Heterogeneous echogenicity of the thyroid parenchyma does not influence the detection of multi-focality in papillary thyroid carcinoma on preoperative ultrasound staging

Heterogeneous echogenicity and micro-nodulations of diffuse thyroid disease on ultrasonography (US) might influence the diagnostic performance of pre-operative US staging, especially the detection of multi-focality. This study was designed to determine whether heterogeneous echogenicity of the thyroid parenchyma influences the diagnostic performance of US in the detection of multi-focality in papillary thyroid carcinoma. Between December 2010 and April 2011, 811 patients underwent pre-operative staging US for papillary thyroid carcinoma and surgery. Twelve radiologists performed the pre-operative US for T and N staging. Underlying parenchymal echogenicity and unilateral and bilateral multi-focality of the thyroid nodules were also evaluated. Patients were divided into two groups on the basis of the underlying echogenicity of the thyroid gland. To evaluate the diagnostic accuracy of US with respect to underlying echogenicity, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated and compared between the two groups. Among the 811 patients included, US revealed underlying heterogeneous echogenicity of the thyroid parenchyma in 204 (25.2%) and underlying homogeneous echogenicity of the thyroid parenchyma in 607 (74.8%). There were no significant differences between the two groups in the diagnostic performance of pre-operative staging US in predicting unilateral multi-focality and bilaterality. Underlying heterogeneous echogenicity in a thyroid gland with Hashimoto's thyroiditis does not significantly influence the detection of multi-focality in papillary thyroid cancer on pre-operative US staging.ope

Positive Predictive Values for Sonographic BI-RADS Assessment Categories by Different Age Groups

Purpose: To investigate positive predictive values (PPVs) of BI-RADS (Breast Imaging Reporting and Data System classification on US in women under age 50 and more than age 50. Materials and Methods: Between May 2009 and October 2009, We reviewed 392 pathologically proven BIRADS category 3, 4, and 5 lesions of 370 patients retrospectively based on BI-RADS US lexicon. Including number of women were 121 patents of aged ≥ 50 (mean age 58.8, range 50~89) and 249 patients of aged < 50 (mean age 38.3, age range 18~49) PPVs for each categories were evaluated in different age groups. By generalized estimating equation. Results: There were 88 benign lesions and 304 malignant lesions. The overall PPV of category 4 and combined category 3, 4, and 5 in women under aged 50 and below was 11.6% and 17.3% versus 25.6% and 33.3% in women aged 50 and above. There was significant positive association between the age-related PPVs and increased age in category 4 and category 3, 4 and 5 (p < 0.001). Conclusion: PPVs of BI-RADS classification on US were significant difference in different age groups. Therefore, more attention should be paid to special age groups that we found sonographic categorizationope

Sonographic and Pathologic Characteristics of Breast Cancers Detected Only by Ultrasound

Purpose: To evaluate the sonographic and pathologic characteristics of breast cancers detected only by ultrasound. Materials and Methods: From March 2009 to January 2010, 13 patients who diagnosed breast cancer by ultrasound (US) with negative mammographic results were included this study. The patients’ age distribution ranged from 45 to 69 years (mean age: 53.2 years). We reviewed the patients’ clinical, imaging and pathologic data. We analyzed sonographic finding of the breast masses, according to ACR BI-RADS - US lexicon classification. Results: 12 patients have grade 3 and 4 dense breasts on mammography and one patient have grade 2 breast density. Breast cancers seen only by US measured 4-12 mm (mean: 8.4 mm). 11 masses were assessed BIRADS category 4a and 2 masses were category 4c. The final surgical pathologic diagnosis were 7 invasive ductal carcinomas, 5 ductal carcinoma in situ and 1 invasive lobular carcinoma. The final pathologic stage were 5 stage 0, 7 stage I, 1 stage IIA. Conclusion: Breast cancers detected only by ultrasound tend to be small masses less than 1 cm without calcification. Patients usually underwent breast conserving surgery and be diagnosed node-negative invasive cancers.ope