Intraoperative frozen section (FS) can be reduced during thyroid lobectomy according to the results of fine needle aspiration (FNA). We evaluated the role of intraoperative FS in thyroid nodules with different diagnostic categories of the Bethesda System for Reporting Thyroid Cytopathology by FNA. This retrospective study included 1,235 nodules collected via thyroidectomy with both preoperative FNA and intraoperative FS at the Second Affiliated Hospital of Zhejiang University School of Medicine, from January 2011 to January 2014. FNA cytological diagnosis was classified into six categories, based on the Bethesda system. The diagnostic findings of FNA cytology and FS histology were compared with the final histological results. 189 nodules were benign. The remainder were malignant. FS diagnosis was more accurate than FNA diagnosis for nodules classified as Bethesda Categories II, III, and IV (P < 0.05). However, the accuracy of FNA diagnosis in nodules assigned Bethesda Categories V and VI was significantly higher than that of FS (P < 0.05). FS appears be beneficial for thyroid nodules classified as Bethesda categories I through IV. FS may not be necessary in nodules diagnosed as Bethesda Categories V and VI.The incidence of thyroid nodules has increased in recent years 1 , with an estimated prevalence of 1-5% for palpable nodules and up to 50% for nonpalpable nodules 2 . This increase in incidence is due to identification through the use of ultrasound examinations and the emphasis on early detection of cancer over the past three decades 3 . Autopsy studies have showed that 50% of the U.S. population has thyroid nodules 4 . The reported incidence of thyroid cancer in all thyroid nodules is approximately 5% 5 .Ultrasound-guided fine needle aspiration 6 is the most useful and reliable method for the evaluation of thyroid nodules 7 . It was used worldwide because of its safety, simplicity, and cost-effectiveness 8,9 . Cytological results are classified according to the Bethesda System for Reporting Thyroid Cytopathology 6 , which has been applied in our institution since 2011. These cytological diagnoses are determined, as follows: 1) Bethesda I, nondiagnostic or unsatisfactory, 2) Bethesda II, benign, 3) Bethesda III, atypical of indeterminate significance or follicular lesion of indeterminate significance, 4) Bethesda IV, follicular neoplasm or suspicious for a follicular neoplasm, 5) Bethesda V, suspicious for malignancy, and 6) Bethesda VI, malignant.FNA diagnoses may not be definitive. This creates a dilemma with regard to follow-up and/or treatment, especially regarding the need for surgery. Frozen section (FS) has been used extensively to help guide intraoperative management of patients with thyroid nodules. However, FS is usually insufficient to determine true capsular or vascular invasion, and deferral to a final pathologic diagnosis is often necessary in the setting of follicular lesions 10 . The use of intraoperative FS has long been debated, secondary to concerns about increased costs and operative time, ...

Fine-needle aspiration cytology (FNAC) is widely used for diagnosing thyroid nodules. However, there has been no specific investigation about the puncture feeling of grittiness. The aim of the present study was to see if the puncture feeling of grittiness during fine-needle aspiration procedure, combined with standard FNAC, could improve the accuracy in diagnosing thyroid cancer. A total of one thousand five hundred and thirty-one thyroid FNAC specimens acquired between January 2013 and January 2017 were retrospectively retrieved. All cases underwent surgical intervention. The FNAC diagnoses and puncture feeling of grittiness were evaluated and compared with the results of final histopathological diagnoses. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of diagnosis for thyroid nodules by FNAC alone, puncture feeling of grittiness alone, and the combination of FNAC plus grittiness were calculated respectively. The findings of our study suggest that puncture feeling of grittiness is a useful adjunct. Adding puncture feeling of grittiness to FNAC can significantly enhance the ability to differentiate malignant thyroid nodules from benign thyroid nodules. More importantly, we found that puncture feeling of grittiness is surprising trust-worthy in being near perfectly reproducible per individual radiologist, and among different operators.

Ultrasound‐targeted microbubble destruction (UTMD) mediates gene transfection with high biosafety and thus has been promising toward treatment of type 1 diabetes. However, the potential application of UTMD in type 2 diabetes (T2D) is still limited, due to the lack of systematic design and dynamic monitoring. Herein, an efficient gene delivery system is constructed by plasmid deoxyribonucleic acid (DNA) encoding glucagon‐like peptide 1 (GLP‐1) in ultrasound‐induced microbubbles, toward treatment of T2D in macaque. The as designed UTMD afforded enhancement of cell membrane penetration and GLP‐1 expression in macaque, which is characterized by ultrasound‐guided biopsy to monitor the dynamic process of islet cells for 6 months. Also, improvement of pancreatic beta cell regeneration, and regulation of plasma glucose in macaque with T2D is achieved. The approach would serve as promising alternatives for the treatment of T2D.

Introduction: The aim of the study is to investigate the usefulness of ultrasound combined with computed tomography (CT) for distinguishing between primary thyroid lymphoma (PTL) and Hashimoto's thyroiditis (HT). Material and methods: The investigation was conducted retrospectively in 80 patients from January 2000 to July 2018. All patients underwent pathological tests to be classified into one of two groups: PTL group and HT group. The cutoff value of CT density was determined using receiver-operating characteristic (ROC) curve analysis. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of diagnosis for thyroid by CT alone, ultrasound alone, and the combination of CT plus ultrasound were calculated. Results: Of the 80 study patients, 27 patients were PTL and 53 patients were HT. Mean CT density had a sensitivity of 90.6% and a specificity of 88.9% at a cutoff value of 53.5 HU, with area under the curve (AUC) 0.88. Ultrasound combined with CT had the highest specificity, accuracy, and PPV compared with CT alone and ultrasound alone (p value < 0.05). Conclusions: Features such as extremely hypoechogenicity, enhanced posterior echo, cervical lymphadenopathy in ultrasound image, and linear high-density strand signs, and very low density in CT imaging have high sensitivity and specificity in thyroid lymphoma. Therefore, ultrasound combined with CT may be useful for distinguishing between PTL and HT.

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