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1.
Int. arch. otorhinolaryngol. (Impr.) ; 26(1): 97-102, Jan.-Mar. 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1364924

ABSTRACT

Abstract Introduction Fine needle aspiration cytopathology (FNAC) is widely used for the stratification of thyroid nodules. Objective The objective of the present study is to validate FNAC reporting based on The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) at our institution and to calculate the risk of malignancy in each category. Methods This was a descriptive cross-sectional study conducted jointly at the Department of Ear, Nose and Throat and at the Department of Pathology for a period of 1.5 years (May 2018 to November 2018). All cases presenting with thyroid swelling in the outpatient department were investigated with ultrasonography (USG) of the neck, thyroid function test, and FNAC. All FNAC reporting was done according to TBSRTC. Results A total of 134 thyroidectomies were performed during the study period. The female to male ratio was 5.3:1. The age ranged from 11 to 74 years old. with a mean age of 51 years old. The FNAC has a specificity of 84.9%, a sensitivity of 89.4%, a positive predictive value of 86.4%, a negative predictive value of 88.2%, and an accuracy of 87.3% in detecting thyroid cancer. The implied risk of malignancy (ROM) in Bethesda II, III, IV, V and VI is 11.7%, 25%,40%,76.6% & 96%, respectively. Conclusion The four studied categories had a ROM comparable to other studies, except for the Bethesda III category. Further studies with larger sample sizes and with the use of USG guidance for the aspiration from the thyroid swelling may give better results by reducing the number of false negative and false positive cases.

2.
Article in Chinese | WPRIM | ID: wpr-920369

ABSTRACT

Objective To investigate the prevalence of thyroid nodules in women participating in physical examination in Beijing and analyze the influencing factors. Methods The data of physical examination (height, weight, blood pressure, blood glucose, etc.) and questionnaire survey (activity intensity, eating habits, etc.) of women in Beijing in 2016 were collected, and the influencing factors of thyroid nodules were analyzed by multivariate logistic regression. Results A total of 4 732 women were included in this study. The prevalence of thyroid nodules was 49.6%. Multivariate logistic regression analysis showed that compared with women aged 18-29 years, OR value was 1.769 (95% CI =1.489 ~ 2.102) for women aged 30 ~ 59 years, and OR value was 4.716 (95% CI = 3.577- 6.216) for women aged 60 years and over. Compared with the balanced diet, the OR value was1.237(95%CI=1.056-1.450)for vegetarian diet. Compared with the normal weight, the OR value was 1.331(95%CI=1.153-1.537)for the overweight. Compared with the healthy women, the OR value was 1.405 (95%CI=1.146-1.723)for hypertension, the OR value was 1.184(95%CI=1.040-1.347)for hyperlipidemia, and the OR value was 1.779(95%CI=1.178-2.687)for diabetes, while the OR value was 1.183(95%CI=1.018-1.376)for women with mammary gland nodules, and the OR value was 1.376(95%CI=1.201-1.575)for women with uterine leiomyoma. Compared with the education degree of high school, technical secondary school, technical school and below, the OR value was 0.648(95%CI=0.522-0.806)for college or undergraduate, and the OR value was 0.564(95%CI=0.440-0.723)for graduate students and above. Conclusion The prevalence of thyroid nodules in women in Beijing is at a high level. Age, vegetarian diet, overweight, hypertension, hyperlipidemia, diabetes, mammary gland nodules and uterine leiomyoma are risk factors for thyroid nodules. Education level is a protective factor for the prevalence of thyroid nodules.

3.
Article in Chinese | WPRIM | ID: wpr-927844

ABSTRACT

Objective To evaluate the performance of micro-flow imaging(MFI)in the differential diagnosis of benign and malignant thyroid nodules. Methods Totally 50 patients with thyroid nodules examined by conventional ultrasound,MFI,and contrast-enhanced ultrasound and confirmed by histological or cytological pathology in the First Medical Center of Chinese PLA General Hospital from May to December in 2020 were enrolled in the study.The clinical data and ultrasound images were retrospectively analyzed.A binary logistic regression model was established to evaluate the performance of the model in predicting benign and malignant thyroid nodules. Results Logistic regression showed that composition and "S-W-C" sign were independent risk factors for predicting malignant thyroid nodule.The sensitivity,specificity,and Youden index of the logistic regression model were 73.33%,80.00%,and 0.53,respectively,and the area under receiver operating characteristic curve was 0.799(95%CI=0.662-0.899). Conclusion MFI facilitates the differential diagnosis of benign and malignant thyroid nodules and has the potential to be applied in the future.


Subject(s)
Diagnosis, Differential , Humans , ROC Curve , Retrospective Studies , Thyroid Nodule/diagnostic imaging , Ultrasonography/methods
4.
Acta de Otorrinolaringología Cir. Cabeza cuello. ; 50(2): 112-116, 20220000. ilus, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1381676

ABSTRACT

Introducción: evaluar la concordancia de la clasificación TI-RADS (Thyroid Imaging Reporting and Data System) y el sistema Bethesda para detectar malignidad en pacientes con nódulo tiroideo. Material y métodos: mediante un estudio observacional, retrospectivo y transversal en 90 pacientes con diagnóstico de nódulo tiroideo a los que se les realizó un ultrasonido de cuello, un estudio histopatológico definitivo y se les aplicó las escalas TI-RADS y Bethesda durante su abordaje desde julio del 2018 hasta noviembre de 2020. Resultados: se encontró una predominancia del sexo femenino, una sensibilidad del 43,6 % y una especificidad del 94,2 % en la clasificación de TI-RADS. Respecto a la clasificación de Bethesda obtuvimos una sensibilidad del 94,5 % y una especificidad del 51,4 %. Como resultado, se obtuvo una concordancia baja entre las dos pruebas. Discusión: de acuerdo con los resultados obtenidos en nuestro estudio pudimos constatar que los pacientes con nódulo tiroideo se ven beneficiados al realizar un abordaje adecuado que incluya un ultrasonido (USG) Doppler de cuello realizado por un profesional con entrenamiento, además de la realización de una biopsia por aspiración con aguja fina (BAAF) en los casos en que estén bien indicados. La prueba de concordancia fue baja, por tanto, consideramos necesario el uso de ambas pruebas diagnósticas dentro de la práctica clínica. Conclusión: el correcto uso de la clasificación TI-RADS para identificar las características de un nódulo tiroideo permite diferenciar de forma confiable a los pacientes que ameritan someterse a una BAAF frente a los que no la requieren. El sistema Bethesda puede apoyar en la toma de decisiones o cambiar una conducta terapéutica, sobre todo en pacientes con alta sospecha de malignidad.


