• Title/Summary/Keyword: nodules

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CT-Guided Microcoil Localization of Small Peripheral Pulmonary Nodules to Direct Video-Assisted Thoracoscopic Resection without the Aid of Intraoperative Fluoroscopy

  • Zhen-guo Huang;Cun-li Wang;Hong-liang Sun;Chuan-dong Li;Bao-xiang Gao;He Chen;Min-xing Yang
    • Korean Journal of Radiology
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    • v.22 no.7
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    • pp.1124-1131
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    • 2021
  • Objective: To evaluate the feasibility, safety, and effectiveness of CT-guided microcoil localization of solitary pulmonary nodules (SPNs) for guiding video-assisted thoracoscopic surgery (VATS). Materials and Methods: Between June 2016 and October 2019, 454 consecutive patients with 501 SPNs who received CT-guided microcoil localization before VATS in our institution were enrolled. The diameter of the nodules was 0.93 ± 0.49 cm, and the shortest distance from the nodules to the pleura was 1.41 ± 0.95 cm. The distal end of the microcoil was placed less than 1 cm away from the nodule, and the proximal end was placed outside the visceral pleura. VATS was performed under the guidance of implanted microcoils without the aid of intraoperative fluoroscopy. Results: All 501 nodules were marked with microcoils. The time required for microcoil localization was 12.8 ± 5.2 minutes. Microcoil localization-related complications occurred in 179 cases (39.4%). None of the complications required treatment. A total of 463 nodules were successfully resected under the guidance of implanted microcoils. VATS revealed 38 patients with dislocated microcoils, of which 28 underwent wedge resection (21 cases under the guidance of the bleeding points of pleural puncture, 7 cases through palpation), 5 underwent direct lobectomy, and the remaining 5 underwent a conversion to thoracotomy. In 4 cases, a portion of the microcoil remained in the lung parenchyma. Conclusion: CT-guided microcoil localization of SPNs is safe and reliable. Marking the nodule and pleura simultaneously with microcoils can effectively guide the resection of SPNs using VATS without the aid of intraoperative fluoroscopy.

Ultrasonographic Findings of Papillary Carcinoma of the Thyroid According to the Size : Especially Less Than 0.5 cm (갑상선 유두암의 크기에 따른 초음파 특징 분류)

  • Park, So-Yung;Kim, Yun-Min;Lee, Hyun-Bok;Cho, Nam-Soo;Yoon, Joon
    • Journal of radiological science and technology
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    • v.36 no.2
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    • pp.149-155
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    • 2013
  • The Korean Thyroid Association recommends fine-needle aspiration biopsy (FNAB) for nodules more than 0.5 cm in diameter. But nodules, smaller than 0.5 cm have been found in papillary carcinomas of the thyroid (PTC) at the health promotion center at SMC. We wanted to evaluate the ultrasonographic findings according to size of nodule in proven PTCs by FNAB, especially less than 0.5 cm. All nodules were classified into three groups by their longest diameter : less than 0.5 cm, more than 0.5 cm but less than 1 cm, and more than 1 cm. Sonographic findings suggesting malignancy were analyzed according to their size groups. Of 288 malignant nodules, 21.5 % (62/288) were less than 0.5 cm, 54.9 % (158/288) were more than 0.5 cm but less than 1 cm, 23.6 % (68/288) exceeded 1 cm. A taller-than-wide shape was observed in 90.3 % (56/62) of nodules less than 0.5 cm, and 48.5 % (33/68) of nodules exceeding 1 cm (p<0.001). There were no well-defined smooth nodules among nodules less than 0.5 cm, and spiculated or irregular margin nodules increased as the size increased (p=0.024). Nodules of size less than 0.5 cm did not showed hyper or isoechogenicity. Hypoechogenicity was greater than the marked hypoechogenicity in each group (p=0.034). Micro- or macro-calcifications were not founded in 77.4 % (48/62) of the nodule group sized less than 0.5 cm. From the small size of the group, micro- or macrocalcifications were observed 21.0 % (13/62), 48.1 % (76/158), 64.7 % (44/68), so the number of nodules containing micro- or macro-calcification increased as size increased (p<0.001). PTCs less than 0.5 cm in size on ultrasonography had taller than-wide shape, spiculated or irregular and ill-defined margins, and exhibited hypo and markedly hypoechogenicity, but microor macro-calcifications were not common. These ultrasonographic features of nodules less than 0.5 cm can be useful in reporting and guiding FNABs or follow-up exams.

