 100％,respectively.Conclusions In comparison with the cut-off value of 1150 HU with an area percentage of no less than 98.4％,the sensitivities for the cut-off value of 450 HU with an area percentage of no less than 46.3％ and for the cut-off value of 550 HU with an area percentage of no less than 81.5％ were lower;however,the specificities increased significantly,providing an important basis for reducing the misdiagnosis of MSCN.
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Objective To investigate diagnostic value of CT signs in papillary thyroid carcinoma (PTC) by comparing CT signs of PTC with different sizes.Methods CT signs of 406 PTC from 396 patients confirmed by histology were analyzed retrospectively.Based on the largest tumor diameter,PTC were divided into 1.1-2.0 cm group,2.1-3.0 cm group and＞3.0 cm group.Distribution of irregular shape,cookie bite sign,enhanced narrow/ fuzzy and microcalcification in each group was analyzed.Results There were 318 pieces in 1.1-2.0 cm group,60 pieces in 2.1-3.0 cm group and 28 pieces in ＞3.0 cm group,respectively.The rate of irregular shape was 89.6％(285/318),75.0％(45/60) and 64.3％(18/28) in each group,the rate of cookie bite sign was 83.6％(266/318),71.7％(43/60) and 64.3％ (18/28),and enhanced narrow/fuzzy was 84％(267/318),78.3％ (47/60) and 67.9％ (19/28) in each group,and microcalcification was 35.5％ (113/318),40.0％ (24/60) and 59.3％ (16/27) in each group.The rate of irregular shape (x2=20.092,P=0.000)and cookie bite sign (x2=9.695,P=0.008)had statistical difference among the three groups,while the rate of enhanced narrow/fuzzy(x2=5.175,P=0.075)and microcalcification (x2=5.277,P=0.071) had no statistical difference among each group.Furthermore,irregular shape and cookie bite sign were compared between groups.Rate of irregular shape in 1.1-2.0 cm group and 2.1-3.0 cm (x2=9.746,P=0.002)group,1.1-2.0 cm group and ＞ 3.0 cm group (x2=15.180,P=0.000) was statistically different.Rate of cookie bite sign in 1.1-2.0 cm group and ＞3.0 cm(x2=6.560,P=-0.010)was statistically different.There was no statistical difference between other groups.Conclusions Although irregular shape,cookie bite sign,enhanced narrow/fuzzy and microcalcification are important CT signs in diagnosing PTC,distribution of different signs varies with tumor sizes.Correct identification of these differences will help to improve the accuracy of preoperative diagnosis,and reduce occurrence of misdiagnosis.
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Objective Based on contrasting CT signs distributed in PTC greater than 1.0 cm in diameter and nodular goiters(NG),multiple logistic regression analysis is adopted to make a statistics of what diagnostic value that CT signs have for PTC.Methods Retrospective analysis of CT findings of 288 PTC with diameter ＞1.0 cm in 277 cases confirmed by histology,including nodular form,cookie bite symptom,microcalcifications and en hanced narrowing/blurring was performed,and compared with CT signs of 276 NG in 231 cases with diameter＞1.0 cm.Analysis of various CT signs were performed by multivariate Logistic regression method,and the sensitivity,specificity of positive CT signs and their combinations in PTC diagnosis were calculated.Results Multivariate Logistic regression analysis showed that irregular nodules,cookie bite symptom,microcalcifications and enhanced arrowing/hlurring were often observed in PTC,with OR values of 17.249(95％ CI 8.954-33.227),23.697 (95％ CI 11.653-48.188),4.536 (95％ CI 2.031-10.132),4.672 (95％ CI 8.954-8.999),respectively.The sensitivity,specificity of single CT sign diagnosing PTC were 31.3％-82.3％ and 83.3％-93.1％,respectively.The sensitivity,specificity of two CT signs combinations diagnosing PTC were 24.0％-70.5％ and 96.7％-100％,respectively.The sensitivity,and specificity of three or four CT signs combinations diagnosing PTC were 19.1％-61.5％ and 99.6％ -100％,respectively.Conclusions Although the nodule form,cookie bite symptom,microcalcifications and enhanced narrowing/blurring are the important signs for diagnosing PTC,the OR values of various signs had great difference.The accurate identification of these differences and various CT signs combinations can further improve the specificity of diagnosing PTC,thus reducing misdiagnosis.
