PAPILLARY thyroid carcinoma （PTC） is the most common thyroid cancer and consists of nearly 80% of all cases of thyroid cancer.1 It is asso- ciated with the lowest level of malignancy and an excellent prognosis. Prim...PAPILLARY thyroid carcinoma （PTC） is the most common thyroid cancer and consists of nearly 80% of all cases of thyroid cancer.1 It is asso- ciated with the lowest level of malignancy and an excellent prognosis. Primary thyroid lymphoma （PTL） is a lymphomatous process which develops in the thyroid without involvement of primary lymphoid organs or distant metastases at diagnosis.2 It is a rare malignancy that accounts for 1%-5% of all thyroid malignancies and less than 2% of all extranodal lymphomas. The incidence of PTL is one or two cases per million.2＇ 3 It occurs frequently in elder woman, with a peak incidence in the sixth decade of life.展开更多
Background： Some ultrasonographic （US） signs overlap between benign and malignant nodules. The purpose of this study was to raise a special US sign of benign thyroid nodules, termed the ＂onion skin-liked sign.＂ M...Background： Some ultrasonographic （US） signs overlap between benign and malignant nodules. The purpose of this study was to raise a special US sign of benign thyroid nodules, termed the ＂onion skin-liked sign.＂ Methods： Twenty-seven patients with 27 nodules who shrank naturally and the ＂onion skin-liked sign＂ appeared on the final US images were enrolled in the study. The ultrasound characters and risk stratifications at the start and end of observation were compared. Then, thirty goiters with fibrosis and thirty papillary thyroid carcinomas （PTC） were randomly selected from the database of our hospital, matched the sizes of 27 nodules at the end point of observation. The differences of ＂onion skin-liked sign＂ between the two groups were analyzed. Results： The average duration of follow-up of 27 nodules was 24.0 ± 12.2 months （range, 12-65 months）. At the end of the follow-up, the size of the nodules decreased on average by 1.26 ± 0.82 cm （range, 0.3-3.4 cm） and calcification was found in 21 nodules, compared with only 2 nodules with calcification at the start of the follow-up. In addition, only negligible or no blood flow signal could be detected at the periphery of all the nodules and 100% （27/27） were high suspicion at the end of observation. In matched groups, all PTC showed high suspicion of malignancy, 18/30 （60%） goiters with fibrosis were high suspicion and 11/30 （37%） were intermediate suspicion. Twenty-two patients in the group of nodular fibrosis presented ＂onion skin-liked sign,＂ which was not shown in any patient of PTC group. The sensitivity, specificity, positive predictive value, and negative predictive value of ＂onion skin-liked sign＂ in predicting nodular goiter with fibrosis were 73.3%, 100%, 100%, and 78.9%, respectively. Conclusions： The ＂onion skin-liked sign＂ was a characteristic US feature of benign thyroid nodules detected in the follow-up of thyroid nodules. It is useful to differentiate PTCs and nodular goiters with fibrosis.展开更多
Background： Endovascular aneurysnl repair （EVAR） is one of the first-line therapies of abdominal aortic aneurysms. Postoperative endoleak is the most common complication of EVAR. Computed tomography angiography （...Background： Endovascular aneurysnl repair （EVAR） is one of the first-line therapies of abdominal aortic aneurysms. Postoperative endoleak is the most common complication of EVAR. Computed tomography angiography （CTA）, which is routine for follow-up, has side effects （e.g., radiation） and also has a certain percentage of missed diagnosis. Preliminary studies on contrast-enhanced ultrasound （CEUS） have shown that the sensitivity of CEUS for detecting endoleak is no lower than that of CTA. To investigate the advantages of CEUS, we conducted CEUS examinations of post-EVAR cases in which CTA failed to detect endoleak or could not verify the type of endoleak. Methods： Post-EVAR patients, who were clinically considered to have endoleak and met the inclusion criteria were enrolled between March 2013 and November 2014. All of the patients underwent color Doppler flow imaging （CDFI） and a CEUS examination. Size, location, microbubble dispersion, and hemodynamic characteristics of leaks were recorded. Comparison between the diagnosis of CEUS and CDF1 was conducted using Fisher＇s exact test and clinical outcomes of all patients were followed up. Results： Sixteen patients were enrolled, and 12 （75%） had endoleaks with verified types by CEUS. Among 12 cases of endoleaks were positive by CEUS, 10 were CDFl-positive, and the four CEUS-negative cases were all negative by CDFI. The diagnostic values of CEUS and CDFI were statistically difl＇erent （P = 0,008）. Six patients with high-pressure endoleaks received endovascular re-intervention guided by CEUS results. One patient with type Ⅲ endoleak had open surgery when endovascular repair failed. Conclusions： C EUS is a new, safe, and effective means for detection ofendoleaks post-EVAR. This technique can be used as a supplement for routine CTA follow-up to provide more detailed information on endoleak and its category.展开更多
