A 74-year-old male patient with a newly diagnosed prostate cancer had whole-body bone scintigraphy for staging. The images did not demonstrate osseous metastasis. However, there was a large ring-shaped, relatively photopenic region with peripherally increased MDP activity in the left back, which was caused by a large lipoma.

A large soft-tissue lipoma shown on bone scintigraphy.

Active surveillance (AS) has been recommended as the first-line treatment strategy for low-risk (LR) papillary thyroid microcarcinoma (PTMC) according to the guidelines. However, preoperative imaging and fine-needle aspiration could not rule out a small group of patients with aggressive PTMC with large-volume lymph node micro-metastasis, extrathryoidal invasion to surrounding soft tissue, or high-grade malignancy from the AS candidates.Among 2,809 PTMC patients, 2,473 patients were enrolled in this study according to the inclusion criteria. Backward stepwise multivariate logistic regression analysis was used to filter clinical characteristics and ultrasound features to identify independent predictors of high-risk (HR) patients. A nomogram was developed and validated according to selected risk factors for the identification of an HR subgroup among “LR” PTMC patients before operation.For identifying independent risk factors, multivariable logistic regression analysis was performed using the backward stepwise method and revealed that male sex [3.91 (2.58–5.92)], older age [0.94 (0.92–0.96)], largest tumor diameter [26.7 (10.57–69.22)], bilaterality [1.44 (1.01–2.3)], and multifocality [1.14 (1.01–2.26)] were independent predictors of the HR group. Based on these independent risk factors, a nomogram model was developed for predicting the probability of HR. The C index was 0.806 (95% CI, 0.765–0.847), which indicated satisfactory accuracy of the nomogram in predicting the probability of HR.Taken together, we developed and validated a nomogram model to predict HR of PTMC, which could be useful for patient counseling and facilitating treatment-related decision-making.

A novel nomogram for identifying high-risk patients among active surveillance candidates with papillary thyroid microcarcinoma

Background. Cytopathological studies of the thyroid gland are important in patient diagnosis. Since the beginning of the Russian invasion, most cytopathological screening procedures (including cancer screening) in Ukraine have been reduced or delayed, threatening medical personnel's ability to provide early cancer detection. The aim was to analyze the results of cytological studies of fine-needle aspiration puncture biopsy (FNA) of thyroid neoplasms according to the Bethesda international classification for 2022-2023. Methods. The study was carried out with the involvement of the database of patients who used the service of cytological studies of FNA of the thyroid gland in the "CSD" Medical Laboratory in the period of 2022-2023. The following were analyzed: 1) cytological findings according to the Bethesda international classification; 2) gender of the patient. Light microscopy (Leica Microsystems, DM2000) was used for cytological research. Results. In the period from 2022 to 2023, an analysis of 4,247 cytological studies of patients with thyroid nodules was carried out. Of them, 3,654 (86 %) concerned women, and 593 (14 %) men. Compared with previous years, where the percentage of cytological studies in women was 87 %, it was established that women are more prone to thyroid diseases. In 2022-2023, the rate of non-diagnostic materials was 18.1 %, which emphasizes the need to improve preanalytical processes. The second class, according to the international classification of Bethesda, accounted for 54.7 % of cases. Despite the decrease in the percentage of diagnosed cases of the thyroid gland during the war, the second class remains the most common class among other classes of cytological diagnosis of the thyroid gland. Such a result indicates the importance of further improvement of diagnostic methods and increasing the effectiveness of treatment of patients with thyroid gland pathology. According to the Bethesda 2023 classification, the AUS category has an average risk of malignancy of 22 %. This class was 13.2 % in the period 2022-2023. There is a trend of growth in the production of this class, compared to previous years (8.2 %). Class 4 was detected in 4.8 % of patients and decreased by almost two times compared to previous years. Grades 5 and 6, which have the highest level of malignancy, were within 4-5 %. Conclusions. During the Russian invasion of Ukraine, the process of cytopathological diagnosis was violated, which led to a decrease in the number of cytological samples, particularly studies of FNA of the thyroid gland, sent to the CSD Medical Laboratory. 

Cytological diagnosis of the thyroid gland in ukraine during martial law conditions

This study aims to explore the feasibility of fine-needle aspiration biopsy (FNAB) under dual modal photoacoustic tomography(PAT)/ultrasound (US) imaging. A total of 25 patients who have thyroid nodules with thyroid imaging reporting and data system (TIRADS) 3 and 4 (malignant risk <85%) were recruited. The specimens obtained from the PAT/US-guided FNAB were collected for cytology analysis. Cytological diagnoses for the 25 patients were classified in perspective of the Bethesda system for reporting thyroid cytopathology diagnostic category (DC) I: 4%(1/25); DC II: 12% (3/25); DC III: 20% (5/25); DC IV: 8% (2/25); DC V: 32% (8/25); and DC VI: 24% (6/25). The DC I nodule exhibited inadequate cytology and had structural characteristic of predominant calcifications in PAT/US mapping. The DC V-VI nodules showed lower photoacoustic (PA) signals compared to the DC I-IV nodules. Regions with a high PA signal demonstrated a significant number of erythrocytes in FNAB cytology. Moreover, nodules with microcalcifications did not show a significant difference compared to their surroundings in the PA signal, while nodules with macrocalcifications gave higher PA signals compared to their surroundings. The conclusions are as follows: combining US with PAT can evaluate the structure and function of thyroid nodules in vivo. This study demonstrates that dual modal PAT/US imaging has the potential to be an effective clinical tool to guide FNAB of thyroid nodules.

