BackgroundNTRK fusions are relatively rare in papillary thyroid carcinoma (PTC), and their clinicopathological characteristics, particularly in unselected populations and in comparison with BRAFV600E PTC, have not been systematically elucidated.MethodsIn this retrospective study, we analyzed PTC patients who underwent surgery between October 2022 and May 2025. All patients underwent preoperative fine-needle aspiration biopsy and multigene molecular testing. Ultimately, 38 patients with NTRK-fusion PTC and 1196 patients with BRAFV600E PTC were included. A comprehensive analysis of the clinical, ultrasonographic, and pathological features of NTRK-fusion PTC was conducted, with comparison to BRAFV600E PTC.ResultsAmong the 38 identified NTRK-fusion PTC patients, NTRK3 (81.6%) was the predominant fusion type. Histologically, classical PTC and mixed growth patterns with follicular architecture (34.2% each) were most frequent, followed by the follicular variant (18.4%). NTRK-fusion PTC demonstrated a high rate of lymph node metastasis (LNM) (78.9%). Among preoperative parameters, a tumor diameter >12 mm on ultrasound was associated with increased risk of lateral LNM (OR = 5.00, 95% CI: 1.10-22.82; P = 0.038). Besides, NTRK1-fusion PTCs demonstrated a significantly higher frequency of bilateral lobe involvement compared to NTRK3-fusion PTCs (57.1% vs. 12.9%, P = 0.025). Compared to patients with BRAFV600E PTC, those with isolated NTRK-fusion (n=34) were significantly younger (median age: 35.0 vs 43.0 years), had larger tumors (median diameter: 10.5 vs 7.0 mm), higher rates of LNM (76.5% vs 50.7%), and greater prevalence of co-existing Hashimoto’s thyroiditis (61.8% vs 28.3%) and follicular nodular disease (26.5% vs 10.6%) (all P < 0.01). Cytopathologically, NTRK-fusion PTC demonstrates a higher proportion of atypia of undetermined significance/follicular neoplasm compared to BRAFV600E PTC (41.2% vs. 16.1%). Sonographically, isoechogenicity (20.6% vs. 7.9%), microcalcifications (79.4% vs. 58.0%), and a wider-than-tall shape (91.2% vs. 52.5%) were more frequently observed in the NTRK-fusion group (all P < 0.05).ConclusionsNTRK-fusion defines a distinct PTC molecular subtype characterized by a high burden of LNM and a spectrum of features linked to follicular growth patterns. These findings facilitate the preoperative identification of this tumor subtype and provide a foundation for individualized risk stratification and tailored management strategies.

Preoperatively distinguishing follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA) remains a significant clinical challenge. Current ultrasound risk stratification systems show limited efficacy for follicular neoplasms, and existing artificial intelligence (AI) approaches lack sufficient validation. We developed and validated a deep learning model using ultrasound images to differentiate FTC from FTA and classify FTC into invasion subtypes. This multicenter retrospective study incorporated data from 31 hospitals, using 1531 patients for model development and 900 across three external test sets for validation. The model demonstrated high diagnostic performance, with AUCs of 0.816-0.847 for FTC vs FTA discrimination across external test sets and robust performance across subtypes (AUC range 0.754-0.910), and generalized well to varied clinical settings. Triple-classification macro-AUCs were 0.818-0.861. It consistently outperformed radiologists and improved diagnostic accuracy as an assistive tool. Our AI model provides a reliable, non-invasive tool for preoperative diagnosis and risk stratification of follicular thyroid neoplasms.

