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Zhou H, Jin Y, Dai L, Zhang M, Qiu Y, Wang K, Tian J, Zheng J. Differential Diagnosis of Benign and Malignant Thyroid Nodules Using Deep Learning Radiomics of Thyroid Ultrasound Images. Eur J Radiol 2020; 127:108992. [PMID: 32339983 DOI: 10.1016/j.ejrad.2020.108992] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/27/2020] [Accepted: 04/05/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE We aimed to propose a highly automatic and objective model named deep learning Radiomics of thyroid (DLRT) for the differential diagnosis of benign and malignant thyroid nodules from ultrasound (US) images. METHODS We retrospectively enrolled and finally include US images and fine-needle aspiration biopsies from 1734 patients with 1750 thyroid nodules. A basic convolutional neural network (CNN) model, a transfer learning (TL) model, and a newly designed model named deep learning Radiomics of thyroid (DLRT) were used for the investigation. Their diagnostic accuracy was further compared with human observers (one senior and one junior US radiologist). Moreover, the robustness of DLRT over different US instruments was also validated. Analysis of receiver operating characteristic (ROC) curves were performed to calculate optimal area under it (AUC) for benign and malignant nodules. One observer helped to delineate the nodules. RESULTS AUCs of DLRT were 0.96 (95% confidence interval [CI]: 0.94-0.98), 0.95 (95% confidence interval [CI]: 0.93-0.97) and 0.97 (95% confidence interval [CI]: 0.95-0.99) in the training, internal and external validation cohort, respectively, which were significantly better than other deep learning models (P < 0.01) and human observers (P < 0.001). No significant difference was found when applying DLRT on thyroid US images acquired from different US instruments. CONCLUSIONS DLRT shows the best overall performance comparing with other deep learning models and human observers. It holds great promise for improving the differential diagnosis of benign and malignant thyroid nodules.
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Affiliation(s)
- Hui Zhou
- HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315010, China; CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Beijing, 100190, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, No.19 (A) Yuquan Road, Shijingshan District, Beijing, 100049, China
| | - Yinhua Jin
- HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315010, China
| | - Lei Dai
- HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315010, China
| | - Meiwu Zhang
- HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315010, China
| | - Yuqin Qiu
- HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315010, China
| | - Kun Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Beijing, 100190, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, No.19 (A) Yuquan Road, Shijingshan District, Beijing, 100049, China.
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Beijing, 100190, China; School of Artificial Intelligence, University of Chinese Academy of Sciences, No.19 (A) Yuquan Road, Shijingshan District, Beijing, 100049, China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, 100191, China.
| | - Jianjun Zheng
- HwaMei Hospital, University of Chinese Academy of Sciences, 41 Xibei Street, Ningbo, 315010, China.
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Zhou H, Wang K, Tian J. Online Transfer Learning for Differential Diagnosis of Benign and Malignant Thyroid Nodules With Ultrasound Images. IEEE Trans Biomed Eng 2020; 67:2773-2780. [PMID: 32011998 DOI: 10.1109/tbme.2020.2971065] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE We aimed to propose a highly automatic and objective model named online transfer learning (OTL) for the differential diagnosis of benign and malignant thyroid nodules from ultrasound (US) images. METHODS The OTL mothed combined the strategy of transfer learning and online learning. Two datasets (1750 thyroid nodules with 1078 benign and 672 malignant nodules, and 3852 thyroid nodules with 3213 benign and 639 malignant nodules) were collected to develop the model. The diagnostic accuracy was also compared with VGG-16 based transfer learning model and different input images based model. Analysis of receiver operating characteristic (ROC) curves were performed to calculate optimal area under it (AUC) for benign and malignant nodules. RESULTS AUC, sensitivity and specificity of OTL were 0.98 (95% confidence interval [CI]: 0.97-0.99), 98.7% (95% confidence interval [CI]: 97.8%-99.6%) and 98.8% (95% confidence interval [CI]: 97.9%-99.7%) in the final online learning step, which was significantly better than other deep learning models (P < 0.01). CONCLUSION OTL model shows the best overall performance comparing with other deep learning models. The model holds a good potential for improving the overall diagnostic efficacy in thyroid nodule US examinations. SIGNIFICANCE The proposed OTL model could be seamlessly integrated into the conventional work-flow of thyroid nodule US examinations.
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Stoian D, Ivan V, Sporea I, Florian V, Mozos I, Navolan D, Nemescu D. Advanced Ultrasound Application - Impact on Presurgical Risk Stratification of the Thyroid Nodules. Ther Clin Risk Manag 2020; 16:21-30. [PMID: 32099374 PMCID: PMC6996024 DOI: 10.2147/tcrm.s224060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/05/2019] [Indexed: 11/23/2022] Open
Abstract
AIM Current major guidelines recommend risk stratification of the thyroid nodules, after each diagnostic evaluation, in order to focus attention on potentially risky nodules. The main aim of our study was to evaluate the performance of combined advanced ultrasound techniques in this process, compared with conventional stratification models, in order to reduce unnecessary fine-needle biopsies, respectively, surgery. MATERIAL AND METHODS We evaluated 261 cases (261 nodules) using conventional ultrasound (2B), real-time Doppler evaluation (4D) respectively, real-time elastography, using a linear multifrequency probe and a linear volumetric probe (Hitachi Prerius Machine, Hitachi Inc, Japan). All the nodules were classified using a risk stratification model comprising seven conventional US characteristics, two 4 D characteristics and a color map RTE aspect. The results were compared with the pathology results, considered the golden standard diagnosis. RESULTS The prevalence of malignant nodules was 21.83% (57 cases). Conventional risk classification generated: 106 low-risk cases, 113 intermediate-risk and 42 high-risk cases. Our proposed risk classification changes the conventional risk classification with a risk upgrade in 27 cases and with a risk downgrade in 69 cases. The diagnostic quality of the combined risk stratification model was better, considering a low-risk category predictive for benignancy and a high category predictive for malignancy: Sensitivity: 80.88% versus 49.01%, respectively, Specificity: 91.22% versus 54.38. The diagnostic power differences were observed regardless of the nodule size. CONCLUSION Advanced ultrasound techniques did add diagnostic value in the presurgical risk assessment of the thyroid nodules.
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Affiliation(s)
- Dana Stoian
- 2nd Department of Internal Medicine, “Victor Babes” University of Medicine, Timisoara, Romania
- Dr. D Center for Ultrasound in Endocrinology, Timisoara, Romania
| | - Viviana Ivan
- 2nd Department of Internal Medicine, “Victor Babes” University of Medicine, Timisoara, Romania
| | - Ioan Sporea
- 2nd Department of Internal Medicine, “Victor Babes” University of Medicine, Timisoara, Romania
| | - Varcus Florian
- 2nd Department of Surgery, “Victor Babes” University of Medicine, Timisoara, Romania
| | - Ioana Mozos
- Department of Physiopathology, “Victor Babes” University of Medicine, Timisoara, Romania
| | - Dan Navolan
- Department of Obstetrics Gynecology, “Victor Babes” University of Medicine, Timisoara, Romania
| | - Dragos Nemescu
- Department of Obstetrics Gynecology, “Gr. T. Popa” University of Medicine, Iasi, Romania
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Seifert P, Görges R, Zimny M, Kreissl MC, Schenke S. Interobserver agreement and efficacy of consensus reading in Kwak-, EU-, and ACR-thyroid imaging recording and data systems and ATA guidelines for the ultrasound risk stratification of thyroid nodules. Endocrine 2020; 67:143-154. [PMID: 31741167 DOI: 10.1007/s12020-019-02134-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/07/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the interobserver agreement (IA) and the impact of consensus reading using four risk stratification systems for thyroid nodules (TN). METHODS Four experienced specialists independently rated US images of 80 TN according to the Kwak-TIRADS, EU-TIRADS, ACR TI-RADS, and ATA Guidelines. The cases were randomly extracted from a prospectively acquired database (n > 1500 TN). The observers were blinded to clinical data. This study was divided into two sessions (S1 and S2) with 40 image sets each. After every session, a consensus reading was carried out (C1, C2). Subsequently, the effect of C1 was tested in S2 with 40 new cases followed by C2. Fleiss' kappa (κ) was calculated for S1 and S2 to estimate the IA and learning curves. The results of C1 and C2 were used as reference for diagnostic accuracy calculations. RESULTS IA significantly increased (p < 0.01) after C1 with κ values of 0.375 (0.615), 0.411 (0.596), 0.321 (0.569), and 0.410 (0.583) for the Kwak-TIRADS, EU-TIRADS, ACR TI-RADS, and ATA Guidelines in S1 (S2), respectively. ROC analysis (C1 + C2) revealed similar areas under the curve (AUC) for the Kwak-TIRADS, EU-TIRADS, ACR TI-RADS, and ATA Guidelines (0.635, 0.675, 0.694, and 0.654, respectively, n.s.). AUC did not increase from C1 (0.677 ± 0.010) to C2 (0.632 ± 0.052, n.s.). ATA Guidelines were not applicable in five cases. CONCLUSIONS IA and diagnostic accuracy were very similar for the four investigated risk stratification systems. Consensus reading sessions significantly improved the IA but did not affect the diagnostic accuracy.
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Affiliation(s)
- Philipp Seifert
- Department of Nuclear Medicine, Jena University Hospital, Jena, Germany.
| | - Rainer Görges
- Department of Nuclear Medicine, Essen University Hospital, Essen, Germany
- Joint Practice for Nuclear Medicine, Duisburg/Moers, Duisburg, Germany
| | - Michael Zimny
- Institute for Nuclear Medicine Hanau, Giessen, Germany
| | - Michael C Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, Magdeburg University Hospital, Magdeburg, Germany
| | - Simone Schenke
- Institute for Nuclear Medicine Hanau, Giessen, Germany
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, Magdeburg University Hospital, Magdeburg, Germany
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Premoli P, Tanda ML, Piantanida E, Veronesi G, Gallo D, Masiello E, Rosetti S, Cusini C, Boi F, Bulla J, Rodia R, Mariotti S, Capelli V, Rotondi M, Magri F, Chiovato L, Rocchi R, Campopiano MC, Elisei R, Vitti P, Barbato F, Pilli T, Castagna MG, Pacini F, Bartalena L. Features and outcome of differentiated thyroid carcinoma associated with Graves' disease: results of a large, retrospective, multicenter study. J Endocrinol Invest 2020; 43:109-116. [PMID: 31327128 DOI: 10.1007/s40618-019-01088-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/17/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Whether differentiated thyroid cancer (DTC) occurring concomitantly with Graves' disease (GD) is more aggressive and bound to a less favorable outcome is controversial. OBJECTIVE Aim of this multicenter retrospective study was to compare baseline features and outcome of DTC patients with GD (DTC/GD+) or without GD (DTC/GD-). PATIENTS Enrolled in this study were 579 patients referred to five endocrine units (Cagliari, Pavia, Pisa, Siena, and Varese) between 2005 and 2014: 193 patients had DTC/GD+ , 386 DTC/GD-. Patients were matched for age, gender and tumor size. They underwent surgery because of malignancy, large goiter size, or relapse of hyperthyroidism in GD. RESULTS Baseline DTC features (histology, lymph node metastases, extrathyroidal extension) did not differ in the two groups, except for multifocality which was significantly more frequent in DTC/GD+ (27.5% vs. 7.5%, p < 0.0001). At the end of follow-up (median 7.5 years), 86% of DTC/GD+ and 89.6% DTC/GD- patients were free of disease. Patients with persistent or recurrent disease (PRD) had "biochemical disease" in the majority of cases. Microcarcinomas were more frequent in the DTC/GD+ group (60% vs. 37%, p < 0.0001) and had an excellent outcome, with no difference in PRD between groups. However, in carcinomas ≥ 1 cm, PRD was significantly more common in DTC/GD+ (24.4% vs. 11.5%; p = 0.005). In the whole group, univariate and multivariate analyses showed that GD+ , lymph node involvement, extrathyroidal invasion, multifocality and tall cell histotype were associated with a worse outcome. Female gender and microcarcinomas were favorable features. No association was found between baseline TSH-receptor antibody levels and outcome. Graves' orbitopathy (GO) seemed to be associated with a better outcome of DTC, possibly because patients with GO may early undergo surgery for hyperthyroidism. CONCLUSIONS GD may be associated with a worse outcome of coexisting DTC only if cancer is ≥ 1 cm, whereas clinical outcome of microcarcinomas is not related to the presence/absence of GD.
