Yun-Fei Zhang

Objectives: Thyroid nodules classified as Bethesda category IV cannot be diagnosed with fine-needle aspiration. RAS mutations have been linked to thyroid cancer, although it is still unclear if they are useful as a pre-operative molecular screening for this particular subgroup. In order to assess the diagnostic accuracy (sensitivity, specificity, AUC, etc.) of RAS mutations in identifying malignancy among Bethesda IV nodules and to ascertain whether this can consistently direct clinical decision-making and minimize non-essential interventions, we carried out a systematic review and meta-analysis using postoperative histopathology as the reference standard. Methods: A literature search of the PubMed, Embase, Cochrane Library, Web of Science and OVID databases was conducted. In all of the included studies, the diagnostic accuracy of RAS was compared with that of postoperative pathology, which was used as a standard. Data were pooled, and the sensitivity, specificity, area under the curve (AUC), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated to estimate the accuracy of RAS. Results: A total of 10 studies were included after screening, comprising 913 cases of Bethesda Category IV nodules. Among them, there were 246 malignant lesions and 667 benign lesions. The pooled sensitivity of RAS mutations was 0.35 (95% CI, 0.29-0.41), and the specificity was 0.93 (95% CI, 0.90-0.95). The positive likelihood ratio was 3.46 (95% CI, 1.94-6.18), the negative likelihood ratio was 0.73 (95% CI, 0.60-0.89), and the AUC was 0.7954. Heterogeneity testing showed p2 = 58.5%, indicating significant heterogeneity. Conclusion: RAS mutations have a moderate diagnostic value in the diagnosis of Bethesda Category IV thyroid nodules. Despite the presence of some heterogeneity, the detection of RAS mutations may be helpful in guiding clinical decision-making and management strategies. Systematic Review Registration: https://www.crd.york.ac.uk/prospero , identifier CRD42024608197.

Objectives: To evaluate the diagnostic performance of image-guided puncture in differentiating malignant from benign peritoneal lesions. Materials and methods: An independent literature search was conducted across multiple English medical databases, including PubMed, Embase, Web of Science, Cochrane Library and Ovid. The diagnostic accuracy of image-guided puncture was compared against postoperative pathology and diagnostic laparoscopy, which served as reference standards. The diagnostic performance of imaging-guided puncture was evaluated by calculating pooled sensitivity, specificity, diagnostic odds ratio (DOR), and the area under the curve (AUC). Subgroup analyses were conducted based on imaging modality, type of puncture, and the risk assessment derived from the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Results: Fifteen eligible studies, comprising a total sample of 1208 patients with 1165 peritoneal lesions, were included in the analysis. The pooled sensitivity of image-guided puncture for differentiating malignant from benign peritoneal lesions was 93% (95% confidence intervals (CI): 91–95%), with a specificity of 95% (95% CI: 92–97%), a DOR of 149.02 (95% CI: 78.47–282.99), and an AUC of 0.97. Conclusion: Overall, this meta-analysis demonstrates that image-guided puncture is a minimally invasive and safe technique with high diagnostic accuracy, regardless of the imaging modality, puncture method, or lesion type (mass or diffuse infiltration). It offers a reliable alternative to invasive biopsy for diagnosing peritoneal lesions. Subgroup analysis revealed no significant differences in diagnostic efficacy across the evaluated parameters. Key Points: Question The diagnosis of peritoneal lesions remains challenging due to the inherent complexity and invasiveness of traditional diagnostic laparoscopy, as well as overlapping imaging features of routine imaging examinations. Findings Image-guided puncture is a minimally invasive and safe technique with high diagnostic accuracy, irrespective of the imaging modality used, the puncture method, or the type of peritoneal lesion. Clinical relevance Image-guided puncture is recognized as a safe, minimally invasive, and highly sensitive diagnostic tool, which can reduce patient discomfort compared to diagnostic laparoscopy. In most clinical scenarios, it represents a reliable and effective alternative to this invasive procedure. Graphical

