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Background: The risk stratification system of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) for thyroid nodules is affected by low diagnostic specificity...

The purpose of this multicenter study was to compare the differential diagnostic value of the 2015 American Thyroid Association (ATA) and 2017 American College of Radiology (ACR) practice guidelines and elastography in thyroid nodules. This study also investigated whether the diagnostic value of practice guidelines can be improved, and the unnecessary biopsy rate decreased in combination with elastography. A total of 498 thyroid nodules were evaluated using the ATA and the ACR guidelines. Strain elastography, acoustic radiation force impulse imaging and point-shear wave elastography were used to assess the nodules. The suspicious levels were downgraded or upgraded after combination and unnecessary biopsy rates were calculated, respectively. The diagnostic performance of the practice guidelines was better than that of elastography. The ACR guidelines had a lower unnecessary biopsy rate and similar diagnostic performance compared with the ATA guidelines. The unnecessary biopsy rates significantly decreased when the ACR guidelines were combined with elastography, but the rates did not decrease when the ATA guidelines were combined with elastography.

To investigate the value of ultrasound (US) and clinicopathological features of papillary thyroid cancer (PTC) in predicting Telomerase Reverse Transcriptase (TERT) promoter mutations. Preoperative US images of 351 surgically confirmed PTCs were evaluated in terms of PTCs size and US features. The basic clinicopathological features were also retrieved. Univariate and multivariate analyses were performed to identify the risk factors for TERT promoter mutations. A scoring system was developed based on the cumulative number of risk factors. The area under the receiver operating characteristic curve (AUC) and cut-off value were calculated to evaluate the diagnostic performance of the scoring system for predicting TERT promoter mutations. TERT promoter mutations were found in 4.84% (17/351) of patients with PTCs. Patient age >50 years (OR: 6.244, P = 0.006), multifocality (OR: 21.071, P = 0.022), taller-than-wide shape (OR: 4.934, P = 0.029), microlobulated margin (OR: 4786, P = 0.032), and capsule contact or involvement (OR: 4.668, P = 0.030) were independent risk factors for TERT promoter mutations. TERT promoter mutations were relevant to more suspicious US and clinicopathological features than TERT promoter wild-type PTC (median, 4 vs. 1, P

The purpose of the study was to explore the differences of conventional ultrasound characteristics, thyroid imaging reporting and data system (TI-RADS) category and shear wave speed (SWS) measurement between follicular adenoma (FA) and follicular thyroid carcinoma (FTC). Twenty-eight FTCs and 67 FAs proven by surgery were retrospectively included for analysis. Conventional ultrasound and point-shear wave elastography (p-SWE) were performed in all of the included patients. The ultrasound features, American Thyroid Association (ATA) TI-RADS category and American College of Radiology (ACR) TI-RADS category, SWS measurement were compared between the two groups. Receiver operating characteristic (ROC) curve was performed and area under ROC curve (AUC) was obtained for significant features. There were no statistical differences in mean age (46.9±15.7years vs. 48.6±13.6years, P = 0.639), gender (9 males, 32.1% vs. 18 males, 29.0%, P = 0.766) and mean diameter (28.3±16.2 mm vs. 33.8±11.9 mm, P = 0.077) between FTCs and FAs. Hypoechogenicity, lobulated or irregular margin, macrocalcification were more common in FTCs than FAs (all P

To evaluate the therapeutic effect of a short course chemotherapy on initially sputum positive cavitary pulmonary tuberculosis or tuberculoma by bacteriological examination of specimens through percutaneous lung biopsy after the chemotherapy.Eighty-three cases of initially sputum positive pulmonary tuberculosis with cavities or tuberculoma were included from Jan. 2002 and May. 2004. The patients finished a course of chemotherapy (2HREZ/4HR), and the sputum was converted to smear-negative and culture-negative, but cavities or tuberculoma remained on the chest X-ray. Lung specimens were obtained from the wall or content of the cavity or from the tuberculoma by CT-guided percutaneous lung biopsy for bacteriological examination within one month after the course.All the needle biopsy specimens were smeared and cultured for Mycobacterium tuberculosis. Eight cases (8/83, 9.6%) showed positive results: 3 were smear-positive and culture-positive, and 5 smear-negative but culture-positive. Drug susceptibility test showed that 7 of them were drug-sensitive and the remaining 1 was resistant to rifampin and isoniazid. After follow-up of 24 months, 6 of them converted to sputum smear-positive.Our study showed that 90.4% (75/83) of the tuberculosis cases achieved real bacteriological negative result on biopsies after a short course chemotherapy, and the bacteriological positive cases on biopsy experienced 75.0% (6/8) sputum bacteriological recurrence. The result suggests that the evaluation criteria with sputum on therapeutic effect of pulmonary tuberculosis needs to be reassessed.