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Ghai S, Goldstein DP, Sawka AM. Ultrasound Imaging in Active Surveillance of Small, Low-Risk Papillary Thyroid Cancer. Korean J Radiol 2024; 25:749-755. [PMID: 39028013 PMCID: PMC11306002 DOI: 10.3348/kjr.2024.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 07/20/2024] Open
Abstract
The recent surge in the incidence of small papillary thyroid cancers (PTCs) has been linked to the widespread use of ultrasonography, thereby prompting concerns regarding overdiagnosis. Active surveillance (AS) has emerged as a less invasive alternative management strategy for low-risk PTCs, especially for PTCs measuring ≤1 cm in maximal diameter. Recent studies report low disease progression rates of low-risk PTCs ≤1 cm under AS. Ongoing research is currently exploring the feasibility of AS for larger PTCs (<20 mm). AS protocols include meticulous ultrasound assessment, emphasis on standardized techniques, and a multidisciplinary approach; they involve monitoring the nodules for size, growth, potential extrathyroidal extension, proximity to the trachea and recurrent laryngeal nerve, and potential cervical nodal metastases. The criteria for progression, often defined as an increase in the maximum diameter of the PTC, warrant a review of precision and ongoing examinations. Challenges exist regarding the reliability of volume measurements for defining PTC disease progression. Although ultrasonography plays a pivotal role, challenges in assessing progression and minor extrathyroidal extension underscore the importance of a multidisciplinary approach in disease management. This comprehensive overview highlights the evolving landscape of AS for PTCs, emphasizing the need for standardized protocols, meticulous assessments, and ongoing research to inform decision-making.
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Affiliation(s)
- Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto, Canada.
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Anna M Sawka
- Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, Canada
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2
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De Vincentis S, Brigante G, Ansaloni A, Madeo B, Zirilli L, Diazzi C, Belli S, Vezzani S, Simoni M, Rochira V. Value of repeated US-guided fine-needle aspiration (US-FNAB) in the follow-up of benign thyroid nodules: a real-life study based on the MoCyThy (Modena's Cytology of the Thyroid) DATABASE with a revision of the literature. Endocrine 2024; 84:193-202. [PMID: 38123877 DOI: 10.1007/s12020-023-03641-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE The utility of repeating ultrasound-guided fine-needle aspiration (US-FNAB) in the follow-up of benign (THY2) thyroid nodules is still debated. The aim of this study was to retrospectively investigate the diagnostic value of re-biopsy of thyroid nodules following an initially benign result. METHODS We retrospectively analyzed US-FNABs performed at the Unit of Endocrinology of Modena from 2006 to 2009. The firstly benign cytological result was compared with the cytological results of subsequent US-FNABs (2nd and/or 3rd) executed on the same nodule. RESULTS Among 10449 US-FNABs, 6270 (60%) received a THY2 cytological categorization. Of them, 278 (4.43%) underwent a subsequent US-FNAB: 86.7% maintained the same cytology, 32 (11.5%) changed to THY3 (indeterminate) and 5 (1.8%) to THY4 (suspicious of malignancy). Among the 24 nodules addressed to surgery, 9 (37%) were histologically malignant, with an overall miss rate of 3.2%. Male patients had higher risk of discordant results at subsequent US-FNAB (p = 0.005, OR:3.59, 95%CI:1.453-7.769) while dimensional increase above 5 mm was predictive of concordant benign cytology (p = 0.036, OR:0.249, 95%CI:0.068-0.915). Age, suspicious US characteristics, and distance between US-FNABs resulted not predictive. CONCLUSIONS Re-biopsy of benign nodules confirmed the benign nature in most cases. In case of discordant cytology, relocation in indeterminate category was the most common. The histological diagnosis of cancer occurred in one quarter of nodules surgically removed, with a low overall clinically significant miss rate. Thus, a small percentage of false negatives exists; males and subjects with US suspicious nodules should be carefully followed-up, considering case by case re-biopsy possibility.
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Affiliation(s)
- Sara De Vincentis
- Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Giulia Brigante
- Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Anna Ansaloni
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Bruno Madeo
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Lucia Zirilli
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Chiara Diazzi
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Serena Belli
- Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Silvia Vezzani
- Endocrinology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Manuela Simoni
- Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Vincenzo Rochira
- Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy.
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy.
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Yan L, Ren L, Li Y, Luo Y. Inter-observer variation in two-dimensional and three-dimensional ultrasound measurement of papillary thyroid microcarcinoma. Cancer Imaging 2023; 23:94. [PMID: 37798807 PMCID: PMC10557328 DOI: 10.1186/s40644-023-00613-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/17/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUNDS The reliable ultrasound (US) measurements of papillary thyroid microcarcinoma (PTMC) are very important during active surveillance. This prospective study was design to investigate the inter-observer reliability and agreement of two- dimensional ultrasound(2DUS) and three-dimensional ultrasound(3DUS) in the measurement of maximum diameter and volume for PTMC. METHODS This prospective study included 51 consecutive patients with solitary PTMC confirmed by biopsy. Two independent observers performed measurements of each tumor using a standardized measurement protocol. The maximum diameter was the largest one of the three diameters measured on the largest transverse and longitudinal 2DUS images. 2DUS volume was calculated using ellipsoid formula method. The virtual organ computer aided analysis(VOCAL) was used to determine 3DUS volume. The inter-observer reliability was assessed using intraclass correlation coefficient(ICC) with 95% confidence intervals(CIs). Bland-Altman analysis was used to evaluate agreement, and expressed as a bias with 95% limits of agreement(LOA). RESULTS The maximum diameter was 0.78 ± 0.14 cm. Volume measured by 3DUS was significantly smaller than that by 2DUS(0.163 ± 0.074 cm3 vs. 0.175 ± 0.078 cm3, P = 0.005). The ICCs of inter-observer reliability of maximum diameter, 2DUS volume and 3DUS volume was 0.922(0.864-0.955), 0.928(0.874-0.959), and 0.974(0.955-0.985), respectively. The ICCs of 2DUS and 3DUS volume was 0.955(0.909-0.976). The inter-observer agreement of maximum diameter, 2DUS volume and 3DUS volume was 1.096(0.7322 to 1.459), 1.008(0.5802-1.435), and 1.011(0.7576-1.265), respectively. The inter-observer agreement of 2DUS and 3DUS volume was 1.096(0.7322 to 1.459). CONCLUSION Maximum diameter had the lowest degree of observer variation among all the measurements. Volume measured by 3DUS had lower variability and higher repeatability than that by 2DUS, which might be helpful to provide more reliable estimates of tumor size for PTMC.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Ling Ren
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yingying Li
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yukun Luo
- Department of Ultrasound, the First Medical Centre, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China.
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Grani G, Del Gatto V, Cantisani V, Mandel SJ, Durante C. A Reappraisal of Suspicious Sonographic Features of Thyroid Nodules: Shape Is Not an Independent Predictor of Malignancy. J Clin Endocrinol Metab 2023; 108:e816-e822. [PMID: 36810804 DOI: 10.1210/clinem/dgad092] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/02/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
CONTEXT For the correct clinical application of the sonographic risk-stratification systems, the definition of independent risk features that are foundational to each system is crucial. OBJECTIVE The aim of this study was to identify the gray-scale sonographic features independently associated with malignancy, and to compare different definitions. METHODS This prospective, diagnostic accuracy study took place in a single thyroid nodule referral center. All patients consecutively referred to our center for fine-needle aspiration cytology of a thyroid nodule between November 1, 2015 and March 30, 2020, were enrolled before cytology. Each nodule was examined by 2 experienced clinicians to record the sonographic features on a rating form. Histologic (when available) or cytologic diagnosis was used as the reference standard. For each single sonographic feature and definition, the sensitivity, specificity, positive and negative predictive values, and diagnostic odds ratios (DOR) were calculated. The significant predictors were then included in a multivariable regression model. RESULTS The final study cohort consisted of 903 nodules in 852 patients. A total of 76 nodules (8.4%) were malignant. Six features were independent predictors of malignancy: suspicious lymph node (DOR 16.23), extrathyroidal extension (DOR 6.60), irregular or infiltrative margins (DOR 7.13), marked hypoechogenicity (DOR 3.16), solid composition (DOR 3.61), and punctate hyperechoic foci (including microcalcifications and indeterminate foci; DOI 2.69). Taller-than-wide shape was not confirmed as an independent predictor. CONCLUSION We identified the key suspicious features of thyroid nodules and provided a simplified definition of some debated ones. Malignancy rate increases with number of features.
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Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome 00161, Italy
| | - Valeria Del Gatto
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome 00161, Italy
| | - Vito Cantisani
- Department of Radiological, Anatomo-Pathological, and Oncological Sciences, "Sapienza" University of Rome, Rome 00161, Italy
| | - Susan J Mandel
- Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Cosimo Durante
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome 00161, Italy
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Tessler FN, Zafereo ME, Acosta GJ, Sacks WL. Response to Toraih et al. re: "Chasing π-fection in Thyroidology". Thyroid 2023; 33:529-530. [PMID: 36746931 DOI: 10.1089/thy.2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Franklin N Tessler
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Head and Neck Surgery, Houston, Texas, USA
| | - Gonzalo J Acosta
- Division of Endocrinology, Department of Medicine, University of Florida, Gainsville, Florida, USA
| | - Wendy L Sacks
- Division of Endocrinology, Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
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Bukasa JK, Bayauli-Mwasa P, Mbunga BK, Bangolo A, Kavula W, Mukaya J, Bindingija J, M’Buyamba-Kabangu JR. The Spectrum of Thyroid Nodules at Kinshasa University Hospital, Democratic Republic of Congo: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16203. [PMID: 36498276 PMCID: PMC9737877 DOI: 10.3390/ijerph192316203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/07/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
We analyzed the spectrum of thyroid nodules in patients attending the endocrinology unit care of the Kinshasa University Hospital and assessed their associated factors. We conducted a cross-sectional study, performing descriptive statistics and logistic regression. From the 888 enrolled patients, thyroid nodules were detected in 658 patients (74.1%), as mononodules in 22.5% and multiple nodules in 77.5%. Thyroid function was normal in 71.3% cases, while hyperthyroidism and hypothyroidism were found in 26.1% and 2.6% of cases, respectively. Women were more affected than men (75.1% vs. 63.6%; p = 0.03). Patients with thyroid nodules were older (44 ± 12 vs. 38 ± 12 years; p < 0.001), with a family history of goiter (38.3% vs. 27.4%; p = 0.003) and residence in the iodine-deficient region (51.7% vs. 38.8%; p = 0.012); they had a higher proportion of longer delays to consultation (47% vs. 20%; p < 0.001), but a higher rate of normal thyroid function (85.5% vs. 3 1.3%; p < 0.001). Thyroid nodules were associated with the delay to consultation (for duration ≥ three years, OR: 6.560 [95% CI: 3.525−12.208)], multiparity (present vs. absent: 2.863 [1.475−5.557]) and family history of goiter (present vs. absent: 2.086 [95% CI:1.231−3.534]) in female patients alone. The high frequency of thyroid nodules observed requires measures aimed at early detection in the population, the training of doctors involved in the management and the strengthening of technical platforms in our hospitals.
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Affiliation(s)
- John Kakamba Bukasa
- Endocrinology Unit, Department of Internal Medicine, University of Kinshasa Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Department of Endocrinology, Liège University Hospital Center, 4000 Liège, Belgium
| | - Pascal Bayauli-Mwasa
- Endocrinology Unit, Department of Internal Medicine, University of Kinshasa Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Branly Kilola Mbunga
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ayrton Bangolo
- Department of Internal Medicine, Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Wivine Kavula
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean Mukaya
- Radiology and Medical Imaging Unit, Department of Internal Medicine, University Hospital of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Joseph Bindingija
- Endocrinology Unit, Department of Internal Medicine, University of Kinshasa Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean-René M’Buyamba-Kabangu
- Cardiology Unit, Department of Internal Medicine, University of Kinshasa Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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7
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Tuttle RM, Fagin J, Minkowitz G, Wong R, Roman B, Patel S, Untch B, Ganly I, Shaha A, Shah J, Li D, Bach A, Girshman J, Lin O, Cohen M, Cohen JM, Cracchiolo J, Ghossein R, Sabra M, Boucai L, Fish S, Morris L. Active Surveillance of Papillary Thyroid Cancer: Frequency and Time Course of the Six Most Common Tumor Volume Kinetic Patterns. Thyroid 2022; 32:1337-1345. [PMID: 36178355 PMCID: PMC9700377 DOI: 10.1089/thy.2022.0325] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: The change in size of the papillary thyroid cancer (PTC) nodule during active surveillance has traditionally been characterized as either stable, increasing, or decreasing based on changes in maximal tumor diameter or tumor volume. More recently, it has been observed that the changes in tumor size observed during observation are more complex with tumor volume kinetic patterns that can be characterized either as stable (Pattern I), early increase in volume (Pattern II), later increase in volume (Pattern III), early increase in volume followed by stability (Pattern IV), stability followed by an increase in volume (Pattern V), or a decrease in tumor volume (Pattern VI). Methods: The frequency, time course, and clinical correlates of these six tumor volume kinetic patterns were analyzed in a cohort of 483 patients with low-risk PTC up to 1.5 cm in maximal diameter followed with active surveillance at our center for a median of 3.7 years. Results: The cumulative incidence of an increase in tumor volume for the entire cohort was 15.9% [confidence interval (CI) 11.8-20.0] at 5 years. At 5 years, most tumors demonstrated stability (78.8%, Pattern I) with 10.0% showing early growth (Pattern II), 4.1% late growth (Pattern III), 1.9% growth then stability (Pattern IV), 0.6% stability then growth (Pattern V), and 5.6% with a decrease in tumor volume (Pattern VI). Tumor volume doubling time during exponential growth significantly differed across the kinetic patterns, with median values of 2.4, 7.1, and 3.3 years for Patterns II, III, and IV, respectively (p < 0.01). Similarly, the time to a change in tumor volume was significantly different across the kinetic patterns, with median values of 1.5, 3, 1.6, 4.7, and 4.1 years for Patterns II, III, IV, V, and VI, respectively (analysis of variance, p < 0.01). Clinical correlates at baseline were not associated with tumor volume kinetic pattern. Conclusions: These six kinetic tumor volume patterns provide a comprehensive description of the changes in PTC tumor volume observed during the first 5 years of active surveillance.
