Mingbo Zhang

Background: In the diagnosis of larger thyroid nodules, the internal structure of the nodules and the surrounding tissues are more complex, making the nodule characteristics atypical. The tissue structure may interfere with the ultrasound examination, increasing the risk of misdiagnosis or missed diagnosis. Meanwhile, the uneven distribution of malignant tissues in large nodules or the tendency of large nodules to undergo necrosis and liquefaction due to their size can lead to a higher false-negative rate in fine needle aspiration cytology (FNAC). This study aimed to evaluate the clinical utility of a dynamic artificial intelligence (AI)-based, ultrasound-assisted diagnostic system in differentiating between benign and malignant thyroid nodules with a diameter >2 cm, and its guiding significance for subsequent management. Methods: The surgical data of 276 patients with 297 thyroid nodules who underwent surgery were collected. Dynamic AI was used to distinguish between the benign and malignant thyroid nodules. The dynamic AI, preoperative ultrasound, preoperative FNAC, computed tomography (CT), and postoperative pathological results of the nodules were compared to evaluate the diagnostic efficacy of dynamic AI. Results: Dynamic AI achieved 86.2% accuracy, with a sensitivity of 86.2% and a specificity of 86.2%, and showed high consistency with the postoperative pathological results (kappa =0.723, P4.0 cm groups. Conclusions: With its non-invasive, safe, objective, and accurate advantages, dynamic AI can conduct real-time, multi-section, and multi-angle diagnosis. It can deeply analyze the subtle characteristics of large thyroid nodules and provide a more objective comprehensive assessment of thyroid nodules with a diameter >2 cm, enabling the precise diagnosis of the benignity or malignancy of these nodules. It promotes the homogenization of diagnosis and has important guiding significance for individualized diagnosis and treatment strategies, and the development of surgical resection ranges.

Purpose: Cytologically indeterminate thyroid nodules constitute 20–30% of fine-needle aspiration samples obtained from suspicious thyroid nodules. Over half of patients with indeterminate thyroid nodules undergo diagnostic surgery; however, 60–80% of excised nodules are benign. While some radiomics studies have built models to enhance the diagnostic efficacy of thyroid nodules, few have focused on indeterminate thyroid nodules with confirmed pathological results. We aimed to develop and evaluate ultrasound radiomics models to improve the diagnosis of indeterminate thyroid nodules and reduce unnecessary surgeries.Methods: We retrospectively analyzed ultrasound images of 197 indeterminate thyroid nodules with definitive pathological results. Regions of interest were manually delineated using 3-Dimensional Slicer software, and radiomics features were extracted using Pyradiomics software. Ultrasound radiomics feature selection and dimensionality reduction were performed using univariate analysis and the least absolute shrinkage and selection operator method. Independent training (n=136) and validation (n=61) cohorts were used to develop three radiomics models. Model performance was evaluated using receiver operating characteristic analysis and compared to two existing assisted diagnostic tools and two junior radiologists.Results: The Radunion model achieved the highest performance, with 90.5% sensitivity, 56.8% specificity, 75.0% positive predictive value, 80.7% negative predictive value, and 76.6% accuracy. The Radsize model minimized biopsies by 21.1%, reducing the rate from 48.9% to 13.8%. These models outperformed the ITS 100 system, Thynet deep learning-based tools (p < 0.05), and junior radiologists.Conclusion: Ultrasound radiomics models are promising, convenient, and accurate adjunct tools for predicting malignancy, improving junior radiologists’ diagnostic performance, reducing unnecessary biopsies, and enhancing diagnostic precision in clinical practice.

Background: Increasing numbers of cytologically indeterminate thyroid nodules (ITNs) present challenges for preoperative diagnosis, often leading to unnecessary diagnostic surgical procedures for nodules that prove benign. Research in ultrasound radiomics and genomic testing leverages high-throughput data and image or sequence algorithms to establish assisted models or testing panels for ITN diagnosis. Many radiomics models now demonstrate diagnostic accuracy above 80% and sensitivity over 90%, surpassing the performance of less experienced radiologists and, in some cases, matching the accuracy of experienced radiologists. Molecular testing panels have helped clinicians achieve accurate diagnoses of ITNs, preventing unnecessary diagnostic surgical procedures in 42%–61% of patients with benign nodules.Objective: In this review, we examined studies on ultrasound radiomics and genomic molecular testing for cytological ITNs conducted over the past 5 years, aiming to provide insights for researchers focused on improving ITN diagnosis.Conclusion: Radiomics models and molecular testing have enhanced diagnostic accuracy before surgery and reduced unnecessary diagnostic surgical procedures for ITN patients.

Study Design.: A randomized controlled study. Objective.: The aim of this study was to develop a clinical process of biplane ultrasound (US) guided percutaneous lumbar intervertebral foramen insertion (PLIFI) and to verify that biplane US can improve accuracy and reduce number of fluoroscopies. Summary of Background Data.: PLIFI is crucial for drug injection and establishment of transforaminal surgical channel. The traditional fluoroscopy guidance involves radiation and requires practical experience. Methods.: Patients with lumbar disc herniation scheduled for an epidural steroid injection or percutaneous endoscopic lumbar discectomy were randomized to the biplane US and fluoroscopy groups. The biplane US group was divided into training and proficiency stages using a learning curve fitted by cumulative sum analysis. All punctures were performed by a junior spine surgeon and a junior sonographer. The primary outcomes were the first success rate, number of punctures and radiographs, puncture time, and confidence score. Results.: Sixty-eight patients (age 51.4±15.4 yr, 36 males) were divided into the biplane US and fluoroscopy groups. According to the 12th turning point of a learning curve, the biplane US group was divided into training and proficiency periods. The first-attempt success rate was achieved in 61% using biplane US at the proficiency period, compared with 32% using fluoroscopy [P=0.033, RR: 1.634]. The number of radiographies [1 (IQR 1–2) vs. 2 (IQR 2–3), P=0.001] was significantly smaller, and puncture time [120 s (IQR 57–210) vs. 197 s (IQR 159–341), P=0.001] was significantly faster using biplane US at the proficiency period. Conclusion.: Biplane US provides an accurate, safe, and convenient approach for PLIFI. With further clinical practice, biplane US would be conducive to rapid skill acquisition for novices and has the potential to achieve a completely radiation-free puncture process.

S Objective To compare the clinical outcomes between radiofrequency ablation (RFA) and microwave ablation (MWA) for the treatment of T1N0M0 papillary thyroid carcinoma (PTC) in a large cohort. Materials and methods This retrospective study included 1111 patients with solitary T1N0M0 PTC treated with RFA (n = 894) or MWA (n = 215) by experienced physicians. A propensity score matching was used to compare disease progression, including lymph node metastases (LNM), recurrent tumors and persistent tumors, recurrence-free survival (RFS), volume reduction ratio (VRR), and complications between the RFA and MWA groups. The subgroup outcomes of T1a and T1b tumors treated with RFA and MWA were also compared. Results During a mean follow-up period of 41.7 ± 12.6 months, the overall incidence rates of disease progression, LNM, recurrent tumors, and persistent tumors were 2.1%, 0.7%, 1.2%, and 0.2%, respectively. Eight patients (0.7%) experienced transient voice change and recovered within 3 months. After 1:1 matching, there were no significant differences in disease progression (3.3% vs. 3.7%, p = 0.793), LNM (1.4% vs. 1.9%, p = 1.000), recurrent tumor (1.4% vs. 1.9%, p = 1.000), persistent tumors (0.5% vs. 0%, p = 0.317), RFS rates (96.7% vs. 96.3%, p = 0.821), VRR (99.3 ± 3.0% vs. 98.3 ± 8.5%, p = 0.865), tumor disappearance rate (87.9% vs. 81.4%, p = 0.061) and complications (1.4% vs. 1.9%, p = 1.000) between the RFA and MWA groups. For T1a and T1b tumors, clinical outcomes were comparable between RFA and MWA. Conclusions RFA and MWA did not show significant differences in clinical outcomes for T1N0M0 PTC. The choice between RFA and MWA could depend on physician expertise and resources of local center resources. A qualified and experienced physician with extensive knowledge of the modalities is recommended when thermal ablation is performed. Key Points Question With radiofrequency ablation (RFA) and microwave ablation (MWA) used worldwide for T1N0M0 papillary thyroid carcinoma (PTC), is one of them superior to the others? Findings There were no significant differences in disease progression, recurrence-free survival, volume reduction ratio, tumor disappearance, or complications between techniques for solitary T1N0M0 papillary thyroid carcinoma. Clinical relevance The choice between RFA and MWA could depend on physician expertise and resources of the local center resources. A qualified and experienced physician with extensive knowledge of the modalities is recommended when thermal ablation is performed.

Lymphoma is a common hematological malignancy with markedly increasing incidence. Its pathological types are complex and heterogeneous, and there are significant differences in treatment options and efficacy. Therefore, early and precise diagnosis, assessment of efficacy, and judgment of prognosis are key clinical problems. Ultrasound (US) has important clinical value in the diagnosis and treatment of lymphoma. This article reviews the progress made with new US technologies in improving the accuracy of diagnosis and staging of lymphoma, predicting the course of lymphoma, monitoring the progression of lesions during treatment, and assisting clinics in formulating accurate and effective treatment plans. In addition, we review the biological basis of US prediction of lymphoma and provide an outlook for future research directions.

Papillary thyroid carcinoma (PTC) is a highly prevalent cancer that typically exhibits indolent behavior and is associated with a favorable prognosis. The treatment of choice is surgical intervention; however, this approach carries the risk of complications, including scarring and loss of thyroid function. Although active surveillance can mitigate the risk of PTC overtreatment, the possibility of tumor growth and metastasis can elicit anxiety among patients. Ultrasoundguided thermal ablation has emerged as a safe and effective alternative for individuals who are ineligible for or decline surgery. This article provides a review of the clinical research on radiofrequency ablation as a treatment for PTC, offering a thorough examination of its efficacy, safety, and future perspectives.

Background: The criteria for determining technical efficacy of thermal ablation for papillary thyroid carcinoma (PTC) are not clearly defined. We analyzed the involution process of the ablation zone with clear pathologic results on core-needle biopsy (CNB) to clarify the relationship between sonographic changes and pathologic findings. Methods: This retrospective cohort study included 382 patients with unifocal T1N0M0 PTC who underwent radiofrequency ablation (RFA) between May 2014 and August 2021. Patients with a single ablation zone biopsy (recommended at 3 or 6 months for T1a and 6 or 12 months for T1b) and regular neck ultrasound (US)/contrast-enhanced ultrasound imaging follow-up at 1, 3, 6, and 12 months and every 6–12 months thereafter after RFA were included. Patients also underwent yearly chest computed tomography. CNB was performed in the target lesion ablation zone's central, peripheral, and surrounding thyroid parenchyma to detect the presence of tumor cells. If the thyrotropin (TSH) was >2 mU/L, levothyroxine was prescribed with the intention of keeping the TSH 0.5–2 mU/L. Technical efficacy was defined as tumor disappearance by imaging follow-up together with the pathologically confirmed absence of tumor cells in the ablation zone. Results: During the mean follow-up period of 67.8 ± 18.2 months (22–110 months), the overall incidence of persistent disease and the technical efficacy rate were 3.9% (15/382; 2.9% of T1a, and 12.2% of T1b) and 96.1%, respectively. Tumor size ( p = 0.03) and subcapsular location ( p = 0.04) were risk factors associated with persistent disease. The technical success rate was 100%. Of the 367 ablation zones with benign CNB results, 336 (91.6%) showed tumor disappearance on US and no re-emergence of imaging-visible tumors during follow-up. Male sex ( p = 0.006), age p = 0.003), T1a tumor ( p < 0.01), and energy per milliliter ( p < 0.03) were significantly associated with tumor disappearance. Conclusions: US-guided RFA is an effective treatment for small low-risk PTC. Tumor disappearance on US after RFA may suggest an excellent prognosis and confirm complete ablation of the macroscopic tumor, but this sonographic finding is generally late and requires histological confirmation.