Presence Of Microcalcifications Research Articles

Predictive value of the single most suspicious ultrasound feature in subcentimeter thyroid nodules: a retrospective observational cohort study

PurposeProper management of subcentimeter thyroid nodules remains challenging for both clinicians and patients. Conducting extensive sonographic research using a safe and inexpensive tool for identifying thyroid nodules is necessary. The aim of this study was to identify whether having the highest-risk ultrasound (US) characteristic suggests that US-guided fine-needle aspiration (FNA) biopsy of subcentimeter nodules is more appropriate for the identification of malignancy than active surveillance (AS) or surgery.MethodsThe data of patients with highly suspicious subcentimeter thyroid nodules and US characteristic data who underwent surgery were retrospectively examined.ResultsAmong a total of 556 subcentimeter nodules, 223 (40.1%) were benign, and 333 (59.9%) were malignant, with a mean maximal nodule size of 8.1 mm. In addition to age younger than 45 years, several US features were significantly associated with malignancy: irregular margins, the presence of microcalcifications, and taller-than-wide shapes (P < 0.001). Multivariate analysis also revealed that a taller-than-wide shape (OR = 8.988, P = 0.0015) was an independent factor associated with malignancy in subcentimeter thyroid nodules. The diagnostic performance of preoperative FNA was classified as a malignancy, with a sensitivity of 98.4%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 76.9%.ConclusionsThis is one of the few reports based on actual data of the most suspicious US features in subcentimeter thyroid nodules. A taller-than-wide shape US feature is most significantly associated with malignancy. FNA is a simple, accurate, and reliable preoperative method for diagnosing malignant subcentimeter thyroid nodules with highly suspicious US characteristics. AS was less appropriate than FNA for subcentimeter nodules with a taller-than-wide shape, especially in patients ≤ 45 years of age.

Evaluation of the risk factors of metastasis to central cervical lymph nodes in patients with papillary thyroid carcinoma.

Papillary thyroid cancer, comprising 80% of thyroid malignancies in iodine-sufficient areas, can be effectively treated if detected early before metastasis. Cervical lymph nodes are a common site of metastasis, prompting some surgeons to suggest prophylactic dissection in all patients. To minimize potential side effects, this study aims to identify patients benefiting from this procedure by assessing risk factors for central lymph node metastasis. This descriptive-analytical study was conducted on 150 patients with papillary thyroid cancer. The samples included cases in which central lymph node involvement was ruled out clinically and radiologically. After proving papillary cancer in the pathology sample, the variables of age, sex, frequency of central lymph node involvement, tumor size, location of thyroid involvement, multi-centric involvement, multi-focal involvement, presence of microcalcification, capsular invasion, lymphovascular invasion, and pathology were analyzed. The results were presented with descriptive statistics. The percentage of central lymph node involvement in this study was reported as 9.3%. In the analysis, capsular invasion (P=0.01), lymphovascular invasion (P=0.0001) and involvement of the upper thyroid pole (P=0.001) were identified as risk factors for central lymph node involvement. There was no significant relationship between the variables of age, sex, tumor size, pathology, multi-centricity and multifocality and central lymph node involvement. Involvement of central lymph nodes in patients with capsular invasion, lymphovascular invasion, and involvement of the upper thyroid bridge is far more common than in other patients, and central lymph node dissection is recommended in patients with several of the above risk factors.

Nomogram for predicting the risk of central lymph node metastasis in papillary thyroid microcarcinoma: a combination of sonographic findings and clinical factors.

A considerable controversy over performing thyroidectomy and central lymph node dissection in patients with papillary thyroid microcarcinoma (PTMC) remained. However, accurate prediction of central lymph node metastasis (CLNM) is crucial for surgical extent and proper management. The aim of this study was to develop and validate a practical nomogram for predicting CLNM in patients with PTMC. A total of 1,029 patients with PTMC who underwent thyroidectomy and central lymph node dissection at Tangdu Hospital (the Second Affiliated Hospital of Air Force Medical University) and Xijing Hospital (the First Affiliated Hospital of Air Force Medical University) were selected. Seven hundred and nine patients were assigned to the training set and 320 patients to the validation set. Data encompassing demographic characteristics, ultrasonography results, and biochemical indicators were obtained. Stepwise backward selection and multiple logistic regression were used to screen the variables and establish the nomogram. Concordance index (C-index), receiver operating characteristic (ROC) curve analysis, and decision curve analysis (DCA) were employed to evaluate the nomogram's distinguishability, accuracy, and clinical utility. Young age, multifocality, bigger tumor, presence of microcalcification, aspect ratio (height divided by width) ≥1, loss of fatty hilum, high free thyroxine (FT4), and lower anti-thyroid peroxidase antibody (TPOAb) were significantly associated with CLNM. The nomogram showed strong predictive capacity, with a C-index and accuracy of 0.784 and 0.713 in the training set and 0.779 and 0.703 in the external validation set, respectively. DCA indicated that the nomogram demonstrated strong clinical applicability. We established a reliable, cost-effective, reproducible, and noninvasive nomogram for predicting CLNM in patients with PTMC. This tool could be a valuable guidance for deciding on management in PTMC.

