Mixed Nodules Research Articles

The evaluation of fine needle aspiration biopsy results in differentiating between benign and malignant thyroid nodules

Introduction: Thyroid fine-needle aspiration biopsy (FNAB) has begun playing an important role in the evaluation of thyroid nodules, in addition to physical examination and imaging techniques. The purpose of this study was to evaluate the results of patients who underwent thyroid FNAB together with their demographic data, imaging findings, and follow-up compliance. Methods: Patients who underwent thyroid FNAB procedures in our hospital’s interventional radiology unit between January 2022 and May 2024 were evaluated retrospectively. Data were retrieved from patient records. Cytological results were classified as malignant, atypia of undetermined significance, benign, and non-diagnostic material. Results: Two hundred twelve solid nodules were detected in the patients who underwent biopsy, and 59 mixed nodules with a cystic component. Non-diagnostic material was reported in 51 cases at cytological examination, benign cytology in 150, atypia of undetermined significance in 53, and malignant material in 17. The incidence of non-diagnostic results was significantly higher in hypoechoic nodules and low-volume nodules. Conclusions: Thyroid FNAB is a valuable diagnostic tool due to its ease of application and provision of useful information in benign-malignant differentiation. Once it becomes capable of application by primary physicians and local state hospitals in Türkiye it will reduce delayed diagnoses, unnecessary surgical procedures, and economic burdens on social security institutions.

Single-cell RNA sequencing reveals transdifferentiation of parathyroid chief cells into oxyphil cells in patients with uremic secondary hyperparathyroidism

The parathyroid gland is one of the main organs that regulate calcium and phosphorus metabolism. It is mainly composed of chief cells and oxyphil cells. Oxyphil cell counts are low in the parathyroid glands of healthy adults but are dramatically increased in patients with uremia and secondary hyperparathyroidism (SHPT). Increased oxyphil cell counts are related to drug treatment resistance, but the origin of oxyphil cells and the mechanism of proliferation remain unknown. Herein, three types of parathyroid nodules (chief cell nodules, oxyphil cell nodules and mixed nodules, respectively) excised from parathyroid glands of uremic SHPT patients were used for single-cell RNA sequencing (scRNA-seq), other molecular biology studies, and transplantation into nude mice. Through scRNA-seq of parathyroid mixed nodules from three patients with uremic SHPT, we established the first transcriptomic map of the human parathyroid and found a chief-to-oxyphil cell transdifferentiation characterized by gradual mitochondrial enrichment associated with the uremic milieu. Notably, the mitochondrial enrichment and cellular proliferation of chief cell and oxyphil cell nodules decreased significantly after leaving the uremic milieu via transplantation into nude mice. Remarkably, the phenotype of oxyphil cell nodules improved significantly in the nude mice as characterized by decreased mitochondrial content and the proportion of oxyphil cells to chief cells. Thus, our study provides a comprehensive single-cell transcriptome atlas of the human parathyroid and elucidates the origin of parathyroid oxyphil cells and their underlying transdifferentiating mechanism. These findings enhance our understanding of parathyroid disease and may open new treatment perspectives for patients with chronic kidney disease.

Simultaneous percutaneous microwave ablation and biopsy for highly suspected malignant pulmonary nodules: a retrospective cohort study.

The conventional diagnosis and treatment for highly suspected malignant pulmonary nodules (PNs) can avoid unnecessary treatment to some extent. However, the relatively separate puncture processes may not only increase puncture-related complications, but also increase the patient's radiation exposure and hospitalization costs. The purpose of this study was to retrospectively analyze the effectiveness of simultaneous percutaneous microwave ablation (MWA) and percutaneous biopsy (PB) for PNs. From August 2015 to August 2022, 65 consecutive patients [48 solid nodules, 6 ground glass opacities (GGOs), 11 mixed nodules] with suspected single malignant PN underwent MWA and PB combination treatments at the First Affiliated Hospital of Zhengzhou University. The total of 30 patients in Group A underwent synchronous PB and MWA (strategy: low-power MWA-PB-high-power MWA), whereas 35 patients in Group B underwent asynchronous PB and MWA. The technical success, complete ablation (CA), complications, total procedure time (TPT), patient exposure dose (PED), hospitalization time, and costs were compared. An independent samples t-, χ2, or Fisher's exact tests were used. The technical success (100% vs. 100%) and CA (100% vs. 97.1%) rates were not significantly different between Groups A and B. The complications of intrapulmonary hemorrhage (16.7% vs. 41.4%, P=0.02) and hemoptysis (0% vs. 8.6%, P=0.04) were significantly different between Groups A and B. TPT (41.6±7.9 vs. 57.3±8.8 min, P<0.001), PED (12.9±1.4 vs. 19.4±2.3 mSv, P<0.001), hospitalization stay (4.7±1.3 vs. 9.1±2.1 days, P<0.001) and costs (3,768.8±652.9 vs. 4,508.0±514.1 USD, P<0.001) also showed significant differences between Groups A and B. Synchronous PB and MWA for PNs is a safe and effective strategy that can decrease bleeding, PED, the hospitalization stay, and costs.