Background： The clinical behavior and management of poorly differentiated thyroid carcinoma （PDTC） are very different from papillary thyroid carcinoma （PTC）. By comparing the clinical and ultrasonographic feature...Background： The clinical behavior and management of poorly differentiated thyroid carcinoma （PDTC） are very different from papillary thyroid carcinoma （PTC）. By comparing the clinical and ultrasonographic features between the two tumors, we proposed to provide more possibilities for recognizing PDTC before treatment. Methods： The data of 13 PDTCs and 39 ageand gender-matched PTCs in Peking Union Medical College Hospital between December 2003 and September 2013 were retrospectively reviewed. The clinical and ultrasonic features between the two groups were compared. Results： The frequencies of family history of carcinoma, complication with other thyroid lesions, lymph node metastases, recurrent laryngeal nerve injuries, and distant metastases were higher in PDTCs （30.8%, 61.6%, 69.2%, 23.1%, and 46.2%, respectively） than those in PTCs （2.6%, 23.1%, 25.6%, 2.6%, and 2.6%, respectively） （P 〈 0.05）. The mortality rate of PDTCs was greatly higher than PTCs （P 〈 0.01）. Conventional ultrasound showed that the size of PDTCs was larger than that of PTCs （3.1±1.9 cm vs. 1.7± 1.0 cm）. Clear margins and rich and/or irregular blood flow were found in 92.3% of PDTCs, which differed substantially from PTCs （51.7% and 53.8%, respectively） （P 〈 0.05）. Conclusions： PDTC is more aggressive and its mortality rate is higher than PTCs. Accordingly, more attention should be given to suspicious thyroid cancer nodules that show large size, regular shape, and rich blood flow signals on ultrasound to exclude the possibility of PDTCs.展开更多
基金Supported by the Natural Science Foundation of China(81541131)
文摘PAPILLARY thyroid carcinoma （PTC） is the most common thyroid cancer and consists of nearly 80% of all cases of thyroid cancer.1 It is asso- ciated with the lowest level of malignancy and an excellent prognosis. Primary thyroid lymphoma （PTL） is a lymphomatous process which develops in the thyroid without involvement of primary lymphoid organs or distant metastases at diagnosis.2 It is a rare malignancy that accounts for 1%-5% of all thyroid malignancies and less than 2% of all extranodal lymphomas. The incidence of PTL is one or two cases per million.2＇ 3 It occurs frequently in elder woman, with a peak incidence in the sixth decade of life.
基金This study was supported by the grants from the National Natural Science Foundation of China，the National International Science and Technology Cooperation Project
文摘Background： Some ultrasonographic （US） signs overlap between benign and malignant nodules. The purpose of this study was to raise a special US sign of benign thyroid nodules, termed the ＂onion skin-liked sign.＂ Methods： Twenty-seven patients with 27 nodules who shrank naturally and the ＂onion skin-liked sign＂ appeared on the final US images were enrolled in the study. The ultrasound characters and risk stratifications at the start and end of observation were compared. Then, thirty goiters with fibrosis and thirty papillary thyroid carcinomas （PTC） were randomly selected from the database of our hospital, matched the sizes of 27 nodules at the end point of observation. The differences of ＂onion skin-liked sign＂ between the two groups were analyzed. Results： The average duration of follow-up of 27 nodules was 24.0 ± 12.2 months （range, 12-65 months）. At the end of the follow-up, the size of the nodules decreased on average by 1.26 ± 0.82 cm （range, 0.3-3.4 cm） and calcification was found in 21 nodules, compared with only 2 nodules with calcification at the start of the follow-up. In addition, only negligible or no blood flow signal could be detected at the periphery of all the nodules and 100% （27/27） were high suspicion at the end of observation. In matched groups, all PTC showed high suspicion of malignancy, 18/30 （60%） goiters with fibrosis were high suspicion and 11/30 （37%） were intermediate suspicion. Twenty-two patients in the group of nodular fibrosis presented ＂onion skin-liked sign,＂ which was not shown in any patient of PTC group. The sensitivity, specificity, positive predictive value, and negative predictive value of ＂onion skin-liked sign＂ in predicting nodular goiter with fibrosis were 73.3%, 100%, 100%, and 78.9%, respectively. Conclusions： The ＂onion skin-liked sign＂ was a characteristic US feature of benign thyroid nodules detected in the follow-up of thyroid nodules. It is useful to differentiate PTCs and nodular goiters with fibrosis.
