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Fan L, Meng F, Sun Q, Zhai Y, Liu P. Assessment of Sustainable Elimination Criteria for Iodine Deficiency Disorders Recommended by International Organizations. Front Nutr 2022; 9:852398. [PMID: 35495946 PMCID: PMC9043767 DOI: 10.3389/fnut.2022.852398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Enormous efforts have been made to evaluate the worldwide prevention and control of iodine deficiency disorders (IDDs). This study evaluated China's achievements in IDD prevention and control against WHO criteria for sustainable elimination of IDD. The study sample consisted of 556,390 school-aged children and 271,935 pregnant women enrolled in the 2018 China National IDD Surveillance. As a result, at the national level, median urine iodine concentration (MUIC) was 206.1 and 163.5 μg/l in children and in pregnant women, respectively. The proportion of households consuming adequate iodized salt (PHCAIS) was 90.2%. The prevalence rates of goiter in children and thyroid disease in pregnant women were 2.0 and 0.8%, respectively. MUIC showed significant non-linear increasing trends with increasing PHCAIS in both children and pregnant women. The prevalence of thyroid disease in pregnant women had a sharp decreasing trend with increasing PHCAIS. Of note, the prevalence of goiter in children and thyroid disease in pregnant women against MUIC both presented as significant U-shaped curves, with the lowest prevalence at 100–300 μg/l of MUIC in children and 150–250 μg/l in pregnant women. PHCAIS, MUIC, and the programmatic indicators at the national level were all above their cut-offs proposed in the 2007 Criteria. Evaluation by adding the prevalence of goiter (<5%) yielded the different results at the county level. Sustainable elimination of IDD has been achieved nationally. 2018 Chinese surveillance data support the expansion of global cut-offs for optimal iodine status in school-age children from 100–199 to 100–299 μg/l as recommended by others and the lower limit of MUIC (150 μg/l) in pregnant women also seems justified. Inclusion of goiter prevalence <5% in our analysis reduced the number of municipalities and counties which had achieved sustainable elimination of IDD.
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Affiliation(s)
- Lijun Fan
- National Health Commission and Education Bureau of Heilongjiang Province, Key Laboratory of Etiology and Epidemiology, Harbin Medical University, Harbin, China
| | - Fangang Meng
- Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, China
| | - Qihao Sun
- Endemic Disease Control Center, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Yuqian Zhai
- Endemic Disease Control Center, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
| | - Peng Liu
- Endemic Disease Control Center, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China
- *Correspondence: Peng Liu
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Hirokawa M, Suzuki A, Kawakami M, Kudo T, Miyauchi A. Criteria for follow-up of thyroid nodules diagnosed as follicular neoplasm without molecular testing - The experience of a high-volume thyroid centre in Japan. Diagn Cytopathol 2022; 50:223-229. [PMID: 35133716 PMCID: PMC9304300 DOI: 10.1002/dc.24937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Clinical management of follicular neoplasms (FNs) using molecular testing of thyroid-aspirated materials is not routinely performed in Japan. This article aims to identify low-risk FN nodules that can be followed up without molecular testing. METHODS The relationship between preoperative findings, factors influencing surgical decision, and the risk of malignancy (ROM) was examined in 356 thyroid nodules with cytological diagnosis of FN at Kuma Hospital from January to December 2020. RESULTS ROMs of FN with cytology results favouring malignancy (41.2%) were significantly higher than those favouring benign (7.7%) or borderline (8.2%) (p < .001). Moreover, ROMs of FN with ultrasonography results of high suspicion (54.5%) were significantly higher than those with low (4.5%) or intermediate suspicion (0%) (p < .0001). There was a large difference in overall ROM in tumours bordering 30 mm in size (<30 mm; 3.6%, ≥30 mm; 20.0%). ROMs of FNs with a tumour volume doubling rate (TVDR) of 1.0/year or more (28.6%) were higher than those of FNs with a lower TVDR (9.9%) (p < .05). The ROMs of FNs with or without one or more of the following four findings suggestive of malignancy: cytological findings favouring malignancy, ultrasonography findings of high suspicion, tumour size ≥30 mm, and TV-DR ≥1.0/year, were 14.6% and 1.0%, respectively. CONCLUSION FNs with no cytological findings favouring malignancy, no ultrasonography findings of high suspicion, tumour size <30 mm and TV-DR <1.0/year, are considered low risk and can be followed up without the need for molecular testing.