Effect of ultrasound parameters of benign thyroid nodules on radiofrequency ablation efficacy

Background and aimUltrasound-guided radiofrequency ablation (RFA) is a minimally invasive therapy for thyroid nodules (TNs). Understanding the determinants of RFA efficacy can improve treatment and prognosis. This study aims to investigate the relationship between ultrasound parameters of benign TNs and the efficacy of RFA.MethodsA pretest–posttest interventional study was conducted in 2021 on 250 randomly sampled patients with benign TNs, receiving RFA. For this purpose, the volume reduction (VR) and the VR ratio (VRR) of the nodules were measured at the 1-, 3-, 6-, and 12-month follow-up periods after the RFA completion. The technical success rate (TSR) of this procedure was then categorized into four states, including low (VRR < 25%), moderate (VRR = 25–49%), high (VRR = 50–74%), and very high (VRR ≥ 75). Ordered logistic regression (OLR) was further utilized to investigate the effect of the ultrasound parameters of TNs on the TSR. The analyses were notably performed using Stata 14.2.ResultsThe VRR at the 1-, 3-, 6-, and 12-month follow-up periods were 38.7%, 53.6%, 59.3%, and 59.9%, respectively. The mean VR was also statistically significant at all follow-ups (p < 0.001). At the 1-, 3-, and 6-month follow-up periods, the VR of over 50% was observed in 28.2%, 52.1%, and 65.2% of the nodules, respectively. The odds ratios (ORs) of the RFA success were found to be 4.3 times higher for the nodules in the left lobe compared to the right lobe (OR: 4.31, p = 0.002), 6.3 times greater for isoechoic nodules compared to hyperechoic nodules (OR: 6.39, p < 0.001), 6.2 times higher for hyper-vascular nodules compared to hypo-vascular nodules (OR: 6.25, p = 0.005), and 2.3 times greater for mixed nodules compared to solid ones (OR: 2.37, p = 0.049).ConclusionThe ultrasound parameters of TNs had a statistically significant effect on the efficacy of RFA. Small-sized, isoechoic, and hyper-vascular nodules, as well as those with mixed tissue, were observed to respond better to RFA, leading to a better prognosis in terms of VR after treatment.

Analysis of 665 thyroid nodules using both EU-TIRADS and ACR TI-RADS classification systems

BackgroundUltrasound-based classification systems allow stratification of thyroid nodules to recommend fine-needle aspiration (FNA) based on their malignancy risk. However, these have discrepancies that may have an impact in thyroid cancer detection. We aimed to compare European Thyroid Association (EU-TIRADS) and American College of Radiology (ACR TI-RADS), in terms of FNA indication and diagnostic performance.MethodsRetrospective study of 665 thyroid nodules from 598 patients who underwent ultrasound and fine-needle aspiration at a tertiary-care institution between January 1st of 2016 and July 31st of 2019. Based on their sonographic features they were classified according to the EU-TIRADS and ACR TI-RADS classification and then their cytological results were obtained. Differences in FNA indications according to these two classifications were analysed. In patients who underwent surgical removal of the nodules, the final pathological diagnosis was obtained.ResultsA statistically significant association was found between EU-TIRADS and ACR TI-RADS classification systems (p < 0.001). ACR TI-RADS allowed greatest reduction in FNA performed (32% vs 24.5%). A different risk category was obtained in 174 (26.1%) nodules, mostly higher with EU-TIRADS. The indication to FNA changed in 54 (8.1%) nodules (49 only indicated following EU-TIRADS recommendations), of which 4 had Bethesda IV and 5 had Bethesda III cytology. The FNA indication in a higher number of nodules using EU-TIRADS was due to difference in the dimensional threshold for FNA on low-risk nodules; to the fact that hypoechogenicity in a mixed nodule ascribes it moderate risk, while using ACR TI-RADS it would only be considered of low risk, and to the use of isolated sonographic features, namely marked hypoechogenicity, microcalcifications and irregular margins, to automatically categorize a nodules as high risk in EU-TIRADS, while ACR TI-RADS requires a group of potentially suspicious features to consider a nodule of high risk. The analysis of pathology proven nodules revealed equally good sensitivity of both systems in the detection of malignancy, but weak specificity, slightly greater with ACR TI-RADS (27.1% vs 18.6%).ConclusionsThe EU-TIRADS and ACR TI-RADS are both suitable to assess thyroid nodules and through risk stratification avoid unnecessary FNA. FNA was less performed using ACR TI-RADS, which was slightly more efficiency in excluding malignancy.

