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Vorländer C, Fischer A, Korkusuz H. High intensity focused ultrasound in the therapy of benign thyroid nodules-first German bicentric study with long-term follow-up. Endocrine 2022; 77:112-120. [PMID: 35476180 DOI: 10.1007/s12020-022-03058-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/10/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE The study evaluated high-intensity-focused ultrasound (HIFU) for benign thyroid nodules in terms of efficiency, complication rate, influence of preablative nodule size, parameters influencing the therapeutic success and hormonal-thyroid-function. METHODS Seventy-two patients with 75 nodules were treated with HIFU at 2 centers from 2014-2019. Median nodule volume was 4.4 ml (range 0.33-53). The therapeutic ultrasound probe (EchoPulse THC900888-H) generated 80-90 °C in the target tissue with 87.6-320.3 J per sonication. Nodal volume was measured at baseline and over 12 months after therapy in a retrospective bicentric-study with long-term follow-up. Hormonal-thyroid function (TSH, T3, T4) was measured before and after ablation. Complications were assessed. RESULTS Significant volume reduction (p < 0.05 Wilcoxon-signed-rank test) of thyroid nodules was 38.98% at 3 months, 37.32% at 6 months, 61.54% at 9 months and 60.66% at 12 months. Volume reduction of nodules <3 ml did not differ significantly from nodules >3 ml (p > 0.05 Mann-Whitney test). At 3 months solid nodules had a significant volume reduction of 52.08%, complex nodules of 32.57%, nodules treated under regional anesthesia of 33.07% and under general anesthesia of 49.47%. Hormonal-thyroid function was not influenced significantly by HIFU therapy (p > 0.05 Wilcoxon-signed-rank test). Complication rate was 3.8%. No long-term complications occurred. CONCLUSION Significant volume reduction of thyroid nodules up to 12 months after HIFU was shown. All complications were reversible. Therapy was more efficient in solid than complex nodules and in nodules treated under general anesthesia than with regional anesthesia. Hormonal-thyroid-function was not affected. TRIAL REGISTRAFTION NUMBER 2020-1728-evBO. Date of registration: 16.06.2020. Agency: Ethik-Kommission bei der Landesäztekammer Hessen.
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Affiliation(s)
- Christian Vorländer
- Bürgerhospital Frankfurt, Nibelungenallee 37, 60318, Frankfurt am Main, Hessen, Germany
| | - Anne Fischer
- DZTA - Deutsches Zentrum für Thermoablation e.V., Nibelungenallee 37-41, 60318, Frankfurt am Main, Hessen, Germany.
| | - Hüdayi Korkusuz
- Afyonkarahisar Sağlık Bilimleri Üniversitesi, Zafer Sağlık Külliyesi, Dörtyol Mahallesi 2078 Sokak No: 3, Afyonkarahisar, Turkey
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Bhatia N, Dhingra VK, Kumari S, Dhawan DK, Chadha VD. Efficacy of dual use of Tc-99m-pertechnetate and Tc-99m-tetrofosmin scintigraphy for the assessment of thyroid nodules. J Med Imaging Radiat Oncol 2020; 64:189-196. [PMID: 32103595 DOI: 10.1111/1754-9485.13006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/06/2019] [Accepted: 12/24/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Radioisotope methods have shown to be useful in the non-invasive diagnosis of thyroid nodules over the past years. The present prospective study aims to evaluate the efficacy of gamma imaging using single and dual tracer using Tc-99m pertechnetate and Tc-99m tetrofosmin for evaluation and management of thyroid nodules. METHODS Dynamic (perfusion) imaging was performed after injecting 148-185 MBq (4-5 mCi) of Tc-99m pertechnetate followed by static imaging. A second, dynamic (perfusion) imaging study within same week was performed with 296-370MBq (8-10mCi) of Tc-99m tetrofosmin on same group of patients followed by early and delayed images. Results of radionuclide perfusion scan from both studies were compared qualitatively with postsurgical histopathology or fine needle aspiration cytology (FNAC). RESULTS Total 65 nodules in 50 patients were included in the study. With single tracer, the specificity and accuracy of Tc-99m pertechnetate was 23% and 45% and for Tc-99m tetrofosmin scan was 40% and 49%. When dual tracers were evaluated for the same group of patients, the specificity was 56% and accuracy was 55%. CONCLUSION Dual Tracer technique with Tc-99m pertechnetate and Tc-99m tetrofosmin could be helpful in selecting nodules need surgical intervention. This technique can be used for convenient and rapid diagnostic evaluation of thyroid nodules non-invasively. We suggest a combination of fine needle aspiration biopsy and dual use of Tc-99m-pertechnetate and Tc-99m-tetrofosmin as a routine diagnostic approach to thyroid nodules.