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Affiliation(s)
| | - Ayana Suzuki
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
| | - Makoto Kawakami
- Medical Information Management Section, Kuma Hospital, Kobe, Japan
| | - Takumi Kudo
- Department of Internal Medicine, Kuma Hospital, Kobe, Japan
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3
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Zhou J, Yin L, Wei X, Zhang S, Song Y, Luo B, Li J, Qian L, Cui L, Chen W, Wen C, Peng Y, Chen Q, Lu M, Chen M, Wu R, Zhou W, Xue E, Li Y, Yang L, Mi C, Zhang R, Wu G, Du G, Huang D, Zhan W. 2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules: the C-TIRADS. Endocrine 2020; 70:256-279. [PMID: 32827126 DOI: 10.1007/s12020-020-02441-y] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/28/2020] [Indexed: 02/05/2023]
Abstract
Thyroid nodules are very common all over the world, and China is no exception. Ultrasound plays an important role in determining the risk stratification of thyroid nodules, which is critical for clinical management of thyroid nodules. For the past few years, many versions of TIRADS (Thyroid Imaging Reporting and Data System) have been put forward by several institutions with the aim to identify whether nodules require fine-needle biopsy or ultrasound follow-up. However, no version of TIRADS has been widely adopted worldwide till date. In China, as many as ten versions of TIRADS have been used in different hospitals nationwide, causing a lot of confusion. With the support of the Superficial Organ and Vascular Ultrasound Group of the Society of Ultrasound in Medicine of the Chinese Medical Association, the Chinese-TIRADS that is in line with China's national conditions and medical status was established based on literature review, expert consensus, and multicenter data provided by the Chinese Artificial Intelligence Alliance for Thyroid and Breast Ultrasound.
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Affiliation(s)
- JianQiao Zhou
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China.
| | - LiXue Yin
- Institute of Ultrasound in Medicine, The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China, Chengdu, 610071, China.
| | - Xi Wei
- Department of Diagnostic and Therapeutic Ultrasound, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Sheng Zhang
- Department of Diagnostic and Therapeutic Ultrasound, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - YanYan Song
- Department of Biostatistics, Institute of Medical Sciences, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - BaoMing Luo
- Department of Ultrasound, SunYat-sen Memorial Hospital, SunYat-sen University, Guangzhou, 510120, China
| | - JianChu Li
- Department of Ultrasound, Peking Union Medical College Hospital, Beijing, 100730, China
| | - LinXue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - LiGang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China
| | - Wen Chen
- Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China
| | - ChaoYang Wen
- Department of Ultrasound, Peking University International Hospital, Beijing, 102206, China
| | - YuLan Peng
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Qin Chen
- Department of Ultrasound, The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China, Chengdu, 610071, China
| | - Man Lu
- Department of Ultrasound, Sichuan Cancer Hospital, Chengdu, 610041, China
| | - Min Chen
- Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Rong Wu
- Department of Ultrasound, Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 201620, China
| | - Wei Zhou
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - EnSheng Xue
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - YingJia Li
- Department of Ultrasound, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, China
| | - LiChun Yang
- Department of Ultrasound, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, 650031, China
| | - ChengRong Mi
- Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuan, 750021, China
| | - RuiFang Zhang
- Department of Ultrasound, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China
| | - Gang Wu
- Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, 450003, China
| | - GuoQing Du
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - DaoZhong Huang
- Department of Ultrasound, Tongji Hospital, Tongji Medical Colloge, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - WeiWei Zhan
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China.