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.

Ultrasound features of multinodular goiter in DICER1 syndrome

DICER1 syndrome is caused by germline pathogenic mutations in the DICER1 gene. Multinodular goiter (MNG) is a common clinical feature of DICER1 syndrome in children and adults. The aim of this study was to determine the ultrasound (US) characteristics of MNG in patients with DICER1 syndrome. This retrospective study evaluated thyroid US in patients with DICER1 germline mutations (DICER1mut+) performed between 2011 and 2018 at a single center by the same pediatric endocrinologist, and the images were re-examined by an independent pediatric radiologist from another academic center. Patients < 18 years with DICER1mut+ and DICER1mut+ parents without previous thyroidectomy were included. Ultrasound phenotypes of MNG in the setting of DICER1 mutations were compared with known US features of thyroid malignancy. Thirteen DICER1mut+ patients were identified (10 children, 3 adults). Three children had a normal thyroid US; therefore, thyroid abnormalities were assessed in seven children and three adults. In both children and adults, multiple (≥ 3) mixed (cystic/solid) nodules predominated with single cystic, single cystic septated and single solid nodules, occasionally with a “spoke-like” presentation. All solid lesions were isoechogenic, and in only one with multiple solid nodules, intranodular blood flow on power/color Doppler was observed. Remarkably, macrocalcifications were present in all three adults. The spectrum of ultrasonographic findings of MNG in DICER1mut+ patients is characteristic and largely distinct from typical features of thyroid malignancy and therefore should inform physicians performing thyroid US of the possible presence of underlying DICER1 syndrome.

Application Value of Spectral CT Imaging in Quantitative Analysis of Early Lung Adenocarcinoma.

Objective To investigate the clinical value of gemstone energy spectral CT imaging for the quantitative analysis of early lung adenocarcinoma. Methods 76 cases of pulmonary ground-glass nodules pathologically confirmed as precancerous lesion and early lung cancer (including pure ground-glass nodules in 46 cases and mixed ground-glass nodules in 30 cases) underwent chest CT scan first and then underwent contrast-enhanced gemstone energy spectral CT to get arterial phase images, venous phase images, and delayed phase images. All the lesions were set the region of interest (ROI). Cases of the pure ground-glass nodule (pGGN) were measured at the maximum level of lesions, cases of the mixed ground-glass nodule (mGGN) were measured in two areas of ground-glass and solid components, CT value and iodine concentrations of lesions in three-phase scanning were separately measured, and at the same time, iodine concentrations of the thoracic aorta were also measured. The normalized iodine concentrations (NICs) were calculated, that is, the ratio of iodine concentrations of lesions and the thoracic aorta. CT values of lesions were also measured at each stage of 70 keV. All the quantitative data were expressed by the mean ± standard deviation, and paired t-test was used for pairwise comparison. Results In 76 cases, in the spectral CT imaging mode, the NIC value of solid components of the GGN was 0.33 ± 0.16 in the arterial phase (AP), 0.52 ± 0.25 in the venous phase (VP), and 0.58 ± 0.34 in the delayed phase (DP). There were significant differences of P values of NICs between each two phases in both solid component cases and the ground-glass component cases in AP/VP, VP/DP, and AP/DP (P < 0.05); there were no statistically significant P values of CT values between each two phases in three-period enhanced CT in both the solid component cases and the ground-glass component cases in AP/VP, VP/DP, and AP/DP (P > 0.05). Conclusion Gemstone energy spectral CT with quantitative imaging can dynamically reflect the enhancement features of the pulmonary GGN.

The Role of the ACR TI-RADS Scoring System to Evaluate Solid and Cystic Thyroid Nodules Compared With Those Solid Nodules With or Without Echogenic Foci and Their Cytology Results