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Affiliation(s)
- Nisha Bhatia
- Centre of Nuclear Medicine, Panjab University, Chandigarh, India.,Department of Nuclear Medicine, Cancer Research Institute, Swami Rama Himalayan University, Dehradun, India
| | - Vandana K Dhingra
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Saumya Kumari
- Department of Nuclear Medicine, Cancer Research Institute, Swami Rama Himalayan University, Dehradun, India
| | | | - Vijayta D Chadha
- Centre of Nuclear Medicine, Panjab University, Chandigarh, India
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Abstract
AbstractObjectives:This study aimed to investigate the prevalence and clinical significance of solitary thyroid nodules in patients who underwent thyroid surgery.Methods:A retrospective review was performed of the case notes of all adult patients who underwent thyroid surgery from January 2003 to December 2009. All patients with solitary thyroid nodules identified by ultrasonography were included.Results:In total, 225 patients underwent thyroid surgery. The prevalence of solitary thyroid nodules was 27.1 per cent (61 out of 225 patients). Seventy-two per cent of patients were women and the mean age at presentation was 52 ± 16 years. In all, 75.4 per cent of solitary nodules had neoplastic pathology and the malignancy rate was 34.4 per cent. The sensitivity and specificity of fine needle aspiration cytology for neoplasm detection were 73.9 per cent and 80.0 per cent, respectively. There was no association between the various ultrasonography parameters and malignancy risk (p > 0.05).Conclusion:Solitary thyroid nodules should be investigated thoroughly with a high index of suspicion because there is a high probability (34.0 per cent) of malignancy.
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Jena A, Patnayak R, Prakash J, Sachan A, Suresh V, Lakshmi AY. Malignancy in solitary thyroid nodule: A clinicoradiopathological evaluation. Indian J Endocrinol Metab 2015; 19:498-503. [PMID: 26180765 PMCID: PMC4481656 DOI: 10.4103/2230-8210.159056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Thyroid nodules are common. They can be either benign or malignant. Solitary thyroid nodules (STN) have a high likelihood of being malignant. They should be characterized properly for optimum management. MATERIALS AND METHODS In this study, we have analyzed our departmental data over a period of 5 years. All the patients who presented to the outpatient department with a clinically detected STN were included in the study group. Our approach was individualized. Preoperative ultrasonography (USG) and fine-needle aspiration cytology were planned in all these patients. Hemi thyroidectomy and total thyroidectomy with and without neck dissection were performed wherever appropriate. RESULTS There were 162 cases of clinically detected STN. USG findings were available in 146 cases. Postoperative histopathology was reported as malignant in 58 cases. Malignant STN was more likely in males. Ultrasonographically detected solid STN were more prone for malignancy as compared to multinodular goiter (P = 0.000) Presence of micro calcification and cervical lymphadenopathy were more commonly noted in malignant thyroid swellings. CONCLUSION Solitary thyroid nodules do have a high likelihood of harboring a malignancy. Solid echogenicity, micro calcification and cervical lymphadenopathy on USG were seen more frequently in malignant nodules.