Introduction: Evaluate the concordance of the TI-RADS classification and the Bethesda system to detect malignancy in patients with a thyroid nodule. Material and Methods: Through an observational, retrospective and cross-sectional study in 90 patients with a diagnosis of thyroid nodule, to which neck ultrasound was performed, definitive histopathological study and the TI-RADS (Thyroid Imaging Reporting and Data System) and Bethesda scales were applied during their approach from July 2018 to November 2020. Results: obtaining as a result, a predominance of the female sex, a sensitivity of 43.6% and specificity of 94.2% in classification of TI-RADS. Regarding the Bethesda classification, we obtained a sensitivity of 94.5% and a specificity of 51.4%. With a low agreement as a result between the two tests. Discussion: according to the results obtained in our study, we could verify that patients with thyroid nodules benefit from an appropriate approach that includes a neck Doppler USG, performed by a trained professional, in addition to the realization of a Fine Needle Aspiration Biopsy (FNA) in the cases in which they are well indicated. The concordance test was low; therefore, we consider it necessary to use both diagnostic tests within clinical practice. Conclusion: the correct use of the TI-RADS classification to identify the characteristics of a thyroid nodule allows reliable differentiation to patients to undergo a FNA of those who do not require it. The Bethesda system can support decision making or change therapeutic behavior, especially in patients with high suspicion of malignancy.


Subject(s)
Humans , Thyroid Nodule , Adenocarcinoma , Classification
5.
Rev. Univ. Ind. Santander, Salud ; 53: e318, dic. 2021. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1365448

ABSTRACT

Resumen Introducción: Los nódulos tiroideos son un crecimiento localizado en el tejido tiroideo, aproximadamente el 8 % son malignos, y el ultrasonido es el método ideal para detectarlos. Objetivo: Determinar cuáles son los hallazgos ecográficos que pueden sugerir una mayor probabilidad de malignidad del nódulo tiroideo. Metodología: Estudio descriptivo de tipo corte transversal en pacientes con nódulo tiroideo en una institución prestadora de salud de Neiva. Resultados: Se evaluaron 63 pacientes con un promedio de edad de 52 años, 95 % fueron femeninos y el 5 % masculinos. El 71 % presentaron nódulos tiroideos benignos, y el 10 % nódulos malignos. En el 100 % de los nódulos tiroideos malignos se encontró vascularidad aumentada, microcalcificaciones, adenopatías asociadas, bordes irregulares y componente sólido, y los hallazgos con respecto a hipoecogenicidad y diámetro anteroposterior mayor al transverso (más alto que ancho), se encontró en el 83 % siendo estadísticamente significativos. La sensibilidad de los hallazgos ecográficos supera el 80 %, excepto la variable "tamaño del nódulo mayor a 1 centímetro". Conclusiones: Los hallazgos ecográficos como adenopatías y el diámetro anteroposterior mayor al transverso son indicadores potenciales de nódulos tiroideos malignos, el tamaño mayor a un centímetro no siempre es predictor de malignidad, sin embargo debido al tamaño de la muestra en nuestro estudio no es posible generalizarlo como un factor determinante para la realización de biopsia, por ende recomendamos el seguimiento de los nódulos teniendo en cuenta los criterios ecográficos de malignidad y la clasificación TIRADS para tomar decisiones con respecto a las biopsias tiroideas.


Abstract Introduction: Thyroid nodules are a localized growth in the thyroid tissue, approximately 8% are malignant, and an ultrasound is the ideal method to detect them. Objective: Determine which are the ultrasound findings that may suggest an increased probability of thyroid nodule malignancy. Methodology: Descriptive cross-sectional study amongst patients with thyroid nodule in a healthcare institution in Neiva. Results: A total of 63 patients were evaluated with an average age of 52 years, 95% were female and 5% male. Seventy-one percent had benign thyroid nodules, and 10% malignant nodules. In 100% of malignant thyroid nodules, increased vascularity, microcalcifications, associated adenopathies, irregular borders and solid component were found, and the findings regarding hypoechogenicity and anteroposterior diameter greater than the transverse (higher than wide), were found in 83%, being statistically significant. The sensitivity of ultrasound findings exceeds 80%, except for the variable nodule size greater than 1 centimetre. Conclusions: Ultrasound findings such as adenopathies and anteroposterior diameters greater than the transverse one are potential indicators of malignant thyroid nodules, the size greater than one centimetre is not always a predictor of malignancy; however, due to the size of the sample in our study it is not possible to generalize it as a determining factor for biopsy. Therefore, we recommend monitoring the nodules considering the ultrasound criteria for malignancy and the TIRADS classification to make decisions regarding thyroid biopsies.