Impact of ultrasound elastography in evaluating Bethesda category IV thyroid nodules with histopathological correlation.

Fine needle aspiration (FNA) is the gold standard method recommended in the diagnosis of thyroid nodules. Bethesda IV cytology results are identified in 7-9% of nodules investigated through FNA, with reported malignancy rate in a wide range of 10-40%. The recommended treatment is either surgical or risk additional molecular testing before surgery. However, a large number of nodules belonging to this category (60-80%) are observed to be benign after surgical excision, which can put the patient at risk of unnecessary surgical morbidity. This study aimed to assess the diagnostic performance of conventional ultrasound, the ACR TI-RADS score and elastography in cases of Bethesda IV cytology on FNA. We evaluated ninety-seven consecutive cases with Bethesda category IV results on FNA by using conventional B-mode ultrasound, qualitative strain or shear-wave elastography (Hitachi Preirus Machine, Hitachi Inc., Japan and Aixplorer Mach 30 Supersonic Imagine, Aix-en-Provence, France) and all nodules were classified according to the ACR TI-RADS system. Conventional ultrasound was used to categorize the nodules as potentially malignant based on the following features: hypoechogenicity, inhomogeneity, a taller than wide shape, irregular margins, presence of microcalcifications, an interrupted thyroid capsule and suspicious cervical lymph nodes. Elastography classified nodules with increased stiffness as suspicious for malignancy. We considered pathology results as the gold standard diagnosis, finding that 32 out of 97 nodules were carcinomas (33%) and 65 out of 97 were benign nodules (67%). The benign group included twenty cases of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Finally, we compared ultrasound data with pathology results, which showed that nineteen out of the 32 malignant nodules presented with increased stiffness on elastography (p=0.0002). On conventional ultrasound, we found that microcalcifications (p=0.007), hypoechogenicity and irregular margins (p=0.006) are features which can distinguish between benign and malignant nodules with statistical significance. Integrating elastography as a parameter of the ACR TI-RADS score in the evaluation of Bethesda category IV nodules showed a sensitivity of 90.62% in detecting thyroid cancer cases (p=0.006). We can conclude that elastographic stiffness as an addition to high risk features observed on conventional ultrasound improves the detection of malignant nodules in cases with Bethesda IV cytology.

Abstract PO3-07-09: B3 breast lesions in Asian Centers: malignant upgrade rates and risk factors

