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1.
Yonsei Med J ; 61(2): 161-168, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31997625

RESUMO

PURPOSE: To compare the diagnostic performances of fine-needle aspiration (FNA) and core-needle biopsy (CNB) for thyroid nodules according to nodule size. MATERIALS AND METHODS: This retrospective study included 320 thyroid nodules from 320 patients who underwent both FNA and CNB at outside clinics and proceeded with surgery in our institution between July 2012 and May 2019. According to nodule size, the diagnostic performances of FNA and CNB were calculated using various combinations of test-negatives and test-positives defined by the Bethesda categories and were compared using the generalized estimated equation and the Delong method. RESULTS: There were 279 malignant nodules in 279 patients and 41 benign nodules in 41 patients. The diagnostic performance of FNA was mostly not different from CNB regardless of nodule size, except for negative predictive value, which was better for FNA than CNB when applying Criteria 1 and 2. When applying Criteria 3, the specificity and positive predictive value of FNA were superior to CNB regardless of size. When applying Criteria 4, diagnostic performance did not differ between FNA and CNB regardless of size. After applying Criteria 5, diagnostic performance did not differ between FNA and CNB in nodules ≥2 cm. However, in nodules ≥1 cm and all nodules, the sensitivity, accuracy, and negative predictive value of CNB were better than those of FNA. CONCLUSION: CNB did not show superior diagnostic performance to FNA for diagnosing thyroid nodules.


Assuntos
Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/patologia , Adulto , Idoso , Biópsia por Agulha Fina , Biópsia com Agulha de Grande Calibre , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Adulto Jovem
2.
Surgery ; 167(1): 28-33, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31515126

RESUMO

BACKGROUND: The evaluation of the malignancy risk of thyroid nodules involves clinical factors, sonographic characteristics, cytopathology, and molecular profiling. Altogether, this algorithm can be costly and time consuming. We evaluated the stepwise contribution of each diagnostic step toward an accurate prediction of malignancy. METHODS: A retrospective study of dominant nodules of 137 patients who underwent surgical excision was performed. A baseline logistic regression model for predicting malignancy was regressed on clinical factors. In a stepwise fashion, the 2015 American Thyroid Association ultrasound risk stratification, Bethesda classification of fine-needle aspiration biopsies, and molecular profiling were added to the baseline model and the significance of each step analyzed using likelihood ratio test. Receiver operating characteristic curves were calculated for each model. RESULTS: The addition of American Thyroid Association risk stratification and Bethesda classification to preceding models were statistically significant (P < .001). The addition of molecular profiling (as a strategy independent of a particular test) was not significant (P = .812). The areas under the curve of the baseline model and models sequentially including American Thyroid Association stratification, cytopathology, and molecular profiling were 0.76, 0.85, 0.91, and 0.91, respectively. CONCLUSION: Clinical factors, sonographic characteristics, and cytopathology are sufficiently accurate in predicting malignancy risk of most thyroid nodules.


Assuntos
Câncer Papilífero da Tireoide/diagnóstico , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Adulto , Idoso , Algoritmos , Biomarcadores Tumorais/genética , Biópsia por Agulha Fina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Câncer Papilífero da Tireoide/genética , Câncer Papilífero da Tireoide/cirurgia , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/genética , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/genética , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia , Ultrassonografia
3.
Medicine (Baltimore) ; 98(50): e18320, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852120