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Affiliation(s)
- Robert Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - James Fagin
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gerald Minkowitz
- Department of Surgery Education, Columbia University Irving Medical Center, New York, New York, USA
| | - Richard Wong
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Benjamin Roman
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Snehal Patel
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Brian Untch
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ian Ganly
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ashok Shaha
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jatin Shah
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Duan Li
- Radiology and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ariadne Bach
- Radiology and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jeffrey Girshman
- Radiology and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Oscar Lin
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marc Cohen
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jean-Marc Cohen
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer Cracchiolo
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ronald Ghossein
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mona Sabra
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Laura Boucai
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Stephanie Fish
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Luc Morris
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Rago T, Vitti P. Risk Stratification of Thyroid Nodules: From Ultrasound Features to TIRADS. Cancers (Basel) 2022; 14:cancers14030717. [PMID: 35158985 PMCID: PMC8833686 DOI: 10.3390/cancers14030717] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Thyroid nodules are a frequent clinical issue. Their incidence has increased mainly due to the widespread use of neck ultrasound scans. Most thyroid nodules are asymptomatic, incidentally discovered, and benign at cytology. Thyroid ultrasound is the most sensitive diagnostic tool to evaluate patients with nodular thyroid disease. It is therefore important to use the ultrasound features to select nodules that require a fine-needle aspiration cytology. Abstract Thyroid nodules are common in iodine deficient areas, in females, and in patients undergoing neck irradiation. High-resolution ultrasonography (US) is important for detecting and evaluating thyroid nodules. US is used to determine the size and features of thyroid nodules, as well as the presence of neck lymph node metastasis. It also facilitates guided fine-needle aspiration (US-FNA). The most consistent US malignancy features of thyroid nodules are spiculated margins, microcalcifications, a taller-than-wide shape, and marked hypoechogenicity. Increased nodular vascularization is not identified as a predictor of malignancy. Thyroid elastosonography (USE) is also used to characterize thyroid nodules. In fact, a low elasticity of nodules at USE has been related to a higher risk of malignancy. According to their US features, thyroid nodules can be stratified into three categories: low-, intermediate-, and high-risk nodules. US-FNA is suggested for intermediate and high-risk nodules.
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9
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Yan L, Li X, Xiao J, Li Y, Zhu Y, He H, Luo Y. Contrast-enhanced ultrasound is a reliable and reproducible assessment of necrotic ablated volume after radiofrequency ablation for benign thyroid nodules: a retrospective study. Int J Hyperthermia 2021; 39:40-47. [PMID: 34936850 DOI: 10.1080/02656736.2021.1991009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To investigate the intra- and inter-observer reliability and agreement of contrast-enhanced ultrasound (CEUS) in measuring ablated volume (Va) after radiofrequency ablation (RFA) for benign thyroid nodules. MATERIALS This retrospective study evaluated 65 patients with 74 benign thyroid nodules who underwent RFA. Patients were followed up at 1, 3, 6, and 12 months and every 12 months thereafter. Two independent observers measured the Va using CEUS during the same follow-up visit. The intra- and inter-observer reliability was assessed using intraclass correlation coefficient (ICC) with 95% confidence interval. The Bland-Altman analysis was used to evaluate the inter-observer agreement, which was expressed as a mean difference with 95% limit of agreement (LOA). RESULTS No significant difference was found in Va measurements by the two observers with a mean follow-up time of 41.17 ± 16.80 months (all p > 0.05). The intra- and inter-observer reliability were both excellent (ICC >0.90) at each follow-up period. The 95% LOA became wider over the follow-up period. The smallest 95% LOA was found at 1 month with a LOA from 0.8117 to 1.122, and the largest 95% LOA was from 0.5694 to 1.343 at 36 months. CONCLUSIONS CEUS could provide a reliable and reproducible assessment of Va after RFA for benign thyroid nodules. In clinical post-ablation follow-up, the irregular morphology of ablated area and the variation by different observers could not affect the assessment of Va by CEUS.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - XinYang Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Jing Xiao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - YingYing Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yaqiong Zhu
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hongying He
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
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Frederick RP, Patel AG, Young SW, Dahiya N, Patel MD. Growth Rate of Ovarian Serous Cystadenomas and Cystadenofibromas. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2123-2130. [PMID: 33320368 DOI: 10.1002/jum.15597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES We analyzed growth rates of benign ovarian serous cystadenomas and cystadenofibromas to understand what percentage would show a volume doubling time (DT) of less than 3 years, between 3 and 5 years, or greater than 5 years. METHODS We retrospectively reviewed pathology records (January 1, 2014, to June 30, 2019) to find all surgically excised ovarian serous cystadenomas and cystadenofibromas. Imaging records were then reviewed to identify those that had been confidently identified with ultrasound imaging, magnetic resonance imaging, or computed tomography at least twice before surgical removal, with at least a 60-day interval between studies. Three orthogonal measurements were recorded on the first and last imaging studies on which the mass was detected, with volume calculations by the prolate formula (product of 3 measurements multiplied by 0.52). The volume DT was calculated and grouped into 1 of 5 categories: (1) DT of less than 1 year; (2) DT of 1 to 3 years; (3) DT of 3 to 5 years; (4) DT of 5 to 10 years; and (5) no growth (any mass with a DT >10 years or showing a decrease in volume). RESULTS A total of 102 of 536 cystadenomas and 44 of 227 cystadenofibromas met inclusion criteria. Of the 146 tumors, 40 (27.4%) had a DT of less than 1 year; 38 (26.0%) had a DT of 1 to 3 years; 22 (15.1%) had a DT of 3 to 5 years; 10 (6.8%) had a DT of 5 to 10 years; and 36 (24.7%) showed no growth. CONCLUSIONS A total of 53.4% of ovarian serous cystadenomas/cystadenofibromas have a DT of less than 3 years; 15.1% have a DT between 3 and 5 years; and 31.5% have a DT of greater than 5 years or show no growth.
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Affiliation(s)
- Ross P Frederick
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Anika G Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Scott W Young
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Maitray D Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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11
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Ghai S, O'Brien C, Goldstein DP, Sawka AM. Ultrasound in active surveillance for low-risk papillary thyroid cancer: imaging considerations in case selection and disease surveillance. Insights Imaging 2021; 12:130. [PMID: 34529219 PMCID: PMC8446145 DOI: 10.1186/s13244-021-01072-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/07/2021] [Indexed: 01/25/2023] Open
Abstract
Active surveillance (AS) of small, low-risk papillary thyroid cancers (PTCs) is increasingly studied in prospective observational studies. Ultrasound is the primary imaging modality for case selection. While researchers have put forward selection criteria for PTCs based on size, absence of suspicious lymph nodes and tumor location, there are limited reported data highlighting inherent ultrasound limitations and guidelines for case selection and follow-up. We report our experience including imaging limitations encountered in the ongoing AS prospective observational study for PTCs measuring < 2 cm at our institute. We define disease progression as an increase in size of > 3 mm in the largest dimension of nodule or evidence of metastatic disease or extrathyroidal extension. Accurate, consistent and reproducible measurements of PTCs are essential in risk stratifying patients for the option of AS or disease progression. Interobserver discrepancy, shadowing from coarse calcification and background parenchyma heterogeneity or thyroiditis can limit accurate PTC size assessment and therefore hinder patient eligibility evaluation or AS follow-up. Following the ACR Thyroid Imaging, Reporting and Data System (TI-RADS) protocol of three-axes technique to measure a thyroid nodule enables reproducibility of measurements. In patients with multi-nodular goiter, accurate identification and labeling of the PTC is important to avoid mistaking with adjacent benign nodules at follow-up. Ultrasound assessment for extrathyroid extension of PTC, and relationship of PTC to trachea and the anatomic course of the recurrent laryngeal nerve are important considerations in evaluation for AS eligibility.
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Affiliation(s)
- Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network - Mount Sinai Hospital - Women's College Hospital, University of Toronto, Toronto, ON, Canada. .,1PMB-283, Toronto General Hospital, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.
| | - Ciara O'Brien
- Joint Department of Medical Imaging, University Health Network - Mount Sinai Hospital - Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - David P Goldstein
- Princess Margaret Cancer Centre, Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Anna M Sawka
- Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
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12
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Wu MH, Chen KY, Chen A, Chen CN. Differences in the ultrasonographic appearance of thyroid nodules after radiofrequency ablation. Clin Endocrinol (Oxf) 2021; 95:489-497. [PMID: 33938024 DOI: 10.1111/cen.14480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 01/07/2023]
Abstract
CONTEXT Radiofrequency ablation (RFA) is a well-tolerated approach to treating benign thyroid nodules (TNs), but no index can predict its success. Other than size decrease, little is known about TN appearance on ultrasonography (US) after RFA. OBJECTIVE This study aimed to (a) assess the effectiveness of single-session RFA treatment, (b) determine whether pre-ablation US characteristics correlate with its effectiveness, and (c) demonstrate TN characteristics on baseline and follow-up US. DESIGN Retrospective cohort study among the patients who underwent single-session RFA for the treatment of benign TNs at a referral medical center between January 2018 and April 2019. PATIENTS A total of 116 patients (137 nodules) were included in the study. MEASUREMENTS Characteristics were quantified using commercial software. TNs were classified into 2015 American Thyroid Association (ATA) sonographic patterns and American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TI-RADS) categories. RESULTS The average volume reduction ratio (VRR) was 74.51% in 1 year (95% confidence interval, 70.63%-78.39%). The only pre-ablation US feature significantly different between nodules with VRR <50% and VRR >50% was the cyst composition (0.05 vs. 0.02, p-value = .02). The VRR and margin change in the first 3 months after ablation were found to be leading indicators significantly correlated to the VRR in 6 months with correlation coefficients (r) = .72 and -.28 (p-value < .0001 and = .0008) and VRR in 1 year with r = .65 and -.17 (p-value < .0001 and = .046), respectively. After RFA, more TNs became ATA high suspicion (2.9% vs. 19.7%, p < .0001) and more appeared to be the non-ATA patterns (12.4% vs. 23.4%, p < .0001). Also, a greater number of post-RFA TNs were classified as ACR-TI-RADS categories 4 and 5 (40.1% vs. 70.1%, p < .0001). CONCLUSIONS Radiofrequency ablation therapy is effective for treating TNs. Pre-ablation cyst components, 3-month post-ablation volume reduction and margin change of TNs were related to the 6-month and 1-year response. Clinicians should consider that TNs would appear peculiar on US after RFA, mistakenly suggesting malignant potential.
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Affiliation(s)
- Ming-Hsun Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuen-Yuan Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Argon Chen
- Graduate Institute of Industrial Engineering, National Taiwan University, Taipei, Taiwan
| | - Chiung-Nien Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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13
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Fukushima M, Fukunari N, Murakami T, Kunii Y, Suzuki S, Kitaoka M. Reconfirmation of the accuracy of the taller-than-wide sign in multicenter collaborative research in Japan. Endocr J 2021; 68:897-904. [PMID: 33790086 DOI: 10.1507/endocrj.ej20-0379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The taller-than-wide sign indicates that the anteroposterior dimension-to-transverse dimension ratio (AP/T ratio) is higher than 1. The aim of the present study was to reconfirm the accuracy of the taller-than-wide sign for diagnosing malignant thyroid nodules by ultrasonography in multicenter collaborative research, and investigate differences according to tumor sizes, histological types, and the influence of the tilt and orientation of the probe. At 6 registered institutes, 2,032 thyroid nodules were successively operated on and diagnosed pathologically. The accuracy of the taller-than-wide sign for diagnosing malignant tumors by ultrasonography was retrospectively analyzed across all nodules as well as in analyses separately stratified by tumor size and histology. The influence of the tilt and orientation of the probe was also assessed. The taller-than-wide sign showed high specificity for diagnosing malignancy in all nodules tested. It also showed high specificity regardless of the tumor size. When tumors were analyzed by histological types, the AP/T ratio of papillary carcinoma was significantly higher than that of benign nodules, whereas no significant difference was observed between follicular carcinoma and benign nodules. The specificity of longitudinal sections was significantly higher, while the AUC of longitudinal sections was significantly larger than those of transverse sections. The AP/T ratio obtained when the probe was tilted was not significantly different from that when it was straight. The present results support the usefulness of the taller-than-wide sign for diagnosing malignant tumors regardless of size, but not follicular carcinoma. The influence of the tilt and orientation of the probe was negligible.
