A comparative analysis of surgically excised hereditary and sporadic pheochromocytomas: Insights from a single-center experience.

Pheochromocytoma is a tumor that usually originating from adrenal medullary chromaffin cells and producing one or more catecholamines, can manifest as hereditary or sporadic. While the majority pheochromocytomas are sporadic, hereditary forms are often associated with genetic syndromes such as von Hippel-Lindau, multiple endocrine neoplasia type 2, and neurofibromatosis type 1. This study aims to analyze data from our series of surgically excited pheochromocytoma patients and compare the characteristics between hereditary and sporadic cases. We retrospectively evaluated 33 diagnosed pheochromocytoma patients, documenting clinical features, surgical complications, and tumor characteristics in both hereditary and sporadic cases. Among the patients, 21% (7 individuals) had hereditary pheochromocytoma, while 79% (26 individuals) had sporadic cases. During diagnosis, hereditary pheochromocytoma patients exhibited a significantly lower mean age compared to the sporadic group (26.4 ± 9.9 years vs. 50.4 ± 14.0 years; p < 0.001). The maximum tumor size was also lower in hereditary cases compared to sporadic cases (p = 0.004). Adrenal tumor localization analysis showed that 63.6% were right-sided, 24.2% were left-sided, and 12.1% were bilateral. Laboratory analysis revealed significantly higher urinary norepinephrine levels in hereditary pheochromocytoma patients (p = 0.021). Our findings suggest that hereditary pheochromocytoma cases are characterized by a younger age at diagnosis, smaller tumor size, and a higher prevalence of multiple bilateral adrenal adenomas. We recommend genetic testing for all pheochromocytoma patients, particularly those with early-onset disease and bilateral adrenal tumors.

Assessment of ChatGPT's adherence to ETA-thyroid nodule management guideline over two different time intervals 14 days apart: in binary and multiple-choice queries.

OBJECTIVE: Artificial intelligence (AI) has significant potential in healthcare, particularly in providing decision-support in specialized domains like thyroid nodule management. This study assesses the effectiveness of ChatGPT-v4, an advanced AI model, in aligning with the European Thyroid Association (ETA) - 2023 guidelines. METHODS: The study utilized a structured questionnaire comprising 100 questions, divided into true/false and multiple-choice formats, reflecting real-world clinical scenarios in thyroid nodule management. These questions encompassed diagnostic criteria, treatment options, follow-up protocols, and patient counseling. ChatGPT response was evaluated for accuracy, consistency, and comprehensiveness using a six-point Likert scale. The assessment occurred initially and was repeated after 14 days. RESULTS: In the binary queries, the AI model showed an ability to correct some initially incorrect responses. However, there was a noticeable regression in certain responses. 8 of the 11 previously non-compliant responses remained unchanged, while 3 non-compliant responses were rectified. Conversely, 6 initially compliant answers transitioned to non-compliance after 14 days. In multiple-choice queries, the AI's performance was more consistent. A majority of the responses, 43 (86% of the total), were initially correct and maintained their correctness upon re-assessment. However, 4 responses that were initially incorrect remained unchanged, and 3 correct responses shifted to non-compliance over time. CONCLUSION: ChatGPT exhibited improving potential as a clinical support tool in thyroid nodule management altgouh it showed varied performance for binary and multiple-choice questions. CLINICAL TRIAL REGISTRATION: N/A.

Investigation of pre-operative demographic, biochemical, sonographic and cytopathological findings in low-risk thyroid neoplasms.

OBJECTIVE: The present article analyses pre-operative demographic, biochemical, sonographic and histopathological characteristics of low-risk thyroid neoplasms (LRTNs), with a focus on four subgroups, "well-differentiated carcinoma-not otherwise specified" (WDC-NOS), "non-invasive follicular thyroid neoplasm with papillary like nuclear features" (NIFTP), "well-differentiated tumours of uncertain malignant potential" (WDT-UMP) and "follicular tumour of uncertain malignant potential" (FT-UMP). METHODS: The study retrospectively analyzed the histopathology of 2453 malignant thyroids and the final analyses included 99 cases diagnosed with LRTNs. The demographic and clinical features, pre-operative thyroid function, ultrasonography results, cytopathology results, histopathology results and prognostic classifications were assessed. RESULTS: The groups were similar demographic characteristics and the majority of clinical data, including comorbidities, thyroid function tests, thyroid cancer/neck radiotherapy history. NIFTPs represented 69.7% of all LRTNs. All (100%) WDT-UMPs had solitary nodules. Index nodule volume differed among the groups (p = .036), it was the lowest in WDC-NOS [0.68 (0.63-0.72 cc)] and highest in FT-UMP [12.6 (0.5-64 cc)]. Echogenicity findings were similar. Index nodule TIRADS demonstrated a significant difference (p = .021) but index nodule halo sign and BETHESDA scores were similar in all groups. The diameter, localisation and multicentric structure of LRTNs were again similar for all groups. Finally, prognostic scores suggested similar outcomes in all groups. CONCLUSION: The majority of LRTNs were NIFTPs in our population and all WDT-UMPs were solitary lesions. Index nodule volume was the most essential discriminating sonographic finding but further research must be performed before discriminatory potential can be described.

A novel proportional index to differentiate between demographically and clinically matched cases with papillary thyroid carcinoma or non-cancerous nodule: PLR-to-PDW ratio.

OBJECTIVES: To analyze PLR-to-PDW ratio as a novel diagnostic index in the discrimination of benign thyroid nodules (BTN) and papillary thyroid carcinoma (PTC), and to analyze the discriminatory power of a novel index (platelet-to-lymphocyte ratio divided by platelet distribution width: PLR-to-PDW ratio) in comparison with previously-examined inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), PLR, prognostic nutritional index (PNI), systemic inflammation index (SII), and systemic inflammatory response index (SIRI). METHODS: This cross-sectional retrospective research included 459 demographically and clinically-matched participants who underwent thyroid examination with ultrasonography and fine-needle aspiration biopsy. NLR, PLR, SII, SIRI and PLR-to-PDW were calculated manually from complete blood count results. PNI was calculated as albumin (g/dL) + 5 × lymphocyte count. RESULTS: Among the inflammatory indices, NLR, PLR and PLR-to-PDW ratio were significantly higher in patients with PTC compared to those with BTN. Logistic regression showed that NLR (OR: 1.414, P=0.0083), PLR (OR: 1.537, P=0.0065) and PLR-to-PDW (OR: 2.054, P=0.0016) were independently associated with a greater likelihood of PTC. Among the previously-examined indices, PLR had the best discriminatory performance with 73.4% sensitivity and 70.8% specificity for a > 149.6 cut-off (AUC: 0.786, P=0.0011). However, the novel ratio examined in this study, PLR-to-PDW, had better predictive value to distinguish PTC cases from BTN with 78.1% sensitivity and 73.7% specificity at a > 9.11 cut-off (AUC: 0.827, P=0.0001). CONCLUSIONS: The presently proposed PLR-to-PDW ratio exhibited the highest diagnostic discriminatory power compared to other inflammatory indices, indicating a relatively better utility to distinguish cases with PTC from those with BTN.