RESUMO

OBJECTIVE: We aimed to investigate the value of the combined use of high-resolution ultrasound thyroid imaging reporting and data system (TI-RADS) classification and thyroid fine needle aspiration cytology (Bethesda classification) for the qualitative diagnosis of benign and malignant thyroid nodules. METHODS: We enrolled 295 patients with 327 thyroid nodules who were scheduled to undergo thyroid nodule surgery. Before surgery, all the patients underwent ultrasound and scoring with the TI-RADS classification, along with thyroid fine needle biopsy cytology under ultrasound guidance (US-FNAC) and scoring with the Bethesda classification. After surgery, the TI-RADS and Bethesda classification scores, separately and in combination, were compared with the postoperative pathological results in terms of the differential diagnosis of thyroid nodules. RESULTS: TI-RADS classification score 4 exhibited the highest diagnostic value for thyroid cancer; the sensitivity, specificity, and accuracy were 92.7%, 70.7%, and 87.1%, respectively, whereas the Kappa and receiver-operating characteristics (ROC) values were 0.651 and 0.817, respectively. Moreover, Bethesda classification score 3 exhibited the highest diagnostic value for thyroid cancer; the sensitivity, specificity, and accuracy were 90.0%, 94.3%, and 91.1%, respectively, whereas the Kappa and ROC values were 0.78 and 0.914, respectively. With regard to the combined diagnostic method, a score of 7 exhibited the highest diagnostic value for thyroid cancer; the sensitivity, specificity, and accuracy were 97.3%, 92.0%, and 95.9%, respectively, whereas the Kappa and ROC values were 0.893 and 0.946, respectively. CONCLUSION: The combination of high-resolution ultrasonography TI-RADS classification and US-FNAC (Bethesda classification) can improve the accuracy of malignant thyroid nodules diagnosis.


Assuntos
Biópsia por Agulha Fina/métodos , Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/classificação , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Criança , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Nódulo da Glândula Tireoide/diagnóstico , Adulto Jovem
4.
BMC Surg ; 19(1): 175, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752786

RESUMO

BACKGROUND: Parathyroid carcinoma is a rare malignancy with an increasing incidence. Most patients are characterized by the presence of severe primary hyperparathyroidism, especially hypercalcemia, while patients with normal level of serum calcium are extremely rare. Unfortunately, patients free of hypercalcemia are usually diagnosed at a later stage and suffer from a rather poor prognosis. CASE PRESENTATION: We describe a patient diagnosed with intrathyroidal normocalcemic parathyroid carcinoma, whose preoperative ultrasonography suggests that the tumor is located inside the thyroid gland and present without obvious clinical manifestations, which makes it more challenging for diagnosis. CONCLUSIONS: Preoperative suspicion of malignancy is of great importance for advanced management while preoperative diagnosis is rather challenging with the limited contribution of imaging examinations. Any abnormality in serum level of calcium or parathormone may help to make an initial diagnosis especially when the level is extremely high. We introduce this case of initial misdiagnosis of an intrathyroidal parathyroid carcinoma, mimicking a suspicious thyroid nodule, to focus on the possible anomalous presentations of this rare condition and on its optimal management.


Assuntos
Hiperparatireoidismo Primário/diagnóstico , Neoplasias das Paratireoides/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Cálcio/sangue , Erros de Diagnóstico , Feminino , Humanos , Hipercalcemia/etiologia , Pessoa de Meia-Idade , Glândulas Paratireoides/patologia , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/cirurgia , Ultrassonografia
5.
Pathologe ; 40(Suppl 3): 342-346, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31705233

RESUMO

BACKGROUND: Advances in diagnostic methods have led to an early detection of thyroid nodules with debatable malignant potential in numerous cases. This can result in a potential overtreatment of thyroid lesions with very good prognosis. OBJECTIVES: To avoid surgical overtreatment, an individualized, risk-adapted management is required that respects the different tumor biology of the underlying histological entities. METHODS: The current guidelines of the leading professional societies, the American Thyroid Association (ATA) and the German Association of Endocrine Surgeons (CAEK), were compared and critically studied, to describe risk-adapted, more conservative treatment options for certain types of thyroid neoplasms according to the 2017 WHO definition. RESULTS: The German CAEK recommends thyroidectomy as a routine operation in the case of thyroid carcinoma. Exceptions are papillary thyroid microcarcinoma and minimally invasive follicular thyroid carcinoma, which can be treated by lobectomy. The ATA proposes an "active surveillance" for papillary thyroid microcarcinoma and lobectomy in cases of differentiated thyroid carcinoma <4 cm in diameter in the absence of clearly predefined risk factors. CONCLUSIONS: The pre- or intraoperative pathological diagnosis of the underlying tumor entity is the key point, which allows for an adaption of the resection strategy for thyroid malignancy. Depending on the type of carcinoma, the current guidelines of international expert societies allow for parenchyma-sparing operations and, according to the ATA, even an "active surveillance."


