• Calcification and size are associated with false negative SWE in malignant NMLs. • In situ cancer is associated with false negative SWE in malignant NMLs. • Distance from the nipple is associated with false positive SWE in benign NMLs. • These factors need consideration when performing SWE on breast NMLs.
Astroblastoma is one of the very unusual type of tumors, whose histogenesis has not been clarified. It occurs mainly among children or young adults. Astroblastoma is grossly well-demarcated, and shows histologically characteristic perivascular pseudorosettes with frequent vascular hyalinization. Perivascular pseudorosettes in astroblastoma have short and thick cytoplasmic processes and blunt-ended foot plates. A 15-yr-old girl presented with headache and diplopia for one and a half year. A well-demarcated mass, 9.7 cm in diameter, was found in the right frontal lobe in brain MRI, and it was a well-enhanced inhomogenous mass. Cystic changes of various sizes were observed inside the tumor mass as well as in the posterior part of the mass, but no peritumoral edema was found. Histologically, this mass belongs to a typical astroblastoma, and no sign of anaplastic astrocytoma, gemistocytic astrocytoma or glioblastoma was found in any part of the tumor. Immunohistochemically, the tumor cells showed diffuse strong positivity for glial fibrillary acidic protein, S-100 protein, vimentin and neuron specific enolase, and focal positivity for epithelial membrane antigen and CAM 5.2, while showing negativity for synaptophysin, neurofilament protein, pan-cytokeratin and high molecular weight keratin.
We aimed to evaluate the diagnostic performance of thyroid ultrasonography (US) in each category of the Bethesda system and analyze false positive/negative findings using US. This retrospective study included 622 thyroid nodules in 592 patients. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and accuracy of US in each category of the Bethesda system were evaluated. False positive/negative cases of US were analyzed. Out of the 622 total thyroid FNAs, 179 (28.8%) were malignant. The malignancy rates for the 6 categories were as follows: I (nondiagnostic): 9.7%, II (benign): 2.5%, III (atypia/follicular lesion of undetermined significance): 37.5%, IV (suspicious for follicular neoplasm): 5.7%, V (suspicious for malignancy): 100%, and VI (malignancy): 100%. The accuracies of US for the 6 categories were 92.5%, 95.6%, 70.8%, 94.3%, 95%, and 92.4% in category order. US showed the lowest sensitivity (50%) in Category IV. Category III demonstrated relatively low sensitivity (66.7%) and specificity (73.3%) due to a high incidence of follicular variant of papillary thyroid carcinoma and a low number of category III nodules. The most optimal performance of US was revealed in Category I with 88.9% sensitivity and 92.9% specificity. In 22 US false positive cases, the most frequent finding was associated with marked hypoechogenicity and the least finding was noncircumscribed margin. The most common US features of 19 false negative cases were circumscribed iso or hypoechoic nodules. These results highlight the excellent diagnostic performance of US in category I of the Bethesda system and the lowest sensitivity of US in category IV. Awareness of US interpreters regarding these pitfalls can minimize false positive/negative diagnoses and prevent unnecessary interventions.
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