Background: Follicular thyroid carcinoma (FTC) is the second most common thyroid malignancy but is challenging to preoperatively distinguish from follicular adenoma. Artificial intelligence (AI) has emerged as an auxiliary diagnostic tool, yet published studies show variable performance. This meta-analysis aims to evaluate the overall diagnostic accuracy of AI in differentiating FTC from benign lesions. Methods: Literature searches were independently conducted across the PubMed, Embase & Medline (via Embase.com), Web of Science, Cochrane Library, and Ovid English medical databases. The diagnostic accuracy of AI was compared against the reference standard of histopathology. Pooled sensitivity, specificity, diagnostic odds ratio and area under the curve were calculated to assess AI accuracy. Meta-regression analyses were performed to investigate heterogeneity related to test set size, validation strategy, and machine learning model type. Results: We analyzed a total of 7 studies involving 3163 follicular thyroid neoplasms (comprising 1876 follicular thyroid adenomas [FTAs] and 1287 FTCs). The pooled sensitivity and specificity of AI for differentiating FTC from FTA were 0.73 (95% CI: 0.70–0.75) and 0.87 (95% CI: 0.86–0.89), respectively. The pooled positive and negative likelihood ratios were 6.19 (95% CI: 3.92–9.79) and 0.28 (95% CI: 0.17–0.46). The diagnostic odds ratio was 22.81 (95% CI: 10.17–51.16), and the area under the curve was 0.94. Meta-regression results indicated no significant heterogeneity associated with validation strategy ( P = .25). However, test set size ( P = .02) and publication year ( P = .04) were identified as potential significant sources of heterogeneity. Subgroup analyses revealed that studies with a test set size > 1000 cases demonstrated superior accuracy compared to those with 1000 cases) achieved higher accuracy than those with smaller test sets (<1000 cases). Furthermore, validation using cross-validation strategies outperformed non-cross-validation (holdout) approaches.

Background: The current diagnostic paradigm for thyroid nodule characterization predominantly depends on fine needle aspiration (FNA) cytology. Nevertheless, in cases of indeterminate cytology classified as Bethesda III and IV, the clinical community continues to face significant challenges in establishing reliable non-invasive diagnostic modalities for accurate pathological differentiation. This meta-analysis evaluates the diagnostic value of ultrasound elastography in Bethesda III-IV thyroid nodules, and compares the diagnostic efficacy when combined with conventional ultrasound. Methods: We searched English medical databases, including PubMed, Embase, Web of Science, Cochrane Library, and Ovid, for relevant literature. These studies were reviewed by 2 members who also extracted pertinent data. We calculated pooled values via random effects meta-analysis to determine diagnostic performance. Results: A total of 2,356 nodules were included in 27 studies. The overall sensitivity of ultrasound elastography was 0.81, the overall specificity was 0.83, the diagnostic odds ratio (DOR) was 16.40, and the area under the curve (AUC) was 0.87. A total of 8 articles incorporated the combined application of ultrasound elastography and conventional ultrasonography. The overall sensitivity was 0.87, the overall specificity was 0.73, the DOR was 21.33, and the AUC was 0.90. Conclusions: Ultrasound elastography has good diagnostic value for Bethesda III–IV thyroid nodules, and the semiquantitative method outperforms the qualitative and quantitative methods. Ultrasound elastography in combination with conventional ultrasonography has better sensitivity and a lower specificity, and there is no significant difference between the 2 methods overall (P>0.05).

This case report details a case of intrathyroid thymic carcinoma (ITTC). ITTC is extremely rare with few reports. Diagnosis is difficult due to a lack of specific features and depends on pathology. A 36‐year‐old male was diagnosed. His condition and relevant tests are described. The tumor was removed, and he recovered well. This case report also discusses ITTC's characteristics, diagnosis, treatment, and prognosis, emphasizing its rarity and the need for a better understanding.

