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Introduction: Thyroglossal duct cyst (TGDC) is the most frequently encountered developmental anomaly in thyroid genesis with a reported incidence of 7% in the adult population. The cyst is known to develop anywhere along the pathway of thyroid descent but is more frequently seen in the infrahyoid neck in the midline. The incidence of malignancy in a TGDC is approximately 1%; a majority of these are papillary carcinomas. This study was conducted at a single tertiary care centre which spanned over a decade which adds practice changing evidence-based knowledge to existing literature on this rare entity. A comprehensive study which conclusively establishes the imaging features predictive of malignancy in TGDC carcinomas (TGDCa), the protocol for optimal management, clinical outcome and long-term survival of these patients is not available. Although TGDC carcinoma is thought to have an excellent prognosis, there is not enough data available on the long-term survival of these patients. The aim of this study was to identify whether neck ultrasound (US) can serve as an accurate imaging tool for the preoperative diagnosis of TGDC carcinomas. Methods: We accessed the electronic medical records of 86 patients with TGDC between January 2005 to December 2021. Of these, 22 patients were detected with TGDC papillary carcinoma on histopathologic examination. Relevant imaging, treatment and follow up information for all cases of TGDC carcinoma were retrospectively reviewed. We compared US characteristics predictive of malignancy across outcomes groups; malignant vs benign using the Chi-square test. Based on the results, a TGC-TIRADS classification was proposed with calculation of the percentage likelihood of malignancy for each category. Results: Compared to benign TGDCs, malignant TGDCs were more likely to present with following US characteristics: irregular or lobulated margins (90.40 vs. 38.10%), solid-cystic composition (61.90 vs. 17.07%), internal vascularity (47.62 vs. 4.88 %), internal calcification (76.19 vs. 7.32 %) (each p value < 0.005). Calcifications and internal vascularity were the most specific while irregular/lobulated margins were the most sensitive feature for malignancy. AUC under the ROC curve was 0.88. Allpatients were operated and were disease free at the end of 5 years or till the recent follow up. Discussion: US is the imaging modality of choice for pre-operative diagnosis of TGDC carcinoma. Thepre-operative diagnosis and risk stratification of thyroglossal lesions will be aided by the application of the proposed TGC-TIRADS classification, for which the percentage likelihood of malignancy correlated well with the results in our study. Sistrunk procedure is adequate for isolated TGDC carcinoma; suspicious neck nodes on imaging also necessitates selective nodal dissection. Papillary carcinomas have an excellent prognosis with low incidence of disease recurrence.
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Objectives: This study aims to evaluate the role of pretherapy MRI in predicting outcomes in carotid body tumors and propose a grading system for high- and low-risk characteristics. Materials and methods: A retrospective observational study of 44 patients with 51 lesions was carried out from year 2005 to 2020. MR images were reviewed for characteristics of carotid body tumor, and a score was given that was correlated with intra- and postoperative findings. The various other classifications and our proposed Mahajan classification were compared with Shamblin's classification. The area under the curve and ROC curves were used to present the accuracy of different predictive models. Results: Our scoring system allotted a score of 0 to 15 on the basis of MRI characteristics, with scores calculated for patients in our study ranging from 0 to 13. Lesions with scores of 0-6 were considered low risk (45%), and scores of 7-15 were regarded as high risk for surgery (55%). The Mahajan classification stages tumors into four grades: I (10%), II (20%), IIIa (8%), and IIIb (62%). The frequency of vascular injury was 50% in category I and 64% in category IIIb. The frequency of cranial nerve injury was 50%, 66%, and 27% in categories I, II, and IIIb. Conclusion: The Mahajan classification of CBTs evaluates high-risk factors like the distance of the tumor from the skull base and the angle of contact with ICA, which form the major predictors of neurovascular damage and morbidity associated with its surgery. Though the Shamblin classification of CBT is the most widely accepted classification, our proposed Mahajan classification system provides an imaging-based alternative to prognosticate surgical candidates preoperatively.
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Papillary microcarcinoma (PMC) is defined as papillary thyroid carcinoma (PTC) measuring ≤1 cm, irrespective of the presence or absence of the high-risk features. PMCs without any high-risk features referred to as the low-risk PMCs are generally indolent, and most of them remain latent without progression or with very slow progression. Active surveillance (observation without immediate surgery) could identify the small minority of PMCs that progress and rescue surgery for these PMCs should be effective resulting in no influence on the patients' prognosis than performing immediate surgery which might result in more harm than good due to associated morbidity. So, with proper patient selection, organization, and patient counselling, active surveillance has the potential to be a long-term management strategy for patients with PMC. The recent update of the ATA guidelines (2015) incorporated active surveillance as an option within the management protocol of PTC, making it an considerable rather than an experimental treatment option. The cost for immediate surgery is higher than the medical costs of active surveillance for 10 years in most scenarios. Developing countries like India may have certain limitations like lack of understanding, financial constraints and lack of adequate radiology services; hence, we propose additional recommendations along with standard surveillance strategy.
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AIM: The objective of the study was to assess the performance of CT Perfusion in comparison to CECT for preoperative detection of metastases to lymph nodes in squamous cell cancers of oral cavity. METHODS: Twenty-five patients with squamous cell cancers of oral cavity underwent CECT and CTP. Two radiologists evaluated CECT and CTP parameters independently. Surgery and post-operative histopathology was performed in all patients. RESULTS: Level wise analysis of the largest node was done. 102 lymph nodes on CECT and 82 lymph nodes on CTP were correlated with post-operative histopathological findings. CECT had a sensitivity, specificity and accuracy of 75 %, 98.6 % and 91.2 %(p-value <0.001) respectively in differentiating benign from metastatic nodes. Mean transit time[MTT] was significantly the most accurate CTP parameter and carried a sensitivity, specificity, accuracy and AUC of 90.5 %, 93.4 %, 92.7 % and 0.96 (p < 0.001). The sensitivity of MTT was higher than the sensitivity of overall CECT. CONCLUSIONS: CTP is a promising tool for detection of metastatic cervical nodes in squamous cell cancers of the oral cavity.
