Heterogeneous echogenicity of the underlying thyroid parenchyma: how does this affect the analysis of a thyroid nodule?
Heterogeneous echogenicity of the thyroid gland has been associated with diffuse thyroid disease and benign and malignant nodules can coexist with diffuse thyroid disease. Underlying heterogeneous echogenicity might make it difficult to differentiate between benign and malignant nodules on US. Thus,...
Gespeichert in:
| Veröffentlicht in: | BMC cancer 2013-11, Vol.13 (1), p.550-550, Article 550 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 550 |
|---|---|
| container_issue | 1 |
| container_start_page | 550 |
| container_title | BMC cancer |
| container_volume | 13 |
| creator | Park, Mina Park, So Hee Kim, Eun-Kyung Yoon, Jung Hyun Moon, Hee Jung Lee, Hye Sun Kwak, Jin Young |
| description | Heterogeneous echogenicity of the thyroid gland has been associated with diffuse thyroid disease and benign and malignant nodules can coexist with diffuse thyroid disease. Underlying heterogeneous echogenicity might make it difficult to differentiate between benign and malignant nodules on US. Thus, the aim of this study was to evaluate the influence of underlying thyroid echogenicity on diagnosis of thyroid malignancies using US.
A total of 1,373 patients who underwent US-guided fine needle aspiration of 1,449 thyroid nodules from June 2009 to August 2009 were included. The diagnostic performance of US assessment for thyroid nodules was calculated and compared according to underlying thyroid echogenicity. The diagnostic performance of US assessments in the diagnosis of thyroid malignancy according to the underlying parenchymal echogenicity was compared using a logistic regression with the GEE (generalized estimating equation) method. Each US feature of malignant and benign thyroid nodules was analyzed according to underlying echogenicity to evaluate which feature affected the final diagnosis.
Among the 1,449 nodules, 325 (22.4%) were malignant and 1,124 (77.6%) were benign. Thyroid glands with heterogeneous echogenicity showed significantly lower specificity, PPV, and accuracy compared to thyroid glands with homogeneous echogenicity, 76.3% to 83.7%, 48.7% to 60.9%, and 77.6% to 84.4%, respectively (P=0.009, 0.02 and 0.005, respectively). In benign thyroid nodules, microlobulated or irregular margins were more frequently seen in thyroid glands with heterogeneous echogenicity than in those with homogenous echogenicity (P |
| doi_str_mv | 10.1186/1471-2407-13-550 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3832886</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A534612318</galeid><sourcerecordid>A534612318</sourcerecordid><originalsourceid>FETCH-LOGICAL-c556t-c6937510378f0f754d3a07a61d5a3a4b926e7f7804783f1f540e29f897349ce43</originalsourceid><addsrcrecordid>eNptkt9r1TAcxYsobk7ffZKCIPrQmTRJ0_qgjKFuMBD88Ryy9Js2Ize5S1Jn_3vTbV5vRfKQ5JvPOaWHUxTPMTrGuG3eYspxVVPEK0wqxtCD4nA3erh3PiiexHiFEOYtah8XBzWtCe86fFjcnEGC4Adw4KdYghqXs1EmzaXXZRqhnFwPwc7GDfk6B2_6cisDODXOG_muHP1N2XuI-dHEUmoNKt3qpJN2jnmWfeRO6nw_WfjwtHikpY3w7H4_Kn58-vj99Ky6-PL5_PTkolKMNalSTUc4w4jwViPNGe2JRFw2uGeSSHrZ1Q1wnf-K8pZorBlFUHe67TihnQJKjor3d77b6XIDvQKXgrRiG8xGhll4acT6xZlRDP6nIC2p27bJBq_vDYK_niAmsTFRgbXyNjGBaYeajjY1y-jLf9ArP4WcwkKxzKAc-V9qkBaEcdrn76rFVJwwQhtcE9xm6vg_VF49bIzyDrTJ85XgzUqQmQS_0iCnGMX5t69r9tUeO4K0aYzeTsl4F9cgugNV8DEG0LvgMBJLA8VSMbFUTGAicgOz5MV-4DvBn8qR35He1BA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1459460991</pqid></control><display><type>article</type><title>Heterogeneous echogenicity of the underlying thyroid parenchyma: how does this affect the analysis of a thyroid nodule?