This study aimed to develop and validate convolutional neural network (CNN) models for distinguishing follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA). Additionally, this current study compared the performance of CNN models with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) ultrasound-based malignancy risk stratification systems. A total of 327 eligible patients with FTC and FTA who underwent preoperative thyroid ultrasound examination were retrospectively enrolled between August 2017, and August 2024. Patients were randomly assigned to a training cohort (n = 263) and a test cohort (n = 64) in an 8:2 ratio using stratified sampling. Five CNN models, including VGG16, ResNet101, MobileNetV2, ResNet152, and ResNet50, pre-trained with ImageNet, were developed and tested to distinguish FTC from FTA. The CNN models exhibited good performance, yielding areas under the receiver operating characteristic curve (AUC) ranging from 0.64 to 0.77. The ResNet152 model demonstrated the highest AUC (0.77; 95% CI, 0.67-0.87) for distinguishing between FTC and FTA. Decision curve and calibration curve analyses demonstrated the models' favorable clinical value and calibration. Furthermore, when comparing the performance of the developed models with that of the C-TIRADS and ACR-TIRADS systems, the models developed in this study demonstrated superior performance. This can potentially guide appropriate management of FTC in patients with follicular neoplasms.

Introduction:Papillary thyroid carcinoma is the most common pathological subtype of thyroid cancer in both children/adolescents (TCCA) and adults (TCA). TCCA manifests more aggressive and invasive behaviors than TCA, which may be attributed to specific genomic alterations. Methods:To better understand the specific molecular, pathological and clinical manifestations of TCCA, we retrospectively analyzed a cohort of 60 patients with sporadic papillary thyroid carcinoma, including 20 TCCAs and 40 TCAs. Fine-needle aspiration tissue samples from these cases were analyzed using next-generation sequencing. Demographics, ultrasound features, postoperative pathology and radiation exposure history were compared between TCCAs and TCAs. To validate our findings, we integrated data from 28 prior studies, resulting in a larger cohort of 1,483 sporadic TCCAs. Results:Multiple gene mutations were more prevalent in TCCAs than TCAs (p=0.013), such as BRAFV600E coexisting with KMT2 family genes or PTEN. Although BRAFV600E was the most common single nucleotide variant in TCCAs (25%, 5/20), its prevalence was significantly lower than in TCAs (95%, 38/40, p<0.0001). RET oncogenic fusions were detected exclusively in TCCAs, with an incidence of 20% (4/20). Compared with TCAs, TCCAs were associated with larger tumor diameters (p<0.001), more advanced tumor staging (T3-T4, p<0.001; N2, p=0.002), higher incidence of extrathyroidal extension (TCCA: 25%, TCA: 5%, p=0.036) and more frequent lymph node metastasis (TCCA: 70%, TCA: 27.5%, p=0.0024). Importantly, TCCAs harboring BRAFV600E alongside other mutations (e.g., ATM, PTEN or KMT2 family genes) exhibited more severe clinical manifestations, including larger tumors and higher rates of lymph node metastasis, compared with those harboring BRAFV600E alone. Discussion:TCCAs exhibit more aggressive and invasive clinical manifestations than TCAs, particularly in cases with RET fusions or BRAFV600E coexisting with other point mutations. Targeted comprehensive molecular profiling may aid in the diagnosis and treatment of TCCA.

Background:The preoperative differential diagnosis of follicular thyroid neoplasms remains a major challenge in clinical practice. This study aimed to analyze the differences in ultrasonic characteristics between follicular thyroid carcinoma (FTC) and follicular thyroid adenoma (FTA), and establish a ultrasound-based risk stratification system (RSS) for follicular thyroid neoplasms. Methods:This was a retrospective multi-center study. Data from patients who underwent surgical treatment and were definitively diagnosed with FTC or FTA based on postoperative pathology at each center between 2017 and 2024 were included. The subjects were randomly divided into a training set and a validation set at a ratio of 8:2. In the training cohort, an RSS tailored for follicular neoplasms (termed predictive score for follicular tumors, F-Score) was developed based on the multivariate logistic regression analysis. The diagnostic performance of the F-Score was subsequently assessed in the validation cohort, and compared with the commonly used Thyroid Imaging Reporting and Data Systems (TIRADSs). Results:A total of 448 patients were included in this study. Multivariate logistic regression analysis showed that hypo/markedly hypoechoic, calcifications (any type), ill-defined/irregular margins, uneven/absent halo, and heterogeneous echotexture were independent risk factors for FTC (all P values <0.05). In the training set and the validation set, the area under the curve (AUC) of the F-Score for differentiating follicular neoplasms was 0.878 [95% confidence interval (CI): 0.842-0.914] and 0.871 (95% CI: 0.789-0.930), respectively. In both cohorts, the AUCs of F-Score were significantly higher than that of the TIRADS published by the American College of Radiology and the Chinese TIRADS (both P<0.01). Additionally, it performed significantly better than the follicular TIRADS (P=0.03) in the validation set. Conclusions:The ultrasound-based RSS can effectively differentiate between FTC and FTA, providing an excellent approach for the preoperative diagnosis of follicular thyroid neoplasms.