Background: Autoimmune pancreatitis (AIP) is an important manifestation of immunoglobulin G4 (IgG4)-related diseases with multi-organ involvement. This study sought to retrospectively analyze pancreatic and extra-pancreatic ultrasonography findings in patients with AIP, and to determine the value of transabdominal ultrasound (TUS) in the diagnosis of AIP. Methods: In total, 19 patients with type 1 AIP (12 males and seven females; mean age: 52.84±15.33 years; range: 18–83 years) underwent ultrasound examinations of the pancreas, peripancreatic lymph nodes, gall bladder, bile ducts, retroperitoneal, kidneys, and submandibular and lacrimal glands. Results: According to the distribution of the lesions, the pancreatic images were categorized into the following three types: diffuse (n=9), segmental (n=5), and focal (n=5). These images showed diffuse, segmental, or focal enlargement of the pancreas with hypoechoic parenchyma. Contrast-enhanced ultrasound (CEUS) revealed hypoenhancement in the diffuse type. A thick capsule-like echo surrounding the lesion was observed in 12 patients. The main pancreatic duct was dilated in eight patients. No calcification was detected in any of the 19 patients. Peripancreatic lymph nodes were identified in four patients. Vascularity was found in four of eight patients for whom color Doppler flow images (CDFIs) of the pancreas were available. The intrahepatic and common bile ducts were dilated in 11 patients. The gallbladder was found to be involved in 13 patients. Except for one patient with hydronephrosis due to retroperitoneal fibrosis, no abnormalities were observed in the kidneys. Retroperitoneal fibrosis was found in one patient. Among the 12 patients for whom data were available, parenchymal inhomogeneity was observed in the parotid glands of three patients, the submandibular glands of five patients, and the lacrimal glands of eight patients. Conclusions: Ultrasonography is valuable in the diagnosis of AIP. In addition to TUS, other ultrasound technologies, such as CEUS and TUS-guided biopsy, could also play a crucial role in the diagnosis of AIP.

Background: Not all the breast lesions were mass-like, some were non-mass-like at ultrasonography. In these lesions, conventional ultrasonography had a high sensitivity but a low specificity. Sonoelastography can evaluate tissue stiffness to differentiate malignant masses from benign ones. Then what about the non-mass lesions? The aim of this study was to evaluate the current accuracy of sonoelastography in the breast non-mass lesions and compare the results with those of the American College of Radiology breast Imaging-Reporting and Data System (BI-RADS). Methods: An independent literature search of English medical databases, including PubMed, Web of Science, Embase & MEDLINE (Embase.com) and Cochrane Library, was performed by 2 researchers. The accuracy of sonoelastography was calculated and compared with those of BI-RADS. Results: Fourteen relevant studies including 1058 breast non-mass lesions were included. Sonoelastography showed a pooled sensitivity of 0.74 (95% CI: 0.70–0.78), specificity of 0.89 (95% CI: 0.85–0.91), diagnostic odds ratio (DOR) of 25.22 (95% CI: 17.71–35.92), and an area under the curve of 0.9042. Eight articles included both sonoelastography and BI-RADS. The pooled sensitivity, specificity, DOR and AUC were 0.69 versus 0.91 (P < .01), 0.90 versus 0.68 (P < .01), 19.65 versus 29.34 (P > .05), and 0.8685 versus 0.9327 (P > .05), respectively. Conclusions: Sonoelastography has a higher specificity and a lower sensitivity for differential diagnosis between malignant and benign breast non-mass lesions compared with BI-RADS, although there were no differences in AUC between them.

Atypical Parathyroid Adenoma (APA) is a type of tumor that lies somewhere between parathyroid adenoma and parathyroid carcinoma. It often affects adults over the age of 60, and the clinical symptoms are consistent with those of hyperparathyroidism. This condition has a low occurrence, and its ultrasonographic signs are strikingly similar to thyroid malignant tumors, making it easily misdiagnosed. As a result, a case of APA ultrasonography misdiagnosis admitted to our hospital was recorded in order to serve as a reference point for APA diagnosis.

