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PubMed1994

Stereotactic aspiration biopsy of nonpalpable nodules of the breast.

To evaluate the reliability of stereotactic aspiration biopsy (SAB) in assessing which nonpalpable nodules of the breast should be excised, SAB was performed upon 373 nodules. The nodules were classified as well-circumscribed or irregular and evaluated for the presence of microcalcifications. The cytologic diagnoses were classified as malignant, atypical or benign. Cytologically malignant and atypical nodules were excised. Benign nodules were excised if there was a family or past history of carcinoma of the breast or if they changed mammographically. Twenty-five nodules proved to be malignant. Of these, the diagnoses by stereotactic aspiration biopsy were adenocarcinoma in 20 patients, atypical in three, malignant hemangiopericytoma in one patient and benign in one. The borders of the malignant nodules were well-defined in eight patients and irregular in 17. Three malignant nodules with irregular borders had clustered microcalcifications. One false-positive instance was a sclerosing papilloma with atypical hyperplasia. Twenty-four nodules with benign cytologic diagnoses, which were excised, proved to be benign. An additional 132 nodules with benign cytologic diagnoses had six month interval mammograms for two years; 131 were without interval change and one increased in size and proved to be a carcinoma. SAB is reliable for diagnosing nonpalpable nodules. Nodules with malignant and atypical results must be excised. It is reasonable to have follow-up evaluation of well-defined nodules mammographically when the aspirate is benign.

Adenocarcinoma↗

PubMedDate not supplied

[Satellite intrarenal tumor nodules in renal carcinoma. Therapeutic implications].

OBJECTIVES: To analyze the incidence of tumoral satellite nodules in renal carcinoma, study the main features of the primary tumor and establish an approach to determine the risk of multicentricity. METHODS: We analyzed 286 radical nephrectomies due to renal carcinoma. Twenty-nine cases (10.13%) that had intrarenal tumoral nodules were chosen; 5 cases (17.2%) had adenoma and 24(82.8%) had carcinoma. All but one case with von Hippel Lindau disease were sporadic tumors. The main features of the principal tumor (size, cellular type, architectural features, grade and stage) in both groups with and without nodules, were analyzed and compared. RESULTS: The mean diameter was 7.89 +/- 4.091 cm (range 3.5-20) for the tumor and 0.85 +/- 0.65 cm (range 0.1-3) for the nodule. The mean tumor diameter was not significantly different from that of the group with no nodules (mean tumor diameter 8.16 +/- 3.58, range 2-25). Ten cases had only 1 nodule (34.48%), 4 had 2 (13.79%), 2 had 3 (6.89%), 3 had 4 (10.34%) and 10 had 5 or more nodules (34.48%). The mean age was 56.89 +/- 11.46 (range 22-76); 24 were males (82.75%) and 5 females (17.14%); 14 cases were located in the right (28.27%) and 15 in the left side (51.72%). The foregoing data were not significantly different from those of the group with no nodules. Nineteen cases had clear cell, 5 granular, 4 mixed and 1 had the fusiform cell type. Seventeen cases were grade 2 (68%) and 8 cases grade 3 (32%); there were no G1 or G4. Ten were Robson stage I (34.48%), 2 were stage II (6.89%), 11 stage III (37.93%) and 6 stage IV (20.68%). Three cases had local recurrence (10.34%). No differences were observed for survival between the two groups. A 3 cm nodule was diagnosed preoperatively in only one case. Assuming the following criteria of a localized tumor, stage I, with a diameter less than 5 cm for performing elective nephron-sparing surgery, only 8 of the 43 cases that met the foregoing criteria had nodules (16.18%). Of these, 4 (2 of which were adenomas) had a single nodule (9.3%). If the criterion of low grade (G1-G2) tumor is also considered, only 5 of the 27 cases that met the foregoing additional criterion had nodules (14.7%). CONCLUSIONS: When nephron-sparing surgery is performed, it should be remembered that there is an approximately 10% risk of leaving tumor nodules of small size in the kidney which may cause local recurrence. Consequently, these patients should be followed very closely.

Adult↗

PubMed2005

Quantitative nodule detection in low dose chest CT scans: new template modeling and evaluation for CAD system design.

