Echogenic Foci Research Articles

Association between papillary thyroid carcinoma and cervical lymph node metastasis based on ultrasonic radio frequency signals.

Papillary thyroid carcinoma (PTC) has a high propensity for cervical lymph node metastasis (CLNM). We evaluated the association between PTC radio frequency (RF) signals and CLNM. Patients with PTC (n = 170) confirmed by pathology after thyroidectomy between July 2019 and May 2022 were enrolled in this retrospective cohort study. Patients were divided into positive and negative groups according to CLNM. Univariate analysis was performed to predict CLNM and a receiver operating characteristic (ROC) curve was generated to evaluate the diagnostic performance of RF signals and the Thyroid imaging Reporting and Data System. Of 170 patients with 182 nodules included in the study, 11 had multiple nodules. Univariate analysis showed that age, maximum tumor diameter, cross-sectional and longitudinal aspect ratio, RF quantitative parameters (cross-sectional intercept, mid-band, S1, and S4, and longitudinal Higuchi, slope, intercept, mid-band, S1), and echogenic foci were independently associated with CLNM (p < 0.05). The area under the curve (AUC) values of the maximum tumor diameter, longitudinal slope, and echogenic foci were 0.68, 0.61, and 0.62, respectively. Linear regression analysis of maximum tumor diameter, longitudinal slope, and echogenic foci showed that the correlations between longitudinal slope and CLNM were greater than that of echogenic foci (ß = 0.203 vs. ß = 0.154). Longitudinal slope and echogenic foci have similar diagnostic efficacy for predicting the risk of CLNM in PTC, although longitudinal slope has a greater correlation with CLNM.

Cardiac structural and functional remodeling in the fetuses associated with maternal hypothyroidism during pregnancy

Objectives We sought to investigate the effect of maternal hypothyroidism during pregnancy on fetal cardiac structural and functional remodeling using fetal echocardiography. Methods A total of 59 pregnant women with history of hypothyroidism were prospectively enrolled as the study group, and 74 normal fetuses as the control group. Fetal echocardiography was performed on each subject. Demographic, clinical, and fetal echocardiographic variables were measured, including left ventricular (LV) and right ventricular (RV) free wall and ventricular septal thickness, fractional shortening (FS), stroke volume (SV), cardiac output (CO), combined cardiac output (CCO), cardiac index (CI), combined cardiac index (CCI), aortic and pulmonary artery velocity, ductus venosus (DV) and pulmonary vein (PV) spectral Doppler, and Tei index. Results The incidence of echogenic intracardiac foci (EIF) was higher in the study group than that in the control group (18.6% vs. 6.8%, p = .036). The thickness of LV free wall and interventricular septum was reduced, the pulmonary velocities and CCI, RV FS, CO, and CI were lower, the S, D, S/A, and pulsatility index (PI) of DV were higher, and LV Tei index was higher in the study group compared with the control group. There was no significant difference in other variables between the two groups. Conclusions There is cardiac remodeling, and systolic, diastolic functional alterations in fetuses with maternal hypothyroidism. Further investigation is warranted to develop strategies to optimize the outcome of these fetuses.

Differential regional importance mapping for thyroid nodule malignancy prediction with potential to improve needle aspiration biopsy sampling reliability.

Existing guidelines for ultrasound-guided fine-needle aspiration biopsy lack specifications on sampling sites, but the number of biopsies improves diagnostic reliability. We propose the use of class activation maps (CAMs) and our modified malignancy-specific heat maps that locate important deep representations of thyroid nodules for class predictions. We applied adversarial noise perturbations to the segmented concentric "hot" nodular regions of equal sizes to differentiate regional importance for the malignancy diagnostic performances of an accurate ultrasound-based artificial intelligence computer-aided diagnosis (AI-CADx) system using 2,602 retrospectively collected thyroid nodules with known histopathological diagnosis. The AI system demonstrated high diagnostic performance with an area under the curve (AUC) value of 0.9302 and good nodule identification capability with a median dice coefficient >0.9 when compared to radiologists' segmentations. Experiments confirmed that the CAM-based heat maps reflect the differentiable importance of different nodular regions for an AI-CADx system to make its predictions. No less importantly, the hot regions in malignancy heat maps of ultrasound images in comparison with the inactivated regions of the same 100 malignant nodules randomly selected from the dataset had higher summed frequency-weighted feature scores of 6.04 versus 4.96 rated by radiologists with more than 15 years of ultrasound examination experience according to widely used ultrasound-based risk stratification American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) in terms of nodule composition, echogenicity, and echogenic foci, excluding shape and margin attributes, which could only be evaluated on the whole rather than on the sub-nodular component levels. In addition, we show examples demonstrating good spatial correspondence of highlighted regions of malignancy heat map to malignant tumor cell-rich regions in hematoxylin and eosin-stained histopathological images. Our proposed CAM-based ultrasonographic malignancy heat map provides quantitative visualization of malignancy heterogeneity within a tumor, and it is of clinical interest to investigate in the future its usefulness to improve fine-needle aspiration biopsy (FNAB) sampling reliability by targeting potentially more suspicious sub-nodular regions.