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Affiliation(s)
- P Premoli
- Department of Medicine and Surgery, University of Insubria, Endocrine Unit, Ospedale di Circolo, ASST dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy
| | - M L Tanda
- Department of Medicine and Surgery, University of Insubria, Endocrine Unit, Ospedale di Circolo, ASST dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy
| | - E Piantanida
- Department of Medicine and Surgery, University of Insubria, Endocrine Unit, Ospedale di Circolo, ASST dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy
| | - G Veronesi
- Research Centre in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
| | - D Gallo
- Department of Medicine and Surgery, University of Insubria, Endocrine Unit, Ospedale di Circolo, ASST dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy
| | - E Masiello
- Department of Medicine and Surgery, University of Insubria, Endocrine Unit, Ospedale di Circolo, ASST dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy
| | - S Rosetti
- Department of Medicine and Surgery, University of Insubria, Endocrine Unit, Ospedale di Circolo, ASST dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy
| | - C Cusini
- Department of Medicine and Surgery, University of Insubria, Endocrine Unit, Ospedale di Circolo, ASST dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy
| | - F Boi
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - J Bulla
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - R Rodia
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - S Mariotti
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - V Capelli
- Unit of Internal Medicine and Endocrinology, Istituti Clinici Scientifici Maugeri, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - M Rotondi
- Unit of Internal Medicine and Endocrinology, Istituti Clinici Scientifici Maugeri, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - F Magri
- Unit of Internal Medicine and Endocrinology, Istituti Clinici Scientifici Maugeri, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - L Chiovato
- Unit of Internal Medicine and Endocrinology, Istituti Clinici Scientifici Maugeri, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - R Rocchi
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M C Campopiano
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Elisei
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - P Vitti
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F Barbato
- Endocrinology Unit, University of Siena, Siena, Italy
| | - T Pilli
- Endocrinology Unit, University of Siena, Siena, Italy
| | - M G Castagna
- Endocrinology Unit, University of Siena, Siena, Italy
| | - F Pacini
- Endocrinology Unit, University of Siena, Siena, Italy
| | - L Bartalena
- Department of Medicine and Surgery, University of Insubria, Endocrine Unit, Ospedale di Circolo, ASST dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy.
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RECIO-CÓRDOVA JM, HIGUERUELA-MÍNGUEZ C, GARCÍA-DUQUE M, ALAN-PEINADO AR. Evaluación endocrinológica del paciente con enfermedad nodular tiroidea. REVISTA ORL 2019. [DOI: 10.14201/orl.21524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Angell TE, Maurer R, Wang Z, Kim MI, Alexander CA, Barletta JA, Benson CB, Cibas ES, Cho NL, Doherty GM, Doubilet PM, Frates MC, Gawande AA, Krane JF, Marqusee E, Moore FD, Nehs MA, Larsen PR, Alexander EK. A Cohort Analysis of Clinical and Ultrasound Variables Predicting Cancer Risk in 20,001 Consecutive Thyroid Nodules. J Clin Endocrinol Metab 2019; 104:5665-5672. [PMID: 31310316 DOI: 10.1210/jc.2019-00664] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/10/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Assessing thyroid nodules for malignancy is complex. The impact of patient and nodule factors on cancer evaluation is uncertain. OBJECTIVES To determine precise estimates of cancer risk associated with clinical and sonographic variables obtained during thyroid nodule assessment. DESIGN Analysis of consecutive adult patients evaluated with ultrasound-guided fine-needle aspiration for a thyroid nodule ≥1 cm between 1995 and 2017. Demographics, nodule sonographic appearance, and pathologic findings were collected. MAIN OUTCOME MEASURES Estimated risk for thyroid nodule malignancy for patient and sonographic variables using mixed-effect logistic regression. RESULTS In 9967 patients [84% women, median age 53 years (range 18 to 95)], thyroid cancer was confirmed in 1974 of 20,001 thyroid nodules (9.9%). Significant ORs for malignancy were demonstrated for patient age <52 years [OR: 1.82, 95% CI (1.63 to 2.05), P < 0.0001], male sex [OR: 1.68 (1.45 to 1.93), P < 0.0001], nodule size [OR: 1.30 (1.14 to 1.49) for 20 to 19 mm, OR: 1.59 (1.34 to 1.88) for 30 to 39 mm, and OR: 1.71 (1.43 to 2.04) for ≥40 mm compared with 10 to 19 mm, P < 0.0001 for all], cystic content [OR: 0.43 (0.37 to 0.50) for 25% to 75% cystic and OR: 0.21 (0.15 to 0.28) for >75% compared with predominantly solid, P < 0.0001 for both], and the presence of additional nodules ≥1 cm [OR: 0.69 (0.60 to 0.79) for two nodules, OR: 0.41 (0.34 to 0.49) for three nodules, and OR: 0.19 (0.16 to 0.22) for greater than or equal to four nodules compared with one nodule, P < 0.0001 for all]. A free online calculator was constructed to provide malignancy-risk estimates based on these variables. CONCLUSIONS Patient and nodule characteristics enable more precise thyroid nodule risk assessment. These variables are obtained during routine initial thyroid nodule evaluation and provide new insights into individualized thyroid nodule care.
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Affiliation(s)
- Trevor E Angell
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rie Maurer
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts
| | - Zhihong Wang
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Thyroid Surgery, First Hospital of China Medical University, Shenyang, China
| | - Matthew I Kim
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Caroline A Alexander
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Carol B Benson
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Edmund S Cibas
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gerard M Doherty
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Peter M Doubilet
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mary C Frates
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Atul A Gawande
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeff F Krane
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ellen Marqusee
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Francis D Moore
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthew A Nehs
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - P Reed Larsen
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erik K Alexander
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Lam CA, McGettigan MJ, Thompson ZJ, Khazai L, Chung CH, Centeno BA, McIver B, Valderrabano P. Ultrasound characterization for thyroid nodules with indeterminate cytology: inter-observer agreement and impact of combining pattern-based and scoring-based classifications in risk stratification. Endocrine 2019; 66:278-287. [PMID: 31300961 PMCID: PMC7771547 DOI: 10.1007/s12020-019-02000-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/29/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The American Thyroid Association (ATA) sonographic patterns stratify the risk of malignancy of cytologically indeterminate thyroid nodules (ITNs). This study aimed to (1) assess inter-observer agreement for sonographic features and patterns; (2) identify potential sources of disagreement; and (3) evaluate whether the number of suspicious features risk-stratifies non-ATA and high-suspicion patterns. METHODS Three observers independently reviewed the ultrasound images of 463 ITNs with histological follow-up consecutively evaluated between October 2008 and June 2015 at an academic cancer center. Each observer evaluated individual sonographic features. ATA sonographic patterns were derived from the interpretation of sonographic features. Nodules not fitting into any of the proposed patterns were clustered into a non-ATA pattern. RESULTS The inter-observer agreement for ATA sonographic patterns and echogenicity was fair, moderate for margins, good for composition and echogenic foci, and very good for extrathyroidal extension and lymph node metastasis. The interpretation of each sonographic feature was significantly different between observers, and there was complete disagreement in at least one of the features in 104 (22%) nodules. A total of 169 nodules (37%) were classified into the non-ATA pattern. The number of suspicious features allowed risk stratifying nodules with non-ATA and high-suspicion sonographic patterns. Most Non-invasive Follicular Thyroid Neoplasms with Papillary-like Nuclear Features had 0-1 suspicious features and none had >2. CONCLUSIONS Echogenicity interpretation was the greatest source of disagreement. The number of suspicious features risk-stratifies ITNs with non-ATA or high-suspicion patterns. Future studies attempting to objectivize the interpretation of echogenicity and heterogeneity are needed.
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Affiliation(s)
- Cesar A Lam
- Department of Diagnostic Imaging, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
| | - Melissa J McGettigan
- Department of Diagnostic Imaging, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Zachary J Thompson
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Laila Khazai
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Christine H Chung
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Barbara A Centeno
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Bryan McIver
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Pablo Valderrabano
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra. de Colmenar Viejo km. 9,100, 28034, Madrid, Spain
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Thyroid nodules: a clinical update for primary care. Br J Gen Pract 2019; 69:462-463. [PMID: 31467025 DOI: 10.3399/bjgp19x705437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/25/2018] [Indexed: 10/31/2022] Open
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60
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Yu Q, Liu K, Xie C, Ma D, Wu Y, Jiang H, Dai W. Development and validation of a preoperative prediction model for follicular thyroid carcinoma. Clin Endocrinol (Oxf) 2019; 91:348-355. [PMID: 31050007 DOI: 10.1111/cen.14002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The low pre- and intraoperative diagnostic rates in follicular thyroid carcinoma (FTC) often lead to inadequate surgical resection and necessitate further completion surgery. Therefore, the preoperative prediction of FTC in thyroid nodules is essential. DESIGN AND PATIENT: Patients were categorized into two data sets: the modelling data set, which included 3649 patients admitted to our centre between January 2014 and December 2016, and the validation data set, which included 1253 patients admitted between January and December 2017. Patient data from the FTC and non-FTC groups were initially included in a modelling data set to establish a preoperative prediction model. This model was subsequently employed in a validation data set for external validation of the predictive value. The positivity rate for FTC predicted by the model was compared with that of the intraoperative frozen sections. RESULTS The preoperative serum thyroglobulin level, nodule diameter, calcification status, solidity and blood supply were selected as predictors for the model. The regression equation was as follows: Y = 0.010 × (thyroglobulin level) + 0.556 × (nodule diameter) + 0.675 × (calcification status) + 2.355 × (nodule component) + 1.072*(blood flow) - 9.787. The model positively predicted FTC at values of Y ≥ -4.11. The accuracy, sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of the prediction model were 89.2%, 90.2%, 87.7%, 39.2 and 0.11, respectively. External validation of the model demonstrated acceptable results. The positive prediction rate of the model was 90.7% (78/86), which was significantly higher than that of the intraoperative frozen sections (10.5% [9/86]; P < 0.0001). CONCLUSIONS We successfully established and validated a simple and reliable preoperative prediction model for FTC using the preoperative thyroglobulin level and ultrasonographic features of the thyroid nodules. This model may improve the preoperative evaluation of FTC in clinical settings and facilitate the development of a reasonable surgical programme for FTC.
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Affiliation(s)
- QingAn Yu
- Department of Thyroid Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - KunPeng Liu
- Department of Thyroid Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - ChangMing Xie
- Department of Thyroid Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - DaKun Ma
- Department of Thyroid Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - YaoHua Wu
- Department of Thyroid Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - HongChi Jiang
- Department of Thyroid Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - WenJie Dai
- Department of Thyroid Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
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61
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Goldenberg D. We cannot ignore the real component of the rise in thyroid cancer incidence. Cancer 2019; 125:2362-2363. [PMID: 31012955 DOI: 10.1002/cncr.32123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 11/10/2022]
Affiliation(s)
- David Goldenberg
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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63
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Sahli ZT, Karipineni F, Hang JF, Canner JK, Mathur A, Prescott JD, Sheth S, Ali SZ, Zeiger MA. The association between the ultrasonography TIRADS classification system and surgical pathology among indeterminate thyroid nodules. Surgery 2018; 165:69-74. [PMID: 30415866 DOI: 10.1016/j.surg.2018.04.094] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/05/2018] [Accepted: 04/03/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND A high proportion of cytologically indeterminate, Afirma-suspicious thyroid nodules are benign. The Thyroid Imaging Reporting and Data System was proposed by the American College of Radiology in 2015 to determine appropriate management of thyroid nodules in a standardized fashion. Our aim was to determine the diagnostic value of the Thyroid Imaging Reporting and Data System in cytologically indeterminate and Afirma-suspicious nodules. METHODS We retrospectively queried cytopathology archives for retrospectively for thyroid fine-needle aspiration specimens obtained between February 2012 and September 2016 that were associated with the following: (1) indeterminate diagnosis, (2) ultrasonographic imaging at our institution, (3) an Afirma Gene Expression Classifier-suspicious result, and (4) surgery at our institution. We then calculated the diagnostic value of the Thyroid Imaging Reporting and Data System in predicting surgical pathology. RESULTS Our cohort consisted of 133 nodules among 131 patients who underwent thyroid surgery for cytologically indeterminate, Afirma-suspicious nodules. A total of 9 nodules (6.8%) were assigned TR2 "not suspicious," 25 (18.8%) TR3 "mildly suspicious," 81 (60.9%) TR4 "moderately suspicious," and 18 (13.5%) TR5 "highly suspicious." Among our cohort, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the Thyroid Imaging Reporting and Data System was 71.4%, 38.1%, 40.2%, 69.6%, and 50.4%, respectively. CONCLUSION Among cytologically indeterminate and Afirma-suspicious nodules, the Thyroid Imaging and Reporting and Data System was a poor predictor of final surgical pathology. Additional prospective studies are needed to validate these findings.