Automatic diagnosis of lung nodules for early detection of lung cancer is the goal of a number of screening studies worldwide. With the improvements in resolution and scanning time of low dose chest CT scanners, nodule detection and identification is continuously improving. In this paper we describe the latest improvements introduced by our group in automatic detection of lung nodules. We introduce a new template for nodule detection using level sets which describes various physical nodules irrespective of shape, size and distribution of gray levels. The template parameters are estimated automatically from the segmented data (after the first two steps of our CAD system for automatic nodule detection) - no a priori learning of the parameters density function is needed. We show quantitatively that this template modeling approach drastically reduces the number of false positives in the nodule detection (the third step of our CAD system for automatic nodule detection), thus improving the overall accuracy of CAD systems. We compare the performance of this approach with other approaches in the literature and with respect to human experts. The impact of the new template model includes: 1) flexibility with respect to nodule topology - thus various nodules can be detected simultaneously by the same technique; 2) automatic parameter estimation of the nodule models using the gray level information of the segmented data; and 3) the ability to provide exhaustive search for all the possible nodules in the scan without excessive processing time - this provides an enhanced accuracy of the CAD system without increase in the overall diagnosis time.

Algorithms↗

PubMed2006

Insertion of virtual pulmonary nodules in CT data of the chest: development of a software tool.

The purpose of this study was to develop a software tool for the insertion of virtual lung nodules into CT data. Forty software-generated nodules were inserted at random locations and sizes on 20 multi-detector row CT studies of the chest (4 x 1-2.5-mm slice collimation). On each scan, two virtual nodules were inserted. The size, shape, margin and attenuation could arbitrarily vary and were individually adjusted to match real lesions of each patient (real nodules: 6.5+/-3.1 mm; virtual nodules: 6.1+/-3.2 mm). Additionally, noise and a random pattern simulating local density variations were added to virtual nodules. Three blinded readers evaluated 40 real and 40 simulated nodules according to a 5-point confidence scale ranging from 1 (definitely simulated) to 5 (definitely real). A multivariate analysis of covariance was performed for statistical assessment (SPSS 11.5, Chicago, IL). Real and simulated lesions were indistinguishable for all three readers (Pillai's trace statistic: P=0.881). However, nodule size was a statistically significant covariable regarding the differentiation of virtual compared to real nodules. Larger simulated nodules were easier to detect than smaller ones (Pillai's trace statistic: P<0.05). The developed algorithm allowed for the synthetic generation of lung nodules that were indistinguishable from real nodules.

Algorithms↗

PubMed2006

Pulmonary nodule characterization: a comparison of conventional with quantitative and visual semi-quantitative analyses using contrast enhancement maps.

PURPOSE: To determine whether conventional nodule densitometry or analysis based on contrast enhancement maps of indeterminate lung nodules imaged with contrast-enhanced CT can distinguish benign from malignant lung nodules. MATERIALS AND METHOD: Thin section, contrast-enhanced CT (baseline, and post-contrast series acquired at 45, 90,180, and 360 s) was performed on 29 patients with indeterminate lung nodules (14 benign, 15 malignant). A thoracic radiologist identified the boundary of each nodule using semi-automated contouring to form a 3D region-of-interest (ROI) on each image series. The post-contrast series having the maximum mean enhancement was then volumetrically registered to the baseline series. The two series were subtracted volumetrically and the subtracted voxels were quantized into seven color-coded bins, forming a contrast enhancement map (CEM). Conventional nodule densitometry was performed to obtain the maximum difference in mean enhancement values for each nodule from a circular ROI. Three thoracic radiologists performed visual semi-quantitative analysis of each nodule, scoring each map for: (a) magnitude and (b) heterogeneity of enhancement throughout the entire volume of the nodule on a five-point scale. Receiver operator characteristic (ROC) analysis was conducted on these features to evaluate their diagnostic efficacy. Finally, 14 quantitative texture features were calculated for each map. A statistical analysis was performed to combine the 14 texture features to a single factor. ROC analysis of the derived aggregate factor was done as an indicator of malignancy. All features were analyzed for differences between benign and malignant nodules. RESULTS: Using 15 HU as a threshold, 93% (14/15) of malignant and 79% (11/14) of benign nodules demonstrated enhancement. The ROC curve when higher values of enhancement indicate malignancy was generated and area under the curve (AUC) was 0.76. The visually scored magnitude of enhancement was found to be less effective in distinguishing malignant from benign lesions, with an average AUC of 0.62. The visually scored pattern of enhancement was found to be more effective with an average AUC of 0.79. From the statistical analysis performed to combine the texture features to a single factor, the area under the ROC curve was 0.84. CONCLUSION: The present study suggests that visual semi-quantitative and quantitative characterization of contrast enhancement patterns may potentially enhance the discrimination between benign and malignant nodules. Further studies and correlation with pathologic material will be important to better understand the potential interplay between CT enhancement features, host stromal elements, and neovascularity that may contribute to these patterns.