Abstract Background Lesions of uncertain malignant potential in the breast (B3 lesions) are composed of a wide spectrum of pathologies with differing risks of breast cancer. With the widespread implementation of screening programs globally, the incidence of these lesions has increased substantially. Asian women tend to have smaller and denser breasts than Western women, making identifying and treating these lesions more challenging. Previous papers quote an upgrade of B3 lesions to malignancy such as ductal carcinoma in situ (DCIS) or cancer at rates of 9.9% to 35.1%. Malignant upgrade on final histology increases patient anxiety and healthcare costs as a second surgical intervention is often required for pathological clearance or lymph node staging. This study aimed to assess the malignant upgrade rate of B3 lesions in Asian women and to evaluate any key factors that may predict the risk of a malignant upgrade. Materials and Methods A retrospective multicentre international study was done on patients at Seoul National University Hospital (SNUH), South Korea, from April 2021 to 2023, and Tan Tock Seng Hospital (TTSH), Singapore, between March 2006 and 2023. Patients who were diagnosed with a B3 lesion on initial breast core needle biopsy and underwent surgical open excision were included in the study. Results A total of 1049 patients were diagnosed with B3 lesions, with 154 (14.7%) upgrading to malignancy. The most common malignancy was DCIS, 118 (76.6%), followed by invasive ductal carcinoma (IDC), 20 (13.0%) and papillary carcinoma, 4 (2.6%). Within the types of B3 lesions, the malignant upgrade rates were found: atypical ductal hyperplasia (ADH), 88/252 (35%); intraductal papilloma (IDP) with atypia, 16/55 (29%); lobular neoplasia (LN), 9/34 (26%); and radial scar (RS), 5/21 (24%). Most patients had both ultrasound and mammographic evaluation, and all lesions in the study were graded BIRADS 4A and above. Univariate analysis showed that age &amp;gt;50 (OR 2.30 [1.61-3.31], p&amp;lt; 0.001), BMI &amp;gt;23 (OR 2.21 [1.20-4.12], p=0.01), post-menopausal status (OR 2.43 [1.34-4.34], p&amp;lt; 0.001), lesion being identified on mammography (OR 3.00 [2.04-4.51], p&amp;lt; 0.001) and presence of microcalcifications on mammography (OR 0.63 [0.41-0.98], p=0.04) were risk factors for malignant upgrade. Conclusion Based on our analysis of Asian women, post-menopausal patients with microcalcifications on mammography and a B3 biopsy result should be treated with a higher degree of suspicion for underlying malignancy. Surgical excision with adequate margins should be routinely considered for B3 lesions such as ADH, IDP with atypia, LN and RS. Avoidance of surgery or vacuum-assisted removal can be considered for younger patients with only ultrasound findings and diagnosis of FEA and IDP. Table 1. Malignant upgrade after excision Table 2. Clinical characteristics of all patients according to malignant upgrade Table 3. Univariate and multivariate analysis for malignant upgrade Citation Format: Wei Wen Ang, Ji-Jung Jung. B3 breast lesions in Asian Centers: malignant upgrade rates and risk factors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-07-09.

Testicular Microlithiasis - The Need for Follow-Up in Pediatric Age

Testicular Microlithiasis - The Need for Follow-Up in Pediatric Age

Evaluation of Ultrasonographic Characteristics and Cytopathological Results of Autonomous (Toxic) Thyroid Nodules

Objective: Thyroid nodules are clinical conditions frequently encountered in the community and known to be associated with malignancy. In this study, it was aimed to determine the frequency of malignancy in patients diagnosed with autonomous (toxic) thyroid nodules (TTN). In addition, the effectiveness of ultrasonography (US) findings and fine needle aspiration (FNA) results in helping the diagnosis of malignancy were investigated.&#x0D; Methods: Autonomous (Toxic) thyroid nodule was diagnosed by presence of nodule on US in the presence of subclinical or clinical hyperthyroidism, and detection of suppression in other parts of the gland with increased activity in scintigraphy performed with Tc‐99m pertechnetate. Fine-needle aspiration was performed on patients who were considered suspicious by ultrasonographic findings. The histopathology results of the patients who were found to need surgical resection were recorded.&#x0D; Results: 125 patients with autonomous (toxic) thyroid nodules were included in the study. Of the patients, 82 (65.60%) were female and 43 (34.40%) were male, with a mean age of 63.55±11.13 years. Ultrasonography revealed that nodules were less frequently located in the isthmus and left upper pole. The presence of microcalcification was detected in 8 (6.4%) patients. Histopathologically, the nodules of 2 (1.6%) patients were found to be malignant. Both patients who were found to be malignant were male and their nodules were seen as hypoechoic on US.&#x0D; Conclusions: Since it has been seen that autonomic (toxic) thyroid nodules may be related to malignancy, careful evaluation of male patients with a hypoechoic image on US was considered appropriate.

A tissue-engineered model of the atherosclerotic plaque cap: Toward understanding the role of microcalcifications in plaque rupture.