Objective: The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) is a reporting system for thyroid nodules detected with sonography and proposed by the ACR. The scoring of punctate echogenic foci (PEF) increases the TI-RADS score and leads to a biopsy of many thyroid nodules, otherwise found clinically. The aim of this study was to assess the risk of malignancy for mixed and solid nodules, with and without PEF, and cytologic correlation. Materials and Methods: Thyroid sonograms and ultrasound-guided thyroid biopsies were performed, at a University of Iowa Hospitals &amp; Clinics for 105 patients, during July 2019 to June 2020. All these retrospective clinical studies were reviewed against the cytologic examinations. Results: Based on the 189 thyroid nodule biopsies reviewed, 82.5% were benign compared with 17.5% malignant lesions. A solid nodule composition was noted in 35.2%, and had a higher risk for malignancy, compared with 7.7% of the mixed nodules. There was a 33.3% incidence of malignancy for solid nodules with PEF, compared with 35.8% of lesions lacking PEF. For mixed nodules, 6.2% nodules demonstrated PEF and 7.7% of nodules, without PEF, were malignant. Conclusion: In this cohort, solid nodules had a higher risk of malignancy than mixed nodules. PEF did not increase the risk of malignancy in either solid or mixed thyroid nodules, in these patients. These findings would suggest that existing guidelines may overestimate the value of PEF in scoring, as well as determining which thyroid nodules require biopsy.

Association of Ultrasonography and Ultrasound-guided Fine Needle Aspiration Cytology in the Diagnosis of Thyroid Nodules

Introduction: Ultrasound (USG) is the most commonly used imaging method to evaluate thyroid nodules. The sonographic features of thyroid nodules are very important to determine whether the nodule is benign or malignant. Fine Needle Aspiration Cytology (FNAC) is the gold standard to determine whether the nodule is benign or malignant.&#x0D; Objective: The purpose of this study was to compare ultrasound and color Doppler features of thyroid nodules with ultrasound-guided FNAC results to determine the relative importance of these features in predicting the risk of malignancy.&#x0D; Methodology: This prospective cross-sectional study was conducted in Birat medical college teaching hospital in Tankisinuwari, Morang, Nepal. The study was conducted from September 2019 to April 2021. In total sixty-one patients with thyroid nodules were evaluated for sonographic characteristics. Finally, USG guided FNA for cytopathological examination was performed. Both descriptive and inferential statistics were used to analyze the result.&#x0D; Results: Out of the 61 patients, 34 (55.7%) were females and 27 (44.2%) were males. Majority of the malignant nodules were solid 11 (91.6%), whereas cystic and mixed nodules were predominantly seen in benign nodules 18 (36.7%) and 30 (61.2%) respectively. In malignant nodules 10 (83.3%) were heterogeneous and 2 (16.6%) were isoechoic. In benign nodules 29 (59.1%) were heterogeneous and 15 (30.6%) were anechoic with comet-tail artifact and 5 (10.2%) were isoechoic. Among 12 malignant cases, internal and peripheral vascularity were equally present in six cases each. Benign nodules showed peripheral vascularity in 48 (97.9%) and internal vascularity was noted in only one nodule. All of the malignant nodules showed calcification. None of the benign nodules showed micro-calcification. In malignant cases, cervical lymph nodes were present in 7 (58.3%) and absent in 5 (41.6%). In benign cases, cervical lymph nodes were present in 4 (8.1%) and absent in 45 (91.83%).&#x0D; Conclusion: The ultrasound features associated with malignancy in thyroid nodules are predominantly solid component, presence of micro-calcifications and internal vascularity. Enlarged cervical lymph nodes are good predictors for malignancy. USG guided FNAC confirms the suspicious features of thyroid nodules seen on USG.

Ultrasound predictive criteria for short term benign thyroid nodular volume reduction after ultrasound guided radiofrequency ablation

Abstract Purpose This study evaluates the outcome of patients complaining of compressive&amp; cosmetic problems due to benign thyroid nodules after recieving RF ablation with correlation between some ultrasound features of the nodules and their shrinkage and volume reduction. Methods and material fifteen patients with benign thyroid nodules causing compressive symptoms (foreign body sensation,neck discomfort or pain) and cosmetic problems. Results A total of 15 patients were included with the age rangmg from 22-82 years old the mean was 52.73 years old (SD + 14.37).Among them 12 patients (800 0)were females and 3 patients(20%) were males. There was statistically significant difference between volume of nodules before the procedure with mean volume was 21.13±5.13 and I month after with mean volume I I .96±3.08 and 3 months after the procedure with mean volume 7.70±2.82 with noticeable improvement in nodules with peri and intranodular vascularity showing mean reduction ratio 69.88% after 3 months vs 59.93% and 64 12% of weak peripheral vascularity and intense intra-nodular vasculanty respectively as well as US structure with spongiform nodules showing mean reduction ratio 68.48% at 3 months vs 59.87% and 62.14% for solid &amp;mixed nodules respectively.Mean symptoms and cosmetic score were significantly reduced. Conclusion: This study validated the efficacy and safety of RFA for treatment of benign thyroid nodules and showed correlation between shrinkage and some common US findings.