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Affiliation(s)
- Zeyad T Sahli
- Endocrine Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Farah Karipineni
- Endocrine Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jen-Fan Hang
- Endocrine Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Joseph K Canner
- Endocrine Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aarti Mathur
- Endocrine Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jason D Prescott
- Endocrine Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sheila Sheth
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Syed Z Ali
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Martha A Zeiger
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA.
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Trimboli P, Paone G, Treglia G, Virili C, Ruberto T, Ceriani L, Piccardo A, Giovanella L. Fine-needle aspiration in all thyroid incidentalomas at 18 F-FDG PET/CT: Can EU-TIRADS revise the dogma? Clin Endocrinol (Oxf) 2018; 89:642-648. [PMID: 30019402 DOI: 10.1111/cen.13819] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/11/2018] [Accepted: 07/15/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Focal thyroid incidentalomas (TIs) are observed in 2% of 18 F-FDG PET/CT representing malignancy in one-third of cases. Currently, due to the lack of evidence on their optimal management, guidelines suggest fine-needle aspiration cytology (FNAC). The study aim was to evaluate the role of ultrasound evaluation according to EU-TIRADS to assess the risk of TIs and inform FNAC prescriptions. DESIGN We retrospectively reviewed 18 F-FDG PET/CT TIs recorded during the period 2014-2017. Enrolled were TIs with histological outcome and autonomous nodules. Cases with uncertain matching between 18 F-FDG PET/CT, ultrasound and histology were excluded. RESULTS According to the selection criteria, 75 TIs, being 13 (17.3%) malignant and 62 (82.7%) benign, were included. Cancers had significantly higher SUVmax and SUVmax ratio (Mann-Whitney P < 0.01) than benign, and the most accurate cut-offs were >7.1 and >3.65, respectively. At ultrasound, the cancer rate was 0% in EU-TIRADS 2, 2.9% in EU-TIRADS 3, 4.2% in EU-TIRADS 4% and 78.6% in EU-TIRADS 5 (chi-squared P < 0.001). Sensitivity, specificity, PPV, NPV and accuracy for malignancy were 92%, 64%, 35%, 98% and 69% for SUVmax; 85%, 68%, 36%, 96% and 71% for SUVmax ratio; and 85%, 95%, 79%, 97% and 93% for EU-TIRADS, respectively. The absence of all these three features reached a specificity of 97.1%. CONCLUSIONS EU-TIRADS, within a clinical careful approach, can discriminate with significant accuracy lesions at high risk of malignancy from those at low risk among TIs at 18 F-FDG PET/CT. Additionally, a centre-based threshold for SUV parameters should be useful for the initial assessment of these lesions during PET/CT reading and reporting.
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Affiliation(s)
- Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Gaetano Paone
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Giorgio Treglia
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
- Health Technology Assessment Unit, Academic Education, Research and Innovation Area, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Camilla Virili
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Teresa Ruberto
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luca Ceriani
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Arnoldo Piccardo
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Zhang F, Oluwo O, Castillo FB, Gangula P, Castillo M, Farag F, Zakaria S, Zahedi T. THYROID NODULE LOCATION ON ULTRASONOGRAPHY AS A PREDICTOR OF MALIGNANCY. Endocr Pract 2018; 25:131-137. [PMID: 30383496 DOI: 10.4158/ep-2018-0361] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The diagnostic capacity of ultrasonography (US) for differentiating between malignant and benign thyroid nodules is crucial in preventing unnecessary invasive procedures. This is the first study to evaluate whether thyroid nodule location on US has predictive value for malignancy. METHODS We retrospectively reviewed data from 219 patients with thyroid nodules who underwent fine-needle aspiration biopsy in 1 year. Patients' demographics as well as nodule's laterality, polarity, morphology, and multinodularity were analyzed. All malignant lesions were confirmed by surgical pathology. RESULTS The majority of the patients were female (86.2%). Nodules were evenly distributed between the right lobe (46.3%) and left lobe (49.5%). Eight nodules (4.2%) were located in the isthmus. Most nodules (79.3%) were located in the lower pole, while 9.6% were located in the upper pole and 6.9% in the middle pole. Seventy-five patients (39.9%) had multiple nodules. Fourteen nodules were malignant, representing a prevalence of 7.4%. A significantly higher frequency of malignancy was observed in upper pole (22.2%) compared to lower pole (4.7%) and middle pole (15.4%). A multiple logistic regression model confirmed such association after adjusting for age, body mass index, multinodularity, and laterality. The odds of malignancy in the upper pole were 4 times higher than other locations (odds ratio, 4.6; P = .03). CONCLUSION Our study is the first showing that thyroid nodules located in the upper pole can be considered as having higher risk for malignancy. It may enhance the predictive value of malignancy if it is included in thyroid nodule ultrasound classification guidelines. ABBREVIATIONS AACE = American Association of Clinical Endocrinologists; ATA = American Thyroid Association; BMI = body mass index; FNA = fine-needle aspiration; TMS = total malignancy score; TTW = taller than wide; US = ultrasonography.
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Haydardedeoglu FE, Bagir GS, Torun N, Kocer E, Reyhan M, Ertorer ME. Hounsfield unit value has null effect on thyroid nodules at 18F-FDG PET/CT scans. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:460-465. [PMID: 30304111 PMCID: PMC10118740 DOI: 10.20945/2359-3997000000063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/18/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Detection rate of thyroid nodules is increasing with the use of new imaging modalities, especially in screening for malignancies. Positron emission tomography/computed tomography (PET/ CT)-positive thyroid nodules should be differentiated for malignancy to avoid unnecessary operations and further follow-up. Most trials evaluate the role of SUVmax, but there is no definitive information about the utility of Hounsfield unit (HU) values for prediction of malignancy. This study aimed to evaluate the HU values beside SUVmax for detecting malignancy risk of PET/CT-positive thyroid nodules. SUBJECTS AND METHODS Results of 98 cancer patients who had fine needle aspiration biopsy (FNAB) for thyroid nodules detected on PET/CT between January 2011 and December 2015 were assessed. The FNABs and surgical pathological results were recorded. RESULTS FNABs revealed benign results in 32 patients (32.7%), malignant in 18 (18.4%), non-diagnostic in 20 (20.4%), and indeterminate in 28 (28.5%). Twenty-four patients underwent thyroidectomy. The mean HU values were not significantly different in benign and malignant nodules (p = 0.73). However, the mean SUVmax was significantly higher (p < 0.001) in malignant ones. Area under curve (AUC) was 0.824 for SUVmax; the cut-off value was over 5.55 (p < 0.001), with 80% sensitivity, 84.5% specificity. CONCLUSIONS Our current study demonstrated that HU value does not add any additional valuable information for discriminating between malignant and benign thyroid nodules. We also defined a SUV cut-off value of 5.55 for malignant potential of thyroid nodules detected on PET/CT Arch Endocrinol Metab. 2018;62(4):460-5.
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Affiliation(s)
| | - Gulay Simsek Bagir
- Baskent University Faculty of Medicine Department of Endocrinology and Metabolism, Adana, Turkey
| | - Nese Torun
- Baskent University Faculty of Medicine Department of Nuclear Medicine, Adana, Turkey
| | - Emrah Kocer
- Baskent University Faculty of Medicine Department of Pathology, Adana, Turkey
| | - Mehmet Reyhan
- Baskent University Faculty of Medicine Department of Nuclear Medicine, Adana, Turkey
| | - Melek Eda Ertorer
- Baskent University Faculty of Medicine Department of Endocrinology and Metabolism, Adana, Turkey
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Topaloğlu O, Başer H, Aksoy Altınboğa A, Ulusoy S, Ersoy R, Çakır B. The Evaluation of Clinicopathologic Features of Differentiated Thyroid Cancers. ANKARA MEDICAL JOURNAL 2018. [DOI: 10.17098/amj.461658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Polednik KM, Simpson MC, Adjei Boakye E, Mohammed KA, J Dombrowski J, Varvares MA, Osazuwa-Peters N. Radiation and Second Primary Thyroid Cancer Following Index Head and Neck Cancer. Laryngoscope 2018; 129:1014-1020. [PMID: 30208210 DOI: 10.1002/lary.27467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES/HYPOTHESIS Radiation is thought to increase risk of developing second primary thyroid cancer (SPTC). This study estimated the rate of SPTC following index head and neck cancer (HNC) and determined whether radiation treatment among HNC survivors increased SPTC risk. STUDY DESIGN Retrospective data analysis. METHOD The Surveillance, Epidemiology, and End Results database (1975-2014) was queried for cases of index HNC (N = 127,563) that developed SPTC. Adjusted multivariable competing risk proportional hazards model tested risk of developing a SPTC following index HNC. Sensitivity analyses using proportional hazards models were also performed restricting data to patients who 1) received both radiation and chemotherapy and 2) radiation alone. RESULTS Only 0.2% of index HNC survivors (n = 229) developed SPTC, yielding a rate of 26.1 per 100,000 person-years. For every increasing year of age at diagnosis, patients were 3% less likely to develop an SPTC (adjusted hazard ratio [aHR] = 0.97, 95% CI: 0.96-0.98). Males were also less likely to develop an SPTC (aHR = 0.73, 95% CI: 0.55-0.96). Radiation (aHR = 0.92, 95% CI: 0.68-1.25), surgery (aHR = 0.79, 95% CI: 0.56-1.11), and chemotherapy (aHR = 1.13, 95% CI: 0.76-1.69) were not significantly associated with developing SPTC. The sensitivity models also did not find an association between treatment and risk of SPTC. CONCLUSIONS Rate of developing SPTC following index HNC was very low, and previous exposure to radiation did not significantly increase risk in our study population. More studies are needed to understand the increasing incidence of thyroid cancer across the United States. LEVEL OF EVIDENCE NA Laryngoscope, 129:1014-1020, 2019.
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Affiliation(s)
| | - Matthew C Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Eric Adjei Boakye
- Center for Health Outcomes Research, Saint Louis University, St. Louis, Missouri
| | - Kahee A Mohammed
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri.,Center for Health Outcomes Research, Saint Louis University, St. Louis, Missouri
| | - John J Dombrowski
- Department of Radiation Oncology, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.,Saint Louis University Cancer Center, St. Louis, Missouri.,Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, U.S.A
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69
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Gedberg N, Karmisholt J, Gade M, Fisker RV, Iyer V, Petersen LJ. The Frequency of Focal Thyroid Incidental Findings and Risk of Malignancy Detected by 18F-Fluorodeoxyglucose Positron Emission Tomography in an Iodine Deficient Population. Diagnostics (Basel) 2018; 8:diagnostics8030046. [PMID: 30018271 PMCID: PMC6165051 DOI: 10.3390/diagnostics8030046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/11/2018] [Accepted: 07/17/2018] [Indexed: 12/21/2022] Open
Abstract
Incidental focal uptake of 18F-fluorodeoxyglucose (FDG) in the thyroid on positron emission tomography (PET/CT) is rare but often associated with malignancy. The epidemiology of thyroid incidentalomas has only to some extent been described in countries with iodine deficiency. Here we report data from Denmark, a country with known iodine deficiency and wide access to PET/CT. All FDG PET/CT comprising the head and neck region, during 2014, were retrospectively reviewed, and patients with focal FDG uptake in the thyroid gland were identified. A total of 2451 patients had an FDG PET/CT of which 59 (2.4%) patients presented with FDG-avid focal lesions in the thyroid gland. Among the 59 patients with FDG-avid lesions, 33 patients (56%) received work up with ultrasound, thyroid technetium scintigraphy, fine needle aspiration, and/or histology of which 20 patients had a conclusive pathology report. Ten patients with FDG-avid lesions were identified with thyroid malignancy. The risk of thyroid malignancy was 16.9% among patient with incidental FDG-avid thyroid lesions. Our findings indicated a similar frequency of FDG thyroid incidentalomas and malignancy rates in an iodine deficient population compared to summary data from prior studies, studies mostly performed in geographical areas of normal or excess iodine supplementation.