ObjectivesThyroid cancer rarely occurs in children and adolescents. Molecular markers such as BRAF, RAS, and RET/PTC have been widely used in adult PTC. It is currently unclear whether these molecular markers have equivalent potential for application in pediatric patients. This study aims to explore the potential utility of a multi-gene conjoint analysis based on next-generation targeted sequencing for pediatric papillary thyroid carcinoma (PTC).Materials and methodsThe patients diagnosed with PTC (aged 18 years or younger) in the pediatrics department of Lishui District Hospital of Traditional Chinese Medicine were retrospectively screened. A targeted enrichment and sequencing analysis of 116 genes associated with thyroid cancer was performed on paraffin-embedded tumor tissues and paired paracancerous tissue of fifteen children (average age 14.60) and nine adults (average age 49.33) PTC patients. Demographic information, clinical indicators, ultrasonic imaging information and pathological data were collected. The Kendall correlation test was used to establish a correlation between molecular variations and clinical characteristics in pediatric patients.ResultsA sample of 15 pediatric PTCs revealed a detection rate of 73.33% (11/15) for driver gene mutations BRAF V600E and RET fusion. Compared to adult PTCs, the genetic mutation landscape of pediatric PTCs was more complex. Six mutant genes overlap between the two groups, and an additional seventeen unique mutant genes were identified only in pediatric PTCs. There was only one unique mutant gene in adult PTCs. The tumor diameter of pediatric PTCs tended to be less than 4cm (p<0.001), and the number of lymph node metastases was more than five (p<0.001). Mutations in specific genes unique to pediatric PTCs may contribute to the onset and progression of the disease by adversely affecting hormone synthesis, secretion, and action mechanisms, as well as the functioning of thyroid hormone signaling pathways. But, additional experiments are required to validate this hypothesis.ConclusionBRAF V600E mutation and RET fusion are involved in the occurrence and development of adolescent PTC. For pediatric thyroid nodules that cannot be determined as benign or malignant by fine needle aspiration biopsy, multiple gene combination testing can provide a reference for personalized diagnosis and treatment by clinical physicians.

Objective To compare the size discrepancy between ultrasonic and pathological measurement of solitary cN0M0 papillary thyroid microcarcinoma (PTMC), and to explore their correlation with lymph node metastasis. Methods From April 2021 to January 2022, 234 patients with solitary cN0M0 PTMC who received thyroid lobectomy or total thyroidectomy in the Department of Thyroid and Breast Surgery of Nanjing University of Chinese Medicine, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine were analyzed retrospectively. The size discrepancy between ultrasonic and pathological measurement were compared, and the risk factors of central lymph node metastasis were analyzed. Results The mean of maximum diameter of PTMC measured by ultrasound was 6.8 (range 5.6 to 8.4) mm, which was significantly bigger than that measured by pathology 5.0 (range 4.0 to 7.0) mm (P=0.000). Of them, 37.2% of the tumor size measured by ultrasound is consistent with pathology, 61.1% of the tumor size measured by ultrasound is bigger than that measured by pathology, and only 1.7% of the tumor size measured by ultrasound is smaller than that measured by pathology. There was a linear correlation between the diameter measured by ultrasound and pathology. And the regression equation can be expressed as: pathological diameter =0.799 × ultrasonic diameter -0.221. In addition, 28.6% patients had central lymph node metastasis. Multivariate Logistic regression analysis showed that the diameter measured by pathology is a risk factor for central lymph node metastasis in patients (OR=17.845, 95%CI: 2.507-127.025, P=0.004), and the cutoff value is 5.5 mm which corresponded to the diameter measured by ultrasound as 7.2 mm. Conclusions The sizes of solitary cN0M0 PTMC measured by ultrasound and pathology are different but also correlated. PMTC with pathological diameter >5.5 mm with its corresponding ultrasonic diameter as 7.2 mm indicated an increased risk of central lymph node metastasis.