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Affiliation(s)
| | - Nobuhiro Fukunari
- Thyroid Center, Showa University Northern Yokohama Hospital, Kanagawa 224-8503, Japan
| | - Tsukasa Murakami
- Department of Endocrinology, Noguchi Thyroid Clinic and Hospital Foundation, Oita 874-0902, Japan
| | - Yo Kunii
- Department of Internal Medicine, Ito Hospital, Tokyo 150-8308, Japan
| | - Shinichi Suzuki
- Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Masafumi Kitaoka
- Department of Endocrinology and Metabolism Center, IMS Miyoshi General Hospital, Saitama 354-0041, Japan
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14
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Yan L, Luo Y. Response to letter to the editor from Dr. Bernardi regarding suitability of residual vital ratio for prediction of local regrowth following radiofrequency ablation for benign thyroid nodules. Int J Hyperthermia 2021; 38:189-190. [PMID: 33576298 DOI: 10.1080/02656736.2021.1883128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
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15
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Sawka AM, Ghai S, Tomlinson G, Baxter NN, Corsten M, Imran SA, Bissada E, Lebouef R, Audet N, Brassard M, Zhang H, Gupta M, Nichols AC, Morrison D, Johnson-Obeski S, Prisman E, Anderson D, Chandarana SP, Ghaznavi S, Jones J, Gafni A, Matelski JJ, Xu W, Goldstein DP. A Protocol for a Pan-Canadian Prospective Observational Study on Active Surveillance or Surgery for Very Low Risk Papillary Thyroid Cancer. Front Endocrinol (Lausanne) 2021; 12:686996. [PMID: 34194396 PMCID: PMC8237853 DOI: 10.3389/fendo.2021.686996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/17/2021] [Indexed: 12/01/2022] Open
Abstract
Background The traditional management of papillary thyroid cancer (PTC) is thyroidectomy (total or partial removal of the thyroid). Active surveillance (AS) may be considered as an alternative option for small, low risk PTC. AS involves close follow-up (including regularly scheduled clinical and radiological assessments), with the intention of intervening with surgery for disease progression or patient preference. Methods This is a protocol for a prospective, observational, long-term follow-up multi-centre Canadian cohort study. Consenting eligible adults with small, low risk PTC (< 2cm in maximal diameter, confined to the thyroid, and not immediately adjacent to critical structures in the neck) are offered the choice of AS or surgery for management of PTC. Patient participants are free to choose either option (AS or surgery) and the disease management course is thus not assigned by the investigators. Surgery is provided as usual care by a surgeon in an institution of the patient's choice. Our primary objective is to determine the rate of 'failure' of disease management in respective AS and surgical arms as defined by: i) AS arm - surgery for progression of PTC, and ii) surgical arm - surgery or other treatment for disease persistence or progression after completing initial treatment. Secondary outcomes include long-term thyroid oncologic and treatment outcomes, as well as patient-reported outcomes. Discussion The results from this study will provide long-term clinical and patient reported outcome evidence regarding active surveillance or immediate surgery for management of small, low risk PTC. This will inform future clinical trials in disease management of small, low risk papillary thyroid cancer. Registration details This prospective observational cohort study is registered on clinicaltrials.gov (NCT04624477), but it should not be considered a clinical trial as there is no assigned intervention and patients are free to choose either AS or surgery.
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Affiliation(s)
- Anna M. Sawka
- Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network-Mt Sinai Hospital-Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Nancy N. Baxter
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Martin Corsten
- Department of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - Syed Ali Imran
- Division of Endocrinology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Eric Bissada
- Department of Otolaryngology-Head and Neck Surgery, l’Université de Montréal, Montreal, QC, Canada
| | - Rebecca Lebouef
- Division of Endocrinology, Department of Medicine, l’Université de Montréal, Montreal, QC, Canada
| | - Nathalie Audet
- Department of Otolaryngology-Head and Neck Surgery, Université Laval, Quebec City, QC, Canada
| | - Maryse Brassard
- Division of Endocrinology, Department of Medicine, Université Laval, Quebec City, QC, Canada
| | - Han Zhang
- Department of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Michael Gupta
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Anthony C. Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Deric Morrison
- Division of Endocrinology, Department of Medicine, Western University, London, ON, Canada
| | | | - Eitan Prisman
- Department of Otolaryngology-Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Don Anderson
- Department of Otolaryngology-Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Shamir P. Chandarana
- Section of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Sana Ghaznavi
- Division of Endocrinology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer Jones
- Department of Psychosocial Oncology, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Amiram Gafni
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - John J. Matelski
- Mount Sinai Hospital, University of Toronto, Toronto, Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Wei Xu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David P. Goldstein
- Department of Otolaryngology and Head and Neck Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
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16
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Ghazizadeh S, Kelly TL, Khajanchee YS, Fleser J, Rozenfeld Y, Neuman M, Hammill CW, Orr L, Aliabadi-Wahle S. Standardization of thyroid ultrasound reporting in the community setting decreases biopsy rates. Clin Endocrinol (Oxf) 2021; 94:1035-1042. [PMID: 33529386 DOI: 10.1111/cen.14431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE With the rising incidence of thyroid cancer, a standardized approach to the evaluation of thyroid nodules is essential. Despite the presence of multiple national guidelines detailing evaluation and management of these nodules, significant variability exists in the information that is collected and reported to clinicians from diagnostic imaging. The aim of this study was to evaluate the impact of thyroid ultrasound standardization on thyroid cancer detection in a community practice setting. DESIGN As part of a physician-driven quality improvement project, a multidisciplinary team created an electronic worksheet to be utilized by sonographers to capture suspicious findings based on societal guidelines and agreed on institutional criteria for recommending fine needle aspiration (FNA) of thyroid nodules. PATIENTS For a one-year period prior to and after the intervention, all ultrasounds performed for suspected thyroid pathology, excluding patients undergoing follow-up imaging, were reviewed at two affiliated community hospitals served by a single radiology and pathology group. MEASUREMENTS The number of fine needle biopsies recommended and performed, as well as the percentage of FNAs positive for malignancy were evaluated. RESULTS A total of 608 and 675 ultrasounds were reviewed in pre- and post-standardization periods, respectively. Following standardization, there was a similar percentage of FNAs recommended (35% vs. 37%, p = .68), fewer FNAs per total ultrasounds performed (36% vs. 31%, p = .03), fewer FNAs performed when FNA was not explicitly recommended (9.9% vs. 2.8%, p = .000046) and an increased detection of cytology consistent with, or suspicious for, malignancy (5% vs. 11.5%, p = .0028). CONCLUSIONS Standardization of thyroid imaging protocol and management recommendations can reduce the number of FNAs performed and increase the percentage of positive tests in a community setting.
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17
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Five-year follow-up and clinical outcome in euthyroid patients with thyroid nodules. Radiol Oncol 2021; 55:317-322. [PMID: 34051706 PMCID: PMC8366738 DOI: 10.2478/raon-2021-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 04/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Thyroid nodule diagnosis has become increasingly frequent. Defining optimum surveillance intervals for patients with unsuspicious thyroid nodules remains a challenge. This was a single centre cohort study in which patients diagnosed with unsuspicious thyroid nodules in whom no treatment was indicated were invited for re-evaluation 5 years after the diagnosis. The primary end point of the study was to estimate the change in nodule size with thyroid ultrasound (US) and the secondary end point was to assess the need for clinical management 5 years after the diagnosis. PATIENTS AND METHODS Baseline patient parameters and ultrasound characteristics of the nodules were retrospectively collected. At follow-up, thyroid ultrasound was performed. RESULTS A hundred and eighteen (107 women / 11 men, aged 56.8 ± 13.4 years) patients were included in the study having 203 nodules at baseline, with mean largest nodule diameter 10.5 ± 7.4 mm. After 5 years, 58 (28.6%) nodules significantly increased in size, 27 (13.3%) decreased, and for 104 (51.2%) of nodules, no change in size was noted. Fourteen (6.9%) nodules disappeared. Additional 26 new nodules (mean largest diameter 7.7 ± 5.0 mm) in 16 patients were identified at follow-up. Regarding the clinical outcome, no new thyroid cancers were found. For 107 (90.7%) patients no further management was indicated. Five (4.2%) patients were referred to thyroidectomy because of the growth of the nodules. Two (1.7%) patients were treated for hyperthyroidism. Four (3.4%) patients did not complete the study. CONCLUSIONS We report a single centre experience of the natural history of unsuspicious thyroid nodules. Our results showed that 71.4% of such nodules remained stable in size, decreased or even disappeared and that the vast majority of the patients remained clinically stable with no need for treatment 5 years after the diagnosis.
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18
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Ittermann T, Richter A, Junge M, Nauck M, Petersmann A, Jürgens C, Below H, Schmidt CO, Völzke H. Variability of Thyroid Measurements from Ultrasound and Laboratory in a Repeated Measurements Study. Eur Thyroid J 2021; 10:140-149. [PMID: 33981618 PMCID: PMC8077478 DOI: 10.1159/000507018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/24/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Variability of measurements in medical research can be due to different sources. Quantification of measurement errors facilitates probabilistic sensitivity analyses in future research to minimize potential bias in epidemiological studies. We aimed to investigate the variation of thyroid-related outcomes derived from ultrasound (US) and laboratory analyses in a repeated measurements study. SUBJECTS AND METHODS Twenty-five volunteers (13 females, 12 males) aged 22-70 years were examined once a month over 1 year. US measurements included thyroid volume, goiter, and thyroid nodules. Laboratory measurements included urinary iodine concentrations and serum levels of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and thyroglobulin. Variations in continuous thyroid markers were assessed as coefficient of variation (CV) defined as mean of the individual CVs with bootstrapped confidence intervals and as intraclass correlation coefficients (ICCs). Variations in dichotomous thyroid markers were assessed by Cohen's kappa. RESULTS CV was highest for urinary iodine concentrations (56.9%), followed by TSH (27.2%), thyroglobulin (18.2%), thyroid volume (10.5%), fT3 (8.1%), and fT4 (6.3%). The ICC was lowest for urinary iodine concentrations (0.42), followed by fT3 (0.55), TSH (0.64), fT4 (0.72), thyroid volume (0.87), and thyroglobulin (0.90). Cohen's kappa values for the presence of goiter or thyroid nodules were 0.64 and 0.70, respectively. CONCLUSION Our study provides measures of variation for thyroid outcomes, which can be used for probabilistic sensitivity analyses of epidemiological data. The low intraindividual variation of serum thyroglobulin in comparison to urinary iodine concentrations emphasizes the potential of thyroglobulin as marker for the iodine status of populations.
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Affiliation(s)
- Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- *Till Ittermann, PD Dr. rer. med, Institute for Community Medicine, University Medicine Greifswald, Walther Rathenau Str. 48, DE–17475 Greifswald (Germany),
| | - Adrian Richter
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- German Rheumatism Research Center, Berlin, Germany
| | - Martin Junge
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Astrid Petersmann
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- Institute for Clinical Chemistry, Interdisciplinary University Laboratory, University Medicine Göttingen, Göttingen, Germany
| | - Clemens Jürgens
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Harald Below
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Chung SR, Choi YJ, Lee SS, Kim SO, Lee SA, Jeon MJ, Kim WG, Lee JH, Baek JH. Interobserver Reproducibility in Sonographic Measurement of Diameter and Volume of Papillary Thyroid Microcarcinoma. Thyroid 2021; 31:452-458. [PMID: 33287640 DOI: 10.1089/thy.2020.0317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Active surveillance is recommended as an alternative to immediate surgery for low-risk papillary thyroid microcarcinoma (PTMC), and determining meaningful changes in diameter and volume on ultrasonography (US) is critical. However, interobserver reproducibility of the sonographic measurement of maximum diameter and volume of PTMC has not been well established. We aimed to determine the reproducibility in the measurement of maximum diameter and volume of PTMC on US. Methods: Consecutive patients who underwent US for pathologically proven PTMC between December 2018 and December 2019 were retrospectively reviewed. Two observers independently performed sonographic measurement of each nodule using standardized measurement methods. Each observer measured maximum transverse, anteroposterior, and longitudinal nodule diameters, and using these, nodule volume was calculated using the ellipsoid formula. Interobserver reproducibility in the measurement of the maximum diameter and volume was assessed using percentage reproducibility coefficient (RC). Z-tests of the intraclass correlation coefficients (ICCs) were used to compare the interobserver reproducibility in subgroups defined according to sonographic characteristics, such as the presence of microcalcification, nodule size, and parenchymal heterogeneity. Results: A total of 197 thyroid nodules from 188 patients were included in the study series. The percentage RCs were 71.8% [95% confidence interval, CI 65.4-79.7%] and 23.7% [CI 21.6-26.3%] for volume and maximum diameter measurements, respectively. There were no significant differences noted in the ICC values according to nodule orientation, presence of calcifications, size, or parenchymal heterogeneity. Conclusion: For PTMC, a difference of up to 24% in the maximum diameter and 72% in the volume may be considered to be within measurement error on US. This value may be used to determine the cutoff for defining meaningful change in the maximum diameter and volume for PTMC during active surveillance.
