Clinical and Sonographic Classification of Neurofibromas in Children with Neurofibromatosis Type 1 – A Cluster Analysis

Purpose High-frequency ultrasound allows the accurate identification of neurofibromas in neurofibromatosis type 1 (NF1). This study aimed to analyze the ultrasound features of neurofibromas in children with NF1, to establish a classification based on the clinical and sonographic patterns of the different types of neurofibromas, and to evaluate the interobserver correlation coefficient (κ) of this classification. Materials and Methods In this prospective, single referral center observational study, clinical and ultrasound findings of neurofibromas in children diagnosed with NF 1 were analyzed. To identify the ultrasound patterns, a cluster analysis allowing the inclusion of both clinical and ultrasound data was designed. The κ coefficient was calculated using 9 external evaluators. Results 265 ultrasound scans were performed on a total of 242 neurofibromas from 108 children diagnosed with NF1. Cluster analysis allowed the identification of 9 patterns (Snedecorʼs F, P < 0.001) classified as “classic” cutaneous neurofibroma, blue-red neurofibroma, pseudoatrophic neurofibroma, nodular subcutaneous neurofibroma, diffuse subcutaneous neurofibroma, congenital cutaneous neurofibroma, congenital plexiform neurofibroma, congenital diffuse and plexiform neurofibroma, and subfascial neurofibroma. The κ coefficient of the interobserver ratings was 0.82. Conclusion Patterns identified in the cluster analysis allow neurofibromas to be classified with a very high interobserver correlation.

Diagnostic Accuracy of a New Sonographic Classification System in Diagnosing Malignant Thyroid Nodules

Objective: To evaluate the validity of new ultrasound classification in diagnosing malignant thyroid nodule keeping fine needle aspiration cytology (FNAC) as gold standard. Materials and Methods: This validation study was carried out at hospital from September 06-2020 to March-2021 in Children Hospital and Institute of Child Health Multan .A total number of 114 patients who presented with inflamed thyroid nodules were included. General information regarding patient like name, age and gender was documented for data collection. Ultrasonography was done using Linear 7.5 MHz and curvilear 3.5 MHz transducer all patient in supine position and comfortable setting. Features of ultrasound were recorded. Patients having U4-U5 score were labelled as having malignant lesions. All cases were followed up by fine needle aspiration and corresponding histopathology report. Results: Mean age of patients was 46.06±10.34 years. Out of 114 patients, 83 (72.81%) patients were female and only 31 (27.19%) were male. On ultrasonography, malignancy was diagnosed in only 24 (21.05%) patients, and remaining 90 (78.95%) were diagnosed of having benign lesions. On histopathology, malignancy was diagnosed in 25 (21.93%) lesions, while remaining 89 (78.07%) patients were diagnosed of having benign lesions. Sensitivity of ultrasound U-score in diagnosing malignant thyroid nodules was 88%, specificity was 97.8%, PPV was 91.7% and NPV was 96.7%. Conclusion: New sonographic classification system has a reliable accuracy for differentiating malignant from benign solid thyroid nodules. So it can be used as preferred radiological scoring system for initial investigation for solid thyroid nodules. Keywords: Thyroid nodules, ultrasound U-Score, Histopathology, Malignancy, Diagnostic accuracy.

Managing patients with suspected postpartum retained products of conception using a novel sonographic classification

Background Suspicion of retained products of conception (RPOC) often arises after delivery and still poses a diagnostic and management challenge. Purpose To prospectively evaluate a sonographic classification for the management of patients with suspected RPOC after delivery. Material and Methods Based on grayscale and Doppler ultrasound parameters, patients were classified into high, moderate, or low probability of RPOC. For the low and moderate probability groups, an ultrasound follow-up at the end of the puerperium was recommended. For the high probability group, a follow-up examination was conducted 10–14 days after the first ultrasound, and patients with persistent high probability findings were referred for surgical intervention. Results The sample was composed of 215 patients at risk of RPOC. Of these, 100, 93, and 22 patients were classified as having a low, moderate, or high probability of RPOC, respectively. Rates of RPOC were 55%, 2%, and 2% in the high, moderate, and low probability categories, respectively. When the categorization was based on the most recent ultrasound obtained during the puerperium, the adjusted RPOC prevalence rates were 71% in the high, 6% in the moderate, and 0% in the low probability groups. Conclusion This study confirms the effectiveness of our sonographic classification for managing patients with suspected RPOC after delivery. In all three categories, it is recommended to adhere to a conservative management protocol in clinically stable women until the end of the puerperium. This approach provides good predictability for RPOC and can reduce unnecessary surgical interventions.