The Clinical Usefulness of Ultrasound-Guided Fine Needle Aspiration Cytology in Thyroid Nodules (갑상선 결절에서 초음파 유도 미세침흡인검사의 임상적 유용성)

  • Kim, Mi-Young;Park, Young-Sun
    • Journal of radiological science and technology
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    • v.31 no.2
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    • pp.141-147
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    • 2008
  • Thyroid nodules are a common disease in clinical practice. Fine needle aspiration (FNA) is an accurate and safe method for the diagnosis of thyroid nodules. One of the limitations of FNA is the variable rate of unsatisfactory specimens, especially in small sized, deep seated or complex cystic nodules. To overcome this problem, ultrasound-guided FNA (US-FNA) has been widely used. In this study, the clinical usefulness of US-FNA cytology in thyroid nodules was investigated. Female to male ratio was 6.58:1. The incidence of nodules were 157 (43.1%) cases on the right, 130 (35.7%) cases on the left and 9 (2.5%) cases in isthmus. Total 139 cases (38.2%) belong to less than 1cm and 225 cases (61.8%) belong to more than 1cm. As for the echo type in the nodules, solid types were 255(70.1%), cystic type 39 (10.7%) cases, and the percentage of mixed type was 19.2%. The results show that US-FNA reduces the possibility of unsatisfactory cytologic specimens and the rate of false-negative diagnosis, and improves the diagnostic accuracy in investigation thyroid nodules.

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Follow-up of thyroid ultrasonography in patients with hemodialysis (혈액투석 환자에서 갑상선 초음파의 추적)

  • Kim, Hyun-Jung;Kim, Bo Ra;Seo, Yeong-Mi;Cho, Yoon Young;Baek, Jong-Ha;Kim, Kyong Young;Kim, Soo-Kyung;Woo, Seung-Hoon;Jung, Jung Hwa;Jung, Jaehoon;Hahm, Jong Ryeal
    • Journal of Yeungnam Medical Science
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    • v.34 no.1
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    • pp.69-74
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    • 2017
  • Background: Chronic kidney disease is considered a risk factor for thyroid nodules as well as thyroid dysfunction such as hypothyroidism. Among patients on hemodialysis, we assessed the size of thyroid nodule and goiter at baseline and 1 year later with ultrasonography. Methods: We prospectively selected 47 patients with hemodialysis at January 2012 and reviewed their medical records. We checked goiter and thyroid nodules at January 2012 and December 2012. Results: In the hemodialysis patients (n=47), 24 patients (51.1%) had thyroid nodules and 33 patients (70.2%) had goiter at baseline. Parathyroid hormone (PTH) was higher in patients with thyroid nodules ($204.4{\pm}102.9$ vs. $129.9{\pm}93.6pg/mL$, p=0.01). Thyroid ultrasonography was conducted in 29 patients after 1 year. The thickness of the thyroid isthmus increased ($2.8{\pm}1.6$ vs. $3.2{\pm}1.9mm$, p=0.003), but the number of nodules did not change ($1.2{\pm}1.9$ vs. $1.4{\pm}2.0$, p=0.109). PTH was associated with the enlargement of thyroid nodules significantly through logistic regression analysis. Conclusion: Thyroid goiter and nodules in hemodialysis patients were more prevalent than in the general population. PTH influenced the production of thyroid nodules in hemodialysis patients. Regular examination with thyroid ultrasonography and thyroid function test should be considered in hemodialysis patients.