Assuntos
Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Carcinoma , Diagnóstico Diferencial , Humanos , Sobremedicalização , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/terapia , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/terapia , Tireoidectomia
6.
Am Surg ; 85(11): 1265-1268, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775969

RESUMO

We investigated whether laryngoscopy should be performed before total thyroidectomy on all patients without a history of neck surgery. A total of 2523 patients who underwent total thyroidectomy between January 1, 2013, and March 18, 2018, were retrospectively examined. Preoperative vocal cord examination was performed on 2070 of these patients by the otorhinolaryngology department using indirect laryngoscopy. Patients with a history of neck or thyroid surgery were not included in the study. The patients were evaluated in terms of age, gender, symptom (hoarseness/dyspnea), comorbidity, surgical history, biopsy, nodule diameter, pathological diagnosis, and tracheal deviation. Preoperative vocal cord paralysis was detected in 0.8 per cent of the patients (17/2070). Four patients (23.5%) were male and 13 patients (76.5%) were female. The mean age was 62 (range, 25-82) years. Seven of the 17 patients (41%) were symptomatic, with complaints of dyspnea in five and hoarseness in two. The univariate analysis revealed that a nodule diameter >30 mm and the presence of dyspnea were associated with vocal cord damage. Furthermore, the multivariate analysis showed that dyspnea alone was an independent variable (P = 0.011). It is recommended that preoperative vocal cord evaluation should be performed only in patients with severe symptoms, such as dyspnea.


Assuntos
Laringoscopia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Paralisia das Pregas Vocais/diagnóstico , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Dispneia/etiologia , Feminino , Rouquidão/etiologia , Humanos , Laringoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Fatores Sexuais , Avaliação de Sintomas/métodos , Câncer Papilífero da Tireoide/diagnóstico , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/cirurgia , Paralisia das Pregas Vocais/complicações
7.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(10): 764-768, 2019 Oct 07.
Artigo em Chinês | MEDLINE | ID: mdl-31606990

RESUMO

Objective: To study the diagnostic value of a multi-gene molecular testing in cytologically indeterminate thyroid nodules. Methods: From February 2018 to September 2018, patients with thyroid nodules who underwent fine needle aspiration(FNA) at Peking University Cancer Hospital were enrolled. Three hundred and sixty patients were included, consisting of 86 men and 274 women, with a mean age of 45.8 years (between 13 and 89 years old). Among 391 nodules, 141 were cytologically inderminate and 75 were resected. FNA samples underwent prospective testing using a next-generation sequencing (NGS) assay, which included 16 genes for point mutations and 26 types of gene fusions. The testing results of indeterminate nodules were compared with surgical outcomes, to determine the diagnostic performance. The results were compared with the BRAF V600E single gene mutation analysis by χ(2) test. Results: The multi-gene testing showed a sensitivity of 73.2%, specificity of 96.8%, positive predictive value of 96.8%, and negative predictive value of 73.2%. The diagnostic accuracy of multi-gene testing was significantly higher than the BRAF V600E mutation test (83.3% vs 73.6%, χ(2)=31.588, P<0.01). Conclusion: Multi-gene testing in FNA samples is an effective method to diagnose cytologically indeterminate thyroid nodules, which has a higher accuracy than BRAF V600E mutation detection.


Assuntos
Biópsia por Agulha Fina , Testes Genéticos , Nódulo da Glândula Tireoide/genética , Nódulo da Glândula Tireoide/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Estudos Prospectivos , Proteínas Proto-Oncogênicas B-raf/genética , Análise de Sequência , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/cirurgia , Adulto Jovem
8.
Artigo em Chinês | MEDLINE | ID: mdl-31623037

RESUMO

Objective:By retrospectively analyzing the results of ultrasound guided coarse needle biopsy(CNB) of thyroid nodules based on large samples, so as to evaluate its diagnostic value as first-line diagnostic tool for thyroid nodules. Method:From October 2015 to November 2017, a total of 508 nodules were studied from 474 patients who underwent CNB in general surgery department of tianjin first central hospital. The nondiagnostic rate, inconclusive rate, unnecessary surgery rate and complication rate of thyroid nodules diagnosed by CNB were calculated. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of CNB in thyroid cancer diagnosis were analyzed. The correlation between inconclusive diagnostic results and ultrasonic findings like echogenicity, composition, margin, calcification type, blood supply and nodule size was analyzed. Result:The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CNB diagnosis were 97.27%, 99.17%, 99.07%, 99.45% and 99.36%, respectively. However, the nondiagnostic rate, the inconclusive rate, the conclusive rate and the unnecessary surgery rate of thyroid nodules diagnosed by CNB were 2.95%, 7.09%, 92.92% and 1.86%, respectively. Conclusion:Ultrasound guided coarse needle biopsy might be safe and reliable for the diagnosis of thyroid nodules, with relatively stable diagnostic effect. It is not only of high diagnostic value but also can significantly reduce diagnostic surgery. Therefore, CNB could be the preferred examinational method for nodules with suspicious ultrasonic findings.


Assuntos
Biópsia por Agulha , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Biópsia com Agulha de Grande Calibre , Humanos , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia de Intervenção
9.
Medicine (Baltimore) ; 98(39): e17286, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574847

RESUMO

BACKGROUND: This study aims to systematically investigate the impact of ultrasound angiography (UA) combined with fine needle aspiration (FNA) for the diagnosis of thyroid nodules (TNs). METHODS: The following electronic databases will be searched: MEDLINE, EMBASE, Cochrane Library, PsycINFO, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will search them from their inceptions to the present without language limitations. We will consider all case-controlled studies on investigating the impact of diagnosis UA combined FNA for TNs. We will apply Quality Assessment of Diagnostic Accuracy Studies tool to assess methodological quality for all eligible studies. RESULTS: In this study, outcomes consist of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. All these outcomes will be analyzed to evaluate the diagnostic accuracy of UA combined with FNA for TNs. CONCLUSION: This study will provide evidence of the diagnostic accuracy of UA combined with FNA for TNs. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019138884.


Assuntos
Angiografia/estatística & dados numéricos , Biópsia por Agulha Fina/estatística & dados numéricos , Biópsia Guiada por Imagem/estatística & dados numéricos , Nódulo da Glândula Tireoide/diagnóstico , Ultrassonografia/estatística & dados numéricos , Angiografia/métodos , Biópsia por Agulha Fina/métodos , Estudos de Casos e Controles , Humanos , Biópsia Guiada por Imagem/métodos , Razão de Chances , Projetos de Pesquisa , Sensibilidade e Especificidade , Revisões Sistemáticas como Assunto , Glândula Tireoide/diagnóstico por imagem , Ultrassonografia/métodos
10.
Medicine (Baltimore) ; 98(38): e17192, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567964

RESUMO

BACKGROUND: Previous clinical studies have reported that ultrasound-guided fine needle aspiration cytology (UGFNAC) can be used for the diagnosis of thyroid nodules (TN) effectively. However, no study has systematically explored its diagnosis accuracy in patients with TN. Thus, this study will assess its diagnosis accuracy for TN. METHODS: We will perform a comprehensive literature search from the following databases from their inceptions to the present without language restrictions: MEDILINE, EMBASE, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will consider all case-controlled studies investigating the impacts of UGFNAC diagnosis for patients with TN for inclusion. Two authors will independently carry out study selection, data collection, and methodological quality assessment. Quality Assessment of Diagnostic Accuracy Studies tool will be used for methodological quality evaluation. We will use RevMan V.5.3 and Stata V.12.0 software to perform statistical analysis. RESULTS: We will apply sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio to judge the diagnostic accuracy of UGFNAC for TN. CONCLUSION: The results of this study will provide latest evidence for the diagnostic accuracy of UGFNAC for TN. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019138805.


Assuntos
Biópsia por Agulha Fina , Nódulo da Glândula Tireoide/diagnóstico , Ultrassonografia de Intervenção , Biópsia por Agulha Fina/métodos , Humanos , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/patologia , Ultrassonografia de Intervenção/métodos
11.
Rev Med Suisse ; 15(665): 1752-1759, 2019 Oct 02.
Artigo em Francês | MEDLINE | ID: mdl-31580019

RESUMO

The incidence of differentiated thyroid cancers has increased in the past 30 years, mainly due to overdiagnosis. It is therefore crucial to adapt diagnostic and therapeutic approaches to avoid overtreatment that exposes patients to unnecessary risks. Accordingly, international guidelines on the subject are regularly updated. Ultrasound and cytology guide the management for thyroid nodules. Some microcarcinomas can now be actively followed without immediate surgery, and some low-risk cancers can be adequately treated with lobo-isthmectomy. The indications for central neck dissection remain controversial. Technological advances allow minimizing specific complications of thyroid surgery and facilitate scarless surgery.


Assuntos
Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/cirurgia , Humanos , Tireoidectomia , Ultrassonografia
12.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(8): 495-501, oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184143

RESUMO

Antecedentes y objetivo: El procedimiento de punción-aspiración con aguja fina ecoguiada de nódulos tiroideos con examen citológico in situ del material extraído puede reducir el número de citologías obtenidas de categoría Bethesda I. El objetivo del estudio ha sido evaluar nuestra experiencia del segundo año en dicha técnica para analizar la eficacia diagnóstica, la prevalencia y los factores predictores de los resultados de categoría Bethesda I. Pacientes y método: Estudio retrospectivo sobre 279 nódulos en 233 pacientes. La punción-aspiración se realizó según los criterios de 2015 de la American Thyroid Association. Una muestra de cada punción se fijó al aire y se procesó in situ mediante tinción con Diff-Quik y examen microscópico para valorar su idoneidad; en caso contrario, se repitió la punción hasta un total de 5veces. La eficacia diagnóstica se valoró en base a la sensibilidad y a la especificidad sobre las categorías citológicas Bethesda II y Bethesda VI. Resultados: La sensibilidad y la especificidad diagnóstica fueron del 100% en ambos casos. Obtuvimos un 5,4% de resultados de categoría Bethesda I y las variables independientemente asociadas fueron la edad (incremento del 4,7% por cada año de vida) y el volumen del nódulo (incremento del 2,3% por cada 1ml de volumen). Conclusiones: La punción-aspiración ecoguiada con aguja fina y examen citológico in situ del material extraído permite obtener una elevada eficacia diagnóstica y demuestra ser un procedimiento de gran validez por conseguir una tasa muy baja de resultados citológicos de categoría Bethesda I, cuyo riesgo ha sido superior en sujetos de mayor edad y en nódulos de mayor tamaño


Background and objective: Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination may decrease the number of Bethesda category I cytologies. The study objective was to evaluate our second-year experience with this procedure to analyze diagnostic efficacy, prevalence, and factors predicting for Bethesda category I results. Patients and method: A retrospective study was conducted of 279 nodules from 233 patients. Ultrasound -guided fine needle aspiration was performed according to the 2015 criteria of the American Thyroid Association. A specimen of each aspiration was air-fixed on site before Diff-Quik staining and microscopic examination to assess its suitability; otherwise, nodule aspiration was repeated up to 5 times. Diagnostic efficacy was assessed based on sensitivity and specificity on the cytological categories Bethesda II and Bethesda VI. Results: Diagnostic sensitivity and specificity were both 100%, 5.4% Bethesda category I results were obtained, and variables independently associated were age (4.7% increase per year of life) and nodule volume (2.3% increase per each 1mL of volume). Conclusions: Ultrasound-guided fine needle aspiration of thyroid nodules with on-site cytological examination allows for a high diagnostic efficacy and has been shown to be a highly relevant procedure because it has a very low rate of cytological results of Bethesda category I, whose risk has been higher in older subjects and with larger nodules