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Núñez DA, Lu Y, Paudyal R, Hatzoglou V, Moreira AL, Oh JH, Stambuk HE, Mazaheri Y, Gonen M, Ghossein RA, Shaha AR, Tuttle RM, Shukla-Dave A. Quantitative Non-Gaussian Intravoxel Incoherent Motion Diffusion-Weighted Imaging Metrics and Surgical Pathology for Stratifying Tumor Aggressiveness in Papillary Thyroid Carcinomas. ACTA ACUST UNITED AC 2020; 5:26-35. [PMID: 30854439 PMCID: PMC6403039 DOI: 10.18383/j.tom.2018.00054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We assessed a priori aggressive features using quantitative diffusion-weighted imaging metrics to preclude an active surveillance management approach in patients with papillary thyroid cancer (PTC) with tumor size 1-2 cm. This prospective study enrolled 24 patients with PTC who underwent pretreatment multi-b-value diffusion-weighted imaging on a GE 3 T magnetic resonance imaging scanner. The apparent diffusion coefficient (ADC) metric was calculated from monoexponential model, and the perfusion fraction (f), diffusion coefficient (D), pseudo-diffusion coefficient (D*), and diffusion kurtosis coefficient (K) metrics were estimated using the non-Gaussian intravoxel incoherent motion model. Neck ultrasonography examination data were used to calculate tumor size. The receiver operating characteristic curve assessed the discriminative specificity, sensitivity, and accuracy between PTCs with and without features of tumor aggressiveness. Multivariate logistic regression analysis was performed on metrics using a leave-1-out cross-validation method. Tumor aggressiveness was defined by surgical histopathology. Tumors with aggressive features had significantly lower ADC and D values than tumors without tumor-aggressive features (P < .05). The absolute relative change was 46% in K metric value between the 2 tumor types. In total, 14 patients were in the critical size range (1-2 cm) measured by ultrasonography, and the ADC and D were significantly different and able to differentiate between the 2 tumor types (P < .05). ADC and D can distinguish tumors with aggressive histological features to preclude an active surveillance management approach in patients with PTC with tumors measuring 1-2 cm.
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Affiliation(s)
- David Aramburu Núñez
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yonggang Lu
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Ramesh Paudyal
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Andre L Moreira
- Department of Pathology, NYU Langone Medical Center, New York, NY
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Yousef Mazaheri
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY.,Departments of Radiology
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Song J, Chai YJ, Masuoka H, Park SW, Kim SJ, Choi JY, Kong HJ, Lee KE, Lee J, Kwak N, Yi KH, Miyauchi A. Ultrasound image analysis using deep learning algorithm for the diagnosis of thyroid nodules. Medicine (Baltimore) 2019; 98:e15133. [PMID: 30985680 PMCID: PMC6485748 DOI: 10.1097/md.0000000000015133] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Fine needle aspiration (FNA) is the procedure of choice for evaluating thyroid nodules. It is indicated for nodules >2 cm, even in cases of very low suspicion of malignancy. FNA has associated risks and expenses. In this study, we developed an image analysis model using a deep learning algorithm and evaluated if the algorithm could predict thyroid nodules with benign FNA results.Ultrasonographic images of thyroid nodules with cytologic or histologic results were retrospectively collected. For algorithm training, 1358 (670 benign, 688 malignant) thyroid nodule images were input into the Inception-V3 network model. The model was pretrained to classify nodules as benign or malignant using the ImageNet database. The diagnostic performance of the algorithm was tested with the prospectively collected internal (n = 55) and external test sets (n = 100).For the internal test set, 20 of the 21 FNA malignant nodules were correctly classified as malignant by the algorithm (sensitivity, 95.2%); and of the 22 nodules algorithm classified as benign, 21 were FNA benign (negative predictive value [NPV], 95.5%). For the external test set, 47 of the 50 FNA malignant nodules were correctly classified by the algorithm (sensitivity, 94.0%); and of the 31 nodules the algorithm classified as benign, 28 were FNA benign (NPV, 90.3%).The sensitivity and NPV of the deep learning algorithm shown in this study are promising. Artificial intelligence may assist clinicians to recognize nodules that are likely to be benign and avoid unnecessary FNA.
