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1.
Oncología (Guayaquil) ; 33(2): 121-130, 14 de agosto del 2023.
Article in Spanish | LILACS | ID: biblio-1451554

ABSTRACT

Introducción: Aunque la mayoría de los nódulos tiroideos son benignos, asintomáticos y estables en la historia clínica de una paciente mujer; en los estudios ecográficos, citológicos e histopatológicos se ha podido obtener la caracterización subclínica de lesiones sugestivas de malignidad. El actual estudio tuvo por objetivo evaluar los factores de riesgo asociados a la malignidad de nódulos tiroideos en pacientes adultas. Metodología: Se realizó un estudio descriptivo, transversal, retrospectivo correlacional de enfoque mixto en el servicio de endocrinología del Hospital Teodoro Maldonado Carbo entre Enero y Junio del 2019. El universo estuvo compuesto por todos los casos con diagnóstico de nódulo tiroideo. Se utilizó el sistema de Bethesda para los reportes. Resultados: Fueron 132 casos de pacientes con nódulos tiroideos, edad entre 45 a 64 años (57,6%). En estado pre menopáusico (52%), con 1 gestación (12%), glucosa >100 mg/dL (34%), IMC entre 25.0 y 29.9 kg/m2 (49%) y con antecedente patológico familiar de cáncer de tiroides (35%). 30 casos con valores de TSH >4.00 uUI/mL (23%). El sistema de Bethesda, 22 casos (17%) categoria IV, 17 casos (13%) categoria V y 11 casos (8%) categoría VI. Conclusiones: La lesión citológica tiroidea más frecuente que se encontró fue la neoplasia benigna. No obstante, la lesión maligna junto con la lesión folicular indeterminada presentaron una prevalencia del 8%. Se encontró una asociación significativa entre los nódulos de citología maligna con los niveles de TSH elevados y con el antecedente patológico familiar de cáncer de tiroides.


Introduction: Although most thyroid nodules are benign, asymptomatic, and stable in the clinical history of a female patient, in ultrasound, cytological, and histopathological studies, it has been possible to obtain the subclinical characterization of lesions suggestive of malignancy. The current study aimed to evaluate the risk factors associated with the malignancy of thyroid nodules in adult patients. Methodology: A descriptive, cross-sectional, retrospective, correlational study with a mixed approach was carried out in the endocrinology service of the Teodoro Maldonado Carbo Hospital between January and June 2019. The study population consisted of all patients diagnosed with thyroid nodules. The Bethesda system was used for reporting. Results: There were 132 patients with thyroid nodules aged between 45 and 64 (57.6%). In a premenopausal state (52%), there was one pregnancy (12%), glucose >100 mg/dL (34%), BMI between 25.0 and 29.9 kg/m2 (49%) and a family history of thyroid cancer (35%). Thirty patients had TSH values >4.00 µUI/mL (23%). In the Bethesda system, 22 cases (17%) were Category IV, 17 cases (13%) were Category V, and 11 cases (8%) were Category VI. Conclusions: The most frequent thyroid cytological lesion found was a benign neoplasm. However, malignant lesions and indeterminate follicular lesions presented a prevalence of 8%. A significant association was found between malignant cytology nodules with elevated TSH levels and a family history of thyroid cancer.


Subject(s)
Humans , Adult , Thyroid Neoplasms , Thyrotropin , Thyroid Nodule , Pathology , Cell Biology
2.
Rev. cuba. cir ; 62(2)jun. 2023.
Article in Spanish | LILACS, CUMED | ID: biblio-1530085

ABSTRACT

Introducción: Los nódulos de tiroides son un problema clínico común. La tiroidectomía es una de las técnicas más realizadas en los servicios de cabeza y cuello y constituye un tratamiento con intención curativa en el cáncer de tiroides y afecciones benignas como el bocio nodular y el adenoma. Objetivo: Describir la experiencia en cirugía de tiroides del servicio de cabeza y cuello en el Hospital Oncológico Conrado Benítez. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de los pacientes que recibieron algún tratamiento quirúrgico por enfermedad tiroidea en el período comprendido entre el 1 de septiembre de 2017 y el 31 de agosto de 2022. Resultados: El 87 por ciento de los pacientes eran mujeres, con una edad media de 47,1 años. A todos se les realizó ecografía y biopsia por aspiración con aguja fina con una estrecha concordancia con el diagnóstico definitivo. Predominó el carcinoma papilar (39,5 por ciento), la tiroidectomía total como técnica más empleada (86,5 por ciento) y el 94,6 por ciento de los pacientes no tuvo complicaciones. La lesión recurrencial solo estuvo presente en el 1,1 por ciento de los casos. Conclusiones: La experiencia en tiroidectomía en el Hospital Oncológico Conrado Benítez es buena, con una concordancia entre medios diagnósticos y biopsia definitiva, tiempo quirúrgico adecuado y pocas complicaciones(AU)


Introduction: Thyroid nodules are a common clinical problem. Thyroidectomy is one of the most performed techniques in head and neck surgery services, as well a treatment with curative intent for thyroid cancer and benign conditions such as nodular goiter and adenoma. Objective: To describe the experience in thyroid surgery at the head and neck surgery service from Hospital Oncológico Conrado Benítez. Methods: A descriptive, longitudinal and prospective study was carried out with patients who received any surgical treatment for thyroid disease in the period from September 1, 2017 to August 31, 2022. Results: 87 percent of patients were female, with a mean age of 47.1 years. All of them underwent ultrasonography and fine-needle aspiration biopsy, presenting a close concordance with their definitive diagnosis. Papillary carcinoma predominated (39.5 percent), total thyroidectomy was the most commonly used technique (86.5 percent) and 94.6 percent of patients had no complications. Any recurrent lesion was present in only 1.1 percent of cases. Conclusions: The thyroidectomy experience at Hospital Oncológico Conrado Benítez is good, based on the concordance between diagnostic means and definitive biopsy, as well as adequate surgical time and few complications(AU)


Subject(s)
Humans , Female , Middle Aged , Thyroid Neoplasms , Thyroid Nodule/diagnostic imaging , Epidemiology, Descriptive , Longitudinal Studies
3.
Medisan ; 27(1)feb. 2023. ilus, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1440563

