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

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

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

The authors analyzed ultrasonographically the total 45 cases of thyroid disease verified by historicaldiagnosis, functional diagnosis, and morphological diagnosis at the Departement of Radiology, Busan NationalUniversity hospital from June to Sept. 1982. The resuls obtained were as follows; 1. In the sex distributionfemale was 38 cases (84.4%), and male 7 cases (15.6%). 2. Among the total 4 cases thyroid adenoma was 24 cases(53.3%), nodular hyperplasia 8 cases (17.7%), thyroid carcinoma 7 cases (15.6%), diffuse hyperplasia 3 cases(6.7%), Hanshimoto's thyroiditis 1 cases (2.2%), subacute thyroiditis 1 cases(2.2%), tuberculous thyroiditis 1cases(2.2%) in orders. 3. On ultrasonogram, total 24 cases of thyroid adenoma showed a single nodule in 24 cases(100.0%), smooth outer margin in 23 cases (95.8%), capsular echo in 23 cases (95.8%), pure cystic nodule in 4cases (16.7%), and increased echogenicity in 17 cases (85.0%) among the 20 cases excluded the pure cystic nodules.4. Total 7 cases of thyroid carcinoma showed no capsular echo in 4 cases (57.1%), irregular outer margine in 4cases(57.1%), no pure cytic nodule in all cases, and enlargement of metastatic lymphnode in 4 cases (57.1%). 5.Total 8 cases of nodular hyperplasia showed enlargement of thyroid gland and multiple nodule in 8 cases (100.0%),and increased echogenicity in 7 cases (87.5%). 6. Total 3 cases of diffuse hyperplasia showed enlargement ofthyroid gland and increased echogenicity in 3 cases (100.0%). 7. Total 3 cases of thyroiditis showed decreasedechogenicity in 3 cases (100.0%) and enlargement of thyroid gland in 2 cases (66.7%). 8. The cold area visualizedon radionuclide scan could be differentiated from a solid mass and cystic one by utrasonogram.
Busan ; Diagnosis ; Humans ; Hyperplasia ; Male ; Thyroid Diseases ; Thyroid Gland ; Thyroid Neoplasms ; Thyroiditis ; Thyroiditis, Subacute ; Ultrasonography

OBJECTIVE: To retrospectively compare the diagnostic performances of two different ultrasound (US)-guided core needle biopsy (CNB) techniques for intermediate or low suspicion thyroid nodules. MATERIALS AND METHODS: Between August 2015 and December 2016, two different biopsy techniques were alternatively applied for 248 consecutive thyroid nodules, of which, 140 intermediate or low suspicion thyroid nodules were included in this study. In the first technique, two specimens included nodular tissue, nodular margin, and surrounding normal parenchyma (i.e., marginal target). In the second technique, two specimens were obtained from two different target areas, one for the marginal target and another for the intranodular target. The diagnostic performances of the two techniques to predict neoplasm and malignancy were compared. RESULTS: CNB was performed on 80 intermediate or low suspicion nodules (57.1%) using the first technique and on 60 (42.9%) using the second technique. The accuracy of the first technique for predicting neoplasm or malignancy was significantly higher than that of the second technique (100% vs. 93.3%, p = 0.032 for predicting neoplasm; 88.8% vs. 75.0%, p = 0.033 for predicting malignancy). The negative predictive value of the first technique for predicting malignancy was also significantly higher than that of the second technique (87.5% vs. 72.7%, p = 0.035). CONCLUSION: For intermediate or low suspicion thyroid nodules, US-guided CNB to obtain two specimens with marginal targets is more effective for diagnosing neoplasm or malignancy than is CNB for respective marginal and intranodular targets.
Biopsy ; Biopsy, Large-Core Needle ; Diagnosis ; Methods ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography