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1.
Medicine (Baltimore) ; 100(16): e25566, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879712

RESUMO

ABSTRACT: This study investigated the feasibility of using immunohistochemistry (IHC) instead of PCR to detect BRAF V600E mutant protein in papillary thyroid carcinoma (PTC), and to determine the value of using preoperative BRAF V600E mutant protein by IHC to assist in the diagnosis of thyroid nodule patients with Hashimoto's thyroiditis (HT).The expression of BRAFV600E mutant protein was measured in 23 cases of HT+PTC, 31 cases of PTC, and 28 cases of HT by IHC, followed by PCR in the same samples for validation. SPSS 19.0 software was used for statistical analysis.The sensitivity and specificity of IHC to detect BRAF V600E mutation were 100% and 42.86%, respectively. In addition, the mutation rate of BRAF V600E protein in the HT+PTC group (34.78%, 8/23) was lower than that in the PTC group (80.65%, 25/31).The application of IHC to detect BRAF V600E mutant protein has good sensitivity but not specificity to diagnose PTC. IHC can be used as a preliminary screening method to detect BRAF V600E mutation. The strongly positive (+++) staining of IHC potently indicated BRAF V600E gene mutation. For suspicious thyroid nodules combined with HT, the detection of BRAF V600E mutant protein with IHC alone is not of great significance for differentiating benign and malignant nodules.


Assuntos
Imuno-Histoquímica/estatística & dados numéricos , Proteínas Mutantes/análise , Proteínas Proto-Oncogênicas B-raf/análise , Câncer Papilífero da Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Adulto , Estudos de Viabilidade , Feminino , Doença de Hashimoto/diagnóstico , Humanos , Imuno-Histoquímica/métodos , Masculino , Pessoa de Meia-Idade , Mutação , Inclusão em Parafina , Reação em Cadeia da Polimerase , Valor Preditivo dos Testes , Período Pré-Operatório , Sensibilidade e Especificidade , Coloração e Rotulagem , Glândula Tireoide/metabolismo , Nódulo da Glândula Tireoide/diagnóstico
2.
Eur J Endocrinol ; 184(5): 677-686, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33667192

RESUMO

Objective: Active surveillance of cytologically proven microcarcinomas has been shown as a safe procedure. However, fine needle aspiration biopsy (FNAB) is not recommended by European Thyroid Association (ETA) and American Thyroid Association (ATA) guidelines for highly suspicious nodules ≤ 10 mm. The aim of the study was to assess the outcomes of active surveillance of EU-TIRADS 5 nodules ≤ 10 mm not initially submitted to FNAB. Patients and methods: 80 patients with at least one EU-TIRADS 5 nodule ≤ 10 mm and no suspicious lymph nodes, accepting active surveillance, were included. Results: Mean baseline diameter and volume were 5.4 mm (±2.0) and 64.4 mm3 (±33.5), respectively. After a median follow-up of 36.1 months, a volumetric increase ≥ 50% occurred in 28 patients (35.0%) and a suspicious lymph node in 3 patients (3.8%). Twenty-four patients underwent an FNAB (30.0%) after at least a 1 year follow-up of which 45.8% were malignant, 8.3% benign, 33.3% undetermined and 8.3% nondiagnostic. Sixteen patients (20.0%) underwent conversion surgery after a median follow-up of 57.2 months, confirming the diagnosis of papillary carcinoma in 15/16 cases (not described in 1 histology report), all in remission at 6-12 months postoperative follow-up. Conclusion: Applying ETA and ATA guidelines to avoid FNA of EU-TIRADS 5 sub-centimeter nodules and proceeding to active surveillance of such nodules in selected patients is a safe procedure. Thus, US-FNAB could be postponed until the nodule shows signs of progression or a suspicious lymph node appears, with no added risk for the patient.


Assuntos
Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/terapia , Conduta Expectante , Adulto , Idoso , Biópsia por Agulha Fina , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Medição de Risco , Nódulo da Glândula Tireoide/patologia , Carga Tumoral , Ultrassonografia
3.
Medicine (Baltimore) ; 100(9): e25070, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655985

RESUMO

RATIONALE: Thyroid nodule rupture is a rare complication after microwave ablation (MWA). The ultrasonographic characteristics, clinical course, treatment, or prognosis of thyroid nodule rupture after ablation have not been systematically summarized. Three cases with thyroid nodule rupture after MWA were reported in this study, including the characteristic ultrasound images before ablation and after rupture. Meanwhile, we investigated the etiology, diagnosis, treatment and prevention of the rupture. These findings can provide references for the future clinical practice. PATIENTS CONCERNS: All 3 patients were pathologically diagnosed as benign thyroid nodules by core needle biopsy and then received 1 session of MWA. DIAGNOSES: Fourteen days to 1 month after MWA later, all 3 patients presented with abrupt neck pain and swelling, and 1 of them had a fever. Ultrasound examinations shared common features that the rupture of thyroid capsule and a soft-tissue mass with unclear margin in front of the thyroid gland, which connected with the post-ablation nodule. Three patients were diagnosed as thyroid nodule ruptures. INTERVENTIONS: All 3 patients received conservative management after the ruptures. With the treatment of intravenous antibiotics for 1 week, the neck swelling of patients 1 and 2 both disappeared. The aggravation of neck swelling was found in patient 3. Ultrasonography of the neck revealed irregular fluid echo in the soft-tissue mass, suggesting abscess formation. Aspiration and irrigation were performed. The neck swelling regressed gradually over another 2 weeks with the treatment of antibiotics. Two months after ablation, ultrasound examination showed that the mass had completely disappeared. OUTCOMES: None of the 3 patients underwent open surgery due to thyroid nodule rupture. At 1-year follow-up, the volume reduction rate of thyroid nodules in 3 patients were as follows: 100%, 98.1% and 90.7%. LESSONS: Nodule rupture is a rare but severe complication after MWA of the thyroid nodules. The diagnosis can be confirmed by clinical symptoms and ultrasound examination, and most nodule ruptures could be cured with conservative treatment. Grasping the characteristics of ultrasound imaging during the course of disease, and dynamically assessing course of disease progression by ultrasonography could avoid unnecessary imaging examinations or invasive procedures.


Assuntos
Micro-Ondas/uso terapêutico , Terapia por Radiofrequência/efeitos adversos , Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Masculino , Micro-Ondas/efeitos adversos , Ruptura , Nódulo da Glândula Tireoide/terapia
4.
Endocr Pract ; 27(3): 223-227, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33779555

RESUMO

OBJECTIVE: The Bethesda System for Reporting Thyroid Cytopathology is a uniform method used worldwide to report thyroid fine-needle aspiration (FNA) outcomes. This study focuses on the Nondiagnostic/Unsatisfactory category, designated as Bethesda1 (B1). The documented risk of malignancy for B1 nodules can vary significantly, implying this category is not homogenous and might be composed of different subtypes. Our hypothesis was that B1 subgroups (blood only, insufficient thyrocytes, cyst content) will vary in their malignancy rate. METHODS: The study design was observational and retrospective. The study population included 154 patients in the Galilee Medical Center who underwent FNA examination of the thyroid gland from 2013-2018 and had a B1 result. We looked at the final diagnosis of malignant or benign for patients who underwent surgery and calculated the malignancy rate for each subgroup. RESULTS: Malignancy rates were higher in the Blood subgroup than in the other subgroups, and higher in the Thyrocytes subgroup than in the Cyst subgroup (P < .05). All malignancies were papillary thyroid carcinomas. There was no significant difference in the malignancy rate when we further divided the B1 samples into 2 groups based on the presence of epithelial cells. Many repeat FNA tests resulted in a different B1 subgroup. CONCLUSION: The different malignancy rates suggest that individual management approaches should be considered for each B1 subgroup.


Assuntos
Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Biópsia por Agulha Fina , Humanos , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico
5.
Lancet Digit Health ; 3(4): e250-e259, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33766289

RESUMO

BACKGROUND: Strategies for integrating artificial intelligence (AI) into thyroid nodule management require additional development and testing. We developed a deep-learning AI model (ThyNet) to differentiate between malignant tumours and benign thyroid nodules and aimed to investigate how ThyNet could help radiologists improve diagnostic performance and avoid unnecessary fine needle aspiration. METHODS: ThyNet was developed and trained on 18 049 images of 8339 patients (training set) from two hospitals (the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, and Sun Yat-sen University Cancer Center, Guangzhou, China) and tested on 4305 images of 2775 patients (total test set) from seven hospitals (the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; the Guangzhou Army General Hospital, Guangzhou, China; the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; the First Affiliated Hospital of Sun Yat-sen University; Sun Yat-sen University Cancer Center; and the First Affiliated Hospital of Guangxi Medical University, Nanning, China) in three stages. All nodules in the training and total test set were pathologically confirmed. The diagnostic performance of ThyNet was first compared with 12 radiologists (test set A); a ThyNet-assisted strategy, in which ThyNet assisted diagnoses made by radiologists, was developed to improve diagnostic performance of radiologists using images (test set B); the ThyNet assisted strategy was then tested in a real-world clinical setting (using images and videos; test set C). In a simulated scenario, the number of unnecessary fine needle aspirations avoided by ThyNet-assisted strategy was calculated. FINDINGS: The area under the receiver operating characteristic curve (AUROC) for accurate diagnosis of ThyNet (0·922 [95% CI 0·910-0·934]) was significantly higher than that of the radiologists (0·839 [0·834-0·844]; p<0·0001). Furthermore, ThyNet-assisted strategy improved the pooled AUROC of the radiologists from 0·837 (0·832-0·842) when diagnosing without ThyNet to 0·875 (0·871-0·880; p<0·0001) with ThyNet for reviewing images, and from 0·862 (0·851-0·872) to 0·873 (0·863-0·883; p<0·0001) in the clinical test, which used images and videos. In the simulated scenario, the number of fine needle aspirations decreased from 61·9% to 35·2% using the ThyNet-assisted strategy, while missed malignancy decreased from 18·9% to 17·0%. INTERPRETATION: The ThyNet-assisted strategy can significantly improve the diagnostic performance of radiologists and help reduce unnecessary fine needle aspirations for thyroid nodules. FUNDING: National Natural Science Foundation of China and Guangzhou Science and Technology Project.


Assuntos
Inteligência Artificial , Tomada de Decisões Assistida por Computador , Aprendizado Profundo , Diagnóstico por Computador/métodos , Nódulo da Glândula Tireoide/diagnóstico , Área Sob a Curva , China/epidemiologia , Humanos , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade
6.
Eur J Endocrinol ; 184(5): 657-665, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33635830

RESUMO

Objective: Surgical resection is recommended for cytologically indeterminate pediatric thyroid nodules due to their intermediate malignancy risk. We evaluated the utility of ultrasound characteristics for refining malignancy risk to inform the management of these nodules. Design: Retrospective cohort study (2004-2019). Methods: We analyzed consecutive thyroid nodules with indeterminate fine-needle aspiration cytology (Bethesda category III, IV, or V) in pediatric patients (<19 years). We assessed the association of demographic and sonographic characteristics with malignancy risk among all indeterminate nodules and within each Bethesda category. Results: Eighty-seven cytologically indeterminate nodules were identified in 78 patients. Bethesda category was III in 56 nodules (64%), IV in 12 (14%), and V in 19 (22%). The malignancy rate was 46/87 (53%) overall, and 23/56 (41%), 8/12 (75%), and 15/19 (79%) in Bethesda III, IV, and V nodules, respectively. Malignancy rate was higher in solitary nodules (67% vs 37%, P = 0.004) and nodules with irregular margins (100% vs 44%, P < 0.001) or calcifications (82% vs 43%, P = 0.002). American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS) risk level TR5 was associated with a higher rate of malignancy than lower TI-RADS risk levels (80% vs 42%, P = 0.002). Within individual Bethesda categories, TI-RADS risk level was not associated with malignancy. No sonographic feature had a negative predictive value for malignancy greater than 80%. Conclusions: In pediatric thyroid nodules with indeterminate cytology, some sonographic features - including higher ACR TI-RADS risk level - are associated with malignancy, but these associations are unlikely to alter clinical management in most cases.


Assuntos
Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Ultrassonografia , Adolescente , Idade de Início , Biópsia por Agulha Fina , Criança , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Margens de Excisão , Valor Preditivo dos Testes , Radioterapia Adjuvante , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/terapia , Nódulo da Glândula Tireoide/epidemiologia , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/terapia , Tireoidectomia
7.
Chirurgia (Bucur) ; 116(1): 66-74, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33638328

RESUMO

Background: Thyroid surgery has various benign and malignant indications. A complete pre-surgical evaluation guides the selection of cases and determines the appropriate extent of the intervention. Minimizing the number of unneeded thyroidectomies could reduce hospitalization costs, as well as post-surgery complications and iatrogenic hypothyroidism. The aim of this study was to retrospectively evaluate the presenting reasons of patients admitted to the hospital for thyroid surgeries and to estimate the need of total thyroidectomies. Methodology: The study included patients admitted in all three Surgical Departments in Timisoara Emergency County Hospital, between January 1st 2018 and December 31st 2019 (2 years). Results: A number of 1036 thyroid surgeries had been performed in 1027 patients and were retrospectively analyzed, comparing the pre-surgical diagnosis with the pathology report. Suspicion of malignancy, compression or functional autonomy was described in 326 /824 total thyroidectomy cases. Cancer was detected in 338 out of the 1027 patients (32.92%), including 39 borderline lesions. A proportion of 80.7% were papillary thyroid cancers. The current presurgical evaluation generated a number of 475 cases displaying differences between the presurgical and postsurgical diagnostic. The phenomenon was observed both in total thyroidectomy and in lobectomy interventions: 22.8% of the lobectomies were diagnosed with thyroid cancer. Conclusion: Our findings confirm that a reliable multidisciplinary approach with standardized presurgical clinical, biochemical and ultrasound evaluation is crucial in patients with indication for thyroid surgery, in order to avoid unnecessary surgeries.


Assuntos
Nódulo da Glândula Tireoide , Tireoidectomia , Humanos , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/classificação , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/classificação , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/cirurgia , Resultado do Tratamento
8.
Endocr Pract ; 27(3): 261-268, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33588062

RESUMO

OBJECTIVE: Contextualizing the evaluation of older adults with thyroid nodules is necessary to fully understand which management strategy is the most appropriate. Our goal was to summarize available clinical evidence to provide guidance in the care of older adults with thyroid nodules and highlight special considerations for thyroid nodule evaluation and management in this population. METHODS: We conducted a literature search of PubMed and Ovid MEDLINE from January 2000 to November 2020 to identify relevant peer-reviewed articles published in English. References from the included articles as well as articles identified by the authors were also reviewed. RESULTS: The prevalence of thyroid nodules increases with age. Although thyroid nodules in older adults have a lower risk of malignancy, identified cancers are more likely to be of high-risk histology. The goals of thyroid nodule evaluation and the tools used for diagnosis are similar for older and younger patients with thyroid nodules. However, limited evidence exists regarding thyroid nodule evaluation and management to guide personalized decision making in the geriatric population. CONCLUSION: Considering patient context is significant in the diagnosis and management of thyroid nodules in older adults. When making management decisions in this population, it is essential to carefully weigh the risks and benefits of thyroid nodule diagnosis and treatment, in view of older adults' higher prevalence of high-risk thyroid cancer as well as increased risk for multimorbidity, functional and cognitive decline, and treatment complications.


Assuntos
Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Idoso , Biópsia por Agulha Fina , Endocrinologistas , Humanos , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/terapia , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/epidemiologia , Nódulo da Glândula Tireoide/terapia
9.
Ther Umsch ; 77(9): 419-425, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33146096

RESUMO

From thyroid nodules to thyroid cancer Abstract. The prevalence of thyroid nodules is around 1 % per life year, whereas 5 % of the nodules are malignant. Primary diagnostics consist of examination of TSH and cervical ultrasound. Depending on the findings, additional laboratory investigations, a scintigraphy or a biopsy are indicated. In case of thyroid cancer, the primary treatment is usually surgery. There are at least nine different clinical guidelines worldwide to provide a standardized perioperative management, whereas the guidelines of the German Association of Endocrine Surgeons (CAEK) and the American Thyroid Association (ATA) are most frequently used in the German speaking part of Europe. Individual therapy concepts are determined at the interdisciplinary endocrinological tumour boards. The indication for postoperative radioiodine treatment or thyroid hormone supplementation in TSH suppression dose in case of differentiated (papillary or follicular) thyroid cancer is evaluated according to the American Thyroid Association (ATA) risk stratification.


Assuntos
Adenocarcinoma Folicular , Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Europa (Continente) , Humanos , Radioisótopos do Iodo , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/terapia , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/terapia , Estados Unidos
10.
Radiol Clin North Am ; 58(6): 1009-1018, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33040844

RESUMO

Thyroid nodules are a common clinical problem encountered in an endocrine practice. More and more thyroid nodules are now being detected on unrelated imaging studies, leading to an increased diagnosis of low-risk thyroid cancers. There is therefore a greater emphasis on risk assessment based on clinical and sonographic features to avoid morbidity secondary to unnecessary therapy. Molecular diagnostics are also being widely used to further characterize indeterminate nodules. The American Thyroid Association and American College of Radiology-Thyroid Imaging Reporting and Data System guidelines are the most commonly used in clinical practice for risk assessment.


Assuntos
Guias de Prática Clínica como Assunto , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Ultrassonografia Doppler/métodos , Biópsia por Agulha , Feminino , Humanos , Incidência , Masculino , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Medição de Risco , Sociedades Médicas , Análise de Sobrevida , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/epidemiologia , Nódulo da Glândula Tireoide/patologia , Estados Unidos
11.
Medicine (Baltimore) ; 99(40): e22350, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019411

RESUMO

BACKGROUND: Ultrasonography is the first choice for clinical diagnosis and differentiation of thyroid cancer Currently. However, due to the complexity and overlapping nature of the thyroid nodule sonograms, it remains difficult to accurately identify nodules with atypical ultrasound characteristics. Previous studies showed that superb microvascular imaging (SMI) can detect tumor neovascularization to differentiate benign from malignant thyroid nodules. However, the results of these studies have been contradictory with low sample sizes. This meta-analysis tested the hypothesis that SMI is accurate in distinguishing benign and malignant thyroid nodules. METHODS: We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the August 20, 2020, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software ((Stata Corp, College Station, TX) will be used for data analysis. RESULTS: This systematic review will determine the accuracy of SMI in distinguishing thyroid nodules. CONCLUSION: Its findings will provide helpful evidence for the accuracy of SMI in in distinguishing thyroid nodules.Systematic review registration: INPLASY202080084.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/patologia , Ultrassonografia/métodos , Diagnóstico Diferencial , Neovascularização Patológica/patologia , Projetos de Pesquisa , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico por imagem
12.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(7): 438-345, ago.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-194700

RESUMO

INTRODUCCIÓN: El nódulo tiroideo (NT) es un motivo de consulta frecuente en la práctica diaria. El objetivo de este estudio es conocer el proceso diagnóstico y terapéutico del NT en nuestro medio y evaluar el estado actual sobre la existencia y estructura de las consultas de alta resolución de NT. MATERIAL Y MÉTODOS: Los miembros de la Sociedad Española de Endocrinología y Nutrición fueron invitados en el año 2018 a participar en una encuesta online sobre los procesos diagnósticos y terapéuticos del NT. RESULTADOS: Se recibieron 211 encuestas válidas. El 30,8% de los encuestados indicaron que existía consulta de alta resolución de NT en su medio, siendo el endocrinólogo el responsable mayoritario de realizar la ecografía (87,7%) y la punción-aspiración con aguja fina (PAAF) (69,2%). Respecto a la clasificación ecográfica, el 32,7% utilizaban criterios ATA y el 32,2% criterios TI-RADS (el 22,7% no utilizaba ninguna clasificación). El 35,5% comprobaban in situ la idoneidad de la muestra y el análisis molecular en el 8,1%. El 65,4% plantearían alta del NT tras 5 años de seguimiento y PAAF benigna. Ante un Bethesda III, el 50,2% de los encuestados repetirían la PAAF y un 35,5% optarían por cirugía; ante un Bethesda IV, el 95,8% optarían por cirugía. CONCLUSIONES: La consulta de alta resolución de NT es una estructura con una creciente introducción en nuestro medio, siendo el endocrinólogo el responsable fundamental de realizar la ecografía y la PAAF. La práctica clínica habitual en nuestro medio es concordante con la mayoría de las recomendaciones de las guías de práctica clínica de NT


INTRODUCTION: Thyroid nodule (TN) is a common reason for consultation in daily practice. The purpose of this study was to evaluate the diagnosis and treatment of TNs in our environment and to assess the current status regarding the existence and structure of high-resolution TN clinics. MATERIAL AND METHODS: Members of the Spanish Society of Endocrinology and Nutrition were invited in 2018 to participate in an online survey on the diagnostic and therapeutic processes of TN. RESULTS: A total of 211 valid surveys were received. Of all respondents, 30.8% stated that there were high-resolution TN clinics in their environment, with the endocrinologist being the main person responsible for performing ultrasonography (87.7%) and fine needle aspiration (FNA) (69.2%). For ultrasound classification of TNs, 32.7% used the ATA criteria, 32.2% the TI-RADS criteria, and 22.7% no classification. In situ verification of sample suitability was performed in 35.5% of the cases, and molecular analysis in 8.1%. With regard to clinical discharge, 65.4% would consider it after 5 years of follow-up and with a benign FNA. In the event of a Bethesda III result, 50.2% of respondents would repeat FNA and 35.5% would opt for surgery; if a Bethesda IV result was found, 95.8% would opt for surgery. CONCLUSIONS: High-resolution TN clinics are structures increasingly implemented in our environment where the endocrinologist is the main person responsible for performing ultrasonography and FNA. The standard clinical practice in our specialty is consistent with most recommendations concerning clinical practice guidelines for TNs


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/terapia , Nódulo da Glândula Tireoide/epidemiologia , Inquéritos Nutricionais/métodos , Sociedades Médicas/estatística & dados numéricos , Acesso à Internet/estatística & dados numéricos
13.
Rev. ORL (Salamanca) ; 11(3): 283-295, jul.-sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-197898