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Affiliation(s)
- Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, and Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun-Ah Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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20
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Wu MH, Chen KY, Chen A, Chen CN. Software-Based Analysis of the Taller-Than-Wide Feature of High-Risk Thyroid Nodules. Ann Surg Oncol 2021; 28:4347-4357. [PMID: 33393024 DOI: 10.1245/s10434-020-09463-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/25/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Shape is one of the most important features in the diagnosis of malignant thyroid nodules. This characteristic has been described qualitatively, but only shapes that appear markedly different can be easily differentiated at first interpretation. This study sought to clarify whether software-based shape indexes are useful for the detection of thyroid cancers. METHODS In the final analysis, 200 participants with 231 pathologically proven nodules participated in the study. Ultrasound features were assessed by clinicians. The tumor contour was auto-defined, and shape indexes were calculated using commercial software. RESULTS Of the 231 nodules, 134 were benign and 97 were malignant. The presence of taller-than-wide (TTW) dimensions differed significantly between the benign and malignant thyroid tumors. Designation of TTW assessed by the software had a higher kappa value and proportional agreement than TTW assessed by clinicians. Disagreement between the clinician and software in designating nodules as TTW occurred for 28 nodules. The presence of other ultrasonic characteristics and small differences in the height and width measurements were causes for the incorrect interpretation of the TTW feature. CONCLUSION The proposed software-based quantitative analysis of tumor shape seems to be promising as an important advance compared with conventional TTW features evaluated by operators because it allows for a more reliable and consistent distinction and is less influenced by other ultrasonic features.
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Affiliation(s)
- Ming-Hsun Wu
- Department of Surgery, National Taiwan University Hospital, No. 7, Chun Shan South Road, Taipei, Taiwan
| | - Kuen-Yuan Chen
- Department of Surgery, National Taiwan University Hospital, No. 7, Chun Shan South Road, Taipei, Taiwan
| | - Argon Chen
- Graduate Institute of Industrial Engineering, National Taiwan University, Taipei, Taiwan.
| | - Chiung-Nien Chen
- Department of Surgery, National Taiwan University Hospital, No. 7, Chun Shan South Road, Taipei, Taiwan.
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Wu MH, Chen KY, Hsieh MS, Chen A, Chen CN. Risk Stratification in Patients With Follicular Neoplasm on Cytology: Use of Quantitative Characteristics and Sonographic Patterns. Front Endocrinol (Lausanne) 2021; 12:614630. [PMID: 33995270 PMCID: PMC8120278 DOI: 10.3389/fendo.2021.614630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/22/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Differentiating thyroid nodules with a cytological diagnosis of follicular neoplasm remains an issue. The goal of this study was to determine whether ultrasonographic (US) findings obtained preoperatively from the computer-aided detection (CAD) system are sufficient to further stratify the risk of malignancy for this diagnostic cytological category. METHODS From September 2016 to September 2018 in our hospital, patients diagnosed with Bethesda category IV (follicular neoplasm or suspicion of follicular neoplasm) thyroid nodules and underwent surgical excisions were include in the study. Quantification and analysis of tumor features were performed using CAD software. The US findings of the region of interest, including index of composition, margin, echogenicity, texture, echogenic dots indicative of calcifications, tall and wide orientation, and margin were calculated into computerized values. The nodules were further classified into American Thyroid Association (ATA) and American College of Radiology Thyroid Imaging Reporting & Data System (TI-RADS) categories. RESULTS 92 (10.1%) of 913 patients were diagnosed with Bethesda category IV thyroid nodules. In 65 patients, the histological type of the nodule was identified. The quantitative features between patients with benign and malignant conditions differed significantly. The presence of heterogeneous echotexture, blurred margins, or irregular margins was shown to have the highest diagnostic value. The risks of malignancy for nodules classified as having very low to intermediate suspicion ATA, non-ATA, and high suspicion ATA patterns were 9%, 35.7%, and 51.7%, respectively. Meanwhile, the risks of malignancy were 12.5%, 26.1%, and 53.8% for nodules classified as TIRADS 3, 4, and 5, respectively. When compared to human observers, among whom poor agreement was noticeable, the CAD software has shown a higher average accuracy. CONCLUSIONS For patients with nodules diagnosed as Bethesda category IV, the software-based characterizations of US features, along with the associated ATA patterns and TIRADS system, were shown helpful in the risk stratification of malignancy.
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Affiliation(s)
- Ming-Hsun Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuen-Yuan Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Argon Chen
- Graduate Institute of Industrial Engineering, National Taiwan University, Taipei, Taiwan
- *Correspondence: Argon Chen,
| | - Chiung-Nien Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Goundan PN, Mamou J, Rohrbach D, Smith J, Patel H, Wallace KD, Feleppa EJ, Lee SL. A Preliminary Study of Quantitative Ultrasound for Cancer-Risk Assessment of Thyroid Nodules. Front Endocrinol (Lausanne) 2021; 12:627698. [PMID: 34093429 PMCID: PMC8170470 DOI: 10.3389/fendo.2021.627698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Gray-scale, B-mode ultrasound (US) imaging is part of the standard clinical procedure for evaluating thyroid nodules (TNs). It is limited by its instrument- and operator-dependence and inter-observer variability. In addition, the accepted high-risk B-mode US TN features are more specific for detecting classic papillary thyroid cancer rather than the follicular variant of papillary thyroid cancer or follicular thyroid cancer. Quantitative ultrasound (QUS) is a technique that can non-invasively assess properties of tissue microarchitecture by exploiting information contained in raw ultrasonic radiofrequency (RF) echo signals that is discarded in conventional B-mode imaging. QUS provides quantitative parameter-value estimates that are a function of the properties of US scatterers and microarchitecture of the tissue. The purpose of this preliminary study was to assess the performance of QUS parameters in evaluating benign and malignant thyroid nodules. METHODS Patients from the Thyroid Health Center at the Boston Medical Center were recruited to participate. B-mode and RF data were acquired and analyzed in 225 TNs (24 malignant and 201 benign) from 208 patients. These data were acquired either before (167 nodules) or after (58 nodules) subjects underwent fine-needle biopsy (FNB). The performance of a combination of QUS parameters (CQP) was assessed and compared with the performance of B-mode risk-stratification systems. RESULTS CQP produced an ROC AUC value of 0.857 ± 0.033 compared to a value of 0.887 ± 0.033 (p=0.327) for the American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS) and 0.880 ± 0.041 (p=0.367) for the American Thyroid Association (ATA) risk-stratification system. Furthermore, using a CQP threshold of 0.263 would further reduce the number of unnecessary FNBs in 44% of TNs without missing any malignant TNs. When CQP used in combination with ACR TI-RADS, a potential additional reduction of 49 to 66% in unnecessary FNBs was demonstrated. CONCLUSION This preliminary study suggests that QUS may provide a method to classify TNs when used by itself or when combined with a conventional gray-scale US risk-stratification system and can potentially reduce the need to biopsy TNs.
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Affiliation(s)
- Poorani N. Goundan
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
- *Correspondence: Poorani N. Goundan,
| | - Jonathan Mamou
- Lizzi Center for Biomedical Engineering, Riverside Research, New York, NY, United States
| | | | - Jason Smith
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, United States
| | - Harshal Patel
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | | | - Ernest J. Feleppa
- Lizzi Center for Biomedical Engineering, Riverside Research, New York, NY, United States
| | - Stephanie L. Lee
- Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
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Yan L, Luo Y, Song Q, Li N, Xiao J, Zhang Y, Zhu Y. Inter-observer reliability in ultrasound measurement of benign thyroid nodules in the follow-up of radiofrequency ablation: a retrospective study. Int J Hyperthermia 2020; 37:1336-1344. [PMID: 33251890 DOI: 10.1080/02656736.2020.1849826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To investigate the inter-observer reliability of ultrasound (US) measurement in volume and volume reduction rate (VRR) of benign thyroid nodules during the follow-up of radiofrequency ablation (RFA). MATERIALS This retrospective study evaluated 76 patients with 88 benign thyroid nodules who underwent RFA. Two independent observers performed the US measurements during the same follow-up visit. The Bland-Altman analysis was used to evaluate the inter-observer reliability of volume and VRR (logarithmic transformation). The mean difference and 95% limits-of-agreement (LOA) were obtained after antilogarithm. RESULTS No significant differences were found in the volume and VRR measurements during a mean follow-up time of 35.52 ± 12.82 months. After antilogarithms, the mean difference of volume was 0.9961, 0.9987, 1.0016, 0.9972, 0.9977 and 0.9969 at 1, 3, 6, 12, 24 and 36 months, respectively. The 95% LOA of volume became wider over the follow-up period, and the largest one was between 0.8471 and 1.1733 at 36 months. The 95% LOA of VRR became narrower over the follow-up period, and the largest one was between 0.9541 and 1.0469 at 1 month. The incidence of regrowth was 20.45% and the largest 95% LOA of regrowth nodules was between 0.9028 and 1.284 at 12 months. At the same follow-up period, VRR had a narrower 95% LOA than volume. Compared with volume ≥10 ml, nodules <10 ml revealed a larger 95% LOA in both the volume and VRR. CONCLUSION The inter-observer reliability of the US measurements of benign thyroid nodules during the follow-up period of RFA was acceptable. The variation by different observers could not affect the evaluation of efficacy.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China.,Health Management Center, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qing Song
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Nan Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ying Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yaqiong Zhu
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
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Non-enhanced ultrasound is not a satisfactory modality for measuring necrotic ablated volume after radiofrequency ablation of benign thyroid nodules: a comparison with contrast-enhanced ultrasound. Eur Radiol 2020; 31:3226-3236. [PMID: 33128600 DOI: 10.1007/s00330-020-07398-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/02/2020] [Accepted: 10/08/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the intra- and inter-observer reliability and agreement between gray-scale and Doppler ultrasound (US) and contrast-enhanced ultrasound (CEUS) in measuring ablated volume (Va) after radiofrequency ablation (RFA) for benign thyroid nodules. METHODS A total of 173 patients with 190 benign thyroid nodules who underwent RFA were included in this study. After RFA, the total volume of ablated nodule was divided into Va and the incompletely treated vital volume. Patients were followed up at 1, 3, 6, 12 months, and every 12 months thereafter. Two independent observers measured Va using US and CEUS during the same follow-up visit. The intra- and inter-observer reliability of the two measurement modalities was assessed using intraclass correlation coefficient (ICC) with 95% confidence interval. The Bland-Altman analysis was used to evaluate agreement, which was expressed as a mean difference with 95% limits of agreement (LOA). RESULTS The mean follow-up time was 23.17 ± 12.70 months. Va measured by US was significantly larger than by CEUS (p < 0.001). The intra- and inter-observer reliability decreased over the follow-up period and became moderate in both subgroups at 12 months (all ICC < 0.75). The mean difference and LOA became larger and wider during the follow-up. The best agreement was found in nodules < 10 ml at 1 month with a mean difference of 1.166 and LOA between 0.413 and 3.294. CONCLUSIONS The intra- and inter-observer reliability and agreement of US and CEUS in measuring Va were unsatisfactory. CEUS should be considered when Va was needed for further evaluation or in the case of nodules with suspected regrowth. KEY POINTS • Va measured by gray-scale and Doppler US was significantly larger than that by CEUS. • Va measured by gray-scale and Doppler US lacked intra- and inter-observer reliability and agreement with CEUS. • CEUS should be preceded to gray-scale and Doppler US for the measurement of Va.
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25
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Evaluation of lymphocytic thyroiditis in children with quantitative gray-scale ultrasound echo intensity using a PACS-based tool. Clin Imaging 2020; 66:93-97. [PMID: 32464508 DOI: 10.1016/j.clinimag.2020.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate diagnostic performance of PACS-based quantitative gray-scale ultrasound as an objective method in evaluation of pediatric thyroiditis. METHODS Quantitative measurements of the echo-intensity level of the thyroid were obtained from ultrasound images, retrospectively using a PACS-based tool in 37 children with the tissue-proven diagnosis. Thyroid/muscle ratio was calculated by dividing the mean echo intensity of thyroid by that of adjacent strap muscle. Heterogeneity index (HI) was calculated by dividing thyroid standard deviation (SD) by thyroid mean values. For qualitative evaluation, two radiologists independently reviewed ultrasounds twice for the presence of thyroiditis. A consensus session was performed for patients for whom there was disagreement. Intra- and inter-observer reliability were assessed. Thyroid/muscle ratio and HI were correlated with final pathology. RESULTS Lymphocytic thyroiditis was found by histopathology in 19/37 (51%). No significant difference between thyroiditis and normal thyroid groups was found for either thyroid/muscle ratio (1.51 and 1.62, respectively, p = .82) or HI (0.23 and.23, respectively, p = .37). A larger proportion of patients for whom the consensus review indicated thyroiditis were confirmed by histopathology than would be expected by chance alone (12/19 (63%), p = .03). There was fair inter-observer agreement (κ with 95% confidence intervals of 0.36 (0.14-0.57), p = .004) and slight intra-observer agreement for each radiologist (κ with 95% confidence intervals of 0.13 (0.17-0.43), p = .39 and 0.17 (0.15-0.49), p = .31). CONCLUSION Quantitative gray-scale echo intensity analysis of US was not sufficient to diagnose thyroiditis in a pediatric population. Consensus qualitative analysis of ultrasound was more consistent with pathological diagnosis.