Objective: To explore the predictive value of multi-parameter combined score of ultrasound including fetal thyroid size, Doppler signals, heart rate and bone maturation in the neonatal thyroid dysfunction of pregnant women with thyroid dysfunction. Methods: A total of 85 cases of pregnant women with thyroid dysfunction were recruited from our hospital from January 2017 to December 2021. The fetal thyroid size, Doppler signals, heart rate and bone maturation were measured with ultrasound. Thyroid function was evaluated at birth. Patients were evaluated with fetal thyroid size and Doppler signals with ultrasound（method 1） and ultrasound multi-parameter scoring including fetal thyroid size, Doppler signals, heart rate and bone maturation（method 2）. The receiver operating characteristic（ROC） curve method was used to evaluate and compare the predictive value of the two scoring systems for neonatal thyroid dysfunction of pregnant women with thyroid dysfunction. Results:The incidence of neonatal thyroid dysfunction in method 1 positive group and method 2 positive group was significantly higher than that in the negative group, and the difference was with statistical significance（P ＜0.001）. When predicting the risk of neonatal thyroid dysfunction, the area under ROC curve（AUC） values of method 1 and method 2 were 0.715 and 0.918 respectively, and the differences were with statistical significance（Z=2.361, P=0.018 2）. The difference of specificity, accuracy,and positive predictive value of two methods was statistically significant. Conclusion: Multi-parameter combined score of ultrasound was of high accuracy for prediction of abnormal thyroid function in neonates, therefore having good clinical value.

Objective Thyroid cancer is the third most prevalent cancer among females. Genetic testing based on next-generation sequencing may provide an auxiliary diagnosis to reduce cytologically diagnostic uncertainty. However, commercial multigene tests are not widely available and are not well-tested in the Chinese population. Methods In this study, we designed a multigene testing panel and evaluated its performance in 529 cytologically indeterminate thyroid nodules (Bethesda III, IV and V). The molecular data of the DNA mutations and RNA fusions of fine needle aspiration samples were reviewed in conjunction with a clinical diagnosis, pathological reports, and definitive surgery for retrospective analysis. Then, the molecular risk stratification was investigated for its accuracy in malignant risk prediction. Results The overall combined consistency revealed substantial agreement (Kappa = 0.726) with the sensitivity, specificity, positive predictive value, and negative predictive values of 97.80%, 82.14%, 98.99%, and 67.65%, respectively. The most common aberration was BRAFV600E (82.59%), followed by NRAS mutants (4.07%), RET fusions (3.70%), and KRAS mutants (3.15%). Two cases (0.44%) were categorized into a high-risk group, 426 cases (94.67%) were categorized into a BRAF-like group with totally histopathologic papillary patterned tumors, and 22 cases (4.89%) were categorized into a RAS-like group with 14 papillary and eight follicular patterned tumors when the cohort concurrent aberrations were excluded. Potentially aggressive features may be related to concurrent molecular alterations of BRAFV600E with TERTQ302R, and AKT1L52R, NRASG12C, NRASQ61R, and CCDC6-RET fusions. Conclusions This study provided a multigene panel for identifying benign nodules from cytologically indeterminate thyroid nodules to avoid unnecessary surgery. We provide further evidence for using molecular risk stratification as a promising predictor of disease outcomes. The results of this study may be limited by the extremely high prevalence of cancer in the cohort for clinical reference.