RESUMO

INTRODUCCIÓN Y OBJETIVO: La Medicina Nuclear tiene un papel destacado en el estudio de la patología de tiroides y paratiroides. El objetivo de este trabajo es realizar una revisión de las técnicas de imagen disponibles actualmente en Medicina Nuclear, para el estudio de dicha patología. SÍNTESIS: La gammagrafía de tiroides sigue siendo una técnica útil en el estudio de la patología tiroidea, como, por ejemplo, en el nódulo tiroideo o el hipotiroidismo congénito. El SPECT-CT mejora el diagnóstico, frente al rastreo corporal total (RCT) con radioyodo, en pacientes con cáncer diferenciado de tiroides y cambia el manejo terapéutico, a la vez que, añadido a la gammagrafía de paratiroides, ayuda a la planificación de la cirugía, sobre todo en adenomas ectópicos. El PET-CT con 18F-FDG y con otros trazadores, tiene un papel relevante en varias indicaciones y tipos histológicos de cáncer de tiroides, aunque principalmente en la sospecha de recidiva. Así mismo, el PET-CT con fluorocolina es una alternativa excelente, con cifras elevadas de localización exitosa, en los casos de hiperparatiroidismo primario (HPTp) con pruebas convencionales negativas. CONCLUSIONES: Con los avances técnicos de los últimos años en el ámbito de la Medicina Nuclear y, particularmente, con la imagen híbrida, se ha mejorado el estudio de la patología tiroidea, fundamentalmente del cáncer de tiroides, así como la localización prequirúrgica del HPTp


INTRODUCTION AND OBJECTIVE: Nuclear Medicine has a relevant role in the study of thyroid and parathyroid gland pathology. The aim of this work is to review the imaging techniques available nowadays in Nuclear Medicine, to study this pathology. SYNTHESIS: Thyroid scinthigraphy is, even today, a useful tool in the study of thyroid pathology, such us in the thyroid nodule or in congenital hypothyroidism. SPECT-CT, compared to whole body scintigraphy (WBS) with radioiodine, improve the diagnosis and change the therapeutic management in patients with differentiated thyroid cancer, at the same time that, added to the parathyroid scintigraphy, it helps planning the surgery, especially in ectopic adenomas. PET-CT with FDG and other tracers has a relevant role in several indications and histology types of thyroid cancer, although mainly in the suspicion of recurrence. In addition, Fluorocholine PET-CT is an excellent alternative, with high successful localization rate, in cases with primary hyperparathyroidism (pHPT) and negative conventional techniques. CONCLUSIONS: With technical advances in the area of Nuclear Medicine, and particularly with hybrid imaging, the study of thyroid pathology has improved, especially in thyroid cancer, as well as pre-surgical localization of pHPT


Assuntos
Humanos , Doenças da Glândula Tireoide/diagnóstico , Medicina Nuclear/métodos , Doenças das Paratireoides/diagnóstico , Diagnóstico por Imagem/métodos , Nódulo da Glândula Tireoide/diagnóstico , Hipotireoidismo Congênito/diagnóstico , Cintilografia , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Fluordesoxiglucose F18
14.
Ann Surg ; 272(4): 621-627, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32773640

RESUMO

OBJECTIVE: FN present a management quandary as they are often benign but may also be aggressive TC. Consensus recommendations have historically advised thyroidectomy for definitive diagnosis. Although MT have robust benefit in hypothetical cost analyses, under current management guidelines a real-time study of their clinical utility in FN is awaited. We investigate if MT use for FN directs appropriate thyroidectomy for TC while triaging to surveillance nodules that are likely benign. METHODS: Data were analyzed for 389 consecutive patients managed from 11/14 to 9/19 for 405 FN, excluding oncocytic neoplasms. TC was defined as same-nodule histologic malignancy. When obtained, MT was performed using ThyroSeq (TS) v2 or 3. RESULTS: With a mean nodule size of 2.7 ±â€Š1.3 cm, MT was used in 89% and was positive in 39%. When MT was positive, thyroidectomy was more often utilized (91% v. MT- 27%; P < 0.001) and more likely for histologic TC (70% vs 16%, P < 0.001). With preoperative MT, all American Thyroid Association intermediate, high-risk, and medullary TC were positive whereas all MT- malignancies were low-risk. With TSv3, ultrasound surveillance was more likely for MT- FN (90% vs TSv2 65%, P < 0.001), and occurred for a total of 174 MT- FN. With mean follow-up of 24.6 months, 82% remained stable in size. CONCLUSIONS: MT use for FN increased the surgical yield of cancer by 4-fold, identified all potentially aggressive malignancies, and allowed apparently safe nonoperative surveillance for >80% of MT-negative patients. Thyroid nodule MT optimizes patient outcomes sufficiently to justify its incorporation into routine practice.


