Prevalence of thyroid carcinoma in nodules with thy 3 cytology: the role of preoperative ultrasonography and strain elastography

Background Fine needle aspiration (FNA) cytology, the gold standard in assessing thyroid nodules, is limited by its inability to determine the true risk of malignancy in Thy 3 nodules. Most patients with Thy3 cytology undergo surgery to establish a histologic diagnosis. The aims of this study were to evaluate the prevalence of malignancy in Thy3 nodules, to examine the ultrasound (US) characteristics that are associated with a high cancer risk and to assess the role of real-time strain elastography. Methods Retrospective cohort study of 99 nodules with Thy3 cytology in 99 patients who underwent thyroidectomy over a three-year period. Grayscale US, Doppler and real-time strain elastography data were evaluated. Results Eighty-one nodules (81.82%) were benign, 18 (18.18%) were malignant, and almost all were papillary thyroid carcinoma (PTC). Univariable analysis revealed irregular margins (p = 0.02), ill-defined borders (p ≤ 0.001), a taller than wide shape (p ≤ 0.001) and the elasticity score (p = 0.02) as significant predictors of malignancy. Multivariable analysis showed that ill-defined borders and the elasticity score were significant and independent factors associated with malignancy. All soft nodules (elasticity scores 1–2) were benign (sensitivity 100%, specificity 33%, NPV 100%, and PPV 23%). There was a higher rate of malignancy in Thy3a nodules than in Thy3f nodules (42.86% versus 11.54%) (p ≤ 0.001). Conclusions Irregular margins, ill-defined borders, a taller than wide shape and low elasticity were associated with malignancy. Elastography should be performed when evaluating Thy3 nodules.

Ultrasonographic Algorithm for the Assessment of Sentinel Lymph Nodes That Drain the Mammary Carcinomas in Female Dogs

The status of sentinel lymph nodes (SLNs) is decisive in staging, prognosis, and therapeutic approach. Using an ultrasonographic examination algorithm composed of B-mode, Doppler technique, contrast-enhanced ultrasound (CEUS) and elastography, this study aimed to determine the diagnostic performance of the four techniques compared to histopathological examination. 96 SLNs belonging to 71 female dogs with mammary gland carcinomas were examined. After examinations, mastectomy and lymphadenectomy were performed. Histopathological examination confirmed the presence of metastases in 54 SLNs. The elasticity score had the highest accuracy—89.71%, identifying metastases in SLNs with 88.9.9% sensitivity (SE) and 90.5% specificity (SP), ROC analysis providing excellent results. The S/L (short axis/long axis) ratio showed 83.3% SE and 78.6% SP as a predictor of the presence of metastases in SLN having a good accuracy of 81.2%. On Doppler examination, the resistivity index(RI) showed good accuracy of 80% in characterizing lymph nodes with metastases versus unaffected ones; the same results being obtained by CEUS examination. By assigning to each ultrasonographic parameter a score (0 or 1) and summing up the scores of the four techniques, we obtained the best diagnostic performance in identifying lymph node metastases with 92.2% accuracy. In conclusion, the use of the presented algorithm provides the best identification of metastases in SLNs, helping in mammary carcinoma staging and appropriate therapeutic management.

SERUM THYROGLOBULIN AND ANTI THYROGLOBULIN LEVELS IN PATIENTS WITH THYROID NODULES

Objectives: To compare the levels and pathological values of serum Tg and TgAb between the patients with benign and malignant thyroid nodules and evaluate the relationship between serum Tg and TgAb levels with the rim characteristic and elasticity score of the nodule by thyroid elasto-echography. Subjects: 30 patients with thyroid nodules, Serum Tg and TgAb levels and thyroid elasto-echography are examen before operation. Results: The ratio of the positive Tg level of malignant thyroid nodules was higher than the benign thyroid nodules (16.7% vs 8.3%) but the serum Tg level was not significantly different (33.48 ± 38.67 ng/ml vs 27.32 ± 28.44 ng/ml, p > 0.05) and The ratio of positive TgAb level of malignant thyroid nodules was higher than that of benign thyroid nodules (22.2% vs 0%) but serum TgAb level was not different (64.15 ± 14.91 UI/ml vs 16.9 ± 14.48 UI/ml, p > 0.05). The combination of the ratio of positive Tg and positive TgAb level did not show any difference in the ratio of pathological value between benign and malignant thyroid nodules (5.6% vs 0%). Serum Tg levels in patients with irregular rim thyroid nodules were higher than those in patients with regular rim thyroid nodules but the serum Tg level was not different when evaluated with the elastic score. Conclusions: The mean level and ratio of the pathological value of serum Tg and TgAb did not differ between malignant and benign thyroid nodules. There is a relationship between serum Tg level and irregular rim characteristic of thyroid nodule (p < 0.05). Key words: serum thyroglobulin level, serum anti thyroglobulin level, thyroid nodule.