Adult↗

PubMed2001

[Multidetector-row CT of the lungs: Multiplanar reconstructions and maximum intensity projections for the detection of pulmonary nodules].

PURPOSE: The present study was performed to evaluate the utility of axial, coronal and sagittal multiplanar reformations (MPR) and maximum intensity projections (MIP) in the detection of pulmonary nodules as compared to axial standard reconstructions (SR). MATERIALS AND METHODS: 103 patients with suspicion or evidence of pulmonary nodules underwent multidetector-row computed tomography (MDCT; Somatom plus 4 Volume Zoom, Siemens, Germany) of the chest in a single-breath-hold technique. The raw data were acquired with a collimation of 1 mm and a pitch of 6 and underwent reconstruction with 0.6 mm increment. MPR and MIP in three planes [5 mm slice thickness (SL), 4 mm increment] were calculated from the raw data and compared to axial SR (5 mm SL). Three blinded observers evaluated the number, size and the quality of depiction of pulmonary nodules according to a 3-point confidence scale (1 = certain, 2 = probable, 3 = uncertain). Four patient groups were formed using the axial SR. Group 1 presenting no nodules, group 2 presenting probable nodules and group 3 presenting definitively lung nodules. Patients with more than 7 pulmonary nodules (group 4) were not included in the study. The 1 mm slice was used as the gold standard. RESULTS: Inter-observer correlation was good at r = 0.77. MIP were superior in the depiction of pulmonary nodules at a statistically significant level of p < 0.05 (mean values in group 3 = 2.58 to 1.97 and group 2 = 0.99 to 0.79 with MIP and SR, respectively). In four patients 6 additional lesions were identified with MIP that were missed with axial SR. Overall, with SR 72 nodules, with MPRs 78, and with MIPs 99 nodules were delineated. Pulmonary nodules larger than 5 mm in size were equally well depicted with both modalities, whereas lesions smaller than 5 mm in size were significantly better depicted with MIP (p < 0.05). Diagnostic confidence for all lesions was highest with MIP and least with SR. CONCLUSION: MIP reformations on the basis of MDCT data sets are superior in the depiction and diagnosis of pulmonary nodules as compared to axial standard reconstructions and MPR.

Adolescent↗

PubMed2005

[Lung nodule detection with ultra-low-dose CT in routine follow-up of cancer patients].

PURPOSE: To evaluate the value of an ultra-low-dose CT protocol (ULD-CT) in the dectection of lungnodules in follow-up of cancer patients. MATERIAL AND METHODS: Between April and August 2003, 72 consecutive patients with a history of malignancy were prospectively examined on a single-slice helical CT scanner (Aquilion, Toshiba) with ULD-CT (120 kV, 5 mAs, D-eff 0.12 mSv) and regular-dose CT (R-CT) (120 kV, 150 mAs, D-eff 4.8 mSv). The ULD-CT examinations were independently evaluated by two radiologists. Afterwards, consensus reading of the ULD-CT and R-CT examinations was done. Individual nodules were classified benign (benign calcifications) and non-benign. The studies were classified in 4 subgroups: 1) non-benign nodule evident; 2) non-benign nodule probable; 3) non-benign nodule possible, but not likely; 4) no-non benign nodule. RESULTS: ULD-CT detected 180 nodules in 47 patients, while R-CT showed 168 nodules in 39 patients. The sensitivity of ULD-CT was 87 % in detecting nodules regardless of size and 94 % in detecting nodules > or = 5 mm. Regarding the prediction of a case with non-benign nodules (subgroups 1 to 3), the sensitivity of ULD-CT was 94 % and the specificity 75 %. CONCLUSION: ULD-CT is a good diagnostic tool in detecting lung nodules > or = 5 mm. Radiation dose can be markedly reduced. A negative ULD-CT study excludes non-benign nodules in R-CT with a high probability. In case of a positive ULD-CT, R-CT can be immediately followed.