目的 分析甲状腺乳头状癌(PTC)患者颈部淋巴结超声特征评分和穿刺洗脱液甲状腺球蛋白(FNA-Tg)结果,探讨两者在PTC颈部淋巴结转移预测价值.方法 回顾性分析PTC根治术患者颈部可疑淋巴结超声特征评分及FNA-Tg结果.绘制ROC曲线提示超声评分>2 分为最佳诊断阈值,采用Kappa检验分别比较超声评分>2、FNA-Tg>1 ng/mL与病理一致性;以 ROC曲线比较超声评分、FNA-Tg及两者联合诊断效能.结果 超声评分、FNA-Tg与病理的一致性 Kappa 值分别为 0.527、0.572;通过 ROC 曲线比较超声、FNA-Tg 及两者联合,联合后提高了诊断的灵敏度和阴性预测值(P<0.05).结论 超声评分及 FNA-Tg对判断 PTC 颈部淋巴结转移均是较好的诊断方法,二者联合能提高诊断的灵敏度和阴性预测值.

对比并分析慢性阻塞性肺疾病（COPD）合并肺心病患者的心电图与超声心动图特征。方法：选取我院于2019年6月—2020年12月收治的62例COPD合并肺心病患者纳入研究组，另选择同时期经检查显示无心血管疾病的62例COPD患者纳入对照组，分析两组患者的超声心动图、心电图特征，比较两种检查的肺心病检出率。结果：对照组的心电图异常以房性期前收缩为主，占16.13％（10/62），研究组的心电图异常仍以房性期前收缩为主，占27.42％（17/62），研究组的心电图异常发生率显著高于对照组；分析两组患者的超声心动图发现，RV、MPA较正常值升高，研究组患者的RA为（39.55±6.12）mm，RV为（40.18±5.17）mm，明显高于对照组[（36.85±4.28）mm、（34.58±6.12）mm]（P＜0.05）；超声心动图的阳性检出率高于心电图（P＜0.05）。结论：心电图和超声心动图均是临床检查心脏病的重要手段，两种检查方法各有优劣，临床上针对不同患者的情况，医师可同时结合心电图和超声心动图结果，针对肺心病及其合并症实现早诊断、早治疗，以提升医院总体治疗水平。

Mutations in the B-Raf proto-oncogene, serine/threonine kinase (BRAF), have been linked to a variety of solid tumors such as papillary thyroid carcinoma. The purpose of this study was to compare the DP-TOF, a DNA mass spectroscopy (MS) platform, and next-generation sequencing (NGS) methods for detecting multiple-gene mutations (including BRAFV600E) in thyroid nodule fine-needle aspiration fluid. In this study, we collected samples from 93 patients who had previously undergone NGS detection and had sufficient DNA samples remaining. The MS method was used to detect multiple-gene mutations (including BRAFV600E) in DNA remaining samples. NGS detection method was used as the standard. The MS method’s overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 95.8%, 100%, 100%, and 88%, respectively in BRAFV600E gene mutation detection. With a kappa-value of 0.92 (95%CI 0.82–0.99), the level of agreement between these methods was incredibly high. Furthermore, when compared to NGS in multiple-gene detection, the MS method demonstrated higher sensitivity and specificity, 82.9% and 100%, respectively. In addition, we collected the postoperative pathological findings of 50 patients. When the postoperative pathological findings were used as the standard, the MS method demonstrated higher sensitivity and specificity, at 80% and 80%, respectively. Our findings show that the MS method can be used as an inexpensive, accurate, and dependable initial screening method to detect genes mutations and as an adjunct to clinical diagnosis.