6.
Arch. endocrinol. metab. (Online) ; 65(6): 752-757, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1349998

ABSTRACT

ABSTRACT Objective: The objective of this study is to compare the total costs of surgery and radiofrequency (RF) ablation for the treatment of benign thyroid nodules. Materials and methods: This is a prospective randomized study comparing cases treated with US-guided RF ablation (cases) and surgery (control). They were selected and allocated to groups (thyroidectomy or radioablation) by permuted block randomization in blocks of five cases each. Results: Five cases of RF Ablation were compared with five cases of thyroidectomies conducted in the same period. Similar complication rates were observed in both groups. Shorter operating time and hospital stay were observed for the RF group. In the evaluation of the total cost between procedures, radioblation represented 76% of the cost of partial thyroidectomy. Conclusion: This study demonstrated that radioablation has a competitive cost, making it an effective alternative in the treatment of benign thyroid nodules.


Subject(s)
Humans , Thyroid Nodule/surgery , Catheter Ablation , Radiofrequency Ablation , Thyroidectomy , Prospective Studies , Treatment Outcome , Cost-Benefit Analysis
7.
Rev. colomb. cir ; 36(4): 682-695, 20210000. tab, graf
Article in English | LILACS | ID: biblio-1365770

ABSTRACT

Abstract Coexistence between thyroid cancer and hyperthyroidism is rare, and most of the nodular lesions from which a malignant tumor is documented in this group of patients correspond to cold nodules. Justified by the increasing number of reports in the literature about malignant tumors diagnosed from hot nodules, a systematic review was carried out to determine possible factors associated with the diagnosis of thyroid cancer from hot nodules in patients with hyperthyroidism. The results suggest that the clinical diagnosis of toxic nodular goiter, nodular lesions of diameter > 10 mm and a histological type compatible with a follicular carcinoma, are factors that on their own increase the risk of making the diagnosis of cancer from a hot nodule.


Resumen La coexistencia entre cáncer de tiroides e hipertiroidismo es infrecuente, y la mayoría de las lesiones nodulares a partir de las cuales se documenta un tumor maligno en este grupo de pacientes corresponden a nódulos fríos. Justificado en el creciente número de reportes en la literatura acerca de tumores malignos diagnosticados a partir de nódulos calientes, se realizó una revisión sistemática que tuvo como objetivo determinar los posibles factores asociados con el diagnóstico de cáncer de tiroides a partir de nódulos calientes en pacientes con hipertiroidismo. Los resultados sugieren que el diagnóstico clínico de bocio nodular tóxico, lesiones nodulares de diámetro mayor de 10 mm y tipo histológico compatible con carcinoma folicular, son factores que aumentan por sí solos el riesgo de realizar el diagnóstico de cáncer a partir de un nódulo caliente.


Subject(s)
Thyroid Gland , Thyroid Neoplasms , Thyroid Nodule , Adenocarcinoma, Follicular , Systematic Review , Hyperthyroidism
8.
Rev. colomb. cir ; 36(4): 682-695, 20210000. fig, tab
Article in Spanish | LILACS | ID: biblio-1291253

ABSTRACT

La coexistencia entre cáncer de tiroides e hipertiroidismo es infrecuente, y la mayoría de las lesiones nodulares a partir de las cuales se documenta un tumor maligno en este grupo de pacientes corresponden a nódulos fríos. Justificado en el creciente número de reportes en la literatura acerca de tumores malignos diagnosticados a partir de nódulos calientes, se realizó una revisión sistemática que tuvo como objetivo determinar los posibles factores asociados con el diagnóstico de cáncer de tiroides a partir de nódulos calientes en pacientes con hipertiroidismo. Los resultados sugieren que el diagnóstico clínico de bocio nodular tóxico, lesiones nodulares de diámetro mayor de 10 mm y tipo histológico compatible con carcinoma folicular, son factores que aumentan por sí solos el riesgo de realizar el diagnóstico de cáncer a partir de un nódulo caliente


Coexistence between thyroid cancer and hyperthyroidism is rare, and most of the nodular lesions from which a malignant tumor is documented in this group of patients correspond to cold nodules. Justified by the increasing number of reports in the literature about malignant tumors diagnosed from hot nodules, a systematic review was carried out to determine possible factors associated with the diagnosis of thyroid cancer from hot nodules in pa-tients with hyperthyroidism. The results suggest that the clinical diagnosis of toxic nodular goiter, nodular lesions of diameter > 10 mm and a histological type compatible with a follicular carcinoma, are factors that on their own increase the risk of making the diagnosis of cancer from a hot nodule


Subject(s)
Humans , Thyroid Neoplasms , Hyperthyroidism , Thyroid Gland , Thyroid Nodule , Adenocarcinoma, Follicular , Systematic Review
9.
Braz. j. otorhinolaryngol. (Impr.) ; 87(4): 402-409, July-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1285714

ABSTRACT

Abstract Introduction Ultrasound sonography provides a quick method for determining which nodule to sample for fine needle aspiration biopsy in thyroid nodules. On the other hand, the computed tomography examination is not restricted by echo attenuation and distinguishes between benign and malignant nodules. Objective To compare computed tomography examinations against ultrasound/fine needle aspiration biopsy in the differential diagnosis of thyroid nodules. Methods Data regarding computed tomography examinations, sonographic finding following fine needle aspiration biopsy, and tumor histology of 953 nodules from 698 patients who underwent thyroidectomy were collected and analyzed. The beneficial score for detection of the malignant tumor for each adopted modality was evaluated. Results Ultrasound images did not show a well-circumscribed solid mass in 89 nodules, and ultimately did not detect nodules in fine needle aspiration biopsies (false positive non-malignant nodules). Ultrasound images showed parenchymatous disease (false positive malignant nodules) in several nodules. Computed tomography examinations demonstrated higher difficulty in detection of malignant nodules of 1.0-2.0 cm size than ultrasound examination following fine needle aspiration biopsies; compared to tumor histological data, computed tomography examinations had a sensitivity of 0.879. Conclusion Computed tomography examinations are a more reliable method for differential diagnosis of thyroid nodules than ultrasound examinations followed by fine needle aspiration biopsy. Level of Evidence III.