Rupture of the cap of an atherosclerotic plaque can lead to thrombotic cardiovascular events. It has been suggested, through computational models, that the presence of microcalcifications in the atherosclerotic cap can increase the risk of cap rupture. However, the experimental confirmation of this hypothesis is still lacking. In this study, we have developed a novel tissue-engineered model to mimic the atherosclerotic fibrous cap with microcalcifications and assess the impact of microcalcifications on cap mechanics. First, human carotid plaque caps were analyzed to determine the distribution, size, and density of microcalcifications in real cap tissue. Hydroxyapatite particles with features similar to real cap microcalcifications were used as microcalcification mimics. Injected clusters of hydroxyapatite particles were embedded in a fibrin gel seeded with human myofibroblasts which deposited a native-like collagenous matrix around the particles, during the 21-day culture period. Second harmonic multiphoton microscopy imaging revealed higher local collagen fiber dispersion in regions of hydroxyapatite clusters. Tissue-engineered caps with hydroxyapatite particles demonstrated lower stiffness and ultimate tensile stress than the control group samples under uniaxial tensile loading, suggesting increased rupture risk in atherosclerotic plaques with microcalcifications. This model supports previous computational findings regarding a detrimental role for microcalcifications in cap rupture risk and can further be deployed to elucidate tissue mechanics in pathologies with calcifying soft tissues.

Detection of microcalcifications using nonlinear beamforming techniques.

Abundant research demonstrates that early detection of cancer leads to improved patient prognoses. By detecting cancer earlier, when tumors are in their primary stages, treatment can be applied before metastases have occurred. The presence of microcalcifications (MCs) is indicative of malignancy in the breast, i.e., 30-50% of all nonpalpable breast cancers detected using mammograms are based on identifying the presence of MCs. Therefore, improving the ability to detect MCs with modern imaging technology remains an important goal. Specifically, improving the sensitivity of ultrasound imaging techniques to detect MCs in the breast will provide an important role for the early detection and diagnosis of breast cancer. In this work, a novel nonlinear beamforming technology for ultrasonic arrays is investigated for its ability to detect MCs. The beamforming technique, called null subtraction imaging (NSI), utilizes nulls in the beam pattern to create images using ultrasound. NSI provides improved lateral resolution, a reduction in side lobes, and an accentuation of bright singular targets. Therefore, it was hypothesized that the use of NSI would result in identification of more MCs in rat tumors having a speckle background. To test this hypothesis, rats with tumors were injected with Hydroxyapatite (HA) particles to mimic MCs. Ultrasound was used to scan the rat tumors and images were constructed using conventional delay and sum and using NSI beamforming. Three readers with experience in diagnostic ultrasound imaging examined the 1,344 images and scored the presence or absence of MCs. In all, 336 different tumor image slices were recorded and each reconstructed using NSI or conventional delay and sum with Hann apodization. In every image where one or MCs were detected in the Hann reconstructions, MCs were detected in the NSI images. In nine rat tumor images, one or more MCs were detected in the NSI images but not in the Hann images. Statistically, the results did support the hypothesis that NSI would increase the number of MCs detected in the rat tumors.

A Pictorial Essay on Ultrasonography of Lymphadenopathies in Children

The purpose of this review is to become familiar with ultrasound (US) characteristics of normal and pathological lymph nodes and with diagnostic imaging approach to lymphadenopaties. Lymphadenopathy is a common finding in the paediatric population. Due to the many pathologies that can present in a similar fashion, imaging is a valuable method used in diagnostic process. Ultrasound is the modality of choice for lymph node detection in children, with a high safety profile as it does not use radiation. In this review the US appearance and characteristics of normal lymph nodes, and of some more common lymphadenopathies, are presented. Special attention is paid to distinguishing between benign and malignant lymph nodes on the basis of US characteristics. All findings must always be correlated with clinical and laboratory findings, and frequently followed by fine-needle aspiration or excisional biopsy as some US morphologies of benign and malignant nodes may overlap. However, the criteria that raise suspicion for malignancy are round shape, predominantly hypoechoic echogenicity, heterogenous echotexture, absent or displaced hilum, irregular outlines, necrosis, multiple confluent lymph nodes, the presence of microcalcifications, and peripheral or mixed flow pattern on colour Doppler imaging.Conclusion - US is the first line imaging method in palpable masses in children, first to confirm the presence of lymph nodes, and second to better delineate the lymph node’s characteristics, which guides further diagnostic decisions and treatment.