Clinicopathological and ultrasound characteristics of breast cancer in BRCA1 and BRCA2 mutation carriers

PurposeBRCA1 and BRCA2 tumors exhibit different characteristics. This study aimed to assess and compare the ultrasound findings and pathologic features of BRCA1 and BRCA2 breast cancers. To our knowledge, this is the first study to examine the mass formation, vascularity, and elasticity in breast cancers of BRCA-positive Japanese women.MethodsWe identified patients with breast cancer harboring BRCA1 or BRCA2 mutations. After excluding patients who underwent chemotherapy or surgery before the ultrasound, we evaluated 89 cancers in BRCA1-positive and 83 in BRCA2-positive patients. The ultrasound images were reviewed by three radiologists in consensus. Imaging features, including vascularity and elasticity, were assessed. Pathological data, including tumor subtypes, were reviewed.ResultsSignificant differences in tumor morphology, peripheral features, posterior echoes, echogenic foci, and vascularity were observed between BRCA1 and BRCA2 tumors. BRCA1 breast cancers tended to be posteriorly accentuating and hypervascular. In contrast, BRCA2 tumors were less likely to form masses. In cases where a tumor formed a mass, it tended to show posterior attenuation, indistinct margins, and echogenic foci. In pathological comparisons, BRCA1 cancers tended to be triple-negative subtypes. In contrast, BRCA2 cancers tended to be luminal or luminal-human epidermal growth factor receptor 2 subtypes.ConclusionIn the surveillance of BRCA mutation carriers, radiologists should be aware that the morphological differences between tumors are quite different between BRCA1 and BRCA2 patients.

Construction of prediction models for determining the risk of lateral lymph node metastasis in patients with thyroid papillary carcinoma based on gender stratification.

Lateral lymph node metastasis (LLNM) is associated with poor prognosis in patients with papillary thyroid cancer (PTC). The purpose of this study was to determine the risk factors for LLNM and establish prediction models that could individually assessed the risk of LLNM. A total of 619 PTC patients were retrospectively analyzed in our study. Univariate and multivariate analysis were performed for male and female patients, respectively, to assess relationships between clinicopathological features and LLNM. By integrating independent predictors selected by binary logistic regression modeling, preoperative and postoperative nomograms were developed to estimate the risk of LLNM. LLNM was detected in 80 of 216 male patients. Of 403 female patients, 114 had LLNM. The preoperative nomogram of male patients included three clinical variables: the number of foci, tuner size, and echogenic foci. In addition to the above three variables, the postoperative nomogram of male patients included extrathyroidal extension (ETE) detected in surgery, central lymph node metastasis (CLNM) and high-volume CLNM. The preoperative nomogram of female patients included the following variables: age, chronic lymphocytic thyroiditis (CLT), BRAF V600E, the number of foci, tumor size and echogenic foci. Variables such as CLT, BRAF V600E, the number of foci, tumor size, ETE detected in surgery, CLNM, high-volume CLNM and central lymph node ratio were included in the postoperative nomogram. Above Nomograms show good discrimination. Considering the difference in the incidence rate of LLNM between men and women, a separate prediction system should be established for patients of different genders. These nomograms are helpful in promoting the risk stratification of PTC treatment decision-making and postoperative management.

Patients undergoing endocrine consultation and first diagnosis of nodular disease: Indications of thyroid ultrasound and completeness of ultrasound reports.