Analysis of Fine Needle Aspiration Results of Thyroid Nodules in Ultrasonography (초음파검사에서 갑상샘 결절의 세침흡인세포검사 결과에 따른 분석)

  • Kwak, Jong-Gil;Han, Jae-Bok;Song, Jong-Nam;Moon, Il-Bong;Choi, Nam-Gil
    • The Journal of the Korea Contents Association
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    • v.16 no.5
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    • pp.290-297
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    • 2016
  • This study analyzed the features of the nodules requiring a fine needle aspiration, which were found in thyroid ultrasonography of the employee health check-up examinees. Based on the fine needle aspiration results, over 1 cm nodules or those implying malignancy on the ultrasonography were categorized into the 1st group. Whereas, regardless of the size the fine needle aspiration results implying malignancy on the ultrasonography were categorized into the 2nd group. In the 1st group, 15.8% were malignant, and in the 2nd group, 28% were malignant. The findings implying malignancy were statistically significant. However, even though the nodules were larger than 1 cm, when the nodules were not accompanied by a high risk factor and showed a spongiform structure in the ultrasonographic results, most of them were benign, and a fine needle aspiration was not required. The ultrasonographic findings are important rationales in making a decision on whether or not a fine needle aspiration is required for thyroid nodules. Currently, the fine needle aspiration for thyroid nodules is commonly performed when the size of the nodule is larger than 1 cm, even though it has a spongiform structure, to relieve the patient's anxiety. However, if ultrasonographic findings of thyroid are correctly understood in differentiating malignant from benign nodules, unnecessary fine needle aspiration can be avoided.

Diagnostic Performance of the Modified Korean Thyroid Imaging Reporting and Data System for Thyroid Malignancy: A Multicenter Validation Study

  • Sae Rom Chung;Hye Shin Ahn;Young Jun Choi;Ji Ye Lee;Roh-Eul Yoo;Yoo Jin Lee;Jee Young Kim;Jin Yong Sung;Ji-hoon Kim;Jung Hwan Baek
    • Korean Journal of Radiology
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    • v.22 no.9
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    • pp.1579-1586
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    • 2021
  • Objective: To evaluate the diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System (K-TIRADS), and compare it with the 2016 version of K-TIRADS using the Thyroid Imaging Network of Korea. Materials and Methods: Between June and September 2015, 5708 thyroid nodules (≥ 1.0 cm) from 5081 consecutive patients who had undergone thyroid ultrasonography at 26 institutions were retrospectively evaluated. We used a biopsy size threshold of 2 cm for K-TIRADS 3 and 1 cm for K-TIRADS 4 (modified K-TIRADS 1) or 1.5 cm for K-TIRADS 4 (modified K-TIRADS 3). The modified K-TIRADS 2 subcategorized the K-TIRADS 4 into 4A and 4B, and the cutoff sizes for the biopsies were defined as 1 cm for K-TIRADS 4B and 1.5 cm for K-TIRADS 4A. The diagnostic performance and the rate of unnecessary biopsies of the modified K-TIRADS for detecting malignancy were compared with those of the 2016 K-TIRAD, which were stratified by nodule size (with a threshold of 2 cm). Results: A total of 1111 malignant nodules and 4597 benign nodules were included. The sensitivity, specificity, and unnecessary biopsy rate of the benign nodules were 94.9%, 24.4%, and 60.9% for the 2016 K-TIRADS; 91.0%, 39.7%, and 48.6% for the modified K-TIRADS 1; 84.9%, 45.9%, and 43.5% for the modified K-TIRADS 2; and 76.1%, 50.2%, and 40.1% for the modified K-TIRADS 3. For small nodules (1-2 cm), the diagnostic sensitivity of the modified K-TIRADS decreased by 5.2-25.6% and the rate of unnecessary biopsies reduced by 19.2-32.8% compared with those of the 2016 K-TIRADS (p < 0.001). For large nodules (> 2 cm), the modified K-TIRADSs maintained a very high sensitivity for detecting malignancy (98%). Conclusion: The modified K-TIRADSs significantly reduced the rate of unnecessary biopsies for small (1-2 cm) nodules while maintaining a very high sensitivity for malignancy for large (> 2 cm) nodules.