Role of Secreted Frizzled-Related Protein 1 in Early Breast Carcinogenesis and Breast Cancer Aggressiveness

A human transcriptome array on ERα-positive breast cancer continuum of risk identified Secreted Frizzled-Related Protein 1 (SFRP1) as decreased during breast cancer progression. In addition, SFRP1 was inversely associated with breast tissue age-related lobular involution, and differentially regulated in women with regard to their parity status and the presence of microcalcifications. The causal role of SFRP1 in breast carcinogenesis remains, nevertheless, not well understood. In this study, we characterized mammary epithelial cells from both nulliparous and multiparous mice in organoid culture ex vivo, in the presence of estradiol (E2) and/or hydroxyapatite microcalcifications (HA). Furthermore, we have modulated SFRP1 expression in breast cancer cell lines, including the MCF10A series, and investigated their tumoral properties. We observed that organoids obtained from multiparous mice were resistant to E2 treatment, while organoids obtained from nulliparous mice developed the luminal phenotype associated with a lower ratio between Sfrp1 and Esr1 expression. The decrease in SFRP1 expression in MCF10A and MCF10AT1 cell lines increased their tumorigenic properties in vitro. On the other hand, the overexpression of SFRP1 in MCF10DCIS, MCF10CA1a, and MCF7 reduced their aggressiveness. Our results support the hypothesis that a lack of SFRP1 could have a causal role in early breast carcinogenesis.

Önemi Belirsiz Foliküler Lezyonda Malignitenin Prediktif Faktörleri

Follicular lesion of undetermined significance (FLUS) is defined in the same Group III with the atypia of undetermined significance according to Bethesda Classification but these subgroups have different malignancy rates and tumor characteristics according to the studies. In this study, the aim was to evaluate the preoperative clinicopathologic features of the patients with cytological Bethesda Category III/FLUS thyroid nodules. The 44 patients were divided into two groups based on fine needle aspiration cytology (FNAC) results as benign (pB) and malignant (pM) and compared the preoperative clinical, ultrasonographic findings and FNAC results of two groups. According to the univariate analyses the presence of hiopechogenicity and presence of microcalcification are found to be significantly higher in malignancy (p&amp;lt;0.05 for all). Also, the presence of microcalcifications (p=0.048), and hypoechogenicity (p=0.014) were found to be independent risk factors for malignancy according to logistic regression analysis. In patients with FLUS, it should be remembered that the incidence of malignancy increases and treatment should be considered in the forefront of surgery instead of recurrent FNAC in the presence of hypoechogenicity and microcalcification in ultrasonography, and in patients with nuclear membrane irregularity according to FNAC.

Cytological Diagnosis of Thyroid Follicular Lesion and Its Correlation with Histological Findings

Introduction: Follicular neoplasms represent a wide clinical spectrum of diseases, with tremendous overlap in clinicopathologic diagnosis, management, and prognosis. Suspicious sonographic features in conjunction with FNAC of thyroid nodules provide the most accurate preoperative diagnosis to guide therapy. Keeping the perception in mind, we summarize our experience with thyroid nodules that were defined as cellular follicular lesions by comparing the clinical, sonographic, and cytological features that were examined histologically to define the most reliable criteria of malignancy. Aim of the Study: The aim of the study was to find out the cytological diagnosis of thyroid follicular lesions and their correlation with histological findings. Methods: This cross-sectional observational study was conducted at the department of Otolaryngology, National institute of ENT, Tejgaon, Dhaka following approval of the protocol for the duration of 6 months. A total of 30 patients were included and they were subjected to details history taking, physical examination, and necessary investigations. We analyzed the data using SPSS version 23, and Chi-square test was used to analyze the significance level of P (&lt;0.05). Results: A total of 30 consecutive patients with a follicular lesion on FNAC (5 men and 25 women) were included in this study. Their mean (SD) age was 46.7 (±13.0) years. Thyroid cancer was diagnosed on histopathology in 8 patients (27%). Papillary cancer was the most common cytologic finding in 6 patients [75%]) and 2 patients (25%) had a diagnosis of follicular cancer. Of the 6 patients with papillary cancer, 2 (33%) had a follicular variant of papillary cancer. The benign histologic diagnoses were follicular adenoma in 6 cases (27%), thyroiditis in 3 cases (13%), and nodular goiter in 13 (60%). The presence of a solitary nodule was not predictive of malignancy (p=0.57). Solid echo structure (p&lt;0.02), presence of microcalcification (p&lt;0.01), and hypoechoic nodules ...