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Kumar V, Webb J, Gregory A, Meixner DD, Knudsen JM, Callstrom M, Fatemi M, Alizad A. Automated Segmentation of Thyroid Nodule, Gland, and Cystic Components From Ultrasound Images Using Deep Learning. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2020; 8:63482-63496. [PMID: 32995106 PMCID: PMC7521441 DOI: 10.1109/access.2020.2982390] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Sonographic features associated with margins, shape, size, and volume of thyroid nodules are used to assess their risk of malignancy. Automatically segmenting nodules from normal thyroid gland would enable an automated estimation of these features. A novel multi-output convolutional neural network algorithm with dilated convolutional layers is presented to segment thyroid nodules, cystic components inside the nodules, and normal thyroid gland from clinical ultrasound B-mode scans. A prospective study was conducted, collecting data from 234 patients undergoing a thyroid ultrasound exam before biopsy. The training and validation sets encompassed 188 patients total; the testing set consisted of 48 patients. The algorithm effectively segmented thyroid anatomy into nodules, normal gland, and cystic components. The algorithm achieved a mean Dice coefficient of 0.76, a mean true positive fraction of 0.90, and a mean false positive fraction of 1.61×10-6. The values are on par with a conventional seeded algorithm. The proposed algorithm eliminates the need for a seed in the segmentation process, thus automatically detecting and segmenting the thyroid nodules and cystic components. The detection rate for thyroid nodules and cystic components was 82% and 44%, respectively. The inference time per image, per fold was 107ms. The mean error in volume estimation of thyroid nodules for five select cases was 7.47%. The algorithm can be used for detection, segmentation, size estimation, volume estimation, and generating thyroid maps for thyroid nodules. The algorithm has applications in point of care, mobile health monitoring, improving workflow, reducing localization time, and assisting sonographers with limited expertise.
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Affiliation(s)
- Viksit Kumar
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine & Science, Rochester, MN, 55905, USA
| | - Jeremy Webb
- Department of Radiology, Mayo Clinic College of Medicine & Science, Rochester, MN, 55905, USA
| | - Adriana Gregory
- Department of Radiology, Mayo Clinic College of Medicine & Science, Rochester, MN, 55905, USA
| | - Duane D Meixner
- Department of Radiology, Mayo Clinic College of Medicine & Science, Rochester, MN, 55905, USA
| | - John M Knudsen
- Department of Radiology, Mayo Clinic College of Medicine & Science, Rochester, MN, 55905, USA
| | - Matthew Callstrom
- Department of Radiology, Mayo Clinic College of Medicine & Science, Rochester, MN, 55905, USA
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine & Science, Rochester, MN, 55905, USA
| | - Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine & Science, Rochester, MN, 55905, USA
- Department of Radiology, Mayo Clinic College of Medicine & Science, Rochester, MN, 55905, USA
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Multi-Reader Multi-Case Study for Performance Evaluation of High-Risk Thyroid Ultrasound with Computer-Aided Detection. Cancers (Basel) 2020; 12:cancers12020373. [PMID: 32041119 PMCID: PMC7072687 DOI: 10.3390/cancers12020373] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/17/2022] Open
Abstract
Physicians use sonographic characteristics as a reference for the possible diagnosis of thyroid cancers. The purpose of this study was to investigate whether physicians were more effective in their tentative diagnosis based on the information provided by a computer-aided detection (CAD) system. A computer compared software-defined and physician-adjusted tumor loci. A multicenter, multireader, and multicase (MRMC) study was designed to compare clinician performance without and with the use of CAD. Interobserver variability was also analyzed. Excellent, satisfactory, and poor segmentations were observed in 25.3%, 58.9%, and 15.8% of nodules, respectively. There were 200 patients with 265 nodules in the study set. Nineteen physicians scored the malignancy potential of the nodules. The average area under the curve (AUC) of all readers was 0.728 without CAD and significantly increased to 0.792 with CAD. The average standard deviation of the malignant potential score significantly decreased from 18.97 to 16.29. The mean malignant potential score significantly decreased from 35.01 to 31.24 for benign cases. With the CAD system, an additional 7.6% of malignant nodules would be suggested for further evaluation, and biopsy would not be recommended for an additional 10.8% of benign nodules. The results demonstrated that applying a CAD system would improve clinicians’ interpretations and lessen the variability in diagnosis. However, more studies are needed to explore the use of the CAD system in an actual ultrasound diagnostic situation where much more benign thyroid nodules would be seen.
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Grani G, Lamartina L, Ramundo V, Falcone R, Lomonaco C, Ciotti L, Barone M, Maranghi M, Cantisani V, Filetti S, Durante C. Taller-Than-Wide Shape: A New Definition Improves the Specificity of TIRADS Systems. Eur Thyroid J 2020; 9:85-91. [PMID: 32257957 PMCID: PMC7109429 DOI: 10.1159/000504219] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/17/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION A taller-than-wide (TTW) shape is a suspicious feature of thyroid nodules commonly defined as an anteroposterior/transverse diameter (AP/T) ratio >1. An intraobserver variability of up to 18% in AP diameter evaluations has been described, which may lead to overreporting of this feature. To potentially improve the reliability of the TTW definition, we propose an arbitrary ratio of ≥1.2. OBJECTIVE The aim of this study was to estimate the impact of this definition on diagnostic performance. METHODS We prospectively analyzed 553 thyroid nodules referred for cytology evaluation at an academic center. Before fine-needle aspiration, two examiners jointly defined all sonographic features considered in risk stratification systems developed by the American Thyroid Association (ATA), the American Association of Clinical Endocrinologists (AACE), the American College of Radiology (ACR TIRADS), the European Thyroid Association (EU-TIRADS), and the Korean Society of Thyroid Radiology (K-TIRADS). TTW was defined according to the current definition (AP/T diameter ratio >1) and an arbitrary alternative definition (AP/T ratio >1.2). RESULTS The alternative definition classified fewer nodules as TTW (28, 5.1% vs. 94, 17%). The current and proposed definitions have a sensitivity of 26.2 and 11.9% (p = 0.03) and a specificity of 83.8 and 95.5% (p < 0.001). Thus, as a single feature, the arbitrary definition has a lower sensitivity and a higher specificity. When applied to sonographic risk stratification systems, however, the proposed definition would increase the number of avoided biopsies (up to 58.2% for ACR TIRADS) and the specificity of all systems, without negative impact on sensitivity or diagnostic odds ratio. CONCLUSIONS Re-defining TTW nodules as those with an AP/T ratio ≥1.2 improves this marker's specificity for malignancy. Using this definition in risk stratification systems will increase their specificity, reducing the number of suggested biopsies without significantly diminishing their overall diagnostic performance.
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Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy
- *Giorgio Grani, MD, PhD, Department of Translational and Precision Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, IT–00161 Rome (Italy), E-Mail
| | - Livia Lamartina
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Valeria Ramundo
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Rosa Falcone
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Cristiano Lomonaco
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Laura Ciotti
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Martina Barone
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Marianna Maranghi
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Vito Cantisani
- Diagnostic and Ultrasound Innovations Unit, Azienda Ospedaliera Universitaria Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy
| | - Sebastiano Filetti
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy
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Abstract
Differentiated thyroid cancer (DTC) is the most common thyroid cancer and is frequently encountered in clinical practice. The incidence of DTC has increased significantly over the past three decades. Surgical resection, radioactive iodine (RAI), and levothyroxine suppression therapy remain the primary modalities for DTC treatment. Active surveillance for low-risk thyroid cancer may be an alternative to immediate surgery for appropriately selected patients. Patient characteristics influence treatment selection and intensity. In the subset of patients with progressive distant metastatic disease, not amenable to treatment with surgery or RAI, novel agents, including targeted therapies and immunotherapy, should be considered.
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Affiliation(s)
- Melissa G Lechner
- Division of Endocrinology, Diabetes, and Metabolism, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, CHS 57-145, Los Angeles, CA 90095, USA
| | - Stephanie Smooke Praw
- Division of Endocrinology, Diabetes, and Metabolism, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, CHS 57-145, Los Angeles, CA 90095, USA
| | - Trevor E Angell
- Division of Endocrinology, Diabetes, and Metabolism, Keck School of Medicine, University of Southern California, 1333 San Pablo Avenue, BMT-B11, Los Angeles, CA 90033, USA.
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Cordes M, Götz TI, Horstrup K, Kuwert T, Schmidkonz C. Growth rates of malignant and benign thyroid nodules in an ultrasound follow-up study: a retrospective cohort study. BMC Cancer 2019; 19:1139. [PMID: 31752781 PMCID: PMC6873423 DOI: 10.1186/s12885-019-6348-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 11/08/2019] [Indexed: 02/07/2023] Open
Abstract
Background Thyroid nodules are frequently detected by cervical ultrasound examinations. In follow-up studies, malignant as well as benign nodules may exhibit an increase in size. The objective of our investigation was to test whether histologically determined malignant and benign thyroid nodules show differences in growth rates above a defined significance level. Methods A retrospective ultrasound cohort follow-up study from 4 to 132 months included 26 patients with differentiated carcinomas and 26 patients with adenomas of the thyroid gland. Significance levels were determined by intra- and interobserver variations of volumetric measurements in 25 individuals. Results Intra- and interobserver volumetric measurements were highly correlated (r = 0.99 and r = 0.98, respectively), with variations of 28 and 40%, respectively. The growth rates of malignant and benign nodules did not show differences with respect to two sonographic measurements (d = − 0.04, 95%CI(P): 0.41–0.85, P = 0.83). Using shorter increments and multiple measurements, growth rates of malignant nodules revealed significantly higher values (d = 0.16, 95%CI(P): 0.02–0.04, P = 0.039). Conclusions The growth rates of benign and malignant thyroid nodules do not appear to differ using two sonographic volumetric measurements. However, due to temporal changes in cellular proliferation and arrest, malignant nodules may exhibit higher growth rates with multiple assessments and shorter increments.
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Affiliation(s)
- Michael Cordes
- Radiologisch-Nuklearmedizinisches Zentrum, Martin-Richter-Str. 43, 90489, Nuremberg, Germany. .,Nuklearmedizinische Klinik, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
| | - Theresa Ida Götz
- Nuklearmedizinische Klinik, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Karen Horstrup
- Radiologisch-Nuklearmedizinisches Zentrum, Martin-Richter-Str. 43, 90489, Nuremberg, Germany
| | - Torsten Kuwert
- Nuklearmedizinische Klinik, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Christian Schmidkonz
- Nuklearmedizinische Klinik, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
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Pilot study of the potential of 3D ultrasound to measure tonsillar volume and hypertrophy. Int J Pediatr Otorhinolaryngol 2019; 126:109612. [PMID: 31408743 DOI: 10.1016/j.ijporl.2019.109612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/28/2019] [Accepted: 07/28/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA), results in approximately 4-5 million outpatient visits per year in the United States. In pediatric patients, OSA is primarily caused by adenotonsillar hypertrophy, and therefore, adenotonsillectomy remains an effective surgical treatment. We investigate whether 3D ultrasound (3DUS) imaging can accurately and objectively assess tonsillar hypertrophy for the potential identification and stratification of candidates for adenotonsillectomy. METHODS A prospective study was performed evaluating pediatric patients (N = 17) between the ages of 4-14 years who were undergoing adenotonsillectomy for OSA symptoms. On the day of surgery, tonsillar ultrasound was performed by a single attending radiologist. Tonsillectomy was performed and each tonsils' principal axes and physical volume by water submergence were measured. The findings were compared using paired T-test, Pearson correlation coefficient and Bland-Altman analysis. RESULTS The average tonsillar physical measurements of length, width and height were 1.54 ± 0.28, 2.0 ± 0.31 cm and 2.72 ± 0.41 cm, and 1.73 ± 0.17, 1.61 ± 0.21 mm and 2.98 ± 0.28 mm from physical and 3DUS estimations, respectively (P < 0.001 for all measurements). The average tonsillar volume was 3.84 ± 1.23 ml and 4.30 ± 1.15 ml from physical and 3DUS measurements, respectively (p = 0.04). The Bland-Altman mean difference ± 95% limit of agreement between length, width, height, and volume results from the two measurements were -0.186 ± 2.01 cm, -0.393 ± 6.33 cm, 0.25 ± 7.71 cm, and 0.45 ± 2.32 ml, respectively. CONCLUSION While 3DUS is feasible, it may not be an accurate estimate of tonsillar volume for assessing hypertrophy. A larger study will be required to establish the accuracy of 3DUS measurements of tonsillar volume.
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Abstract
Objective: To assess which measure of thyroid nodule growth on serial neck ultrasound, if any, is associated with malignancy. Methods: Retrospective exploratory chart review of malignant thyroid nodules assessed at Kingston Health Sciences Centre (2006-2016) and benign thyroid nodules (2016), at least 1 cm in diameter and with 2 ultrasounds completed at least 30 days apart. Groups were compared using independent samples Student's t test, chi-square test, or Mann-Whitney U test as appropriate, as well as multivariable logistic and linear regression modelling to adjust for age and baseline volume. Results: One hundred and seventy-eight nodules were included in the study. When growth was defined as >20% increase in 2 dimensions (minimum 2 mm), malignant nodules (MNs) underwent significantly more growth than benign nodules (BNs) (16.8% BN versus 29.8% MN [P = .026]; odds ratio = 2.49; 95% confidence interval = 1.12 to 5.56). There was no significant difference between the groups when growth was defined as >2 mm/year or ≥50% volume growth. Nodules shrank >2 mm/year in each group and the difference was not statistically significant (24.2% BN versus 20.7% MN [P = .449]). The median doubling time for the nodules that grew was 1022.1 days in the BN group and 463.2 days in the MN group (P = .036). The median doubling time for all nodules was 456.5 days in the BN group and 244.2 days in the MN group (P = .015). Conclusion: Thyroid nodule growth defined as >20% increase in 2 dimensions (minimum 2 mm) is associated with risk of malignancy. Nodule shrinkage did not distinguish between BNs and MNs. Abbreviations: BN = benign nodule; CI = confidence interval; FNA = fine needle aspiration; KHSC = Kingston Health Science Centre; MN = malignant nodule; OR = odds ratio; ROC = receiver operating characteristic.
