OBJECTIVE. The purpose of this study was to compare the diagnostic accuracy of ultrasound imaging with that of CT in the preoperative evaluation of primary tumors and cervical lymph nodes in patients with papillary thyroid carcinoma and to determine whether CT has greater diagnostic value than ultrasound alone in the care of these patients.MATERIALS AND METHODS. The study population consisted of 299 consecutively registered patients with pathologically proven papillary thyroid carcinoma. The diagnostic accuracies of ultrasound, CT, and the combination of ultrasound and CT in the evaluation of primary tumors and lymph node metastasis were compared. We performed subgroup analysis to compare the findings on papillary thyroid microcarcinoma (10 mm in maximum diameter or smaller) with the findings on papillary thyroid carcinoma larger than 1 cm in maximum diameter.RESULTS. Ultrasound was more accurate than CT in prediction of the presence of extrathyroidal tumor extension and of malignant disease in both thyro...

To retrospectively evaluate the diagnostic performance of power Doppler ultrasonography (US) in depicting vascularity and to determine whether the combination of vascularity and suspicious gray-scale US features is more useful in predicting thyroid malignancy than are gray-scale features alone. This was an institutional review board-approved retrospective study, with waiver of informed consent. A total of 1083 thyroid nodules in 1024 patients (median age, 51 years; range, 16-83 years), consisting of 886 women (median age, 50 years; range, 16-83 years) and 138 men (median age, 53 years; range, 19-74 years), were included. Nodules with marked hypoechogenicity, noncircumscribed margins, microcalcifications, and taller-than-wide shape were classified as suspicious according to gray-scale US criteria. Vascularity was classified as none, peripheral, and intranodular. The diagnostic performance of gray-scale and power Doppler US features was compared and classified as follows: criterion 1, any single suspicious gray-scale US feature; criterion 2, addition of any vascularity as one of the suspicious features to criterion 1; criterion 3, addition of peripheral vascularity to criterion 1; criterion 4, addition of intranodular vascularity to criterion 1; criterion 5, addition of no vascularity to criterion 1; criterion 6, American Association of Clinical Endocrinologists and Associazione Medici Endocrinology guidelines--all hypoechoic nodules with at least one of the following US features: irregular margins, intranodular vascular spots, taller-than-wide shape, or microcalcifications. Of 1083 nodules, 814 were benign and 269 were malignant. Intranodular vascularity was frequently seen in benign nodules and no vascularity was more frequent in malignant nodules (P < .0001, respectively). The area under the receiver operating characteristic curve (A(z)) of criterion 1 was superior (A(z) = 0.851) to that of criteria 2 (A(z) = 0.634), 3 (A(z) = 0.752), 4 (A(z) = 0.733), 5 (A(z) = 0.718), and 6 (A(z) = 0.806) (P < .0001). Vascularity itself or a combination of vascularity and gray-scale US features was not as useful as the use of suspicious gray-scale US features alone for predicting thyroid malignancy.

Background: Thyroid ultrasound (US) is used as the first diagnostic tool to assess the management of the disease. In spite of its importance, US is a very subjective method and highly dependent on the skill of the performer. There have been few reports evaluating thyroid US performance and even fewer reports of observer variability in US assessment. Therefore, we evaluated inter- and intraobserver variations in US assessment of thyroid nodules and diagnosis among four radiologists and estimated its diagnostic accuracy. Methods: A total of 204 thyroid nodules in 144 patients were reviewed. There were 89 benign and 115 malignant cases. Four radiologists with more than 5 years of experience independently reviewed US images twice at 6-week intervals. Echogenicity, composition, margin, shape, calcification, vascularity, and final assessment were evaluated. Inter- and intraobserver variations were determined with Cohen's kappa statistics, and accuracy was calculated. Results: For interobserver variations, echogenicity showed slight agreement (κ = 0.34); composition, margin, calcification, and final assessment had fair agreement (κ = 0.59, 0.42, 0.58, and 0.54, respectively); shape and vascularity showed substantial agreement (κ = 0.61 and 0.64, respectively). For intraobserver variability, almost all showed substantial agreement (κ > 0.61). Overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the four radiologists were 88.2%, 78.7%, 76.2%, 89.6%, and 82.8%, respectively. Conclusions: Experienced radiologists showed more than a moderate degree of agreement in US assessment of thyroid nodules, and their final assessments were highly accurate.

OBJECTIVE. The objective of our study was to investigate interobserver agreement for the diagnosis of malignant thyroid nodules using conventional B-mode ultrasound and real-time freehand ultrasound elastography.MATERIALS AND METHODS. Between December 2007 and February 2008, 45 patients (age range, 19–73 years; mean age ± SD, 45.0 ± 12.2 years) with 52 thyroid nodules were examined with conventional B-mode ultrasound and real-time freehand ultrasound elastography. All the patients were scheduled to undergo thyroid surgery because a thyroid nodule had been proven malignant on aspiration cytology. Three radiologists independently performed conventional ultrasound and elastography and analyzed the ultrasound images. Using conventional ultrasound, observers recorded the following information about nodular features: composition (solid, cystic, or mixed cystic–solid), echogenicity (hyperechoic, isoechoic, hypoechoic, or markedly hypoechoic), margin (well circumscribed, microlobulated, or irregular), calcificati...

Ultrasonographically (US) guided core needle biopsy is currently recognized as a reliable alternative to surgical biopsy for the histopathologic diagnosis of breast lesions. However, despite advances in biopsy devices and techniques, false-negative diagnoses are unavoidable and may delay the diagnosis and treatment of breast cancer. The most common reasons for false-negative diagnosis are (a) technical or sampling errors, (b) failure to recognize or act on radiologic-histologic discordance, and (c) lack of imaging follow-up after a benign biopsy result. Technical difficulties (eg, poor lesion or needle visualization, deeply located lesions, dense fibrotic tissue) cause inaccurate sampling but can be reduced by using modified standard techniques. Radiologic-histologic correlation is also of critical importance in US-guided core needle biopsy. Radiologic-histologic discordance occurs when the histologic results do not provide a sufficient explanation for the imaging features and indicates that the lesion may not have been sampled adequately, so that repeat biopsy is warranted. Appropriate follow-up imaging is invaluable; even patients with concordant benign findings after US-guided core needle biopsy are directed to undergo follow-up imaging because there may be delays in the recognition of false-negative findings. Optimization of technique, radiologic-histologic correlation, and postbiopsy follow-up protocols are recommended to reduce the occurrence of false-negative diagnosis at US-guided core needle biopsy performed by radiologists.