Serum WNT-induced secreted protein 1 level as a potential biomarker for thyroid nodules

Background. Thyroid nodule (TN) is a common thyroid disease worldwide, and it has increased significantly last decades. Most TNs are usually incidental findings of asymptomatic, benign lesions discovered by imaging modalities performed for reasons unrelated to thyroid diseases. The purpose of this study was to investigate the value of serum WNT-induced secreted protein 1 (WISP1) level as a supporting biomarker to perform differential diagnosis of benign and non-benign thyroid nodules. Materials and methods. The study was completed with the 89 patients undergone fine needle aspiration biopsy and 43 controls. The patients were composed of 96 (72.7%) females and 36 (27.3%) males. And they were divided into 2 group according to the Bethesda cytological evaluation as Benign (Bethesda 2) and Non-Benign (Bethesda 3–6) groups. Their serum WISP1 levels were measured by an ELISA method. Results. There were 58 (43.9%) patients in Benign (Bethesda 2) and 31 (23.5%) in non-Benign (Bethesda 3–6) groups. In the contrary nodule size was bigger in the Non-benign group than that benign group (p=0.006). The serum WISP1 level in the Benign (Bethesda 2) group was significantly higher than that in the and Non-Benign (Bethesda 3–6) group, and controls (p&lt;0). The difference between benign and non-benign group accordingly to their echogenicitiy was significant (p&lt;0.05). In benign group there was 76.9% mixed echoic nodules, 76.7% isoechoic nodules 68.4% isohypoechoic nodules and 35.7% hypoechoic nodules. In the non-benign group, the highest hypoechoic echo (64.3%), the least mixed echo (23.1%), while in the benign group, the most mixed echo (76.9%), the least hypoechoic echo (35.7%) was present. There was no relation between WISP1 levels and echogenicity with Kruskal-Wallis H test. Conclusions. According to the preliminary results of current study, addition of serum WISP1 measurement to the differential diagnostic work-up of thyroid nodules patients may provide supportive information. Inthyroid nodules patients with Benign (Bethesda 2) category of cytological evaluation, a higher level of serum WISP1 may support cytological diagnosis.

Abdominal wall endometriosis: Is structure in imaging related to nodule localisation? A retrospective study

Objective:Investigate the relationship between the structure of abdominal wall endometriotic nodules in MRI and their localisation in abdominal wall layers in order to better understand nodule origins.Design:Women who had an MRI prior to surgical treatment of an abdominal wall endometriotic nodule between 2005 and 2016.Population:Thirty-six patients including four patients with two nodules.Methods:MRI images were reviewed. Each nodule was analysed according to its structure (fibrous, cystic, mixed), localisation (subcutaneous fat, intra muscular, intermediary position), and size.Results:Forty nodules were analysed in MRI with no relationship found between localisation and nodule structure ( p = 0.48). 87.5% of mixed nodules were revealed to have a cystic superficial rim extending towards the subcutaneous fat layer. This finding suggests that the glandular part of the nodule is the active part of the disease from which nodule progression occurs. Intermediary and intramuscular nodules were respectively statistically larger than subcutaneous fat nodules indicating a relationship between nodule size and localisation (35 mm (22–53) vs 17 mm (17–23)) ( p = 0.03).Conclusion:Despite differences in environments surrounding the nodules, no significant relationship between nodule structure in imaging and abdominal wall localisation was found. Data from mixed nodules indicate however the possible role of nodule environment on structure and that the mechanism of nodule growth may be linked to development of cystic superficial rims, at the forefront of disease progression, abdominal wall nodules growing from deep to superficial. Studies are required to further investigate our findings and enable greater understanding of the origins of AWE.

Ultrasound Guided Percutaneous Ethanol Ablation of Benign Thyroid Nodule: A Study From a Tertiary Hospital in Eastern India