Twelve-Month Volume Reduction Ratio Predicts Regrowth and Time to Regrowth in Thyroid Nodules Submitted to Laser Ablation: A 5-Year Follow-Up Retrospective Study

  • Roberto Negro;Gabriele Greco;Maurilio Deandrea;Matteo Rucco;Pierpaolo Trimboli
    • Korean Journal of Radiology
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    • v.21 no.6
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    • pp.764-772
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    • 2020
  • Objective: Laser ablation is a therapeutic modality used to reduce the volume of large benign thyroid nodules. Unsatisfactory reduction and regrowth are observed in some treated nodules. The aim of the study was to evaluate the long-term outcomes of laser treatment for solid nodules during a 5-year follow-up period, the regrowth rate, and the predictive risk factors of nodule regrowth. Materials and Methods: We retrospectively evaluated patients with benign, solid, cold thyroid nodules who underwent laser ablation and were followed-up for 5 years. According to the selection criteria, 104 patients were included (median baseline nodule volume, 12.5 mL [25.0-75.0%, 8-18 mL]; median energy delivered, 481.5 J/mL [25.0-75.0%, 370-620 J/mL]). Nodule volume, thyroid function test results, and ultrasound were evaluated at baseline and then annually after the procedure. Results: Of 104 patients, 31 patients (29.8%) had a 12-month volume reduction ratio (VRR) < 50.0% and 39 (37.5%) experienced nodule regrowth. Of these 39 patients, 17 (43.6%) underwent surgery and 14 (35.9%) underwent a second laser treatment. The rate of nodule regrowth was inversely related to the 12-month VRR, i.e., the lower the 12-month VRR, the higher the risk of regrowth (p < 0.001). The mean time for nodule regrowth was 33.5 ± 16.6 months. The 12-month VRR was directly related to time to regrowth, i.e., the lower the 12-month VRR, the shorter the time to regrowth (p < 0.001; R2 = 0.3516). Non-spongiform composition increased the risk of regrowth with an odds ratio of 4.3 (95% confidence interval [CI] 1.8-10.2; p < 0.001); 12-month VRR < 50.0% increased the risk of regrowth with an odds ratio of 11.7 (95% CI 4.2-32.2; p < 0.001). Conclusion: The VRR of thyroid nodules subjected to similar amounts of laser energy varies widely and depends on the nodule composition; non-spongiform nodules are reduced to a lesser extent and regrow more frequently than spongiform nodules. A 12-month VRR < 50.0% is a predictive risk factor for regrowth and correlates with the time to regrowth.

Incidence of Malignancy and Its Predictive Factors in Intrapulmonary Nodules Associated with cT1-2N0M0 Non Small Cell Lung Cancer (임상적 병기 T1-2N0M0인 비소세포폐암에 동반된 폐결절의 악성여부 및 그 예측인자)

  • Yoon, Ho Il;Yim, Jae-Jun;Lee, Choon-Taek;Kim, Young Whan;Han, Sung Koo;Shim, Young-Soo;Yoo, Chul-Gyu
    • Tuberculosis and Respiratory Diseases
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    • v.56 no.2
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    • pp.151-158
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    • 2004
  • Background : When a non small cell lung caner patient at the $_cT_{1-2}N_0M_0$ stage is diagnosed with intrapulmonary nodule(s), the treatment plan and prognosis of the patient largely depend on whether the nodule is benign or malignant. In most cases, however, it is hard to conduct a biopsy on such a nodule, due to its small size. Furthermore, the predictive factors that may imply benignancy or malignancy of the nodules remain unknown. As such, the purpose of our study was to validate the incidence of malignant nodules in such cases, and find if there are any predictive factors. Methods : Chest computed tomography(CT) scans and the medical records of 444 patients, who had undergone non small cell lung cancer surgery, between July, 2001 and September, 2003, at Seoul National University Hospital, were retrospectively reviewed. Among $_cT_{1-2}N_0M_0$ non small cell lung cancer patients, with intrapulmonary nodule(s), only those cases where a CT scan or a biopsy of the nodules had been conducted, and had been followed up at intervals of more than 6 months were included. However, patients who had received chemotherapy or radiation therapy, pre- or post-operatively, or with calcified nodules, were excluded. Results : Our study group consisted of 39 patients, divided into two groups. The first group, 33 patients, had benign nodules, and the second group, 6 patients, had malignant nodules. The two groups were compared with regard to gender, age, cell type, pathologic stage, shape, size, location and number of nodules and presence of calcification around the nodules. There was no statistically significant difference between the two groups. Conclusion : The intrapulmonary nodules in non small cell lung cancer patients at the $_cT_{1-2}N_0M_0$ stage were mostly benign. Therefore, surgical treatment for such patients can be considered. Moreover, without predictive factors, pathological confirmation of the diagnosed nodules should be sought in all patients.