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Affiliation(s)
- Amitabh Jena
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Rashmi Patnayak
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Jaya Prakash
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Alok Sachan
- Department of Endocrinology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - V. Suresh
- Department of Endocrinology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Amarchala Yadagiri Lakshmi
- Department of Radiology, Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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Proietti A, Sartori C, Borrelli N, Giannini R, Materazzi G, Leocata P, Elisei R, Vitti P, Miccoli P, Basolo F. Follicular-derived neoplasms: morphometric and genetic differences. J Endocrinol Invest 2013; 36:1055-61. [PMID: 23888303 DOI: 10.3275/9063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The distinction between follicular adenomas (FAs) and well differentiated follicular and papillary carcinomas is often a demanding task and sometimes only intuitive. AIM We report an histomorphological evaluation of follicular neoplasms [FAs, follicular carcinomas (FCs), and follicular variant of papillary carcinomas (FVPTCs)], supported by a qualitative and quantitative image analysis and by a molecular characterization. MATERIAL AND METHODS Tumor fibrosis and haemorrhage, neoplastic capsule thickness, follicle diameter, number of neoplastic cells, nuclear diameter of neoplastic cells, vessels density, vessels area and intratumoral distribution were evaluated. Ras and BRAF mutations, RET/PTC1, RET/PTC3, and PAX8/PPARγ rearrangements were analyzed. Correlations with clinico-pathological features have been studied. RESULTS We found that FAs had a more extensive intratumoral haemorrhage, while malignant neoplasms were characterized by an evident fibrosis, higher cellularity and larger size. FVPTCs had higher nuclear diameter; cells count was higher in the minimally invasive follicular thyroid carcinomas, as well as a thickener neoplastic capsule. The CD34 stain showed a higher microvessel density in the FVPTCs group. A higher peripheral vessels distribution was observed only in malignant neoplasms. We observed overall Ras mutations in 2.4% of adenomas, in 41.5% of FVPTCs, and in 44.8% of FCs. It is outstanding that there is a marked difference in the Ras mutation distribution between the benign and malignant tumors in our series. CONCLUSIONS We found that genotyping of Ras gene family together with an accurate analysis of selected morphological features could help in the differential diagnosis of follicular-derived thyroid neoplasms.
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MESH Headings
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/pathology
- Adenoma/genetics
- Adenoma/pathology
- Adult
- Aged
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary, Follicular/genetics
- Carcinoma, Papillary, Follicular/pathology
- Diagnosis, Differential
- Female
- Genes, ras/genetics
- Genotype
- Humans
- Male
- Middle Aged
- Proto-Oncogene Proteins B-raf/genetics
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/pathology
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Affiliation(s)
- A Proietti
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Via Paradisa 2, 56124 Pisa, Italy
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Heikkilä A, Hagström J, Mäenpää H, Louhimo J, Siironen P, Heiskanen I, Haglund C, Arola J. Loss of estrogen receptor Beta expression in follicular thyroid carcinoma predicts poor outcome. Thyroid 2013; 23:456-65. [PMID: 23106428 DOI: 10.1089/thy.2012.0363] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Well-differentiated follicular thyroid carcinomas (FTCs) usually act indolently, while aggressively acting tumors are difficult to detect early enough. Estrogen receptors (ERs) have prognostic significance in many cancers. Thyroid diseases, including neoplasms, are associated with the female sex. The prognostic significance of ERs in FTCs has not been reported previously. METHODS We studied the role of ERα and ERβ in 83 cases of follicular thyroid adenoma (FTA) and 43 FTC cases, including seven cases of poorly differentiated FTC, obtained from the Department of Surgery, Helsinki University Central Hospital between 1990 and 2009. Patient follow-up was conducted until March 2011. Expression of ERα, ERβ, and MIB-1/Ki-67 was investigated by immunohistochemistry and correlated with clinicopathological characteristics, including survival. RESULTS Two major observations were apparent. First, ERβ expression was significantly higher in FTA than in FTC, and it was a stronger differential diagnostic marker than MIB-1/Ki-67. Second, low ERβ expression correlated with poor survival in FTC. All cancer-specific deaths due to FTC were among low ERβ-score patients. CONCLUSION ERβ is a differential marker for malignancy and could thus be used as a preoperative tool. FTC patients with a low ERβ score need more thorough follow-up and may benefit from more aggressive treatment.
