Histogram analysis of based on two-dimensional ultrasound images to differentiate medullary thyroid carcinoma and thyroid adenoma / 中华肿瘤杂志

Objective: To investigate the feasibility and value of histogram analysis based on two-dimensional gray-scale ultrasonography in the differential diagnosis of medullary thyroid carcinoma (MTC) and thyroid adenoma (TA). Methods: The preoperative ultrasound images of 86 newly diagnosed MTC patients and 100 TA patients treated in the Cancer Hospital of Chinese Academy of Medical Sciences from January 2015 to October 2021 were collected. Histograms were performed based on the regions of interest (ROIs) delineated manually by two radiologists, thereafter, mean, variance, skewness, kurtosis, percentiles (1st, 10th, 50th, 90th, 99th) were generated. The histogram parameters between the MTC group and the TA group were compared, and the independent predictors were screened by multivariate logistic regression analysis. Receiver operating characteristic (ROC) analysis was used to compare the individual diagnostic efficacy and joint diagnostic efficacy of independent predictors. Results: Multivariate regression analysis showed that mean, skewness, kurtosis and 50th percentile were independent factors. The skewness and kurtosis in the MTC group were significantly higher than those in the TA group, and the mean and 50th percentile were significantly lower than those in the TA group. The area under the individual ROC curve of mean, skewness, kurtosis and 50th percentile is 0.654-0.778. The area under the combined ROC curve is 0.826. Conclusion: Histogram analysis based on two-dimensional gray-scale ultrasonography is a promising tool to distinguish MTC from TA, in which the joint diagnosis value of mean, skewness, kurtosis and 50th percentile is the highest.

Comprehensive evaluation of medullary thyroid carcinoma before surgery / 中华医学杂志(英文版)

BACKGROUND@#Medullary thyroid carcinoma (MTC) is a rare disease, but it exhibits more aggressive behaviors. The aim of this study was to improve the diagnostic accuracy of MTC before surgery by analyzing the clinical and ultrasonic data of patients with MTC.@*METHODS@#The study included 71 patients (96 lesions) with histopathologically proven MTC between April 2011 and September 2016 in the Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College. The clinical characteristics and sonographic findings were retrospectively reviewed and compared between the ultrasonic correct diagnosis group and the ultrasonic misdiagnosis group with the t test or Mann-Whitney U test for quantitative parameters and the χ test or Fisher exact test for qualitative parameters.@*RESULTS@#Compared with the ultrasonic correct diagnosis group, the proportion of the cystic change in the ultrasonic misdiagnosed group was high (25.0% vs. 4.2%), the uncircumscribed margin and irregular shape proportions were low (20.8%, 58.3% vs. 74.7%, 87.3%), calcification was relatively rare (20.8% vs. 56.3%), and rich vascularity was relatively rare (25.0% vs. 78.9%).@*CONCLUSIONS@#In the case of atypical MTC, such as cystic change, circumscribed margin, regular shape, no calcification, no rich vascularity, and normal cervical lymph nodes, MTC is easily misdiagnosed as benign by ultrasound. Therefore, ultrasound, cytology and serum calcitonin should be comprehensively evaluated for a preoperative diagnosis of MTC.

Sentinel lymph node biopsy in papillary thyroid cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the reliability and feasibility of sentinel lymph node biopsy (SLNB) of papillary thyroid carcinoma using combination of lymphoscintigraphy, the gamma probe and methylene blue staining techniques.</p><p><b>METHODS</b>Twenty-three consecutive patients with thyroid papillary carcinoma were entered in the study between August 2007 and August 2009. All cases were without clinical evidence of cervical lymph node involvement. The (99)Tc(m)-dextran of 74 MBq (2mCi) was injected intratumorally under ultrasound guidance about 2 h to 5 h prior to surgery. Methylene blue was injected around the tumor during surgery. Preoperative lymphoscintigraphy, intra-operative hand-held gamma probe detecting and methylene blue staining techniques were used to detect the sentinel lymph node (SLN). SLN biopsies were sent to prepare frozen sections and the results were compared with specimen of routine selective neck dissection.</p><p><b>RESULTS</b>The SLNs were identified in all cases with the combination techniques. The SLN identification rates were 87.0% and 100% with methylene blue staining and lymphoscintigraphy plus probe scanning, respectively. Metastases in SLNs were revealed by frozen-section histology in 12 patients. In one case, SLNs frozen-section were negative, but metastasis was detected in routine histology. In other case both SLN and routine histology were negative, but metastasis was detected in non-SLN (level VI) neck dissection. The overall accuracy of the SLN biopsy was 91.3%, positive predictive value 100% and negative predictive value 81.8%.</p><p><b>CONCLUSION</b>The results seem the SLN biopsy technique is a feasible and valuable method for detecting cervical lymph node metastasis and is helpful to decide performing neck dissection in patients with cN0 papillary thyroid carcinoma.</p>

