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      Clinical applications of high resolution usg.

    . !etection of thyroid and other cer"ical #asses $efore

    and after thyroidecto#y.

    2.  !i%erentiation of $enign fro# #alignant

    #asses.

    .Ultrasound detects the presence& si'e&

      site& nu#$er& characteristics of thyroid nodule

    2

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    Nor#al ultrasound anato#y of thyroid (t is located anterior

    and lateral to trachea $elo) the le"el of thyroid cartilage and a$o"e the sternal notch. *infrahyoid

    co#part#ent+

    !(,(-(N :

     R(/0T AN! L12T LB1-&

     (-T03U-

     P4RA3(!AL LB1 *5675 8+

    3

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    4

    Normal thyroid parenchyma has

    homogenous medium to high level echogenicity & bounded by a thin hyperechoic line(the

    thyroid capsule).

     Landmarks to be identiied!

    "idline #$rachea andoesophagus.

    Laterally# %ommon %arotid artery ' *nterolaterally!+trap

    muscles o the neck

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    ,

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    -

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    NR3AL !(31N-(N- 2 T04R(! LB1-

      A-P  LENGTH

    N1WBRN 96## 96;5## (N2ANT ;6

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    Sonogram of the left lobe of the thyroid gland in the transverse plane  showing a rounded lobe of a goiter. L=enlarged lobe, I= widened

    isthmus,T=trachea,C=carotid artery,J=ugular vein,  S=Sternocleidomastoid muscle, m=strap muscles, !=esophagus. 

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    “Pattern Recognition of Benign Nodules at

    Ultrasound of the Thyroid: Which Nodules Can Be

    Left Alone?”

     ohn A. Bona"ita& ason 3ayo& a#es Ba$$&

    /ene"ie"e Bennet& Thaira )eity& 3ichael 3acari& oseph 4ee

    1

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    B1CT(,1 The purpose of this study was to evaluate morphologic

    features predictive of benign thyroid nodules.

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    MATERIALS AND METHODS. From a registry of

    the records of 1!"! fine#needle aspiration biopsies

    performed $ointly by the cytology and radiology departments at a single institution between !%%& and

    !%%' the cases of (&% patients were identified for

    whom both a pathology report and ultrasound

    images were available. From the alphabeti)ed list generated the first &%% nodules were reviewed. *e

    analy)ed the accuracy of individual sonographic

    features and of 1% discrete recogni)able

    morphologic patterns in the prediction of benign histologic findings.

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    Fig. 1A —(ndi"idual ultrasound features of nodules. 9

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    Fig. 1B —+ndividual ultrasound features of nodules. ,(#year#

    old woman with papillary carcinoma. -ltrasound scan shows

    nodule with ill#defined borders

    1,

    Fi 1C ( di id l lt d f t f d l

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    Fig. 1C —(ndi"idual ultrasound features of nodules. =>6year6old #an )ith papillary carcino#a. Ultrasound scan sho)s #icrocalcications *arrow+& )hich are easily confused )ith co#et6tail shado)ing. (#portant

    nding is hypoechogenicity of nodule

    1-

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    Fig. 1D —+ndividual ultrasound features of nodules.

    "'#year#old woman with medullary carcinoma.

    -ltrasound scan shows macrocalcification.

    1

    Fig 1E +ndividual ultrasound features of

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    Fig. 1E —+ndividual ultrasound features of nodules. "'#year#old woman with papillary

    carcinoma. olor Doppler ultrasound image

    shows hypervascular nodule.

    1/

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    Fig. 2A —/orphologic patterns. ,1#year#old man

    with colloid nodule. -ltrasound scan shows

    spongiform nodule. Similarity of nodule to water#

    filled sponge is evident

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    Fig. 2B —/orphologic patterns. &!#year#old man

    with colloid cyst. -ltrasound scan shows cyst with

    colloid clot. *hen cystic portion of nodule is

    subtracted type 1 or spongiform nodules remain

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    Fig. 2C —/orphologic patterns. !1#year#old woman

    with 0ashimotos thyroiditis. -ltrasound scan shows

    nodule that loo2s li2e giraffe hide having light

    bloc2s separated by blac2 bands

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    Fig. 2D —/orphologic patterns. ",#year#old woman

    with 0ashimotos thyroiditis. -ltrasound scan shows

    3white 2night4 or hyperechoic nodule.

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    2ig. ;1 3orphologic patterns. >6year6old )o#an )ith follicular adeno#a. Color !oppler ultrasound i#age sho)s red light&D

    or hyper"ascular& nodule.

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    Fig. 2F —/orphologic patterns. !5#year#old woman

    with papillary carcinoma. -ltrasound scan shows

    hypoechoic nodule.

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    . . )o#an )ith papillary carcino#a. Ultrasound scan sho)s isoechoic nodule )ithout halo. Coincidental #icrocalcications *arro)s+ are

    e"ident

    2,

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    Fig. 2H —/orphologic patterns. !year#old man

    with nodular goiter. -ltrasound scan shows

    isoechoic nodule with halo

    2-

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    Fig. 2I —/orphologic patterns. &year#old woman

    with hyperplastic nodule. olor Doppler ultrasound

    image shows 3ring of fire4 or peripheral

    hypervascularity.

    2

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    RESULTS. 

    We found that grouping of thyroid nodules into reproduci$le patterns of #orphology& or pattern recognition& rather than analysis of indi"idual sonographic features& )as eFtre#ely accurate in the identication of $enign nodules. 2our specic patterns )ere identied: spongifor# conguration& cyst )ith colloid clot& gira%e pattern& and di%use hyperechogenicity& )hich had a 558 specicity for $enignity. (n our series& identication of nodules )ith one of these four patterns could ha"e o$"iated #ore than >58 of thyroid $iopsies.

    2/

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    CONCLUSION. 

    Recognition of specic #orphologic patterns is an accurate #ethod of

    identifying $enign thyroid nodules that do not reGuire cytologic e"aluation. Use of this approach #ay su$stantially

    decrease the nu#$er of unnecessary$iopsy procedures.

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    THANK YOU

    3