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Affiliation(s)
- Annukka Heikkilä
- Department of Pathology, Haartman Institute, University of Helsinki and HUSLAB, Helsinki, Finland
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7
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Kim NR, Cho HY, Piña-Oviedo S, De La Roza G, Lee YD, Ro JY. Follicular adenoma with extensive extracellular mucin deposition: report on two cases. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2012; 5:155-62. [PMID: 23236259 PMCID: PMC3516128 DOI: 10.4137/ccrep.s10520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report two cases of follicular adenoma of the thyroid with extensive extracellular mucin deposition. Fine needle aspiration in Case 1 showed singly discohesive polygonal cells in a granular mucinous background. They contained abundant eosinophilic cytoplasm, nuclear irregularities, and frequent nuclear inclusions with occasional bizarre mitoses. A right lobectomy was done. In Case 2, a 47-year-old Caucasian woman with multinodular goiter had total thyroidectomy and a yellow-tan nodule was found within the right lobe. Both tumors were well-encapsulated masses with thick capsules. Each was characterized by microfollicles without papillae in a mucinous stroma. Tumor cells were positive for thyroglobulin and negative for calcitonin, CEA, galectin-3, HBME-1, and CK19. The extracellular mucin stained with Alcian-blue and colloidal iron but not with mucicarmine and D-PAS. No BRAF gene mutation was detected. Because there were neither capsular nor vascular invasions, both cases were diagnosed as follicular adenomas of the thyroid with extensive extracellular mucin deposition, which as proposed by the WHO classification can be categorized as a mucinous variant of follicular adenoma. Retrospectively, frequent nuclear inclusions and the absence of nuclear grooves in the mucin-containing background of cytologic smears and histologic sections were shared by those of mucin-producing papillary carcinoma. It is unclear whether it belongs to an existing category of thyroid neoplasm with mucin production or whether it is truly a new tumor variant. Furthermore, pathologists should pay attention to avoid misdiagnosis of this variant of follicular neoplasm that shows an overlapping cytology with that of papillary carcinoma.
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Affiliation(s)
- Na Rae Kim
- Department of Pathology, Gachon University Gil Medical Center, Incheon, Korea
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Chang H, Lee E, Lee H, Choi J, Kim A, Kim BH. Comparison of diagnostic values of thyroid aspiration samples using liquid-based preparation and conventional smear: one-year experience in a single institution. APMIS 2012; 121:139-45. [PMID: 23030349 DOI: 10.1111/j.1600-0463.2012.02944.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 05/25/2012] [Indexed: 01/05/2023]
Abstract
Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy. Fine-needle aspiration (FNA) is the most useful tool in the diagnosis of thyroid nodules. Liquid-based preparation (LBP) in FNA of thyroid nodules is now widely used and is replacing the conventional smear (CS). We compared the diagnostic value of the LBP method with that of CS in thyroid lesions. A total of 1767 CS FNA samples and 2523 LBP FNA samples were included in this comparison of diagnostic values. We also assessed the differences in cytomorphologic features in 41 randomly selected cases of PTC. The measured sensitivities of CS and LBP were 78.9% and 76.3%, respectively, and the specificities were 64.2% and 54.9%, respectively, whereas the positive predictive values were 92.3% and 94.3%, respectively, and the negative predictive values were 89.5% and 81.8%, respectively. The cytomorphological features of LBP showed better-preserved nuclear details, cleaner background and fewer large papillae than were evident in CS. The results indicate that LBP reduces the diagnosis of non-diagnostic or unsatisfactory/atypia of undetermined significance or follicular lesion of undetermined significance, although the diagnostic values for CS and LBP are not appreciably different.