Background: Ultrasound is widely used for detecting thyroid nodules in clinical practice. This retrospective study aimed to assess the diagnostic efficacy of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS), S-Detect, and elastography of the carotid artery for suspicious thyroid nodules and to determine the complementary value of artificial intelligence and elastography. Methods: Between January 2021 and November 2021, 101 consecutive patients with 138 thyroid nodules were enrolled in The First Hospital of China Medical University. All nodules were evaluated using ACR-TIRADS categories (TR), S-Detect, and elastography, and then the diagnostic performance of the different methods and the combined assessment were compared. The inclusion criteria were the following: (I) TR3, TR4, and TR5 nodules, which were defined as “suspicious nodules”; (II) patients who had surgical or cytopathological results after ultrasound examination; and (III) voluntary enrollment in this study. Meanwhile, the exclusion criteria were the following: (I) TR1 and TR2 nodules, (II) patients who had undergone fine-needle aspiration before ultrasound examination, and (III) inconclusive cytologic findings. Results: A total of 71 patients (12 men and 59 women) with 94 suspicious thyroid nodules (42 benign nodules and 52 malignant nodules) were finally included in this study. S-Detect had a significantly better sensitivity than did ACR-TIRADS [S-Detect: 98.1%, 95% confidence interval (CI): 89.7–100.0%; ACR-TIRADS: 84.6%, 95% CI: 71.9–93.1%; P=0.036], but its specificity was much lower (S-Detect: 19.0%; 95% CI: 8.6–34.1%; ACR-TIRADS: 40.5%, 95% CI: 25.6–56.7%; P=0.032). The accuracy was not significantly different between S-Detect (62.8%; 95% CI: 52.2–72.5%) and ACR-TIRADS (64.9%; 95% CI: 54.4–74.5%) (P=0.761). The elasticity contrast index (ECI) was not definitively useful in identifying suspicious thyroid nodules (P=0.592). Compared with the use of ACR-TIRADS and S-Detect alone, the specificity (45.2%; 95% CI: 29.8–61.3%), positive predictive value (65.2%; 95% CI: 52.4–76.5%), accuracy (66.0%; 95% CI: 55.5–75.4%), and the area under the receiver operating characteristic curve (0.640; 95% CI: 0.534–0.736) of their combination were higher but not significantly so. Conclusions: At present, S-Detect cannot replace manual diagnosis, and the value of elastography of the carotid artery in diagnosing suspected thyroid nodules remains unclear.

Background: Autoimmune pancreatitis (AIP) is often misdiagnosed as pancreatic adenocarcinoma (PAC), resulting in unnecessary surgical interventions. On computed tomography (CT) scans, the capsule-like rim is an essential radiological characteristic for differentiating AIP from PAC. It presents as a hypoattenuating halo surrounding the pancreas. However, this characteristic is infrequently observed in ultrasonography. Objectives: The aim of this study was to assess the accuracy of the thickness measurement of the capsule-like structure surrounding lesions during ultrasonography in order to distinguish between AIP and PAC. Patients and Methods: This case-control study was conducted on 19 patients with type 1 AIP (AIP1) as the case group and 37 patients with PAC as the controls. The ultrasound images of these patients were obtained from our institute's database. The thickest part of the hyperechoic capsule-like structure around lesions was identified and measured on the workstation retrospectively. The difference in the thickness of the capsule-like structure between AIP1 and PAC was compared in all lesions and mass lesions, respectively. The optimal cut-off thickness was determined by the maximum Youden index (calculated as sensitivity + specificity - 1). A P-value of < 0.05 (or < 0.05/3 after applying the Bonferroni correction) was considered statistically significant. Results: All lesions appeared hypoechoic, and there were no significant differences in gender, age, abdominal pain symptoms, jaundice, or weight loss between the case and control groups (P > 0.05). However, there was a significant difference regarding the involved pancreatic location (P = 0.008). Among the lesions, 46 were mass lesions. The hyperechoic capsule-like rim was thicker in the case group compared to the control group for all lesions (mean = 0.40 ± 0.12 vs. 0.32 ± 0.09 cm, P = 0.006) and also for mass lesions (mean = 0.41 ± 0.13 vs. 0.31 ± 0.09 cm, P = 0.006). The cut-off thickness for AIP1 was estimated at 0.41 cm, according to the maximum Youden index in both all lesions and mass lesions. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and odds ratio for all lesions were 0.58, 0.86, 0.77, 0.69, 0.80, and 8.80 (95% confidence interval [CI]: 2.37 – 32.64), respectively. In mass lesions, the corresponding values were 0.58, 0.88, 0.80, 0.64, 0.86, and 10.50 (95% CI: 2.23 – 49.52), respectively. Conclusion: Patients with a hyperechoic capsule-like rim thickness of ≥0.41 cm during ultrasonography are more likely to have AIP1. This finding holds valuable clinical significance in differentiating between AIP1 and PAC.