Resumo Introdução A ultrassonografia é um método rápido para determinar de qual nódulo se deve coletar uma amostra para biópsia por aspiração com agulha fina. Por outro lado, o exame de tomografia computadorizada não é restringido pela atenuação do eco e distingue entre nódulos benignos e malignos. Objetivo Comparar exames tomográficos versus biópsia por ultrassonografia/aspiração por agulha fina no diagnóstico diferencial de nódulos tireoidianos. Método Dados sobre exames tomográficos, achados ultrassonográficos após biópsia por aspiração com agulha fina e histologia tumoral de 953 nódulos de 698 pacientes submetidos à tireoidectomia foram coletados e analisados. O escore de benefício para detecção do tumor maligno para cada modalidade adotada foi avaliado. Resultados As imagens de ultrassom não mostraram uma lesão sólida bem circunscrita em 89 nódulos; e na análise final não foram detectados nódulos nas biópsias por aspiração com agulha fina (nódulos não malignos falsos positivos). As imagens ultrassonográficas mostraram doença parenquimatosa (nódulos malignos falsos positivos) em vários nódulos. Os exames de tomografia computadorizada apresentaram grandes dificuldades na detecção de nódulos malignos de 1,0-2,0 cm de tamanho em comparação com o exame de ultrassonografia após biópsias por aspiração com agulha fina; comparados aos dados histológicos do tumor, os exames de tomografia computadorizada apresentaram sensibilidade de 0,879. Conclusão Os exames de tomografia computadorizada são um método mais confiável para o diagnóstico diferencial de nódulos tireoidianos do que os exames de ultrassonografia, seguidos por biópsia por aspiração com agulha fina.


Subject(s)
Humans , Thyroid Neoplasms/diagnostic imaging , Thyroid Nodule/diagnostic imaging , Tomography, X-Ray Computed , Retrospective Studies , Sensitivity and Specificity , Biopsy, Fine-Needle , Diagnosis, Differential
10.
Arch. endocrinol. metab. (Online) ; 65(3): 322-327, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1285159

ABSTRACT

ABSTRACT Objective: Percutaneous ethanol injection (PEI) is an alternative to surgery for the treatment of thyroid nodules (TNs). However, size reductions of treated (TTNs) and untreated TN (UTNs) have not been compared. Volumetric reductions in TTNs with PEI were evaluated by comparing TTNs and UTNs in the same patient, and independent variables predicting good post-PEI outcomes were analyzed. Materials and methods: Overall, 282 patients with multinodular goiters were selected. Two nodules located in different lobes were compared for common disease behaviors. Overall, 150 nodules were selected from 75 patients (6 M: 69 F) with a mean age of 50.1 ± 17.4 years. This prospective nonrandomized intervention study prioritized treating TNs of greater volume or single hyperfunctioning TNs. A single observer experienced in PEI and an ultrasound specialist performed the interventions. Results and discussion: TTNs (mean volume: 14.8 ± 16.2 mL) were reduced by 72.6 ± 27.3% of their initial volume, while UTNs increased by a mean of 365.7 ± 1.403.8% (p < 0.00001). The patients underwent a mean of 4.0 ± 3.1 outpatient PEI sessions without relevant complications. Logistic regression analysis showed that the magnitude of the PEI induced reduction was associated with the number of treatment sessions (p = 0.03, CI [1.1-38.2]) and not with ultrasonographic characteristics of the nodules. Each PEI session increased the rate of TN reduction by a factor of 6.7. Conclusions: PEI is a well-tolerated outpatient procedure that effectively reduces the volume of TNs and is noticeably superior to conservative treatment for all ultrasonographic classifications.


Subject(s)
Humans , Adult , Aged , Thyroid Nodule/drug therapy , Thyroid Nodule/diagnostic imaging , Prospective Studies , Ultrasonography , Treatment Outcome , Ethanol , Middle Aged
11.
Braz. j. otorhinolaryngol. (Impr.) ; 87(3): 338-345, May-Jun. 2021. tab, graf
Article in English | LILACS | ID: biblio-1285684

ABSTRACT

Abstract Introduction Only 5%-15% of thyroid surgical specimens are reported as malignant. Most of the operations are performed due to suspicion of malignancy as a result of fine needle aspiration biopsy but invasiveness, non-diagnostic results and potential repeat biopsies are disadvantages of fine needle aspiration biopsy. Objective The aim of this study was to investigate the effectiveness of simultaneously using both the strain ratio and elasticity score in the differential diagnosis of thyroid nodules, as well as to assess the compatibility of these two methods. Methods A total of 144 nodules were included in the study. The final histopathologic diagnosis was used as the reference standard. The area under the curve sensitivity, specificity, and cut-off values of the strain ratio and elasticity score were determined using receiver operating characteristic curve analysis. The compatibility and comparison of strain ratio and elasticity score were also performed. Results Twenty eight nodules (19.4%) were malignant. The strain ratio and elasticity score results were found to be significantly successful in predicting thyroid malignancy (p < 0.001 for both). Moreover, the area under the curve for the strain ratio and elasticity score were found to be 0.944 and 0.960, respectively. The diagnostic accuracy of the elasticity score was found to be superior to that of the strain ratio, but this difference was not statistically significant (p = 0.456). When the compatibility of the strain ratio and elasticity score was examined, the two evaluations were revealed to be statistically consistent with each other (Kappa = 0.767; p < 0.001). When the strain ratio and the elasticity score were used together, the specificity of capturing the correct diagnosis increased from 84.5% to 93.1%. Conclusion When the strain ratio an elasticity score were used together for the differential diagnosis of thyroid nodules, more accurate results were obtained. Thus, combining both methods may be a promising alternative to fine needle aspiration biopsy in order to prevent unnecessary surgical interventions for suspected thyroid nodules.


