Accuracy of a new sonographic classification system in differentiating benign from malignant solid thyroid nodules

Objective: To determine diagnostic accuracy of sonographic criteria in differentiating benign from malignant solid thyroid nodule by using new sonographic classification system

Study Design: Cross sectional validation study

Place and Duration of Study: Department of Radiology, Combined Military Hospital Multan from Oct 2014 to Mar 2015

Material and Methods: A total of 150 consecutive cases of either sex ranging in age from 19-60 years with palpable thyroid nodules referred for diagnostic workup were subjected to ultrasound [US] examination for assessment of solid thyroid nodules and it was followed by US-guided fine-needle aspiration [FNA] of all solid thyroid nodules. Each of the biopsied nodule was subsequently placed into one of five categories on the basis of sonographic features i.e. [malignant] [suspicious for malignancy] [borderline] probably benign] and [benign]. Evaluation of accuracy of sonographic diagnosis for solid thyroid nodule was done by comparing results of fine needle aspiration biopsy [FNAB]

Results: The mean age of the patients [n=150] was 42.34 +/- 4.78 years; seventy three percent [n=109] were females and twenty seven percent [n=41] were males. Frequency of thyroid nodules [on FNAB as gold standard] was revealed as 20.7% [n=31] malignant and 79.3% [n=119] benign, accuracy of a new sonographic classification system in differentiating benign from malignant solid thyroid nodules, keeping FNAB as gold standard showed 18.7% [n=28] true positive, 4.7% [n=7] false positive, 2% [n=3] false negative and 74.6% [n=112] true negative

Ultrasound finding has sensitivity of 90.3%, specificity of 94.12% and diagnostic accuracy of 93.3%

Conclusion: Accuracy of a new sonographic classification system in differentiating benign from malignant solid thyroid nodules, while keeping FNAB as gold standard was high and is recommended for diagnosis of malignant solid thyroid nodules

Bilateral renal lymphangiectasia with ascites and pleural effusion

A 42 year male patient with complaints of dull abdominal pain and hematuria for 01 year was referred by Nephrologist for abdominal ultrasound [USG]

USG demonstrated echogenic kidneys, perinephric and renal sinus cystic fluid collections bilaterally with minimal ascites and mild right sided pleural effusion. The USG findings were confirmed by computed tomography [CT] and magnetic resonance imaging [MRI] scan and were characteristic of renal lymphangiectasia. Awareness regarding renal lymphangiectasia will result in early diagnosis and management and decreased morbidity

Number of renal echogenic foci in patients of fatty liver in relation with diabetes

Objective: To establish a relationship of numbers of renal echogenic foci and the grades of fatty liver with the time span of diabetes mellitus

Study Design: Cross sectional study

Place and Duration of Study: Radiology Department of Combined Military Hospital [CMH] Kohat from 1[st] January 2014 to 1[st] May 2014

Material and Methods: Patients reporting for ultrasound abdomen in Radiology Department at CMH Kohat and showing renal echogenic foci i.e. bright foci without significant distal acoustic shadowing and fatty liver were selected and included in this study. Forty [40] patients were selected in the study by non probability purposive sampling and these were categorized into three groups according to the number of renal echogenic foci i.e. those with less than 5 were grouped as REF 1, those with 5-10 as group REF-2 and those with more than 10 foci as group REF-3. Patients having associated fatty liver that is those showing bright liver along with vascular blurring in liver parenchyma were grouped as mild, moderate and severe depending upon the ultrasound attributes of fatty liver [FL]. The clinical and demographic variables were laid down. All of the patients were subsequently subjected to fasting blood sugar levels and glycated hemoglobin HBA1C with their consent. The patients having normal fasting blood sugar levels [3.3-5.6 mmol/L] were excluded from the study. These cases were grouped according to the HbAlC levels i.e. 5.6-6.8%, 6.8%-7.6% and >7.6% as good, fair or poor control patients respectively. Data was analyzed by SPSS version 20

Results: Average age of patients included in the study was 48.62 years [SD=10.43] with 70% female patients. Twenty four [60%] patients had mild FL, 14 [35%] patients had moderate FL and 2 [5%] patients had severe FL. Thirteen [32.5%] patients were in REF-1 group, 9 [47.5%] were in group REF-2 and 8 [20%] were in group REF-3. Fifteen [37.5%] patients had good control of diabetes, 16 [40%] patients had fair control while 9 [22.5%] patients had poor control. Duration of diabetes varied from newly diagnosed [0 years] to 20 years with mean duration of 5.33 years [SD=4.73]. Nine [22.5%] patients were recently diagnosed, 18 [45%] patients had disease span of 2 - 5 years while 13 [32.5%] patients had disease span of more than 5 years. Number of echogenic foci had significant and stronger association with disease span [p<0.001, Cramer's V= 0.660] than disease control [p=0.002, Cramer's V=0.466]. Insignificant association was observed between severity of fatty liver with disease span [p = 0.373] and disease control [p=0.581]

Conclusion: In diabetics with fatty liver the number of the renal echogenic foci have a link to the time span of diabetes. The greater the number of renal echogenic foci in these cases, the longer is the time span of the disease