To evaluate reasons for performing ultrasonography (US) and completeness of US reports in patients undergoing endocrine consultation with the first diagnosis of nodular disease. Since January 1 to June 30, 2021, we prospectively collected patient data (age and thyroid-stimulating hormone concentrations), reasons for performing thyroid US, and completeness of reports regarding the description of the thyroid gland and nodules. In the case of multiple nodules, we considered the nodule suspected of malignancy and the largest one. To evaluate the accuracy of thyroid nodule description, we referred to the five characteristics suggested by the ACR TI-RADS system. A total of 341 patients with thyroid nodules received endocrine consultation (female, 78%). The most frequent reasons for performing thyroid US were unrelated to a suspected thyroid disease (31.7%), followed by incidentaloma (23.5%), dysfunction or positivity for thyroid antibodies (19.1%), symptomatic or visible nodules (17.6%), and family history of any thyroid disease (8.2%). Gland texture was not reported in 41.9%. The depth of the lobes was the dimension reported most frequently (42.2%), but any diameter was not reported in 57.8% of the cases. As regards the description of the most relevant nodule, length was reported more frequently (75.9%). Margins and echogenicity were more frequently described (54.5% and 44.3%, respectively) than other characteristics (composition: 27%; shape: 8.8%; echogenic foci: 6.7%). No reports had indicated the malignancy risk stratification. The results of the study demonstrate that in patients undergoing endocrine consultation with first detected thyroid nodules, US was mostly performed in asymptomatic cases, US reports were incomplete, and no risk stratification system was reported.

Subcategorization of intermediate suspicion thyroid nodules based on suspicious ultrasonographic findings.

This study compared the malignancy risk of intermediate suspicion thyroid nodules according to the presence of suspicious ultrasonographic (US) findings. From January 2014 to December 2014, 299 consecutive intermediate suspicion thyroid nodules in 281 patients (mean age, 50.6±12.5 years) with final diagnoses were included in this study. Two radiologists retrospectively reviewed the US findings and subcategorized the intermediate suspicion category into nodules without suspicious findings and nodules with suspicious findings, including punctate echogenic foci, nonparallel orientation, or irregular margins. The malignancy rates were compared between the two subcategory groups. Of the 299 intermediate suspicion thyroid nodules, 230 (76.9%) were subcategorized as nodules without suspicious findings and 69 (23.1%) as nodules with suspicious findings. The total malignancy rate was 33.4% (100/299) and the malignancy rate of nodules with suspicious findings was significantly higher than that of nodules without suspicious findings (47.8% vs. 29.1%, P=0.004). In nodules with suspicious findings, the most common suspicious finding was punctate echogenic foci (48/82, 58.5%) followed by nonparallel orientation (22/82, 26.8%) and irregular margins (12/82, 14.6%). Thirteen nodules had two suspicious findings simultaneously. A linearly increasing trend in the malignancy rate was observed according to the number of suspicious US findings (P for trend=0.001). Intermediate suspicion thyroid nodules with suspicious findings showed a higher malignancy rate than those without suspicious findings. Further management guidelines for nodules with suspicious findings should differ from guidelines for nodules without suspicious findings, even in the same US category.

Accuracy of American College of Radiology Thyroid Imaging Reporting and Data System in Characterisation of Thyroid Nodules: A Tertiary Hospital Study in India

Background: Thyroid nodules (TNs) are commonly and frequently encountered in the day-to-day clinical practice. Clinical suspicion of malignancy as well as patient anxiety is the frequent reasons for fine-needle aspiration cytology or biopsy (FNAC/B) of TN. American College of Radiology has developed a Thyroid Imaging Reporting and Data System (ACR TI-RADS) based on TN ultrasound features to suggest malignancy to minimise the number of TN subjected to FNAC/B. Aim to assess the diagnostic accuracy of ACR TI-RADS in our Tertiary Hospital Health Facility. Patients, Materials and Methods: Sixty-nine patients with TN included in our study following institutional ethics committee approval and written informed consent underwent high-resolution ultrasonography followed by FNAC using a high-frequency linear transducer on Siemen Acuson S3000 ultrasound scanner. The data were recorded in the predesigned proforma followed by statistical analysis to assess the diagnostic accuracy of ACR TI-RADS. Results: Our study had female predominance (50/69) with the left side more commonly affected (37/69). The mean age of the participants was 42.2 ± 15.6 years with significantly higher age at presentation in those with malignant TN. Mixed nodules were predominant (46/69) with nearly half of the malignant nodules being solid and only 8/61 benign nodules being solid. Although the majority of the nodules were hyperechoic (50/69 including 2 malignant), a significant number of the hypoechoic/very hypoechoic nodules (6/14) were malignant with only 8/61 benign nodules being hypoechoic. Half of the malignant nodules (4/8) had lobulated or ill-defined margins, whereas only 2/61 benign nodules had similar margins. The majority (5/8) of the malignant TN had internal punctate echogenic foci with only 1/61 benign TN showing similar appearance. Half of the malignant TN (4/8) had lymphadenopathy, whereas it was noted in only 2/61 cases of benign TN. Conclusions: TNs though have a high prevalence, but malignant TNs are uncommon with majority being solid, taller than wider, hypoechoic with microcalcifications. The presence of adenopathy is usually a feature of malignant thyroid nodule rarely seen with benign nodules. Thus, to summarise all TNs should be thoroughly evaluated as per ACR TI-RADS for stratification of risk of malignancy.