Adult↗

PubMed1986

Computerized search of chest radiographs for nodules.

A computer program that recognizes potential pulmonary nodules in PA chest radiographs has been developed. This program produces a display of candidate nodules that require interpretation by a radiologist. Some false positives are rejected by a program, the Nodule Expert. Detection performance with and without Nodule Expert has been evaluated. Using the untrained program (no Nodule Expert), and after inspecting 45 candidate nodules, a radiologist may be confident that a nodule was inspected, if one was located by the program. When pattern recognition techniques are incorporated, the number of false positives presented for inspection is reduced. The radiologist must inspect, at most, 10 candidate nodules to be confident of having inspected a nodule, if one was located by the program. Concomitant with this decrease in the candidate nodule false-positive rate is a decrease in sensitivity (film true-positive rate) from 92 to 86%. This program was trained on candidate nodules from 37 radiographs and also tested on these 37. Some of the features used by the pattern classifier to classify candidate nodules are comparable to those used by human observers.

Diagnosis, Computer-Assisted↗

PubMed1998

A comparative phenotypical analysis of rheumatoid nodules and rheumatoid synovium with special reference to adhesion molecules and activation markers.

OBJECTIVES: (1) To analyse the in situ expression of adhesion molecules in rheumatoid nodules. (2) To compare the endothelial expression of adhesion molecules in synovial tissue and subcutaneous nodules obtained from the same patients. (3) To compare the expression of adhesion molecules and activation markers on T cell lines from nodules and synovium. METHODS: (1) Immunohistochemical analysis by APAAP technique of E selectin, CD44, ICAM-1, PECAM-1, and VCAM-1 was performed on 10 rheumatoid nodules from seven patients with rheumatoid arthritis (RA); nodules and synovium were simultaneously analysed from three patients. (2) T cell lines were generated from RA nodules (n = 7) and synovium (n = 7) by interleukin 2 expansion, and subsequently characterised by flow cytometry for surface expression of alpha E beta 7, alpha 4 beta 7, CD44, L selectin, LFA-1a, PECAM-1, and CD30. RESULTS: (1) In rheumatoid nodules, the palisading layer strongly stains for ICAM-1 and PECAM-1, but less pronounced for CD44. VCAM-1 staining was usually negative. ICAM-1 is upregulated in the vessels surrounding the central zone of fibrinoid necrosis. The immunohistological picture in different nodules derived from the same patient was similar. (2) The endothelial expression of adhesion molecules is comparable in RA nodules and synovium on an individual level, except for E selectin, which is overexpressed in nodule endothelium. (3) T cell lines from nodules and synovium display similar adhesion molecule profiles. However, the expression of CD30, a T cell activation marker linked with Th2 subsets, is higher in nodules compared with synovium. CONCLUSION: These data support a recirculation hypothesis of T cells between articular and extra-articular manifestations in RA, although the activation state of the T cells in each of these localisations may differ.

Adult↗

PubMed2003

Subtle lung nodules: influence of local anatomic variations on detection.

