Shear Wave Elastography and Thyroid Imaging Reporting and Data System (TIRADS) for the Risk Stratification of Thyroid Nodules—Results of a Prospective Study

Purpose: To compare the diagnostic performance of thyroid imaging reporting and data system (TIRADS) in combination with shear wave elastography (SWE) for the assessment of thyroid nodules. Methods: A prospective study was conducted with the following inclusion criteria: preoperative B-mode ultrasound (US) including TIRADS classification (Kwak-TIRADS, EU-TIRADS), quantitative SWE and available histological results. Results: Out of 43 patients, 61 thyroid nodules were detected; 10 nodules were found to be thyroid cancer (7 PTC, 1 FTC, 2 HüCC) and 51 were benign. According to Kwak-TIRADS the majority of benign nodules (47 out of 51, 92.2%) were classified in the low-risk- and intermediate-risk class, four nodules were classified as high-risk (7.8%). When using EU-TIRADS, the benign nodules were distributed almost equally across all risk classes, 21 (41.2%) nodules were classified in the low-risk class, 16 (31.4%) in the intermediate-risk class and 14 (27.4%) in the high-risk class. In contrast, most of the malignant nodules (eight out of ten) were classified as high-risk on EU-TIRADS. One carcinoma was classified as low-risk and one as intermediate-risk nodule. For SWE, ROC analysis showed an optimal cutoff of 18.5 kPa to distinguish malignant and benign nodules (sensitivity 80.0%, specificity 49.0%, PPV 23.5% and NPV 92.6%). The addition of elastography resulted in an increase of accuracy from 65.6% to 82.0% when using Kwak-TIRADS and from 49.2% to 72.1% when using EU-TIRADS. Conclusion: Our data demonstrate that the combination of TIRADS and SWE seems to be superior for the risk stratification of thyroid nodules than each method by itself. However, verification of these results in a larger patient population is mandatory.

[18F]FDG-PET/CT to prevent futile surgery in indeterminate thyroid nodules: a blinded, randomised controlled multicentre trial

Purpose To assess the impact of an [18F]FDG-PET/CT-driven diagnostic workup to rule out malignancy, avoid futile diagnostic surgeries, and improve patient outcomes in thyroid nodules with indeterminate cytology. Methods In this double-blinded, randomised controlled multicentre trial, 132 adult euthyroid patients with scheduled diagnostic surgery for a Bethesda III or IV thyroid nodule underwent [18F]FDG-PET/CT and were randomised to an [18F]FDG-PET/CT-driven or diagnostic surgery group. In the [18F]FDG-PET/CT-driven group, management was based on the [18F]FDG-PET/CT result: when the index nodule was visually [18F]FDG-positive, diagnostic surgery was advised; when [18F]FDG-negative, active surveillance was recommended. The nodule was presumed benign when it remained unchanged on ultrasound surveillance. In the diagnostic surgery group, all patients were advised to proceed to the scheduled surgery, according to current guidelines. The primary outcome was the fraction of unbeneficial patient management in one year, i.e., diagnostic surgery for benign nodules and active surveillance for malignant/borderline nodules. Intention-to-treat analysis was performed. Subgroup analyses were performed for non-Hürthle cell and Hürthle cell nodules. Results Patient management was unbeneficial in 42% (38/91 [95% confidence interval [CI], 32–53%]) of patients in the [18F]FDG-PET/CT-driven group, as compared to 83% (34/41 [95% CI, 68–93%]) in the diagnostic surgery group (p < 0.001). [18F]FDG-PET/CT-driven management avoided 40% (25/63 [95% CI, 28–53%]) diagnostic surgeries for benign nodules: 48% (23/48 [95% CI, 33–63%]) in non-Hürthle cell and 13% (2/15 [95% CI, 2–40%]) in Hürthle cell nodules (p = 0.02). No malignant or borderline tumours were observed in patients under surveillance. Sensitivity, specificity, negative and positive predictive value, and benign call rate (95% CI) of [18F]FDG-PET/CT were 94.1% (80.3–99.3%), 39.8% (30.0–50.2%), 95.1% (83.5–99.4%), 35.2% (25.4–45.9%), and 31.1% (23.3–39.7%), respectively. Conclusion An [18F]FDG-PET/CT-driven diagnostic workup of indeterminate thyroid nodules leads to practice changing management, accurately and oncologically safely reducing futile surgeries by 40%. For optimal therapeutic yield, application should be limited to non-Hürthle cell nodules. Trial registration number This trial is registered with ClinicalTrials.gov: NCT02208544 (5 August 2014), https://clinicaltrials.gov/ct2/show/NCT02208544.