</title><source>SpringerOpen</source><source>MEDLINE</source><source>SpringerLink</source><source>PubMed Central</source><source>Directory of Open Access Journals</source><source>EZB Electronic Journals Library</source><source>PubMed Central Open Access</source><creator>Park, Mina ; Park, So Hee ; Kim, Eun-Kyung ; Yoon, Jung Hyun ; Moon, Hee Jung ; Lee, Hye Sun ; Kwak, Jin Young</creator><creatorcontrib>Park, Mina ; Park, So Hee ; Kim, Eun-Kyung ; Yoon, Jung Hyun ; Moon, Hee Jung ; Lee, Hye Sun ; Kwak, Jin Young</creatorcontrib><description>Heterogeneous echogenicity of the thyroid gland has been associated with diffuse thyroid disease and benign and malignant nodules can coexist with diffuse thyroid disease. Underlying heterogeneous echogenicity might make it difficult to differentiate between benign and malignant nodules on US. Thus, the aim of this study was to evaluate the influence of underlying thyroid echogenicity on diagnosis of thyroid malignancies using US.
A total of 1,373 patients who underwent US-guided fine needle aspiration of 1,449 thyroid nodules from June 2009 to August 2009 were included. The diagnostic performance of US assessment for thyroid nodules was calculated and compared according to underlying thyroid echogenicity. The diagnostic performance of US assessments in the diagnosis of thyroid malignancy according to the underlying parenchymal echogenicity was compared using a logistic regression with the GEE (generalized estimating equation) method. Each US feature of malignant and benign thyroid nodules was analyzed according to underlying echogenicity to evaluate which feature affected the final diagnosis.
Among the 1,449 nodules, 325 (22.4%) were malignant and 1,124 (77.6%) were benign. Thyroid glands with heterogeneous echogenicity showed significantly lower specificity, PPV, and accuracy compared to thyroid glands with homogeneous echogenicity, 76.3% to 83.7%, 48.7% to 60.9%, and 77.6% to 84.4%, respectively (P=0.009, 0.02 and 0.005, respectively). In benign thyroid nodules, microlobulated or irregular margins were more frequently seen in thyroid glands with heterogeneous echogenicity than in those with homogenous echogenicity (P<0.001).
Heterogeneous echogenicity of the thyroid gland significantly lowers the specificity, PPV, and accuracy of US in the differentiation of thyroid nodules. Therefore, caution is required during evaluation of thyroid nodules detected in thyroid parenchyma showing heterogeneous echogenicity.</description><identifier>ISSN: 1471-2407</identifier><identifier>EISSN: 1471-2407</identifier><identifier>DOI: 10.1186/1471-2407-13-550</identifier><identifier>PMID: 24237991</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adult ; Biopsy, Fine-Needle ; Cellular biology ; Comparative analysis ; Diagnosis ; Diagnosis, Differential ; Female ; Graves disease ; Health aspects ; Histopathology ; Humans ; Laboratories ; Male ; Methods ; Middle Aged ; Patients ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid cancer ; Thyroid diseases ; Thyroid gland ; Thyroid Gland - diagnostic imaging ; Thyroid Gland - pathology ; Thyroid Neoplasms - diagnostic imaging ; Thyroid Neoplasms - pathology ; Thyroid Nodule - diagnostic imaging ; Thyroid Nodule - pathology ; Ultrasonography ; Ultrasound imaging</subject><ispartof>BMC cancer, 2013-11, Vol.13 (1), p.550-550, Article 550</ispartof><rights>COPYRIGHT 2013 BioMed Central Ltd.