Abstract Introduction: Ultrasound guided percutaneous ethanol injection (PEI) of benign thyroid nodule is an easy and effective procedure particularly in cystic and predominantly cystic nodule. Aims: To evaluate efficacy and safety of PEI in managing purely cystic and mixed cystic and solid thyroid nodules. Materials and Methods: Patients of either sex presented with solitary purely cystic benign thyroid nodule, solitary benign mixed with predominantly cystic (&amp;gt;50% of total volume) thyroid nodule, solitary benign mixed with predominantly solid (&amp;gt;50% of total volume) thyroid nodule, solitary solid thyroid nodule were included in this study. Patients who had a nodule BETHESDA 3 and above, pregnancy, patients with critical or terminal illness, patients with other malignancies, multinodular lesions of thyroid, patients with raised T3, T4 and/ or suppressed TSH level were excluded from the study. One hundred sixty patients presenting with thyroid nodule were initially evaluated with thyroid function test and USG. Only those patients with euthyroid solitary thyroid nodules are subjected for fine needle aspiration (FNA). Nodules under BETHESDA 2 are considered for US guided percutaneous ethanol injection (PEI). One hundred twenty-three patients were excluded because of various reasons. Finally ethanol ablation was done in 37 patients. Benign, purely cystic and mixed thyroid nodules were aspirated under ultrasonography guidance. Sterile absolute alcohol (99.99%) (50% of volume aspirated/ maximum 10 ml) was injected and reviewed after 2, 5and 7 months. In case of solid nodule alcohol (50% of nodule volume) was injected. A reduction in volume is calculated at each follow up visit. An adequate response is considered as ≥50 percent reduction in size from baseline after 7 months. If the reduction is &amp;lt;50%, then a second session of absolute ethanol injection is given. Again, patients were similarly followed up after 2, 5 and 7 months. Results: Thirty seven patients underwent PEI. Thirty three patients were considered for final analysis (4 lost to follow up). Response rate of PEI for purely cystic nodule was 100.0% and the overall response rate for mixed nodule was 53.57%. None of the solid nodule responded to PEI even after second session. Among the responder in the mixed nodules, 93.33% responded after first session of PEI. Minor complications like headache occurred in 54.1% patients in the first session. Transient pain at injection site were complained by 86.5% and 37.8% patients in the first and second session respectively. Nausea and vomiting were complained by 18.9% and 16.2% patients in the first and second session respectively. Conclusions: PEI is an effective and safe for purely cystic and mixed thyroid nodules. It is a relatively safe and less invasive procedure from management of benign solitary cystic and mixed thyroid nodules.

Nutcracker Esophagus: Investigation In A Female Patient With Dysphagia And Odinophagy

Introduction: Odinophagia and dysphagia are important symptoms related to the upper gastrointestinal tract, specifically at the level of the oropharynx and esophagus. Objective: to investigate the possible cause of these symptoms through clinical history and complementary exams, thus outlining a more specific approach. Methodology: anamnesis was performed followed by neck ultrasound, fine needle aspiration (FNAP), videolaryngoscopy, computed tomography of the neck, ultrasound with thyroid dopller, esophagogastroduodenal seriography, esophageal manometry, hormone and thyroid antibodies dosage, and evaluation of thyroid antibodies. speech therapy. Results: neck ultrasound with topical thyroid gland, diffusible to swallow, diffusely heterogeneous, mixed nodule in upper / middle and anterior third of the left lobe measuring about 2.2cm x 1.6cm x 1.0 cm, in addition to sparse colloidal cysts by the glandular parenchyma, no larger than 0.6 cm, cervical lymph nodes increased in number and dimensions, some coalescent, the largest being located in the left submandibular region, measuring 1.8 cm in its longest axis. US-guided FNAB: Oncotic Cytology- Benign nodule (Category II of the Bethesda system) consistent with benign follicular nodule (Colloid goiter). Paraffin inclusion- Some follicular epithelial ceslls, in addition to leukocytes, amidst eosinophilic background (system I category) Bethesda). High digestive endoscopy without changes. Videolaryngoscopy without alterations. Computed tomography of the neck showing homogeneous prominent palatine tonsils. Heterogeneous thyroid lobes. Submandibular prominent lymph node on the right (IIA) measuring 1.1 cm. Ultrasonography with thyroid doppler confirms the p revious findings. Manometry showed hypertonia of the lower esophageal sphincter, compatible with nutcracker esophagus. Final Considerations: A patient admitted to investigate dysphagia with two months of evolution associated with odynophagia reaches a final diagnosis of nutcracker esophagus, in addition to a benign thyroid nodule. Thus, the investigation should be supplemented on an outpatient basis with high-resolution manometry. He is discharged with a medical prescription and guidance to start monitoring with a gastroenterologist.

