Objectives To explore the ultrasonic features in the differential diagnosis of thyroid multiple nodules with thyroid carcinoma and summarize the causes of misdiagnosis,and to improve the accuracy of ultrasonic diagnosis of thyroid carcinoma.Methods The ultrasound images from the 40 patients with thyroid carcinoma were selected,whose diagnosis of thyroid carcinoma was confirmed by the pathological examinations after surgery but misdiagnosed or not identified by ultrasound examination.These ultrasound images were retrospectively analyzed through observing the carcinomatous nodules in size,aspect ratio,shape,border,envelope,internal echo,calcification characteristics,posterior echo,acoustic halo,the distribution of blood flow,and the relationship with thyroid capsule and anterior organization,whether to transfer to neck or spraclavicular lymph nodes,and the performance of elasticity imaging,and then these features were compared with the ultrasonic features of the benign thyroid nodules.Results The ultrasonic features of thyroid multiple nodules with thyroid carcinoma were complicated and each nodule should be observed and analyzed individually.The ultrasonic features of carcinomatous nodules were:(1) irregnlar shape,(2)aspect ratio ≥ 1,(3)unclear border,(4)no capsule,(5)heterogeneous hypo echo inside of the carcinomatous nodules,(6)scattered distribution of clustered microcalcifications,(7)incomplete acoustic halo or absent,(8)blood supply to the centrality inside of the carcinomatous nodules,(9)invaded thyroid capsule and anterior organizations,(10)transformation to neck or supraclavicular lymph nodes in the minority of patients,(11) elasticity imaging score of 3 ～ 5.Conclusions It is quite difficult to identify the ultrasonic features of thyroid multiple nodules with thyroid carcinoma and it is with high misdiagnosis rate.A comprehensive analysis of sonographic features is essential in clinical practices,and it will contribute to improving the accuracy of the ultrasonic diagnosis of thyroid multiple nodules with thyroid carcinoma.

Objective To investigate the learning curve of contrast-enhanced ultrasonography ( CEUS) in sentinel lymph node( SLN ) of breast cancer and provide a theoretical basis for leaners to learn SLN CEUS . Methods The multi-center study of SLN CEUS in breast cancer" was planned by Sichuan Cancer Hospital . According to the uniform inclusion and exclusion criteria , 511 patients with complete clinical data and follow-up results from 9 hospitals in Multi-center were included in this study . According to the inspection time ,the patients were divided into 3 groups named as group A ( 170 patients) ,group B ( 170 patients) and group C ( 171 patients ) ,respectively . The basic clinical data ,ultrasound imaging data , intraoperative and postoperative pathological findings of all patients were recorded . With the accumulation of cases examined ,analysis was performed to find the learning curve of the SLN CEUS examination time , SLN CEUS detection rate ,SLN CEUS surface marking accuracy rate and SLN CEUS diagnosis rate ,the learning curve was analyzed . Results ① There was no statistical significant difference in patients ages , tumors sizes ,tumors locations ,SLNs numbers and LCs numbers among the three groups( all P > 0 .05) . ②As the number of cases examined increases ,the examination time was reduced gradually ,but SLN detection rate ,surface marking accuracy and SLN diagnostic coincidence rate were increased gradually( F = 151 .75 , 1 .96 ,7 .49 ,5 .50 ; P = 0 .000 ,0 .143 ,0 .001 ,0 .005 ) . Conclusions The skill of the doctor is improved gradually when learning SLN CEUS . With the number of the cases increase ,the operating time of SLN CEUS is shorted ,and the SLN detection rate ,surface marking accuracy and SLN diagnostic coincidence rate of SLN-CEUS are gradually increased . It has an important clinical significance for beginners to learn the SLN CEUS technology .