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Affiliation(s)
- Hyeyoon Chang
- Department of Pathology, Korea University Guro Hospital, Guro-gu, Seoul, Korea
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Chang H, Lee H, Yoon SO, Kim H, Kim A, Kim BH. BRAFV600E mutation analysis of liquid-based preparation–processed fine needle aspiration sample improves the diagnostic rate of papillary thyroid carcinoma. Hum Pathol 2012; 43:89-95. [DOI: 10.1016/j.humpath.2011.04.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 04/04/2011] [Accepted: 04/08/2011] [Indexed: 11/29/2022]
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10
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Mevawalla N, McMullen T, Sidhu S, Sywak M, Robinson B, Delbridge L. Presentation of clinically solitary thyroid nodules in surgical patients. Thyroid 2011; 21:55-9. [PMID: 20954812 DOI: 10.1089/thy.2009.0230] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Thyroid nodules occupy a unique position in relation to clinical diagnosis since most patients with a thyroid nodule do not present with overt symptoms. There are, however, no good published data demonstrating the way in which clinically solitary thyroid nodules come to medical attention, with most of the literature being anecdotal. This study aims to evaluate the mode of presentation of solitary thyroid nodules, and to assess whether the presence of a malignancy influences that presentation. METHODS In this retrospective cohort study, data were obtained from the University of Sydney Endocrine Surgery Database and through a review of the patient records. The study cohort comprised 419 consecutive patients who presented with a clinically solitary thyroid nodule and who subsequently underwent surgery. Patient files lacking data on mode of presentation and patients in whom thyroid nodules were incidentally discovered during parathyroid surgery were excluded, leaving a total of 299 patients. Data were analyzed using a computer-based statistical software package. Continuous variables were compared using Student's t-test. Categorical variables were analyzed using Fishers exact test. Statistical significance was set at p < 0.05. RESULTS Solitary thyroid nodules are most commonly detected by the patients themselves (40%), followed by the incidental discovery of nodules on imaging studies performed for unrelated reasons (30%), and lastly due to third-party diagnosis by family, friends, acquaintances, or medical practitioners (30%). Nodules detected by medical practitioners were statistically more likely to be malignant (p = 0.02). No other differences between the clinical presentation of benign and malignant nodules were found. CONCLUSIONS Patients themselves are the ones who most commonly first become aware of the thyroid nodules that are eventually seen by thyroid surgeons. Incidental discovery on image studies is also important. Thyroid nodules detected by medical practitioners should be dealt with most urgently because they are most likely to be malignant.
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HEIKKILÄ ANNUKKA, SIIRONEN PÄIVI, HAGSTRÖM JAANA, HEISKANEN ILKKA, SANKILA RISTO, LOUHIMO JOHANNA, HAGLUND CAJ, AROLA JOHANNA. Follicular thyroid neoplasm: clinicopathologic features suggesting malignancy. APMIS 2010; 118:846-54. [DOI: 10.1111/j.1600-0463.2010.02668.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Pang T, Ihre-Lundgren C, Gill A, McMullen T, Sywak M, Sidhu S, Delbridge L. Correlation between indeterminate aspiration cytology and final histopathology of thyroid neoplasms. Surgery 2010; 148:532-7. [DOI: 10.1016/j.surg.2010.01.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2008] [Accepted: 01/21/2010] [Indexed: 10/19/2022]
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Zou CC, Zhao ZY, Liang L. Childhood minimally invasive follicular carcinoma: clinical features and immunohistochemistry analysis. J Paediatr Child Health 2010; 46:166-70. [PMID: 20105250 DOI: 10.1111/j.1440-1754.2009.01656.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To report on two cases of childhood thyroid minimally invasive follicular carcinoma (MIFC) to highlight the clinical features, laboratory findings and diagnosis of this rare disease. METHODS The patients' age, gender, clinical features, laboratory findings, pathology and therapy were reviewed. Immunohistochemistry analysis was performed on the resected masses section. RESULTS From 2000 to 2008, a total of 15 cases of thyroid cancer were confirmed by pathological analysis, which account for about 2.16% of all malignant solid tumours. They included nine of thyroid papillary carcinoma, two of MIFC and one of undifferentiated thyroid carcinoma. For the two children with MIFC, one was an 8-year-boy and one was a 12-year-old girl. Thyroid mass was found as the primary sign. Imaging findings showed well-defined heterogeneous mass and radionuclide scintigraphy with 99mTc demonstrated small cold nodules in the right lobe of thyroid in two cases. Histopathology confirmed the diagnosis of MIFC. Immunohistochemical staining was positive for thyroglobulin, thyroid transcription factor-1, galectin-3, Hector Battifora mesothelial antigen-1, cytokeratin-AE1/AE3, cytokeratin-19, proliferating cell nuclear antigen and E-cadherin in two cases, and S-100 in one case, while CD56, vimentin and desmin were negative. One case was undertaken lobectomy and the other was undertaken subtotal thyreoidectomy with L-T4 replacement therapy. CONCLUSION MIFC is exceedingly rare in children and should be included in the differential diagnosis of thyroid mass. The diagnosis of MIFC depends mainly on the pathological findings.