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Affiliation(s)
- Nina Gedberg
- Department of Otolaryngology, Aarhus University Hospital, DK-8000 Aarhus, Denmark.
| | - Jesper Karmisholt
- Department of Endocrinology, Aalborg University Hospital, DK-9000 Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark.
| | - Michael Gade
- Department of Nuclear Medicine, Clinical Cancer Research Centre, Aalborg University Hospital, DK-9000 Aalborg, Denmark.
| | - Rune V Fisker
- Department of Nuclear Medicine, Clinical Cancer Research Centre, Aalborg University Hospital, DK-9000 Aalborg, Denmark.
- Department of Radiology, Aalborg University Hospital, DK-9000 Aalborg, Denmark.
| | - Victor Iyer
- Department of Nuclear Medicine, Clinical Cancer Research Centre, Aalborg University Hospital, DK-9000 Aalborg, Denmark.
| | - Lars J Petersen
- Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark.
- Department of Nuclear Medicine, Clinical Cancer Research Centre, Aalborg University Hospital, DK-9000 Aalborg, Denmark.
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Maino F, Forleo R, Martinelli M, Fralassi N, Barbato F, Pilli T, Capezzone M, Brilli L, Ciuoli C, Di Cairano G, Nigi L, Pacini F, Castagna MG. Prospective Validation of ATA and ETA Sonographic Pattern Risk of Thyroid Nodules Selected for FNAC. J Clin Endocrinol Metab 2018; 103:2362-2368. [PMID: 29672763 DOI: 10.1210/jc.2018-00274] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/11/2018] [Indexed: 02/08/2023]
Abstract
CONTEXT Recently, the American Thyroid Association (ATA) and the European Thyroid Association (ETA) have proposed that thyroid ultrasound (US) should be used to stratify the risk of malignancy in thyroid nodules and to aid decision-making about whether fine-needle aspiration cytology (FNAC) is indicated. OBJECTIVE To validate and to compare the ATA and ETA US risk stratification systems of thyroid nodules in a prospective series of thyroid nodules submitted to FNAC. SETTING We prospectively evaluated 432 thyroid nodules selected for FNAC from 340 patients. Cytology reports were based on the five categories according to the criteria of the British Thyroid Association. RESULTS The proportion of Thy2 nodules decreased significantly, whereas the proportion of Thy4/Thy5 nodules significantly increased with increasing US risk class (P < 0.0001). The ability to identify benign and malignant nodules was similar between ATA and ETA systems. According to ATA and ETA US risk stratification systems, 23.7% and 56.0% nodules did not meet the criteria for FNAC, respectively. Considering only categories at lower risk of malignancy, the cumulative malignancy rate in these nodules was 1.2% for ATA and 1.7% for ETA US risk stratification systems. CONCLUSIONS ETA and ATA US risk stratification systems provide effective malignancy risk stratification for thyroid nodules. In clinical practice, using this approach, we should be able to reduce the number of unnecessary FNAC without losing clinically relevant thyroid cancer.
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Affiliation(s)
- Fabio Maino
- Department of Medical, Surgical, and Neurological Sciences, University of Siena, Siena, Italy
| | - Raffaella Forleo
- Department of Medical, Surgical, and Neurological Sciences, University of Siena, Siena, Italy
| | - Martina Martinelli
- Department of Medical, Surgical, and Neurological Sciences, University of Siena, Siena, Italy
| | - Noemi Fralassi
- Department of Medical, Surgical, and Neurological Sciences, University of Siena, Siena, Italy
| | - Filomena Barbato
- Department of Medical, Surgical, and Neurological Sciences, University of Siena, Siena, Italy
| | - Tania Pilli
- Department of Medical, Surgical, and Neurological Sciences, University of Siena, Siena, Italy
| | - Marco Capezzone
- Department of Medical, Surgical, and Neurological Sciences, University of Siena, Siena, Italy
| | - Lucia Brilli
- Department of Medical, Surgical, and Neurological Sciences, University of Siena, Siena, Italy
| | - Cristina Ciuoli
- Department of Medical, Surgical, and Neurological Sciences, University of Siena, Siena, Italy
| | - Giovanni Di Cairano
- Department of Medical, Surgical, and Neurological Sciences, University of Siena, Siena, Italy
| | - Laura Nigi
- Department of Medical, Surgical, and Neurological Sciences, University of Siena, Siena, Italy
| | - Furio Pacini
- Department of Medical, Surgical, and Neurological Sciences, University of Siena, Siena, Italy
| | - Maria Grazia Castagna
- Department of Medical, Surgical, and Neurological Sciences, University of Siena, Siena, Italy
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Chung SR, Choi YJ, Suh CH, Kim HJ, Lee JJ, Kim WG, Sung TY, Lee YM, Song DE, Lee JH, Baek JH. Thyroid Incidentalomas Detected on 18F-Fluorodeoxyglucose Positron Emission Tomography with Computed Tomography: Malignant Risk Stratification and Management Plan. Thyroid 2018; 28:762-768. [PMID: 29759033 DOI: 10.1089/thy.2017.0560] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aims of this study were to stratify the risk of malignancy in thyroid incidentalomas detected on 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) using ultrasound features according to guidelines for thyroid nodules and to develop a subsequent management plan. METHODS From a historical cohort of 96,942 consecutive patients who underwent 18F-FDG PET/CT between October 2008 and September 2015, 1342 patients with 1364 nodules underwent ultrasound evaluation for focal uptake in thyroid gland, with a final diagnosis made for 877 patients with 907 nodules, which were included in this study. Ultrasound images were retrospectively reviewed, and they were stratified according to the American Thyroid Association and Korean Thyroid Image Reporting and Data System guidelines. The calculated malignancy risks were compared with the estimated risks suggested by the guidelines. RESULTS The overall malignancy risk of thyroid incidentalomas detected on 18F-FDG PET/CT was 54.7%. When stratified according to the American Thyroid Association guidelines, the malignancy risks of thyroid incidentalomas with high and intermediate suspicion (93.2% and 45.2%, respectively) were higher than those indicated in the guidelines. The malignancy risks of thyroid incidentalomas with low and very low suspicion (8.1% and 0%, respectively) were within the guideline ranges. These findings were also noted when thyroid incidentalomas were stratified according to the Korean Thyroid Image Reporting and Data System, and in a subgroup of nodules >1 cm. CONCLUSIONS Ultrasound examinations can be used to stratify the malignancy risk of thyroid incidentalomas detected on 18F-FDG PET/CT. The risk of malignancy did not increase in thyroid incidentalomas with low and very low suspicion, indicating that only selective biopsies may be needed in these categories of thyroid incidentalomas.
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Affiliation(s)
- Sae Rom Chung
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Young Jun Choi
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Chong Hyun Suh
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
- 2 Department of Radiology, Namwon Medical Center , Namwon-Si, Republic of Korea
| | - Hwa Jung Kim
- 3 Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Jong Jin Lee
- 4 Department of Nuclear Medicine, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Won Gu Kim
- 5 Department of Endocrinology and Metabolism, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Tae Yon Sung
- 6 Department of Surgery, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Yu-Mi Lee
- 6 Department of Surgery, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Dong Eun Song
- 7 Department of Pathology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Jeong Hyun Lee
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Jung Hwan Baek
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
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72
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Germano A, Schmitt W, Almeida P, Mateus-Marques R, Leite V. Ultrasound requested by general practitioners or for symptoms unrelated to the thyroid gland may explain higher prevalence of thyroid nodules in females. Clin Imaging 2018; 50:289-293. [PMID: 29738997 DOI: 10.1016/j.clinimag.2018.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/23/2018] [Accepted: 05/01/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND A higher prevalence of thyroid nodules/carcinoma in females is well-known from the literature. The reasons for this difference are not fully explained. We intended to assess gender variation in the referral for ultrasound-guided fine needle aspiration (FNA) of thyroid nodules, to study reasons for gender referral differences, and to assess differences in nodules characteristics between genders. METHODS Included were 272 consecutive patients, with 290 nodules submitted to FNA. Patients were questioned on the reason why ultrasound (US) examination was required. Electronic medical records were reviewed. Nodules' ultrasound/cytological characteristics were assessed. Variables studied: referral cause; referral pattern (hospital-specialist versus general-practitioner); number of nodules; age, thyroid function; nodule size, TIRADS classification, resistive index, Doppler pattern, Bethesda categorisation. Variables were compared between males and females referred for FNA. Significant variables were assessed with logistic regression. RESULTS Of the 272 patients, 215(79%) were women with a female:male referral ratio for FNA of 3.8:1. Non-parametric statistically significant differences (p < 0.05) were found between genders in: thyroid function, nodule size, referral pattern and referral cause. Nodule size and thyroid function tests became non-significant in logistic regression. Cause and referral pattern remained significantly associated with gender. Referral by a general-practitioner was associated with a 2.6-fold increase in odds of referring a female. Causes unrelated to the thyroid were associated with a 3.2-fold increase in odds of female reference. CONCLUSIONS A referral bias might be responsible for the higher rate of thyroid nodules in female patients, both due to referral by general practitioners and due to causes indirectly related to the thyroid gland.
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Affiliation(s)
- Ana Germano
- Hospital Professor Doutor Fernando Fonseca, EPE; Serviço de Imagiologia. IC 19, Amadora, Portugal.
| | - Willian Schmitt
- Hospital Professor Doutor Fernando Fonseca, EPE; Serviço de Imagiologia. IC 19, Amadora, Portugal
| | - Pedro Almeida
- Instituto de Biofísica e Engenharia Biomédica; Faculdade de Ciências, Universidade de Lisboa, Campo Grande, Lisbon, Portugal.
| | - Rui Mateus-Marques
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, Lisbon, Portugal
| | - Valeriano Leite
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
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73
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Tugendsam C, Petz V, Buchinger W, Schmoll-Hauer B, Schenk IP, Rudolph K, Krebs M, Zettinig G. Ultrasound criteria for risk stratification of thyroid nodules in the previously iodine deficient area of Austria - a single centre, retrospective analysis. Thyroid Res 2018; 11:3. [PMID: 29760786 PMCID: PMC5941562 DOI: 10.1186/s13044-018-0047-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/23/2018] [Indexed: 12/19/2022] Open
Abstract
Background We aimed to study the validity of six published ultrasound criteria for risk stratification of thyroid nodules in the former severely iodine deficient population of Austria. Methods Retrospective, single centre, observer blinded study design. All patients with a history of thyroidectomy due to nodules seen in the centre between 2004 and 2014 with preoperative in-house sonography and documented postoperative histology were analyzed (n = 195). A board of five experienced thyroidologists evaluated the images of 45 papillary carcinomas, 8 follicular carcinomas, and 142 benign nodules regarding the following criteria: mild hypoechogenicity, marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, taller than wide shape, missing thin halo. Results All criteria but mild hypoechogenicity were significantly more frequent in thyroid cancer than in benign nodules. The number of positive criteria was significantly higher in cancer (2.79 ± 1.35) than in benign nodules (1.73 ± 1.18; p < 0.001). Thus, with a cut-off of two or more positive criteria, a sensitivity of 85% and a specificity of 45% were reached to predict malignancy in this sample of thyroid nodules. As expected, the findings were even more pronounced in papillary cancer only (2.98 ± 1.32 vs. 1.73 ± 1.18, p < 0.001). The six ultrasound criteria could not identify follicular cancer. Conclusion Our findings support the recently published EU-TIRADS score. Apart from mild hypoechogenicity, the analyzed ultrasound criteria can be applied for risk stratification of thyroid nodules in the previously severely iodine deficient population of Austria.