A Unique Case of Multicentric Infantile Myofibromatosis with Radiologic-Pathologic Correlation

Infantile myofibromatosis (IM) is a rare condition with a variable clinical presentation that characteristically affects young children. Most frequently it presents as one or more benign nodules of the skin, bones, soft tissues, or, rarely, visceral organs. According to the location and number of lesions, there are three different forms: solitary, multicentric without visceral involvement, and multicentric with visceral involvement (generalised), with the latter having the least favourable prognosis. We present a unique case of severe congenital generalised IM in a new-born male who required intubation and mechanical ventilation immediately after the birth due to respiratory distress. A chest radiograph showed numerous tumours involving the entire lung, resembling a metastatic lung disease. Additionally, the neonate had multiple, bluish, papular skin nodules and a biopsy of a skin nodule ultimately led to the diagnosis of IM. Diffuse lung involvement prevented adequate ventilation which resulted in multiorgan failure and death before targeted treatment could have been initiated. The presented case is unique, as such atypical extensive involvement of the lung and leptomeninges in IM has not been reported before. In this brief report, we present the findings of radiographic and ultrasonographic examinations in correlation with autopsy and histopathology.

Histological patterns of thyroid lesions among different age groups in Mogadishu, Somalia

Background: Thyroid nodules are seen in 4-7% of the population which are more common in women. Excising all of these lesions is impractical and associated with certain risk factors as well. Fine needle aspiration (FNA) biopsy is the most relevant diagnostic procedure to decide those that need to be surgically excised or not. Methodology: The present study was conducted in Liban clinic, Mogadishu, Somalia. 220 patients whom were diagnosed with various types of tyroid lesions within 2 years of period were included in the study. Main objectives were to put forward the distribution of histological findings according to fine needle aspiration (FNA) biopsy results among different age groups, and to define the prevelance of certain subtypes of thyroid nodules in the region. Results: 207 patients had ‘benign’ nodules and 13 patients had ‘malignant’ nodules according histological evaluationof fine needle aspiration (FNA) biopsy results. ‘31-40’ years of age interval was found to have the highest percentage of histologically ‘benign findings’, while patients within ‘41-50’ years of age had the highest rate of ‘malignant lesions’ in count among the study population. ‘Papillary’ (n=8)(61.5%) and ‘medullary’ (n=5)(38.5%) carcinomas were most common malignant features.Mostly recorded benign lesions were ‘colloidal goiter, multinodular goiter (MNG), nodular hyperplasia and adenomatoid goiter’ (n=94)(45.4%). Conclusion: Characteristics of thyroidlesions in region of Mogadishu, Somalia show similar patterns based upon correlation of age with histological differences compared to recent literature. With the aid of FNA, majority of the population can be managed conservatively safely without need of surgical interventions. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 67-71

Value of Contrast-Enhanced Ultrasound in Partially Cystic Papillary Thyroid Carcinomas

Partially cystic papillary thyroid carcinomas (PCPTCs) are rarely reported papillary thyroid carcinomas (PTCs) and are usually misdiagnosed as benign nodules. The objective of this study was to provide the various sonographic characteristics of partially cystic thyroid nodules for differentiation between malignant and benign nodules, including those for conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS). Twenty-three PCPTC patients and 37 nodular goiter patients were enrolled in this study. We evaluated the size, cystic percentage, solid echogenicity, calcification, vascularity, and CEUS parameters for each nodule. The final diagnosis of all patients was confirmed via surgery. Univariate analysis demonstrated that compared with benign nodular goiters, PCPTCs more frequently presented with calcification, hypoechogenicity of the solid part, hypoenhancement, heterogeneous enhancement, centrifugal perfusion, peak intensity index &lt;1, time to peak index ≥1, and area under the curve index &lt;1 on preoperative US and CEUS. Binary logistic regression analysis demonstrated that heterogeneous enhancement, centrifugal perfusion, and peak intensity index &lt;1 are independent CEUS characteristics related to malignant PCPTCs and can be used for their differentiation from benign nodular goiters (all p &lt; 0.05). Our study indicated that preoperative CEUS characteristics may serve as a useful tool to distinguish malignant PCPTCs from benign thyroid nodules.