Comparison of ultrasonography and pathology features between children and adolescents with papillary thyroid carcinoma

ObjectiveTo compare the ultrasonography and pathology features between children and adolescents with papillary thyroid carcinoma (PTC). MethodsA total of 53 patients who were surgically diagnosed with childhood or adolescent PTC between 2017 and 2022 were included in this study. The pre-operative ultrasonography, post-operative histology, and molecular and clinical characteristics were retrospectively analyzed. ResultsNo differences were observed in composition, echogenicity, and shape using ultrasonography. Moreover, there was a significantly higher rate of extrathyroidal extension, punctate echogenic foci, and lymph node metastases in children compared to adolescents. The molecular analysis showed that BRAFV600E mutations are the most prevalent abnormality in adolescent PTC (12/20, 60.0%). However, they are less in childhood PTC (7/23, 30.4%). In addition, using next-generation sequencing, three cases with oncogenic fusion (one TRIM33-RET case, one CCDC6-RET case, and one STRN-ALK case) were identified in childhood PTC. ConclusionThe frequency of extrathyroidal extension, punctate echogenic foci, and lymph node metastases were higher in childhood PTC, while BRAFV600E mutations were higher in adolescent PTC.

A rare case of sialolipoma of submandibular gland

&lt;p class="abstract"&gt;Lipomas in head and neck region are common but prevalence in salivary glands is rare with majority in parotid. Sialolipoma is a rare tumour of the salivary gland that is composed of mature adipocytes and normal salivary gland tissue. We report an extremely rare case of sialolipoma of left submandibular gland in a 39-year-old male who presented with complaints of insidious onset gradually progressive swelling in left submandibular region with no pain, discolouration or discharge. On examination, a 5×4 cm soft, non-tender swelling was noticed in (L) submandibular region. Ultrasonography of neck revealed enlarged (L) submandibular gland with hypoechoic area of 5 mm diameter and small areas of echogenic foci with no cervical lymphadenopathy. Contrast enhanced computed tomography (CECT) neck showed a 5.6×2.7×4 cm well defined fat attenuated lesion in (L) submandibular space, suggestive of lipoma with a well-defined enhancing soft tissue component within the lesion. He underwent excision of (L) submandibular gland along with fibrofatty tissue under general anaesthesia. Histopathological examination revealed submandibular gland with normal histomorphological features along with mature adipocytes in fibrofatty tissue. The patient is on regular follow-up with no recurrence.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Incorporation of a machine learning pathological diagnosis algorithm into the thyroid ultrasound imaging data improves the diagnosis risk of malignant thyroid nodules.