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Objective To investigate the diagnostic significance of CT in thyroid benign solitary coarse calcification nodules (BCCN).Methods A total of 56 BCCN confirmed by surgical pathology in 55 patients were evaluated,and they were compared with 33 papillary thyroid carcinoma (PTC) in 32 patients.The distribution differences of the average CT values and the maximum CT values in BCCN and PTC were observed.The optimal thresholds of the average CT values and the maximum CT values in BCCN and PTC were established by re ceiver operating characteristic(ROC) curve analysis.Results The average CT values in BCCN and PTC were significantly different (t=4.992,P=0.000).The ROC area under curve (AUC) was 0.757 (95％ confidence interval 0.0657-0.0857).When the critical value was 743.4 Hu,Youden index was the largest and the sensitivity and specificity was 48.2％ and 93.9％,respectively.When the critical value was 891.1 Hu,the sensitivity and specificity was 21.4％ and 100％,respectively.The maximum CT values in BCCN and PTC were significantly different (t=5.029,P=0.000).The ROC AUC was 0.775 (95％ confidence interval 0.0681-0.0869).When the critical value was 1201.5 Hu,Youden index was the largest and the sensitivity and specificity was 51.7％ and 91.0％,respectively.When the critical value was 1373.5 Hu,the sensitivity and specificity was 42.9％ and 100％,respectively.Conclusions CT value is of great significance to the diagnosis of BCCN and has high specificity.Compared with the average CT value,the maximum CT value has a relatively higher sensitivity,providing an important base for reducing unnecessary surgical trauma.
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Objective To investigate the predictive value of multiple CT signs in the diagnosis of benign and malignant thyroid nodules.Methods The CT data of 1 009 nodules with diameter >1.0 cm confirmed by histology from 931 patients was retrospectively analyzed, including 548 benign nodules from 484 patients and 461 malignant nodules from 447 patients.According to the inspection time, all nodules were divided into model group(2009—2014)and test group(2015—2016).The distribution of nodules with irregular shape, bite cake syndrome, micro calcification, enhanced range reduction/blur, cystic and high enhancement were evaluated in two groups.Univariate and multivariate logistic regression analysis were performed to evaluate the predicting value of multiple CT sighs for benign and malignant thyroid nodules in two groups.Results The numbers of benign and malignant nodules were 252 and 233 in model group,and were 296 and 228 in test group.The univariate logistic analysis of the model group and the test group showed that irregular shape, bite cake syndrome, micro calcification, enhanced range reduction/blur were more common in malignant nodules.OR values were 4.172 and 6.327,3.927 and 3.493,5.354 and 6.674, 11.814 and 5.082,8.680 and 14.562,respectively.The areas under the predicted probability curve were 0.946 and 0.936, respectively.The micro calcification was an independent predictive factor in the multivariate logistic regression analysis in the model group but not in the test group.Conclusion Irregular shape,bite cake syndrome and enhanced blur/range reduction are the CT signs of the stable malignant nodules,cystic and high enhancement are the CT signs of stable and benign nodules.Combination of multiple CT signs could improve the accuracy of diagnosis for Benign and Malignant Thyroid Nodules.
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Objective To explore the value of axillary MRI in differential diagnosis of metastatic axillary lymph nodes in patients with breast cancer.Methods Axillary MRI was performed in 44 breast cancer patients proved by pathology.Long axis,short axis,cortex thickness,ADC value,hilus,margin,perifocal fat gap,signal intensity on DWI,enhancement pattern and time-signal intensity curve were analyzed.The diagnostic ability of long axis,short axis,cortex thickness and ADC value were analyzed with ROC curves.Results Twenty-four patients (24/44,54.55 ％) were proved with metastases axillary lymph nodes,the other 20 patients (20/44,45.45％) were negative.Long axis,short axis,cortex thickness,ADC value,hilus absence,irregular margin,fuzzy perifocal fat gap,high signal intensity on DWI and heterogeneous enhancement showed statistically significant between patients with metastatic and without metastatic axillary lymph nodes (all P＜0.05).The area under ROC curve of long axis,short axis,cortex thickness and ADC value were 0.797,0.765,0.848,0.749 respectively.Conclusion MRI plays an important role in differential diagnosis of axillary lymph nodes me tastasis.The cortex thickness larger than 0.54 cm can help to predict metastatic axillary lymph nodes.