ObjectiveTo assess the efficacy and safety of ultrasound-guided microwave ablation (MWA) in the treatment of primary hyperparathyroidism (PHPT), and to investigate whether MWA can improve the bone turnover and renal function. MethodsA total of 20 consecutive PHPT patients with 21 parathyroid lesions treated with MWA in our center from May 2019 to March 2021 were recruited in this study. Serum parathyroid hormone (PTH), calcium and phosphorus levels before MWA and at 20 minutes, 4 hours, 1 day, 3 months, 6 months and 12 months after MWA were measured. Bone turnover biomarkers, renal function and lesion volume with volume reduction rate (VRR) before MWA and at the last follow-up were compared. Any complication related with MWA was evaluated. The technical and clinical success rates of MWA in the treatment of PHPT were calculated. Clinical success was defined as normal serum PTH and calcium without PHPT-associated manifestations at more than 6 months after ablation. Technical success was defined as complete ablation indicated by immediate postoperative contrast-enhanced ultrasound. ResultsThe serum PTH, calcium and phosphorus levels at their respective follow-up time points dropped significantly after MWA (P <0.05). The volume of parathyroid lesions at the final examination was significantly reduced, compared with pre-ablation volume (P <0.001), with a median VRR reaching 89%. The technical and clinical success rates were 100% and 63.6%, respectively. Substantial changes of bone turnover biomarkers were observed before and after MWA (P <0.05), but the differences in renal function were not statistically significant. No major complications were reported in all cases. Pre-MWA serum PTH, lesion volume, maximum diameter of lesion and ablation time were significantly different between patients with successful and failed MWA. ConclusionsPHPT can be effectively and safely treated by ultrasound-guided MWA, as proven by drop in serum PTH and reduction in the volume of parathyroid adenomas. Besides, MWA can impede bone remodeling to suppress hyperparathyroidism in the condition of PHPT.

目的:分析晚期妊娠孕妇宫颈前角(ACA)及宫颈长度(CL)对自发性早产的预测价值.方法:回顾性收集2018年3月-2020年12月于本院有早产高危因素的孕妇221例,根据妊娠结局分为早产组42例与足月产组179例,均行超声测量ACA及CL并比较两组临床资料差异,分析ACA联合CL对自发性早产的预测效能.结果:早产组CL(25.8±7.0mm)小于足月产组(32.4±10.6mm),ACA(115.3±10.2)°大于足月产组的(105.3±11.5)°(均 P＜0.001).晚期流产及(或)早产史、CL＜25mm、ACA＞109°是自发性早产的独立影响因素(P＜0.05),年龄≥35岁、妊娠合并症、子宫颈手术史非自发性早产的独立影响因素(P＞0.05);CL、ACA、CL联合 ACA对自发性早产均具有预测效能(P＜0.05),但CL联合ACA检测AUC(0.863),敏感度(69.1％)及特异度(73.7％)最高.结论:妊娠晚期超声测量ACA联合CL对自发性早产预测效能更佳,CL＜23.5mm、ACA＞123.4°时早产风险会大幅度升高.

Objective To compare the clinical value of ultrasonic elastography ( UE) and three common ultrasonic features in diagnosing papillary thyroid carcinoma ( PTC).Methods From January 2012 to December 2017,the clinical data of 105 cases with PTC which were confirmed by postoperative pathologic examination and 20 cases with benign thyroid nodules (BTN) in the Integration of Chinese and Western Medicine Hospital Affiliated to Nanjing University of Traditional Chinese Medicine were analyzed retrospectively.The UE and common ultrasonic features comprising a taller -than-wide shape,irregular margins and microcalcifications were analyzed.The sensitivity, specificity and area under curve ( AUC) of PCT dingnosis with two different ultrasonic parameters are calculated. Results Based on surgical pathology ,the diagnostic sensitivity of irregular boundary is the highest amony the three paraneters of ordinary ultrasound.Although an irregular margin showed higher sensitivity than taller -than -wide shape and microcalcifications with 71.42% vs.59.04% vs.60.00%,but there was no statistically significant difference (χ2 ＝4.3,P＝0.116).There was also no statistically significant difference in specificity (χ2 ＝0.134,P＝0.935). The diagnostic efficiency of UE was higher than taller -than-wide shape (Z＝3.046,P＝0.002),irregular margin (Z＝2.962,P＝0.003) as well as microcalcifications (Z＝3.942,P＝0.000),the difference was statistically signifi-cant(P＜0.05).The diagnostic efficiency of UE was higher than the combined three common ultrasonic features together (Z＝3.125,P＝0.001).Conclusion UE score shows a higher diagnostic efficiency ,easy to perform, indicating the important application value in preoperative diagnosis of PTC ,and is worthy of promoting in clinic.