PD18-06 PREDICTORS OF AZOOSPERMIA IN MEN WITH TESTIS CANCER

You have accessJournal of UrologyCME1 Apr 2023PD18-06 PREDICTORS OF AZOOSPERMIA IN MEN WITH TESTIS CANCER Luis F. Novaes, Richard S. Matulewicz, Joel Sheinfeld, John P. Mulhall, and Jose M. Flores Luis F. NovaesLuis F. Novaes More articles by this author , Richard S. MatulewiczRichard S. Matulewicz More articles by this author , Joel SheinfeldJoel Sheinfeld More articles by this author , John P. MulhallJohn P. Mulhall More articles by this author , and Jose M. FloresJose M. Flores More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003273.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Testis cancer (TC) is the most common cancer in young men. Many men with TC are also found to be sub-fertile at the time of diagnosis. Standard treatment modalities often negatively affect reproductive potential, making fertility a vital consideration in this population. We aimed to evaluate predictors of azoospermia in the pre-radical orchiectomy (RO) semen analysis (SA) in men with TC to inform patient counseling and guide fertility preservation. METHODS: Our analytic cohort included (i) men treated with RO for testicular cancer at our institution from January 2010 to August 2022 who had a (ii) SA, and (iii) fertility endocrine profile available prior to surgery. SA evaluated sperm concentration categorized as: azoospermia (0 M/ml), severe oligospermia (<5 M/ml), oligospermia (5-15 M/ml), normospermia (>15 M/ml). Parameters were reported as frequencies or median (IQR). Patient demographics, total testosterone (T), FSH levels, and testis ultrasound (TUS) parameters were also collected. TUS parameters analyzed were testis volume of each testis, tumor volume, number of tumors, and presence of microcalcifications. Multivariable analysis (MVA) was used to explore factors associated with azoospermia. Factors included in the model were testis volume of the side affected by tumor, tumor volume, FSH levels, and the presence of microcalcifications. RESULTS: A total of 97 men met inclusion criteria. Median age was 30 (25, 35) years. Median SA volume was 3 (1.5, 4) mL, median concentration 13 (0.3, 40) M/ml; 15% had azoospermia, 20% severe oligospermia, 19% oligospermia, 46% normospermia. Median total T was 393 (319, 529) ng/dL; 19% had T level ≤300 ng/dL. Median FSH was 18 (3, 32) IU/mL. The median testis volume was 15 (10, 23) cc, the median tumor volume was 4 (1, 18) cc. 96% of tumors were unilateral, and 29% had microcalcifications. In men with testis volume of the side affected by the tumor ≤10cc the rate of azoospermia was 21%, versus 13% in men with testis volume >10 cc. On MVA, testis volume of the side affected by the tumor was the only factor statistically associated with azoospermia. CONCLUSIONS: For men with testis cancer, lower testis volume of the side affected by the tumor is independently associated with azoospermia. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e504 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luis F. Novaes More articles by this author Richard S. Matulewicz More articles by this author Joel Sheinfeld More articles by this author John P. Mulhall More articles by this author Jose M. Flores More articles by this author Expand All Advertisement PDF downloadLoading ...

Considerable interobserver variation calls for unambiguous definitions of thyroid nodule ultrasound characteristics.

Thyroid nodule ultrasound characteristics are used as an indication for fine-needle aspiration cytology, usually as the basis for Thyroid Imaging Reporting and Data System (TIRADS) score calculation. Few studies on interobserver variation are available, all of which are based on analysis of preselected still ultrasound images and often lack surgical confirmation. After the blinded online evaluation of video recordings of the ultrasound examinations of 47 consecutive malignant and 76 consecutive benign thyroid lesions, 7 experts from 7 thyroid centers answered 17 TIRADS-related questions. Surgical histology was the reference standard. Interobserver variations of each ultrasound characteristic were compared using Gwet's AC1 inter-rater coefficients; higher values mean better concordance, the maximum being 1.0. On a scale from 0.0 to 1.0, the Gwet's AC1 values were 0.34, 0.53, 0.72, and 0.79 for the four most important features in decision-making, i.e. irregular margins, microcalcifications, echogenicity, and extrathyroidal extension, respectively. The concordance in the discrimination between mildly/moderately and very hypoechogenic nodules was 0.17. The smaller the nodule size the better the agreement in echogenicity, and the larger the nodule size the better the agreement on the presence of microcalcifications. Extrathyroidal extension was correctly identified in just 45.8% of the cases. Examination of video recordings, closely simulating the real-world situation, revealed substantial interobserver variation in the interpretation of each of the four most important ultrasound characteristics. In view of the importance for the management of thyroid nodules, unambiguous and widely accepted definitions of each nodule characteristic are warranted, although it remains to be investigated whether this diminishes observer variation.

