To compare the clinical value of superb microvascular imaging (SMI) and contrast enhanced ultrasound (CEUS) in the differential diagnosis of thyroid nodules, and to further study whether the combination of SMI and/or CEUS with thyroid imaging reporting and data system (TI-RADS) can improve the diagnostic value of TI-RADS.
 Methods: SMI, CEUS, TI-RADS, TI-RADS combined with CEUS, TI-RADS combined with SMI, TI-RADS combined with SMI and CEUS were used to differentiate thyroid nodules. TI-RADS 4b, 5 categories in two-dimensional ultrasound, hypoenhancement in CEUS, and peripheral blood flow with penetrating vessels in SMI were considered malignant signs. The diagnostic efficacy of these methods was compared according to post-operative pathology or fine needle aspiration cytology.
 Results: A total of 237 patients with 296 thyroid nodules were included in the study. The sensitivity, specificity and accuracy for TI-RADS were 78.4%, 77.7% and 78.0% respectively, 75.5%, 86.6% and 81.4% in SMI, 82.0%, 88.5% and 85.5% in CEUS, 92.1%, 90.4% and 91.2% in TI-RADS combined with SMI and CEUS. Area under the receiver operating characteristic curve (AUROC) showed no significant difference between SMI, CEUS, TI-RADS (χ2=4.29, P=0.117). AUROC of both TI-RADS combined with CEUS (χ2=39.62, P<0.001), TI-RADS combined with SMI (χ2=36.61, P<0.001) were higher than TI-RADS. AUROC of TI-RADS combined with SMI and CEUS was higher than TI-RADS combined with SMI (χ2=4.50, P=0.033) or TI-RADS combined with CEUS (χ2=4.24, P=0.039).
 Conclusion: Peripheral blood flow with penetrating vessels in SMI possesses high diagnostic value in differentiating thyroid cancer. The combination of SMI and/or CEUS with TI-RADS can be used to improve the diagnostic efficacy of TI-RADS in differential diagnosis of thyroid nodules.
Diagnosis, Differential ; Humans ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography

The detection of thyroid nodules has become more common with the widespread use of ultrasonography (US). US is the mainstay for detecting and making the differential diagnosis of thyroid nodules as well as for providing guidance for a biopsy. The Task Force on Thyroid Nodules of the Korean Society of Thyroid Radiology has developed recommendations for the US diagnosis and US-based management of thyroid nodules. The review and recommendations in this report have been based on a comprehensive analysis of the current literature, the results of multicenter studies and from the consensus of experts.
Biopsy, Fine-Needle ; Diagnosis, Differential ; Humans ; Thyroid Gland/pathology/ultrasonography ; Thyroid Neoplasms/pathology/ultrasonography ; Thyroid Nodule/pathology/*ultrasonography ; Ultrasonography, Interventional

PURPOSE: Whole body Positron Emission Tomography (PET) was used to evaluate the existence of cancer cells. However, PET had limitations in identifying thyroid cancer cells because of their slow progression, and evidence regarding its accuracy in finding thyroid cancer cells is insufficient. Therefore, we investigated the usefulness of PET for evaluation of patients with thyroid nodules by studying the relationships between PET and thyroid ultrasonography. METHODS: We evaluated 4,627 patients who had undergone PET from January 2007 to October 2011 and selected 370 patients who had undergone thyroid ultrasonography. We compared and analyzed the amount of thyroid SUVmax of PET, the pattern of glucose uptake, and findings of thyroid ultrasonography based on their size, shape, location, and FNAC. RESULTS: Of 370 patients, 197 (53.2%) subjects were found to have thyroid nodules, and 211 (57.0%) subjects had higher sugar metabolism, regardless of having thyroid nodules. No statistical correlations were observed among nodule size, nodule location,and higher sugar metabolism, however, noticeable relationships were observed between the shape of the cells on thyroid ultrasonography and FDG uptake of PET. In cases of papillary thyroid cancer, there was higher FDG uptake, compared to benign lesions in particular, SUVmax of the papillary thyroid cancer showed a significantly elevated level of FDG uptake. CONCLUSION: Despite its limited usefulness in identifying the characteristics of thyroid nodules being benign or malignant, PET is appropriate for evaluation of the malignancy of thyroid cells
Diagnosis* ; Electrons* ; Glucose ; Humans ; Metabolism ; Positron-Emission Tomography* ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Ultrasonography