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Affiliation(s)
| | - Veronika Petz
- 2Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Brigitta Schmoll-Hauer
- Schilddruesenpraxis Josefstadt, Laudongasse 12/8, Vienna, AT-1080 Austria.,4Department of Nuclear Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - Iris Pia Schenk
- Schilddruesenpraxis Josefstadt, Laudongasse 12/8, Vienna, AT-1080 Austria.,Department of Nuclear Medicine, Sozialmedizinisches Zentrum Hietzing, Vienna, Austria
| | - Karin Rudolph
- Schilddruesenpraxis Josefstadt, Laudongasse 12/8, Vienna, AT-1080 Austria
| | - Michael Krebs
- Schilddruesenpraxis Josefstadt, Laudongasse 12/8, Vienna, AT-1080 Austria.,6Clinical Division of Endocrinology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Georg Zettinig
- Schilddruesenpraxis Josefstadt, Laudongasse 12/8, Vienna, AT-1080 Austria
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74
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Weiss VL, Andreotti RF, Ely KA. Use of the thyroid imaging, reporting, and data system (TI-RADS) scoring system for the evaluation of subcentimeter thyroid nodules. Cancer Cytopathol 2018; 126:518-524. [PMID: 29733503 DOI: 10.1002/cncy.22015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/06/2018] [Accepted: 04/19/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND The American Thyroid Association (ATA) recommends fine-needle aspiration (FNA) biopsy of nodules measuring >1.5 cm with low-suspicion sonographic patterns or >1.0 cm with high/intermediate-suspicion features. Routine biopsy of nodules <1 cm is not recommended. However, despite these recommendations, subcentimeter nodules are often referred for FNA biopsy. METHODS This was a retrospective chart review of consecutive thyroid FNAs during an 18-month period (1157 patients, 1491 nodules, 2016-2017) to evaluate age, sex, medical history, diagnoses, and follow-up. Radiographic information was used to identify 61 subcentimeter nodules (4%) from 57 patients. Ultrasound studies were re-evaluated using criteria according to the American College of Radiology Thyroid Imaging, Reporting, and Data System (TI-RADS). RESULTS Reported reasons for biopsy included a larger companion nodule (44%), a personal or family history of cancer (26%), or a suspicious sonogram, including calcification and/or irregular contours (16%). FNA diagnoses included: 69% benign (42 of 61 nodules), 10% papillary thyroid carcinoma (PTC) (6 of 61 nodules), and 15% atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) (9 of 61 nodules). Seven percent of nodules were unsatisfactory/nondiagnostic (4 of 61 nodules) compared with a 3% nondiagnostic rate for all sized nodules. Fifty-one nodules had an ultrasound available for re-review using the TI-RADS scoring system. A high TI-RADS score (4-5) was indicative of PTC in 29.4% of nodules. A low TI-RADS score (1-2) was indicative of PTC in 0% of nodules (P < .01). High and intermediate TI-RADS scores (3 and 4-5, respectively) were indicative of PTC/AUS/FLUS in 32% of nodules compared with 0% in those with low TI-RADS scores (P < .01). CONCLUSIONS The current results demonstrate successful use of the TI-RADS scoring system in evaluation of the risk of malignancy in subcentimeter nodules. Larger studies will be necessary to determine whether biopsy is warranted for TI-RADS high-subcentimeter nodules. Cancer Cytopathol 2018. © 2018 American Cancer Society.
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Affiliation(s)
- Vivian L Weiss
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rochelle F Andreotti
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kim A Ely
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
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75
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The prevalence of thyroid nodules in northwest China and its correlation with metabolic parameters and uric acid. Oncotarget 2018; 8:41555-41562. [PMID: 28107199 PMCID: PMC5522227 DOI: 10.18632/oncotarget.14720] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 01/03/2017] [Indexed: 11/25/2022] Open
Abstract
This study aimed to estimate the prevalence of thyroid nodules (TN) and investigate its correlation with metabolic parameters, especially uric acid (UA) in northwest Chinese population. We conducted a large cross-sectional survey with 67,781 residents (33,020 men, 34,761 women), aged from 18 to 86 years in Shanxi, China, from January 2012 to December 2014. A thyroid ultrasound examination was performed with number and size of nodules being recorded. Metabolic parameters including body mass index (BMI), blood pressure (BP), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), fasting glucose (FG), and uric acid (UA) were also examined. Our study revealed that approximately 30.7% of men and 39.9% of women in Northwest China had TN, about half of which were multi-nodularity and a quarter of their TN larger than 1 cm. The prevalence of TN increased with aging and increasing BMI, and metabolic disorders, which also related to the increased incident of multi-nodularity and larger TN. Serum UA appeared to be a protective factor for TN in men older than 30 years, but a risk factor in both men younger than 30 years and women older than 30 years. This phenomenon needs to be further investigated.
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Abstract
AIM The preoperative diagnosis of differentiated thyroid carcinomas (DTC) is particularly challenging in view of the high prevalence of thyroid nodules in the general population. Incidental diagnosis of DTC, on the other hand, can lead to reoperations and increased risk of morbidity. This study aimed to assess the prediction value of preoperative DTC dignity assessment and it's impact on surgical approaches. METHODS We retrospectively reviewed 107 cases of DTC and subdivided them in three groups based on the preoperative dignity assessment: suspected malignancy (SM), unclear dignity (UD), and incidental findings (IF). The group differences were investigated in terms of diagnostic methods, findings, and impact on the subsequent surgical approach. RESULTS The patient groups consisted of n = 51 (SM), n = 32 (UD), and n = 24 (IF). The tumor size, T staging, and ultrasound (US) assessment had the largest impact on the dignity classification (each p < 0.001). Scintigraphy was performed in 80 % of the patients, fine-needle aspiration cytology (FNAC) in 28 %. Hypofunction at scintigraphy (p < 0.001) and cytology results (p < 0.01) were identified as significant predictors for group assignment. Other significant factors were the frequency of the US documentation of nodule characteristics (p < 0.001) and malignancy criteria (p < 0.01) as well as reduced thyroid-stimulating hormone (TSH) levels (p < 0.01). Frozen section (p < 0.001) and total thyroidectomy (p < 0.01) at initial surgery were performed significantly more often in the MV group. Reoperations were significantly more frequent in the IF group (p < 0.001). CONCLUSIONS A relevant number of DTC cases was diagnosed incidentally, leading to significantly more frequent reoperations. A more systematic diagnostic approach with complete documentation of the findings according to current guidelines should be pursued.
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Song CM, Jang YI, Ji YB, Park JS, Kim DS, Tae K. Factors affecting operative time in robotic thyroidectomy. Head Neck 2017; 40:893-903. [PMID: 29206321 DOI: 10.1002/hed.25033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/07/2017] [Accepted: 10/25/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate factors related to operative time in robotic thyroidectomy. METHODS We retrospectively analyzed 240 patients who underwent robotic thyroidectomy. The total thyroidectomy cases and lobectomy cases were both categorized into those with long operative times (LOTs; upper 25% of cases) and those with short operative times (SOTs; lower 25%). RESULTS Among the total thyroidectomy cases, body mass index (BMI) ≥23 kg/m2 (hazard ratio [HR] 5.34; P = .008) and bilateral central neck dissection (CND; HR 14.92; P = .028) were more frequent in the LOT group in multivariate analysis. Among the lobectomy cases, BMI ≥23 kg/m2 (HR 12.92; P = .003) and unilateral CND (HR 21.38; P = .017) were the only independent risk factors for prolonged operative time. CONCLUSION Body habitus and clinical nodal status in the central compartment should be considered in deciding the indications for robotic thyroidectomy.
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Affiliation(s)
- Chang Myeon Song
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Youn Il Jang
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Yong Bae Ji
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Jeong Seon Park
- Department of Radiology, College of Medicine, Hanyang University, Seoul, Korea
| | - Dong Sun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Kyung Tae
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
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Sahli ZT, Umbricht CB, Schneider EB, Zeiger MA. Thyroid Nodule Diagnostic Markers in the Face of the New NIFTP Category: Time for a Reset? Thyroid 2017; 27:1393-1399. [PMID: 28859553 DOI: 10.1089/thy.2017.0238] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Current thyroid molecular tests are specifically designed for the differential diagnosis of nodules with indeterminate or suspicious fine-needle aspiration (FNA) cytology. SUMMARY However, their clinical validity faces challenges from both variation among institutions in cancer prevalence and, most recently, the new category of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). The latter diagnosis was previously classified as malignant. Relevant to this, all molecular panels on the market today were originally tested and validated within the context of these entities being considered malignant. CONCLUSION This review examines possible effects of the NIFTP reclassification as a precancerous lesion on the original validation studies and, investigates the effect of the significant reported variability in thyroid cancer prevalence on the performance of these tests.
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MESH Headings
- Adenocarcinoma, Follicular/classification
- Adenocarcinoma, Follicular/epidemiology
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/pathology
- Biomarkers, Tumor/genetics
- Biopsy, Fine-Needle
- Carcinoma, Papillary/classification
- Carcinoma, Papillary/epidemiology
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/pathology
- Diagnosis, Differential
- Gene Expression Profiling
- Humans
- Predictive Value of Tests
- Prevalence
- Prognosis
- Terminology as Topic
- Thyroid Cancer, Papillary
- Thyroid Neoplasms/classification
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/pathology
- Thyroid Nodule/classification
- Thyroid Nodule/epidemiology
- Thyroid Nodule/genetics
- Thyroid Nodule/pathology
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Affiliation(s)
- Zeyad T Sahli
- 1 Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Christopher B Umbricht
- 2 Departments of Oncology, Pathology, and Surgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Eric B Schneider
- 3 Health Services Outcomes Research Center, The Ohio State University College of Medicine , Department of Surgery, Columbus, Ohio
| | - Martha A Zeiger
- 1 Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine , Baltimore, Maryland
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Kawano Y, Nambu M, Uejima Y, Sato S, Suganuma E, Takano T, Oh-Ishi T. Risk Factors for Thyroid Cancer in Systemic Lupus Erythematosus. Glob Pediatr Health 2017; 4:2333794X17736700. [PMID: 29085866 PMCID: PMC5648094 DOI: 10.1177/2333794x17736700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 11/16/2022] Open
Abstract
We studied 3 patients with systemic lupus erythematosus (SLE) who developed thyroid cancer (TC). Potential risk factors for TC development was explored. Fifty-three patients with a clinical diagnosis of rheumatic diseases including SLE at our hospital between July 2014 and December 2014 were enrolled. Demographic, clinical, and laboratory findings were retrospectively compared between TC-positive and TC-negative patients. Among rheumatic diseases, lymphadenopathy/splenomegaly at treatment commencement, and lymphadenopathy/splenomegaly, painless ulcer (oral, nasal, or mucosal), and weight loss during the entire study period were precipitating factors. Lower current values of hemoglobin and methylprednisolone pulse therapy favored TC development. In 29 SLE patients, lymphadenopathy/splenomegaly at treatment commencement, lymphadenopathy/splenomegaly and weight loss during the entire study period, urinary granular casts at treatment commencement, and a lower current value of hemoglobin predisposed patients to TC. Several risk factors of TC are present in pediatric SLE. Patients with SLE should be investigated vigorously for TC with ultrasound.
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Affiliation(s)
| | - Meika Nambu
- Saitama Children's Medical Center, Saitama, Japan
| | - Youji Uejima
- Saitama Children's Medical Center, Saitama, Japan
| | - Satoshi Sato
- Saitama Children's Medical Center, Saitama, Japan
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80
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Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS. Eur Thyroid J 2017; 6:225-237. [PMID: 29167761 PMCID: PMC5652895 DOI: 10.1159/000478927] [Citation(s) in RCA: 656] [Impact Index Per Article: 93.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/17/2017] [Indexed: 01/04/2023] Open
Abstract
Thyroid ultrasound (US) is a key examination for the management of thyroid nodules. Thyroid US is easily accessible, noninvasive, and cost-effective, and is a mandatory step in the workup of thyroid nodules. The main disadvantage of the method is that it is operator dependent. Thyroid US assessment of the risk of malignancy is crucial in patients with nodules, in order to select those who should have a fine needle aspiration (FNA) biopsy performed. Due to the pivotal role of thyroid US in the management of patients with nodules, the European Thyroid Association convened a panel of international experts to set up European guidelines on US risk stratification of thyroid nodules. Based on a review of the literature and on the American Association of Clinical Endocrinologists, American Thyroid Association, and Korean guidelines, the panel created the novel European Thyroid Imaging and Reporting Data System, called EU-TIRADS. This comprises a thyroid US lexicon; a standardized report; definitions of benign and low-, intermediate-, and high-risk nodules, with the estimated risks of malignancy in each category; and indications for FNA. Illustrated by numerous US images, the EU-TIRADS aims to serve physicians in their clinical practice, to enhance the interobserver reproducibility of descriptions, and to simplify communication of the results.
