Publications

Precision Medicine with 3D Ultrasound

author: Dr. Azizi et al. / published on July 13, 2023

Our 4th video publication with VideoEndocrinology: Precision Medicine with 3D Ultrasound.

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3D Ultrasound and Thyroid Cancer Diagnosis: A Prospective Study

author: Dr. Azizi et al. / published on February 16, 2021

3D Ultrasound & Thyroid Cancer Diagnosis: A Prospective Study 

Ghobad Azizi MD^, Kirk Faust MD, Lorna Ogden MD, Laura Been MD, Michelle L. Mayo, PA-C, Kele Piper, Carl Malchoff MD 

B-mode, or 2-dimensional ultrasound (2D-US), stratifies the malignancy risk of thyroid nodules, but lacks sensitivity. We tested the hypothesis that 3-dimensional ultrasound (3D-US) is superior to 2D-US in predicting malignancy in thyroid nodules.

We prospectively evaluated 344 thyroid nodules using both 2D and 3D ultrasound followed by fine needle aspiration biopsy.

            Thyroid nodules were divided into four groups based on the 3D ultrasound appearance of the margins. Bivariate and multivariate analyses were used. A total of 59 patients with 63 thyroid nodules underwent surgery, surgical pathology confirmed 44 thyroid cancers in 40 patients.   For 2D-US, irregular margins and microcalcifications were found more frequently in malignant thyroid nodules. Irregular margins on 2D-US had a sensitivity and specificity of 61.4% and 79.3% respectively. Irregular margins on 3D-US had a sensitivity and specificity of 86.4% and 83.3% respectively.  Sensitivity, specificity, positive and negative predictive values were higher for irregular margins on 3D-US, than microcalcifications and irregular margins on 2D-US.

We conclude that the evaluation of thyroid nodule margins by 3D-US distinguishes benign from malignant thyroid nodules with greater sensitivity and specificity than other ultrasound criteria including the evaluation of margins by 2D-US.

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Precision Medicine with 3D Ultrasound

author: Dr. Azizi et al. / published on July 14, 2020

Cancer imaging redefined! Our newest publication: Precision medicine with 3D ultrasound. Diagnosing thyroid cancer with 3D Ultrasound.

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Diagnosis of Thyroid Nodule with New Ultrasound Imaging Modalities

author: Dr. Azizi et al. / published on March 19, 2020

We are thrilled to announce our newest video publication with American Thyroid Association’s VideoEndocrinology™ journal.

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Diagnosis of Parathyroid Adenomas with New Ultrasound Imaging Modalities

author: Dr. Azizi et al. / published on December 27, 2019

3DParathyroid® has arrived! We are thrilled to announce our newest video publication with American Thyroid Association’s VideoEndocrinology™ journal. This is the first 3D ultrasound publication in diagnosing parathyroid adenomas. This is a cutting edge and non-invasive technology.

Ultrasound technology is becoming an integral part of diagnosing parathyroid adenomas. Careful ultrasound evaluation with b-mode, shear wave elastography, and three-dimensional (3D) of parathyroid adenomas may improve localization and outcome.

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Persistent metastatic thyroid carcinoma

author: Dr. Azizi et al. / published on December 26, 2019

The decision to biopsy small thyroid nodules (TNs) is controversial. Careful ultrasound (US) evaluation with shear wave elastography (SWE) of TN and cervical lymph nodes (LNs) may aid in the decision to biopsy and subsequently influence the extent of surgery. A 46-year-old female presented with TNs and hypothyroidism. Her target TN in the left lobe measured 4.8 mm × 4 mm × 4 mm. Fine needle aspiration biopsy of the left TN and a left neck level 6 LN was diagnostic for papillary thyroid carcinoma. In the left lateral neck posterior to the jugular vein, there was a LN with possible microcalcifications that could not be sampled due to vascular proximity. SWE examination showed high velocity suspicious for metastatic disease. In summary, risk stratification for small TNs and cervical LNs can be difficult. SWE can provide valuable information for assessing the risk for malignancy.

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Shear wave elastography and Afirma™ gene expression classifier in thyroid nodules with indeterminate cytology: a comparison study

author: Dr. Azizi et al. / published on February 7, 2018

This study compares shear wave elastography (SWE) and Afirma™ gene expression classifier (GEC) for diagnosis of malignancy in thyroid nodules (TNs) with Bethesda Classification (BC) III or IV indeterminate cytology. This preliminary single-center prospective study evaluated 151 consented patients with 151 indeterminate TNs (123 BC III, 28 BC IV) on fine-needle aspiration biopsy (FNAB). B-mode ultrasound, vascularity, and SWE were performed prior to FNAB. TN stiffness was measured as shear wave velocity (SWV) in meters per second (m/s). The stiffest area of the TN was selected for SWV measurement. GEC testing was performed with a second FNAB. Surgery was recommended for GEC-suspicious TNs, or GEC-benign TNs with two or more worrisome B-mode US features. Surgical pathology confirmed 31 malignant TNs. This preliminary study indicates that SWE and GEC are independent predictors of malignancy in TNs with BC III or IV.