Primary role of ultrasound in patients with thyroid nodule is to determine the multiplicity and detect occult carcinoma. We analyzed US findings of 53 thyroid carcinomas with multiple nodular lesions from january 1988 to december 1991. The results were as follows: 1. 109 malignant nodules in 53 cases and 24 benign in 23 were comfirmed. 2. The nature of the masses were solid in 72 malignant nodules (74.2%), and complex in 25 (25.8%) of which 19 were predominantly solid. 3. The echo pattern of the solid and solid predominant masses were hypoechoic in 78 malignant nodules (80.4%), hyperechoic in 10 (10.3%), and isoechoic in 3 (9.3%) 4. Internal punctate calcifications within the masses were observed in 31 malignant nodules (31.9%). 5. Halo sign was present in 16 malignant nodules(16.5%). 6. The preoperative sonographic diagnosis of thyroid carcinoma was made in 39.4% of 53 cases with multiple nodules on US. In conclusion, the number, and halo formation of nodules were insignificant to differentiate the benign nodule from the malignant. The heterogeneous hypoechoic nodules with size greater than 4cm, multiple stippled calcifications, displacement of the trachea or other surrounding structures of combined lymph node enlargements seem to indicate the possibility of malignancy.
Diagnosis ; Goiter* ; Humans ; Lymph Nodes ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Trachea ; Ultrasonography

BACKGROUND AND OBJECTIVES: We investigated the clinical value of additional von Kossa staining in thyroid nodules with "suspicious for malignancy" on cytology. MATERIALS AND METHODS: From March 2010 to November 2010, 55 patients with 55 nodules which were diagnosed as "suspicious for malignancy" on cytology and had microcalcifications on ultrasound (US) underwent surgery and made up our final study population. We evaluated the role of the von Kossa stain as a preoperative diagnostic factor for thyroid cancer using histopathology as the "gold standard". Diagnostic performances were calculated of the presence of psammoma bodies on both cytology and the von Kossa staining and of US in predicting thyroid cancers. RESULTS: Of 55 nodules with microcalcifications on US and "suspicious for malignancy" on cytology, 53 (96.4%) were malignant and 2 (3.6%) were benign on histopathology. All pathologically benign nodules were negative on the von Kossa stain. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the von Kossa stain were 28.3%, 100%, 30.9%, 100%, and 5% for diagnosis, respectively. CONCLUSION: Von Kossa staining can be a valuable diagnostic tool in a thyroid nodule with "suspicious for malignancy" on cytology and microcalcifications on US, objectively.
Biopsy, Fine-Needle ; Diagnosis ; Humans ; Sensitivity and Specificity ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule* ; Ultrasonography

BACKGROUND: Fine needle aspiration(FNA) is regarded as the best procedure in the diagnosis of thyroid malignancies. However, the rate of false negative and indeterminate results are between 5~10 and 10~30%, respectively. Therefore, a new diagnostic tool to assist FNA is required. Recently, high resolution ultrasonography(US) has become a useful tool in the detection of malignant thyroid nodules. Therefore, the sonographic characteristics differentiating malignant from benign nodules were analyzed, and the usefulness of US in the diagnosis of thyroid malignancy assessed. METHODS: Of the 212 patients that underwent surgery due to a thyroid nodule, at the Daegu Catholic University Hospital between January 2002 and June 2004, and 181 patients(199 nodules) who underwent high resolution US examination before surgery, were included in this study. The characteristics of the sonographic parameters, such as depth/width ratio, shape, margin, structure, sponge sign, calcification and halo, and the homogeneity and echogenicity of the solid component and invasion, were observed. RESULTS: In a univariate analysis of the nonfollicular neoplasms, the depth/width ratio, shape, margin, structure, calcification and halo, and the homogeneity and echogenicity of the solid component were found to be significant parameters. The "sponge sign", a new parameter suggested by us, was found only in benign nodules. In a multiple logistic regression analysis, only the depth/width ratio, shape, presence of calcification and echogenicity of the solid component were significant parameters. According to the results of the multiple logistic regression analysis, the point and estimate of each characteristic of the significant parameters were found, and a formula for calculating a score for the prediction of malignancy computed. At a score of 0.44, the sensitivity and specificity of US were 85.9 and 88.7%, respectively. In a univariate analysis of follicular neop-lasms, the shape, calcification and echogenicity were found to be significant parameters. CONCLUSION: It was conclude that high resolution US is a very useful tool in the differentiation of benign and malignant nodules, especially in nonfollicular neoplasms. It is also suggested that the "sponge sign" might be used as a strong indicator for the confirmation of benign nodules
Daegu ; Diagnosis ; Humans ; Logistic Models ; Needles ; Porifera ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Ultrasonography*