The Cole Relaxation Frequency as a Parameter to Identify Cancer in Lung Tissue: Preliminary Animal and ex vivo Patient Studies (Preprint)

UNSTRUCTURED Lung cancer is the world’s leading cause of cancer deaths, and diagnosis remains challenging. Lung cancer starts as small nodules; early and accurate diagnosis allows timely surgical resection of malignant nodules while avoiding unnecessary surgery in patients with benign nodules. The Cole Relaxation Frequency (CRF) is a derived electrical bioimpedance signature, which may be utilized to distinguish cancerous tissues from normal tissues. Here we show that CRF allows for diagnosis of cancer in human subjects, based on evaluation of 60 specimens obtained from 30 patients. We observed clear discrimination of CRF values in tumor and distant normal tissues, resulting in a high degree of sensitivity (97%) and specificity (87%) in cancer diagnosis. Furthermore, we tested 20 xenograft small animal model specimens, observing a similar separation of CRF values as in the human in-vivo measurements. We also obtained CRF measurements in pressurized and unpressurized lungs by implanting tumors into ex-vivo porcine lungs. CRF measurements align with previous tests in human and small animal models.

P-L01 Newly detected liver nodules with a history of colorectal cancer: are they metastasis?

Background The diagnosis of newly detected liver nodules in patients with colorectal cancer (CRC) is crucial for determining prognosis and treatment. Accurate identification of benign nodules can help avoid unnecessary therapy. The aim of our study was to retrospectively review CRC patients who underwent liver resection for newly detected liver nodules in our institution. Methods We went over all patients with a history of CRC, who underwent liver resection from January 2012 to December 2019 in our institution. We specifically focused on nodules pathologically confirmed benign. Clinicopathological characteristics of these patients were collected. Results From 2012 to 2019, a total of 2632 CRC patients received liver resection for liver nodules, among which 2584 cases were proved to be malignant, and 48 cases were benign. Among these 48 cases, 24 were pathologically confirmed as focal nodular hyperplasia (FNH), 10 were inflammatory lesions, 9 were peliosis, and 5 were hemangioma. At least one pre-operative imaging examination (MRI, US, or PET-CT) indicated CRLM, while no one underwent gadoxetic acid-enhanced MRI. The median size of nodule was 2.0 cm (range, 0.4-8.0 cm). For therapy, ten patients received laparoscopic surgery, and 38 patients received open surgery; ten patients received chemotherapy after discovery of liver nodules. Conclusions Newly detected liver nodules with a history of colorectal cancer could be benign. Gadoxetic acid-enhanced MRI should be considered especially for indeterminate liver nodules that would be mimicker of colorectal cancer liver metastasis.

Application of Multislice Spiral CT Imaging Technology in the Diagnosis of Patients with Chest Sarcoidosis

Objective. To study the qualitative value of multislice spiral CT (MSCT) dynamic enhancement scanning for solitary nodules (SPN) of the chest. Methods. In this paper, 40 cases of chest nodules (including 25 cases of malignant nodules, 8 cases of inflammatory nodules, and 7 cases of benign nodules) were first scanned to determine the scope of nodules. At the two rates of 5 ml/s and 3 ml/s, CT dynamic enhancement scans were performed at the center of the nodule, and the CT values, peak enhancement (PH) and peak time (PT) before and after SPN enhancement, were recorded. It is mainly strengthened, with 80% (20/25) of net added value between 20 and 60 Hu, and 20% (5/25) >60 Hu or <20 Hu. The enhancement peak and peak time are (31.31 ± 10.62) Hu and 45 s, respectively. The time-density curve (T-DC) showed a slowly rising type; the inflammatory nodules were mainly severely strengthened, with a net increase of >40 Hu. The enhancement peak value is (49.25 ± 12.44) Hu, and the peak time is 80 s and 140 s. There is a characteristic of rising and falling and then rising in the curve. Conclusion. Multislice spiral CT dynamic enhancement scan reflects the dynamic characteristics of chest nodular blood flow, which can be used to noninvasively evaluate and diagnose SPN.

The Cole Relaxation Frequency as a Parameter to Identify Cancer in Lung Tissue: Preliminary Animal and ex vivo Patient Studies

Lung cancer is the world’s leading cause of cancer deaths, and diagnosis remains challenging. Lung cancer starts as small nodules; early and accurate diagnosis allows timely surgical resection of malignant nodules while avoiding unnecessary surgery in patients with benign nodules. The Cole Relaxation Frequency (CRF) is a derived electrical bioimpedance signature, which may be utilized to distinguish cancerous tissues from normal tissues. Here we show that CRF allows for diagnosis of cancer in human subjects, based on evaluation of 60 specimens obtained from 30 patients. We observed clear discrimination of CRF values in tumor and distant normal tissues, resulting in a high degree of sensitivity (97%) and specificity (87%) in cancer diagnosis. Furthermore, we tested 20 xenograft small animal model specimens, observing a similar separation of CRF values as in the human in-vivo measurements. We also obtained CRF measurements in pressurized and unpressurized lungs by implanting tumors into ex-vivo porcine lungs. CRF measurements align with previous tests in human and small animal models.