ABSTRACT

Introducción: El nódulo tiroideo es un hallazgo común en la actualidad y, por sus características ecográficas, constituye una lesión distinta al parénquima glandular, con una prevalencia alta en la población general. Objetivo: Describir el uso del sistema Bethesda como método de diagnóstico de nódulos tiroideos y el grado de malignidad. Métodos: Se efectuó un estudio descriptivo y retrospectivo de 1771 pacientes con diagnóstico de nódulo tiroideo, a quienes se les realizó citología por aspiración con aguja fina en el Departamento de Anatomía Patológica del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba durante el cuatrienio 2016-2019. Resultados: En la serie predominó el grupo etario de 41-50 años y la edad media fue de 49,51±13,14 años. Asimismo, sobresalió la categoría II del sistema Bethesda (73,8 %); en tanto, de los 204 diagnosticados correspondientes a la categoría III, 111 fueron intervenidos quirúrgicamente y 29 de estos presentaron neoplasias malignas (27,6 %). El grado de malignidad osciló entre 22,8 y 36,0 %. Conclusiones: La aplicación del sistema Bethesda fue muy útil para el diagnóstico citopatológico de nódulos tiroideos y el grado de malignidad se correspondió con cifras adecuadas.


Introduction: The thyroid nodule is a common finding nowadays and, for its echographic characteristics, it constitutes a lesion different to the glandular parenchyma, with a high prevalence in the general population. Objective: To describe the use of the Bethesda system as diagnostic method of thyroid nodules and the degree of malignancy. Methods: A descriptive and retrospective study of 1 771 patients with diagnosis of thyroid nodule was carried out, who underwent fine needle aspiration cytology, in the Pathology Department of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba during 2016-2019. Results: In the series there was a prevalence of the 41-50 age group and the mean age was of 49,51±13,14 years. Also, the category II of the Bethesda system was notable (73.8 %); as long as, of the 204 diagnosed corresponding to the category III, 111 were surgically intervened and 29 of them presented mlignancy (27.6 %). The degree of malignancy oscillated between 22.8 and 36.0 %. Conclusions: The application of the Bethesda system was very useful for the cytopathologic diagnosis of thyroid nodules and the degree of malignancy corresponded with appropriate figures.


Subject(s)
Thyroid Nodule , Biopsy, Fine-Needle
4.
Mali méd. (En ligne) ; 38(3): 27-32, 2023. figures, tables
Article in French | AIM | ID: biblio-1516106

ABSTRACT

Introduction : l'échographie est l'examen de première intention dans l'exploration morphologique de la thyroïde. Elle constitue un excellent outil diagnostique et pronostique dans les thyropathies nodulaires. Objectif : déterminer le profil des nodules thyroïdiens à l'échographie selon la classification EU-TIRADS. Matériel et méthodes : étude transversale descriptive réalisée dans le service de radiologie du CHU de Bouaké durant une année. Nous avons inclus tous les comptes rendus d'échographie thyroïdienne des patients ayant des nodules thyroïdiens. Les données ont été analysées à l'aide du logiciel Epi Info 7. Résultats : Au total, 60 patients présentaient des nodules sur 97 reçus pour thyropathies soit 60,8%. L'âge moyen était de 45,6 ans [13-82 ans]. Legenre féminin prédominait avec 82,7%. La tuméfaction cervicale antérieure était la principale indication dans 72%. Le volume thyroïdien était augmenté chez 63%des patients avec un volume moyen de 71 cm3. Il s'agissait de nodule solitaire dans 46,55%. Les nodules spongiformes prédominaient dans 32%. Les nodules étaient solides dans 29,8% et mixtes dans 16,5.%. L'hypo-échogénicité était retrouvée dans 44,8% des cas de nodules solides. Les lésions étaient classées EU-TIRADS 2 dans 58,8%, EU-TIRADS 3 dans 23,5%, EU-TIRADS 4 dans 14,7% et EU-TIRADS 5 dans 2,9%. Conclusion : la caractérisation et la classification des nodules thyroïdiens constituent une étape importante pour la prise en charge des patients. Ces nodules dans notre étude sont essentiellement d'allure bénigne (EU-TIRADS 2 et 3) avec une prédominance féminine. Un arbre décisionnel tenant compte des éléments cliniques et cytopathologiques servirait davantage pour d'éventuelles chirurgies.


Introduction: Ultrasound is the first-line examination in the morphological exploration of the thyroid. It is an excellent diagnostic and prognostic tool in nodular thyropathy. Objective: to determine the profile of thyroid nodules on ultrasound according to the EU-TIRADS classification. Material and methods: descriptive cross-sectional study carried out in the radiology department of the University Hospital of Bouaké during one year. We included all thyroid ultrasound reports of patients with thyroid nodules. Data were analysed using Epi Info 7 software. Results: A total of 60 patients had nodules out of 97 referred for thyropathy (60.8%). The mean age was 45.6 years [13-82 years]. Females predominated with 82.7%. Anterior cervical swelling was the main indication in 72%. Thyroid volume was increased in 63% of patients with a mean volume of 71 cm3. Solitary nodules were present in 46.55%. Spongiform nodules were predominant in 32%. The nodules were solid in 29.8% and mixed in 16.5%. Hypoechogenicity was found in 44.8% of solid nodules. Lesions were classified as EU-TIRADS 2 in 58.8%, EU-TIRADS 3 in 23.5%, EU-TIRADS 4 in 14.7% and EU-TIRADS 5 in 2.9%. Conclusion: The characterisation and classification of thyroid nodules is an important step in the management of patients. In our study, these nodules are essentially benign (EU-TIRADS 2 and 3) with a female predominance. A decision tree taking into account the clinical and cytopathological elements would be more useful for possible surgery.