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Objective To assess the value of CT in identification and diagnosis of benign and malignant calcified thyroid nodules.Methods Retrospective analysis was performed on the CT data of 313 surgically and pathologically confirmed cases with 378 calcified nodules.Based on the size,morphology,and number,calcification was divided into microcalcification (d≤2 mm and axis displayed in only one cross-section),coarse calcification (d＞2 mm or displayed in two or more cross-sections),annular calcification (arc or annular),and multiple microcalcifications (solitary multiple microcalcification without a soft tissue lump);a distribution of microcalcification,coarse calcification,and annular calcification as well as a clearer enhanced periphery or internal calcification than nonenhanced data in benign and malignant thyroid nodules were observed.Results The 378 nodules consisted of 259 benign nodules (68.5％) (all were nodular goiters) and 119 malignant nodules (31.5％) (including 111 papillary thyroid carcinomas,4 follicular carcinomas,3 medullary thyroid carcinomas and 1 lymphoma).Microcalcification was more common in malignant nodules (MNs) than in benign nodules (BNs),with a rate of 43.6％ vs 12.4％,respectively (P≤0.05),and its sensitivity,specificity,positive predicted value,and negative predicted value were 42.9％,87.6％,61.4％ and 76.9％,respectively.Coarse calcification,annular calcification,and clearer enhanced periphery or internal calcification than nonenhanced data were more common in BNs than in MNs,with rates of 52.9％ vs 20.2％ (P≤0.05),66.0％ vs 42.0％ (P≤0.05) and 43.2％ vs 19.3％ (P≤0.05),respectively,whose sensitivity,specificity,positive predicted value and negative predicted value were 66.0％ vs 22.4％ vs 43.2％,58.0％ vs 86.6％ vs 80.7％,77.4％ vs 78.4％ vs 83％,and 43.9％ vs 33.9％ vs 39.8％,respectively.Two multiple microcalcifications without a soft tissue lump were MNs (papillary thyroid carcinoma).Conclusions Microcalcification and multiple calcifications are conducive to the diagnosis of MNs,whereas coarse calcification,annular calcification,and clearer enhanced periphery or internal calcification than nonenhanced data benefit the diagnosis of BNs,but the low specificity and high false positive rate suggest that the judgment of BNs or MNs should not depend on coarse calcification alone.
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Objective To investigate the diagnostic value of hyperenhancement sign on ultrasound,CT and their combination in diagnosis of thyroid benign and malignant nodules.Methods The contrast-enhanced ultrasound and enhanced CT datas of 172 thyroid nodules in 144 cases confirmed by operation and pathology were retrospectively analyzed,including 97 benign nodules and 75 malignant nodules.According to the degree of enhancement,these nodules were divided into iso-or low-enhancement and hyperenhancement.The distributions of ultrasound hyperenhancement,CT hyperenhancement and both of them in thyroid benign and malignant nodules,adenomatoid lesions and nodular goiters were analyzed,followed byx2 test for statistical analysis.Results In 172 thyroid nodules,the proportions of ultrasound hyperenhancement,CT hyperenhancement and both of them in thyroid benign and malignant nodules were 53.6％(52/97) and 20.0％(15/75)(x2＝20.090,P＜0.05),34.0％ (33/97) and 4.0％ (3/75) (x2＝23.033,P＜0.05),31.0％ (30/97) and 0％ (0/75) (x2＝28.096,P＜0.05),respectively.Their sensitivity and specificity of diagnosing benign nodules were 53.6％ (52/97) and 80.0％ (60/75),34.0％ (33/97) and 96％ (72/75),30.9％ (30/97) and 100％ (75/75),respectively.The proportions of ultrasound hyperenhancement,CT hyperenhancement and both of them in adenomatoid lesions and nodular goiters were 96.9％(31/32) and 32.3％(21/65)0x2＝35.946,P＜0.05),65.6％(21/32) and 18.5％(12/65)(x2＝21.250,P＜0.05),65.6％(21/32) and 13.8％ (9/65)(x2＝26.912,P＜0.05).Their sensitivity and specificity of diagnosing adenomatoid lesions were 96.9％(31/32) and 67.7％(44/65),65.6％(21/32) and 81.5％(53/65),65.6％(21/32) and 87.2％(56/65).Conclusions Ultrasound hyperenhancement,CT hyperenhancement for diagnosing thyroid benign nodules are of significant value.Especially for adenomatoid nodules,ultrasound hyperenhancement has a higher sensitivity,while CT hyperenhancement has a higher specificity.Their combination can further improve the diagnostic specificity,thus reducing the unnecessary surgical trauma.
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OBJECTIVE The aim of the study was to evaluated the difference and consistency in tumor size measured by sonographic and pathological examination in papillary thyroid carcinoma(PTC).METHODS A total of 114 patients with PTC, including 122 malignant nodules, was collected from Hangzhou First People's Hospital between Jun 2012 and Jun 2014. The tumor sizes were measured by preoperative sonographic and postoperative pathologic evaluation. Pearson correlation analysis, paired t-test, and Bland-Altman plot were used to evaluate the correlation and consistency in tumor size measured by the two methods.RESULTS Pearson correlation analysis showed that the largest tumor size measured by sonography were positively correlated with pathologic size (r=0.957, P=0.000). Paired t-test showed that there were statistically difference between sonographic size and pathological size (8.24±5.06) mmvs (7.79±4.75) mm,P=0.001. The absolute difference value of the largest tumor size measured by the two methods was from zero to 6.5 mm, with the average of (1.03±1.14) mm. Bland-Altman analysis showed that the limits of agreement (LoA) of difference was from -2.41 mm to 3.33 mm, with the 95% confidence interval from -2.87 mm to 3.78 mm.Within the limit of the consistency, the maximum moduli was 2.9 mm.CONCLUSION There is a significant discrepancy between the preoperative sonographic and the pathologic size of the papillary thyroid carcinoma, which should be taken into account in clinical practice.