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Biópsia por Agulha Fina/instrumentação , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/epidemiologia , Valor Preditivo dos Testes , Biópsia por Agulha Fina/métodos , Nódulo da Glândula Tireoide/patologia , Glândula Tireoide/citologia , Estudos Retrospectivos , Sensibilidade e Especificidade
13.
Cir Pediatr ; 32(3): 135-140, 2019 Jul 29.
Artigo em Espanhol | MEDLINE | ID: mdl-31486305

RESUMO

PURPOUSE: Thyroid nodules are unusual findings in children. Some authors highlight the higher rate of malignancy in this group. The Bethesda system, created in adults to stratify thyroid nodules according to the risk of malignancy, constitutes a reference system for the management of this pathology. The American Thyroid Association promotes its use in the pediatric population, although there is no available data showing an equivalent risk. The aim of this study was to assess the risk of malignancy represented by each Bethesda stage in a pediatric study population. METHODS: A retrospective cohort study was performed in pediatric patients with thyroid nodules biopsied by fine needle aspiration, during the period 2005-2017. During the follow-up, the outcome was assessed by comparing the Bethesda stage (cytology) with the surgical specimen histology. For patients not surgically treated, Bethesda Class was compared with the clinical and imaging follow up. RESULTS: 105 patients with fine needle aspiration of a thyroid nodule were analyzed and classified by the Bethesda system. 47 patients were excluded for incomplete follow-up. All Bethesda I nodules were benign, 6.6% of Bethesda II were malignant and all Bethesda IV, V and VI nodules were histologically malignant. CONCLUSION: The rate of malignancy among patients with Bethesda II, IV, V and VI was higher than published in Bethesda classification for adults. The risk of malignancy in pediatric patients might be greater than expected. These results may have a significant impact on follow-up strategies and also in therapeutic algorithms.


Assuntos
Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Adolescente , Biópsia por Agulha Fina , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Retrospectivos , Risco , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/epidemiologia , Nódulo da Glândula Tireoide/diagnóstico
14.
Biomed Res Int ; 2019: 7150527, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31531363

RESUMO

Background: Approximately 15 to 30% of thyroid nodules evaluated by fine-needle aspiration (FNA) were classified as indeterminate; the accurate diagnostic molecular tests of these nodules remain a challenge. We aimed to evaluate the diagnostic performance of Afirma gene expression classifier (GEC) for the indeterminate thyroid nodules (ITNs). Methods: Studies published from January 2005 to December 2018 were systematically reviewed. The gold reference standard relied on the histopathologic results diagnosis from thyroidectomy surgical specimens. MetaDisc software was used to investigate the pooled sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curves. Results: A total of 18 studies involving 5290 patients with 3290 cases of ITNs were included. Collected data revealed that the pooled sensitivity of GEC was 95.5% (95% CI 93.3%-97.0%, p < 0.001), the specificity was 22.1% (95% CI 19.4%-24.9%, p < 0.001), the NPV was 88.2% (95% CI 0.833-0.921, p < 0.001), the PPV was 44.3% (95% CI 0.416-0.471, p < 0.001), and the DOR was 5.25 (95% CI 3.42-8.04, p= 0.855). Conclusion: The GEC has quite high sensitivity of 95.5% but low specificity of 22.1%. The high sensitivity makes it probable to rule out malignant nodules. Thus, over half of nodules with GEC-suspicious results still require further validation like molecular markers, diagnostic surgery, or long follow-up, which limits its use in future clinical practice.