Resumo Introdução Apenas 5% a 15% das amostras cirúrgicas de tireoide são relatadas como malignas. A maioria das cirurgias é feita devido à suspeita de lesão maligna como resultado da biópsia por punção aspirativa com agulha fina. Entretanto, invasividade, resultados não diagnósticos e biópsias repetidas são desvantagens desse procedimento. Objetivo Investigar a eficácia do uso simultâneo da razão de compressão e do escore de elasticidade no diagnóstico diferencial de nódulos tireoidianos, bem como avaliar a compatibilidade desses dois métodos. Método Foram incluídos no estudo 144 nódulos. O diagnóstico histopatológico final foi usado como padrão de referência. A área sob a curva sensibilidade, especificidade e valores de corte da razão de compressão e do escore de elasticidade foram determinados com a análise da curva Receiver Operating Characteristic. A compatibilidade e comparação da razão de compressão e do escore de elasticidade também foram feitas. Resultados Eram malignos 28 nódulos (19,4%). Os resultados da razão de compressão e do escore de elasticidade foram significantemente bem-sucedidos em prever a lesão maligna de nódulos da tireoide (p < 0,001 para ambos). Além disso, as áreas sob a curva para a razão de compressão e o escore de elasticidade foram de 0,944 e 0,960, respectivamente. A acurácia diagnóstica escore de elasticidade foi superior à da razão de compressão, mas essa diferença não foi estatisticamente significante (p = 0,456). Quando a compatibilidade da razão de compressão e do escore de elasticidade foi examinada, as duas avaliações mostraram-se estatisticamente consistentes (Kappa = 0,767; p < 0,001). Quando a razão de compressão e o escore de elasticidade foram usados em conjunto, a especificidade de captar o diagnóstico correto aumentou de 84,5% para 93,1%. Conclusão Quando a razão de compressão e o escore de elasticidade foram usados juntos para o diagnóstico diferencial de nódulos tireoidianos, resultados mais precisos foram obtidos. Assim, o uso combinado dos dois métodos pode ser uma opção promissora à biópsia por punção aspirativa com agulha fina e evitar intervenções cirúrgicas desnecessárias para nódulos tireoidianos suspeitos.


Subject(s)
Humans , Thyroid Nodule/surgery , Thyroid Nodule/diagnostic imaging , Elasticity Imaging Techniques , Sensitivity and Specificity , Biopsy, Fine-Needle , Diagnosis, Differential
12.
An. Fac. Med. (Perú) ; 82(2): 118-123, abr.-jun 2021. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1339083

ABSTRACT

RESUMEN Objetivo. Establecer la asociación entre insulinorresistencia y nódulos tiroideos en mujeres eutiroideas residentes de Lima Metropolitana. Métodos. Estudio en mujeres eutiroideas, de 20 a 70 años de edad: 32 casos (con nódulos tiroideos) y 32 controles (sin nódulos tiroideos), por ecografía tiroidea, anticuerpos anti tiroideos negativos y excreción de yodo urinario (EUI) adecuado, pareados por edad e IMC, atendidos en la Red Asistencial Almenara EsSalud. Mediante una ficha clínica se registró la edad y parámetros antropométricos. Se midió: glucosa, insulina basal (IB), e insulinorresistencia (IR) mediante el modelo homeostático (HOMA-IR ≥ 2,97). EUI fue detectada por espectrofotómetro a 420 nm, se consideró adecuado entre 100-300 ug/L. Para el análisis estadístico se utilizó la prueba t de student, la prueba Chi2, la prueba exacta de Fisher y Odds Ratio ajustado por edad y obesidad abdominal, considerándose un p<0,05 estadísticamente significativo. Resultados. Se observó diferencias significativas de los promedios entre el grupo de casos y controles en la glucosa en ayunas, IB, HOMA-IR (4,3 vs 2,5, p <0,05), y los niveles de EUI fueron menores en el grupo de casos comparados con los controles (167,2 vs 228,3 ug/L, p <0,001). La IR fue más frecuente en el grupo de casos que en el grupo control (82,3% vs 28,1%; p <0,001). El Odds Ratio fue 14,8 (95% IC: 3,4-65,1). Conclusión. En este estudio se encontró una significativa asociación entre la presencia de nódulos tiroideos e insulinorresistencia en mujeres adultas eutiroideas residentes de una región yodo suficiente.


ABSTRACT Objective. To establish the association between insulin resistance and thyroid nodules in euthyroid women from Metropolitan Lima. Methods. Study in euthyroid women, 20 to 70 years of age: 32 cases (with thyroid nodules) and 32 controls (without thyroid nodules), by ultrasound of the thyroid, negative anti-thyroid antibodies, and adequate urinary iodine excretion (EUI), matched by age and BMI, treated in the Almenara-EsSalud care network. Using a clinical record, age and anthropometric parameters were recorded. Was measured: glucose, basal insulin (IB), and insulin resistance (IR) using the homeostatic model (HOMA- IR ≥ 2.97). EUI was detected by spectrophotometer at 420 nm, it was considered adequate between 100-300 ug/L. For the statistical analysis, the student's t-test, Chi-square test, Fisher's exact test, and Odds Ratio adjusted for age and abdominal obesity were used, considering a statistically significant p <0.05. Results. Significant differences were observed in the means between the group of cases and controls in fasting glucose, IB, HOMA-IR (4.3 vs 2.5, p <0.05), and EUI levels were lower in the group of cases (167.2 vs 228.3 ug/L p <0.001). IR was more frequent in the case group than in the control group (82.3% vs 28.1%; p <0.001). The Odds Ratio was 14.8 (95% CI: 3.4-65.1). Conclusion. In this study, a significant association was found between the presence of thyroid nodules and insulin resistance in euthyroid adult women residing in an iodine-sufficient region.