</rights><rights>2013 Park et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</rights><rights>Copyright © 2013 Park et al.; licensee BioMed Central Ltd. 2013 Park et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c556t-c6937510378f0f754d3a07a61d5a3a4b926e7f7804783f1f540e29f897349ce43</citedby><cites>FETCH-LOGICAL-c556t-c6937510378f0f754d3a07a61d5a3a4b926e7f7804783f1f540e29f897349ce43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832886/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832886/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24237991$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Park, Mina</creatorcontrib><creatorcontrib>Park, So Hee</creatorcontrib><creatorcontrib>Kim, Eun-Kyung</creatorcontrib><creatorcontrib>Yoon, Jung Hyun</creatorcontrib><creatorcontrib>Moon, Hee Jung</creatorcontrib><creatorcontrib>Lee, Hye Sun</creatorcontrib><creatorcontrib>Kwak, Jin Young</creatorcontrib><title>Heterogeneous echogenicity of the underlying thyroid parenchyma: how does this affect the analysis of a thyroid nodule?</title><title>BMC cancer</title><addtitle>BMC Cancer</addtitle><description>Heterogeneous echogenicity of the thyroid gland has been associated with diffuse thyroid disease and benign and malignant nodules can coexist with diffuse thyroid disease. Underlying heterogeneous echogenicity might make it difficult to differentiate between benign and malignant nodules on US. Thus, the aim of this study was to evaluate the influence of underlying thyroid echogenicity on diagnosis of thyroid malignancies using US.
A total of 1,373 patients who underwent US-guided fine needle aspiration of 1,449 thyroid nodules from June 2009 to August 2009 were included. The diagnostic performance of US assessment for thyroid nodules was calculated and compared according to underlying thyroid echogenicity. The diagnostic performance of US assessments in the diagnosis of thyroid malignancy according to the underlying parenchymal echogenicity was compared using a logistic regression with the GEE (generalized estimating equation) method. Each US feature of malignant and benign thyroid nodules was analyzed according to underlying echogenicity to evaluate which feature affected the final diagnosis.
Among the 1,449 nodules, 325 (22.4%) were malignant and 1,124 (77.6%) were benign. Thyroid glands with heterogeneous echogenicity showed significantly lower specificity, PPV, and accuracy compared to thyroid glands with homogeneous echogenicity, 76.3% to 83.7%, 48.7% to 60.9%, and 77.6% to 84.4%, respectively (P=0.009, 0.02 and 0.005, respectively). In benign thyroid nodules, microlobulated or irregular margins were more frequently seen in thyroid glands with heterogeneous echogenicity than in those with homogenous echogenicity (P<0.001).
Heterogeneous echogenicity of the thyroid gland significantly lowers the specificity, PPV, and accuracy of US in the differentiation of thyroid nodules. Therefore, caution is required during evaluation of thyroid nodules detected in thyroid parenchyma showing heterogeneous echogenicity.</description><subject>Adult</subject><subject>Biopsy, Fine-Needle</subject><subject>Cellular biology</subject><subject>Comparative analysis</subject><subject>Diagnosis</subject><subject>Diagnosis, Differential</subject><subject>Female</subject><subject>Graves disease</subject><subject>Health aspects</subject><subject>Histopathology</subject><subject>Humans</subject><subject>Laboratories</subject><subject>Male</subject><subject>Methods</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Sensitivity and Specificity</subject><subject>Thyroid cancer</subject><subject>Thyroid diseases</subject><subject>Thyroid gland</subject><subject>Thyroid Gland - diagnostic imaging</subject><subject>Thyroid Gland - pathology</subject><subject>Thyroid Neoplasms - diagnostic imaging</subject><subject>Thyroid Neoplasms - pathology</subject><subject>Thyroid Nodule - diagnostic imaging</subject><subject>Thyroid Nodule - pathology</subject><subject>Ultrasonography</subject><subject>Ultrasound