PURPOSE: To assess the influence of local anatomic noise on the detection of subtle lung nodules depicted on chest radiographs. MATERIALS AND METHODS: Six 8 x 8-cm lung regions were extracted from digital chest radiographs obtained in healthy subjects. Simulated nodules emulating the radiographic characteristics of subtle tissue-equivalent lesions 3.2-6.4 mm in diameter (equivalent to 0.1-0.4 mm in contrast-diameter product [CD]) were added to the images. On multiple renditions of each image, nodules were inserted at slightly different locations within 6 mm of the center; this process allowed different local background patterns to overlie the nodules. An observer detection study involving 15 experienced radiologists was performed. The authors performed analysis of variance and pairwise t test analyses to determine variations in nodule detectability related to nodule location and size on each image. RESULTS: Results indicated a strong correlation between nodule size and observer detection score and significant variation in nodule detectability as a function of location. Changes in nodule position caused observer score variations that were equivalent to the variation caused by an up to 185% change in nodule CD (78% average over all six images), an up to 68% change in diameter (32% average), and an up to 28% change in area under the receiver operating characteristic curve (Az) (14% average). CONCLUSION: Local anatomic variations surrounding and overlying a subtle lung nodule on a chest radiograph that are created by the projection of anatomic features in the thorax, such as ribs and pulmonary vessels, can greatly influence the detection of nodules, altering the Az by as much as 28%.

Analysis of Variance↗

PubMed2005

High prevalence of suspicious cytology in thyroid nodules associated with positive thyroid autoantibodies.

OBJECTIVE: We assessed the association between thyroid autoimmunity and thyroid cancer in a retrospective series of unselected thyroid nodules submitted to fine-needle aspiration cytology (FNAC) to avoid the selection bias of surgical series. SUBJECTS AND METHODS: Ultrasound (US)-guided FNACs were obtained from 590 unselected consecutive patients with single thyroid nodules and positive (ATA + , n = 197) or negative (ATA - , n = 393) serum anti-thyroid antibody (ATA). Cytological results were classified in three classes of increased risk of malignancy: low risk or benign (class II); indeterminate risk (class III); and suspect or malignant (class IV). RESULTS: A higher prevalence of class III (28.9% vs 21.4%, P < 0.05) and class IV (18.8% vs 9.2%, P < 0.001) and lower prevalence of class II (52.3% vs 69.5%, P < 0.001) were found in ATA + vs ATA - nodules respectively. By multivariate logistic regression analysis ATA + conferred a significant risk (odds ratio (OR): 2.29 (95% confidence interval (CI): 1.39-3.76)) for class IV cytology independently from age and sex. In 106 patients where thyroidectomy was carried out, thyroid cancer was found in 54/61 (88.5%) patients with class IV nodules (with similar positive predictive value for cancer in ATA + (96.4%) and ATA- (81.8%) nodules), in 6/31 (19.3%) of class III nodules (all ATA - ) and in none of 14 class II nodules. Non-specific cytological atypias from hyperplastic nodules in lymphocytic thyroiditis probably accounted for the different prevalence of cancer in class III ATA + and ATA - nodules. Histologically proven thyroid cancer (mostly papillary) was then observed in a higher proportion (27/197 = 13.7%) of ATA + , when compared with ATA - nodules (33/393 = 8.4%, P = 0.044), but the significance of this finding is limited by the low number of class II nodules operated on. CONCLUSIONS: The presence of ATA + confers an increased risk of suspicious or malignant cytology in unselected thyroid nodules. Since ATA + is not responsible for increased false-positive class IV FNAC, our study provides indirect evidence supporting a significant association between thyroid carcinoma and thyroid autoimmunity, although further studies with a different design are needed for a definitive histological proof.

Adult↗

PubMed2000

[The diagnosis and operative treatment of solitary thyroid nodule: a prospective study].