Sonographically guided percutaneous ethanol injection for therapy of thyroid benign lesion / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To develop the microtrauma therapy for thyroid benign lesion, to evaluate efficacy of sonographically guided percutaneous ethanol injection for therapy of thyroid benign lesion.</p><p><b>METHODS</b>Thirty-two patients with thyroid benign lesion were treated in Cancer Hospital, the patients had thyroid disease with cystic or cystic and solid nodule without heart and lung disease, and no allergy to ethanol, but the most diameter was below 3 cm for the solid disease. These patients were divided into two groups, the first group were 14 patients (from June 2002 to August 2003), the second group was 18 patients (from September 2003 to March 2006). The mean injection times was four (1-6) in the first group, the volume of each ethanol injection made the absolute ethanol well-distributed and kept slight compression intralesional for five minutes for solid disease. Partial liquid was extracted for cystic disease first, and 2-10 ml ethanol was injected into cyst, the internal time between two punctures was one week. Each patient received six times ethanol injection in the second group, ethanol injection was same with the first group. The mean follow-up was 29 (12-57) months.</p><p><b>RESULTS</b>The efficacy rate was 100.0%, the cure rate was 69.2% in the first group. The efficacy rate was 100.0%, the cure rate was 77.8% in the second group. There was no significant difference in the cure rate between the groups (chi2 = 0.0258, P > 0.05). During follow-up, ultrasound revealed no recurrence for the cured patients and no growth for the remnant lesion. Its complications were transient after the procedure, no severe complications occurred.</p><p><b>CONCLUSIONS</b>Sonographically guided percutaneous ethanol injection should be simple, effective, and safe for the thyroid benign lesion, it is easy popularized and may has the effect of cosmetology and microtrauma.</p>

Diagnostic value of ultrasonography in thyroid lesions / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyse ultrasonographic mapping of the thyroid lesions, so as to summarize ultrasonographic characteristics, and improve the accuracy rate of preoperative diagnosis for thyroid lesions.</p><p><b>METHODS</b>The clinical data were analyzed for 1700 patients with different thyroid lesions who were treated between January 2002 and December 2005. The appearance of gray scale and colour Doppler sonography for the lesions was prospectively studied, the different blood flow index was determined. All patients underwent surgery and had histopathologic diagnosis at Cancer Hospital, Chinese Academy of Medical Sciences. The criterion of diagnosis for benign lesions were (1) multinodular; (2) the presence of peripheral halo; (3) regular and defined margins, intranodular uniform echogenicity; (4) macrocalcification; (5) the degree of blood flow was I or IV grade, the distribution of blood flow was I type; (6) the blood resistance index was over 0. 6, the blood peak value speed was below 12 cm/s. The criterion of diagnosis for malignant lesions were (1) single nodular; (2) irregular and partly defined margins; (3) intranodular irregular hypoechogenicity; (4) microcalcification; (5) the degree of blood flow was II or III grade, the distribution of blood flow was II type; (6) the presence of metastatic lymph node in region; (7) the blood resistance index was below 0. 6, the blood peak value speed was over 12 cm/s.</p><p><b>RESULTS</b>Of all cases, 1284 cases were benign and 416 cases malignant. The accuracy rate of gray scale sonography for benign and malignant thyroid lesions was respectively 80. 0% and 75.0%. The accuracy rate of ultrasound diagnosis for benign and malignant thyroid lesions was respectively 86.0% and 82.0%, total accuracy rate for thyroid lesion was 85.0%.</p><p><b>CONCLUSIONS</b>Gray scale sonography was very important to distinguishing between benign and malignant lesions of thyroid tumor, the accuracy rate was greatly improved with colour Doppler sonography, but the determination of blood flow index is no help to differentiating between benign and malignant lesions of thyroid tumor. The accurate rate of ultrasound for the diagnosis of thyroid lesions is high, it is the first choice measure in preoperative diagnosis for thyroid lesions.</p>

Value of high-resolution ultrasonography in differential diagnosis of cervical cystic lesions / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze ultrasonographic features of the different kinds of cervical cystic lesions, and propose differential diagnostic standard for these lesions based on the evidence of high resolution ultrasonography.</p><p><b>METHODS</b>The clinical data of 107 patients with different kinds of cervical cystic lesions were analyzed. The role of gray scale and colour Doppler sonography for such lesions was prospectively studied.</p><p><b>RESULTS</b>The rate of accuracy for benign cervical cystic lesions was 91.1% (92/101), however, it was only 16.7% (1/6) for malignant cervical cystic lesions.</p><p><b>CONCLUSION</b>High-resolution ultrasonography is effective and simple in differential diagnosis of different kinds of cervical cystic lesions, especially for benign ones.</p>