BACKGROUND: Fine needle aspiration(FNA) is regarded as the best procedure in the diagnosis of thyroid malignancies. However, the rate of false negative and indeterminate results are between 5~10 and 10~30%, respectively. Therefore, a new diagnostic tool to assist FNA is required. Recently, high resolution ultrasonography(US) has become a useful tool in the detection of malignant thyroid nodules. Therefore, the sonographic characteristics differentiating malignant from benign nodules were analyzed, and the usefulness of US in the diagnosis of thyroid malignancy assessed. METHODS: Of the 212 patients that underwent surgery due to a thyroid nodule, at the Daegu Catholic University Hospital between January 2002 and June 2004, and 181 patients(199 nodules) who underwent high resolution US examination before surgery, were included in this study. The characteristics of the sonographic parameters, such as depth/width ratio, shape, margin, structure, sponge sign, calcification and halo, and the homogeneity and echogenicity of the solid component and invasion, were observed. RESULTS: In a univariate analysis of the nonfollicular neoplasms, the depth/width ratio, shape, margin, structure, calcification and halo, and the homogeneity and echogenicity of the solid component were found to be significant parameters. The "sponge sign", a new parameter suggested by us, was found only in benign nodules. In a multiple logistic regression analysis, only the depth/width ratio, shape, presence of calcification and echogenicity of the solid component were significant parameters. According to the results of the multiple logistic regression analysis, the point and estimate of each characteristic of the significant parameters were found, and a formula for calculating a score for the prediction of malignancy computed. At a score of 0.44, the sensitivity and specificity of US were 85.9 and 88.7%, respectively. In a univariate analysis of follicular neop-lasms, the shape, calcification and echogenicity were found to be significant parameters. CONCLUSION: It was conclude that high resolution US is a very useful tool in the differentiation of benign and malignant nodules, especially in nonfollicular neoplasms. It is also suggested that the "sponge sign" might be used as a strong indicator for the confirmation of benign nodules
Daegu ; Diagnosis ; Humans ; Logistic Models ; Needles ; Porifera ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Ultrasonography*

PURPOSE: Fine Needle Aspiration Cytology (FNAC) is considered as the most feasible preoperative diagnostic tool for thyroid lesions. However, the false results of FNAC are not uncommon, and so we need a development of novel supportive preoperative diagnostic modality. In previous studies, galectin-3, a beta-galactosidase-binding protein, was expressed preferentially in thyroid malignancies. In this study, we analyzed whether the galectin-3 immunohistochemistry (IHC) is useful as a preoperative diagnostic tool. METHODS: 79 patients who underwent a definite surgery for thyroid nodule were analyzed. The preoperative routine stained cytology and galectin-3 IHC for fine-needle aspirates and the galectin-3 IHC for postoperative specimen were performed. Individual results were compared with the final diagnoses. RESULTS: Of 79 specimens, 28 (35.4%) were malignant. The false negative rate (FNR) of galectin-3 IHC in the surgical specimen was 10.0%. The FNR of galectin-3 IHC for the fine-needle aspirates was 50.0% and the FNR of routine cytology was 20.5%. However, the FNR of galectin-3 IHC in the fine-needle aspirates was lowered up to 20.0% in thyroid lesions obtained by using ultrasound-guided aspiration. Among the 14 cases reported as suspicious in routine cytology, 13 cases were revealed the accurate correlations in galectn-3 IHC. CONCLUSION: It appears that galectin-3 IHC in preoperative FNAC alone had a little accuracy. However, preoperative galectin-3 IHC in thyroid lesions obtained under the ultrasound guidance could be diagnostic. Especially in suspicious group in FNAC, galectin-3 IHC could be critical method in differentiating malignant lesions from benign lesions of thyroid.
Biopsy, Fine-Needle* ; Diagnosis ; Galectin 3* ; Humans ; Immunohistochemistry ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Ultrasonography