Clinical utility of TIRADS and ultrasound elastography in characterization of thyroid nodules

Background: Thyroid nodules are a common entity in an iodine deficient population, however malignant nodules are relatively uncommon with excellent prognosis. Ultrasound elastography is a useful tool for characterization of nodules and allows selection of tumors for FNAC. This study aimed to evaluate the diagnostic value of strain elastography and acoustic radiation force impulse (ARFI) imaging in differentiating malignant from benign thyroid nodules.Methods: This study included 100 thyroid nodules evaluated using ultrasound TIRADS classification. Strain elastography evaluated the nodules using the elasticity score and strain ratio followed by VTI and shear wave velocity generated from ARFI data to characterize the nodules. Final diagnoses were obtained from cytological and/or histological evaluation. The diagnostic performance of the two elastography methods was analyzed and compared by multiple receiver operating characteristic curve analysis.Results: Of the 100 thyroid nodules observed in 100 patients (82 females and 18 males), 22% were malignant nodules and 78% were benign. The cut off values for elasticity scores, mean SR, VTI grade and mean SWV for predicting malignant thyroid nodules were greater than or equal to score 2, 2.4, grade 3, 2.5m/s respectively. The area under the receiver operating characteristic curve for elasticity score, mean SR, VTI grade and mean SWV was 0.79, 0.78, 0.89 and 0.84, respectively (P>0.05) and the accuracy was 74, 81.6, 88 and 87.5%, respectively (P>0.05). The accuracy of the combined use of conventional sonography, strain elastography and ARFI imaging was 85.6% respectively, which was higher than that of conventional sonography (P>0.05).Conclusions: Strain elastography and ARFI imaging have high sensitivity and specificity for differentiating malignant from benign thyroid nodules and therefore have good clinical utility in evaluating these lesions.

Correlation between resilience and social support and anxiety in obstetric nurses

Objective The aim of this study was to explore the correlation between psychological resilience and social support and anxiety in obstetric nurses and to provide theoretical basis for improving the mental health of obstetric nurses. Methods In this study, 190 obstetric nurses were included, using the general information questionnaire and The Connor-Davidson Resilience Scale (CD-RISC), Social Support Rating Scale, and survey of Self-evaluation of Anxiety Scale. Results There are differences in the type of work and the score of psychological resilience (P<0.05), obstetric nurses’ resilience score was 65.58±10.65; self-rating anxiety score of obstetric nurses was 36.89±6.87; and social support score of obstetric nurses was 44.37±7.86. The psychological elasticity score and anxiety were negatively related (P<0.01), whereas the resilience score and total score of social support were positively related (P<0.01). Conclusions Obstetric nurses have many responsibilities and stress. Nursing managers should focus on obstetric nurses’ mental health, lighten the obstetric nurses’ anxiety, and thus improve their mental flexibility and optimize the quality of nursing service better, with more passion into work.

Endoscopic Ultrasound Elastography for Evaluation of Lymph Nodes: A Single Center Experience

Background and Aim. The differentiation between malignant and benign lymph nodes (LNs) is important for tumor staging, for detection of prognosis, and for selection of the best treatment strategy in many cancers. On B-mode EUS, there are some known criteria that suggest the malignant nature of LNs; these criteria may be found in benign LNs. The aim of the work is to evaluate the effectiveness of elasticity score and SR to differentiate between benign and malignant LNs. Patients and Methods. The study was designed as a retrospective study that included 40 patients with abdominal or mediastinal LNs, either associated with primary masses or isolated, referred for EUS evaluation. Elasticity scores and SR were determined during the examination and finally, EUS-FNA was done at the end of the procedure. Results. In this 2-years study, 40 patients were enrolled (24 malignant; 16 benign). There were 23 males and 17 females. Their mean age was 52.5 years (range: 28–77). ES alone had a specificity of 87.5%, sensitivity of 41.7%, PPV of 83.3%, NPV of 50%, and accuracy of 60%. Based on the ROC curve analysis results, the best cut-off level of SR to obtain the maximum area under the curve (AUC) was 6.7 with a specificity of 99.9%, sensitivity of 57.1%, PPV of 99.9%, NPV of 64%, and accuracy of 77.5%. Conclusion. The use of elasticity score and SR increases the reliability of differentiation between benign and malignant LNs and can decrease the number of unnecessary biopsies.

Pencitraan Elastisitas Jaringan dengan Ultrasonografi pada Analisa Tumor Mammae

Tissue elasticity imaging with ultrasonography (USG) is used to obtain information about tissue sti?ness. Elasticity is the ability of an object to return to its original shape after a force from the outside given. There are three changes to the form known in the review of the elasticity of an object, namely strain, compression and shear. Modulus of elasticity is stress compared to strain, or the stress per unit strain, and is also called as elastic modulus of the material (tissue). Real-time ultrasound elastography is a further investigation after a detected mass in B-mode, after which pressure is applied lightly using the same transducer. Several studies report that ultrasound elastography diagnostic accuracy in assessing the massas benign or malignant is similar to conventional ultrasound (sensitivity 89.8%, specifcity 88.3%). Elastogram interpretation that is often used is two, namely the value of elasticity (elasticity score) and the ratio of strain (strain ratio). Based on these principle; malignant tumor tissue is rigid, not easily change shape and color with compression, and dark on elastogram, whereas benign tumor is softer, changing as the tissue is compressed and lighter colored. Elastography value can be used as additional data in di?erentiating malignant or benign mammary tumors particularly when the tumor is found dubious.