This study aimed at establishing a new model to predict malignant thyroid nodules using machine learning algorithms. A retrospective study was performed on 274 patients with thyroid nodules who underwent fine-needle aspiration (FNA) cytology or surgery from October 2018 to 2020 in Xianyang Central Hospital. The least absolute shrinkage and selection operator (lasso) regression analysis and logistic analysis were applied to screen and identified variables. Six machine learning algorithms, including Decision Tree (DT), Extreme Gradient Boosting (XGBoost), Gradient Boosting Machine (GBM), Naive Bayes Classifier (NBC), Random Forest (RF), and Logistic Regression (LR), were employed and compared in constructing the predictive model, coupled with preoperative clinical characteristics and ultrasound features. Internal validation was performed by using 10-fold cross-validation. The performance of the model was measured by the area under the receiver operating characteristic curve (AUC), accuracy, precision, recall, F1 score, Shapley additive explanations (SHAP) plot, feature importance, and correlation of features. The best cutoff value for risk stratification was identified by probability density function (PDF) and clinical utility curve (CUC). The malignant rate of thyroid nodules in the study cohort was 53.2%. The predictive models are constructed by age, margin, shape, echogenic foci, echogenicity, and lymph nodes. The XGBoost model was significantly superior to any one of the machine learning models, with an AUC value of 0.829. According to the PDF and CUC, we recommended that 51% probability be used as a threshold for determining the risk stratification of malignant nodules, where about 85.6% of patients with malignant nodules could be detected. Meanwhile, approximately 89.8% of unnecessary biopsy procedures would be saved. Finally, an online web risk calculator has been built to estimate the personal likelihood of malignant thyroid nodules based on the best-performing ML-ed model of XGBoost. Combining clinical characteristics and features of ultrasound images, ML algorithms can achieve reliable prediction of malignant thyroid nodules. The online web risk calculator based on the XGBoost model can easily identify in real-time the probability of malignant thyroid nodules, which can assist clinicians to formulate individualized management strategies for patients.

Can prenatal renal pelvicalyceal echogenic foci support the diagnosis of cystinuria?

Cystinuria is an inherited disease caused by a defect in renal and intestinal tubular transport affecting cystine and dibasic amino acids (lysine, ornithine and arginine). It is transmitted as an autosomal recessive disease. On fetal ultrasound, the colon is usually seen as hypoechoic or isoechoic. Antenatal hyperechoic appearance of the fetal colon was previously considered as a normal variant. However, recent studies have shown that hyperechoic colon is associated with cystinuria. We present a case of cystinuria, who was referred to us due to fetal hyperechogenic colon at 32 weeks of gestation. Additional fetal pericalyceal echogenic focal structures were observed on ultrasonography. The diagnosis of cystinuria was confirmed in the postnatal period.

LASSO-based machine learning models for the prediction of central lymph node metastasis in clinically negative patients with papillary thyroid carcinoma.

The presence of central lymph node metastasis (CLNM) is crucial for surgical decision-making in clinical N0 (cN0) papillary thyroid carcinoma (PTC) patients. We aimed to develop and validate machine learning (ML) algorithms-based models for predicting the risk of CLNM in cN0 patients. A total of 1099 PTC patients with cN0 central neck from July 2019 to March 2022 at our institution were retrospectively analyzed. All patients were randomly split into the training dataset (70%) and the validation dataset (30%). Eight ML algorithms, including the Logistic Regression, Gradient Boosting Machine, Extreme Gradient Boosting (XGB), Random Forest (RF), Decision Tree, Neural Network, Support Vector Machine and Bayesian Network were used to evaluate the risk of CLNM. The performance of ML models was evaluated by the area under curve (AUC), sensitivity, specificity, and decision curve analysis (DCA). We firstly used the LASSO Logistic regression method to select the most relevant factors for predicting CLNM. The AUC of XGB was slightly higher than RF (0.907 and 0.902, respectively). According to DCA, RF model significantly outperformed XGB model at most threshold points and was therefore used to develop the predictive model. The diagnostic performance of RF algorithm was dependent on the following nine top-rank variables: size, margin, extrathyroidal extension, sex, echogenic foci, shape, number, lateral lymph node metastasis and chronic lymphocytic thyroiditis. By incorporating clinicopathological and sonographic characteristics, we developed ML-based models, suggesting that this non-invasive method can be applied to facilitate individualized prediction of occult CLNM in cN0 central neck PTC patients.

Changes in the thymus gland with age: A sonographic evaluation.