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Book Chapter: "Ultrasound Elastography of Thyroid Nodules" in Thyroid and Parathyroid Ultrasound and Ultrasound-Guided FNA

author: Dr. Azizi et al. / published on December 30, 2017

Elastography is a new ultrasound technology that has the potential to help distinguish benign from malignant thyroid nodules.  In this book chapter, Dr. Azizi and Dr. Malchoff review both strain and shear wave elastography: from exam performance techniques to spectacular case examples to recent research.  Both technologies improve risk stratification in thyroid nodules when added to B-mode ultrasound exam, which could lead to fewer invasive procedures and surgeries.

Shear wave elastography and parathyroid adenoma: A new tool for diagnosing parathyroid adenomas

author: Dr. Azizi et al. / published on July 18, 2016

This study prospectively determines the shear wave elastography characteristics of parathyroid adenomas using virtual touch imaging quantification, a non-invasive ultrasound based shear wave elastography method. This prospective study examined 57 consecutive patients with biochemically proven primary hyperparathyroidism and solitary parathyroid adenoma identified by ultrasound and confirmed by at least one of the following: surgical resection, positive Technetium–99 m Sestamibi Scintigraphy (MIBI) scan, or fine needle aspiration biopsy with positive PTH washout (performed only in MIBI negative patients).

Shear Wave Elastography and Cervical Lymph Nodes: Predicting Malignancy

author: Dr. Azizi et al. / published on March 17, 2016

This prospective study evaluates the accuracy of virtual touch imaging quantification (VTIQ), a non-invasive shear wave elastography method for measuring cervical lymph nodes (LN) stiffness in differentiating benign from malignant LN. The study evaluated 270 LN in 236 patients with both conventional B-mode ultrasound and VTIQ shear wave elastography before fine-needle aspiration biopsy (FNAB).

Thyroid Nodules and Shear Wave Elastography: A New Tool in Thyroid Cancer Detection

author: Dr. Azizi et al. / published on August 13, 2015

This study determines the performance of virtual touch imaging quantification (VTIQ), a non-invasive shear wave elastography method for measuring thyroid nodule (TN) stiffness, in distinguishing benign from malignant TNs. This prospective study evaluates 707 TNs in 676 patients with fine-needle aspiration biopsy (FNAB).

Association of Hashimoto’s thyroiditis with thyroid cancer: A Prospective Study

author: Dr. Azizi et al. / published on September 12, 2014

This prospective study investigates the relationship between Hashimoto’s thyroiditis (HT) and thyroid cancer (TC) in patients with thyroid nodules (TNs). We prospectively examined 2100 patients with 2753 TNs between January 5, 2010 and August 15, 2013. A total of 2023 patients with 2669 TNs met the inclusion criteria of TN >5 mm and age >18 years.

Performance of Elastography for the Evaluation of Thyroid Nodules: A Prospective Study

author: Dr. Azizi et al. / published on November 8, 2012

In the ultrasound evaluation of masses, elastography measures stiffness, which may predict malignancy. We prospectively tested the hypothesis that TN stiffness, as measured by strain elastography (SE), is an independent predictor of thyroid cancer (TC) in unselected TNs.In 706 unselected patients with 912 TNs meeting the ATA criteria for a fine-needle aspiration biopsy (FNAB), we first performed conventional thyroid ultrasound and SE.

Three-Dimensional US Images and Fine-Needle Aspiration Biopsy of a Thyroid Nodule

author: Dr. Azizi et al. / published on August 1, 2011

Autoimmune Thyroid Disease: A Risk Factor for Thyroid Cancer

author: Dr. Azizi et al. / published on December 31, 2010

Objective: To examine the relationship between clinical markers of autoimmune thyroid disease and the risk of thyroid cancer in patients with thyroid nodules.  A retrospective cohort analysis was performed in a single clinical practice. In 2,500 consecutive patients, fine-needle aspiration biopsy (FNAB) was performed on all 3,658 ultrasonography-positive thyroid nodules that were ≥1.0 cm in diameter or ≥0.5 cm in diameter with ultrasound features suspicious for thyroid cancer. Serum concentrations of thyroglobulin antibodies (TgAb), thyroid peroxidase antibodies, and thyroid-stimulating hormone were measured before FNAB. Diagnosis of thyroid cancer was based on pathologic analysis of thyroidectomy tissue. Associations of thyroid cancer with the independent variables were determined by multivariate logistic regression analysis and reported as the adjusted odds ratio (OR) with the 95% confidence interval (CI).

Effect of micronized progesterone on bone turnover in postmenopausal women on estrogen replacement

author: Dr. Azizi et al. / published on May 10, 2003

PURPOSE: To determine whether daily oral micronized progesterone affects bone turnover, as estimated by serum and urine biochemical markers, in postmenopausal women on long-term estrogen replacement therapy (ERT).We recruited 14 women aged 65 or older to participate in a 9-week trial with micronized progesterone. Each woman had undergone a hysterectomy and was on unopposed ERT at time of study entry. Women received micronized progesterone 100 mg twice daily in the first week and then received 200 mg twice daily in weeks 2-9. We measured markers of bone turnover in serum and urine collected at baseline and at 3 weeks, 6 weeks, and 9 weeks on treatment.

An Endocrine Practice Case Report – Visual vignette: Grave’s disease

author: Dr. Azizi et al. / published on November 10, 2000