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Affiliation(s)
- Gilles Russ
- Thyroid and Endocrine Tumors, Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France
| | - Steen J. Bonnema
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Murat Faik Erdogan
- Department of Endocrinology and Metabolism, University of Ankara School of Medicine, İbni Sina Hastanesi, Ankara, Turkey
| | - Cosimo Durante
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Rose Ngu
- Head Neck and Thyroid Imaging, Department of Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Laurence Leenhardt
- Thyroid and Endocrine Tumors, Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France
- *Laurence Leenhardt, MD, PhD, Thyroid and Endocrine Tumors Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 83 Bd de l'Hôpital, FR–75651 Paris Cedex 13 (France), E-Mail
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81
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US-Guided Percutaneous Radiofrequency versus Microwave Ablation for Benign Thyroid Nodules: A Prospective Multicenter Study. Sci Rep 2017; 7:9554. [PMID: 28842651 PMCID: PMC5573330 DOI: 10.1038/s41598-017-09930-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/31/2017] [Indexed: 12/27/2022] Open
Abstract
Compared with microwave ablation (MWA), percutaneous radiofrequency ablation (RFA) and laser ablation (LA) have been recommended as minimally invasive treatments for patients with symptomatic benign thyroid nodules (BTNs) because of the large number of clinical applications. This prospective multicenter study sought to evaluate the clinical outcomes of RFA and MWA for BTNs. In eight participating institutions, the total number of 1252 patients treated by RFA and MWA were 649 ones with 687 BTNs and 603 ones with 664 BTNs, respectively. The clinical outcomes including the nodular maximal diameter reduction ratio (MDRR), the nodular volume reduction ratio (VRR), and the incidence of complications were compared to evaluate the efficacy and safety of the two techniques. The results for the nodular MDRR and VRR in the RFA group were significantly better than those in the MWA group at 6 months and later follow-up, and the major complication rates of 4.78% and 6.63% in RFA and MWA groups showed no statistically significant differences. In conclusion, both RFA and MWA are safe and effective techniques for selected patients with symptomatic BTNs. The achieved MDRR and VRR in the RFA group were greater than those in the MWA group at 6 months and later follow-up.
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82
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Cohen O, Tzelnick S, Lahav Y, Schindel D, Halperin D, Yehuda M. Selection of Atypia/Follicular Lesion of Unknown Significance Patients for Surgery Versus Active Surveillance, Without Using Genetic Testing: A Single Institute Experience, Prospective Analysis, and Recommendations. Thyroid 2017; 27:928-935. [PMID: 28463595 DOI: 10.1089/thy.2016.0237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Atypia/follicular lesion of unknown significance (AUS/FLUS) has variable rates of malignancy. The recommended management includes active surveillance (AS), repeated fine-needle aspiration (RFNA), diagnostic surgery, or genetic testing for malignancy. The objective of this study was to assess the management of AUS/FLUS patients in a dedicated thyroid clinic without implementing genetic testing. METHODS This was a single institute cohort study of all patients aged ≥18 years who underwent ultrasound-guided FNA thyroid biopsies between January 2009 and January 2013 and were followed until January 2016. The median follow-up time was 4.6 years (range 3.2-6.8 years). Forty-eight (57%) patients were referred to AS, and 36 (43%) patients were referred for diagnostic surgery. Thirty-six (75%) patients from the AS group underwent RFNA. An additional eight patients from the AS group subsequently underwent diagnostic surgery. RESULTS Malignancies were found in 15/44 (34%) diagnostic surgical samples, and benign cytologies were found in 61.1% of the RFNAs. Analysis of adherence to follow-up in the 36 AS patients showed an adherence rate of only 53%, with males tending to comply better than females did (31.6% vs. 5.8%, respectively; p = 0.052), especially males in their sixth decade of life. CONCLUSIONS Genetic tests for AUS/FLUS patients are accepted today as complementary evaluations in many well-developed health systems. Yet, when these tests are not feasible due to financial or availability issues, careful management of AUS/FLUS patients may still offer good results in the selection of patients for surgery or AS. The present results also indicate that compliance to follow-up schedules is a major consideration when selecting patients for AS.
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Affiliation(s)
- Oded Cohen
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University in Jerusalem , Rehovot, Israel
| | - Sharon Tzelnick
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University in Jerusalem , Rehovot, Israel
| | - Yonatan Lahav
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University in Jerusalem , Rehovot, Israel
| | - Doron Schindel
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University in Jerusalem , Rehovot, Israel
| | - Doron Halperin
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University in Jerusalem , Rehovot, Israel
| | - Moshe Yehuda
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah School of Medicine, Hebrew University in Jerusalem , Rehovot, Israel
- 2 Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University , Tel-Aviv, Israel
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83
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Ye Q, Woo JS, Zhao Q, Wang P, Huang P, Chen L, Li X, Xu K, Yong Y, (Sung-Eun) Yang S, Rao J. Fine-Needle Aspiration Versus Frozen Section in the Evaluation of Malignant Thyroid Nodules in Patients With the Diagnosis of Suspicious for Malignancy or Malignancy by Fine-Needle Aspiration. Arch Pathol Lab Med 2017; 141:684-689. [DOI: 10.5858/arpa.2016-0305-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
The Bethesda System for Reporting Thyroid Cytopathology recommends against the use of intraoperative frozen section (FS) during lobectomy of a thyroid nodule with a fine-needle aspiration (FNA) diagnosis of malignant. Bethesda recommendations for FS in the FNA category of suspicious for malignancy (SFM) is less well-defined. In some institutions in China, FS examination is performed during lobectomy even for FNA-proven malignant cases.
Objective.—
—To compare the efficacy of FNA versus FS in the evaluation of malignant thyroid lesions.
Design.—
A 3-year retrospective analysis from a single institution was performed on cases with an FNA diagnosis of SFM or malignant with subsequent FS examination during thyroidectomy. The results of FNA and FS findings were compared to the final thyroidectomy pathology.
Results.—
—A total of 5832 thyroidectomy procedures were performed: 1265 cases had FNA and FS results available. Fine-needle aspiration gave a diagnosis of SFM to 306 cases and a diagnosis of malignant to 821 cases. Of the SFM cases, 10.5% (32 of 306) had benign/indeterminate, 4.6% (14 of 306) suspicious, and 84.9% (260 of 306) malignant FS results. Final pathology showed 56.3% (18 of 32), 64.3% (9 of 14), and 100% (260 of 260) malignancy rates, respectively. For the malignant FNA group, 10.0% (82 of 821) had benign/indeterminate, 4.4% (36 of 821) suspicious, and 85.6% (703 of 821) malignant FS results. The final pathology showed 96.4% (79 of 82), 97.2% (35 of 36), and 99.9% (702 of 703) malignancy rates, respectively.
Conclusions.—
Frozen section should not be performed for the malignant FNA category because FS evaluation may result in 10% falsely negative findings. Performing FS for SFM may be better justified; however, more than half of FS cases read as benign in this category had malignant final pathology. Therefore, caution should be taken for FS results even in the SFM group.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jianyu Rao
- From the Departments of Pathology (Drs Ye, Chen, and Xu, and Ms Li), Surgery (Drs Zhao and Wang), and Ultrasonography (Dr Huang), Second Affiliate Hospital, Zhejiang University, Hangzhou, China; and the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Drs Woo, Yang, and Rao, and Mr Yong)
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Characterization of Thyroid Nodules by 4-Dimensional Computed Tomography: Initial Experience. J Comput Assist Tomogr 2017; 41:195-198. [PMID: 27560025 DOI: 10.1097/rct.0000000000000495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to evaluate the use of 4-dimensional computed tomography (4DCT) for characterization of thyroid nodules. METHODS Our study drew from 100 consecutive patients with primary hyperparathyroidism who underwent 4D parathyroid CT imaging for adenoma localization. Included subjects had tissue sampling of a thyroid nodule within 3 months of 4DCT. RESULTS Twenty subjects (18 women and 2 men) had thyroid nodules that were pathologically confirmed. Precontrast nodule attenuation was significantly lower in malignant nodules when compared with benign nodules (36 vs 61 HU, P = 0.05). Arterial phase and delayed phase nodule attenuations were not significantly different in malignant and benign nodules (128 vs 144 HU, P = 0.7; 74 vs 98 HU, P = 0.3). CONCLUSIONS Our initial experience with a small group of patients was unable to support the use of 4DCT for characterizing thyroid nodules; however, precontrast nodule attenuation was significantly lower in malignant nodules when compared with benign nodules.
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Sonographic differences between conventional and follicular variant papillary thyroid carcinoma. Eur Arch Otorhinolaryngol 2017; 274:2907-2913. [DOI: 10.1007/s00405-017-4557-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
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Mathonnet M, Cuerq A, Tresallet C, Thalabard JC, Fery-Lemonnier E, Russ G, Leenhardt L, Bigorgne C, Tuppin P, Millat B, Fagot-Campagna A. What is the care pathway of patients who undergo thyroid surgery in France and its potential pitfalls? A national cohort. BMJ Open 2017; 7:e013589. [PMID: 28389487 PMCID: PMC5558818 DOI: 10.1136/bmjopen-2016-013589] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The rate of thyroid cancer is increasing in France, as well as concerns about overdiagnosis and treatment. OBJECTIVES To examine the care pathway of patients who undergo thyroid surgery in France and detect potential pitfalls. DESIGN A large observational study based on medical reimbursements, 2009-2011. SETTING Data from the Sniiram (National Health Insurance Information System). PATIENTS Patients with thyroid surgery in 2010, classified into 4 groups: thyroid cancer, benign nodule, goitre or multiple nodules, other (hyperthyroidism, head-neck cancer). MAIN OUTCOME MEASURES Medical investigations during, prior and after thyroidectomy. RESULTS A total of 35 367 patients underwent surgery (mean age 51 years, 80% women): 17% had a reported diagnosis of thyroid cancer, 20% benign nodule, 38% goitre or multiple nodules and 25% another diagnosis. The ratio of thyroidectomies with cancer over thyroidectomies with benign nodule was 0.8 and varied across regions. In the year preceding surgery, 82% of patients had an investigation by thyroid ultrasonography, 21% thyroid scintigraphy, 34% fine-needle aspiration cytology, 40% serum calcitonin assay and 54% serum calcium assay. In the following year, all patients with total thyroidectomy and 44% of patients with partial thyroidectomy and a diagnosis of benign nodule were taking thyroid hormone therapy. 100 patients had been reoperated for a compressive haematoma and 63 died during the first month, half of whom had been operated for cancer. Mean rates of recurrent laryngeal nerve injury and hypocalcaemia (requiring blood tests plus treatments within 4-12 months) were estimated at 1.5% and 3.4%, respectively, and were higher in the cancer group (2.3% and 5.7%). CONCLUSIONS This almost nationwide study demonstrates the suboptimal management of patients prior to thyroidectomy in France. It suggests overdiagnosis and potential harms to patients, and calls for a review of the relevance of thyroidectomy, particularly with regard to microcancers.
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Affiliation(s)
| | - Anne Cuerq
- Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | - Christophe Tresallet
- Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital, Paris, France
| | | | | | - Gilles Russ
- Department of Thyroid Diseases and Endocrine Tumors, Pitié Salpêtrière Hospital, University Paris VI, Institut E3M, Paris, France
| | - Laurence Leenhardt
- Department of Thyroid Diseases and Endocrine Tumors, Pitié Salpêtrière Hospital, University Paris VI, Institut E3M, Paris, France
| | - Claude Bigorgne
- Department of Pathology, La Pitié Salpétrière Hospital, Paris, France
| | - Philippe Tuppin
- Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | | | - Anne Fagot-Campagna
- Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
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Negro R, Attanasio R, Grimaldi F, Frasoldati A, Guglielmi R, Papini E. A 2016 Italian Survey about Guidelines and Clinical Management of Thyroid Nodules. Eur Thyroid J 2017; 6:75-81. [PMID: 28589088 PMCID: PMC5422755 DOI: 10.1159/000453032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 10/28/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND While thyroid nodules are frequent in endocrine clinical practice, patients are often asymptomatic and euthyroid, and death is rare in cases of malignancy. OBJECTIVES To evaluate the perception of current international guidelines regarding thyroid nodule management among Italian endocrinologists, and to compare daily clinical practice with suggested recommendations. METHODS Italian Association of Clinical Endocrinologists (AME) members were invited to participate in a Web-based survey. RESULTS A total of 566 physicians responded. About 50% had read the full text of the guidelines. Over half appreciated the suggested ultrasound (US) risk categories. Fine-needle aspiration (FNA) was obtained more frequently than recommended. Follow-up of a cytologically benign nodule was largely performed according to the guidelines. Molecular testing would be most commonly requested when cytology reports showed atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) (TIR3A for Italian System). Iodine and/or levothyroxine were largely prescribed for cytologically benign asymptomatic nodules. Laser/radiofrequency ablation and percutaneous ethanol injection were commonly considered as alternatives to surgery (46.2 and 71.4%, respectively). CONCLUSIONS Efforts are needed to make the guidelines more user-friendly and to encourage the use of codified risk categories in thyroid US reports. FNA indications remain a matter of debate as FNA is obtained in clinical practice more often than is recommended. Current US follow-up modalities for a benign nodule are correct, but probably could be performed less frequently without any harm. Molecular testing, if accessible, would be helpful in guiding clinicians' strategies in cases of AUS/FLUS-TIR3A cytologic results. Nonsurgical procedures are favorably embraced.