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Affiliation(s)
- Chao Chun Zou
- Department of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine and Zhejiang Key Laboratory for Diagnosis and Therapy of Neonatal Disease, Hangzhou, China
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Suliburk J, Delbridge L. Surgical management of well-differentiated thyroid cancer: state of the art. Surg Clin North Am 2009; 89:1171-91. [PMID: 19836491 DOI: 10.1016/j.suc.2009.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Nonmedullary well-differentiated thyroid cancer (WDTC) comprises a group of tumors including papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC), with Hürthle cell carcinoma being a subtype of follicular carcinoma. This article reviews the epidemiology, pathogenesis, preoperative and diagnostic evaluation, imaging, and staging of WDTC. Different approaches to therapy and follow-up care are discussed. The prognosis for WDTC remains good and most patients can expect to be cured of their disease.
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Affiliation(s)
- James Suliburk
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Kuru B, Gulcelik NE, Gulcelik MA, Dincer H. Predictive index for carcinoma of thyroid nodules and its integration with fine-needle aspiration cytology. Head Neck 2009; 31:856-66. [DOI: 10.1002/hed.21049] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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16
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Reliability of benign fine needle aspiration cytology of large thyroid nodules. Surgery 2008; 144:963-8; discussion 968-9. [PMID: 19041004 DOI: 10.1016/j.surg.2008.09.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 09/23/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND With increasing use of thyroid ultrasonography, thyroid nodules have been found to be extremely common. For over 25 years, fine needle aspiration (FNA) has been the pivotal diagnostic test to discriminate benign from potentially malignant thyroid nodules. Recently, false negative rates exceeding 10% have led to recommendations that thyroid nodules >/=4 cm should be resected regardless of cytology results. Our aim was to determine the false negative rate of FNA cytology on thyroid nodules >/=3 cm interpreted as benign at our institution. METHODS A retrospective review was performed at Mayo Clinic from January 2002 through December 2006. RESULTS From 6,921 ultrasonographic-guided thyroid FNAs, 742 were interpreted as benign and >/=3 cm. A definitive histologic diagnosis was available for 145 (20%) patients who underwent thyroidectomy: 1 (0.7%) was false negative. No additional thyroid malignancies were identified in 550 index nodules with average follow-up of 3 years. CONCLUSION With precise ultrasonographic-guided aspiration, strict adherence to guidelines for adequacy of the sample, proper cytologic preparation, and most importantly, expert cytologic analysis, a diagnosis of benign is extremely reliable for thyroid nodules, regardless of size. Resection for diagnosis is not necessary, and a size >/=3 cm should not be an independent indication for resection.
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Baloch ZW, LiVolsi VA, Asa SL, Rosai J, Merino MJ, Randolph G, Vielh P, DeMay RM, Sidawy MK, Frable WJ. Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol 2008; 36:425-37. [PMID: 18478609 DOI: 10.1002/dc.20830] [Citation(s) in RCA: 536] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The National Cancer Institute (NCI) sponsored the NCI Thyroid Fine-needle Aspiration (FNA) State of the Science Conference on October 22-23, 2007 in Bethesda, MD. The two-day meeting was accompanied by a permanent informational website and several on-line discussion periods between May 1 and December 15, 2007 (http://thyroidfna.cancer.gov). This document summarizes matters regarding diagnostic terminology/classification scheme for thyroid FNA interpretation and cytomorphologic criteria for the diagnosis of various benign and malignant thyroid lesions. (http://thyroidfna.cancer.gov/pages/info/agenda/).