imaging</subject><issn>1471-2407</issn><issn>1471-2407</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNptkt9r1TAcxYsobk7ffZKCIPrQmTRJ0_qgjKFuMBD88Ryy9Js2Ize5S1Jn_3vTbV5vRfKQ5JvPOaWHUxTPMTrGuG3eYspxVVPEK0wqxtCD4nA3erh3PiiexHiFEOYtah8XBzWtCe86fFjcnEGC4Adw4KdYghqXs1EmzaXXZRqhnFwPwc7GDfk6B2_6cisDODXOG_muHP1N2XuI-dHEUmoNKt3qpJN2jnmWfeRO6nw_WfjwtHikpY3w7H4_Kn58-vj99Ky6-PL5_PTkolKMNalSTUc4w4jwViPNGe2JRFw2uGeSSHrZ1Q1wnf-K8pZorBlFUHe67TihnQJKjor3d77b6XIDvQKXgrRiG8xGhll4acT6xZlRDP6nIC2p27bJBq_vDYK_niAmsTFRgbXyNjGBaYeajjY1y-jLf9ArP4WcwkKxzKAc-V9qkBaEcdrn76rFVJwwQhtcE9xm6vg_VF49bIzyDrTJ85XgzUqQmQS_0iCnGMX5t69r9tUeO4K0aYzeTsl4F9cgugNV8DEG0LvgMBJLA8VSMbFUTGAicgOz5MV-4DvBn8qR35He1BA</recordid><startdate>20131116</startdate><enddate>20131116</enddate><creator>Park, Mina</creator><creator>Park, So Hee</creator><creator>Kim, Eun-Kyung</creator><creator>Yoon, Jung Hyun</creator><creator>Moon, Hee Jung</creator><creator>Lee, Hye Sun</creator><creator>Kwak, Jin Young</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ISR</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20131116</creationdate><title>Heterogeneous echogenicity of the underlying thyroid parenchyma: how does this affect the analysis of a thyroid nodule?</title><author>Park, Mina ; Park, So Hee ; Kim, Eun-Kyung ; Yoon, Jung Hyun ; Moon, Hee Jung ; Lee, Hye Sun ; Kwak, Jin Young</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c556t-c6937510378f0f754d3a07a61d5a3a4b926e7f7804783f1f540e29f897349ce43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Biopsy, Fine-Needle</topic><topic>Cellular biology</topic><topic>Comparative analysis</topic><topic>Diagnosis</topic><topic>Diagnosis, Differential</topic><topic>Female</topic><topic>Graves disease</topic><topic>Health aspects</topic><topic>Histopathology</topic><topic>Humans</topic><topic>Laboratories</topic><topic>Male</topic><topic>Methods</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Sensitivity and Specificity</topic><topic>Thyroid cancer</topic><topic>Thyroid diseases</topic><topic>Thyroid gland</topic><topic>Thyroid Gland - diagnostic imaging</topic><topic>Thyroid Gland - pathology</topic><topic>Thyroid Neoplasms - diagnostic imaging</topic><topic>Thyroid Neoplasms - pathology</topic><topic>Thyroid Nodule - diagnostic imaging</topic><topic>Thyroid Nodule - pathology</topic><topic>Ultrasonography</topic><topic>Ultrasound imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Park, Mina</creatorcontrib><creatorcontrib>Park, So Hee</creatorcontrib><creatorcontrib>Kim, Eun-Kyung</creatorcontrib><creatorcontrib>Yoon, Jung Hyun</creatorcontrib><creatorcontrib>Moon, Hee Jung</creatorcontrib><creatorcontrib>Lee, Hye Sun</creatorcontrib><creatorcontrib>Kwak, Jin Young</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health Medical collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Park, Mina</au><au>Park, So Hee</au><au>Kim, Eun-Kyung</au><au>Yoon, Jung Hyun</au><au>Moon, Hee Jung</au><au>Lee, Hye Sun</au><au>Kwak, Jin Young</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Heterogeneous echogenicity of the underlying thyroid parenchyma: how does this affect the analysis of a thyroid nodule?</atitle><jtitle>BMC cancer</jtitle><addtitle>BMC Cancer</addtitle><date>2013-11-16</date><risdate>2013</risdate><volume>13</volume><issue>1</issue><spage>550</spage><epage>550</epage><pages>550-550</pages><artnum>550</artnum><issn>1471-2407</issn><eissn>1471-2407</eissn><abstract>Heterogeneous echogenicity of the thyroid gland has been associated with diffuse thyroid disease and benign and malignant nodules can coexist with diffuse thyroid disease. Underlying heterogeneous echogenicity might make it difficult to differentiate between benign and malignant nodules on US. Thus, the aim of this study was to evaluate the influence of underlying thyroid echogenicity on diagnosis of thyroid malignancies using US.
