Qualitative and Semiquantitative Elastography for the Diagnosis of Intermediate Suspicious Thyroid Nodules Based on the 2015 American Thyroid Association Guidelines.

OBJECTIVES: To evaluate qualitative and semiquantitative elastography for the diagnosis of intermediate suspicious thyroid nodules based on the 2015 American Thyroid Association (ATA) guidelines. METHODS: Through a retrospective search of our institutional database, 746 solid thyroid nodules found on grayscale ultrasonography, strain elastography, and ultrasound-guided fine-needle aspiration between June and November 2009 were collected. Among them, 80 nodules from 80 patients with an intermediate suspicion of malignancy based on the 2015 ATA guidelines that were 10 mm or larger were recruited as the final study nodules. Elastographic findings were categorized according to the criteria of Rago et al (J Clin Endocrinol Metab 2007; 92:2917-2922) and Asteria et al (Thyroid 2008; 18:523-531), and strain ratio values were calculated and recorded. The independent 2-sample t test and χ2 test (or Fisher exact test) were used to evaluate differences in clinical parameters between benign and malignant thyroid nodules. All variables were compared by univariate and multivariate logistic regression analyses, and odds ratios with 95% confidence intervals were calculated. RESULTS: Of the 80 nodules, 6 (7.5%) were malignant, and 74 (92.5%) were benign. No significant differences were observed in age, sex, nodule size, elasticity score, and strain ratio between benign and malignant nodules. No variables significantly predicted thyroid malignancy on the univariate analysis. On the multivariate logistic regression analysis, there were no independent variables associated with thyroid malignancy, including the elasticity score and strain ratio (all P > .05). CONCLUSIONS: Elastographic analysis using the elasticity score and strain ratio has limited ability to characterize the benignity or malignancy of thyroid nodules with an intermediate suspicion of malignancy based on the 2015 ATA guidelines.

Serial Ultrasound Findings After Laser Ablation for Benign Breast Lesions on Long-Term Follow-Up: Implications for Evaluation of Procedural Success.

OBJECTIVE: The purpose if this study was to describe the follow-up ultrasound (US) findings of percutaneous US-guided laser ablation for small benign breast lesions, and to define the procedural success. BACKGROUND DATA: There are limited reports on follow-up imaging after laser ablation, because the ablated tumors were generally resected by surgery. MATERIALS AND METHODS: US-guided laser ablation was performed on 19 benign breast lesions in 10 patients. The median size of the lesions was 7.8 mm (range, 3-11 mm). The lesions were diagnosed as image-pathology concordant benign by US-guided core biopsy. After ablation, we performed follow-up US with an interval of 3-12 months; the median follow-up period was 32 months (range, 30-36 months). We evaluated the morphologic and size changes by using serial follow-up US. RESULTS: US findings of the 13 cases followed within the first 6 months after ablation showed hypoechoic lesions having inner hyperechogenicity with or without a hypoechoic center. The size of these lesions during this period increased in comparison with the initial lesion size, and then decreased or became stable on serial follow-up US. On the last follow-up US examination, in 14 cases (73.6%), the lesions were invisible, 4 cases (21.1%) showed scar changes, and 1 case (5.3%) showed a hypoechoic remnant lesion. CONCLUSIONS: US findings within 6 months after laser ablation showed mixed echoic lesions with increased size, followed by gradual decrease in size. Therefore, the success of laser ablation may be evaluated by checking the changes in the lesions by comparing the size of the lesions with the first follow-up US within 6 months and not the original tumor.

The effects of QRS duration and pacing sites on the acute hemodynamic changes during right ventricular pacing.

BACKGROUND: Has been reported that patients exhibiting prolonged paced QRS duration tend to have more serious heart disease, and the paced QRS duration can be an effective indicator of impaired left ventricular function. However, the acute and chronic hemodynamic effects of paced QRS duration and pacing sites during right ventricular (RV) pacing remain unknown. METHODS: A total of 14 patients who underwent electrophysiologic study for paroxysmal supraventricular tachycardia were examined. RV pacing was performed at 10 different sites with cycle lengths of 600 ms and 500 ms utilizing a 6-7F deflectable quadripolar electrode catheter. Systolic, diastolic, and mean blood pressures during pacing were measured once the blood pressure was stabilized. RESULTS: During RV pacing, blood pressures (systolic/diastolic/mean) decreased. The change of post-pacing QRS duration and pre-pacing the systolic blood pressure (SBP) were greater in the group with paced QRS duration. The differences overall were greater than 140 ms. The SBP decrease during pacing was larger in the group exhibiting paced QRS duration of greater than 140 ms. The SBP decrease during pacing showed relation to QRS duration during pacing (r = 0.500, p = 0.001), the change of QRS duration post-pacing (r = 0.426, p = 0.001), and SBP during sinus rhythm (r = 0.342, p = 0.001) on linear correlation analysis. The pacing site, on the other hand, did not affect acute hemodynamic changes during pacing. CONCLUSION: Ventricular pacing of less than 40 ms at the area of paced QRS duration is recommended.