文摘Background： Endovascular aneurysnl repair （EVAR） is one of the first-line therapies of abdominal aortic aneurysms. Postoperative endoleak is the most common complication of EVAR. Computed tomography angiography （CTA）, which is routine for follow-up, has side effects （e.g., radiation） and also has a certain percentage of missed diagnosis. Preliminary studies on contrast-enhanced ultrasound （CEUS） have shown that the sensitivity of CEUS for detecting endoleak is no lower than that of CTA. To investigate the advantages of CEUS, we conducted CEUS examinations of post-EVAR cases in which CTA failed to detect endoleak or could not verify the type of endoleak. Methods： Post-EVAR patients, who were clinically considered to have endoleak and met the inclusion criteria were enrolled between March 2013 and November 2014. All of the patients underwent color Doppler flow imaging （CDFI） and a CEUS examination. Size, location, microbubble dispersion, and hemodynamic characteristics of leaks were recorded. Comparison between the diagnosis of CEUS and CDF1 was conducted using Fisher＇s exact test and clinical outcomes of all patients were followed up. Results： Sixteen patients were enrolled, and 12 （75%） had endoleaks with verified types by CEUS. Among 12 cases of endoleaks were positive by CEUS, 10 were CDFl-positive, and the four CEUS-negative cases were all negative by CDFI. The diagnostic values of CEUS and CDFI were statistically difl＇erent （P = 0,008）. Six patients with high-pressure endoleaks received endovascular re-intervention guided by CEUS results. One patient with type Ⅲ endoleak had open surgery when endovascular repair failed. Conclusions： C EUS is a new, safe, and effective means for detection ofendoleaks post-EVAR. This technique can be used as a supplement for routine CTA follow-up to provide more detailed information on endoleak and its category.
文摘Background： The clinical behavior and management of poorly differentiated thyroid carcinoma （PDTC） are very different from papillary thyroid carcinoma （PTC）. By comparing the clinical and ultrasonographic features between the two tumors, we proposed to provide more possibilities for recognizing PDTC before treatment. Methods： The data of 13 PDTCs and 39 ageand gender-matched PTCs in Peking Union Medical College Hospital between December 2003 and September 2013 were retrospectively reviewed. The clinical and ultrasonic features between the two groups were compared. Results： The frequencies of family history of carcinoma, complication with other thyroid lesions, lymph node metastases, recurrent laryngeal nerve injuries, and distant metastases were higher in PDTCs （30.8%, 61.6%, 69.2%, 23.1%, and 46.2%, respectively） than those in PTCs （2.6%, 23.1%, 25.6%, 2.6%, and 2.6%, respectively） （P 〈 0.05）. The mortality rate of PDTCs was greatly higher than PTCs （P 〈 0.01）. Conventional ultrasound showed that the size of PDTCs was larger than that of PTCs （3.1±1.9 cm vs. 1.7± 1.0 cm）. Clear margins and rich and/or irregular blood flow were found in 92.3% of PDTCs, which differed substantially from PTCs （51.7% and 53.8%, respectively） （P 〈 0.05）. Conclusions： PDTC is more aggressive and its mortality rate is higher than PTCs. Accordingly, more attention should be given to suspicious thyroid cancer nodules that show large size, regular shape, and rich blood flow signals on ultrasound to exclude the possibility of PDTCs.