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Affiliation(s)
- Zubair W Baloch
- Department of Pathology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA.
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McCartney CR, Stukenborg GJ. Decision analysis of discordant thyroid nodule biopsy guideline criteria. J Clin Endocrinol Metab 2008; 93:3037-44. [PMID: 18505762 PMCID: PMC2515085 DOI: 10.1210/jc.2008-0448] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
CONTEXT Recently published guidelines are discordant regarding diagnostic approaches to small (10-14 mm) thyroid nodules. OBJECTIVE The objective of the study was to explore the relative desirability of alternative diagnostic approaches to small thyroid nodules using decision analysis. DESIGN Four diagnostic approaches to a 10- to 14-mm thyroid nodule are modeled: 1) observation only, consistent with American Thyroid Association guidelines; 2) routine fine-needle aspiration biopsy (FNAB), an approach traditionally chosen by many endocrinologists and consistent with American Thyroid Association guidelines; 3) FNAB only when microcalcifications are present, as recommended by Society of Radiologists in Ultrasound guidelines; and 4) FNAB only when the nodule is hypoechoic and has at least one other ultrasonographic risk factor, as endorsed by American Association of Clinical Endocrinologists guidelines. MAIN OUTCOME MEASURES Measures included expected values; a priori likelihoods of prespecified outcomes; and two-way sensitivity analyses based on the utility of observation only in the setting of thyroid cancer and thyroid surgery for benign, asymptomatic thyroid disease. RESULTS Expected values (EVs) were similar among decision alternatives modeling Society of Radiologists in Ultrasound guidelines, American Association of Clinical Endocrinologists guidelines, and routine observation (EVs from 0.912 to 0.927). Routine FNAB had the lowest EV (0.757-0.861), primarily related to a high a priori likelihood of having surgery for a benign nodule. CONCLUSIONS As a general approach to 10- to 14-mm thyroid nodules, routine FNAB appears to be the least desirable. This analysis offers additional data that physicians can use when choosing diagnostic approaches to small thyroid nodules based on perceived risks of delayed cancer diagnosis and unnecessary thyroid surgery.
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Affiliation(s)
- Christopher R McCartney
- Division of Endocrinology and Metabolism, Department of Medicine, Box 800391, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
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Abstract
Thyroid nodules are common, with up to 8% of the adult population having palpable nodules. With the use of ultrasound, up to 10 times more nodules are likely to be detected. Increasing numbers of nodules are being detected serendipitously because of the rising use of imaging to investigate unrelated conditions. The primary aim in investigating a thyroid nodule is to exclude the possibility of malignancy, which occurs in about 5% of nodules. This begins with a thorough history, including previous exposure to radiation and any family history of thyroid cancer or other endocrine diseases. Clinical examination of the neck should focus on the thyroid nodule and the gland itself, but also the presence of any cervical lymphadenopathy. Biochemical assessment of the thyroid needs to be followed by thyroid ultrasound, which may demonstrate features that are associated with a higher chance of the nodule being malignant. Fine-needle aspiration biopsy is crucial in the investigation of a thyroid nodule. It provides highly accurate cytologic information about the nodule from which a definitive management plan can be formulated. The challenge remains in the management of nodules that fall under the "indeterminate" category. These may be subject to more surgical intervention than is required because histological examination is the only way in which a malignancy can be excluded. Surgery followed by radioactive iodine ablation is the mainstay of treatment for differentiated thyroid cancers, and the majority of patients can expect high cure rates.
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Affiliation(s)
- Meei J Yeung
- The Alfred Hospital, Monash University Endocrine Surgery Unit, Melbourne, Australia.