13.
Gac. méd. Méx ; 157(1): 19-24, ene.-feb. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1279068

ABSTRACT

Resumen Introducción: La elastografía por ondas de corte (SWE) ha demostrado ser predictiva de malignidad en nódulos tiroideos. Objetivo: Determinar mediante SWE, el punto de corte de la rigidez con mayor especificidad y sensibilidad para detectar nódulos tiroideos que requieren cirugía. Métodos: Estudio transversal de pacientes con nódulos tiroideos evaluados ultrasonográficamente en un periodo de tres años; se empleó la clasificación TI-RADS y mediante SWE se determinó la rigidez de los nódulos. Con el sistema Bethesda se clasificaron las muestras histopatológicas y mediante curva ROC se obtuvo el punto de corte de la rigidez con mayor especificidad y sensibilidad. Resultados: 41 % de los nódulos fue TI-RADS 5 y 59 %, TI-RADS 1-4. En los TI-RADS 5, la mediana de rigidez de los nódulos con categoría IV-VI del sistema Bethesda fue de 35.9 kPa y en los nódulos con TI-RADS 1-4, 21.6 kPa. En los nódulos TI-RADS 5, la rigidez > 32.5 kPa tuvo especificidad de 75 % y sensibilidad de 57 % para detectar los que requieren cirugía; en los TI-RADS 1-4, el valor de corte de 21.5 kPa tuvo especificidad de 63 % y sensibilidad de 51 %. Conclusión: La rigidez determinada por SWE es útil para detectar nódulos que requerirán exploración quirúrgica.


Abstract Introduction: Shear-wave elastography (SWE) has been shown to be predictive of malignancy in thyroid nodules. Objective: To determine, by SWE, the stiffness cutoff point with the highest specificity and sensitivity to detect thyroid nodules that require surgery. Methods: Cross-sectional study of ultrasonographically-evaluated patients for thyroid nodules over a period of three years; the TI-RADS classification system was used, and nodule stiffness was determined by SWE. Histopathological specimens were classified using the Bethesda system, and the stiffness cutoff point with the highest specificity and sensitivity was obtained using ROC curves. Results: Forty-one percent of the nodules were classified as TI-RADS 5, and 59 %, as TI-RADS 1-4. In TI-RADS 5 nodules, median stiffness of those in Bethesda system IV-VI categories was 35.9 kPa; in nodules with TI-RADS 1-4, 21.6 kPa. In TI-RADS 5 nodules, a cutoff point > 32.5 kPa had a specificity of 75 % and sensitivity of 57 % to detect those requiring surgery; in TI-RADS 1 to 4 nodules, a cutoff point of 21.5 kPa had a specificity of 63 % and sensitivity of 51 %. Conclusion: SWE-determined stiffness is useful to detect nodules that require surgical evaluation.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Thyroid Nodule/diagnostic imaging , Elasticity Imaging Techniques/methods , Thyroid Gland/pathology , Thyroid Gland/diagnostic imaging , Cross-Sectional Studies , Sensitivity and Specificity , Thyroid Nodule/pathology , Biopsy, Fine-Needle/methods
14.
Chinese Journal of Radiology ; (12): 710-715, 2021.
Article in Chinese | WPRIM | ID: wpr-910229

ABSTRACT

Objective:To explore the value of multi-parametric MRI for thyroid gland in differentiating benign and malignant thyroid nodules.Methods:From December 2018 to May 2020, 78 patients with 91 post-surgically pathologically confirmed thyroid nodules were enrolled in Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. For each patient, the following MRI findings were obtained including the nodules′ location, size, shape, margin, signal intensity, cystic change, degree and pattern of contrast enhancement, involvement of surrounding structure, and ADC values. The time-intensity curve (TIC) were plotted and subtyped based on dynamic contrast enhancement MRI. The MRI findings between the benign and malignant thyroid nodules were compared using Mann-Whitney U test, χ 2 test or Fisher exact test. Multiple logistic regression analysis was used to select independent predictive variables and build a combined model, and the ROC curve was used to evaluate the diagnostic performance of each MRI finding and the combined model. Results:Between the benign and malignant thyroid nodules, the significant differences were found in size, shape, margin, presence of cystic changes, T 1WI signal intensity, ADC value, enhancement homogeneity, TIC subtypes and presence of thyroid capsule involvement ( P<0.05). Multivariate logistic analysis showed that ill-defined margin (OR=77.61), no presence of cystic changes (OR=36.11) and difference between TIC subtypes (OR=83.41) were independent predictive variables, and the area under the ROC curve (AUC) was 0.879, 0.788, and 0.751, respectively. The AUC, sensitivity and specificity of the combined model were 0.977, 0.986, and 0.904, respectively. Conclusions:Thyroid multi-parametric MRI derived findings can be used for the differential diagnosis of benign and malignant nodules. Combined with the independent risk factors with ill-defined margin, no presence of cystic changes, TIC of type plateau or washout, the diagnostic model has a higher diagnostic efficiency.

15.
Chinese Journal of Rheumatology ; (12): 516-520,C8-1, 2021.
Article in Chinese | WPRIM | ID: wpr-910200

ABSTRACT

Objective:By analyzing the clinical and pathologic manifestations of systemic mastocytosis (SM) to improve the recognition of the disease.Methods:Clinical manifestations, diagnosis and treatment of a middle-aged male patient with SM was reported with multidisciplinary discussions.Results:A middle-aged man with bone pain, thyroid nodules and lymphadenectasis came to our clinic. Thyroid cancer with lymph node and bone metastasis was suspected by imaging examination. The pathological results showed cell proliferation with transparent cytoplasm and irregular nuclear in the trabecular bone. Toluidine blue staining showed the proliferated cells were mast cells(+). Immunohistochemistry showed proliferating mast cells stained with CD117 and CD2. SM with extensive bone marrow involvement was diagnosed and treated with thalidomide and calcitriol.Conclusion:Knowing the characteristics of SM is helpful for accurate diagnosis and treatment.