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Objective To investigate the value of CT signs in combination with clinical materials of papillary thyroid carcinoma (PTC) to predict the central lymph node metastasis (CLNM).Methods This article reviewed the CT signs and clinical materials of 366 patients with surgically and pathologically verified PTC.The single factor and multi-factor logistic regression analyses were performed on the relation of tumor position,thyroid marginal contact,calcification,plain scan border,border after enhancement,diameter,age and sex with CLNM.Results Among the 366 patients with PTC,the number of patients with positive CLNM and negative CLNM was 155 and 211 respectively.The single factor and multi-factor logistic regression analysis indicated that the thyroid marginal contact,diameter,age and sex were related with CLNM,and the more common patients diagnosed with CLNM had the following features:thyroid marginal contact,a diameter ＞1.0 cm,age ＜45 years and males (P＜ 0.05).Among the single risk factors,the tumor position,calcification,plain scan border and border after enhancement were unrelated with CLNM (P＞0.05).Conclusion The thyroid margin contact,diameter＞l.0 cm,age＜45 years and males are independent risk factors in diagnosis of positive CLNM.
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Objective To discuss the predictive value of multiple ultrasonic features combination in diagnosis of thyroid papillary carcinoma (PTC) more than 1.0 cm in diameter. Methods The ultrasonic features of 258 PTC nodules from 251 patients and 207 nodular goiter (NG) nodules from 190 patients in the First People′s Hospital of Hangzhou were retrospectively analyzed. All the nodules were confirmed by pathological examination after surgery. The ultrasonic features included the shape of nodules, internal echo,anteroposterior/transverse diameter ratio (A/T), and microcalcification. The χ2 test was used to analyze the differences of ultrasonic features between PTC and NG. Multi-variate analyses (Logistic regression) was used to analyze the predictive risk ultrasonic features of PTC. The sensitivity and specificity of ultrasonic features were analyzed based on the gold standard of pathological results. Results There were significantly differences between 258 PTC nodules and 207 NG nodules in irregular shape, hypoechogenicity,A/T > 1 and microcalcification (χ2 values were 121.511, 105.411, 41.483, 121.072, all P 1 and microcalcification were risk ultrasonic features of PTC. And their OR values were 5.013 (95%CI 2.919-8.610), 5.811 (95%CI 3.411-9.901), 15.399 (95%CI 7.576-31.301), 4.141 (95%CI 1.687-10.164) respectively. The sensitivity and specificity of single ultrasonic feature were 26.0%-79.5% and 71.5%-96.1%; the sensitivity and specificity of two ultrasonographic features combination were 11.2%-57.0% and 92.3%-99.0%; and the sensitivity and specificity of three or four ultrasonographic features combination were 8.1%-31.8% and 99.0%-99.5%.Conclusions Irregular shape, hypoechogenicity, A/T> 1 and microcalcification of thyroid neoplasm are important ultrasonic features of PTC. Although the sensitivity of single ultrasonic feature in diagnosing PTC is higher than that of multiple features combination, it has a lower specificity. Therefore, combination of multiple ultrasonographic features can improve the specificity in diagnosing PTC and reduce the misdiagnosis of PTC.
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Objective To assess the value of computed tomgraphy (CT)in differential diagnosis between medullar thyroid carcinoma (MTC)and papillary thyroid carcinoma (PTC).Methods CT findings of 20 lesions in 16 MTC patients and 35 lesions in 35 PTC patients were retrospectively analyzed.All patients were confirmed by pathology exam.We investigated the shape,location,bitten cookie sign,calification and lymph node metastasis between the two groups of patients to summarize the sensitivity and specificity of regular shape for MTC or lesions located in lower thyroid lobe,bitten cookie sign,lymph node metastasis for PTC.Results Regular shape was more common in MTC patients than in PTC patients (X2=5.815,P=0.016),with sensitivity and specificity of 55％ and 77.1％ respectively.Lesions were located at lower thyroid(X2=10.732,P=0.001),bitten cookie sign(X2=18.832,P=0.000)and lymph node metastasis (X2=4.377,P=0.036)was significantly more common in PTC patients than in MTC patients,with sensitivity and specificity of 40％ (14/35)and 100％ (16/16),80％ (28/35)and 80％ (16/20),and 68.6％(24/35)and 62.5％(10/16)respectively.Calcification was not significantly different between MTC and PTC patients (X2=0.550,P=0.458).Conclusions CT plays an important role in differential diagnosis between MTC and PTC.Regular shape is helpful for the diagnosis of MTC.Leisions located at lower thyroid,with bitten cookie sign and lymph node metastasis are conductive to the diagnosis of PTC.