A Clinical Study on Nodular Thyroid Disease (결절성 갑상선 질환에 대한 임상적 고찰)

  • Lee Gyu-Joon;Park Soon-Tae;Ha Woo-Song;Kwon Soo-In;Choi Sang-Kyeon;Hong Soon-Chan;Lee Young-Joon;Lee Young-Jae
    • Korean Journal of Head & Neck Oncology
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    • v.14 no.2
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    • pp.244-252
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    • 1998
  • The thyroid nodules are the most common endocrine disease requiring surgical management. We perfomed a clinical study of 298 cases with thyroid nodules, who were admitted to and operated at the Department of Surgery, College of Medicine, Gyeong sang National University from January 1987 to April 1997 and the results were summarized as follows: 1) Patients were composed of 214 cases(71.8%) of benign nodule and 84 cases(28.2%) of malignant nodule. Benign and malignant nodules were prevalent in fifth decade. 2) The sex distribution showed a preponderance of females with ratio of 5.88:1 in benign nodule and 11:1 in malignant nodule. 3) The nodules were located in the right lobe(134 cases, 44.9%), the left lobe(121 cases, 40.6%), both lobes(34 cases, 11.4%), and isthmus(8 cases, 2.7%). The possibility of malignancy was higher in the solid rather than cystic lesions. 4) Radioactive iodine scintiscans were perfomed in 273 cases and revealed cold nodules in 237 cases(86.8%), 58 of these cases(24.4%) were malignant. 5) According to the histopathologic classification, benign nodules included follicular adenomas 136 cases(63.5%), adenomatous goiters 67 cases(31.3%), Hurthle cell adenomas 4 cases(1.9%), cysts 3 cases(1.4%) and thyroiditis 4 cases(1.4%). In malignant nodules, papillary carcinomas 72 cases(85.7%), follicular carcinoma 8 cases(9.5%), undifferentiated carcinoma 2 cases(2.4%), medullary carcinoma 1 case(1.2%) and malignant lymphoma 1 case(1.2%). 6) The most commonly performed operative procedure was a lobectomy with isthmusectomy(85.5%) for bengn nodules and a total thyroidectomy(51.2%) for malignant nodules. 7) The rate of complications was higher in the cases with malignant nodules(20.2%) than in the benign cases(0.5%). The recurrence rate was 8.3%(7 cases).

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Regional Variability of Manganese Nodule Facies in the KR1 Area in KODOS Area, Northeastern Equatorial Pacific (북동태평양 한국 KODOS 연구지역 중 KR1 지역 망간단괴의 지역적인 특성 변화)

  • Lee, Hyun-Bok;Kim, Wonnyon;Ko, Young-Tak;Kim, Jonguk;Chi, Sang-Bum;Park, Cheong-Kee
    • Economic and Environmental Geology
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    • v.45 no.5
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    • pp.477-486
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    • 2012
  • High-resolution bathymetry and physico-chemical properties of manganese nodules were explored to identify the relationship between morphological features and nodule occurrences in the KR1, one of the Korean contract nodule fields located in the NE Pacific. The high-resolution seabed mapping showed that the southwestern sector of the KR1 (KR1-1) was relatively deeper than the northeastern sector (KR1-2) which is occupied by small-scale seamounts. In terms of nodule occurrence, manganese nodules in the KR1-1 were comparatively larger (2-4 cm) with rough surface (t-type) and discoidal shapes (D-type), while those in the KR1-2 were generally small (<2 cm) with smooth surface (s-type) and irregular shapes (I-type). In addition, the nodules in the KR1-1 had higher contents of Cu, Mn and Ni. Such connections of water depths to nodule appearances and metal contents are commonly observed in the Pacific nodule fields. On the other hand, the nodules in the KR1-2 tend to be controled by morphological features. The seamounts in the KR1-2 might continuously provide rock fragments as new nuclei of manganese nodules. As a result, the nodules could not grow over than 2 cm and showed the shapes of a newbie (i.e., smooth surface and irregular shapes). As a result, our observations indicate that occurrence features of manganese nodules could be subjected to water depths and seabed morphology simultaneously.