Assuntos
Expressão Gênica/genética , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/genética , Biópsia por Agulha Fina/métodos , Testes Diagnósticos de Rotina/métodos , Perfilação da Expressão Gênica/métodos , Regulação Neoplásica da Expressão Gênica/genética , Humanos , Técnicas de Diagnóstico Molecular/métodos , Razão de Chances , Curva ROC , Sensibilidade e Especificidade , Software , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/genética , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Tireoidectomia/métodos
15.
Orv Hetil ; 160(36): 1417-1425, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31492087

RESUMO

Introduction: Twenty-five percent of fine-needle aspiration biopsy samples of thyroid nodules produce indeterminate cytological results. Genetic testing of nodules can contribute to accurate diagnosis. Aim: Developing the first gene panel in Europe utilizing the 23 most relevant thyroid oncogenes with 568 mutations. Method: Examination of the isolated DNA from biopsy samples by Ion Torrent new generation sequencing. Results: The validation of our method was performed on tumor tissue samples, in which 127 genetic variations were identified, yet unknown in thyroid tumors. AXIN1 was the most polymorphic gene, while BRAF c.1799T>A (V600E) was the most frequently identified mutation. We detected 36 clinically relevant variants, 75% of which have not been described in the literature. Six of our 8 cytologically malignant and 8 of our 14 indeterminate as well as 20 of our 28 cytologically benign samples were identified as containing pathologic variants in a driver gene (BRAF c.1799T>A, NRAS c.181C>A). Conclusion: We have developed a validated, reliable new generation sequencing-based method with high positive predictive value (89%) and sensitivity (79%), suitable for the early detection of malignant lesions in the thyroid. Orv Hetil. 2019; 160(36): 1417-1425.


Assuntos
Testes Genéticos/métodos , Patologia Molecular/métodos , Proteínas Proto-Oncogênicas B-raf/genética , Neoplasias da Glândula Tireoide/genética , Nódulo da Glândula Tireoide/genética , Biópsia por Agulha Fina/métodos , Análise Mutacional de DNA , Europa (Continente) , Humanos , Mutação , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/patologia
17.
Genet Test Mol Biomarkers ; 23(9): 681-687, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31411490

RESUMO

Aims: To compare fine-needle aspiration cytology (FNAC) with imprinted gene detection in the differential diagnosis of benign and malignant thyroid nodules. Methods: A total of 34 patients (35 cases of thyroid nodules) were examined using fine-needle puncture biopsy under ultrasound guidance, and the biopsy tissues were examined by cytologic examination and imprinted gene detection. Combined with postoperative pathology and follow-up results, the diagnostic value and consistency of the two methods were analyzed and compared. Results: The detection of benign and malignant thyroid nodules by ARHI imprinted gene had a high consistency with FNAC, and ARHI imprinted gene detection had a higher detection rate, sensitivity, and accuracy. Conclusions: Imprinted gene detection has high accuracy and sensitivity in the differential diagnosis of benign and malignant thyroid nodules. It provides a scientific reference for clinical treatment and should be incorporated into diagnostic protocols for thyroid tumor.


Assuntos
Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Proteínas rho de Ligação ao GTP/genética , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/patologia , Adolescente , Adulto , Idoso , Biópsia por Agulha Fina , Carcinoma Papilar, Variante Folicular/diagnóstico , Carcinoma Papilar, Variante Folicular/patologia , Diagnóstico Diferencial , Células Epiteliais/citologia , Feminino , Impressão Genômica , Bócio Nodular/diagnóstico , Bócio Nodular/patologia , Doença de Hashimoto/diagnóstico , Doença de Hashimoto/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/patologia , Tireoidite Subaguda/diagnóstico , Tireoidite Subaguda/patologia , Ultrassonografia , Adulto Jovem
18.
Medicine (Baltimore) ; 98(32): e16379, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393347

