Search

Objective The purpose of this study was to evaluate a novel radiofrequency ablation (RFA) application utilizing an adjustable electrode for treatment of benign thyroid nodules. Materials and methods From April 2011 to December 2018, 21 patients underwent RFA treatment on 21 thyroid nodules, utilizing an 18-gauge internally cooled electrode equipped with a size adjustable active tip. The peripheral nodule portions were ablated with the moving-shot technique and a shorter active tip, and the nodule centers were ablated with the fixed technique and a longer active tip. We assessed parameters including characteristics of the treated nodules, use of variablesized active tips, volume reduction rate, therapeutic success rate, and post-procedural complications. The therapeutic success rate was defined as a > 50% volume reduction of the initial nodule volume at the 6- or 12-month follow-up. Results The treated thyroid nodules were large enough to cause symptoms (mean volume, 29.6 mL). Two types of active tips per session were used for all nodules. The mean volume reduction rate at the last follow-up was 68.3 ± 4.4% and our therapeutic success rate was 90.5%. Both symptoms and cosmetic scores decreased significantly. Minor complications in three patients were recorded during and after the procedure. Conclusion This initial study demonstrated that an adjustable electrode for RFA of benign thyroid nodules effectively and safely resulted in volume reduction.

Objective To retrospectively compare the diagnostic performances of two different ultrasound (US)-guided core needle biopsy (CNB) techniques for intermediate or low suspicion thyroid nodules. Materials and methods Between August 2015 and December 2016, two different biopsy techniques were alternatively applied for 248 consecutive thyroid nodules, of which, 140 intermediate or low suspicion thyroid nodules were included in this study. In the first technique, two specimens included nodular tissue, nodular margin, and surrounding normal parenchyma (i.e., marginal target). In the second technique, two specimens were obtained from two different target areas, one for the marginal target and another for the intranodular target. The diagnostic performances of the two techniques to predict neoplasm and malignancy were compared. Results CNB was performed on 80 intermediate or low suspicion nodules (57.1%) using the first technique and on 60 (42.9%) using the second technique. The accuracy of the first technique for predicting neoplasm or malignancy was significantly higher than that of the second technique (100% vs. 93.3%, p = 0.032 for predicting neoplasm; 88.8% vs. 75.0%, p = 0.033 for predicting malignancy). The negative predictive value of the first technique for predicting malignancy was also significantly higher than that of the second technique (87.5% vs. 72.7%, p = 0.035). Conclusion For intermediate or low suspicion thyroid nodules, US-guided CNB to obtain two specimens with marginal targets is more effective for diagnosing neoplasm or malignancy than is CNB for respective marginal and intranodular targets.

Objective To evaluate the ultrasonography (US) features and clinical characteristics of columnar cell variant of papillary thyroid carcinoma (CCV-PTC) that can predict disease progression. Materials and Methods Six cases of CCV-PTC were identified via surgical pathology analysis at our institution from 1994 to 2016. The histological, architectural, and cytological features met the diagnostic criteria of CCV-PTC. We reviewed the US features and clinicopathological findings in the six cases. Results An indolent clinical course was observed in four young female patients aged 27-34 years (median: 32 years), while two older patients aged 55 years or 70 years had an aggressive clinical course. All patients underwent total thyroidectomy and radioiodine therapy. The indolent group included patients with T1 and nodal metastasis, where the disease was not observed during the follow-up period (range: 8-17 years). On the other hand, a larger tumor size (1.8 cm and 6.0 cm), gross extrathyroidal extension to the muscle and lymph node, and distant metastasis were observed in the aggressive group. In one male patient, recurrence occurred immediately after operation, and this patient died 4 years after the diagnosis of thyroid cancer. Based on US, the individuals from the indolent group had a smooth margin, except for one. Both cases in the aggressive group had a microlobulated margin. Conclusion Favorable prognosis in CCV-PTC is observed in young patients with T1 staging and demonstrates a smooth margin at US. These US findings might help exclude the same treatment as the aggressive type in the indolent type of CCV-PTC.