Assuntos
Técnicas de Diagnóstico Molecular , Nódulo da Glândula Tireoide/diagnóstico , Adulto , Idoso , Biópsia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia
15.
Eur J Endocrinol ; 183(5): 521-528, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32841935

RESUMO

Objective: The ultrasonographic scores EU TI-RADS and ACR TI-RADS were introduced to give the clinicians indications for fine needle aspiration cytology (FNAC). The predictive role of these scores was never evaluated and compared in a surgical series of patients. The aim of this study was to evaluate the ex post diagnostic accuracy of EU TI-RADS and ACR TI-RADS in a real-life series of thyroidectomized patients and to evaluate the 'missing' thyroid cancer following the operational indications of these scores. Design: Retrospective monocentric cohort study. Methods: In total, 255 patients (harboring 304 nodules) undergoing thyroidectomy for benign and malignant thyroid conditions were enrolled. The prevalence of thyroid malignancy for each class of ACR TI-RADS and EU TI-RADS, their diagnostic accuracy, the number of 'unnecessary' FNAC and the number of 'missed' cancers were evaluated. Results: ACR TI-RADS and EU TI-RADS score had similar and satisfactory accuracy values for predicting thyroid malignancy (AUC: 0.835 for ACR TI-RADS vs 0.827 for EU TI-RADS). The ACR TI-RADS and EU TI-RADS categories (suspicious vs non-suspicious), age, sex and presence of a single nodule significantly and independently predicted the presence of malignancy in a logistic regression model. An ex post analysis according to the indications for FNAC for each score indicated that 31 and 16 cases of cancer would have been missed by ACR TI-RADS and EU TI-RADS scores, respectively. Conclusions: ACR TI-RADS and EU TI-RADS display a good performance in predicting thyroid cancer when histology is taken as reference standard, but additional clinical judgement is required to decide the indication for FNAC.


Assuntos
Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/patologia , Tireoidectomia , Ultrassonografia , Adulto Jovem
16.
Rev Med Suisse ; 16(699): 1311-1315, 2020 Jul 01.
Artigo em Francês | MEDLINE | ID: mdl-32608589

RESUMO

One or more thyroid nodules, most often asymptomatic, may be found in more than half of the population, and they usually do not require specific therapeutic management, except for cancerous nodules. In order to avoid under-diagnosis and over-treatment, we propose a diagnostic strategy in line with current recommendations, based on the collaboration between general internist, radiologist, and endocrinologist. In addition to clinical information and thyroid function tests, thyroid ultrasound remains the first step in assessing the risk of nodule malignancy and setting the indication for fine needle aspiration. Cytology then makes it possible to define the therapeutic strategy, from an observation of the evolution to interventional, surgical or radiofrequency management.


Assuntos
Tomada de Decisão Clínica , Médicos , Especialização , Nódulo da Glândula Tireoide/diagnóstico , Biópsia por Agulha Fina , Humanos , Nódulo da Glândula Tireoide/terapia
17.
Eur J Endocrinol ; 183(3): 255-264, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32544875

RESUMO

Objective: Several thyroid imaging reporting and data systems (TIRADS) have been proposed to stratify the malignancy risk of thyroid nodule by ultrasound. The TIRADS by the European Thyroid Association, namely EU-TIRADS, was the last one to be published. Design: We conducted a meta-analysis to assess the prevalence of malignancy in each EU-TIRADS class and the performance of EU-TIRADS class 5 vs 2, 3 and 4 in detecting malignant lesions. Methods: Four databases were searched until December 2019. Original articles reporting the performance of EU-TIRADS and adopting histology as reference standard were included. The number of malignant nodules in each class and the number of nodules classified as true/false positive/negative were extracted. A random-effects model was used for pooling data. Results: Seven studies were included, evaluating 5672 thyroid nodules. The prevalence of malignancy in each EU-TIRADS class was 0.5% (95% CI: 0.0-1.3), 5.9% (95% CI: 2.6-9.2), 21.4% (95% CI: 11.1-31.7), and 76.1% (95% CI: 63.7-88.5). Sensitivity, specificity, PPV, NPV, LR+, LR- and DOR of EU-TIRADS class 5 were 83.5% (95% CI: 74.5-89.8), 84.3% (95% CI: 66.2-93.7), 76.1% (95% CI: 63.7-88.5), 85.4% (95% CI: 79.1-91.8), 4.9 (95% CI: 2.9-8.2), 0.2 (95% CI: 0.1-0.3), and 24.5 (95% CI: 11.7-51.0), respectively. A further improved performance was found after excluding two studies because of limited sample size and low prevalence of malignancy in class 5. Conclusions: A limited number of studies generally conducted using a retrospective design was found. Acknowledging this limitation, the performance of EU-TIRADS in stratifying the risk of thyroid nodules was high. Also, EU-TIRADS class 5 showed moderate evidence of detecting malignant lesions.


