Reliability of the ultrasound classification system of thyroid nodules in predicting malignancy

Aim: This study aims to evaluate the reliability of theUltrasound (U) Classification system in predicting thyroidmalignancy by using pathology diagnosis as the referencestandard.Methods: It was a cross-sectional study carried out atUniversiti Kebangsaan Malaysia Medical Centre (UKMMC),Malaysia. Records of patients with focal thyroid nodules onultrasound (US) for which US-guided fine needle aspirationcytology (FNAC) was performed and pathology results wereavailable, from January 2014 to May 2016 were selected forreview. Correlation of the U Classification with pathologyresults was assessed. Sensitivity, specificity, positivelikelihood ratio, negative likelihood ratio, predictive value,negative predictive value and accuracy were calculated in aconservative and non-conservative method. The thresholdfor statistical performance was set at 0.05. Eachsonographic feature was also compared with its pathologyresults.Results: A total of 91 patients with 104 nodules were eligible.12 nodules out of 104 (11.5%) were malignant. Thesensitivity, specificity, positive likelihood ratio, negativelikelihood ratio, positive predictive value, negativepredictive value and accuracy were 100%, 91.3%, 11.5, 0.0,60%, 100% and 92.3%, and 100%, 91.4%, 11.7%, 0.0, 78.6%,100% and 93.5%, for the non-conservative and conservativemethod of calculations respectively.Conclusion: The U Classification is reliable in predictingthyroid malignancy. More evidence is neverthelessnecessary for widespread adaptation and use.

Familial Adenomatous Polyposis-Associated Papillary Thyroid Cancer

Papillary thyroid carcinoma (PTC) associated with familial adenomatous polyposis (FAP) is rare. It is usually associated with the cribriform-morular variant of PTC, with unusual patterns on detailed histology examination. This variant is known to have a good prognosis. Papillary thyroid carcinoma associated with FAP commonly occurs in females in their 30s and rarely in the elderly. We report a case of a 69-year-old female presenting with thyroid swelling and a history of FAP.

An Early Single Institutional Experience in Sutureless Total Thyroidectomy

In experienced hands, ultrasonic shears had been found to be a useful tool in total thyroidectomy surgery as long as the safety precautions are adhered to closely. It has the advantage of minimising operating time and will eventually reduce the cost of surgery. A randomised controlled trial is thus suggested to further evaluate its efficacy.

Breast Carcinoma Occurring from Chronic Granulomatous Mastitis

Chronic granulomatous mastitis is known as a benign and relatively rare disorder that is often difficult to differentiate from breast carcinoma. We highlight the case of a 34-year-old woman who had recurrent episodes of right breast swelling and abscess for 8 years. These were proven to be chronic granulomatous mastitis by tissue biopsies on 3 different occasions. Her condition improved on similar courses of antibiotics and high-dose prednisolone. However, she subsequently developed progressive loss of vision due to an orbital tumour. She then underwent a craniotomy and left orbital decompression with excision of the tumour, which proved to be a metastatic carcinoma. A trucut biopsy of the right breast was then done and showed features consistent with an infiltrating ductal carcinoma. This case illustrates the possibility that chronic granulomatous mastitis could be a precursor for malignancy and the difficulty in differentiating one from the other. The possible mechanisms of development and the implications for future management are also discussed.