RESUMO

BACKGROUND: More and more automated efficient ultrasound image analysis techniques, such as ultrasound-based computer-aided diagnosis system (CAD), were developed to obtain accurate, reproducible, and more objective diagnosis results for thyroid nodules. So far, whether the diagnostic performance of existing CAD systems can reach the diagnostic level of experienced radiologists is still controversial. The aim of the meta-analysis was to evaluate the accuracy of CAD for thyroid nodules' diagnosis by reviewing current literatures and summarizing the research status. METHODS: A detailed literature search on PubMed, Embase, and Cochrane Libraries for articles published until December 2018 was carried out. The diagnostic performances of CAD systems vs radiologist were evaluated by meta-analysis. We determined the sensitivity and the specificity across studies, calculated positive and negative likelihood ratios and constructed summary receiver-operating characteristic (SROC) curves. Meta-analysis of studies was performed using a mixed-effect, hierarchical logistic regression model. RESULTS: Five studies with 536 patients and 723 thyroid nodules were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (DOR) for CAD system were 0.87 (95% confidence interval [CI], 0.73-0.94), 0.79 (95% CI 0.63-0.89), 4.1 (95% CI 2.5-6.9), 0.17 (95% CI 0.09-0.32), and 25 (95% CI 15-42), respectively. The SROC curve indicated that the area under the curve was 0.90 (95% CI 0.87-0.92). The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and DOR for experienced radiologists were 0.82 (95% CI 0.69-0.91), 0.83 (95% CI 0.76-0.89), 4.9 (95% CI 3.4-7.0), 0.22 (95% CI 0.12-0.38), and 23 (95% CI 11-46), respectively. The SROC curve indicated that the area under the curve was 0.96 (95% CI 0.94-0.97). CONCLUSION: The sensitivity of the CAD system in the diagnosis of thyroid nodules was similar to that of experienced radiologists. However, the CAD system had lower specificity and DOR than experienced radiologists. The CAD system may play the potential role as a decision-making assistant alongside radiologists in the thyroid nodules' diagnosis. Future technical improvements would be helpful to increase the accuracy as well as diagnostic efficiency.


Assuntos
Diagnóstico por Computador/métodos , Diagnóstico por Computador/normas , Radiologistas/normas , Nódulo da Glândula Tireoide/diagnóstico , Inteligência Artificial , Diagnóstico Diferencial , Humanos , Curva ROC , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/patologia , Ultrassonografia
20.
Endocr Pathol ; 30(3): 201-218, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31300997

RESUMO

Immunohistochemistry (IHC) in evaluating thyroid surgical specimens may facilitate diagnostic and prognostic evaluation, with potential therapeutic implications. We performed a systematic review and meta-analysis examining the analytic validity of IHC in detecting BRAFV600E mutations in thyroid cancer (primary or metastatic). We screened citations from three electronic databases (until December 20, 2018), supplemented by a hand search of authors' files and cross-references of reviews. Citations and full-text papers were independently reviewed in duplicate, and consensus was achieved on inclusion of papers. Two reviewers independently critically appraised and abstracted data from included papers. Random-effect meta-analyses were conducted for sensitivity and specificity estimates. We reviewed 1499 unique citations and 93 full-text articles. We included 1 systematic review and 30 original articles. The published review (from 2015) needed to be updated as there were multiple subsequent original studies. The pooled sensitivity of IHC in detecting a BRAFV600E mutation was 96.8% (95% confidence interval [CI] at 94.1%, 98.3%) (29 studies, including 2659 BRAFV600E mutant tumors). The IHC pooled specificity was 86.3% (95% CI 80.7%, 90.4%) (28 studies, including 1107 BRAFV600E wild-type specimens). These meta-analyses were subject to statistically significant heterogeneity, partly explained by antibody type (sensitivity and specificity) and tissue/tumor type (specificity). In conclusion, BRAF IHC is highly sensitive and reasonably specific in detecting the BRAFV600E mutation; however, there is some variability in analytic performance.


Assuntos
Citodiagnóstico/métodos , Mutação de Sentido Incorreto , Proteínas Proto-Oncogênicas B-raf/genética , Proteínas Proto-Oncogênicas B-raf/metabolismo , Glândula Tireoide/metabolismo , Glândula Tireoide/patologia , Substituição de Aminoácidos , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Diagnóstico Diferencial , Ácido Glutâmico/genética , Humanos , Imuno-Histoquímica , Valor Preditivo dos Testes , Prognóstico , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/genética , Neoplasias da Glândula Tireoide/metabolismo , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/genética , Nódulo da Glândula Tireoide/metabolismo , Nódulo da Glândula Tireoide/patologia , Valina/genética
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