Validation of Diagnostic Performance and Interobserver Agreement of DTD-TIRADS for Diffuse Thyroid Disease on Ultrasound: A Single-Center Study

Thyroid Dysfunction in Mycosis Fungoides: Sonographic and Laboratory Insights

INTRODUCTION

Thyroid gland affection in mycosis fungoides has rarely been reported. It occurs as extracutaneous involvement, incidentally, as a second malignancy, or as a side effect of systemic retinoids.

OBJECTIVE

This study aimed to specifically screen for biochemical or structural thyroid gland affection in a larger number of mycoses fungoides patients.

METHODS

Twenty-eight mycosis fungoides patients received a formal thyroid ultrasound examination, and their thyroid hormones and anti-thyroid peroxidase antibody levels were evaluated.

RESULTS

Hypoechogenic thyroid gland (suggesting thyroiditis) was detected in 39.3% of patients, and 39.3% had thyroid nodules. Thyroid hormones and anti-thyroid peroxidase antibodies were normal in 92.9% of patients. There was a statistically significant relationship between the mycosis fungoides variant and glandular echogenicity. Eighty percent of patients with the hypopigmented variant had hypoechoic gland, compared to 43.8 % of patients with the patch stage and none of the patients with the poikilodermatous variant (P=0.017*). There was a statistically significant relationship between the mycosis fungoides variant and DTD-TIRADS score (P=0.014*). The mean duration of mycosis fungoides was longer in patients with DTD-TIRADS III and IV and with thyroid nodules, however, without statistical significance. Patients treated with systemic psoralen ultraviolet A phototherapy, compared to narrow-band ultraviolet B phototherapy, were more likely to have thyroiditis, however, without statistical significance (P=0.265).

CONCLUSIONS

We recommend regular screening for thyroid gland affection in mycosis fungoides patients because of the possible association with thyroiditis and thyroid nodules, especially in patients with the hypopigmented variant.

Ultrasonographic features and diagnostic accuracy of FNA and CNB in secondary thyroid malignancies: A retrospective study

Objective

This study aims to examine the ultrasonographic features of secondary thyroid malignancies and compare the diagnostic efficacy of fine-needle aspiration (FNA) and core needle biopsy (CNB) in this condition.

Methods

A retrospective analysis was conducted on 29 patients with secondary thyroid malignancies treated at our center between July 2011 and October 2022. Ultrasound images and clinical data were analyzed, and the lesions were classified according to the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS).

Results

Among the 29 patients studied, primary tumor sites were predominantly the esophagus, lung, and nasopharynx. Comprehensive ultrasound data was available for 28 of these patients, revealing nodular lesions in 24 cases and diffuse lesions in 4 cases. Nodular lesions were predominantly solid or nearly solid hypoechoic nodules with parallel growth and extrathyroidal extension features, with a few showing macrocalcifications. Most patients had varying degrees of metastasis to neck lymph nodes. FNA accurately diagnosed 31.6 % of the lesions as secondary thyroid malignancies, while 5.3 % were misdiagnosed as papillary thyroid carcinoma (PTC). However, CNB demonstrated 100 % reliability in diagnosing secondary thyroid malignancies.

Conclusion

This study's categorization of secondary thyroid malignancy ultrasonographic features identifies nodular and diffuse patterns, with the application of ACR TI-RADS proving effective for nodular types. In detecting these lesions, CNB demonstrates superior sensitivity compared to FNA. Thus, in cases of thyroid lesions suspected to be malignant, particularly with enlarged neck lymph nodes and in patients with a history of malignancy, CNB is recommended as the diagnostic method of choice.

Diagnostic Accuracy of Quantitative Imaging Biomarkers in the Differentiation of Benign and Malignant Vertebral Lesions : Combination of Diffusion-Weighted and Proton Density Fat Fraction Spine MRI

Purpose

To compare and combine the diagnostic performance of the apparent diffusion coefficient (ADC) derived from diffusion-weighted imaging (DWI) and proton density fat fraction (PDFF) derived from chemical-shift encoding (CSE)-based water-fat magnetic resonance imaging (MRI) for distinguishing benign and malignant vertebral bone marrow lesions (VBML).

Methods

A total of 55 consecutive patients with 53 benign (traumatic, inflammatory and primary) and 36 malignant (metastatic and hematologic) previously untreated VBMLs were prospectively enrolled in this IRB-approved study and underwent sagittal DWI (single-shot spin-echo echo-planar with multi-slice short TI inversion recovery fat suppression) and CSE-based MRI (gradient-echo 6‑point modified Dixon) in addition to routine clinical spine MRI at 1.5 T or 3.0 T. Diagnostic reference standard was established according to histopathology or imaging follow-up. The ADC = ADC (0, 800) and PDFF = fat / (water + fat) were calculated voxel-wise and examined for differences between benign and malignant lesions.

Results

The ADC and PDFF values of malignant lesions were significantly lower compared to benign lesions (mean ADC 861 × 10⁻⁶ mm²/s vs. 1323 × 10⁻⁶ mm²/s, p < 0.001; mean PDFF 3.1% vs. 28.2%, p < 0.001). The areas under the curve (AUC) and diagnostic accuracies were 0.847 (p < 0.001) and 85.4% (cut-off at 1084.4 × 10⁻⁶ mm²/s) for ADC and 0.940 (p < 0.001) and 89.9% for PDFF (cut-off at 7.8%), respectively. The combined use of ADC and PDFF improved the diagnostic accuracy to 96.6% (malignancy if ADC ≤ 1118.2 × 10⁻⁶ mm²/s and PDFF ≤ 20.0%, otherwise benign).

Conclusion

Quantitative evaluation of both ADC and PDFF was useful in differentiating benign VBMLs from malignancy. The combination of ADC and PDFF improved the diagnostic performance and yielded high diagnostic accuracy for the differentiation of benign and malignant VBMLs.