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Affiliation(s)
- Roberto Negro
- Division of Endocrinology, “V. Fazzi” Hospital, Lecce, Italy
- *Roberto Negro, MD, FACE, Division of Endocrinology, “V. Fazzi” Hospital, Piazza Muratore 1, IT-73100 Lecce (Italy), E-Mail
| | | | - Franco Grimaldi
- Endocrinology and Metabolic Disease Unit, Azienda Ospedaliero-Universitaria “S. Maria della Misericordia,” Udine, Italy
| | - Andrea Frasoldati
- Division of Endocrinology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Rinaldo Guglielmi
- Department of Endocrinology, Regina Apostolorum Hospital, Albano Laziale, Italy
| | - Enrico Papini
- Department of Endocrinology, Regina Apostolorum Hospital, Albano Laziale, Italy
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88
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Moifo B, Moulion Tapouh JR, Dongmo Fomekong S, Djomou F, Manka'a Wankie E. Ultrasonographic prevalence and characteristics of non-palpable thyroid incidentalomas in a hospital-based population in a sub-Saharan country. BMC Med Imaging 2017; 17:21. [PMID: 28259145 PMCID: PMC5336663 DOI: 10.1186/s12880-017-0194-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 02/27/2017] [Indexed: 11/27/2022] Open
Abstract
Background Thyroid incidentalomas (TI) are highly prevalent asymptomatic thyroid nodules with ultrasound as the best imaging modality for their detection and characterization. Although they are mostly benign, potential for malignancy is up to 10–15%. In sub-Saharan Africa little data exists on the prevalence and risk categorization of TI. The aim of this study was to determine the prevalence and ultrasound characteristics of non-palpable thyroid incidentalomas among adults in sub-Saharan setting. Methods A cross sectional study was carried out between March and August 2015, at two university teaching hospitals. Sampling was consecutive and included all adults aged ≥ 16 years, presenting for any ultrasound other than for the thyroid, with no history or clinical signs of thyroid disease, and no palpable thyroid lesion. Ultrasound was done using 4 to 11 MHz linear probes. Subjects with diffuse thyroid abnormalities were excluded. Variables studied were age, gender, thyroid volume, ultrasound characteristics of thyroid nodules, TIRADS scores. Differences were considered statistically significant for p-value < 0.05. Results The prevalence of TI was 28.3% (126 persons with TI /446 examined). This prevalence was 46.2% in population ≥ 61-year-old; 6.3% in population ≤ 20-year-old; 33.3% for females and 18.4% for males (p < 0.001). Of the 241 TI found, 49.4% were cysts, 33.6% solid, 17.0% mixed; 37.8% <5 mm and 22% >10 mm. Solid TI were mainly hyperechoic (42.0%), 3/81 were markedly hypoechoic. Sixty-nine out of 126 persons with TI (54.8%) had at least two nodules. Solitary nodules were predominant in the age group ≤20 years. Of 241 TI, 129 (53.5%) were classified TIRADS 2, 81 (33.6%) TIRADS 3, 25 (10.4%) TIRADS 4A, 6 (2.5%) TIRADS 4B, and none TIRADS 5. Characteristics associated with increased risk of malignancy where mostly founded on solid nodules (p < 0.000) and nodules larger than 15 mm (p < 0.001). Conclusion Thyroid incidentalomas were very frequent with a prevalence of 28.3% and potential risk of malignancy in 12.9%. Prevalence had a tendency to increase with age and in female. Cystic nodules were the most prevalent. Potential for malignancy would be increased for larger and solid nodules.
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Affiliation(s)
- Boniface Moifo
- Department of Radiology and Radiation Oncology, Faculty of Medicine and Biomedical Sciences, The University of Yaounde 1, Yaounde, Cameroon. .,Radiology Department YGOPH, Yaounde Gynaeco-Obstetric and Pediatric Hospital, PO Box 4362, Yaounde, Cameroon.
| | - Jean Roger Moulion Tapouh
- Department of Radiology and Radiation Oncology, Faculty of Medicine and Biomedical Sciences, The University of Yaounde 1, Yaounde, Cameroon.,Yaounde University Teaching Hospital, Yaounde, Cameroon
| | - Sylviane Dongmo Fomekong
- Department of Radiology and Radiation Oncology, Faculty of Medicine and Biomedical Sciences, The University of Yaounde 1, Yaounde, Cameroon
| | - François Djomou
- Department of Radiology and Radiation Oncology, Faculty of Medicine and Biomedical Sciences, The University of Yaounde 1, Yaounde, Cameroon.,Yaounde University Teaching Hospital, Yaounde, Cameroon
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Martín-Hernández T, Díez Gómez JJ, Díaz-Soto G, Torres Cuadro A, Navarro González E, Oleaga Alday A, Sambo Salas M, Reverter Calatayud JL, Argüelles Jiménez I, Mancha Doblas I, Fernández García D, Galofré JC. Criterios sobre la utilización y requerimientos técnicos de la ecografía tiroidea en los servicios de endocrinología y nutrición. ENDOCRINOL DIAB NUTR 2017; 64 Suppl 1:23-30. [DOI: 10.1016/j.endinu.2016.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/09/2016] [Accepted: 10/17/2016] [Indexed: 12/19/2022]
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Yoo J, Ahn HS, Kim SJ, Park SH, Seo M, Chong S. Evaluation of Diagnostic Performance of Screening Thyroid Ultrasonography and Imaging Findings of Screening-Detected Thyroid Cancer. Cancer Res Treat 2017; 50:11-18. [PMID: 28231691 PMCID: PMC5784632 DOI: 10.4143/crt.2016.600] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/08/2017] [Indexed: 12/13/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the diagnostic performance and cost of screening thyroid ultrasonography (US) in an asymptomatic population and determine the US features of screening-detected thyroid cancer. Materials and Methods This study included 1,845 asymptomatic participants who underwent screening thyroid US between March and August 2012 at the screening center in our hospital. We evaluated the diagnostic performance of screening thyroid US for thyroid cancer and the average cost of diagnosis for each patient. We also determined the characteristic US features of screening-detected thyroid cancer. Results Of the 1,845 subjects, 661 showed no abnormalities, 1,155 exhibited benign thyroid nodules, and 29 exhibited thyroid cancer. Imaging features such as solid composition, hypoechogenicity, taller-than-wide axis, and ill-defined or spiculated margins of nodules were suggestive of malignancy. The rate of detection of cancer was 1.6% (29/1,845), and the sensitivity, specificity, and positive and negative predictive values were 100% (18/18), 98.7% (1,051/1,065), 56.3% (18/32), and 100% (1,051/1,051), respectively. Of 18 patients who underwent thyroidectomy, three (16.7%) had a pathological tumor staging of T3, and four (22.2%) had a pathological nodal staging of N1a. The average cost of diagnosis for each patient with cancer was $7,319. Conclusion Screening thyroid US exhibited a good diagnostic performance, with a feasible social cost of use. This modality demonstrated significant differences in sonographic features between screening-detected cancer and benign nodules.
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Affiliation(s)
- Jeongin Yoo
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Soo Jin Kim
- Department of Radiology, New Korea Hospital/Human Medical Imaging and Intervention Center, Gimpo, Korea
| | - Sung Hee Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mirinae Seo
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.,Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Semin Chong
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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91
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Clinkscales W, Ong A, Nguyen S, Harruff EE, Gillespie MB. Diagnostic Value of RAS Mutations in Indeterminate Thyroid Nodules. Otolaryngol Head Neck Surg 2017; 156:472-479. [PMID: 28116986 DOI: 10.1177/0194599816685697] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objectives To determine the diagnostic value of HRAS, KRAS, and NRAS mutations in fine-needle aspiration biopsies of thyroid nodules that are nondiagnostic on cytology. Data Sources PubMed, Scopus, Embase, CINAHL. Review Methods Two authors independently searched the data sources. To be included, studies reported the RAS mutational status and postoperative histopathologic diagnosis of nodules that exhibited indeterminate cytology after fine-needle aspiration biopsy. Data were extracted to calculate sensitivity, specificity, and positive/negative predictive values of any HRAS, KRAS, or NRAS mutation. A meta-analysis was performed to generate pooled values for each parameter. Results A total of 7 studies with a combined 1025 patients met inclusion criteria. The pooled sensitivity of a RAS mutation for detecting cancer was 0.343 (95% confidence interval [95% CI], 0.198-0.506), while the pooled specificity was 0.935 (95% CI, 0.882-0.973). The weighted averages for positive predictive value and negative predictive value were 78.0% and 64.0%, respectively, with 68.0% accuracy. The positive likelihood ratio was 4.235 (95% CI, 1.506-11.910), and the negative likelihood ratio was 0.775 (95% CI, 0.630-0.953). Conclusion Our data suggest that testing for any RAS mutation is unlikely to change the clinical management of thyroid nodules that have indeterminate cytology. While a RAS mutation may rule in malignancy, the sensitivity of testing is low enough to merit further mutational analysis, repeat fine-needle aspiration, or surgical excision, even in the presence of a negative test.
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Affiliation(s)
- William Clinkscales
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Adrian Ong
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun Nguyen
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elizabeth Emily Harruff
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marion Boyd Gillespie
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Negro R, Salem TM, Greco G. Laser ablation is more effective for spongiform than solid thyroid nodules. A 4-year retrospective follow-up study. Int J Hyperthermia 2016; 32:822-8. [DOI: 10.1080/02656736.2016.1212279] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Roberto Negro
- Division of Endocrinology, “V. Fazzi” Hospital, Lecce, Italy
| | - Tarek M. Salem
- Department of Internal Medicine, Alexandria University, Alexandria, Egypt
| | - Gabriele Greco
- Division of Endocrinology, “V. Fazzi” Hospital, Lecce, Italy
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Sui X, Liu HJ, Jia HL, Fang QM. Contrast-enhanced ultrasound and real-time elastography in the differential diagnosis of malignant and benign thyroid nodules. Exp Ther Med 2016; 12:783-791. [PMID: 27446276 DOI: 10.3892/etm.2016.3344] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 01/26/2016] [Indexed: 12/17/2022] Open
Abstract
The diagnostic value of contrast-enhanced ultrasound (CEUS) or real-time elastography (RTE) alone, as well as a combination of CEUS and RTE, in distinguishing benign from malignant thyroid nodules was investigated. Between August 2012 and June 2014, a total of 97 consecutive patients (50 male and 47 female patients; mean age, 48.6±12.4; age range, 27-70 years) with thyroid nodules referred for surgical treatment were examined by CEUS and RTE. The final diagnosis was obtained based on histological findings. Image analysis of the CEUS and RTE scans was performed. Considering the postoperative pathological results as the golden standard, a receiver operating characteristic (ROC) curve was constructed. Subsequently, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CEUS alone, RTE alone and CEUS + RTE combination were calculated. Pathological examination showed 66 papillary carcinomas and 43 benign lesions, including 21 adenomas and 22 nodular goiters. The sensitivity, specificity, PPV, NPV and accuracy of CEUS were 81.82, 90.70, 93.10, 90.70 and 85.32%, respectively. In the case of RTE, the sensitivity, specificity, PPV, NPV and accuracy were 80.30, 88.37, 91.38, 88.37 and 83.49%, respectively. Furthermore, the combination of CEUS + RTE had a sensitivity of 95.45%, specificity of 95.35%, PPV of 96.92%, NPV of 95.35% and accuracy of 95.41%. Therefore, the CEUS + RTE combination showed a significantly higher sensitivity and specificity compared with CEUS or RTE alone (all P<0.05). Based on ROC analysis, the area under the curve (AUC) for CEUS, RTE and CEUS + RTE combination was 0.883, 0.863 and 0.959, respectively. The AUC of RTE alone was significantly lower compared with that of the CEUS + RTE combination. In conclusion, our results demonstrate that CEUS + RTE combination significantly increases the diagnostic performance for differential diagnosis of malignant and benign thyroid nodules compared with CEUS or RTE alone.
