Are the anatomical, clinical, and ultrasound characteristics of thyroid nodules with Bethesda III or IV cytology and ACR TI-RADS 3, 4, or 5 able to refine the indications for molecular diagnostic tests?

ABSTRACT Objective: To analyze the association of clinical, anatomical, and ultrasound (US) characteristics of malignancies in Bethesda III or IV (III-B or IV-B) thyroid nodules. Subjects and methods: The association between malignancies and the following variables were analyzed: III-B or IV-B, age < 55 years and ≥ 55 years, sex, family history of thyroid cancer, history of irradiation, nodule size, and ACR TI-RADS classification in 62 participants who underwent thyroidectomy. Results: Of the 62 participants, 87.1% (54/62) were women, 74.2% were < 55 years old, 95.2% had no family history of thyroid cancer, 56.5% had nodules < 2 cm in size, 62.9% were IV-B, and 69.4% were ACR TI-RADS 4. Thirty-two patients had thyroid carcinoma, and 30 had benign histology. Among all factors associated with malignancy, only ACR TI-RADS 5 classification on US was found to be statistically significant (p = 0.014), while III-B with architectural atypia cytological classification was the only one significantly associated with benign status (p = 0.004). Conclusion: Only a high risk of malignancy as assessed using US was able to refine the indication for molecular tests in a group of patients with indeterminate nodules. We found 85% (53/62) of III-B or IV-B thyroid nodules would benefit from available molecular diagnostic tests.

Estudo Prospectivo duplo-cego randomizado entre preparos de cólon com PEG 4000 e Lactulose / Prospective randomized double blinded trial between colon preparations with PEG 4000 and lactulose

A colonoscopia atualmente é um dos principais métodos diagnósticos de alterações intestinais e para o rastreamento de câncer colorretal. Um preparo intestinal de boa qualidade é essencial para o adequado exame diagnóstico e para as abordagens terapêuticas necessárias. Esse estudo visa comparar dois preparos quanto à eficácia: o PEG 4000, padrão ouro nos Estados Unidos, e a solução de Lactulose a 10%, laxante osmótico ainda sem indicação formal para preparo intestinal. Método: estudo prospectivo, duplo-cego e randomizado com a inclusão de 400 pacientes submetidos a exames eletivos de colonoscopia em clínica privada. Os pacientes foram randomizados em dois grupos de 200 pacientes e, em cada grupo, foi utilizado um dos preparos analisados. Foi avaliada a qualidade do preparo através da Escala de Preparo Intestinal de Boston (BBPS). Resultados: dos 400 exames feitos, apenas 13 foram considerados inadequados. Dos pacientes que utilizaram PEG, apenas seis (3%) tiveram preparo considerado inadequado e, do grupo que usou Lactulose, apenas sete (3,5%). Isso resulta em um p=0,778, o que determina que não há diferença estatística em relação à eficácia entre os dois preparos. Conclusão: o estudo concluiu que a eficácia da solução de Lactulose, como preparo intestinal para exames de colonoscopia, é semelhante à do PEG 4000, podendo a solução de Lactulose a 10% ser indicada como opção de preparo de cólon para exames de colonoscopia, respeitando-se suas contraindicações e restrições.

Colonoscopy represents nowadays one of the best diagnostic methods for colorectal diseases and for colorectal cancer screening. Good colon preparation is essential for a high quality diagnostic examination and for the necessary therapeutic approaches. This study aims to compare two preparations regarding efficacy: The PEG 4000 preparation, with is the gold standard in the United States, and the 10% lactulose solution. Lactulose is an osmotic laxative still without formal indication as colon preparation. Method: it is a prospective randomized double blinded trial with 400 patients included, submitted to elective out-patient colonoscopies in private clinic. The patients were randomized in two 200 patients groups and in each group one preparation was used. The Boston bowel preparation scale was used in order to measure the colon preparation quality. Results: in only 13 patients the preparation was considered inadequate. In PEG patients only six (3%) and in lactulose patients seven (3.5%), were considered inadequate. There was no statistical difference between both groups regarding efficacy (p=0.778). Conclusion: the study concluded that lactulose solution is as effective as PEG 4000 as bowel preparation for colonoscopic exams. The lactulose solution can be indicated as an option for colon preparation for colonoscopic exams. Its restrictions and contra-indications should be respected.