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Qadan L, Ahmed A, Kapila K. Thyroid Ultrasound Reports: Deficiencies and Recommendations. Med Princ Pract 2019; 28:280-283. [PMID: 30739108 PMCID: PMC6597922 DOI: 10.1159/000497789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 02/10/2019] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Thyroid ultrasound plays a major role in the clinical management of patients with thyroid nodules. Comprehensive reporting enables malignant risk stratification and biopsy decisions. In this study, we aimed at a systematic evaluation of the content and completeness of thyroid radiology reports. METHODS A retrospective study was undertaken. A total of 200 thyroid ultrasound reports of examinations performed over a 1-year period were reviewed. After excluding 18 reports, the remaining 182 were evaluated for the inclusion of the following nodule characteristics: size, 3-axis dimensions, location, presence or absence of five signs suspicious of malignancy, namely microcalcification, hypoechogenecity, irregular margin, height-to-width ratio, and intranodular vascularity. RESULTS While all reported nodules could be stratified easily as being more or less than 1 cm in size, only 23.6% of these nodules were reported in 3 dimensions, and 33.5% of the nodules were specifically localized. For any described nodule, the frequency of reporting on echogenicity was 50%, on vascularity 19.2%, on margin 10.4%, on calcifications 9.3%, and no report contained a description of the height-to-width ratio. The cumulative frequency of reporting on one characteristic per nodule was 84%, of two characteristics 27%, three characteristics 4.4%, and no report included ≥4 characteristics per nodule. CONCLUSION Despite easily accessible templates, reporting of thyroid nodule sonogram continues to be incomplete and inconsistent. This in turn constitutes a waste of a significant tool that could otherwise help in making timely informed medical decisions and in providing a significant platform for patients' future follow-up.
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Affiliation(s)
- Laila Qadan
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait,
| | - Adel Ahmed
- Department of Radiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Kusum Kapila
- Department of Pathology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
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Wu TJ, Ha PK, El-Sayed IH, George JR, Heaton CM, Ryan WR, Russell MD. Socioeconomic disparities in a population of patients undergoing total thyroidectomy for benign disease. Head Neck 2018; 41:715-721. [PMID: 30521675 DOI: 10.1002/hed.25421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/07/2018] [Accepted: 09/12/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND This study examines the effect of insurance status (as a measure of socioeconomic status) on patient with benign thyroid disease. METHODS A retrospective review was performed among 60 patients undergoing total thyroidectomy for benign thyroid disease. Univariate and multivariable analyses examined the relationship between insurance status and thyroid volume (sum of the left and right lobe volumes). RESULTS Twenty-eight (47%) patients were considered of underinsured/uninsured status, and 32 (53%) patients were considered of private/government/military insurance status. Median pathologic whole thyroid volume was 66 mL (range, 2-855). After multivariable linear regression, underinsured/uninsured status was the only significant predictor of larger volume (correlation coefficient [r] = 118; 95% CI, 42 to 194; P = .003), after adjusting for age, sex, body mass index, and presence of concomitant thyroid disease and compressive symptoms. CONCLUSION Patients of underinsured/uninsured status suffered more severe disease presentations at time of thyroidectomy, as measured by larger thyroid volumes.
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Affiliation(s)
- Tara J Wu
- Department of Head and Neck Surgery, Los Angeles Medical Center, Ronald Reagan University of California, California, Los Angeles
| | - Patrick K Ha
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Ivan H El-Sayed
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Jonathan R George
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Chase M Heaton
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - William R Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Marika D Russell
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
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Grani G, Lamartina L, Biffoni M, Giacomelli L, Maranghi M, Falcone R, Ramundo V, Cantisani V, Filetti S, Durante C. Sonographically Estimated Risks of Malignancy for Thyroid Nodules Computed with Five Standard Classification Systems: Changes over Time and Their Relation to Malignancy. Thyroid 2018; 28:1190-1197. [PMID: 30105949 DOI: 10.1089/thy.2018.0178] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Over 50% of newly diagnosed thyroid nodules are either cytologically benign or presumed to be benign on the basis of low-suspicion sonographic findings. The strategies used for their long-term surveillance are based mainly on the estimated residual risk of malignancy calculated with various ultrasonographic classification systems (e.g., Thyroid Image Reporting and Data Systems [TIRADS]). We conducted a longitudinal study to evaluate the temporal stability of the initial risk estimates computed with five widely used systems and to determine whether risk class increases during follow-up are indeed predictive of malignancy. METHODS We re-analyzed data prospectively collected at a single academic referral center on 232 patients (age: 54.1 ± 13.7 years) with 432 asymptomatic, sonographically or cytologically benign thyroid nodules at baseline (T0) and 122 new nodules that were present five years later (T5). At both time points, the sonographically estimated risk of malignancy was calculated as recommended by the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi, the American College of Radiologists' TIRADS, the American Thyroid Association's 2015 practice guidelines, the European Thyroid Association's TIRADS (EU-TIRADS), and the TIRADS of the Korean Society of Thyroid Radiology (K-TIRADS). RESULTS For 57 to 127 (13.2-29.4%) of the original nodules, depending on the system used, the estimated malignancy risk increased over the 5-year interval. Of the nodules whose baseline risk had not warranted cytological assessment, very few (6.3-8.3%) met the criteria for cytology at the 5-year evaluation. Biopsy was indicated for only 4 to 8 (3.3-6.6%) of the new nodules based on T5 risk estimates. Despite these changes, none of the 232 patients was ever diagnosed with a cancer. CONCLUSIONS Ultrasound-based risk classes of presumably benign thyroid nodules remain fairly stable over time, and changes warranting biopsy are rare indeed. The appearance of new nodules is a frequent event, but very few (<5%) are classified as high risk, and only the 3-7% meet the criteria for cytological assessment. Collectively, these findings support the view that patients with presumably benign thyroid nodules can be safely followed with less intensive protocols.
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Affiliation(s)
- Giorgio Grani
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Livia Lamartina
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Marco Biffoni
- 2 Dipartimento di Scienze Chirurgiche, and Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Laura Giacomelli
- 2 Dipartimento di Scienze Chirurgiche, and Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Marianna Maranghi
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Rosa Falcone
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Valeria Ramundo
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Vito Cantisani
- 3 Unitá Operativa Semplice Innovazioni Diagnostiche e Ultrasonografiche, Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Sebastiano Filetti
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
| | - Cosimo Durante
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Azienda Ospedaliera Universitaria Policlinico Umberto I , Università di Roma Sapienza, Rome, Italy
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Lee HJ, Yoon DY, Seo YL, Kim JH, Baek S, Lim KJ, Cho YK, Yun EJ. Intraobserver and Interobserver Variability in Ultrasound Measurements of Thyroid Nodules. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:173-178. [PMID: 28736947 DOI: 10.1002/jum.14316] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/01/2017] [Accepted: 04/03/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The purpose of this study was to assess the intraobserver and interobserver variability in ultrasound (US) measurements of thyroid nodules. METHODS We performed a prospective study of the US examinations of 73 patients with 122 thyroid nodules greater than 5 mm in size. Ultrasound measurements in 4 dimensions (anteroposterior, transverse, longitudinal, and maximum diameters) and measurement of the estimated volume (using the ellipsoid formula) of each thyroid nodule were performed twice by 2 independent radiologists (A and B, with 10 years and 6 months of experience, respectively). The intraobserver and interobserver variability in measurements of thyroid nodules was assessed by a Bland-Altman analysis of agreement. The absolute values for intraobserver and interobserver variability were compared by a paired t test. RESULTS The 95% intraobserver and interobserver limits of agreement for the anteroposterior, transverse, longitudinal, and maximum diameters and estimated volume of thyroid nodules were ±18.2%, ± 14.3%, and ±21.0%; ± 17.2%%, ± 17.3%, and 18.2%; ± 14.6%, ± 15.5%, and ±22.3%; ± 13.8%, ± 15.5%, and ±19.6%; and ±30.2%, ± 27.7%, and ±44.1%, respectively. The absolute values for intraobserver variability were lower than those for interobserver variability for all measurements. CONCLUSIONS There was considerable intraobserver and interobserver variability in US measurement of thyroid nodules, which must be taken into account during follow-up US examinations of patients with thyroid nodules.
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Affiliation(s)
- Hyung Jin Lee
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dae Young Yoon
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Young Lan Seo
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sora Baek
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kyoung Ja Lim
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Young Kwon Cho
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Eun Joo Yun
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea
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Grani G, Bruno R, Lucisano G, Costante G, Meringolo D, Puxeddu E, Torlontano M, Tumino S, Attard M, Lamartina L, Nicolucci A, Cooper DS, Filetti S, Durante C. Temporal Changes in Thyroid Nodule Volume: Lack of Effect on Paranodular Thyroid Tissue Volume. Thyroid 2017; 27:1378-1384. [PMID: 28806880 DOI: 10.1089/thy.2017.0201] [Citation(s) in RCA: 4] [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] [Indexed: 11/13/2022]
Abstract
BACKGROUND The term "nodular goiter" has long been used to refer to a nodular thyroid gland, based on the assumption that nodule growth may be associated with hyperplasia of the surrounding non-nodular tissue. The aim of this prospective, multicenter, observational study was to determine whether nodule growth is accompanied by growth in the non-nodular tissue. METHODS Eight Italian thyroid-disease referral centers enrolled 992 consecutive patients with one to four benign nodules. Nodular and non-nodular thyroid tissue volumes were assessed for five years with annual ultrasound examinations. RESULTS In participants whose nodules remained stable (n = 839), thyroid volumes did not change (baseline 15.0 mL [confidence interval (CI) 14.5-15.6]; five-year evaluation 15.1 mL [CI 14.5-15.7]). In participants with significant growth of one or more nodule (n = 153), thyroid volumes increased and by year 5 were significantly greater than those of the former group (17.4 mL [CI 16-18.7]). In 76 individuals with unilateral nodules that grew, the mean nodular lobe volume significantly exceeded that of the contralateral lobe (8.6 mL [CI 7.4-9.8] vs. 6.7 mL [CI 6-7.4]). The unaffected lobe volumes remained stable over time, while nodular lobes grew steadily and were significantly greater at the end of follow-up (10.1 mL [CI 8.9-11.3]). Excluding the volume of the largest growing nodule in these cases, the remaining volume of the affected lobe remained virtually unchanged with respect to its baseline value. Furthermore, there was no significant difference in the non-nodular tissue volume between the unaffected lobe and the affected lobe (with the largest growing nodule volume subtracted), both at baseline and at the end of follow-up. CONCLUSIONS The growth of thyroid nodules is a local process, not associated with growth of the surrounding non-nodular tissue. Therefore, a normal-sized thyroid containing nodules should be referred to as a "uni- or multinodular thyroid gland" and considered a distinct entity from "uni- or multinodular goiter."
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Affiliation(s)
- Giorgio Grani
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma Sapienza , Rome, Italy
| | - Rocco Bruno
- 2 Unità di Endocrinologia , Ospedale di Tinchi-Pisticci, Matera, Italy
| | - Giuseppe Lucisano
- 3 Center for Outcomes Research and Clinical Epidemiology , Pescara, Italy
| | - Giuseppe Costante
- 4 Dipartimento di Scienze della Salute, Università di Catanzaro Magna Graecia , Catanzaro, Italy
- 5 Department of Internal Medicine, Institut Jules Bordet Comprehensive Cancer Center , Brussels, Belgium
| | - Domenico Meringolo
- 6 Unità Operativa Semplice Dipartimentale di Endocrinologia , Ospedale di Bentivoglio, Bologna, Italy
| | - Efisio Puxeddu
- 7 Dipartimento di Medicina, Università di Perugia , Perugia, Italy
| | - Massimo Torlontano
- 8 Unità Operativa di Endocrinologia, Istituto di Ricovero e Cura a Carattere Scientifico , Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Salvatore Tumino
- 9 Dipartimento di Scienze Mediche e Pediatriche, Università di Catania , Catania, Italy
| | - Marco Attard
- 10 Unità Operativa di Endocrinologia , Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Livia Lamartina
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma Sapienza , Rome, Italy
| | - Antonio Nicolucci
- 3 Center for Outcomes Research and Clinical Epidemiology , Pescara, Italy
| | - David S Cooper
- 11 Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Sebastiano Filetti
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma Sapienza , Rome, Italy
| | - Cosimo Durante
- 1 Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma Sapienza , Rome, Italy
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Tuttle RM, Fagin JA, Minkowitz G, Wong RJ, Roman B, Patel S, Untch B, Ganly I, Shaha AR, Shah JP, Pace M, Li D, Bach A, Lin O, Whiting A, Ghossein R, Landa I, Sabra M, Boucai L, Fish S, Morris LGT. Natural History and Tumor Volume Kinetics of Papillary Thyroid Cancers During Active Surveillance. JAMA Otolaryngol Head Neck Surg 2017; 143:1015-1020. [PMID: 28859191 DOI: 10.1001/jamaoto.2017.1442] [Citation(s) in RCA: 286] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Active surveillance of low-risk papillary thyroid cancer (PTC) is now an accepted alternative to immediate surgery, but experience with this approach outside of Japan is limited. The kinetics (probability, rate, and magnitude) of PTC tumor growth under active surveillance have not been well defined. Objective To describe the kinetics of PTC tumor growth during active surveillance. Design, Setting, and Participants Cohort study of 291 patients undergoing active surveillance for low-risk PTC (intrathyroidal tumors ≤1.5 cm) with serial tumor measurements via ultrasonography at a tertiary referral center in the United States. Intervention Active surveillance. Main Outcomes and Measures The cumulative incidence, rate, and magnitude of the change in tumor diameter or volume, as well as associations with patient and tumor characteristics. Results Of the 291 patients, 219 (75.3%) were women; mean (SD) age was 52 (15) years. During a median (range) active surveillance of 25 (6-166) months, growth in tumor diameter of 3 mm or more was observed in 11 of 291 (3.8%) patients, with a cumulative incidence of 2.5% (2 years) and 12.1% (5 years). No regional or distant metastases developed during active surveillance. In all cases, 3-dimensional measurements of tumor volume allowed for earlier identification of growth (median, 8.2 months; range, 3-46 months before increase in tumor diameter). In multivariable analysis, both younger age at diagnosis (hazard ratio per year, 0.92; 95% CI, 0.87-0.98; P = .006) and risk category at presentation (hazard ratio for inappropriate, 55.17; 95% CI, 9.4-323.19; P < .001) were independently associated with the likelihood of tumor growth. Of the tumors experiencing volume growth, kinetics demonstrated a classic exponential growth pattern, with a median doubling time of 2.2 years (range, 0.5-4.8 years; median r2 = 0.75; range, 0.42-0.99). Conclusions and Relevance The rates of tumor growth during active surveillance in a US cohort with PTCs measuring 1.5 cm or less were low. Serial measurement of tumor volumes may facilitate early identification of tumors that will continue to grow and thereby inform the timing of surveillance imaging and therapeutic interventions.
