Background
Diagnosis of giant cell arteritis by temporal artery biopsy is time-consuming and visual loss lies in the first week after its diagnosis. The purpose of the study was to test the hypothesis that ultrasound can reduce the risk of overdiagnosis and overtreatment in giant cell arteritis.
Methods
Data regarding physical/ clinical features examinations, temporal artery biopsy examinations, ultrasound findings, and magnetic resonance imaging examinations of 980 suspected patients for giant cell arteritis were included in the study. Decision curve analysis was applied to get a beneficial score for selected diagnostic modalities. Cost analysis was performed for each patient.
Results
Fewer numbers of false positive giant cell arteritis results were reported under physical/ clinical features examinations following ultrasound detection than physical/clinical features examinations following temporal artery biopsy examinations (45 vs. 127,
p
< 0.0001). The working area that detects giant cell arteritis at least one time for physical/ clinical features examinations following ultrasound detection and physical/ clinical features examinations following temporal artery biopsy examinations were 0–91% and 0–86%. No significant difference for true negative results between magnetic resonance imaging and physical and clinical features examinations following ultrasound detection (
p
= 0.007). Physical and clinical features examinations following ultrasound detection were less expensive method than physical/ clinical features examinations following temporal artery biopsy examinations (14,023 ± 982 ¥/patient vs. 18,551 ± 1231 ¥/patient,
p
< 0.0001) and MRI.
Conclusion
Physical and clinical features examinations following ultrasound are recommended for diagnosis of patients with suspected giant cell arteritis.
Objective: The objective of the study was to develop an association between clinicopathologic and sonographic features of patients with papillary thyroid microcarcinoma and the prevalence of lymph node metastasis. Subjects and methods: Clinicopathologic and sonographic features of 415 patients of papillary thyroid microcarcinoma with (n = 102) or without (n = 313) lymph node metastasis were retrospectively reviewed. The thickness of the lymph node ≥ 6 mm with intra-lymph nodal occupying lesions considered lymph node metastasis. Also, it was considered metastasis if lymph node perfusion or blood flow defect was found with any thickness size. Univariate following multivariate analysis was performed for the prediction of sonographic features and clinicopathologic factors for the prevalence of lymph node metastasis. Results: Male gender (p = 0.041), age < 45 years (p = 0.042), preoperative calcitonin > 65 pg/ mL (p = 0.039), nodule size > 5 mm in diameter (p = 0.038), bilaterality (p = 0.038), tumor capsular invasion (p = 0.048), cystic change (p = 0.047), and hyper vascularity (p = 0.049) of thyroid nodules were associated with lymph node metastasis. Also, thyroid nodules 5 mm and more in diameter may have high aggressiveness. Conclusion: These data helped the surgeon for individualized treatment in thyroid carcinoma and avoid unnecessary prophylactic surgery of the lymph node.
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