The aim of the paper is to evaluate the usefulness of pre- and intraoperative examination methods in the diagnostics of solitary thyroid nodules, as well as the assessment of the histologic structure of these nodules. From 1.12.1997 to 15.06.1998 in the Clinic of Endocrinological and General Surgery at the Medical University of Lodz, 102 patients were operated for a solitary nodule. The solitary nodule was diagnosed on the basis of the clinical and ultrasound examination. A fine needle aspiration biopsy (FNAB) was performed in all patients. During the operation the presence of the solitary nodule was confirmed on the basis of macroscopic examination. If malignancy was suspected on intraoperative macroscopic examination, intraoperative histologic examination was carried out. In 82 patients with the solitary nodule, the benign nodule was diagnosed on the basis of FNAB in 45 (54.9%) patients and malignant one in 8 (9.7%). Malignancy in the nodule (follicular tumour, Hürthle cell tumour, cellulae suspectae) was suspected in 29 (35.4%) patients--in this group the intraoperative histologic examination was conducted. On the basis of postoperative histologic examination a thyroid malignant neoplasm was detected in 18 (21.9%) of 82 patients with the solitary nodule. Finally, out of 18 thyroid cancers, 8 (44.4%) were recognised preoperatively (FNAB), 3 (16.7%) intraoperatively and 7 postoperatively. Since the incidence of malignancy in solitary thyroid nodules is high the authors suggest that their precise pre- and intraoperative diagnostics is necessary. The use of described diagnostic methods enabled to recognise malignancy in the solitary nodule and to perform a primary radical operation in 61.1% patients. On the basis of the obtained results it seems justifiable to search new diagnostic methods which enable better pre- and intraoperative differentiation of benign and malignant thyroid nodules.

Adolescent↗

PubMedDate not supplied

[Thyroid gland nodules registered at the Endocrinology Department of the Medical Center in Prokuplje].

INTRODUCTION: Thyroid nodules are often found in clinical practice. General population prevalence is about 4%, whereas in women it is over 6%. The basic disorder of cell kinetics of thyroid tumors is inappropriate growth response to corresponding thyroid-stimulating hormone (TSH) concentration. MATERIAL AND METHODS: At the Endocrinology Department of Medical Centre in Prokuplje, during the first year of practice (1997), 430 patients with thyroid gland disease were registered, both male and female belonging to different age groups. Patients were examined in regard to: sex, age, heredity, symptoms. Basic laboratory analyses were done with the aim to establish inflammatory syndromes: sedimentation, leukocytes, differential blood picture, cholesterolemia and fibrinogenemia; hormones of thyroid glands (T3, T4, TSH) with corresponding radioimmunoassay (RIA) technique. In the aim of identifying the nodules in the thyroid gland and perceiving nodular features, an ultrasound examining was done and scintigraphy of thyroid gland if necessary. Scintigraphy was done with radioactive technicium-99 mTc. RESULTS: From the total number of registered patients (430) with thyroid gland disease, nodules were found in 172 glands (40%). The presence of thyroid nodules is more frequent in women (91.3%). The average age of thyroid gland patients is 50.33 years, of which men aged 52 and women aged 50.17. The following risk factors are stated as the most frequent: chronic stress 58.13%, consuming goiter substances 46.51% (cabbage, kale, sulphonamide). Swollen thyroid gland--goiter occurred in 105 cases (61.07%), whereas in 120 patients (69.32%) normal function was registered. In most cases the nodules are solitary 90 (52.32%). In 71.01% of patients cold nodules were found. In 36.04% of patients nodules were 1 to 1.9 cm in size. The greatest number of patients--83 (36.61%) complained of heart disorder as a symptom. 2.9% out of 172 patients with thyroid nodules underwent operation. DISCUSSION: The obtained data mostly coincide with the findings of other authors. Trbojević found thyroid nodules 3 to 4 times more often with women. In this research it is ten times more frequent. Bozović especially pointed out the existence of inflammatory factors, mentioned in this group in 12.97% cases. We can not neglect the hereditary factor either--11.62% which is not clearly defined by other authors [1,2,3]. According to Trbojević, solitary nodules are present in 60% of cases. In this research the number is 52.32%. Cold nodules are found in 71.07% (according to Trbojević 90%). Only 2.9% of patients were operated, which is not enough if we follow all the medical indications. CONCLUSION: Out of the total number of patients (430) with thyroid gland disease, 172 patients (40%) with nodular changes in thyroid glands have been found. Far more frequent (90%) are women aged 51 to 60 years (after menopause). The number of operated patients with thyroid nodules is insufficient.

Adult↗

PubMed2005

Clinical importance of solitary solid nodule of the thyroid in endemic goiter region.