Objective The aim of this study was to evaluate the diagnostic performance of gray-scale ultrasonography (US), Doppler scan, and elastography using carotid artery pulsation in the diagnosis of thyroid nodules and to find a complementary role of elastography. Materials and Methods A total 197 thyroid nodules with 91 malignant and 106 benign pathologic results from 187 patients (41 males and 146 females; age range, 20–83 years; mean age, 49.4 years) were included in this prospective study. The gray-scale, Doppler US images, elastography with elasticity contrast index (ECI), and stiffness color were assessed. The diagnostic performances of each dataset were assessed in order to differentiate benign from malignant thyroid nodules. Results The optimal cut-off value of the ECI was 1.71. The area under receiver operating characteristic curve (Az value) was 0.821 for gray-scale US, 0.661 for the ECI, 0.592 for stiffness color, and 0.539 for Doppler US. The Az value for a combined assessment of gray-scale US and the ECI was higher than that for the gray-scale US alone; however, there was no statistical difference between the two (p = 0.219). The median ECI values of follicular thyroid carcinoma (FTC) and follicular variant of papillary thyroid carcinoma (FVPTC) were significantly lower than those of the other malignant lesions (p = 0.005). Meanwhile, the diffuse sclerosing variant of PTC and a metastatic nodule showed the two highest median values of the ECI. Conclusion For differentiating thyroid nodules, the diagnostic performances of the combination of gray-scale US and elastography with the ECI were similar to, but not superior, to those of gray-scale US alone. FVPTC and FTC have a significantly lower ECI value than those of the other malignant lesions.

Objective Core needle biopsy (CNB) of the thyroid is an additional diagnostic method for non-diagnostic or indeterminate cytology samples. We sought to evaluate a new modified core biopsy technique and compare the concordance of its diagnosis with the final diagnosis of the surgically resected specimen. Materials and Methods A retrospective analysis was conducted on 842 patients who had a thyroid CNB with or without a previous fine-needle aspiration from August 2002 to March 2015; 38% of patients ultimately underwent thyroidectomy. We divided the patients into two groups for comparison: conventional group (n = 329) and new modified technique group (n = 513) that enabled sampling of not only the lesion but also the margin and surrounding parenchyma. The diagnostic conclusiveness of CNB and concordant rate with thyroidectomy was compared between the two groups. Results The overall diagnostic conclusiveness did not exhibit a significant increase (77% in the conventional technique group and 75% in the modified technique group, p = 0.408). In terms of the diagnostic concordance rate between CNB and thyroidectomy, no overall significant increase was observed (83% in the conventional technique group and 88% in the modified technique group, p = 0.194). However, only in follicular-patterned lesions (nodular hyperplasia, follicular neoplasm, and follicular variant of papillary thyroid carcinoma), a significant increase in the diagnostic concordance rate was observed (83% in the conventional group and 94% in the modified technique group, p = 0.033). Conclusion Modified CNB technique can be beneficial for the accurate diagnosis of follicular-patterned thyroid lesions.

Core needle biopsy (CNB) has been suggested as a complementary diagnostic method to fine-needle aspiration in patients with thyroid nodules. Many recent CNB studies have suggested a more advanced role for CNB, but there are still no guidelines on its use. Therefore, the Task Force Committee of the Korean Society of Thyroid Radiology has developed the present consensus statement and recommendations for the role of CNB in the diagnosis of thyroid nodules. These recommendations are based on evidence from the current literature and expert consensus.

The rate of detection of thyroid nodules and carcinomas has increased with the widespread use of ultrasonography (US), which is the mainstay for the detection and risk stratification of thyroid nodules as well as for providing guidance for their biopsy and nonsurgical treatment. The Korean Society of Thyroid Radiology (KSThR) published their first recommendations for the US-based diagnosis and management of thyroid nodules in 2011. These recommendations have been used as the standard guidelines for the past several years in Korea. Lately, the application of US has been further emphasized for the personalized management of patients with thyroid nodules. The Task Force on Thyroid Nodules of the KSThR has revised the recommendations for the ultrasound diagnosis and imaging-based management of thyroid nodules. The review and recommendations in this report have been based on a comprehensive analysis of the current literature and the consensus of experts.