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Affiliation(s)
- Xin Sui
- Department of Ultrasound, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Huai-Jun Liu
- Department of Radiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050050, P.R. China
| | - Hong-Li Jia
- Department of Radiology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Qin-Mao Fang
- Department of Ultrasound, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
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Hao Y, Pan C, Chen W, Li T, Zhu W, Qi J. Differentiation between malignant and benign thyroid nodules and stratification of papillary thyroid cancer with aggressive histological features: Whole-lesion diffusion-weighted imaging histogram analysis. J Magn Reson Imaging 2016; 44:1546-1555. [PMID: 27093648 DOI: 10.1002/jmri.25290] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 04/04/2016] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To explore the usefulness of whole-lesion histogram analysis of apparent diffusion coefficient (ADC) derived from reduced field-of-view (r-FOV) diffusion-weighted imaging (DWI) in differentiating malignant and benign thyroid nodules and stratifying papillary thyroid cancer (PTC) with aggressive histological features. MATERIALS AND METHODS This Institutional Review Board-approved, retrospective study included 93 patients with 101 pathologically proven thyroid nodules. All patients underwent preoperative r-FOV DWI at 3T. The whole-lesion ADC assessments were performed for each patient. Histogram-derived ADC parameters between different subgroups (pathologic type, extrathyroidal extension, lymph node metastasis) were compared. Receiver operating characteristic curve analysis was used to determine optimal histogram parameters in differentiating benign and malignant nodules and predicting aggressiveness of PTC. RESULTS Mean ADC, median ADC, 5th percentile ADC, 25th percentile ADC, 75th percentile ADC, 95th percentile ADC (all P < 0.001), and kurtosis (P = 0.001) were significantly lower in malignant thyroid nodules, and mean ADC achieved the highest AUC (0.919) with a cutoff value of 1842.78 × 10-6 mm2 /s in differentiating malignant and benign nodules. Compared to the PTCs without extrathyroidal extension, PTCs with extrathyroidal extension showed significantly lower median ADC, 5th percentile ADC, and 25th percentile ADC. The 5th percentile ADC achieved the highest AUC (0.757) with cutoff value of 911.5 × 10-6 mm2 /s for differentiating between PTCs with and without extrathyroidal extension. CONCLUSION Whole-lesion ADC histogram analysis might help to differentiate malignant nodules from benign ones and show the PTCs with extrathyroidal extension. J. Magn. Reson. Imaging 2016;44:1546-1555.
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Affiliation(s)
- Yonghong Hao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chu Pan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - WeiWei Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Li
- Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - WenZhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - JianPin Qi
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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De Napoli L, Bakkar S, Ambrosini CE, Materazzi G, Proietti A, Macerola E, Basolo F, Miccoli P. Indeterminate Single Thyroid Nodule: Synergistic Impact of Mutational Markers and Sonographic Features in Triaging Patients to Appropriate Surgery. Thyroid 2016; 26:390-4. [PMID: 26548748 DOI: 10.1089/thy.2015.0311] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Patients labeled as having indeterminate thyroid nodular disease following fine-needle aspiration cytology are at risk of non-optimal initial surgery: an overly radical total thyroidectomy, or an unnecessary two-stage operation. The objective of this study was to assess the impact of combining mutational markers and ultrasonographic (US) features preoperatively on predicting the risk of malignancy in patients with indeterminate nodules, thereby offering them a tailored initial surgical intervention. METHODS The records of 258 patients who underwent conventional total thyroidectomy for single nodules reported as suspicious for a follicular neoplasm (Bethesda category IV) in a four-year period were reviewed. Main issues addressed included: certain US findings (individually and in combination), mutational markers (BRAF and NRAS), and combinations of both. Correlation of these with malignancy was assessed, as was their ability to predict malignancy. The usefulness of combining the absence of suspicious sonographic features and the absence of mutational markers was also evaluated. RESULTS Among the 258 patients with an indeterminate diagnosis, only 90 lesions were found to be malignant. The sonographic features that correlated significantly with malignancy were irregular margins, microcalcifications, and a "taller than wide" shape. The presence of irregular margins was the feature with the highest positive predictive value. Combinations of two or more features were always associated with predictivity in excess of 90%, and at times at 100%. NRAS mutation was the most common gene alteration. Both BRAF and NRAS mutations were mutually exclusive and correlated significantly with malignancy. Their predictivity of malignancy was high, particularly when combined with suspicious sonographic features (100%). The major limitation of both suspicious sonographic features and/or mutational markers was their low occurrence in malignancy. The absence of both mutational markers and suspicious sonographic features proved extremely useful in tailoring surgical strategy, as it could have ultimately spared 143/258 patients (55%) an overly radical thyroidectomy. CONCLUSION The preoperative utility of mutational markers and sonographic features in combination has a synergistic impact. It can predict the risk of malignancy with high accuracy, properly triaging patients to appropriate surgery.
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Affiliation(s)
- Luigi De Napoli
- 1 Division of Surgery; University Hospital of Pisa , Pisa, Italy
| | - Sohail Bakkar
- 1 Division of Surgery; University Hospital of Pisa , Pisa, Italy
| | | | | | - Agnese Proietti
- 2 Division of Pathology, Department of Surgical Pathology; University Hospital of Pisa , Pisa, Italy
| | - Elisabetta Macerola
- 2 Division of Pathology, Department of Surgical Pathology; University Hospital of Pisa , Pisa, Italy
| | - Fulvio Basolo
- 2 Division of Pathology, Department of Surgical Pathology; University Hospital of Pisa , Pisa, Italy
| | - Paolo Miccoli
- 1 Division of Surgery; University Hospital of Pisa , Pisa, Italy
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Chae IH, Kwon HJ, Kim EK, Moon HJ, Yoon JH, Lee HS, Kwak JY. Value of additional von Kossa staining in thyroid nodules with echogenic spots on ultrasound. Pathol Res Pract 2016; 212:415-20. [PMID: 26916952 DOI: 10.1016/j.prp.2016.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/26/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the clinical value of additional von Kossa staining on cytology in thyroid nodules with echogenic spots on ultrasound (US). MATERIALS AND METHODS 342 thyroid nodules were analyzed for cytology and von Kossa staining was performed to detect microcalcifications. We compared diagnostic performances and accuracies of FNA and FNA with von Kossa staining to detect malignancy. We evaluated associations of aggressive pathologic features and von Kossa positivity in the surgically confirmed papillary thyroid carcinoma (PTC) group. RESULTS Two hundred and thirty two (67.8%) nodules were malignant and 110 (32.2%) were benign on cytopathology. Compared to cytology alone, additional von Kossa staining slightly improved sensitivity from 89.7% to 90.9% (P=0.081). In 207 cases of surgically confirmed PTC, von Kossa positivity was an independent predictor of central lymph node metastasis in PTCs by multivariate analysis (odds ratio, 2.218; P=0.021). CONCLUSIONS Adding von Kossa staining to cytology improved the sensitivity of thyroid nodules with echogenic spots on US. Positive von Kossa stains in PTCs may also be useful in predicting central lymph node metastasis.
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Affiliation(s)
- In Hye Chae
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Hyeong Ju Kwon
- Department of Pathology, Yonsei University, College of Medicine, Seoul, South Korea; Department of Pathology, Yonsei University, Wonju College of Medicine, Seoul, South Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Hee Jung Moon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Hye Sun Lee
- Biostastistics Collaboration Unit, Medical Research Center, Yonsei University, College of Medicine, Seoul, South Korea
| | - Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
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97
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Lacout A, Chevenet C, Salas J, Marcy PY. Thyroid Doppler US: Tips and tricks. J Med Imaging Radiat Oncol 2015; 60:210-5. [PMID: 26663777 DOI: 10.1111/1754-9485.12424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
Abstract
Incidental diagnosis of thyroid nodules is very common on adult neck ultrasonography (US) examination. They are primarily assessed on size and greyscale ultrasound criteria such as hypoechogenicity, taller than wide, spiculated margins and calcifications. In difficult situations Doppler US features may improve tumour characterisation and staging.
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Affiliation(s)
| | | | - Joël Salas
- Service de Chirurgie ORL, Centre Médico-Chirurgical, Aurillac, France
| | - Pierre Yves Marcy
- Polyclinique Les Fleurs, Service Imagerie Médicale, Ollioule, France
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98
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Kim D, Hwang SH, Cha J, Jo K, Lee N, Yun M. Risk Stratification of Thyroid Incidentalomas Found on PET/CT: The Value of Iodine Content on Noncontrast Computed Tomography. Thyroid 2015; 25:1249-54. [PMID: 26335604 DOI: 10.1089/thy.2015.0200] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Hounsfield unit (HU) ratio of thyroid nodules was assessed compared to the contralateral thyroid lobe on noncontrast computed tomography (CT) to stratify further the risk of malignancy in thyroid incidentalomas found on 18F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/CT (PET/CT). METHODS This retrospective analysis included 82 patients who had thyroid incidentalomas on PET/CT in 2011. On PET/CT, the maximal standardized uptake value ratios of the thyroid nodule compared to liver (T/BSUV) and the HU ratios of the thyroid nodule compared to contralateral thyroid lobe (T/BHU) were calculated. Diagnostic performances of the T/BSUV and T/BHU were compared. RESULTS The area under the curve of T/BHU was higher than that of T/BSUV (0.941 vs. 0.689, p < 0.0001). The sensitivity, specificity, and accuracy of T/BHU were significantly higher than those of T/BSUV (100% vs. 77.8%, p = 0.0313; 80.0% vs. 60.0%, p = 0.0433; 86.6% vs. 65.9%, p = 0.0041, respectively). The risk of malignancy was much higher (71.1%) in nodules with a T/BHU cutoff value ≤0.68, whereas it was 0% in nodules with a T/BHU of >0.68. In this study, there were 18 nodules with nondiagnostic (n = 7) or atypia of undetermined significance or follicular lesion of undetermined significance cytologies (n = 11) after fine-needle aspiration biopsy (FNAB). When the T/BHU cutoff value was applied, three (60%) of the five nodules with a T/BHU of ≤0.68 were found to be papillary carcinomas. The remaining 13 nodules with a T/BHU of >0.68 were all benign with a risk of malignancy of 0%. CONCLUSIONS T/BHU is a simple and effective parameter to stratify the risk of malignancy in thyroid incidentalomas found on PET/CT. This may be of clinical relevance in those nodules with nondiagnostic or undetermined significance cytologies upon FNAB in the scheme of current clinical practice.
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Affiliation(s)
- Dongwoo Kim
- 1 Yonsei University College of Medicine , Seoul, South Korea
| | - Sang Hyun Hwang
- 2 Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine , Seoul, South Korea
| | - Jongtae Cha
- 2 Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine , Seoul, South Korea
| | - Kwanhyeong Jo
- 2 Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine , Seoul, South Korea
| | - Narae Lee
- 2 Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine , Seoul, South Korea
| | - Mijin Yun
- 2 Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine , Seoul, South Korea
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99
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Auladell M, Boronat S, Barber I, Thiele EA. Thyroid nodules on chest CT of patients with tuberous sclerosis complex. Am J Med Genet A 2015; 167A:2992-7. [DOI: 10.1002/ajmg.a.37339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 08/10/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Maria Auladell
- Department of Neurology; Massachusetts General Hospital; Boston Massachusetts
| | - Susana Boronat
- Department of Neurology; Massachusetts General Hospital; Boston Massachusetts
- Department of Pediatric Neurology; Vall d'Hebron Hospital; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Ignasi Barber
- Department of Pediatric Radiology; Vall d'Hebron Hospital; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Elizabeth A. Thiele
- Department of Neurology; Massachusetts General Hospital; Boston Massachusetts
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100
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Bhatia P, Abd Elmageed ZY, Friedlander P, Aslam R, Kandil E. The utility of molecular markers in pre-operative assessment of thyroid nodules. Future Oncol 2015; 11:2343-50. [PMID: 26260812 DOI: 10.2217/fon.15.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The pre-operative diagnosis of thyroid tumors is determined by gold standard fine needle aspiration (FNA) biopsy. This has been widely accepted and offers the most cost-effective approach for evaluation of thyroid nodules. However, its diagnostic accuracy can pose a challenging scenario to surgeons. These diagnostic difficulties may subject patients to unnecessary thyroidectomies for benign thyroid nodules. Thus, additional molecular tests are needed to improve the sensitivity and specificity of FNA. The role of molecular markers is being proposed to predict the type and risk of malignancy to abate the need for diagnostic thyroidectomies. This review discusses their utility and validity in pre-operative diagnosis of thyroid nodules and how these markers can enhance the accuracy of FNA cytology.
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Affiliation(s)
- Parisha Bhatia
- Department of Surgery, Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Zakaria Y Abd Elmageed
- Department of Surgery, Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Paul Friedlander
- Department of Otolaryngology, Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Rizwan Aslam
- Department of Otolaryngology, Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA.,Department of Otolaryngology, Tulane University School of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA
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