A total of 1,373 patients who underwent US-guided fine needle aspiration of 1,449 thyroid nodules from June 2009 to August 2009 were included. The diagnostic performance of US assessment for thyroid nodules was calculated and compared according to underlying thyroid echogenicity. The diagnostic performance of US assessments in the diagnosis of thyroid malignancy according to the underlying parenchymal echogenicity was compared using a logistic regression with the GEE (generalized estimating equation) method. Each US feature of malignant and benign thyroid nodules was analyzed according to underlying echogenicity to evaluate which feature affected the final diagnosis.
Among the 1,449 nodules, 325 (22.4%) were malignant and 1,124 (77.6%) were benign. Thyroid glands with heterogeneous echogenicity showed significantly lower specificity, PPV, and accuracy compared to thyroid glands with homogeneous echogenicity, 76.3% to 83.7%, 48.7% to 60.9%, and 77.6% to 84.4%, respectively (P=0.009, 0.02 and 0.005, respectively). In benign thyroid nodules, microlobulated or irregular margins were more frequently seen in thyroid glands with heterogeneous echogenicity than in those with homogenous echogenicity (P<0.001).
Heterogeneous echogenicity of the thyroid gland significantly lowers the specificity, PPV, and accuracy of US in the differentiation of thyroid nodules. Therefore, caution is required during evaluation of thyroid nodules detected in thyroid parenchyma showing heterogeneous echogenicity.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>24237991</pmid><doi>10.1186/1471-2407-13-550</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1471-2407 |
| ispartof | BMC cancer, 2013-11, Vol.13 (1), p.550-550, Article 550 |
| issn | 1471-2407 1471-2407 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3832886 |
| source | SpringerOpen; MEDLINE; SpringerLink; PubMed Central; Directory of Open Access Journals; EZB Electronic Journals Library; PubMed Central Open Access |
| subjects | Adult Biopsy, Fine-Needle Cellular biology Comparative analysis Diagnosis Diagnosis, Differential Female Graves disease Health aspects Histopathology Humans Laboratories Male Methods Middle Aged Patients Retrospective Studies Sensitivity and Specificity Thyroid cancer Thyroid diseases Thyroid gland Thyroid Gland - diagnostic imaging Thyroid Gland - pathology Thyroid Neoplasms - diagnostic imaging Thyroid Neoplasms - pathology Thyroid Nodule - diagnostic imaging Thyroid Nodule - pathology Ultrasonography Ultrasound imaging |
| title | Heterogeneous echogenicity of the underlying thyroid parenchyma: how does this affect the analysis of a thyroid nodule? |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-29T12%3A34%3A04IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Heterogeneous%20echogenicity%20of%20the%20underlying%20thyroid%20parenchyma:%20how%20does%20this%20affect%20the%20analysis%20of%20a%20thyroid%20nodule?&rft.jtitle=BMC%20cancer&rft.au=Park,%20Mina&rft.date=2013-11-16&rft.volume=13&rft.issue=1&rft.spage=550&rft.epage=550&rft.pages=550-550&rft.artnum=550&rft.issn=1471-2407&rft.eissn=1471-2407&rft_id=info:doi/10.1186/1471-2407-13-550&rft_dat=%3Cgale_pubme%3EA534612318%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1459460991&rft_id=info:pmid/24237991&rft_galeid=A534612318&rfr_iscdi=true |