Ultrasound evaluation of normal, ectopic, asymmetric, and hyperplastic thymus and also its differentiation from abnormalities are challenging in children, and few studies have addressed this issue. This study aimed to investigate the thymus sonographic changes with age. In this cross-sectional study, 118 healthy children were categorised into six age groups. Sonographic features of the thymus, including volume, anatomical position, symmetry, and echo-texture, were recorded. The thymus was visible at all ages from the suprasternal view. In 77.5% of participants, the thymus gland volume in lobes was symmetrical; however, left (21.2%) and right (1.3%) predominance were also found. The most common position of the thymus was in front of the great vessels (100%) with suprasternal extension (97.5%). The mean volume of thymus was 21.3 ± 10.5 (mm). There was no significant difference in the volumes of the thymus between different age groups. The predominant echo-texture of the thymus in different age groups was hypoechoic with thin echogenic septa (liver-like) in below 2-3 years of age, the appearance of echogenic foci and hyperechoic echo-texture (liver-like with starry sky) in 2-14 years, and uniform hyperechoic echo-texture (fatty liver-like) or geographic echo-texture with coarse reticular pattern in above 14 years. In children, the thymus gland is visible in ultrasound examination in all age groups from the suprasternal view; however, the echo-texture of the normal thymus changes with age. There was no significant correlation between age and sex with total thymic volume. The specificity of these appearances has made ultrasound a problem-solving modality in children.

ODP457 A Single-center Retrospective Study of Thyroid Nodules 4 cm or Larger

Abstract Background There is conflicting data and no clear consensus regarding the management of thyroid nodules 4 cm or larger. Diagnostic accuracy of fine needle aspiration (FNA) cytology of these nodules has been variable. Few studies have reported higher false negative rates suggesting surgery as reasonable option whereas other studies reported low false negative rates with no significant difference between small and large nodules. The goal of our study was to evaluate the reliability of FNA cytology in excluding malignancy in thyroid nodules 4 cm or larger in our patient population and to investigate the association between malignancy and any patient specific risk factors or ultrasound features. Methods We conducted a retrospective review of 380 patients with thyroid nodules who underwent thyroid surgery between 2014 and 2021 at our institution. Patient demographics such as age, gender and ethnicity, number and size of thyroid nodules, TSH level, FNA cytology, type of surgery and final surgical pathology results were recorded for patients with nodules 4 cm or larger and nodules between 2-4 cm. False negative rate of FNA cytology was compared between these two groups. Accessible ultrasound images for nodules 4 cm or larger were reviewed. Patient specific and nodule characteristics were compared between malignant and benign nodules. Fisher exact tests and multivariate logistic regression were used for data analysis. Results A total of 81 patients with thyroid nodules 4 cm or larger were studied, of which 22 patients (27.1%) had thyroid cancer. Mean age in patients with malignant nodules was 48.1 +/- 18.3 years versus 51.7 +/- 14.5 years in patients with benign nodules. The adjusted odds of malignancy for males was 20 times (95% CI: 3.3-125; p=0. 001) the odds for females. The adjusted odds of malignancy for nodules with both peripheral and internal vascularity on doppler ultrasound was 9.9 times (95% CI: 1.36-71.70; p=0. 024) that of nodules with only peripheral vascularity. Other nodule characteristics like composition, echogenicity, margins, halo, echogenic foci and taller than wide shape were not significantly different between malignant and benign nodules. False negative rate of FNA cytology for nodules 4 cm or larger was 8.7% (4/46 patients) as compared to 10% (4/40 patients) for nodules between 2-4 cm. This was not statistically significant (p=1. 0). Conclusion In our study, the false negative rate of FNA cytology in thyroid nodules 4 cm or larger was similar to that of nodules between 2-4 cm. This indicates that patients with thyroid nodules 4 cm or larger and benign cytology can be managed conservatively with appropriate clinical follow up. Male gender and nodules with peripheral and internal vascularity on doppler ultrasound were associated with thyroid malignancy in our review. Presentation: No date and time listed

Elastography as predictor for thyroid nodule malignancy

Background: Ultrasound elastography is a promising noninvasive technique that is still in its infancy. It uses tissue elasticity measurements to distinguish between benign (soft tissues) and malignant (hard tissues) nodules. Objectives: to see if elastography has diagnostic significance and if it may be used as a predictor of thyroid nodule malignancy Methods: An analytical cross-sectional study was done and data collected using Philips Epiq 7 linear transducer 8-12MHZ, strain type of elastography. A sample of 27 patients from Al-Hada Armed Forces Hospital, Taif, Saudi Arabia were included. Data about patients’ demographics, AP, TR, Echogenicity, Margin, Composition, Echogenic foci, FNA result, Elastography findings and TIRADs classification were collected. Results: According to FINA findings, the majority of patients (96.3 percent) had a benign tumour, and 81.5 percent had soft elastography. T2 was the most common TIRADs classification (55.6 percent). The percentage of patients with T2 (TIRADs) was significantly greater in patients with a younger mean age, and there was a non-significant association between TIRADs categorization and FINA findings. Females had a much higher percentage of benign diagnoses based on FINA results, with no significant link detected between FINA results and the demographic or clinical characteristics of the patients. Both TIRADs categorization and FINA results were shown to have no significant link with the elastography data. Conclusion: The elastography findings were found to have a non-significant link with both TIRADs categorization and FINA results. Future studies with larger samples should be conducted to clarify the study outcomes. Keywords: Elastography, predictor, thyroid, nodule, malignancy