16.
Article in Chinese | WPRIM | ID: wpr-910131

ABSTRACT

Objective:To validate the Chinese version of Thyroid Imaging Report and Data System (C-TIRADS) for the malignancy risk stratification assessment of thyroid nodules, and compare with the American College of Radiology TIRADS(ACR-TIRADS) for diagnostic performance.Methods:A total of 1 306 patients with 1 389 thyroid nodules in the First Affiliated Hospital of Hainan Medical University from January 2015 to March 2021 were reviewed and assessed for diagnostic performance according to the C-TIRADS and the ACR-TIRADS, respectively, and the histopathological results were taken as golden standard.Results:The 1 389 thyroid nodules consisted of 973 benign nodules and 416 malignant nodules. The C-TIRADS 4C and ACR-TIRADS 5 had the highest accuracies and were taken respectively as the optimized cut-off values for diagnosis.The sensitivity, specificity, positive and negative predictive values and AUC by C-TIRADS 4C and ACR-TIRADS 5 for thyroid nodule evaluation were 87.39%, 89.92%, 75.00%, 95.38%, 0.89, and 85.58%, 91.88%, 81.84%, 93.71%, 0.89, respectively(all P>0.05). Conclusions:The C-TIRADS and ACR-TIRADS have good diagnostic performance for the malignancy risk stratification of thyroid nodules, and C-TIRADS 4C has comparable diagnostic performance to ACR-TIRADS 5.

17.
Article in Chinese | WPRIM | ID: wpr-910121

ABSTRACT

Objective:To compare the diagnostic values of C-TIRADS, ACR-TIRADS and EU-TIRADS.Methods:According to the classification methods of the 3 guidelines, the ultrasonographic features of 283 thyroid nodules from 266 patients in Sir Run Run Shaw Hospital from January 2019 to June 2020 were analyzed retrospectively. The pathological results were taken as the gold standard, the malignant percentage of different classification was calculated, the ROC curve was plotted, the area under the ROC curve (AUC) and the best diagnostic cut-off value were calculated, and the diagnostic values of the three guidelines were compared. According to the FNA recommendations of the guidelines, the recommended number of thyroid nodules and the detection rate of malignant nodules in different guidelines were analyzed.Results:The AUCs of C-TIRADS, ACR-TIRADS and EU-TIRADS were 0.80, 0.66, 0.61, respectively. The AUC of C-TIRADS was higher than those of ACR-TIRADS and EU-TIRADS ( P<0.001, P<0.001). The best diagnostic cutoff values of C-TIRADS, ACR-TIRADS and EU-TIRADS were 4C, 5 and 5, respectively. Under the critical points, the sensitivities of the 3 guidelines were 95.27%, 98.10%, 99.53%, the specificities were 54.17%, 33.33%, 20.83%, respectively. There was no significant difference in the number of FNA recommendations among the 3 guidelines(all P>0.05), their FNA recommendations were highly consistent (Kappa>0.9). Conclusions:The diagnostic value of C-TIRADS in the classification of benign and malignant thyroid nodules is higher than those of ACR-TIRADS and EU-TIRADS. The best critical value for diagnosis of thyroid nodules is C-TIRADS 4C. The three guidelines are similar in the number of FNA recommendations and the detection rate of malignancy.

18.
Article in Chinese | WPRIM | ID: wpr-910112

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Objective:To explore the applicational value of identifying different types of echogenic foci and distinguishing the lesions between benign and malignant lesions in histopathology classification.Methods:The detailed clinical data of 223 patients (264 thyroid nodules) with echogenic foci in preoperative ultrasound from October 2018 to December 2019 in the Sir Run Run Shaw Hospital of Zhejiang University School of Medicine were retrospectively analyzed. The echogenic foci were categorized as big comet-tail artifact, small comet-tail artifact, microcalcification, coarse calcification, peripheral calcification and eggshell calcification. At the same time, other ultrasonographic features were included in order to comparatively analyze with postoperative pathological findings. Independent samples t test and univariate chi-square test were performed to obtain meaningful information of sex, age, body mass index (BMI), thyroid stimulating hormone (TSH), serum free triiodothyronine (FT 3), serum free thyroxine (FT 4), aspect ratio, composition, margin, echo type, echogenic foci; Logistic regression analysis was performed to screen out the independent influence factors in order to forecast malignant lesions. Spearman correlation analysis was performed to determine the ralationships between the clinical indicators and the pathologic results of thyroid lesions. Results:Among the 264 lesions, there were 219(83.0%) malignant nodules and 45(17.0%) benign nodules. For malignant lesions, except for big comet-tail artifact, other types of echogenic foci were all founded, including 152(69.4%) microcalcification, 41(18.7%) small comet-tail artifact, 17(7.8%) coarse calcification, 7(3.2%) peripheral calcification, 2(0.9%) eggshell calcification. While in benign lesions, there were 13(28.9%) microcalcification, 9(20.0%) coarse calcification, 8(17.8%) peripheral calcification, 6(13.3%) small comet-tail artifact, 6(13.3%) big comet-tail artifact, 3(6.7%) eggshell calcification with all echogenic foci types included. Univariate analysis showed that differences between benign and malignant lesions regarding age, serum FT 4, aspect ratio, composition, margin, echo type, echogenic foci were statistically significant (all P<0.05), Logistic regression analysis indicated that age, serum FT 4, hypoechoic, solid, small comet-tail artifact and microcalcification were independent influence factors for malignancy( OR=0.946, 0.026, 47.656, 9.032, 7.925, 12.767; all P<0.05), age and serum FT 4 were correlated with the pathologic results of thyroid lesions ( rs=-0.259, -0.156; all P<0.05). Conclusions:It is highly suggestive of malignancy when the thyroid lesions are solid, hypoechoic, and echogenic foci type is small comet-tail artifact or microcalcification.