OBJECTIVES The aims of our study were to explore the preoperative diagnostic value of ultrasound elastography combined with BRAF gene detection in malignant thyroid nodule, and find whether shear wave elastography (SWE) combined with BRAF gene detection can improve the diagnostic sensitivity and specificity. METHODS From 1480 patients with thyroid nodule examined between January 2015 and December 2017, a retrospective analysis was performed on 161 patients who underwent thyroidectomy. Diagnosis was confirmed by postoperative pathology, including 139 malignant thyroid nodules and 22 benign thyroid nodules. All the patients underwent SWE, BRAF gene detection, and the combination for their preoperative evaluation. The sensitivities, specificities, and accuracies of SWE, BRAF gene detection, and the combination for detection of malignant thyroid nodules were calculated and then compared using Fisher's exact probability test, based on the original preoperative reports and postoperative pathology. A receiver-operating characteristic curve analysis was performed to compare the diagnostic performance of SWE, BRAF gene detection, and combination for detecting malignant thyroid nodules. RESULTS Based on the original preoperative reports and postoperative pathology, SWE, BRAF gene detection, and the combination showed sensitivities of 88.67%, 78.41%, 92.8%, and specificities of 72.77%, 77.27%, 95.45%. A correct diagnosis was obtained in 85.82%, 78.26%, 93.16% and missed diagnosis rates were 12.23%, 21.58%, and 7.19%. The sensitivities, specificities, and correct diagnosis rate in the combination group were significantly higher than any single detection method (P<0.05). The missed diagnosis rate in the combination group was significantly lower than any single detection method (P<0.05). The receptor operating characteristics curve analysis showed a significantly higher diagnostic performance for the combination than for SWE and BRAF gene detection (P<0.05). The interobserver agreement for detecting malignant thyroid nodule was better for the combination than for SWE or BRAF gene detection alone. CONCLUSION For the detection of a malignant thyroid nodule, SWE combined with BRAF gene detection was more sensitive and showed a higher diagnostic performance than SWE or BRAF gene detection alone.

The purpose of the study was to analyze the characteristics of transcranial ultrasonography (TCS) neuroimaging in patients with Parkinson’s disease complicated with depression (PD+D) and without depression (PD-D), and to explore the value of TCS in the diagnosis and differential diagnosis of both diseases. From September 2010 to July 2016, 50 patients with PD+D and 50 patients with PD-D who were admitted to the dyskinesia clinic and neuropsychiatric depression in our hospital were selected as the research objects, and 50 healthy adults and 50 patients with depression were selected as the control objects. TCS examination was performed in each group, and the changes of TCS in substantia nigra (SN) and central nucleus (BR) were compared and analyzed. The results showed that the positive rates of SN in PD+D group and PD-D group were 80% and 86%, respectively, which were significantly higher than those in depression group and control group (8.0% and 10.0%, P < 0.01). The positive rates of BR in PD+D group and depression group were 78.0% and 82.0%, respectively, which were significantly higher than those in PD-D group (18.0%) and control group (10.0%), respectively (P < 0.01). To sum up, TCS, as an assistant examination method for Parkinson’s disease, is of clinical value in the diagnosis of PD+D and PD-D and their differential diagnosis by detecting the specific high echo of SN and abnormal BR echo in patients with Parkinson’s disease.