Assuntos
Nódulo da Glândula Tireoide/diagnóstico por imagem , Humanos , Estudos Retrospectivos , Medição de Risco/métodos , Nódulo da Glândula Tireoide/diagnóstico , Ultrassonografia/métodos
18.
Eur J Endocrinol ; 183(1): G41-G48, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32438345

RESUMO

Most patients with thyroid nodules and thyroid cancer (TC) referred for diagnostic work-up and treatment are not considered at higher risk of infection from SARS-CoV-2 compared to the general population. On the other hand, healthcare resources should be spared to the maximum extent possible during a pandemic. Indeed, while thyroid nodules are very common, only a small percentage are cancerous and, in turn, most thyroid cancers are indolent in nature. Accordingly, diagnostic work-up of thyroid nodules, thyroid surgery for either benign or malignant thyroid nodules and radioiodine treatment for differentiated thyroid cancers may be safely postponed during SARS-CoV-2 pandemic. Appropriate patient counselling, however, is mandatory and red flags should be carefully identified prompting immediate evaluation and treatment as appropriate. For these selected cases diagnostic work-up (e.g. ultrasound, scintigraphy, fine-needle aspiration), surgery and radioiodine therapy may proceed despite the threat of SARS-CoV-2 infection and COVID-19, after an individual risk-benefit analysis.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Nódulo da Glândula Tireoide/diagnóstico , Infecções por Coronavirus/virologia , Gerenciamento Clínico , Endocrinologia/métodos , Humanos , Pandemias , Pneumonia Viral/virologia , Medição de Risco , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/terapia , Neoplasias da Glândula Tireoide/virologia , Nódulo da Glândula Tireoide/complicações , Nódulo da Glândula Tireoide/terapia , Nódulo da Glândula Tireoide/virologia
20.
Clin Imaging ; 65: 133-137, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32470834

RESUMO

BACKGROUND: Thyroid Imaging Reporting Data System (TI-RADS) is used to characterize thyroid nodules while reducing unnecessary FNAC. Over the years, several versions of TI-RADS have been developed but there is no consensus on which TI-RADS is the best system. This study aimed to compare the diagnostic accuracy and ability of ACR TI-RADS, EU TI-RADS, K TI-RADS, AI TI-RADS to eliminate unnecessary FNAC. METHODS: In this prospective study, thyroid nodules were characterized by using the four TI-RADS systems and US-guided FNAC was done for nodule with the highest ACR TI-RADS score. Correlation between TI-RADS and FNAC results were analyzed. RESULTS: Out of 244 thyroid nodules, 100 nodules with either size <1 cm (43 nodules) non-diagnostic or inconclusive FNAC results (57 nodules) were excluded. Seven nodules (4.9%) were confirmed to be malignant on FNAC. K TI-RADS showed 100% sensitivity and NPV but the lowest specificity (40.2%). EU TI-RADS had the highest specificity (83.2%) but the lowest sensitivity (57.1%) and NPV (97.4%). ACR TI-RADS had an average sensitivity (85.7%) and NPV (98.6%). The specificity of ACR TI-RADS (51.1%) was lower than EU TI-RADS but higher than K TI-RADS. AI TI-RADS showed higher specificity (61.8% vs 51.1%, p < 0.05) but comparable NPV and sensitivity to ACR TI-RADS. AI TI-RADS was able to avoid the highest number of unnecessary FNAC (62.5%) followed by ACR TI-RADS(54.2%), EU TI-RADS(37.5%) and K TI-RADS(11.8%). CONCLUSION: AI TI-RADS is a more simple scoring system with better overall diagnostic performance and ability to exclude unnecessary FNAC with high NPV. ADVANCES IN KNOWLEDGE: Highest number of unnecessary FNAC thyroid could be prevented by applying AI TI-RADS.


Assuntos
Biópsia por Agulha Fina , Sistemas de Dados , Nódulo da Glândula Tireoide/diagnóstico por imagem , Cistografia , Humanos , Estudos Prospectivos , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Sensibilidade e Especificidade , Nódulo da Glândula Tireoide/diagnóstico , Ultrassonografia/métodos
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