Ultrasonographical features of perinatal testicular torsion: an assessment of interobserver variability among radiologists and pediatric urologists.

To retrospectively compare interpretations of Doppler ultrasound (US) in newborns with confirmed perinatal testicular torsion (PTT) by an experienced faculty (staff) pediatric radiologist (SPR), pediatric radiology fellow (PRF), pediatric urology fellow (PUF) and staff pediatric urologist (SPU). US images of 27 consecutive males with PTT between May 2000 and July 2020 were retrieved. The testicles were classified as affected or non-affected by PTT. We performed a blinded comparison of interpretation by four assessors (SPR, PRF, PUF, SPU), with respect to the US features of PTT. Paired inter-rater agreement was calculated using Cohen's Kappa (κ) and overall agreement was assessed using Fleiss' kappa. Overall comparison using Fleiss' kappa found fair agreement for most features except testicular echogenicity and echogenic foci at interface for which there was poor agreement. Paired comparisons revealed better agreement between the SPR and PRF compared to the remaining two pairs, suggesting a need for the pediatric urologists (PUF and SPU) to acquaint themselves with testicular ultrasonography as this may have an impact on patient risk stratification and the quality of information given to parents. This study highlights the need for focused training program for pediatric urologists to attain similar agreement as the radiologists, suggesting a need for the pediatric urologists (PUF and SPU) to acquaint themselves with testicular ultrasonography as this may have an impact on patient risk stratification and the quality of information given to parents.

Efficacy of endoscopic ultrasound in the evaluation of small gastrointestinal stromal tumors.

BACKGROUNDGastrointestinal stromal tumors (GISTs) with a diameter of < 2 cm are called small GISTs. Currently, endoscopic ultrasound (EUS) is widely used as a regular follow-up method for GISTs, which can also provide a preliminary basis for judging the malignancy potential of lesions. However, there are no studies on the accuracy of EUS to assess the malignant potential of small GISTs.AIMTo evaluate the efficacy of EUS in the diagnosis and risk assessment of small GISTs.METHODSWe collected data from patients with small GISTs who were admitted to Shengjing Hospital of China Medical University between October 2014 and July 2019. The accurate diagnosis and risk classifications of patients were based on the pathological assessment according to the modified National Institute of Health criteria after endoscopic resection or laparoscopic surgery. Preoperative EUS features (marginal irregularity, cystic changes, homogeneity, ulceration, and strong echogenic foci) were retrospectively analyzed. The assessment results based on EUS features were compared with the pathological features.RESULTSA total of 256 patients (69 men and 187 women) were enrolled. Pathological results included 232, 16, 7, and 1 very low-, low-, intermediate-, and high-risk cases, respectively. The most frequent tumor location was the gastric fundus (78.1%), and mitoses were calculated as > 5/50 high power field in 8 (3.1%) patients. Marginal irregularity, ulceration, strong echo foci, and heterogeneity were detected in 1 (0.4%), 2 (0.8%), 22 (8.6%), and 67 (65.1%) patients, respectively. However, cystic changes were not detected. Tumor size was positively correlated with the mitotic index (P < 0.001). Receiver operating curve analysis identified 1.48 cm as the best cut-off value to predict malignant potential (95% confidence interval: 0.824–0.956). EUS heterogeneity with tumor diameters > 1.48 cm was associated with higher risk classification (P < 0.05).CONCLUSIONSmall GISTs (diameters > 1.48 cm) with positive EUS features should receive intensive surveillance or undergo endoscopic surgery. EUS and dissection are efficient diagnostic and therapeutic approaches for small GISTs.