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Affiliation(s)
- R Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James A Fagin
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gerald Minkowitz
- Department of Pathology, NYU Langone Medical Center, New York, New York.,Minkowitz Pathology, PC, Brooklyn, New York
| | - Richard J Wong
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Benjamin Roman
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Snehal Patel
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brian Untch
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark Pace
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Duan Li
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ariadne Bach
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adrian Whiting
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ronald Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Inigo Landa
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mona Sabra
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Laura Boucai
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephanie Fish
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Luc G T Morris
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Pustelnik FS, Gronbek C, Døssing H, Nguyen N, Bonnema SJ, Hegedüs L, Godballe C, Sorensen JR. The compensatory enlargement of the remaining thyroid lobe following hemithyroidectomy is small and without impact on symptom relief. Eur Arch Otorhinolaryngol 2017; 275:161-167. [PMID: 29043478 DOI: 10.1007/s00405-017-4777-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
According to previous studies, hemithyroidectomy results in growth of the remaining thyroid lobe by up to 30% in first 12 months after surgery. However, this estimate is based on imprecise methods, high inter- and intra-observer variability, and lack of blinding of the measurements. Furthermore, it is unknown whether enlargement of the remaining hemi-thyroid interferes with the improvement in symptoms after surgery for goiter. We aimed to assess the impact of postoperative thyroid growth on goiter symptom relief following hemithyroidectomy in patients with benign nodular goiter. Outcomes were measured before and 6 months after hemithyroidectomy in 44 patients. Thyroid volumes were determined by two independent and blinded observers using magnetic resonance imaging (MRI). Inter- and intra-observer variability was visualized by Bland-Altman plots. Goiter symptoms were assessed by the Thyroid-Specific Patient-Reported-Outcome Questionnaire (ThyPRO) on a scale from 0 to 100 points. After hemithyroidectomy, the remaining thyroid lobe was 13.7 ± 6.4 mL, and enlarged by a mean of 1.8 mL over 6 months [95% confidence interval (CI) (1.6; 2.1), p < 0.001], corresponding to an increase of 17% [95% CI (12; 22)]. The Goiter Symptom score improved by 27 points [95% CI (21; 34), p < 0.0001] from median 39 points (range 2-86) at baseline, and was unaffected by the compensatory thyroid growth. Six months after hemithyroidectomy, using blinded MRI evaluations, we demonstrated a small but significant postoperative growth of the remaining hemi-thyroid, which did not significantly affect the considerable improvement in goiter symptoms.
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Affiliation(s)
- Frederik Schultz Pustelnik
- Department of ORL Head & Neck Surgery, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Casper Gronbek
- Department of ORL Head & Neck Surgery, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Helle Døssing
- Department of ORL Head & Neck Surgery, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Nina Nguyen
- Department of Radiology, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000, Odense C, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000, Odense C, Denmark
| | - Christian Godballe
- Department of ORL Head & Neck Surgery, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Jesper Roed Sorensen
- Department of ORL Head & Neck Surgery, Odense University Hospital, J.B. Winsløws vej 4, 5000, Odense C, Denmark. .,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, 5000, Odense C, Denmark.
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Rossi M, Lupo S, Rossi R, Franceschetti P, Trasforini G, Bruni S, Tagliati F, Buratto M, Lanza G, Damiani L, Degli Uberti E, Zatelli MC. Proposal for a novel management of indeterminate thyroid nodules on the basis of cytopathological subclasses. Endocrine 2017; 57:98-107. [PMID: 27623969 DOI: 10.1007/s12020-016-1105-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/25/2016] [Indexed: 01/19/2023]
Abstract
Indeterminate thyroid nodules include heterogeneous lesions that could benefit from a differential management. Our aim is to better define the management of the Bethesda System for Reporting Thyroid Cytopathology class III and IV nodules, by identifying cytological subcategories among Bethesda System for Reporting Thyroid Cytopathology class III associated with different clinical risk, by means of ultrasound, repeated FNAB, and BRAFV600E molecular analysis. We also evaluated the outcome of nodules not operated, over a 5-year follow-up. Out of 460 nodules (269 Bethesda System for Reporting Thyroid Cytopathology class III and 191 Bethesda System for Reporting Thyroid Cytopathology class IV), 344 were operated on surgical group and 116 followed-up conservatively (follow-up group). Bethesda System for Reporting Thyroid Cytopathology class III was divided into four subcategories on the basis of cytomorphological features (III-1, III-2, III-3, III-4). Clinical risk was defined on the basis of histological, cytological, and ultrasound data. Malignancy was higher in Bethesda System for Reporting Thyroid Cytopathology class III vs. Bethesda System for Reporting Thyroid Cytopathology class IV (34.4 vs. 26.2 %; p < 0.01). Papillary thyroid carcinoma was the most frequent cancer in each Bethesda System for Reporting Thyroid Cytopathology class (35 %). BRAFV600E diagnostic accuracy was 87 %. Repeated FNAB reclassified as benign nearly 40 % of nodules, selecting patients where surgery could be spared. Significant nodule growth occurred in 13.7 % of nodules, belonging mostly to Bethesda System for Reporting Thyroid Cytopathology class III-2 and Bethesda System for Reporting Thyroid Cytopathology class IV. Overall clinical risk was higher in Bethesda System for Reporting Thyroid Cytopathology III-1, III-4, and IV classes. We propose a differential management of Bethesda System for Reporting Thyroid Cytopathology III and IV classes and related subcategories: surgery may be indicated in Bethesda System for Reporting Thyroid Cytopathology class III-1, III-4, and IV; a conservative follow-up avoiding repeated FNAB may be appropriated in class III-3, while repeated FNAB may be useful in class III-2.
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Affiliation(s)
- Martina Rossi
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Sabrina Lupo
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
| | - Roberta Rossi
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Paola Franceschetti
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Giorgio Trasforini
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Stefania Bruni
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Federico Tagliati
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Mattia Buratto
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
| | - Giovanni Lanza
- Section of Pathology and Biomolecular Diagnostics, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
| | - Luca Damiani
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
| | - Ettore Degli Uberti
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy.
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy.
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Chew CR, Lam T, Chan STF, Chin-Lenn L. Systematic differences between ultrasound and pathological evaluation of thyroid nodules: a method comparison study. ANZ J Surg 2017; 88:464-467. [PMID: 28608502 DOI: 10.1111/ans.14045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/26/2017] [Accepted: 03/29/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The size of thyroid nodules as measured by ultrasound (ultrasound size, USS) is routinely used in clinical decision-making. Reports of discrepancy between USS and pathological size (PS) evaluation have not analysed their systematic differences. The objective of this study was to uncover the lack of agreement (bias) between USS and PS measurements. METHODS A retrospective study was performed on 121 patients who had a total or hemi-thyroidectomy for a solitary nodule. Ordinary least product regression was used to detect and distinguish constant and proportional bias in unidimensional size measurements between USS and PS evaluation. Three-dimensional volume measurements were compared in a subgroup of 31 patients. Pre-specified acceptable limits of interchange were defined as 20% difference. RESULTS Ordinary least product regression demonstrated no constant or proportional bias between the two methods; regression equation: USS = (0.863) + (1.040) × PS. When nodules were grouped by size, discrepancies between the two methods were observed in nodules <10 mm (P = 0.004). However, potential overtreatment of patients with USS >10 mm but PS <10 mm only accounted for 4.1% of total patients. Subgroup analysis of volume measurements showed no bias between USS and PS evaluation. CONCLUSIONS USS and PS measurements were interchangeable, as there was no evidence of constant or proportional bias between the two measurements. However, USS may misclassify the size for smaller nodules and potentially lead to unnecessary workup and treatment. Discrepancy in size measurements between USS and PS should be taken into account in clinical practice, particularly in smaller nodules.
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Affiliation(s)
- Carolyn R Chew
- Endocrine Surgery Unit, Department of Surgery, Western Hospital, Melbourne, Victoria, Australia
| | - Tracey Lam
- Endocrine Surgery Unit, Department of Surgery, Western Hospital, Melbourne, Victoria, Australia
| | - Steven T F Chan
- Department of Surgery, North West Academic Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Laura Chin-Lenn
- Endocrine Surgery Unit, Department of Surgery, Western Hospital, Melbourne, Victoria, Australia
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42
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Bilginer MC, Ozdemir D, Baser H, Dogan HT, Yalcin A, Ersoy R, Cakir B. Is ultrasonographically detected nodule diameter concordant with pathological tumor size? Int J Surg 2017; 42:95-102. [DOI: 10.1016/j.ijsu.2017.04.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
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Hahn LD, Kunder CA, Chen MM, Orloff LA, Desser TS. Indolent thyroid cancer: knowns and unknowns. CANCERS OF THE HEAD & NECK 2017. [PMID: 31093348 DOI: 10.1186/s411990160021-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Thyroid cancer incidence is rapidly increasing due to increased detection and diagnosis of indolent thyroid cancer, i.e. cancer that is likely to be clinically insignificant. Clinical, radiologic, and pathologic features predicting indolent behavior of thyroid cancer are still largely unknown and unstudied. Existing clinicopathologic staging systems are useful for providing prognosis in the context of treated thyroid cancer but are not designed for and are inadequate for predicting indolent behavior. Ultrasound studies have primarily focused on discrimination between malignant and benign nodules; some studies show promising data on using sonographic features for predicting indolence but are still in their early stages. Similarly, molecular studies are being developed to better characterize thyroid cancer and improve the yield of fine needle aspiration biopsy, but definite markers of indolent thyroid cancer have yet to be identified. Nonetheless, active surveillance has been introduced as an alternative to surgery in the case of indolent thyroid microcarcinoma, and protocols for safe surveillance are in development. As increased detection of thyroid cancer is all but inevitable, increased research on predicting indolent behavior is needed to avoid an epidemic of overtreatment.
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Affiliation(s)
- Lewis D Hahn
- 1Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H-1307, Mail code 5621, Stanford, CA 94305 USA
| | - Christian A Kunder
- 2Department of Pathology, Stanford University School of Medicine, Stanford, USA
| | - Michelle M Chen
- 3Department of Otolaryngology, Stanford University School of Medicine, Stanford, USA
| | - Lisa A Orloff
- 3Department of Otolaryngology, Stanford University School of Medicine, Stanford, USA
| | - Terry S Desser
- 1Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H-1307, Mail code 5621, Stanford, CA 94305 USA
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Hahn LD, Kunder CA, Chen MM, Orloff LA, Desser TS. Indolent thyroid cancer: knowns and unknowns. CANCERS OF THE HEAD & NECK 2017; 2:1. [PMID: 31093348 PMCID: PMC6460732 DOI: 10.1186/s41199-016-0021-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/21/2016] [Indexed: 01/21/2023]
Abstract
Thyroid cancer incidence is rapidly increasing due to increased detection and diagnosis of indolent thyroid cancer, i.e. cancer that is likely to be clinically insignificant. Clinical, radiologic, and pathologic features predicting indolent behavior of thyroid cancer are still largely unknown and unstudied. Existing clinicopathologic staging systems are useful for providing prognosis in the context of treated thyroid cancer but are not designed for and are inadequate for predicting indolent behavior. Ultrasound studies have primarily focused on discrimination between malignant and benign nodules; some studies show promising data on using sonographic features for predicting indolence but are still in their early stages. Similarly, molecular studies are being developed to better characterize thyroid cancer and improve the yield of fine needle aspiration biopsy, but definite markers of indolent thyroid cancer have yet to be identified. Nonetheless, active surveillance has been introduced as an alternative to surgery in the case of indolent thyroid microcarcinoma, and protocols for safe surveillance are in development. As increased detection of thyroid cancer is all but inevitable, increased research on predicting indolent behavior is needed to avoid an epidemic of overtreatment.