Correlation between Ultrasound, Cytology and Anatomo Pathology in Thyroid Nodules

Introduction: Surgical pathologies of the thyroid are frequent; essential tools for its assessment constitute ultrasound, Fine Needle Aspiration (FNA), and Pathological Anatomy (PA) of the resected sample. Objective: To determine the correlation between sonographic, cytological and pathological findings of thyroid nodules in years. Materials and methods: Observational, descriptive and retrospective study of thyroidectomized patients between 2010 and 2014 at Clinical’s Hospital-Uruguay. Results: Sixty-seven patients, 59 women and 8 men, with a mean age of 45 ± 16 years. According to ultrasound findings, the majority corresponded to EU-TIRADS 3 (43%), followed by EU-TIRADS 4 (27%). According to Bethesda classification, the most frequent was indeterminate (48%), followed by benign (32%) and malignant (19%). 54% had benign PA and 46% malignant, papillary carcinoma was the most frequent (61%). Discussion: A significant association between EU-TIRADS 4-5 and the Bethesda classification was demonstrated. The finding of a probably benign (EU-TIRADS 3) or suspicious (EU-TIRADS 4) nodule, whose risk described in the literature of 2-4% and 6-17%, can hide a malignant tumor in up to 1/4 or 6 /10 cases respectively. Sensitivity of ultrasound was 74% and specificity 66%. The ultrasound elements significantly related to malignancy were the solid variant, hypoechoic and the presence of microcalcifications. Bethesda classification categories clearly associated with malignancy were IV, V, and VI. Conclusions: An adequate correlation was demonstrated to differentiate benignity from malignancy when comparing ultrasound findings of thyroid nodules with FNA and PA.

Association between vitamin D and calcium intakes, breast microcalcifications, breast tissue age-related lobular involution and breast density.

To demystify the potential role of vitamin D and calcium intakes in breast carcinogenesis, we explored the association between these two nutrients and three biomarkers of breast cancer risk: the presence of microcalcifications, age-related lobular involution and breast density. A total of 82 premenopausal and 79 postmenopausal women diagnosed with breast cancer completed a food frequency questionnaire to assess their total vitamin D and calcium intakes. Presence of microcalcifications was determined by reviewing pathology reports. Age-related lobular involution was assessed in nontumoral breast tissue on hematoxylin-eosin-stained slides and percent breast density was assessed by a computer-assisted method. Multivariate generalized linear models were used to evaluate associations between quartiles of vitamin D and calcium intakes and the biomarkers of breast cancer risk. Increasing quartiles of vitamin D intake were inversely associated with the presence of microcalcifications (fourth quartile [Q4] prevalence ratio [PR] = 0.55; Ptrend = 0.021) and breast density (Q4-Q1 = -7.7%; Ptrend = 0.023) in postmenopausal women, and positively associated with age-related lobular involution in women with microcalcifications (Q4 PR = 1.62; Ptrend = 0.036). Increasing quartiles of calcium intake were inversely associated with microcalcifications among all (Q4 PR = 0.44), premenopausal (Q4 PR = 0.37) and postmenopausal women (Q4 PR = 0.38; Ptrend < 0.014 for all). It was also inversely associated with breast density in women without microcalcification (Q4-Q1 = -8.3%; Ptrend = 0.047), but positively associated with breast density in women with microcalcifications (Q4-Q1 = 10.0%; Ptrend = 0.032). Results suggest that the association between vitamin D and calcium intakes and breast cancer risk factors could be influenced by the presence of microcalcifications.

The effect of plaque morphology, material composition and microcalcifications on the risk of cap rupture: A structural analysis of vulnerable atherosclerotic plaques.