Subject(s)
Humans , Male , Female , Thyroid Gland , Thyroid Nodule , Ultrasonic Therapy
5.
Rev. venez. cir ; 76(1): 10-14, 2023. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1552933

ABSTRACT

La comunidad científica se ha preocupado por cuantificar el volumen tiroideo según variables como sexo, edad y deficiencias de yodo asociadas, sin embargo, pese al uso globalizado de TI-RADS para estimación de riesgo de malignidad en la patología tiroidea, no existe suficiente información en relación a si el tamaño de la glándula guarda o no relación con esta escala. Objetivo: comparar el Volumen Tiroideo con TI-RADS en pacientes atendidos en la unidad de ecografía diagnóstica del Centro Clínico Naguanagua en el período enero 2022 - enero 2023. Métodos: estudio observacional-descriptivo de nivel comparativo, con diseño transversal y prospectivo. Muestra no probabilística censal, abarcando la totalidad de los pacientes a los cuales se les efectuó ecografía tiroidea en el período establecido. Se efectuó un registro en cuanto a la cuantificación del volumen de: lóbulo tiroideo derecho, lóbulo tiroideo izquierdo y total de tiroides, TI-RADS, edad y sexo del paciente. Se utilizó el estadístico ANOVA y se empleó el programa Statistical® de licencia libre. Resultados: muestra de 126 pacientes, con edad promedio de 51,71 años ± 1,44, mediana de 53 años. Cuando se comparó el Volumen Total de Tiroides con TI-RADS, se constató que el mayor promedio lo registraron aquellos pacientes clasificados como 4B (p <0,05). Conclusión: aun cuando se registran mayores promedios de volumen total glandular en pacientes con hallazgos nodulares, llama la atención que entre los datos registrados existan pacientes con valores muy similares a lo reportado en la literatura como volúmenes normales en presencia de patología nodular tiroidea(AU)


The scientific community has been concerned with quantifying thyroid volume according to variables such as sex, age, and associated iodine deficiencies; however, despite the global use of TI-RADS to estimate the risk of malignancy in thyroid pathologies, there is not enough information in regarding whether or not the size of the gland is related to this scale. Objective: to compare the Thyroid Volume with TI-RADS in patients treated in the diagnostic ultrasound unit of the Naguanagua Clinical Center in the period January 2022 - January 2023. Methods: observational-descriptive study of a comparative level, with a crosssectional and prospective design. Non-probabilistic census sample, covering all the patients who underwent thyroid ultrasound in the established period. A record was made regarding the quantification of the volume of: right thyroid lobe, left thyroid lobe and total thyroid, TI-RADS, age and sex of the patient. The ANOVA statistic was used and the free license Statistical® program was used. Results: sample of 126 patients, mean age 51.71 ± 1.44 years, median 53 years. When the Total Thyroid Volume was compared with TI-RADS, it was found that the highest mean was registered by those patients classified as 4B (p <0.05). Conclusion: even when higher total glandular volume averages are recorded in patients with nodular findings, it is noteworthy that among the recorded data there are patients with values very similar to those reported in the literature as normal volumes in the presence of thyroid nodular pathology(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Thyroid Diseases , Thyroid Gland/anatomy & histology , Diagnostic Imaging , Thyroid Nodule/diagnostic imaging
6.
Rev. venez. cir ; 76(1): 76-79, 2023. ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1552972

ABSTRACT

Introducción: Las células de Hürtle fueron descritas por Max Askanazy en 1898, aunque su denominación inapropiada ha permanecido en el léxico. Pueden observarse en una amplia variedad de lesiones tiroideas, desde afecciones no neoplásicas hasta francamente malignas. Caso clínico: Femenina de 62 años de edad, asmática e hipertensa controlada, alérgica al yodo y a la penicilina, quien inicia enfermedad actual 1 año previo al presentar aumento de volumen en región anterior del cuello. Ecografía tiroidea reportó glándula aumentada de tamaño, con nódulo tiroideo derecho, complejo de 4 cm; y nódulo tiroideo izquierdo, complejo de 2 cm, TI-RADS 4C. Tomografía computarizada reportó lesión ocupantne de espacio del lóbulo tiroideo derecho de 6 cm y nódulos tiroideos izquierdos de 3 y 2 cm. Pruebas tiroideas sin alteraciones. Se realizó tiroidectomía total. Diagnóstico histopatológico: adenoma de células de Hürtle. Conclusión: En la actualidad, el término correcto es neoplasia de células oncocíticas, bien sea para el adenoma o para el carcinoma. Este tipo de tumores se presenta con mayor frecuencia en mujeres de mediana edad y con un tamaño considerable al momento del diagnóstico. Es necesario establecer un protocolo de acción ante el diagnóstico presuntivo mediante punción por aspiración por aguja fina, debido a la dificultad para diferenciar entre patología benigna y maligna, con la finalidad de garantizar una conducta terapeútica adecuada(AU)


Introduction: Hürtle cells were described by Max Askanazy in 1898, although their inappropriate name has remained in the lexicon. They can be seen in a wide variety of thyroid lesions, from non-neoplastic to frankly malignant conditions. Clinical case: A 62-year-old female, asthmatic and controlled hypertensive, allergic to iodine and penicillin, who started the current disease 1 year before presenting volume increase in the anterior region of the neck. Thyroid ultrasound reported an enlarged gland, with a 4-cm complex right thyroid nodule; and left thyroid nodule, 2 cm complex, TI-RADS 4C. Computed tomography reported a 6 cm space-occupying lesion of the right thyroid lobe and 3 and 2 cm left thyroid nodules. Thyroid tests without alterations. Total thyroidectomy was performed. Histopatological diagnosis: Hürtle cell adenoma. Conclusion: Currently, the correct term is oncocytic cell neoplasm, either for adenoma or for carcinoma. This type of tumors occurs more frequently in middle-aged women and with a considerable size at the time of diagnosis. It is necessary to establish a protocol of action before the presumptive diagnosis by means of fine needle aspiration procedure, due to the difficulty to differentiate between benign and malignant pathology, with the purpose of guaranteeing an adequate therapeutic conduct(AU)


Subject(s)
Humans , Female , Middle Aged , Thyroid Gland/pathology , Thyroid Neoplasms , Thyroid Nodule , Epithelium , Iodine
7.
Rev. bras. ginecol. obstet ; 45(10): 557-561, 2023. tab
Article in English | LILACS | ID: biblio-1529881

ABSTRACT

Abstract Objective We compared thyroid volume (TV) and presence of nodular goiter (NG) in pregnant vs. non-pregnant women in an iodine-sufficient area. We also evaluated the relationship between gestational age, parity, and TV in the pregnant women group, and determined the 2.5th and 97.5th percentiles of normal TV in pregnancy. Methods This cross-sectional study included 299 healthy women (216 pregnant) without previous thyroid diseases. Thyroid ultrasounds were performed and compared between pregnant and non-pregnant women. The range of normal distribution of TV (2.5th and 97.5th percentiles) in pregnancy was determined after excluding individuals with positive thyroid antibodies, NG, and/or abnormal serum thyrotropin (TSH) or free thyroxine (FT4). Results Thyroid volume was larger among pregnant compared to non-pregnant women (8.6 vs 6.1 cm3; p< 0.001) and was positively correlated with gestational age (rs = 0.221; p= 0.001), body mass index (BMI, rs 0.165; p= 0.002), and FT4 levels (rs 0.118 p= 0.021). Nodular goiter frequency did not differ between the two groups. There was a negative correlation between TV and TSH (rs -0.13; p= 0.014). Thyroid volume was lower among primiparous compared to multiparous patients (7.8 vs 8.9; p< 0.001) and was positively correlated with parity (rs 0.161; p= 0.016). The 2.5th and 97.5th percentiles of TV were 4.23 and 16.47 cm3, respectively. Conclusion Thyroid volume was higher in pregnant compared to non-pregnant women and was positively related to parity, BMI, and gestational age in a normal iodine status population. Pregnancy did not interfere with the development of NG.


Resumo Objetivo Comparamos o volume tireoidiano (VT) e a presença de bócio nodular (BN) em mulheres grávidas e não grávidas em uma área suficiente em iodo. Também avaliamos a relação entre idade gestacional, paridade e VT no grupo de gestantes e determinamos os percentis 2,5 e 97,5 de VT normal na gestação. Métodos Este estudo transversal incluiu 299 mulheres saudáveis (216 grávidas) sem doenças tireoidianas prévias. Ultrassonografias de tireoide foram realizadas e comparadas entre mulheres grávidas e não grávidas. A faixa de distribuição normal de VT (percentis 2,5 e 97,5) na gestação foi determinada após a exclusão de indivíduos com anticorpos tireoidianos positivos, BN e/ou tireotropina sérica (TSH) ou tiroxina livre (T4L) anormais. Resultados O VT foi maior entre as gestantes em comparação com as mulheres não grávidas (8,6 vs 6,1 cm3; p< 0,001) e foi positivamente correlacionado com a idade gestacional (rs = 0,221; p= 0,001), índice de massa corporal (IMC, rs 0,165; p= 0,002) e níveis de T4L (rs 0,118 p= 0,021). A frequência de BN não diferiu entre os dois grupos. Houve correlação negativa entre VT e TSH (rs -0,13; p= 0,014). O VT foi menor entre as primíparas em comparação com as multíparas (7,8 vs 8,9; p< 0,001) e foi positivamente correlacionado com a paridade (rs 0,161; p= 0,016). Os percentis 2,5 e 97,5 de VT foram 4,23 e 16,47 cm3, respectivamente. Conclusão O VT foi maior em gestantes em comparação com mulheres não grávidas e foi positivamente relacionado à paridade, IMC e idade gestacional em uma população com status iódico normal. A gravidez não interferiu no desenvolvimento de BN.


Subject(s)
Humans , Female , Pregnancy , Thyroid Gland , Body Mass Index , Thyroid Nodule , Iodine
8.
Acta Academiae Medicinae Sinicae ; (6): 929-933, 2023.
Article in Chinese | WPRIM | ID: wpr-1008148

ABSTRACT

Objective To investigate the influencing factors of Bethesda Ⅲ results in fine-needle aspiration biopsy of thyroid nodules.Methods A total of 300 thyroid nodules with cytological diagnosis results were analyzed retrospectively,including 100 Bethesda Ⅲ nodules and 50 nodules of Bethesda Ⅱ,Ⅳ,Ⅴ,and Ⅵ categories,respectively.Univariate analysis and Logistic regression analysis were performed on the clinical data of patients and the ultrasound signs of thyroid nodules to clarify the factors influencing the diagnosis of Bethesda Ⅲ nodules.Results Univariate analysis showed that Bethesda Ⅲ nodules were mostly adjacent to the capsule(P<0.001),with no blood flow in the color Doppler assessment(P=0.011)and lack of blood supply(P=0.033)and maximum diameter ≤0.9 cm(P=0.038)as revealed by the contrast-enhanced ultrasound.Logistic regression showed that the position close to the capsule(OR=5.110,95%CI=2.153-12.130,P<0.001)and color Doppler without blood flow signal(OR=3.015,95%CI=1.094-8.311,P=0.033)were independent risk factors for the diagnosis of Bethesda Ⅲ nodules.Conclusions The puncture difficulty caused by the dangerous position of thyroid nodules close to the capsule and the aspiration difficulty caused by the absence of blood flow signal in color Doppler are the main factors influencing the diagnosis of Bethesda Ⅲ nodules.Therefore,corresponding avoidance measures should be taken during the aspiration process to reduce the diagnosis results of Bethesda Ⅲ nodules.


Subject(s)
Humans , Thyroid Nodule/diagnostic imaging , Thyroid Neoplasms/diagnosis , Biopsy, Fine-Needle/methods , Retrospective Studies , Ultrasonography/methods
9.
Acta Academiae Medicinae Sinicae ; (6): 921-928, 2023.
Article in Chinese | WPRIM | ID: wpr-1008147

ABSTRACT

Objective To explore the diagnostic efficacy of American Thyroid Association(ATA)guidelines,American College of Radiology Thyroid Imaging Report and Data System(ACR-TIRADS),and Chinese Thyroid Imaging Reporting and Data System(C-TIRADS)alone and combined with BRAFV600E mutation in atypia of undetermined significance/follicular lesion of undetermined significance(AUS/FLUS).Methods A total of 138 patients who underwent ultrasound-guided fine needle aspiration(FNA)in the Chinese PLA General Hospital from January 2020 to May 2023 were selected.The clinicopathological and ultrasound characteristics were retrospectively analyzed for each nodule.Each nodule underwent preoperative BRAFV600E mutation testing and was diagnosed according to the ATA guidelines,ACR-TIRADS,and C-TIRADS.The diagnostic efficacy of ATA guidelines,ACR-TIRADS,and C-TIRADS alone and combined with BRAFV600E mutation was assessed based on the results of histopathological diagnosis.Results The 138 AUS/FLUS thyroid nodules included 45(32.6%)benign ones and 93(67.4%)malignant ones.The patient age(t=1.444,P=0.151),gender(χ2=0.259,P=0.611),and location of nodules(χ2=2.055,P=0.358)had no statistical significance for the differentiation between benign and malignant nodules,while nodule size(Z=2.500,P=0.012),echo(χ2=14.693,P<0.001),composition(χ2=17.075,P<0.001),aspect ratio ≥1(χ2=9.477,P=0.002),and microcalcification(χ2=6.892,P=0.009)were of significance for the differentiation.When applied alone,BRAFV600E mutation showed high specificity(95.56%)and positive predictive value(95.65%).Among the three ultrasound grading systems,ACR-TIRADS had the highest sensitivity(χ2=37.923,P<0.001;χ2=40.462,P<0.001)and accuracy(χ2=81.595,P<0.001;χ2=76.912,P<0.001),while C-TIRADS had the highest specificity(χ2=11.746,P<0.001;χ2=21.235,P<0.001).However,the three systems showed no statistically significant difference in the diagnostic efficiency when applied alone(Z=1.177,P=0.239;Z=0.213,P=0.831;Z=1.016,P=0.310).The combination of BRAFV600E mutation with ACR-TIRADS or C-TIRADS improved the diagnostic efficacy of BRAFV600E mutation in distinguishing the benign and malignant AUS/FLUS nodules(Z=2.107,P=0.035;Z=2.752,P=0.006).The combination of ATA guidelines with BRAFV600E mutation increased the diagnostic accuracy of BRAFV600E mutation(χ2=20.679,P<0.001),while it had no statistically significant difference in distinguishing the benign and malignant AUS/FLUS nodules(Z=1.321,P=0.186).The combination of ATA guidelines,ACR-TIRADS,or C-TIRADS with BRAFV600E mutation improved the diagnostic efficacy of ultrasound grading systems for AUS/FLUS nodules(Z=2.770,P=0.006;Z=2.770,P=0.006;Z=2.890,P=0.004).Specifically,ACR-TIRADS combined with BRAFV600E mutation showed the highest sensitivity(χ2=4.712,P=0.030;χ2=4.712,P=0.030),while C-TIRADS combined with BRAFV600E mutation showed the highest accuracy(χ2=77.627,P<0.001;χ2=85.827,P<0.001).However,there were no statistically significant differences in diagnostic performance between the combinations(Z=1.276,P=0.202;Z=0.808,P=0.419;Z=1.615,P=0.106).Conclusion ATA guidelines,ACR-TIRADS,and C-TIRADS combined with BRAFV600E mutation can improve the diagnostic efficacy of BRAFV600E mutation or ultrasound grading system alone in AUS/FLUS nodules,which can facilitate the further management and treatment of such patients.


Subject(s)
Humans , Infant , United States , Thyroid Neoplasms/genetics , Proto-Oncogene Proteins B-raf/genetics , Adenocarcinoma, Follicular/pathology , Retrospective Studies , Data Systems , Thyroid Nodule/genetics , Ultrasonography/methods , Mutation , China , Radiology
10.
Philippine Journal of Otolaryngology Head and Neck Surgery ; : 26-30, 2023.
Article in English | WPRIM | ID: wpr-1003645

ABSTRACT

Objective@#To compare selected clinicodemographic factors of patients with thyroid nodules who underwent thyroid surgeries with their tissue biopsy results and determine any association between clinicodemographic factors and tissue biopsy results.@*Methods@#Design: Retrospective review of records. Setting: Tertiary Government Training Hospital. Participants: 251 patients with thyroid nodules.@*Results@#Of 251 patients with thyroid nodules, the majority (218; 86.9%) were females while 33 (13.1%) were males. The average age in years was 41.5±13.3 The same population also had malignant outcomes at 79.3%. Most of the patients did not have family history of thyroid malignancy (54%) and had no palpable cervical lymph nodes at presentation (75.9%). Furthermore, there was no distant metastasis at presentation for both lungs (97.7%) and bones (98.9%). There were no significant differences in tissue biopsy results when correlated with age (df=249; t=-.144; p = .886), duration of goiter (df=249; t=-.829; p = .408), and distant metastasis at presentation for lungs (Z=-5.977; p = .052) and bones (Z=-.457; p = .648). Significant differences were only evident for clinicodemographic factors such as sex (Z=-2.570; p = .010), family history (Z=-2.239; p = .020), palpable cervical lymph nodes at presentation (Z=-5.977; p = .000), and the following comorbidities: pulmonary tuberculosis (Z=-2.388; p = .017) and bronchial asthma (Z=-2.148; p = .032) and smoking history (Z=-3.455; p=.001). Furthermore, having no palpable cervical lymph nodes at presentation were associated with malignant tissue biopsy results (B=3.616; p=.001). Patients without palpable cervical lymph nodes at presentation were 37.204 times [OR=37.204] more likely to have benign biopsy results [95% CI: 4.705 – 294.168].@*Conclusion@#There are greater odds of having benign biopsy results for patients without palpable cervical lymph nodes at presentation.


Subject(s)
Thyroid Nodule , Thyroid Neoplasms , Biopsy, Fine-Needle
11.
Acta Academiae Medicinae Sinicae ; (6): 366-373, 2023.
Article in Chinese | WPRIM | ID: wpr-981280

ABSTRACT

Objective To investigate the influencing factors and establish a model predicting the performance of needle visualization in fine-needle aspiration (FNA) of thyroid nodules. Methods This study prospectively included 175 patients who underwent FNA of thyroid nodules in the Department of Ultrasound in China-Japan Friendship Hospital and compared the display of the needle tips in the examination of 199 thyroid nodules before and after the application of needle visualization.We recorded the location,the positional relationship with thyroid capsule,ultrasonic characteristics,and the distribution of the soft tissue strip structure at the puncture site of the nodules with unclear needle tips display before using needle visualization.Furthermore,according to the thyroid imaging reporting and data system proposed by the American College of Radiology,we graded the risk of the nodules.Lasso-Logistic regression was employed to screen out the factors influencing the performance of needle visualization and establish a nomogram for prediction. Results The needle tips were not clearly displayed in the examination of 135 (67.8%) and 53 (26.6%) nodules before and after the application of needle visualization,respectively,which showed a significant difference (P<0.001).Based on the positional relationship between the nodule and capsule,anteroposterior/transverse diameter (A/T) ratio,blood supply,and the distribution of subcutaneous strip structure at the puncture site,a nomogram was established to predict the probability of unclear display of the needle tips after application of needle visualization.The C-index of the prediction model was 0.75 (95%CI=0.67-0.84) and the area under the receiver operating characteristic curve was 0.72.The calibration curve confirmed the appreciable reliability of the prediction model,with the C-index of 0.70 in internal validation. Conclusions Needle visualization can improve the display of the needle tip in ultrasound-guided FNA of thyroid nodules.The nomogram established based on ultrasound features such as the positional relationship between the nodule and capsule,A/T ratio,blood supply,and the distribution of subcutaneous strip structure at the puncture site can predict whether needle visualization is suitable for the examination of nodules.


Subject(s)
Humans , Thyroid Nodule/diagnostic imaging , Biopsy, Fine-Needle/methods , Reproducibility of Results , Ultrasonography , Retrospective Studies , Thyroid Neoplasms
12.
Acta Academiae Medicinae Sinicae ; (6): 361-365, 2023.
Article in Chinese | WPRIM | ID: wpr-981279

ABSTRACT

Objective To evaluate extrathyroidal extension (ETE) in papillary thyroid microcarcinoma (PTMC) with three-dimensional tomographic ultrasound imaging (3D-TUI). Methods A total of 97 thyroid nodules of 79 patients with PTMC treated in PUMC Hospital from February 2016 to January 2018 were included in this study.Two ultrasound experts performed independent blinded assessment of the relationship between thyroid nodules and thyroid capsule by two-dimensional ultrasound (2D-US) and 3D-TUI.The results of 2D-US and 3D-TUI in evaluating ETE were compared with intraoperative findings and postoperative histological and pathological results. Results Among the 97 nodules,54 (55.7%) nodules had ETE.The diagnostic sensitivity (68.5% vs.37.0%;χ2=10.737,P=0.002),accuracy (74.5% vs.56.7%;χ2=6.686,P=0.015),and area under the receiver operating characteristic curve[0.761 (95%CI=0.677-0.845) vs.0.592 (95%CI=0.504-0.680);Z=3.500,P<0.001] of 3D-TUI were higher than those of 2D-US.However,3D-TUI and 2D-US showed no significant difference in the specificity (84.1% vs.81.4%;χ2=0.081,P=0.776),negative predictive value (67.9% vs.50.7%;χ2=3.645,P=0.066),or positive predictive value (84.1% vs.71.4%;χ2=1.663,P=0.240). Conclusion Compared with 2D-US,3D-TUI demonstrates increased diagnostic efficiency for ETE of PTMC.


Subject(s)
Humans , Thyroid Nodule , Thyroid Neoplasms/diagnosis , Carcinoma, Papillary/pathology , Ultrasonography/methods , Retrospective Studies
13.
Chinese Journal of Internal Medicine ; (12): 369-373, 2023.
Article in Chinese | WPRIM | ID: wpr-981046

ABSTRACT

Because mammary glands are regulated by endocrine factors, they are prone to various abnormalities and disorders. Breast nodules are common and occur frequently in clinical practice. The clinical management of breast nodules mainly includes follow-up observation, lesion biopsy, and surgical intervention, and surgical intervention is an effective treatment. Ultrasound-guided percutaneous microwave ablation is a new minimally invasive treatment technology developed in recent years. It has the advantages of short operation time, no scarring, less damage to the lactiferous duct, quick recovery, and good curative effects without bleeding. The establishment of an expert consensus on microwave ablation for benign breast nodules aims to provide a reliable clinical basis for microwave ablation of benign breast nodules, standardize the treatment process, and improve treatment efficacy, so as to serve as a reference for physicians in clinical practice.


Subject(s)
Humans , Consensus , Microwaves/therapeutic use , Catheter Ablation , Thyroid Nodule/surgery , Radiofrequency Ablation , Treatment Outcome
14.
Chinese Medical Journal ; (24): 1225-1230, 2023.
Article in English | WPRIM | ID: wpr-980902

ABSTRACT

BACKGROUND@#Three-dimensional shear wave elastography (3D-SWE) is a promising method in distinguishing benign and malignant thyroid nodules. By combining with conventional method, it may further improve the diagnostic value. The study aimed to assess the diagnostic value of American College of Radiology (ACR) thyroid imaging reporting and data system (TI-RADS) combined with 3D-SWE in ACR TI-RADS 4 and 5 thyroid nodules.@*METHODS@#All nodules were examined by conventional ultrasonography, ACR TI-RADS classification, and 3D-SWE examination. Conventional ultrasonography was used to observe the location, size, shape, margin, echogenicity, taller-than-wide sign, microcalcification, and blood flow of thyroid nodules, and then ACR TI-RADS classification was performed. The Young's modulus values (3D-C-Emax, 3D-C-Emean, and elastography standard deviation [3D-C-Esd]) were measured on the reconstructed coronal plane images. According to the receiver operating characteristic (ROC) curve, the best diagnostic efficiency among 3D-C-Emax, 3D-C-Emean, and 3D-C-Esd was selected and the cut-off threshold was calculated. According to the surgical pathology, they were divided into benign group and malignant group. And appropriate statistical methods such as t -test and Mann-Whitney U test were used to compare the difference between the two groups. On this basis, 3D-SWE combined with conventional ACR TI-RADS was reclassified as combined ACR TI-RADS to determine benign or malignant thyroid nodules.@*RESULTS@#Of the 112 thyroid nodules, 62 were malignant and 50 were benign. The optimal cut-off value of three-dimensional maximum Young's modulus in coronal plane (3D-C-Emax) was 51.5 kPa and the area under the curve (AUC) was 0.798. The AUC, sensitivity, specificity, and accuracy of conventional ACR TI-RADS were 0.828, 83.9%, 66.0%, and 75.9%, respectively. The AUC, sensitivity, specificity, and accuracy of combined ACR TI-RADS were 0.845, 90.3%, 66.0%, and 79.5%, respectively. The difference between the two AUC values was statistically significant.@*CONCLUSIONS@#Combined ACR TI-RADS has higher diagnostic efficiency than conventional ACR TI-RADS. The sensitivity and accuracy of combined ACR TI-RADS showed significant improvements. It can be used as an effective method in the diagnosis of thyroid nodules.


Subject(s)
Humans , Thyroid Nodule/pathology , Elasticity Imaging Techniques/methods , Retrospective Studies , Ultrasonography/methods
15.
Journal of Southern Medical University ; (12): 122-127, 2023.
Article in Chinese | WPRIM | ID: wpr-971504

ABSTRACT

OBJECTIVE@#To assess the safety and efficacy of"leverage pry-off method"for preventing thermal injury during microwave ablation of benign thyroid nodules.@*METHODS@#From July, 2017 to September, 2019, a total of 348 patients with benign thyroid nodules underwent ultrasound-guided microwave ablation. For protecting from thermal injury during the ablation, "hydrodissection technique" was used in 174 of the patients (admitted from July, 2017 to August, 2018) and "leverage pry-off method" in the other 174 patients (admitted from September, 2018 to September, 2019). All the patients were followed up for 1 to 12 months after the operation for observation of severe complications and nodular residues.@*RESULTS@#Ultrasound-guided microwave ablation was completed in all the 348 patients. The most common severe complication associated with the ablation was voice change, occurring in 3 cases (1.7%) in "hydrodissection technique" group and in 4 (2.3%) in the "leverage pry-off method" group, showing no significant difference between the two groups (P>0.05). During the follow-up, no significant difference was found in the rate of nodular residues between the "hydrodissection technique" group and "hydrodissection technique" group (9.8% vs 10.9% (P>0.05).@*CONCLUSIONS@#The "leverage pry-off method" is simple and effective for preventing thermal injury during microwave ablation of benign thyroid nodules.


Subject(s)
Humans , Microwaves/therapeutic use , Thyroid Nodule/surgery , Burns , Hospitalization , Radiofrequency Ablation
16.
Journal of Peking University(Health Sciences) ; (6): 234-242, 2023.
Article in Chinese | WPRIM | ID: wpr-986844

ABSTRACT

OBJECTIVE@#To explore the protocol for diagnosing thyroid nodules based on core needle biopsy (CNB) and study the biomarkers' application in distinguishing indeterminate samples.@*METHODS@#Patients with thyroid nodules treated at Peking University First Hospital from 2015 to 2020 were reviewed. In the study, 598 cases with CNB and matched resected specimens were retrieved. According to "diagnostic categories of thyroid CNB" proposed by the Korean Endocrine Pathology Thyroid Core Needle Biopsy Study Group, the CNB samples were diagnosed as follows: Ⅰ, unsatisfactory; Ⅱ, benign; Ⅲ, indeterminate; Ⅳ, follicular neoplasm; Ⅴ, suspicious for malignancy; and Ⅵ, malignant. The samples of CNB Ⅲ were stained by immunohistochemistry (IHC) using antibodies against CK19, Galectin-3, HBME-1, and CD56, and detected by next-generation sequencing (NGS) using an OncoAim® thyroid cancer multigene assay kit (Singlera Genomics) that detected 26 genes. Taking the resected specimens' classification as the gold standard, the predictive value of CNB for determining the malignancy of thyroid nodules and the biomarkers for distinguishing the samples of CNB Ⅲ was calculated.@*RESULTS@#The study included 598 patients, of which none were CNB Ⅰ, 40 cases were CNB Ⅱ, 40 cases were CNB Ⅲ, 32 cases were CNB Ⅳ, 35 cases were CNB Ⅴ, and 451 cases were CNB Ⅵ. The predictive value of CNB Ⅳ for determining follicular neoplasm was sensitivity (Sen) 100.00% and specificity (Sep) 100.00%, CNB Ⅴ-Ⅵ for determining malignancy was Sen 94.55% and Sep 100.00%, CNB Ⅱ for determining benign lesions was Sen 75.00% and Sep 99.80%. The predictive value of biomarkers for determining malignancy in cases of CNB Ⅲ was Sen 96.30% and Sep 92.31% by NGS, and Sen 81.48% and Sep 92.30% by IHC.@*CONCLUSION@#The Korean "diagnostic categories of thyroid CNB", which considers the histological specificity of CNB samples and the habits of clinicians, have strong operability, high diagnosis rate, and high clinical value. Under this framework, the cases of CNB Ⅵ should be treated with surgical operation, the cases of CNB Ⅴ-Ⅵ are recommended to be treated as malignant neoplasms, and the major cases of CNB Ⅱ could be followed up without worrisome except the one considered malignant by ultrasound. The value of biomarkers in distinguishing the cases of CNB Ⅲ is significant.


Subject(s)
Humans , Thyroid Nodule/surgery , Biopsy, Large-Core Needle/methods , Thyroid Neoplasms/surgery , Biomarkers
17.
Chinese Journal of Pathology ; (12): 696-701, 2023.
Article in Chinese | WPRIM | ID: wpr-985760

ABSTRACT

Objective: To assess the feasibility of nuclear score combined with cyclin D1 immunocytochemistry in classifying indeterminate thyroid nodules with fine-needle aspiration (FNA) cytological diagnosis of Bethesda category Ⅲ-Ⅴ. Methods: A consecutive cohort of 118 thyroid FNA specimens with indeterminate diagnosis (TBSRTC category Ⅲ-Ⅴ) and available histopathologic follow-up data were collected between December 2018 and April 2022 at the Department of Pathology, Beijing Hospital, China. These cases were subjected to cytological evaluation and cyclin D1 immunocytochemistry. The optimal cut-off points of a simplified nuclear score and the percentage of cyclin D1-positive cells for the diagnosis of malignancy or low-risk neoplasm were determined using the receiver operating characteristic (ROC) curves and area under the ROC curve (AUC). The specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of nuclear score and cyclin D1 immunostaining were evaluated from the crosstabs based on cut-off points. The diagnostic accuracy of simplified nuclear score combined with cyclin D1 immunostaining was estimated using ROC curve analysis. Results: Nuclear grooves, intra-nuclear inclusions and chromatin clearing were more commonly found in malignancy/low-risk neoplasms than benign lesions (P=0.001, P=0.012 and P=0.001 respectively). A cut-off point of≥2 for the simplified nuclear score was sensitive for defining malignancy/low-risk neoplasm, and its PPV, NPV, sensitivity and specificity were 93.6%, 87.5%, 99.0% and 50.0% respectively. A positive cut-off point of 10% positive thyroid cells in cyclin D1 immunostaining demonstrated sensitivity of 88.5%, specificity of 100%, PPV of 100% and NPV of 53.8% for correctly detecting thyroid malignancy or low-risk neoplasm. The sensitivity and PPV of simplified nuclear score combined with cyclin D1 immunostaining were 93.3% and 100%, respectively. Both specificity and NPV were maintained at high levels (100% and 66.7%, respectively). The diagnostic accuracy of simplified nuclear score combined with cyclin D1 immunostaining in detecting thyroid malignancy/low-risk neoplasm was increased to 94.1% compared to using either of them alone. Conclusions: Combing simplified nuclear score and cyclin D1 immunostaining on FNA cytology specimens can increase the diagnostic accuracy in classifying thyroid nodules of indeterminate cytological categories. Thus, this supplementary approach provides a simple, accurate, and convenient diagnostic method for cytopathologists so that may reduce unnecessary thyroidectomies.


Subject(s)
Humans , Thyroid Nodule/pathology , Biopsy, Fine-Needle , Cyclin D1 , Immunohistochemistry , Thyroid Neoplasms/pathology , Retrospective Studies
18.
Journal of the ASEAN Federation of Endocrine Societies ; : 120-124, 2023.
Article in English | WPRIM | ID: wpr-984401

ABSTRACT

@#A 31-year-old Indian female with a history of near-total thyroidectomy 2.5-years prior presented with recurrent neck swelling. Magnetic resonance imaging (MRI) of the neck revealed an infiltrating mass involving the thyroid bed. Biopsy from the mass and review of slides from the previous thyroidectomy revealed a spindle cell tumour with interspersed areas of fibrosis and infiltrative edges entrapping thyroid follicles. Beta-catenin immunopositivity and CTNNB1 mutation confirmed the diagnosis of fibromatosis. The case is being reported for its rarity and the discussion of its differential diagnoses.


Subject(s)
Thyroid Gland , Fibroma , Immunohistochemistry , Thyroid Nodule
19.
Med. lab ; 27(3): 197-198, 2023.
Article in Spanish | LILACS | ID: biblio-1444004

ABSTRACT

De acuerdo con las estadísticas de GLOBOCAN 2020, el cáncer de tiroides ocupa el noveno lugar de incidencia a nivel mundial [1]. Afecta en su mayoría a mujeres en un 75 %, y aunque puede presentarse a cualquier edad, la mediana al momento del diagnóstico es alrededor de los 50 años [2]. En los últimos 5 a 10 años, el manejo del cáncer de tiroides ha sufrido una transformación, con nuevas opciones de diagnóstico, incluyendo las pruebas moleculares, y de tratamiento. El Laboratorio Clínico Hematológico y la revista Medicina & Laboratorio realizaron el pasado mes de junio el Segundo Simposio de Medicina Diagnóstica. Conversemos de: Nódulo Tiroideo y Cáncer de Tiroides, con la participación de expositores nacionales e internacionales expertos en el tema. Los resúmenes han sido incluidos en el presente número de la revista. El doctor Alejandro Román-González en su conferencia "Actualización en el estudio del nódulo tiroideo", abarca paso a paso la conducta a seguir desde la detección de un nódulo tiroideo, su clasificación y posible tratamiento. Además, alerta a la sensibilización del clínico ante la angustia que padece un paciente que presenta un nódulo tiroideo. El doctor Alejandro Vélez-Hoyos con su presentación "Actualización del sistema de reporte Bethesda de citología de tiroides 2023", hace un recuento de dicho sistema desde su creación, y expone la clasificación más reciente del sistema Bethesda para tiroides, tanto en adultos como en niños. El doctor Roberto Ruiz-Cordero en su conferencia "La relevancia del análisis molecular en el diagnóstico y manejo de los nódulos tiroideos, y su utilidad como medida de control de calidad entre citopatólogos", menciona cómo el estudio genómico ha alcanzado grandes avances en el cáncer de tiroides, permitiendo la identificación de mutaciones de los genes RAS y la mutación BRAF p.V600E, entre otras. Adicionalmente, expone cómo el análisis molecular ha surgido como una herramienta crítica en el diagnóstico y manejo de los nódulos tiroideos, al mejorar significativamente la precisión diagnóstica y el número de intervenciones quirúrgicas innecesarias.


The Clinical Hematology Laboratory and the Medicina & Laboratorio Journal held the Second Diagnostic Medicine Symposium last June. Let's talk about: Thyroid Nodule and Thyroid Cancer, with the participation of national and international speakers who are experts on the subject. The abstracts have been included in this issue of the journal.


Subject(s)
Humans , Thyroid Nodule , Thyroid Neoplasms , Molecular Biology
20.
Med. lab ; 27(3): 263-266, 2023.
Article in Spanish | LILACS | ID: biblio-1444444

ABSTRACT

Los nódulos tiroideos son una ocurrencia común. Aunque la mayoría de los nódulos son benignos y asintomáticos, un pequeño porcentaje de ellos puede ser maligno. Por esta razón, es crucial identificar los nódulos malignos y proporcionar el tratamiento apropiado


Subject(s)
Humans , Thyroid Nodule , Atrial Natriuretic Factor , Thyroid Cancer, Papillary
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