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“Scarless” (in the Neck) Endoscopic Thyroidectomy (SET): An Evidence-based Review of Published Techniques. World J Surg 2008; 32:1349-57. [DOI: 10.1007/s00268-008-9555-3] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Evaluation and management of incidental thyroid nodules in patients with another primary malignancy. Surgery 2007; 142:581-6; discussion 586-7. [PMID: 17950351 DOI: 10.1016/j.surg.2007.06.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 06/05/2007] [Accepted: 06/09/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND Studies indicate that incidentally discovered thyroid nodules >or=1 cm in size may have a higher rate of malignancy (7% to 29%) than traditionally discovered nodules (5%). We sought to determine the rate of malignancy in incidental thyroid nodules in patients with other malignancies, and examine the accuracy of ultrasound (US) versus computed tomography (CT) in determining nodule size. METHODS We evaluated 41 patients with history of another known malignancy (gastrointestinal, 23; breast, 11; other, 7) referred with an incidental thyroid nodule. Patients underwent office-based US and biopsy of nodules >or=1 cm. Surgical intervention was based on biopsy results. We compared nodule size at pathology with size seen on CT or US. RESULTS Thirty-five patients met criteria for biopsy. Of the 35, 20 (57%) had atypical biopsy results warranting resection. Sixteen of those 20 underwent surgery. Pathology yielded 4 papillary thyroid cancers (PTC), 4 microPTC, 2 metastatic cancers, and 7 benign lesions. Ultrasound measurement of nodules compared to size measured at pathology had an r2 correlation value of 0.90 with P value <.0001. CT scan had an r2 value of 0.83 and P value of .005. CONCLUSIONS Incidental thyroid nodules in patients with another primary malignancy warranted resection in 57%. The rate of malignancy in incidental thyroid nodules was 24%, which is above the expected rate of 5% seen in traditionally discovered nodules. US correlation with nodule size at pathology was excellent and superior to CT scan. Incidentally discovered thyroid nodules >or=1 cm, seen in patients with another malignancy, warrant further evaluation.
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Tsan CJL, Serpell JW, Poh YY. THE IMPACT OF SYNOPTIC CYTOLOGY REPORTING ON FINE-NEEDLE ASPIRATION CYTOLOGY OF THYROID NODULES. ANZ J Surg 2007; 77:991-5. [DOI: 10.1111/j.1445-2197.2007.04297.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Walsh JP, Ryan SA, Lisewski D, Alhamoudi MZ, Brown S, Bennedbaek FN, Hegedüs L. Differences between endocrinologists and endocrine surgeons in management of the solitary thyroid nodule. Clin Endocrinol (Oxf) 2007; 66:844-53. [PMID: 17437521 DOI: 10.1111/j.1365-2265.2007.02823.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is not known whether management of the solitary thyroid nodule differs between endocrinologists and endocrine surgeons. METHODS A questionnaire containing a hypothetical case (a 42-year-old euthyroid woman with a 2-x-3-cm solitary thyroid nodule) and 13 clinical variations was sent to endocrinologists and endocrine surgeons in Australia. RESULTS The response rate was 51%, including 122 endocrinologists and 48 endocrine surgeons. For the index case, serum thyroid-stimulating hormone (TSH), fine needle aspiration biopsy (FNAB) and ultrasonography were widely used by both groups, but thyroid antibody tests and scintigraphy were ordered more commonly by endocrinologists. In the setting of benign cytology, treatment differed significantly between specialties for the index case (endocrinologists: no treatment 78%, surgery 11%, thyroxine 11%; surgeons: no treatment 73%, surgery 25%, thyroxine 2%; P = 0.032). Treatment recommendations also differed significantly for 12 of the 13 clinical variations. In particular, for a patient with a suppressed serum TSH concentration, a majority of endocrinologists recommended radioiodine treatment, whereas surgeons favoured surgery (endocrinologists: radioiodine 53%, surgery 22%, no treatment 25%; surgeons: surgery 60%, radioiodine 11%, no treatment 27%; P < 0.001). For most of the variations, a higher proportion of surgeons than endocrinologists recommended surgical treatment. Comparison with previous surveys of European Thyroid Association and American Thyroid Association members (predominantly endocrinologists) demonstrated considerable international differences in management. CONCLUSION There are clinically significant differences between Australian endocrinologists and endocrine surgeons in management of the solitary thyroid nodule, and international differences in management of this disorder.
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Affiliation(s)
- John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
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