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Affiliation(s)
- Lewis D Hahn
- 1Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H-1307, Mail code 5621, Stanford, CA 94305 USA
| | - Christian A Kunder
- 2Department of Pathology, Stanford University School of Medicine, Stanford, USA
| | - Michelle M Chen
- 3Department of Otolaryngology, Stanford University School of Medicine, Stanford, USA
| | - Lisa A Orloff
- 3Department of Otolaryngology, Stanford University School of Medicine, Stanford, USA
| | - Terry S Desser
- 1Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H-1307, Mail code 5621, Stanford, CA 94305 USA
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45
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Cancer Measurement at Ultrasound: State of the Art. Ultrasound Q 2016; 33:116-124. [PMID: 27984513 DOI: 10.1097/ruq.0000000000000266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reliable and reproducible tumor measurement is fundamental in the oncologic decision making. In this article, we first highlight the importance of a precise tumor measurement, reviewing the correct modality of measuring tumor lesions at ultrasound. Then we analyze the measurement discrepancies between ultrasound and pathology as well as the discrepancies reported between ultrasound and other imaging modalities. Thereafter, basing on the existent literature and on our experience, we discuss the factors influencing the tumor size measurements at ultrasound. Finally, we illustrate the current strategies to improve the effectiveness of cancer lesions measurement.
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Sciacchitano S, Lavra L, Ulivieri A, Magi F, Porcelli T, Amendola S, De Francesco GP, Bellotti C, Trovato MC, Salehi LB, Bartolazzi A. Combined clinical and ultrasound follow-up assists in malignancy detection in Galectin-3 negative Thy-3 thyroid nodules. Endocrine 2016; 54:139-147. [PMID: 26475496 DOI: 10.1007/s12020-015-0774-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/08/2015] [Indexed: 12/29/2022]
Abstract
The use of galectin-3 ThyroTest in the preoperative evaluation of cytologically indeterminate (Thy-3) thyroid nodules has been largely validated by retrospective and prospective multicentre studies. Here we report the results of galectin-3 ThyroTest routinely applied in the management of Thy-3 nodules in combination with clinical and ultrasonography (US) examination, in which galectin-3 positive nodules were directly referred to surgery whereas galectin-3 negative lesions were considered for clinical and US long-term follow-up. A cohort of 331 patients, bearing 340 thyroid Thy-3 nodules, was enrolled and subjected to galectin-3 expression analysis. A total of 256 galectin-3 negative nodules were directed to periodical clinical and US examination, while 84 galectin-3 positive cases were referred to surgery. Excluding 63 dropout patients plus 15 patients that were operated because of clinical reasons the remaining 176 galectin-3 negative nodules were followed with clinical and US examination for an average period of 31 months. During the follow-up, the volume of galectin-3 negative nodules was unchanged in 85 cases (48 %), reduced in 47 (27 %), and increased in 44 (25 %). Based on combined clinical features and US follow-up results, a total of 36 out of 191 galectin-3 negative nodules (19 %) were referred to surgery, with a final histological finding of 28 benign lesions, three follicular tumor of uncertain malignant potential (FT-UMP), and five malignant lesions, corresponding to a 7 % false negative rate. In the group of 84 galectin-3 positive nodules, we detected 65 thyroid cancers with a prevalence of 77 %, 12 FT-UMPs, and 7 false positive lesions, corresponding to a 4 % false positive rate. A total of 150 patients were not operated and are still under clinical and US monitoring while surgery was performed in 118 patients with a final 70 thyroid cancers diagnosed, corresponding to a 59 % prevalence of malignancy detected at surgery and to a 26 % prevalence of malignancy among the entire Thy-3 nodule population. Galectin-3 ThyroTest is an easy and cheap diagnostic procedure that integrates conventional fine-needle-aspiration cytology, reduces the number of unnecessary thyroidectomies and increases the rate of malignancy at surgery. Clinical and US follow-up of galectin-3 negative lesions allows to further reduce false negative cases.
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Affiliation(s)
- Salvatore Sciacchitano
- Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena n. 324, 00161, Rome, Italy.
- Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy.
| | - Luca Lavra
- Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy
| | - Alessandra Ulivieri
- Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy
| | - Fiorenza Magi
- Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy
| | - Tommaso Porcelli
- Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena n. 324, 00161, Rome, Italy
| | - Stefano Amendola
- Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena n. 324, 00161, Rome, Italy
| | - Gian Paolo De Francesco
- Department of Oncological Science, Breast Unit, St Andrea University Hospital, Via di Grottarossa, 1035/39, 00189, Rome, Italy
| | - Carlo Bellotti
- Operative Unit Surgery of Thyroid and Parathyroid, Sapienza University of Rome, S. Andrea Hospital, Via di Grottarossa, 1035/39, 00189, Rome, Italy
| | - Maria Concetta Trovato
- Department of Clinical and Experimental Medicine, University of Messina, Policlinico Universitario "G. Martino", via Consolare Valeria, Gazzi, 98125, Messina, Italy
| | - Leila B Salehi
- Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy
- Department of Biopathology and Diagnostic Imaging, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy
| | - Armando Bartolazzi
- Laboratory of Surgical and Experimental Pathology, St Andrea University Hospital, Via di Grottarossa, 1035/39, 00189, Rome, Italy
- Department of Oncology-Pathology, Cancer Center Karolinska Universitetssjukhuset Solna, 17176, Stockholm, Sweden
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Krejbjerg A, Pedersen IB, Laurberg P. Can Elastography Predict Growth of Incidental Thyroid Nodules? A Pilot Two-Year Follow-Up Study. ULTRASONIC IMAGING 2016; 38:303-313. [PMID: 26346886 DOI: 10.1177/0161734615604626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of this study was to examine the ultrasonography (US) and ultrasound elastography (USE) features of thyroid incidentalomas in a population exposed to iodine deficiency and to investigate whether baseline elasticity scores (ES) predicted changes in thyroid nodule US characteristics. We conducted a two-year follow-up pilot study of thyroid incidentalomas by US and USE. One sonographer performed the US and USE examination on the same apparatus at baseline and at follow-up. We evaluated 83 incidental thyroid nodules detected in a population study. The follow-up period saw no change in median thyroid nodule diameter (p = 0.18) or in the prevalence of thyroid nodule US characteristics (hypoechoic: p = 0.05; solid nodule: p = 1.00; microcalcifications: p = 0.55). Individual changes in thyroid nodule diameter (>20%) were seen in 23% (11% had decreased, and 12% had increased in diameter). Changes in ES were frequently observed; 37% changed from ES A + B to ES C + D, and 27% changed from ES C + D to ES A + B. In a multivariate logistic regression model, we found no association between baseline ES and individual changes in nodule size. In an area with mild iodine deficiency and a high prevalence of thyroid nodules, thyroid USE performed on thyroid incidentalomas did not predict individual changes in thyroid nodule size.
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Affiliation(s)
- Anne Krejbjerg
- Departments of Clinical Medicine and Endocrinology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Inge Bülow Pedersen
- Departments of Clinical Medicine and Endocrinology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Peter Laurberg
- Departments of Clinical Medicine and Endocrinology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
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Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, Paschke R, Valcavi R, Vitti P. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES--2016 UPDATE. Endocr Pract 2016; 22:622-39. [PMID: 27167915 DOI: 10.4158/ep161208.gl] [Citation(s) in RCA: 708] [Impact Index Per Article: 88.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Thyroid nodules are detected in up to 50 to 60% of healthy subjects. Most nodules do not cause clinically significant symptoms, and as a result, the main challenge in their management is to rule out malignancy, with ultrasonography (US) and fine-needle aspiration (FNA) biopsy serving as diagnostic cornerstones. The key issues discussed in these guidelines are as follows: (1) US-based categorization of the malignancy risk and indications for US-guided FNA (henceforth, FNA), (2) cytologic classification of FNA samples, (3) the roles of immunocytochemistry and molecular testing applied to thyroid FNA, (4) therapeutic options, and (5) follow-up strategy. Thyroid nodule management during pregnancy and in children are also addressed. On the basis of US features, thyroid nodules may be categorized into 3 groups: low-, intermediate-and high-malignancy risk. FNA should be considered for nodules ≤10 mm diameter only when suspicious US signs are present, while nodules ≤5 mm should be monitored rather than biopsied. A classification scheme of 5 categories (nondiagnostic, benign, indeterminate, suspicious for malignancy, or malignant) is recommended for the cytologic report. Indeterminate lesions are further subdivided into 2 subclasses to more accurately stratify the risk of malignancy. At present, no single cytochemical or genetic marker can definitely rule out malignancy in indeterminate nodules. Nevertheless, these tools should be considered together with clinical data, US signs, elastographic pattern, or results of other imaging techniques to improve the management of these lesions. Most thyroid nodules do not require any treatment, and levothyroxine (LT4) suppressive therapy is not recommended. Percutaneous ethanol injection (PEI) should be the first-line treatment option for relapsing, benign cystic lesions, while US-guided thermal ablation treatments may be considered for solid or mixed symptomatic benign thyroid nodules. Surgery remains the treatment of choice for malignant or suspicious nodules. The present document updates previous guidelines released in 2006 and 2010 by the American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE) and Associazione Medici Endocrinologi (AME).
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Singh Ospina N, Maraka S, Espinosa DeYcaza A, O'Keeffe D, Brito JP, Gionfriddo MR, Castro MR, Morris JC, Erwin P, Montori VM. Diagnostic accuracy of thyroid nodule growth to predict malignancy in thyroid nodules with benign cytology: systematic review and meta-analysis. Clin Endocrinol (Oxf) 2016; 85:122-31. [PMID: 26562828 DOI: 10.1111/cen.12975] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/09/2015] [Accepted: 10/30/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Thyroid ultrasound to assess for nodular growth is commonly performed during the follow-up of patients with benign thyroid nodules, with the goal of identifying patients with a missed diagnosis of thyroid cancer. The objective of this study was to summarize the evidence regarding the diagnostic accuracy of growth during follow-up of benign thyroid nodules for thyroid cancer. METHODS We searched multiple electronic databases using a search strategy designed by an experienced medical librarian from inception to March 2015. Eligible studies included patients with benign thyroid nodules assessed for growth during follow-up and evaluated for thyroid cancer either by surgical histology or a repeat fine needle aspiration biopsy. Reviewers working independently and in duplicate recorded data and assessed each study. RESULTS The seven eligible studies lacked safeguards against bias and generated results that were imprecise with wide confidence intervals and inconsistent across studies. This warrants very low confidence in these results. The odds of nodule growth in patients with thyroid cancer on histopathology over these odds in patients without thyroid cancer (diagnostic odds ratio) was 0·58 (95% CI: 0·26-1·3); the diagnostic odds ratio was 2·2 (95% CI: 0·26-18) when an abnormal repeat biopsy was the reference standard. CONCLUSION The body of evidence linking nodule growth with thyroid cancer during the follow-up of benign nodules warrants very low confidence. In the era of high-value health care, the commonplace practice of following benign thyroid nodules with serial ultrasound assessment of growth to diagnose cancer can be questioned, calling for imminent evaluation.
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Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Spyridoula Maraka
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ana Espinosa DeYcaza
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Derek O'Keeffe
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Juan P Brito
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael R Gionfriddo
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Mayo Graduate School, Mayo Clinic, Rochester, MN, USA
| | - M Regina Castro
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - John C Morris
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Victor M Montori
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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50
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Singh PK, Sharma SK, Sinha A, Dutta P. Can thyroid volume predict thyroid dysfunction in patients with systemic sclerosis? A prospective cross-sectional study from a tertiary care center in North West India. Clin Rheumatol 2016; 35:765-9. [PMID: 26861031 DOI: 10.1007/s10067-016-3209-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/21/2016] [Accepted: 02/01/2016] [Indexed: 11/27/2022]
Abstract
Previous studies have documented an association between thyroid dysfunction, predominant hypothyroidism, and antibody positivity in patients with systemic sclerosis (SSc). There are no studies reporting the relationship between thyroid volume and thyroid functions in patients with SSc. This study was conducted to correlate thyroid dysfunction with thyroid volume as measured on ultrasound and antibody positivity. Complete thyroid workup was done in 106 patients of SSc which included thyroid function test, antithyroid peroxidase (TPO) antibody, antithyroid-stimulating hormone receptor (TSHR) antibody, antithyroglobulin antibody, and thyroid ultrasound to assess thyroid volume, echogenicity and blood flow, and fine needle aspiration cytology of suspicious thyroid lesions. Prevalence of subclinical hypothyroidism was 8.5 %, overt hypothyroidism 1.9 %, subclinical hyperthyroidism 2.8 %, and overt hyperthyroidism in 0.9 % of the patients. Antithyroid peroxidase antibody was positive in 16 %, anti-TSH receptor antibody in 5.7 %, and antithyroglobulin antibody in none of the patients. Thyroid volume was in the range of atrophy (<4.5 ml) in 57.5 % patients, echogenicity altered in 15.1 %, and blood flow increased in 15.1 %. Thyroid volume correlated strongly with the pulmonary function test (FEV1). Routine thyroid ultrasound and thyroid function tests may be included in the workup of patients with SSc for the early detection of hypothyroidism since a small but significant percentage of patients developed thyroid dysfunction. Antithyroid antibodies may not correlate with the thyroid functions and hence should not be recommended.
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Affiliation(s)
- Pawan Kumar Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), 4th Floor, F Block, Nehru Hospital, Sector 12, Chandigarh, 160012, India
| | - Shefali Khanna Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), 4th Floor, F Block, Nehru Hospital, Sector 12, Chandigarh, 160012, India.
| | - Anindita Sinha
- Department of Radio-diagnosis, PGIMER, Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, PGIMER, Chandigarh, India
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