CONTEXT: Endemic area and iodine supplementation may affect the pathogenesis of the nodule which commonly occurs in endemic thyroid enlargement due to iodine deficiency. AIMS: To establish pathological changes in solitary solid and larger nodule of the thyroid in endemic area. SETTING AND DESIGN: Retrospective study in Surgical Department of University Hospital. METHODS AND MATERIAL: We determined 44 surgically treated patients with solitary solid nodule in endemic goiter area in which the population routinely receives iodinated salt. The thyroid nodule was preoperatively evaluated with blood chemistry, ultrasound, nuclear scanning and FNAC. The results of preoperative evaluation, surgical interventions, and histopathological examination were analyzed. STATISTICAL ANALYSIS: Student t test and Fisher's exact test. RESULTS: Twenty (45%;20/44) patients with hot (autonomous) nodule have received the diagnosis of toxic adenoma. Twenty four patients had solitary solid and cold nodule. Total thyroidectomy was performed on two patients with papillary cancer (PTC) diagnosed by FNAC from cold nodules. Forty two patients have been treated with total excision of the lobe including hyper or hypoactive solitary solid nodule. Pathological examination has reported two more cases of PTC and one case of insular cancer arising from cold nodules. Completion thyroidectomy was performed on these 3 patients. CONCLUSIONS: Solitary solid and large nodule is a common indication for thyroid surgery in endemic goiter area. High incidence of hyperthyroidism due to single autonomous nodule, and high rate of malignant change (mainly papillary cancer) in solitary hypoactive nodule arises from this series in endemic thyroid enlargement.

Adult↗

PubMed1990

[Computed tomography of the solitary pulmonary nodule].

The value of computed tomography (CT) using thin-slice technique in the differentiation between benign and malignant pulmonary nodules was evaluated both experimentally and clinically. Experiments using a standard reference phantom and simulation nodules showed that CT number varies according to the size of the nodule and the difference of CT unit. A standard CT number above which a nodule should be considered as calcified and benign was first calculated for various sizes of nodules and then was applied to clinical cases. Motion artifact which can give falsely high CT numbers was also created and its characteristic appearance was identified. Clinically 101 cases of solitary pulmonary nodules whose diagnoses were confirmed either histologically or on follow-up were studied. There were 40 benign nodules, 53 primary lung cancers, and 8 metastatic lung tumors. There was no case of malignancy in which calcification was diagnosed to be present on CT. On the other hand, 14 of 40 benign nodules (35.0%) was diagnosed to contain calcium and therefore benign on CT. As for the margin of the nodule described on CT, a moderate to marked irregularity was predominantly seen in primary lung cancers, while most benign nodules and metastatic lung tumors had smooth margins. If CT criteria for benignancy are limited to the nodule both with calcification and smooth margin, 13 of 40 cases (32.5%) would be correctly diagnosed. CT is considered to be useful in distinguishing between benign and malignant solitary pulmonary nodules as far as herein described technique is observed.

Adolescent↗

PubMed1998

Hürthle cell tumor dwelling in hot thyroid nodules: preoperative detection with technetium-99m-MIBI dual-phase scintigraphy.

UNLABELLED: Single injection dual-phase scintigraphy (early and late acquisitions) with 99mTc-MIBI was used to differentiate benign and malignant hot thyroid nodules. METHODS: Thirteen euthyroid and two hyperthyroid patients displaying a hot thyroid nodule on the 99mTc scan due to an autonomously functioning thyroid nodule (AFTN) underwent early (15-30 min) and late (3-4 hr) thyroid scintigraphy after the administration of 740-1000 MBq 99mTc-MIBI. Visual scoring was done to assess nodular tracer uptake and retention. In addition, the nodular-to-thyroid (N/T) uptake ratio in the early and late image and the washout rates (WO) from the nodule and thyroidal tissue were measured. All patients underwent thyroid surgery. RESULTS: Histopathology revealed a Hürthle cell tumor in three nodules, a benign adenoma with oxyphilic metaplasia in two nodules and a benign adenoma without oxyphilic cells in the remaining 10 nodules. The Hürthle cell tumor nodules displayed intense and persistent uptake of 99mTc-MIBI (N/T was 2.81 +/- 0.52 and 5.53 +/- 1.06 in early and late images, respectively; WO from the nodule was 12.33 +/- 0.47, WO from the thyroidal tissue was 22.00 +/- 3.56). The benign nodules showed intense uptake in the early image and intense uptake to absent retention in the late image (N/T was 2.94 +/- 1.31 and 1.62 +/- 0.50 in the early and late images, respectively; WO from the nodule was 20.25 +/- 2.92, WO from the thyroidal tissue was 20.33 +/- 2.92). CONCLUSION: Single injection dual-phase 99mTc-MIBI scintigraphy of the thyroid with AFTN can identify nodules as a result of the activity of a Hürthle cell tumor, since these tumors cause intense and persistent tracer uptake in contrast with a benign AFTN.

