Chen X, et al. - In view of the observation that variability of modules and the experience of sonographers affects hypoechogenicity, one of the clinically relevant features associated with suspicion of malignant thyroid disease, thus leading to unsatisfying results, researchers propose the ultrasound gray scale ratio (UGSR) that may allow obtaining an objective, numerical estimate of the echogenicity degree in different-sized thyroid nodules. In addition, they investigated its diagnostic efficacy in differentiating benign and malignant thyroid lesions. In total, they analyzed 553 ultrasound images of thyroid nodules from one kind of ultrasonographic scanner; of these, 281 were papillary thyroid carcinomas (PTCs) and 272 were nodular goiters (NGs). An increase in the UGSR was accompanied by a decrease in the sensitivity of diagnosing PTCs, as well as an increase in the specificity. When the maximum Jordan index was 0.611, the best cut-off value was 0.692, and the corresponding sensitivity and specificity of diagnosing PTCs were 87.9% and 73.2%, respectively. Results completely support the UGSR as an appropriate objective, numerical method for evaluating the echogenicity degree; this method exhibited various diagnostic efficacies in different-sized thyroid nodules. This supports its possible utility as an additional ultrasound parameter in the diagnosis of different-sized PTCs and NGs.