The purpose of this study was to clarify ultrasound (US) evaluation of microcalcifications and determine whether the calcifications seen in US scans can reliably predict malignant thyroid tumors. Diagnostic accuracy of microcalcification and other various signs seen in US scans for predicting malignancy was evaluated prospectively in 259 pathologically verified thyroid nodules. Sonographic and pathologic correlation of calcifications was performed on 69 of 99 surgically removed nodules. Pathologic studies revealed that hyperechoic areas with acoustic shadowing represented mostly amorphous dense calcifications and sometimes microcalcifications, but small particles without acoustic shadowing mainly reflected microcalcifications and sometimes large amount of fibrous bands and condensed colloids. Of the various sonographic signs, microcalcification showed the highest accuracy (76%), specificity (93%), and positive predictive value (70%) for malignancy as a single sonographic sign, but its sensitivity (36%) was poor. Although sonographic microcalcification showed relatively high specificity, the accuracy of this finding for malignancy was insufficient.

• In patients with previous adverse reactions, changing contrast media is recommended. • Premedication is unnecessary against previous reactions to high-osmolar or ionic CM. • Changing from one to another low-osmolar non-ionic CM may be effective.

Background. The relation between esophageal cancers and head and neck tumors was studied in order to improve the treatment results in patients with multiple cancers. Methods. We reviewed the records of 3,375 patients with an indexed squamous cell carcinoma of the head and neck treated at our institution between 1960 and 1994; and 81 patients were found to have an associated esophageal carcinoma. Similarly, the records of 434 patients with an indexed esophageal cancer were reviewed; and 54 patients had cancers in other organs or in the residual esophagus. A total of 135 esophageal cancers with 154 synchronous or metachronous cancers were entered into the analysis. Results. The risk of developing esophageal cancer was ten times higher in male patients with head and neck cancer than in female patients. Synchronous or metachronous esophageal cancer associated with head and neck cancer was most frequently seen with pharyngeal cancer (2/360 = 7.8%), followed by in the oral cavity (47/2148 = 2.2%). Conclusions. Better knowledge of the relation between an esophageal cancer and a head and neck cancer may lead to the early detection of subsequent small, potentially curable neoplasms sited in either the esophagus or the head and neck region.

Ultrasound (US)-guided fine-needle aspiration biopsy (FNA) was performed on 268 thyroid nodules (135 palpable, 133 nonpalpable) in 210 patients with various thyroid conditions; 62 nodules also had palpation-guided FNA. Surgical pathology was obtained in 67 malignant nodules and 32 benign nodules. Although the initial failure rate for palpation-guided FNA (12 of 62) was significantly higher than that for US-guided FNA (10 of 268) (p < 0.001), sensitivity (96%), specificity (91%), accuracy (94%), and positive (96%) and negative predictive values (91%) of US-guided FNA for malignancy (n = 99) were not significantly different from those (88%, 90%, 88%, 95%, and 75%, respectively) of palpation-guided FNA (n = 34) for those nodules where an adequate biopsy was obtained. US-guided FNA established a correct diagnosis in 20 of 22 patients with nonpalpable malignancy and in another nodule in the opposite thyroid lobe in 16 of 17 patients with thyroid malignancy. This procedure determined the correct cancer staging in 19 of 21 patients. US-guided FNA can reliably (1) select a patient who needs surgery and (2) avoid unnecessary surgery. This technique will help determine a cancer staging and institute an appropriate treatment.

The incidence of air embolism with clinical symptoms and needle track implantation complicating percutaneous thoracic biopsy is more frequent than the previously reported rate.