S2840 Hepatic Tuberculoma Caused by Mycobacterium Fortuitum: A Rare Case Diagnosed by EUS-FNA

Introduction: Mycobacterium fortuitum is a type of nontuberculous mycobacteria belonging to a group classified as Rapidly Growing Mycobacteria (RGM), along with Mycobacterium abscessus and Mycobacterium chelonae. M. fortuitum is predominantly associated with skin, soft tissue, and surgical-wound infections. Catheter-related sepsis and disseminated disease can also occur. Isolated liver involvement by atypical mycobacterial infection is exceedingly rare. Here we describe a case of M. fortuitum presenting as an asymptomatic liver mass. Case Description/Methods: A 67-year-old male was referred for endoscopic ultrasound (EUS) to evaluate a gastric body subepithelial lesion (SEL) and a 3 cm incidental liver mass. He was asymptomatic. Percutaneous CT-guided biopsy was performed, but pathologic results were nondiagnostic. Patient was thus referred for EUS to evaluate the gastric SEL and determine if the liver mass represented metastasis. A 14 by 4 mm elongated intramural hypoechoic mass arising from the muscularis propia highly suggestive of a leiomyoma or GIST was identified. A heterogeneous mass with cystic spaces and echogenic foci in the left liver lobe measuring 27 by 20 mm was sampled using a 22g FNA needle. Pathology revealed granulomatous inflammation with necrosis. An AFB stain was positive for acid fast bacilli. PCR analysis of the specimen detected M. fortuitum DNA. Patient was treated with levofloxacin 750 mg daily plus trimethoprim and sulfamethoxazole (Septra DS) 800 mg - 160 mg twice daily. Follow-up contrast-enhanced MRI revealed complete resolution of liver lesion after 3 months of antibiotics. Discussion: Isolated liver involvement by nontuberculous mycobacteria is uncommon, usually asymptomatic, and its diagnosis can easily be missed or mistaken. We report the first case of a hepatic tuberculoma caused by M. fortuitum diagnosed by EUS-FNA. Precise and accurate recognition by a minimally invasive technique via EUS-FNA resulted in prompt treatment and resolution of the disease.

The analysis and validation of the prediction value of conventional and contrast-enhanced ultrasonography for BRAF mutant papillary thyroid microcarcinoma

BRAF has certain potential in distinguishing aggressive papillary thyroid microcarcinoma (PTMC). However, it is not recommended to conduct BRAF analysis for all suspicious thyroid nodules <1 cm. In order to investigate the ultrasound value indicating BRAF mutation among PTMC, which showed discrepancy in previous studies, we aimed to establish a predictive model based on conventional and contrast-enhanced ultrasonography. We consecutively and retrospectively enrolled patients with PTMC who underwent fine-needle aspiration biopsy (FNAB) at our hospital between January 2020 and January 2021. All PTMC patients received conventional and contrast-enhanced ultrasound prior to FNAB, samples gained went through cytological analysis and BRAF testing subsequently. The following conventional ultrasonography data were analyzed: maximum diameter, echogenicity, echo homogeneity, echogenic foci, location, shape, boundary, aspect ratio, and blood flow volume. Moreover, the following contrast-enhanced ultrasonography data were also analyzed: degree, homogeneity, completeness, and enhancement method. Time-intensity curves from contrast-enhanced ultrasonography were analyzed using VueBox software for different regions of interest, including the entire tumor, the area of strongest enhancement, and healthy thyroid glands. The independent risk factors for BRAF mutation in PTMC were identified using univariate and multivariate logistic regression. Their predictive value was tested through internal validation. Of the 103 PTMC lesions analyzed, 72 involved BRAF mutations. Five independent ultrasonographic risk factors for BRAF mutation were identified: relative time to peak value in the area of strongest enhancement, unclear boundary, location adjacent to thyroid capsules, maximum diameter >0.5 cm, and punctate echogenic foci. A predictive model based on these factors was able to diagnose BRAF mutations in PTMC, with an area under the curve (AUC) of 0.824. During internal validation, this model showed an AUC of 0.723. Conventional and contrast-enhanced ultrasound characteristics, including relative time to peak value in the area of strongest enhancement, unclear boundary, location adjacent to thyroid capsules, maximum diameter >0.5 cm, and punctate echogenic foci, may be useful for predicting BRAF mutations in patients with PTMC.