Purpose: We wanted to evaluate the sonographic findings of recurrent breast cancer in the patients who underwent mastectomy or breast conserving surgery (BCS). We also wanted to evaluate the characteristics of recurrent cancer that’s detected on follow up sonography only. Materials and Methods: We retrospectively reviewed 87 patients with recurrent breast cancer and who were operated on during the previous 10 years. We analyzed the method of detection and the sonographic appearance of tumor, including the location, size, shape, margin, internal echogenicity and BI-RADS categories, in 52 patients who had abnormal sonographic findings. We compared the sonographic findings of the recurrent cancer between the patients who underwent mastectomy and the patients who underwent BCS. We also analyzed the characters of the recurrent cancer that was only detectable on follow-up sonography. Results: Among the 87 patients with recurrent breast cancer, 37 patients had undergone previous mastectomy and 50 patients had undergone previous BCS. The most common mode of detection was a palpable mass on physical examination for the patients who underwent mastectomy (64.9%, 24/37) and the most common mode of detection was the follow-up sonography for the patients who underwent BCS (40%, 20/50). The sonographic appearance of the recurrent cancer was similar for both the patients who underwent mastectomy or BCS. The most common locations were the breast parenchymal layer in 82% (36/44) of the patients who underwent BCS and the subcutaneous fat layer of the operated area in 67% (14/21) of the patients who underwent mastectomy. The type of recurrent cancer detected on sonography only was small nodules in the patients who underwent BCS, and that for the patients who underwent mastectomy was nodules, regardless of size, that were located in the deep muscle layer. Conclusion: Recurrent breast cancer, regardless of size, was frequently detected on a physical examination in the patients who underwent previous mastectomy, and this was detected on sonography in the patients who underwent with previous BCS. Follow up sonography was valuable to evaluate for tumor recurrence after breast cancer surgery, and this detected 16% (6/37), 28% (14/50) of the recurrent cancers that were otherwise occult tumor.

Synchronous tumor of the fallopian tube and endometrium is an unusual co-occurrence of gynecologic malignancies. To the best of our knowledge, there have been no reports on synchronous papillary tumor of the fallopian tube and endometrium. In this report, we present the case of a patient who synchronously suffered with papillary serous adenocarcinoma of the fallopian tube and endometrium and the tumor showed characteristic frondlike projections on magnetic resonance imaging.

Purpose: To develop a VX-II carcinoma model in the rabbit uterus and to describe the MR imaging findings of an experimentally induced VX-II uterine carcinoma along with the histopathologic findings. Materials and Methods: 13 New Zealand rabbits were included in this study. Two pieces of tissue suspension (1 2) of VX-II carcinoma were loaded in an 18 gauge disposable needle and the tissue embedded in the wall of each horn of the rabbits’uterus. We obtained the MR images at 2 weeks in group A (n=5), or at 2 and 4 weeks in group B (n=8). T2-weighted images were obtained using an extremity coil. On MR imaging, we measured the signal intensity of the tumor and the uterine wall. We also measured the size and shape of the tumor and we compared this with the histopathologic results. Results: On MR images obtained 2 weeks after inoculation, all the rabbit uteruses (group A and B, n=13) show a thick tubular wall, and the uteruses demonstrated a high signal intensity on T2-weighted images. The thickened uterine walls were measured as 3-10 mm (mean: 6.5 mm). Peritoneal nodules were observed in 3/13 rabbits (23%), the nodules measured 1.5-1.83.0 cm; uterine masses were observed in 3/13 rabbits (23%), and they measured 0.6-1.51.3-1.5 cm. On MR images obtained 4 weeks after the inoculations (group B, n=8), rabbit uteruses that had VX-II carcinoma show thick tubular wall in all cases (n=8, 100%) and round uterine masses (n=6, 75%). The thickened uterine walls measured 5-14 mm (mean 7.6 mm) and uterine masses measured 1.3-3.01.5-6.0 cm. All the rabbit uteruses having VX-II carcinoma showed high signal- to-noise ratios along the thickened uterine walls or masses on T2WI. On the histopathologic exam after sacrificing the rabbit, a few viable tumor cells were found because of necrosis in the inner portion of the uterine tumors, and abundant viable tumor cells were found at the periphery of the uterine tumors. Conclusion: We can develop an animal model with uterine tumor in rabbit uterus using VX-II carcinoma. Experimentally induced VX-II carcinomas in rabbit uterus demonstrated central necrosis, and MR imagings of experimentally induced uterine VX-II carcinomas were well correlated with the histopathology.