Official Proceedings - AIUM

American Institute of Ultrasound in Medicine Proceedings J Ultrasound Med 32(suppl):S1–S134, 20131518801 Ultrasound-Guided Fine-Needle Aspiration Biopsy ofThyroid Nodules Performed by Family Practitioners in aHealth Clinic SettingMaría Mata Castrillo, 1 * Jose Ignacio Jaen Diaz, 1 BlancaCordero Garcia, 1 Eugenio Cerezo Lopez, 2 Francisco Lopezde Castro, 1 Paolo Ciardo 1 1 Buenavista Health Care Center,Toledo, Spain; 2 Ultrasound Explorations, Madrid, SpainObjectives—Evaluate the impact of family practitioner interventionson the development of nodular thyroid pathology: techniques diagnosis,fine-needle aspiration biopsy (FNAB), and surgical follow-up.Methods—Two family practitioners at a health clinic in Toledo,Spain, which is charged with overseeing the health of 16,800 individuals,performed all thyroid ultrasonography requested by the health centerphysicians for their patients. These evaluations were previously performedin a reference hospital. All explorations were analyzed in writing, and thereports included a recommendation regarding patient follow-up and treatment.According to recommendations from the international literature, andfollowing informed consent, FNAB was performed on those nodules thatwere suitable for the procedure. Previously, the decision to perform theFNAB, its execution, and the treatment course were all left in the handsof the reference hospital.Results—A total of 392 ultrasonographic explorations wereperformed between July 2011 and July 2012. Of these, 336 (85.7%) ofthe subjects were female (mean age, 46.4 years), and 56 (14,3%) weremale (mean age, 45.2 years). The reasons for performing the explorationsincluded the following: clinical suspicion of thyroid pathology (goiter,nodules), 37.5%; suspicion of thyroid pathology based on clinical analyses,15.9%; follow-up of known nodular pathology, 34.4%; and follow-upof other known thyroid problems (thyroiditis, postsurgical thyroids),12.2%. Seventy-five FNAB procedures were performed, 9 (12%) of whichyielded insufficient material for diagnosis. Four cases of cancer were detected,all of them of a papillary nature. There were no complications duringthe conduct of these procedures.Conclusions—Ultrasound-guided thyroid FNAB is a simpleand uncomplicated procedure that can be performed with a high degree ofsuccess by family practitioners in community health centers as part of thecomprehensive management of nodular thyroid pathology. In our study,this approach was time efficient for patients and provided a mechanism forrapid intervention in a rather frequent pathology. Future studies will be requiredto evaluate the overall cost-effectiveness of this approach.1522432 Small Retained Foreign Bodies: What Is the Limit of DetectionUsing Current Emergency Ultrasound Equipment?Daniel Jafari, 1 Kenneth Cody, 2 Nova Panebianco, 1 FrancesShofer, 1 Bon Ku, 3 Arthur Au, 3 Anthony Dean 1 *1 EmergencyMedicine, University of Pennsylvania, Philadelphia, PennsylvaniaUSA; 2 Emergency Medicine, Kaiser Oakland MedicalCenter, Oakland, California USA; 3 Emergency Medicine,Thomas Jefferson University, Philadelphia, Pennsylvania USAObjectives—Previous studies of small foreign bodies (FBs)have shown a wide range of accuracies of FB detection using animal models,with high accuracy rates for FBs >10 mm and variable accuracy ratesfor 4- to 5-mm FBs. This study aimed to determine the lower limit of sonographicdetection of FB using current emergency ultrasound equipment ina soft tissue model.Methods—FBs made of metal, glass, wood, and plastic (3 ofeach), 1 × 1 × 3 mm in size, were placed at a depth of 0.5 to 2.0 cm in 12pork feet. Eight feet were punctured without FB placement. Pork feet weresubmerged during this process to minimize air in tissue. Seven emergencydepartment (ED) sonologists with >2 years of experience were blinded tothe overall number, type, and depth of FBs but not to size. FB sites werescanned by each sonologist using either a hockey stick or traditional lineararray transducer in a randomized preassigned order. Sonologist confidencein the diagnosis was reported using a visual analog scale for eachsite. Sensitivity, specificity, and positive and negative predictive values(PPV and NPV) with 95% confidence intervals (CIs) were calculated. Todetermine if sonologist confidence differed by the perceived presence orabsence of a foreign body, a paired t test was used.Results—A total of 140 ultrasound scans were performed,which reported sensitivity, specificity, PPV, and NPV as 50% (95% CI,39%–61%), 50% (37%–61%), 60% (48%–72%), and 40% (28%–52%),respectively. There was little agreement among the sonologists (only 2sites with 100% agreement). Sensitivity ranged from 25% to 75%, specificity37% to 62%, PPV 42% to 75%, and NPV 25% to 57% for each sonologist.Sonologists were more confident reporting a positive result (81%vs 51%; P < .0001), irrespective of the actual presence of FBs. The differencebetween detection rates of 4 types of FB did not reach statisticalsignificance.Conclusions—Current emergency ultrasound equipment usedby ED sonologists is unreliable in detection of 3-mm FBs in a human extremitysoft tissue model. Future studies may further delineate accuracyrates among different sizes and materials of FBs.1522516 Four Consecutive Recurrent Cesarean Scar Pregnancies ina Single PatientSimi Gupta, 1 * Christina Cordeiro, 2 Grace Pineda, 1 ShermanRubin, 3 Ilan Timor 1 1 Obstetrics and Gynecology, New YorkUniversity, New York, New York USA; 2 Weill Cornell MedicalCollege, New York, New York USA; 3 Sherman Rubin, JacksonHeights, New York USAObjectives—With the increase in conservative management ofcesarean scar pregnancies (CSP), there has been a growing interest in fertilityoutcomes for these patients. This is the first known report of 4 recurrentCSPs.Methods—This is a case report on a patient who was referredto a single institution with 4 recurrent CSPs. Data on evaluation, treatment,and follow-up of each of the pregnancies were collected.Results—The patient had a pertinent obstetric history of 2 cesareansections, the first for breech presentation and the second an electiverepeat cesarean section. The patient’s first CSP was diagnosed 7 years laterwith an ultrasound finding of a pregnancy in the prior cesarean sectionscar at 7 6/7 weeks of gestation with positive fetal cardiac activity. Thispregnancy was initially treated with transcervical intra-amniotic injectionof methotrexate with complete resolution. Nine months later, the patientpresented with her second CSP at 6 0/7 weeks of gestation with positivefetal cardiac activity and was treated similarly with transcervical injectionof methotrexate with complete resolution. The patient’s third recurrencewas 9 months later when she presented at 5 4/7 weeks of gestation withpositive fetal cardiac activity and again was treated with transcervical injectionof methotrexate with complete resolution. Finally, the patient’sfourth recurrence occurred 8 months later. She was diagnosed at 6 1/7weeks of gestation with positive fetal cardiac activity and again was treatedwith transcervical injection of methotrexate. The patient is currently receivingfollow-up for this CSP.Conclusions—This is the first case report of 4 recurrent CSPsin single patient. Each of this patient’s CSPs was treated conservativelywith local methotrexate. In reviewing the literature, there have been 6cases of recurrent CSPs, with 1 report of 3 CSPs in the same patient. Thosecases were reportedly treated with methotrexate or surgery with or withoutresection of the scar. This information is important to help counsel patientswho desire future fertility after a CSP.S89