To the Editor: We have read with great interest the article by Wang et al, titled "Value of echogenic foci in diagnosing papillary thyroid carcinoma and predicting aggressive biological behavior." 1 The aim of this retrospective study was to classify the echogenic foci viewed in thyroid nodules, establish association with papillary carcinoma, and to correlate biological aggressiveness by the presence of cervical lymph node metastasis. Hence, this work is of vast significance for our diagnostic center to evaluate echogenic foci, however, we have some thoughts and questions about the study.The authors interestingly found that punctate and mixed echogenic foci are associated with higher malignancy risk and those nodules with comet-tail artifacts and with peripheral rim were protective factors for papillary carcinoma with PPV of 84.6 and 85.7%, respectively. Although about the latest finding,
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