Objectives-To assess the diagnostic value of echogenic foci in papillary thyroid carcinoma (PTC) and the relationship between echogenic foci and aggressiveness of PTC.Methods-From January 2018 to January 2021, a total of 950 patients diagnosed with thyroid nodules (n = 1113) in our hospital were retrospectively analyzed. Among the 1113 nodules, single PTC in 527 patients confirmed by surgery was studied for their aggressive biological behavior. The patterns of echogenic foci were classified as: no echogenic foci, sparse punctate echogenic foci, focal punctate echogenic foci, diffuse punctate echogenic foci, petal-like punctate echogenic foci, comet-tail artifacts, coarse echogenic foci, peripheral rim (eggshell echogenic foci), and mixed echogenic foci. The clinical and ultrasonographic characteristics were also analyzed. A univariate analysis was performed, and binary logistic regression was performed to screen independent risk factors.Results-For the differential diagnosis of PTC, age < 50 years, size <1.1 cm, hypoechoic or very hypoechoic, aspect ratio > 1, irregular shape, types II (punctate echogenic foci) and VI (mixed echogenic foci) were independent risk factors. For the aggressive biological behavior of PTC, male sex, age<42 years, size <1.0 cm, types IIb (focal punctate echogenic foci), IIc (diffuse punctate echogenic foci), and VI (mixed echogenic foci) were independent risk factors for predicting cervical lymph node metastasis of PTC.Conclusion-Echogenic foci are useful in diagnosing PTC and predicting aggressiveness of PTC, which contribute to screening invasive PTC and avoiding overdiagnosis and overtreatment.
To the Editor: Thank you very much for your interest in our published article entitled "Value of Echogenic Foci in Diagnosing Papillary Thyroid Carcinoma and Predicting Aggressive Biological Behavior". In response to the information contained in your letter to the editor, we respond as follows:1. In this article, Type III (comet-tail artifacts) refers to the larger comet tail. We apologize for not specifying it in the text. 2. The diagnostic value of peripheral rim calcification in PTC is still controversial. In this study, there were a total of 21 nodules with Type V (peripheral rim or eggshell-like echogenic foci), of which 18 were benign and 3 were malignant. After classifying the nodules according to echogenicity, Type V were associated with benign nodules in all hypoechoic and very hypoechoic nodules (P = .000). However, in this group of data, there were a total of three isoechoic and hyperechoic nodules with Type V, all of them were benign. (Table 1) 3. We totally agree with the letter writer that the frequency of the probe is important to evaluate thyroid nodules. This was a retrospective study. Two devices were used in this study: iU22 scanner (Phillips Medical Systems, Netherlands) or an ACUSON Sequoia (Siemens Medical Solutions, Germany). The iU22 scanner has a linear probe of 5-12 MHz and ACUSONS Sequoia has a linear probe of 4-10 MHz.In previous related studies, [1][2][3][4][5] the frequency of the transducers used by different investigators was also different. Some transducers were close to 10-14 MHz or higher than that and others were lower than that.The doctors were based on maximizing the display of nodules as well as the ultrasonographic features of nodules when acquiring images. At the same time, we are aware of the limitations of this study. And at the "Limitations of this study" in the article, it is proposed that the sensitivity of two different ultrasound devices to calcification may be different. In future studies and clinical practice, we will avoid such problems as far as possible.
Introduction. Nonspecific chronic low back pain (NCLBP) became a public health and economic problem. Acupoint injection was used widely for patients with NCLBP. However, there were inconsistent results on the efficacy for these people. Therefore, this review was performed to systematically assess the efficacy and safety of acupoint injection. Materials and Methods. The literature sources were collected via EMBASE, Medline, CENTRAL, CINAHL, CNKI, VIP, Wanfang, and Sino-Med Database from their inception to October 13, 2019. Endnote X7, widely used document management software, was used to manage and screen the literature sources. Each record was screened according to the predetermined inclusion criteria by two review authors independently. Quality assessment tool, “Risk of table,” was used to assess the quality of the included studies according to the recommendation of the Cochrane Handbook for Systematic Reviews of Interventions. Data extraction was performed by one reviewer and verified by another reviewer. Any disagreement was addressed via consulting with a third reviewer in the abovementioned processes. All procedures were performed according to the Cochrane Handbook for Systematic Reviews of Interventions. Results. This review included 13 studies involving 1381 patients with NCLBP. Quantitative analysis results indicated that there is no sufficient evidence that acupoint injection can improve the pain of patients with low back pain based on two trails: Visual Analogue Scale (VAS: MD = −1.33, 95% confidence interval (95% CI) −3.30 to 0.64, P = 0.18 , random-effect model). When assessing the effectiveness of acupoint injection therapy, the results indicated that acupoint injection can improve the effective rate for nonspecific chronic low back pain (OR = 3.64, 95% CI 2.4 to 5.21, P < 0.0001 , fixed-effect model). Conclusion. There is insufficient evidence to indicate that acupoint injection therapy could improve the pain for patients with NCLBP. However, the level of evidence was downgraded to “very low quality” because of the poor methodological quality and clinical heterogeneity. The results should be interpreted with caution. Higher quality RCTs with more appropriate comparison, more objective outcome instruments, and adequate follow-up periods are necessary to assess the efficacy of acupoint injection for NCLBP. The PROSPERO Research registration identifying number is CRD42019119158.
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