BackgroundThe mechanical rupture of an atheroma cap may initiate a thrombus formation, followed by an acute coronary event and death. Several morphology and tissue composition factors have been identified to play a role on the mechanical stability of an atheroma, including cap thickness, lipid core stiffness, remodeling index, and blood pressure. More recently, the presence of microcalcifications (μCalcs) in the atheroma cap has been demonstrated, but their combined effect with other vulnerability factors has not been fully investigated.Materials and methodsWe performed numerical simulations on 3D idealized lesions and a microCT-derived human coronary atheroma, to quantitatively analyze the atheroma cap rupture. From the predicted cap stresses, we defined a biomechanics-based vulnerability index (VI) to classify the impact of each risk factor on plaque stability, and developed a predictive model based on their synergistic effect.ResultsPlaques with low remodeling index and soft lipid cores exhibit higher VI and can shift the location of maximal wall stresses. The VI exponentially rises as the cap becomes thinner, while the presence of a μCalc causes an additional 2.5-fold increase in vulnerability for a spherical inclusion. The human coronary atheroma model had a stable phenotype, but it was transformed into a vulnerable plaque after introducing a single spherical μCalc in its cap. Overall, cap thickness and μCalcs are the two most influential factors of mechanical rupture risk.ConclusionsOur findings provide supporting evidence that high risk lesions are non-obstructive plaques with softer (lipid-rich) cores and a thin cap with μCalcs. However, stable plaques may still rupture in the presence of μCalcs.

The Role of Ultrasound, Scintigraphy, and Cytology in Evaluating Thyroid Nodules

Abstract&#x0D; Background: Thyroid function testing and imaging studies guide the initial management of thyroid nodules. Our study aims to assess the role that ultrasound (US) and scintigraphy play in thyroid nodules.&#x0D; Methods: We conducted a prospective case series study of 212 consecutive patients presented with thyroid nodules at the tertiary University Hospital of Tirana (“Mother Teresa”) for further evaluation between January 2018 and March 2018. All patients were examined with US and scintigraphy with 99mTc and underwent fine- needle aspiration cytology. Generalized Linear Model (ordinal logistic) was used to predict the dependent variable with 'ordered' multiple categories and independent variables.&#x0D; Results: The majority of patients (85%) were female, and (15%) males, p&lt;0.001. The ordered logit for US finding’s presence of microcalcifications, adenopathy, solid or solidcystic nodules, being in a higher TIR category was 1.27, 4.56, 2.70 and 1.70 more than absence of microcalcifications, adenopathy and cystic nodules, respectively. Conversely, a one unit (year) increase in age would result in a 0.035 unit decrease in the ordered log-odds of being in a higher TIR category. For the scintigraphy findings, the ordered logit for isohypofunctional and hypofunctional nodules (vs. isofunctional), in a higher TIR category, was 1.70 and 2.10 higher, respectively.&#x0D; Conclusions: In thyroid glandular nodules, only a small percentage are malignant, therefore examination with ultrasound, scintigraphy and FNA are important to lower the number of patients undergoing surgery. Given the study's results, scintigraphy has a significant value, but in order to diagnose malignant nodules ultrasound remained an initial and important diagnostic tool, which, when combined with FNA, rounds out a clear diagnosis of thyroid nodules.

Association Between Imaging Features Using the BI-RADS and Tumor Subtype in Patients with Invasive Breast Cancer.

Different molecular breast cancer subtypes present different biologic features, treatment options, and clinical prognoses. The breast cancer imaging phenotype may help precisely classify breast cancer in a non-invasive manner. To identify the association between the imaging and clinicopathologic features of invasive breast cancer according to the molecular subtype. We retrospectively reviewed the electronic medical records of 313 consecutive women with breast cancer who underwent surgery between March 2018 and February 2019. Preoperative imaging studies were also reviewed and the association between the clinicopathologic and imaging features was evaluated according to the molecular subtype. On mammography, the presence of microcalcifications was correlated with the human epidermal factor receptor 2-positive subtype (67%, 14/21). Luminal A and B tumors were more likely to have a spiculated margin (57% [63/110] and 41% [34/81]), while human epidermal factor receptor 2-positive and triple-negative breast cancers were more likely to have an indistinct margin (56% [10/18] and 35% [17/48]). On ultrasonography, luminal A tumors were likely to be depicted as masses with an irregular shape (85%, 115/136) and spiculated margin (49%, 66/136). On magnetic resonance imaging, triple-negative breast cancer appeared as a mass (n=13) that frequently had an irregular shape (62%, 8/13) but was more likely to be oval or round (39%, 5/13) than other subtypes. Some imaging features on mammography, ultrasonography, and magnetic resonance imaging could be useful predictors of the molecular subtype of breast cancer and may aid precision medicine development for patients with breast cancer according to the subtype.