OBJECTIVE: To prospectively evaluate the diagnostic performance of computer-aided diagnosis (CAD) for detection of thyroid cancers via ultrasonography (US). MATERIALS AND METHODS: This study included 50 consecutive patients with 117 thyroid nodules on US during the period between June 2016 and July 2016. A radiologist performed US examinations using real-time CAD integrated into a US scanner. We compared the diagnostic performance of radiologist, the CAD system, and the CAD-assisted radiologist for the detection of thyroid cancers. RESULTS: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the CAD system were 80.0, 88.1, 83.3, 85.5, and 84.6%, respectively, and were not significantly different from those of the radiologist (p > 0.05). The CAD-assisted radiologist showed improved diagnostic sensitivity compared with the radiologist alone (92.0% vs. 84.0%, p = 0.037), while the specificity and PPV were reduced (85.1% vs. 95.5%, p = 0.005 and 82.1% vs. 93.3%, p = 0.008). The radiologist assisted by the CAD system exhibited better diagnostic sensitivity and NPV than the CAD system alone (92.0% vs. 80.0%, p = 0.009 and 93.4% vs. 88.9%, p = 0.013), while the specificities and PPVs were not significantly different (88.1% vs. 85.1%, p = 0.151 and 83.3% vs. 82.1%, p = 0.613, respectively). CONCLUSION: The CAD system may be an adjunct to radiological intervention in the diagnosis of thyroid cancer.
Artificial Intelligence ; Diagnosis* ; Humans ; Prospective Studies ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Ultrasonography*

OBJECTIVE: To determine whether a computer-aided diagnosis (CAD) system for the evaluation of thyroid nodules is non-inferior to radiologists with different levels of experience.MATERIALS AND METHODS: Patients with thyroid nodules with a decisive diagnosis of benign or malignant nodule were consecutively enrolled from November 2017 to September 2018. Three radiologists with different levels of experience (1 month, 4 years, and 7 years) in thyroid ultrasound (US) reviewed the thyroid US with and without using the CAD system. Statistical analyses included non-inferiority testing of the diagnostic accuracy for malignant thyroid nodules between the CAD system and the three radiologists with a non-inferiority margin of 10%, comparison of the diagnostic performance, and the added value of the CAD system to the radiologists.RESULTS: Altogether, 197 patients were included in the study cohort. The diagnostic accuracy of the CAD system (88.48%, 95% confidence interval [CI] = 82.65–92.53) was non-inferior to that of the radiologists with less experience (1 month and 4 year) of thyroid US (83.03%, 95% CI = 76.52–88.02; p < 0.001), whereas it was inferior to that of the experienced radiologist (7 years) (95.76%, 95% CI = 91.37–97.96; p = 0.138). The sensitivity and negative predictive value of the CAD system were significantly higher than those of the less-experienced radiologists were, whereas no significant difference was found with those of the experienced radiologist. A combination of US and the CAD system significantly improved sensitivity and negative predictive value, although the specificity and positive predictive value deteriorated for the less-experienced radiologists.CONCLUSION: The CAD system may offer support for decision-making in the diagnosis of malignant thyroid nodules for operators who have less experience with thyroid US.
Cohort Studies ; Diagnosis ; Humans ; Prospective Studies ; Sensitivity and Specificity ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography