Performance of a multigene genomic classifier and clinical parameters in predicting malignancy in a Southeast Asian cohort of patients with cytologically indeterminate thyroid nodules.

BACKGROUND: Most thyroid nodules are benign. It is important to determine the likelihood of malignancy in such nodules to avoid unnecessary surgery. The primary objective of this study was to characterize the genetic landscape and the performance of a multigene genomic classifier in fine-needle aspiration (FNA) biopsies of cytologically indeterminate thyroid nodules in a Southeast Asian cohort. The secondary objective was to assess the predictive contribution of clinical characteristics to thyroid malignancy. METHODS: This prospective, multicenter, blinded study included 132 patients with 134 nodules. Molecular testing (MT) with ThyroSeq v3 was performed on clinical or ex-vivo FNA samples. Centralized pathology review also was performed. RESULTS: Of 134 nodules, consisting of 61% Bethesda category III, 20% category IV, and 19% category V cytology, and 56% were histologically malignant. ThyroSeq yielded negative results in 37.3% of all FNA samples and in 42% of Bethesda category III-IV cytology nodules. Most positive samples had RAS-like (41.7%), followed by BRAF-like (22.6%), and high-risk (17.9%) alterations. Compared with North American patients, the authors observed a higher proportion of RAS-like mutations, specifically NRAS, in Bethesda categories III and IV and more BRAF-like mutations in Bethesda category III. The test had sensitivity, specificity, negative predictive value, and positive predictive value of 89.6%, 73.7%, 84.0%, and 82.1%, respectively. The risk of malignancy was predicted by positive MT and high-suspicion ultrasound characteristics according to American Thyroid Association criteria. CONCLUSIONS: Even in the current Southeast Asian cohort with nodules that had a high pretest cancer probability, MT could lead to potential avoidance of diagnostic surgery in 42% of patients with Bethesda category III-IV nodules. MT positivity was a stronger predictor of malignancy than clinical parameters.

Convulsive Syncope From Carotid Sinus Syndrome as a Manifestation of Laryngeal Cancer.

OBJECTIVE: Carotid sinus syndrome (CSS) is a rare yet serious presentation of head and neck malignancy. To our knowledge, syncope and seizure-like episodes as a manifestation of carotid sinus syndrome secondary to laryngeal cancer has not been reported to date. We report a case of laryngeal cancer causing convulsive syncope masquerading as seizures due to CSS. METHODS: Case report. The patient's medical record was reviewed for demographic and clinical information. RESULTS: A 62-year-old male presented with multiple episodes of syncope and hoarseness of voice. On nasoendoscopic examination, left vocal cord palsy and left aryepiglottic fold tumor were visualized. Computerized tomography (CT) neck showed a large 2.4 × 3.6 cm left supraglottic tumor with local invasion and extensive cervical lymphadenopathy compressing the carotid sinus. CT guided biopsy of the tumor revealed invasive squamous cell carcinoma. While undergoing evaluation, the patient developed seizure-like episodes. Inpatient telemetry monitoring revealed significant bradycardia and hypotension during these episodes. A permanent pacemaker was inserted which resulted in resolution of the syncopal and seizure-like episodes. CONCLUSION: In patients with unexplained syncope or seizure-like episodes and a background of head and neck cancer, clinicians should consider the diagnosis of CSS. CSS is a poor prognostic factor due to the associated higher stage of disease.

[Observation on therapeutic effect of warming needle moxibustion on knee osteoarthritis of deficiency-cold type].

OBJECTIVE: To compare clinically therapeutic effects of warming needle moxibustion and simple acupuncture on knee osteoarthritis. METHODS: One hundred and twenty cases conformed with the diagnostic criteria of knee osteoarthritis with TCM kidney-yang deficiency and cold syndrome were randomly divided into a warming needle moxibustion group and a simple acupuncture group. Guanyuan (CV 4), Qihai (CV 6), Zusanli (ST 36) and others were selected in the two groups. Their therapeutic effects were assessed with joint pain scale, knee osteoarthritis severity index scale and cold syndrome differentiation factors. RESULTS: Both warming needle moxibustion and simple acupuncture could alleviate pain of knee osteoarthritis, improve dysfunction of the knee joint, reduce symptoms. The clinically basic cured rate and the total effective rate were 32.1% and 96.4% in the warming needle moxibustion group, which were better than 7.4% and 92.6% in the simple acupuncture group. CONCLUSION: Warming needle moxibustion is an effective therapy for knee osteoarthritis with kidney-yang deficiency and cold type.