目的 探讨甲状腺弹性超声、细针穿刺细胞学检查、BRAF基因检测以及联合诊断对甲状腺恶性结节术前诊断价值分析.方法 选取2015年1月至2017年12月在南京中医药大学附属中西医结合医院甲状腺外科住院行手术切除的甲状腺结节患者共193例.收集患者一般资料、甲状腺弹性超声(UE)、细针穿刺病理学检查(FNAC)、BRAF基因实变情况以及术后病理等资料.将术后病理诊断结果作为基本依据,对UE,FNAC以及BRAF单一诊断和联合诊断价值进行比较.结果 恶性结节共164例,均由术后病理证实,乳头状癌156例,滤泡细胞癌8例.156例乳头状癌中,合并结节性甲状腺肿2例,合并淋巴细胞性甲状腺炎1例,合并亚急性甲状腺炎1例.手术确诊良性结节29例,其中胶质囊肿1例,桥本甲状腺炎1例,结节性甲状腺肿19例,腺瘤8例.UE诊断效能(AUC=0.635)高于FNAC(AUC=0.605)与BRAF(AUC=0.623),差异有统计学意义(P<0.05).UE+FNAC诊断效能(AUC=0.684)高于FNAC+BRAF(AUC=0.658)与UE+BRAF(AUC=0.636),差异有统计学意义(P<0.05).联合3种诊断方法诊断灵敏性有所下降(63.4％),但特异性提高到78.6％,AUC为0.710.结论 三种方法联合应用后特异性和诊断效能提高,可以避免不必要的手术.

目的 分析甲状腺术后患者颈部手术缝线刺激形成的异物肉芽肿的超声表现.方法 回顾性分析47例甲状腺乳头状癌、甲状腺全切术或部分切除术后患者,经超声、细针穿刺细胞学及临床观察诊断86枚颈部肉芽肿结节,观察其声像图特征.结果 肉芽肿结节均分布于甲状腺残端边缘或手术区软组织内,表现为低回声结节,无包膜,形态多样,边缘不规则,其内均见多发性点状强回声,后方多伴声影.86枚颈部肉芽肿结节中,80枚显示血流信号稀少(80/86,93.02％),6枚血流丰富(6/86,6.98％);弹性超声检查显示弹性评分2级24枚(24/86,27.91％),3级24枚(24/86,27.91％),4级38枚(38/86,44.19％).结论 甲状腺术后缝线肉芽肿声像图多表现为甲状腺残端或周围颈部软组织内不规则低回声,内部伴集中于结节中心的点状强回声.

目的 探讨ACR TI-RADS对甲状腺结节的诊断及对穿刺选择的指导价值.方法 回顾性分析177例甲状腺结节患者227枚结节的临床资料,以病理结果为参照分析ACR TI-RADS的诊断效能,探讨ACR推荐的穿刺界值对诊断效能的影响及对侵袭性肿瘤的筛选能力.结果 纳入的227枚结节,TR 1～2类均为良性,TR 3～5类恶性率分别为2.5％、21.3％、78.2％.以TR 5类为诊断点,TI-RADS的灵敏度为89.4％、特异度78.9％.根据穿刺界值分组,＜1 cm的TR 5类结节恶性率高于≥1 cm组(P=0.027),TR 3～4类结节不同组别中恶性率无统计学差异(P＞0.05).TR 5类恶性结节患者中,结节≥1 cm者淋巴结转移率显著高于＜1 cm者(P=0.035),而两组间出现被膜侵犯或腺体外浸润的比例均无统计学差异(P＞0.05).结论 ACR TI-RADS具有良好的风险预测及诊断价值.仅依据TI-RADS分级及大小指导穿刺会造成相当部分恶性结节不能明确诊断,且筛选侵袭性肿瘤的效率不高.