Pattern of Primary Thyroid Malignancy in a Tertiary Care Hospital

Background: Among the endocrine malignancies thyroid cancer is the most common. It constitutes a heterogeneous group of malignancies ranking it as the fifth most common cancer worldwide. On health as well as health system it has severe implication. Thyroid cancer incidence is rising most rapidly worldwide. Different thyroid malignancy requires different management strategy. Proper addressing and prompt management of different thyroid malignancies can lessen the suffering.&#x0D; Objective: The study aimed to evaluate the pattern of primary thyroid malignancy in a tertiary care hospital.&#x0D; Methods: The study was a hospital based descriptive cross sectional study and was conducted in Dhaka Medical College Hospital, Dhaka for one-year period following approval of this protocol. Patients suffering from primary thyroid carcinoma admitted in or attending the outpatient department (OPD) in the department of Otolaryngology and Head-Neck Surgery was approached for inclusion in the study. Written informed consent was taken from the subject and ethical issues were ensured. A total of 50 individual suffering from primary thyroid carcinoma calculated by sample size formula was selected by inclusion and exclusion criteria and data was collected by interview using a semi-structured questionnaire and by personal document analysis. Collected data was analyzed by the SPSS 20 for windows. This study reflects the pattern of primary thyroid malignancy in a tertiary care hospital in Bangladesh.&#x0D; Results: Mean age of the participants was 32.7 years with SD ± 13.8 years, Minimum age was 17 years and maximum age was 70 years. Majority of the patients (46%) were in the age group of 31- 40 years. Among the participants, 70% were female and 30% were male. The majority of the patients belong to Dhaka and Rangpur divisions (26% &amp; 22% respectively) of which maximum patients were from rural area (70%). By occupation, maximum (22%) of the study subjects were businessman, maximum study subjects were below SSC (24%) and maximum patients (42%) had relatively low income per month. Half of the participants had habit of tobacco. All patients (100%) had presented with palpable thyroid swelling. Among the total participants 54% had lymphadenopathy, 10% had dysphagia, 4% had hoarseness of voice and 4% had lumpiness in throat. Only 2% of patients had the symptom of dyspnoea. No palpable lymph nodes were found in 46% followed by Single node lymphadenopathy 26%, multiple nodules in one side in 18%, bilateral lymphadenopathy 8% and 20% participants had Central compartment lymphadenopathy. USG findings of thyroid revealed Single solid nodule in 22.0%, Single cystic nodule in 16.0%, multiple mixed (solid + cystic) nodules in 62.0% cases. FNAC findings revealed Anaplastic carcinoma in 2.0%, Follicular neoplasm in 16.0% and Follicular variant of papillary carcinoma in 8.0%. Papillary carcinoma found in maximum 70.0% cases. No lymphoma found whereas medullary carcinoma found in 4.0% cases. Histopathological findings confirmed Anaplastic carcinoma in 4.0%, Follicular carcinoma in 16.0%, Follicular variant of papillary carcinoma in 8.0% and Papillary carcinoma 68.0% cases. By histopathological examination no lymphoma found whereas medullary carcinoma found in 4.0% cases. Only 24% participants had hypertension and 76% had DM as co-morbid diseases. Distant metastasis of carcinoma was not present in any of the participants.&#x0D; Conclusion: In this study, middle age group and female sex prevalent thyroid cancer. Geographical distribution also has an important role. Business, low educational level, low socioeconomic status and tobacco smoking are found the most important risk factors. Histopathologically papillary carcinoma was predominant followed by follicular carcinoma, follicular variant of papillary carcinoma, anaplastic carcinoma and medullary carcinoma. No lymphoma found.&#x0D; J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 161-174

Radiofrequency Ablation of Thyroid Nodules: A Long-Term Prospective Study of 24 Patients.

To evaluate the volume reduction rate (VRR) of thyroid nodules over a long period of time after radiofrequency (RF) ablation treatment in both solid and mixed nodules; to determine ablation parameters; and to evaluate complications and success rates and safety of RF ablation. In this prospective study, 24 patients (83% females and 17% males; age 50.17 ± 13.6 years) underwent ultrasound-guided percutaneous RF ablation of benign thyroid nodules with radiologic follow-up at 1, 3, 6, 12, 24, and 36 months after treatment. All patients presented with compressive or cosmetic complaints and with Thyroid Imaging Reporting and Data System 1 or 2 nodules under ultrasound and were confirmed to be Bethesda Category II after 2 fine-needle aspirations. A total of 24 nodules (54.2% solid, 37.5% solid predominance, and 8.3% cystic predominance) were included in this study. Significant results in VRR (%) were found at 24 months and 36 months of 69.92 ± 19.23 and 76.84 ± 15.92, respectively. Furthermore, a logarithmic relationship was found when VRR was plotted over time, in both solid and mixed nodules. No correlations were found with any of the ablation parameters. The success rate reached 72.22% at 12 months, and the total complication rate was 16.67% (12.5% minor complications and 4.2% major complications-1 laryngeal nerve palsy), reaching an 83.3% safety. RF ablation can be an alternative treatment modality in the management of benign symptomatic thyroid nodules. The results show that it is a safe and effective treatment if trans-isthmic approach and moving-shot techniques are correctly followed.

