Utilidad diagnóstica de la ecografía tiroidea en la evaluación de nódulos tiroideos en niños y adolescentes / Diagnostic utility of thyroid ultrasound ecografy in thyroid nodules evaluation in children and adolescents

AIM: To evaluate the diagnostic utility of ultrasonography and other antecedents and exams usually availables, in the study of patients with thyroid nodules aged 0-20 years. SUBJECTS AND METHODOLOGY: Cross-sectional analytical observational study. We reviewed the data of patients undergoing FNAP (thyroid puncture with a fine needle) and / or thyroidectomy between January 2007 and December 2013. The ultrasound evaluation was performed by 3 specialists. The surgical biopsy was considered an indicator of benignity or malignancy and, in its absence the FNAP (excluding the Bethesda diagnoses 3 and 4). The association between cancer and the different variables was evaluated through binary logistic regression, with measure of association of odds ratio (OR). With the initially significant variables, a multivariate analysis was carried out and a cut-off score was subsequently defined to allow the diagnosis to be discriminated. RESULTS: 104 nodules are included in the analysis (100 patients), 89♀ / 11♂; age x16 ± 2.8; TSH 2.8 uIU / ml ± 5; lymphocytic thyroiditis 30%; pathological anatomy: benign 46 (44%) cancer 58 (56%). Sonographic findings predictive of malignancy were: hypoechogenicity (OR 2.95 p = 0.008) irregular shape (100% CA) non-smooth edges (OR 8.5 p = 0.000) microcalcifications (OR 39 p = 0.000) thick calcifications (OR 18 p = 0.001) and presence of suspicious adenopathy (100% CA). In the TIRADS classification, cases classified as 4 and 5 corresponded to cancer in 50 and 92%. The presence of thyroiditis did not show an insignificant association with malignancy. From the joint analysis of the significant variables, a score with adequate sensitivity and specificity is obtained. CONCLUSIONS: The usefulness of ultrasound as a fundamental examination in the evaluation of the pediatric patient who consults by thyroid nodule is corroborated. Accurately describing their sonographic characteristics and, above all, analyzing them together, allows us to determine an approximate risk of malignancy and define with greater certainty the indication of performing FNAP

Resonancia Magnetica Mamaria: Indicaciones Poco Habituales / Breast MR imaging: unusual indications

The indications of breast MRI are now clearly established and internationally accepted. They are also applied in Chile as was agreed in the last the National Consensus on the management of breast cancer. In our study the indications not mentioned in the consensus were classified as infrequent. We determined that a 9.2 percent of breast MRI performed in our study centers were due to infrequent indications, leading to a change in medical management in 71,4 percent of these patients, although this change sometimes had no scientific evidence availing it. These results suggest that MRI could be useful in specific situation and reveal a need for multicentric high quality studies in order to gather enough evidence to justify its use in indications other than the ones already established. In other situations MRI would not be recommended. In exceptional cases, where it seems useful to perform this type of exam it is suggested to make the advisable to make the decision after discussion in a interdisciplinary committee.

Las indicaciones de resonancia magnética mamaria están bien definidas e internacionalmente aceptadas. Se aplican también en Chile según lo establecido en el último Consenso Nacional sobre cáncer mamario, sin embargo observamos que un porcentaje no despreciable (9.2 por ciento) de las resonancias mamarias realizadas en nuestros centros de atención son por indicaciones distintas a las establecidas. En un 71.4 por ciento de estos casos generó un cambio en la conducta médica, situación que en algunos casos no contó con respaldo científico establecido. Estos resultados orientan a pensar que la resonancia sería de utilidad en casos específicos y demuestran la necesidad de estudios sistematizados, multicéntricos que lleven a reunir la evidencia suficiente para justificar su uso en indicaciones distintas a las ya aceptadas. En los casos en que parezca conveniente realizar este tipo de estudio, sería recomendable discutir su eventual utilidad e influencia en la conducta clínica, en el seno de equipos de especialistas multidisciplinarios.

Detección y caracterización por ultrasonido de cuerpos extraños de partes blandas / Detection and characterization of soft tissue foreign bodies by ultrasonography

Background: Soft tissue foreign bodies are a frequent cause of consultation in emergency rooms. It is difficult to verify their existence since conventional radiology only detects radio opaque objects. Ultrasound can be a useful diagnostic procedure. Aim: To report our experience in the detection of soft tissue foreign bodies by ultrasound examination. Patients and methods: The ultrasonographic appearance of vegetables, glass and plastic, metal, bone and stones was studied in gelatin preparations. In a second stage, 52 patients (27 male, aged 3 to 88 years old) were studied, in whom the presence of a soft tissue foreign body was confirmed surgically. Results: The mean error of the procedure for the assessment of foreign body size was 0.2 mm in vitro and 0.5 mm in vivo. The deepness and involved planes were correctly diagnosed in 96 percent, the number of fragments were diagnosed correctly in 94 percent of cases. The type of foreign body was identified correctly in 77 percent of cases and complications were detected in 100 percent of cases. Conclusions: Ultrasound is a sensitive and accurate method for the detection of soft tissue foreign bodies