Adenoma, Oxyphilic↗

PubMed1991

nodT, a positively-acting cultivar specificity determinant controlling nodulation of Trifolium subterraneum by Rhizobium leguminosarum biovar trifolii.

Rhizobium leguminosarum biovar trifolii strain TA1 nodulates a range of Trifolium plants including red, white and subterranean clovers. Nitrogen-fixing nodules are promptly initiated on the tap roots of these plants at the site of inoculation. In contrast to these associations, strain TA1 has a 'Nod-' phenotype on a particular cultivar of subterranean clover called Woogenellup (A.H. Gibson, Aust J Agric Sci 19: (1968) 907-918) where it induces rare, poorly developed, slow-to-appear and ineffective lateral root nodules. By comparing the nodulation gene region of strain TA1 with that of another R. leguminosarum bv. trifolii strain ANU843, which is capable of efficiently nodulating cv. Woogenellup, we have shown that the nodT gene (B.P. Surin et al., Mol Microbiol 4: (1990) 245-252) is essential for nodulation on cv. Woogenellup. The nodT gene is naturally absent in strain TA1. A cosmid clone spanning the entire nodulation gene region of strain TA1 was capable of conferring nodulation ability to R.l. bv. trifolii strains deleted for nodulation genes, but only on cultivars of subterranean clovers nodulated by strain TA1. This shows that cultivar recognition events are, in part, determined by genes in the nodulation region of strain TA1. Complementation studies also indicated that strain TA1 contains negatively-acting genes located on the Sym plasmid and elsewhere, which specifically block nodulation of cv. Woogenellup.

Cloning, Molecular↗

PubMedDate not supplied

Significance of hyperattenuating and contrast-enhancing hepatic nodules detected in the cirrhotic liver during arterial phase helical CT in pre-liver transplant patients: radiologic-histopathologic correlation of explanted livers.

BACKGROUND: Hyperattenuating nodules detected by arterial phase helical computed tomography (HCT) in patients with cirrhosis usually are believed to represent hepatocellular carcinomas (HCCs). We correlated HCT morphology of hyperattenuating hepatic nodules detected during arterial phase scans with the histopathology of explanted livers of patients with hepatic cirrhosis undergoing liver transplantation. METHODS: Three hundred fifty-four patients had arterial and portal phase HCT performed before subsequent hepatic transplantation. Each patient received 180 mL of contrast by power injection at 5 mL/s. All hyperattenuating nodules detected on arterial phase HCT were assessed for morphology and evidence for contrast enhancement. Explanted livers in all patients were then sectioned at 10-mm intervals, and the histology of the nodules was correlated with the HCT findings. RESULTS: Sixty-one hyperattenuating nodules were detected on the arterial phase HCT in 43 patients: 41 nodules were benign regenerating nodules (RN), three were dysplastic nodules (DP), and 17 were HCCs. Most RN/DP nodules were 5-20 mm in diameter, had distinct margins, were homogeneous, and were isoattenuating on precontrast, portal, and delayed scans. Thirty-six showed positive contrast enhancement and displayed a wide range of attenuation profiles. HCC nodules were 6-50 mm. All showed positive contrast enhancement and displayed a wide range of attenuation profiles. CONCLUSION: Hyperattenuating nodules seen on arterial phase HCT are likely to be RN/DP nodules. In many cases, it is not possible to distinguish between RN/DP and HCC. Thus, clinical decisions regarding inclusion criteria for transplantation based on CT morphology of liver lesions may be tenuous.

Carcinoma, Hepatocellular↗