Electrophysiological differences between typical and dense benign prostatic hyperplasia tissues retrieved after holmium laser enucleation of the prostate

Electrophysiological differences between typical and dense (beach ball) benign prostatic hyperplasia (BPH) tissues were investigated using a needle device with a micro-electrical impedance spectroscopy (µEIS) sensor. Ten pieces of typical BPH tissues and beach balls were collected from ten patients during the morcellation procedure of Holmium laser enucleation of the prostate. Their impedance was measured at a frequency range from 100 to 1 MHz using the µEIS-on-a-needle (µEoN). The impedance data (magnitude) were compared between the two tissue types and their correlation with the pathologic features was investigated. The mean magnitude of the beach balls tended to be larger than that of the typical BPH tissues at all investigated frequencies. Notably, significantly larger magnitudes were observed in the beach balls at the frequencies higher than 15.9 kHz (p ≤ 0.02). The variation of mean log-transformed magnitudes by frequency was significantly different between both tissue types (p < 0.001). The pathologic features of the beach balls presented pure stromal nodules of nodular hyperplasia, while the typical BPH tissues presented mixed epithelial-stromal nodules. The impedance difference between typical BPH tissues and beach balls is assumed to be attributed to the amount of their stromal content.

Multislice spiral CT findings and its diagnostic value of mixed glandular glass nodular adenocarcinoma

Objective To analyze the characteristics of mixed ground glass nodular adenocarcinoma in multi-slice spiral CT(MSCT) and its diagnostic value. Methods This study was prospective study, 120 patients with mixed glass nodules lung adenocarcinoma were classified as lung adenocarcinoma in the People's Hospital of Xinzhou from January 2014 to December 2016.178 cases of mixed glass nodular pneumonitis were classified as pneumonia.The MSCT signs were compared between the two groups.The imaging features of medullographic nodules with different pathologic types of lung adenocarcinoma by grouping of patients with lung adenocarcinoma were compared. Results In the lung adenocarcinoma group, the dizzy uneven thickness rate(61.67%), leaf rate(60.00%), clear boundary rate(80.83%), blood vessels, gather tax rate(64.17%), pleural indentation rate(61.67%) were significantly higher than those in the pneumonia group(35.96%, 35.39%, 41.01%, 44.94%, 41.57%, χ2=8.69, 12.47, 33.64, 7.62, 7.97, all P<0.01). The mixed grinding glass nodules of IAC, MIA and MIS in size, number, shape, position and density were significantly different(all P<0.05). The IAC type mixed grinding glass nodules was irregular single nodules(volume generally≥5 mm), common deviation centricity growth, and with blood vessels.The AIS type mixed grinding glass nodule was single nodule(volume generally≥5 mm), formed a polygon or dotted, common growth of centricity, vascular density was close to the same level.The volume of the MIA type mixed grinding hyaline nodules was most <5 mm, common to multiple, with oval or round most, common to deviate from the centricity growth, lower density than plane tree blood vessels. Conclusion MSCT is helpful in the differential diagnosis of mixed ground glass nodules of lung adenocarcinoma and mixed ground glass nodular inflammatory lesions, and pathological types have leaded to the identification of mixed ground glass nodules of lung adenocarcinoma MSCT, which has higher application value. Key words: Lung neoplasms; Adenocarcinoma; Tomography, spiral computed; Diagnosis

Morphological patterns of the pretendinous cord in Dupuytren’s disease: a predictor of clinical outcome?

The morphology of the pretendinous cord in Dupuytren’s disease is poorly described in vivo and especially with respect to recurrence after treatment. This prospective study was designed to describe the morphology of Dupuytren’s cords by ultrasound and to identify possible correlation between the ultrasonographic characteristics of these cords and the clinical outcomes two years after treatment. Thirty-nine patients with a contracture of at least 20° in the metacarpophalangeal (MCP) joint, who were scheduled for local treatment by either injectable collagenase clostridium histolyticum (CCH) or percutaneous needle fasciotomy (PNF), were examined by ultrasound. The echogenicity and position of the pretendinous cords in relation to flexor tendons and neurovascular bundles were categorized. The structure of the cords was described and characterized as predominantly nodular or fibrillar. All 39 patients were assessed clinically after two years. A majority of the patients (84%) had cords with nodular components, and six patients (16%) had fibrillar cords. After two years, the clinical results were compared to the ultrasonographic findings before treatment. Three patients had recurrent contracture, and a retrospective analysis showed that all of these patients had cords with mixed echogenicity and nodules before treatment. Fifteen patients had a palpable pretendinous cord, and all but one of these had cords with mixed echogenicity and nodular structure before treatment. This pilot study indicates that some ultrasonographic features of the Dupuytren’s cord, such as mixed echogenicity and nodular structure, may predict recurrence after minimally invasive treatment for Dupuytren’s contracture. However, a larger study in correlation with histological examination of the excised cords would be necessary to confirm the pathoanatomical significance of these ultrasonographic features.