Photoacoustic Tomography Combined with Ultrasound Mapping for Guiding Fine-Needle Aspiration of Thyroid Nodules: A Pilot Study

This study aimed to construct a nomogram based on novel ultrasound vascularity features to differentiate follicular thyroid carcinoma (FTC) from follicular benign neoplasms (FBN).

Establish a Nomogram Based on Ultrasound Novel Vascularity Characteristics to Differentiate Follicular Thyroid Carcinoma From Follicular Benign Neoplasms.

/pdf/factors-influencing-the-sample-adequacy-of-ultrasound-guided-3hzl0v4l.pdf

Factors Influencing the Sample Adequacy of Ultrasound-Guided Fine-Needle Aspiration from Solid Thyroid Nodules for Liquid-Based Cytology: A Demographic, Sonographic, and Technical Perspective

A 55-year-old woman complaining of discomfort and tenderness on the right inferior thorax for 2 weeks underwent thoracic CT scan on which a well-defined expansile lesion with fat and calcification density was demonstrated in the right ninth rib. The lesion showed marked radiotracer uptake on bone scintigraphy. Histology confirmed intraosseous lipoma with inflammatory infiltration.

Intraosseous lipoma of rib with intense radiotracer uptake on bone scintigraphy.

Bilateral papillary thyroid cancer: pitfalls of ACR TI-RADS and evaluation of modified parameters.

Objective This study aimed to examine the relationship between sonographic features and histological manifestations in the tall-cell variant of papillary thyroid microcarcinoma (TCV-PTMC), thus proposing the concept of “sonographic histology” and examine its value in the clinical management of the aggressive tall-cell variant. Methods This study retrospectively included 104 participants who were admitted to Peking University Third Hospital from 2015 to 2022 and were histopathologically confirmed as having TCV-PTMC or classical PTMC. We mainly compared the general characteristics, sonographic characteristics, and pathological specimens between the two cohorts. Results Hypoechoic nodules with a localized central isoechoic lesion and hypoechoic halo around nodules were most often observed in TCV-PTMC, which correlated with circumferentially distributed tumor epithelium and densely distributed tumor stroma histopathologically. Additionally, TCV-PTMC showed nodules with a more regular margin and less microcalcification than classical PTMC, which led to an underestimation of the risk of TCV-PTMC. Conclusion The good association between the ultrasound echo pattern and tissue cell arrangement was defined as sonographic histology in this study and can be applied in the preoperative identification of TCV-PTMC. This concept may provide novel insight for the identification of special subtypes of thyroid tumors and may modify pitfalls of the Thyroid Imaging Reporting and Data System in aggressive variants of microcarcinoma.

/pdf/reconceptualize-tall-cell-variant-papillary-thyroid-2j572dhf.pdf

Reconceptualize tall-cell variant papillary thyroid microcarcinoma: From a “sonographic histology” perspective

OBJECTIVES
This study aims to identify distinct ultrasound (US) characteristics for distinguishing follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA), and construct a user-friendly preoperative risk stratification model for thyroid follicular neoplasms.


METHODS
In this retrospective study, patients diagnosed with pathologically confirmed FTA or FTC and undergoing US examinations between July 2017 and June 2021 were designated as the training cohort, and those from July 2021 to June 2023 were enrolled as the external validation set. We systematically assessed and compared the sonographic and clinical characteristics of FTC and FTA. Univariable and multivariable logistic regression analyses were used to assess the association of US features with FTC in the training set. A prediction nomogram model, incorporating US features independently associated with FTC, was developed and validated externally to assess its performance.


RESULTS
A total of 645 patients (FTA/FTC = 530/115) were included in the training set, while 197 patients (FTA/FTC = 165/32) constituted the validation set. In the training set, solid composition, hypo-echogenicity, irregular margin, calcification, protrusion sign, trabecular formation, absent or thick halo, and mainly central hypervascularity were identified as independent factors associated with FTC. The prediction nomogram model constructed using these variables showed good performance in differentiating FTC from FTA with an area under the curve of 0.948 in the training set and 0.915 in the validation set.


CONCLUSIONS
The preoperative nomogram model constructed based on US features serves as an effective tool for the risk stratification of thyroid follicular neoplasms.

Role of Ultrasound and Ultrasound-Based Prediction Model in Differentiating Follicular Thyroid Carcinoma From Follicular Thyroid Adenoma.

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