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Affiliation(s)
- Junho Song
- Graduate School of Convergence Science and Technology, Seoul National University, Suwon
| | - Young Jun Chai
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | | | - Sun-Won Park
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul
| | - Su-jin Kim
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - Hyoun-Joong Kong
- Department of Biomedical Engineering, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul
| | - Joongseek Lee
- Graduate School of Convergence Science and Technology, Seoul National University, Suwon
| | - Nojun Kwak
- Graduate School of Convergence Science and Technology, Seoul National University, Suwon
| | - Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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Texture analysis and machine learning to characterize suspected thyroid nodules and differentiated thyroid cancer: Where do we stand? Eur J Radiol 2018; 99:1-8. [DOI: 10.1016/j.ejrad.2017.12.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/21/2017] [Accepted: 12/06/2017] [Indexed: 01/31/2023]
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7
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Postoperative ultrasonography surveillance in patients with follicular thyroid carcinoma: a multicenter study. LA RADIOLOGIA MEDICA 2017; 122:530-537. [DOI: 10.1007/s11547-017-0753-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
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Higuchi M, Hirokawa M, Suzuki A, Takada N, Yamao N, Kuma S, Miyauchi A. Cytological features of solid variants of papillary thyroid carcinoma: a fine needle aspiration cytology study of 18 cases. Cytopathology 2016; 28:268-272. [PMID: 27862483 DOI: 10.1111/cyt.12399] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Solid variants of papillary thyroid carcinoma (SV-PTC) are rare, and there have been few reports describing the cytological findings of such variants. METHODS The cytological features of cellular specimens aspirated from 18 histologically confirmed SV-PTC cases were evaluated, retrospectively. RESULTS Solid and small papillary clusters were observed in 14 (77.8%) and 13 (72.2%) cases, respectively. The incidences of large papillary clusters (11.1%) and sheet-like arrangements (11.1%) were low. Nuclear features were consistent with conventional PTC. The background was clean, and there were no colloid materials, foamy histiocytes, multinucleated giant cells, psammoma bodies, or necrotic materials. CONCLUSIONS Solid clusters and small papillary clusters in conjunction with a clean background are diagnostic clues that indicate SV-PTC cytologically. It is thought that small papillary clusters reflect the micropapillary growth pattern seen within the lumen of middle-sized follicular structures. The presence of nuclear findings typical of conventional PTC and the absence of mitotic figures and necrotic materials are important for distinguishing SV-PTC from poorly differentiated carcinoma.
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Affiliation(s)
- M Higuchi
- Department of Laboratory Science, Kuma Hospital, Kobe, Japan
| | - M Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
| | - A Suzuki
- Department of Laboratory Science, Kuma Hospital, Kobe, Japan
| | - N Takada
- Department of Laboratory Science, Kuma Hospital, Kobe, Japan
| | - N Yamao
- Department of Laboratory Science, Kuma Hospital, Kobe, Japan
| | - S Kuma
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
| | - A Miyauchi
- Department of Surgery, Kuma Hospital, Kobe, Japan
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9
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Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules. Eur Radiol 2016; 27:2619-2628. [DOI: 10.1007/s00330-016-4605-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/28/2016] [Accepted: 09/07/2016] [Indexed: 02/07/2023]
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10
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Hsu YC, Lin YT, Yeh DW, Wang CP. Follicular Lymphoma in Bilateral Submandibular Glands and Thyroid Gland. J Med Ultrasound 2014. [DOI: 10.1016/j.jmu.2014.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Moon JH, Kim YI, Lim JA, Choi HS, Cho SW, Kim KW, Park HJ, Paeng JC, Park YJ, Yi KH, Park DJ, Kim SE, Chung JK. Thyroglobulin in washout fluid from lymph node fine-needle aspiration biopsy in papillary thyroid cancer: large-scale validation of the cutoff value to determine malignancy and evaluation of discrepant results. J Clin Endocrinol Metab 2013; 98:1061-8. [PMID: 23393171 DOI: 10.1210/jc.2012-3291] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT There are still some controversies regarding the cutoff value and the influential factors of thyroglobulin (Tg) concentration in washout fluid from fine-needle aspiration (FNA) biopsy (FNA-Tg) on cervical lymph nodes (LNs) in patients with papillary thyroid cancer (PTC). OBJECTIVE Our aims were to validate the cutoff value of FNA-Tg in diagnosing malignant LNs on a large scale and to investigate the influential factors that could result in the discrepancy between the final diagnosis and FNA-Tg. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective cohort study based on hospital records with 528 cases of FNA-Tg measurement from 419 PTC patients. MAIN OUTCOME MEASURE The cutoff value of FNA-Tg was obtained from receiver operating characteristic analysis with final diagnosis. Binary logistic regression analysis was performed to investigate the influential factors. RESULTS In the final diagnosis, 190 LNs were malignant, and 338 LNs were benign. The median FNA-Tg was 521.2 (3676.8) ng/mL in malignant LNs, and 0.1 (0.2) ng/mL in benign LNs. The optimal cutoff value of FNA-Tg in distinguishing malignant LNs from benign LNs was 1.0 ng/mL (sensitivity, 93.2%; specificity, 95.9%) in all cases. Combining FNA-Tg and FNA cytology showed superior diagnostic power (sensitivity, 98.4%; specificity, 94.4%) when compared with diagnostic strategy using either FNA cytology or FNA-Tg alone. FNA-Tg, serum TSH, and serum Tg were higher in nonthyroidectomized patients than in thyroidectomized patients (P < .001, respectively). FNA-Tg was correlated with serum TSH and Tg levels (P < .001, respectively), and binary logistic regression analysis showed that serum TSH suppression and serum Tg presence independently affected the diagnosis made by FNA-Tg. CONCLUSIONS Our results validated 1.0 ng/mL of FNA-Tg as a cutoff value for diagnosing LN metastasis of PTC and suggested that serum TSH suppression and serum Tg presence should be considered in diagnosing LN malignancy with FNA-Tg in PTC patients.
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Affiliation(s)
- Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Korea
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12
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Lee KE, Chung IY, Kang E, Koo DH, Kim KH, Kim SW, Youn YK, Oh SK. Ipsilateral and contralateral central lymph node metastasis in papillary thyroid cancer: patterns and predictive factors of nodal metastasis. Head Neck 2012; 35:672-6. [PMID: 22715063 DOI: 10.1002/hed.23016] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 01/29/2012] [Accepted: 02/28/2012] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aims of this study were to evaluate the rate and risk factors of ipsilateral and contralateral central lymph node (CLN) metastases in patients with papillary thyroid cancer (PTC). METHODS A total of 161 patients who underwent total thyroidectomy with prophylactic CLN dissection (CLND) to treat PTC were enrolled. RESULTS Of 134 total cases excluding tumors located in the isthmus and bilateral lobes, 72 cases (53.7%) involved CLN metastases. Tumor size, age, and sex were found to be predictive of ipsilateral CLN metastasis and the rate of ipsilateral CLN metastasis in tumors > 1 cm was 59.6%. Contralateral CLN metastases were more prevalent only in tumors that already had ipsilateral CLN metastases (27.3%, p = .002). CONCLUSIONS It is suggested that risk factors of ipsilateral and contralateral CLN metastases should be considered while planning the extent of CLND in patients with clinically node-negative and unilateral PTC upon preoperative ultrasonography.
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Affiliation(s)
- Kyu Eun Lee
- Department of Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
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13
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Maruyama E, Minami N, Niino M, Fujiki N, Doi S, Watanabe M, Shima K, Kikuchi S, Sasaki H. Impact of screening with thyroid ultrasonography in myasthenia gravis patients. Acta Neurol Scand 2012; 125:398-402. [PMID: 21824114 DOI: 10.1111/j.1600-0404.2011.01580.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This study was conducted to screen thyroid abnormality evaluated with ultrasonography (US) in patients with myasthenia gravis (MG) and investigate further when malignancy is suspected. METHODS Thyroid screening using US was conducted in 162 patients with MG. In cases where malignancy was suspected, further investigations were performed. RESULTS Abnormal US findings were detected in 125 of 162 patients with MG (72 patients with nodules, 74 patients with cysts, 27 patients with diffuse findings such as enlargement, atrophy, a hypoechoic pattern or a heterogenous echoic pattern, and 28 patients with calcification). From among these 125 subjects, 30 patients underwent further examinations such as needle aspiration cytology. As a result, six patients (3.7% of 162 cases) were positive for papillary carcinoma. The size of the carcinoma in three patients was <10 mm, yet the stage of thyroid carcinomas was high (stage III or IVa) in all six cases. CONCLUSIONS Our data suggest that the prevalence of thyroid carcinoma in cases of MG may be higher than that of the general population. Furthermore, in patients with MG, there is a possibility that the stage of the carcinoma is higher even when the carcinoma is of a very small size. Patients with MG, when diagnosed, should be advised to undergo US screening of the thyroid because most cases of thyroid carcinoma are highly curable.
