Importance: Although most thyroid nodules are benign, 10% to 15% of them harbor cancer. Thyroid ultrasonography is useful for risk stratification of nodules, and American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) classification provides recommendations for fine-needle aspiration cytology (FNAC) based on objective ultrasonographic features of these nodules. Objective: To validate the concordance of ACR TI-RADS classification with Bethesda classification and histopathology. Design, Setting, and Participants: This retrospective cohort study was performed to evaluate the concordance of ACR TI-RADS classification with Bethesda classification and histopathology and was conducted in Singapore General Hospital Outpatient Otolaryngology clinic in March 2021 to May 2021. Data analysis was performed in May 2021. Main Outcomes and Measures: Results were deemed concordant when ACR TI-RADS recommendations aligned with Bethesda scores. Conversely, results were classified as nonconcordant with Bethesda scores and/or histopathology results when nodules that were recommended for FNAC yielded benign results or nodules that were not recommended for FNAC yielded malignant results. Results: A total of 446 patients (370 women [83%]; mean [range] age, 60 [24-89] years) who underwent ultrasonography of the thyroid and ultrasonography-guided thyroid FNACs were identified. A total of 492 of 630 nodules (78.1%) were benign on FNAC (Bethesda II). Score 3 ACR TI-RADS nodules yielded the highest negative predictive values: 94.6% (95% CI, 92.9%-95.9%; P < .001) compared with Bethesda scoring and 100.0% (95% CI, 15.8%-100.0%; P = .003) compared with histopathology. Score 4 or 5 ACR TI-RADS nodules yielded positive predictive values of 2.8% and 16.2%, respectively, compared with Bethesda scoring and 6.1% and 66.7%, respectively, compared with histopathology. Small (<1.5 cm) ACR TI-RADS nodules of scores of 4 and 5 that were not recommended for FNAC yielded a malignant risk of 5.7% and 25.0% on Bethesda 5 and 6, respectively. On surgical excision, 5 of 46 (10.9%) ACR TI-RADS 4 nodules and 15 of 21 (71.4%) of ACR TI-RADS 5 nodules were confirmed to be malignant. Among nodules initially not recommended for FNAC, histopathology-proven cancer was found in 4 of 13 (30.7%) and 3 of 6 (50.0%) of nodules, respectively. Conclusions and Relevance: These findings suggest that ACR TI-RADS score 3 nodules have a low risk of cancer and should be considered for FNAC only if nodules are 2.5 cm or larger. Patients with small (<1.5 cm) ACR TI-RADS 4 and 5 nodules should be appropriately counseled for FNAC to exclude cancer.
Thyroid Nodule , Humans , Female , Middle Aged , Thyroid Nodule/diagnostic imaging , Retrospective Studies , Biopsy, Fine-Needle , Risk Assessment
BACKGROUND: The objective of the study was to evaluate the quality of life (QOL) of head and neck cancer survivors after surgical treatment and to identify patients' main concerns. The study also aims to establish pre-treatment reference values particularly for the Asian patient. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and Head and Neck module (EORTC QLQ-HN35) were used for objective evaluation. METHODS: Patients planned for elective surgery for head and neck cancers were enrolled in the study. The questionnaires were completed at pre-treatment and at 6 months after surgery. Results were compared with previously published reference values. RESULTS: One hundred forty patients completed both questionnaires. Locally advanced tumour and extent of surgery (tracheostomy (p<0.01), surgical flap (p<0.01)) were associated with lower global health scores. Adjuvant treatment was also a contributory factor (p<0.01). Dysphagia and social eating was a primary concern within our population. CONCLUSION: Surgical treatment of head and neck cancers is safe, but there is poor QOL in the early post-treatment period especially with eating. Previously published data suggested improvement after a year.
Head and Neck Neoplasms , Quality of Life , Head and Neck Neoplasms/surgery , Humans , Surveys and Questionnaires , Survivors
INTRODUCTION: Giant intra-abdominal cystic lesions are seldom encountered and can post a diagnostic challenge pre-operatively. These often present as increasing abdominal size and from its mass effect. PRESENTATION OF CASE: Here, we present a case of a 58 year-old gentleman with worsening bloating and abdominal distension. A contrasted CT scan of the abdomen revealed a giant intra-abdominal cyst with no definite organ of origin. He underwent a laparotomy and excision of the giant cyst which was not found to be attached to any organ or mesentery. This resulted in resolution of his symptoms and a drastic improvement in his appetite. DISCUSSION: It is often difficult to identify the origin of giant intra-abdominal cysts as pre-operative imaging may show it abutting multiple organs due to its size. Common intra-abdominal cysts include mesenteric, ovarian or peritoneal cysts. A precipitating history such as pancreatitis or surgical implants can suggest pseudocysts. Surgical excision alone is curative but can be difficult due to the size. Controlled intra-operative aspiration can aid in visualization and dissection. CONCLUSION: Giant intra-abdominal cystic lesions cause significant discomfort due to its mass effect. Pre-operative investigations may not identify its cause. Surgical excision is recommended to diagnostic and therapeutic purposes.
Primary squamous cell carcinoma of the thyroid gland (PSCCTh) and anaplastic thyroid carcinoma with extensive squamous differentiation are rare entities which pose a diagnostic challenge in determining the primary site when presented as metastases. The difficulty in confirming a thyroid primary is further compounded by the aggressive nature of these tumours which frequently present at advanced stages. We present a case in which the patient presented with a thyroid mass and a lung mass simultaneously. The risk of misinterpreting the site of primary tumour as lung is greatly increased because squamous cell carcinoma of lung is much more common than its thyroid counterpart. This case highlights the effectiveness of PAX-8 stain in determining the primary site of tumour when squamous cell carcinoma is found in both lung and thyroid gland.