19.
Clinical Medicine of China ; (12): 526-531, 2021.
Article in Chinese | WPRIM | ID: wpr-909789

ABSTRACT

Objective:To analyze the correlation between simple thyroid nodule and blood lipid and glucose metabolism and iodine nutrition level.Methods:A cross-sectional study was conducted by collecting data of the population undergoing epidemiological investigation in Jinshan District, Shanghai from July to December 2015, to calculate the prevalence of thyroid nodules and analyze relevant functional indicators.Results:Simple thyroid nodules were detected in 603 subjects, with a prevalence of 22.6% (603/2 669). There were 358 female patients with simple thyroid nodules, with a prevalence rate of 26.9%, and 245 male patients with simple thyroid nodules, with a prevalence rate of 18.3%. The prevalence of simple thyroid nodule in female was higher than that in male, and the difference was statistically significant (χ 2=27.686, P<0.001). In addition, the prevalence of simple thyroid nodules increased with age (13.1% (92/704) and 20.2% (104/514) and 25.1% (145/578) and 24.4% (107/439) and 36.3% (98/270) and 34.8% (57/164), χ 2=83.872,P<0.001). In the ≤30 years group (8.0% (30/704) vs. 18.8% (62/331), χ 2=35.716, P<0.001), >30 to ≤40 years old group (14.1% (37/263) vs. 26.7% (67/251), χ 2=12.683, P<0.001), >60 to ≤70 years old group (26.2% (33/126) vs. 45.1% (65/144), χ 2=10.435, P<0.001), and the 70-year-old group (24.4% (21/86) vs. 46.2% (36/78), χ 2=8.521, P<0.001). The prevalence of simple thyroid nodules in males was lower than that in females. In the simple positive thyroid nodule group, Fasting blood glucose (5.12 (4.80, 5.69) and 5.02 (4.72, 5.48)), total cholesterol (1.24 (0.85, 1.86) and 1.13 (0.77, 1.76)), triglyceride (4.77 (4.09, 5.48) and 4.49 (3.92, 5.16)), low density lipoprotein((2.79 (2.26, 3.36) and 2.63 (2.19, 3.16)), and high density lipoprotein cholesterol (1.41 (1.18, 1.66) and 1.35 (1.13, 1.61)) were higher than those in the negative group ( U values were 554 818, 578 468, 535 622, 556 067 and 567 960, respectively, all P<0.01). The BMI index grade distribution of thyroid nodule positive group was higher than that of negative group, and the difference was statistically significant (3.7% (77/2 066), 50.1% (1 034/2 066), 32.4% (669/2 066), 13.8% (286/2 066), 3.2% (19/603), 43.6% (263/603), 38.1% (230/603), 15.1% (91/603), χ2=9.5201, P=0.023). The prevalence of simple thyroid nodules was significantly lower in the iodized salt group than in the non-iodized salt group (20.7% (436/2 102) vs. 29.5% (167/567), χ 2=19.376, P<0.001). The urinary iodine level in the positive thyroid nodule group was significantly lower than that in the negative group (148.4(100.2, 213.7) vs. 169.5(115.4, 241.75), U=545 129.5, P<0.001). After Logistic regression screening, age ( OR=1.57, 95% CI: 1.292-1.908, P<0.001), gender ( OR=1.278, 95% CI: 1.193-1.368, P<0.001), BMI grade ( OR=1.166, 95% CI: 1.022-1.330, P=0.022), total cholesterol ( OR=1.105, 95% CI: 1.005-1.214, P=0.040), iodized salt ( OR=0.689, 95% CI: 0.556-0.854, P=0.001) were independent influencing factors of thyroid nodule. Conclusion:The prevalence of simple thyroid nodules in Shanghai is relatively low. Age, sex, BMI level, total cholesterol and iodized salt are independent factors causing thyroid nodules. In addition, blood glucose level may also be related to the prevalence of thyroid nodules.

20.
Journal of Chinese Physician ; (12): 813-816, 2021.
Article in Chinese | WPRIM | ID: wpr-909624

ABSTRACT

Objective:To investigate the diagnostic value of high frequency ultrasound in benign and malignant thyroid partially cystic nodules.Methods:The preoperative ultrasound features of 159 thyroid cystic and solid nodules confirmed by surgery and pathology in Shenzhen Longgang Central Hospital from June 2017 to January 2021 were retrospectively analyzed. According to the ultrasonic manifestations, it can be divided into four types: type Ⅰ, band separation or flocculent echo in the interior; type Ⅱ, the small papillary middle echo process was seen on the wall; type Ⅲ, with band separation or flocculent echo and papillary medium echo process; type Ⅳ, the internal was mainly solid echo, and the inner part was irregular small piece echo and fissure echo free echo. The coincidence rate of ultrasonic diagnosis and pathological results of all types was observed.Results:Among 159 cystic and solid thyroid nodules, 22 were malignant and 137 were benign. The coincidence rate of ultrasonic diagnosis and pathological results of type Ⅰ, Ⅱ, Ⅲ and Ⅳ cystic solid thyroid nodules were 97%(61/63), 80%(45/56), 90%(9/10) and 67%(20/30), respectively. Type Ⅰ, type Ⅱ, type Ⅲ were mainly cystic components, with cystic components ≥ 50%; In type Ⅳ, solid component was the main component and cystic component was less than 50%.Conclusions:The internal zonal separation or flocculent echo was the characteristic ultrasonic manifestation of benign cystic solid nodules; It is easy to be misdiagnosed because of the lowest coincidence rate of ultrasound diagnosis for cystic and solid thyroid nodules with internal solid echo, irregular small piece like and fissure like anechoic. Careful observation of the characteristics can improve the accuracy of ultrasound diagnosis.

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