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Affiliation(s)
- E Maruyama
- Department of Clinical Laboratory, Hokkaido Medical Center, Sapporo, Japan
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14
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Sato S, Endo K, Iizaka T, Saiki R, Iwaku K, Sato S, Takahashi Y, Otsuka F, Taniyama M. A case of painless thyroiditis in a very early stage of pregnancy. Intern Med 2012; 51:475-7. [PMID: 22382562 DOI: 10.2169/internalmedicine.51.5742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of painless thyroiditis detected during the first trimester of pregnancy. A 29-year-old Japanese woman was hospitalized because of thyrotoxicosis and she was confirmed to be pregnant. The gestational age was 4 weeks. Blood examinations revealed negative TSH receptor antibodies, however, we started potassium iodide because we were unable to rule out Graves' disease. Thyroid hormone levels were normalized in 3 weeks and remained low even after discontinuation of medication. She received replacement therapy with levothyroxine sodium hydrate till 3 months after delivery. Painless thyroiditis can be one of the differential diagnoses of thyrotoxicosis in a very early stage of pregnancy.
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Affiliation(s)
- Shiori Sato
- Endocrinology and Metabolism, Showa University Fujigaoka Hospital, Japan.
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15
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Kim DW, Lee EJ, Jung SJ, Ryu JH, Kim YM. Role of sonographic diagnosis in managing Bethesda class III nodules. AJNR Am J Neuroradiol 2011; 32:2136-41. [PMID: 21920860 DOI: 10.3174/ajnr.a2686] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Bethesda class III cytology is an important limitation of the US-FNA in assessing thyroid nodules. This study aimed to assess the diagnostic efficacy of US in evaluating thyroid nodules with Bethesda class III cytology. MATERIALS AND METHODS From January 2008 to December 2009, 1036 patients with 1289 thyroid nodules diagnosed by US and subsequent US-FNA biopsy were enrolled in the study. On the basis of US features, each thyroid nodule was prospectively classified by a single radiologist into 1 of 5 diagnostic categories: benign, probably benign, borderline, possibly malignant, and malignant. Solid nodules were classified by using all 5 categories, whereas partially cystic nodules were classified by using 4 (borderline was omitted). We calculated the diagnostic efficacy of thyroid US by comparing the US diagnoses with the histopathology results of Bethesda class III nodules. RESULTS Of the 51 Bethesda class III nodules, 35 were surgically confirmed and 8 were histologically diagnosed, and a malignancy rate of 46.5% (20/43) was determined. From the 43 nodules, the sensitivity, specificity, positive and negative predictive values, and accuracy were calculated with 9 borderline nodules excluded (100%, 94.7%, 93.3%, 100%, and 97.0%, respectively) and with the 9 when reclassified as benign (63.6%, 95.2%, 93.3%, 71.4%, and 79.1%, respectively) and malignant (100%, 85.7%, 88.0%, 100%, and 93.0%, respectively). The values obtained with exclusion and malignancy reclassification of 9 borderline nodules were not significantly different (P = .250). CONCLUSIONS US diagnosis by using the present US classification system can be helpful for managing Bethesda class III nodules.
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Affiliation(s)
- D W Kim
- Department of Radiology, Inje University College of Medicine, Busan, South Korea.
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Russ G, Bigorgne C, Royer B, Rouxel A, Bienvenu-Perrard M. Le système TIRADS en échographie thyroïdienne. ACTA ACUST UNITED AC 2011; 92:701-13. [DOI: 10.1016/j.jradio.2011.03.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 02/24/2011] [Accepted: 03/14/2011] [Indexed: 10/18/2022]
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Sholosh B, Borhani AA. Thyroid Ultrasound Part 1: Technique and Diffuse Disease. Radiol Clin North Am 2011; 49:391-416, v. [DOI: 10.1016/j.rcl.2011.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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