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1.
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
2.
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
3.
Eur J Endocrinol ; 183(3): 317-323, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32717718

RESUMO

Objective: The association between chronic autoimmune thyroiditis (CAT) and differentiated thyroid cancer (DTC) remains controversial. The incidence of DTC increases when screening procedures are implemented, as typically occurs in CAT patients being routinely submitted to thyroid ultrasound (US). The aim of this study was to longitudinally evaluate the long-term development of DTC in patients with CAT. Design and methods: A retrospective longitudinal cohort study was designed. For the study, 510 patients with chronic autoimmune thyroiditis (CAT) with a 10-year follow-up were enrolled. Patients were divided in two groups according to the presence (CAT+ NOD+; n = 115) or absence (CAT+ NOD-; n = 395) of co-existent nodules at diagnosis. The main outcome measures were appearance of new thyroid-nodules and development of DTC during follow-up. Results: During a 10-year median follow-up period, new thyroid-nodules were detected in 34/115 (29.5%) patients in the CAT+ NOD+ group and in 41/395 (10.3%) in the CAT+ NOD- group (P < 0.001). Logistic regression analysis showed that thyroid-volume at diagnosis and belonging to the CAT+ NOD+ group significantly predicted the appearance of a new thyroid nodule during follow-up, independently of baseline age and sex. Among the 75 patients experiencing the appearance of a new nodule, 27 (39%) met the criteria for fine-needle-aspiration-cytology (FNAC). A benign cytological diagnosis was rendered in all cases. Conclusions: In our series of CAT patients, the appearance of new thyroid-nodules was frequent, but none of them were found to be malignant. The presence of CAT appears to be associated with a negligible risk of developing clinically overt DTC.


Assuntos
Neoplasias da Glândula Tireoide/epidemiologia , Tireoidite Autoimune/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Tireoidite Autoimune/patologia , Adulto Jovem
4.
Clinics (Sao Paulo) ; 75: e1594, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32578823

RESUMO

OBJECTIVE: Fine-needle aspiration cytology is the risk stratification tool for thyroid nodules, and ultrasound elastography is not routinely used for the differential diagnosis of thyroid cancer. The current study aimed to compare the diagnostic parameters of ultrasound elastography and fine-needle aspiration cytology, using surgical pathology as the reference standard. METHODS: In total, 205 patients with abnormal thyroid function test results underwent ultrasound-guided fine-needle aspiration cytology on the basis of the American College of Radiology Thyroid Imaging-Reporting and Data System classification and strain ultrasound elastography according to the ASTERIA criteria. Histopathological examination of the surgical specimens was performed according to the 2017 World Health Organization classification system. Moreover, a beneficial score analysis for each modality was conducted. RESULTS: Of 265 nodules, 212 measured ≥1 cm. The strain index value increased from benign to malignant nodules, and the presence of autoimmune thyroid diseases did not affect the results (p>0.05 for all categories). The sensitivities of histopathological examination, ultrasound elastography, and fine-needle aspiration cytology for detection of nodules measuring ≥1 cm were 1, 1, and 0.97, respectively. The working area for detecting nodule(s) in a single image was similar between strain ultrasound elastography and fine-needle aspiration cytology for highly and moderately suspicious nodules. However, for mildly suspicious, unsuspicious, and benign nodules, the working area for detecting nodule(s) in a single image was higher in strain ultrasound elastography than in fine-needle aspiration cytology. CONCLUSION: Strain ultrasound elastography for highly and moderately suspicious nodules facilitated the detection of mildly suspicious, unsuspicious, and benign nodules.


Assuntos
Biópsia por Agulha Fina/métodos , Técnicas de Imagem por Elasticidade/métodos , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Tireotropina/sangue
5.
Medicine (Baltimore) ; 99(23): e20634, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32502044

RESUMO

To evaluate the diagnostic efficiency of computer-aided diagnosis (CAD) system and 111 radiologists with different experience in identifying benign and malignant thyroid nodules, and to summarize the ultrasound features that may affect the diagnostic of CAD and radiologists.Fifty thyroid nodules and 111 radiologists were enrolled in this study. All the 50 nodules were diagnosed by the 111 radiologists and the CAD system simultaneously. The diagnostic performance of the CAD system, senior and junior radiologists with the maximum accuracy were calculated and compared. Interobserver agreement for different ultrasound characteristics between the CAD and senior radiologist were analyzed.CAD system showed a higher specificity than junior radiologist (87.5% vs 70.4%, P = .03), and a lower sensitivity than the senior radiologist and junior radiologist but the statistics were not significant (76.9% vs 86.9%, P > .5; 76.9% vs 82.6%, P > .5). The CAD system and senior radiologist got larger AUC than junior radiologist but the differences were not statistically significant (0.82 vs 0.76, respectively; P = .5). The interobserver agreement for the US characteristics between the CAD system and senior radiologist were: substantial agreement for hypoechoic and taller than wide (kappa value = 0.66, 0.78), and moderate agreement for irregular margin and micro-calcifications (kappa value = 0.52, 0.42).The CAD system achieved equal diagnostic accuracy to the senior radiologists and higher accuracy than the junior radiologists. The interobserver agreements in the US features between the CAD system and senior radiologist were substantial agreement for hypoechoic and taller than wide; moderate agreement for irregular margin and micro-calcifications. The location of a thyroid nodule and the feature of macrocalcification with wide acoustic shadow may influence the analysis of the CAD system.


Assuntos
Interpretação de Imagem Assistida por Computador/normas , Radiologia/normas , Nódulo da Glândula Tireoide/diagnóstico por imagem , Humanos , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide/patologia , Ultrassonografia
7.
PLoS One ; 15(4): e0231775, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32310968

RESUMO

The diagnostic accuracy of contrast-enhanced ultrasound (CEUS) for distinguishing malignant thyroid nodules from benign thyroid nodules remains controversial. This meta-analysis was performed to evaluate the overall diagnostic value of CEUS for the characterization of thyroid nodules. Relevant studies were identified by searching PubMed, Embase and the Cochrane Library until August 1th 2019 to assess the overall diagnostic accuracy of CEUS. 37 eligible studies were included in the present meta-analysis. The pooled sensitivity, specificity, positive likelihood rate, negative likelihood rate and diagnostic odds ratio of CEUS were 0.87, 0.83, 5.38, 0.17 and 38.94, respectively, with the AUC of 0.9263. Subgroup analysis showed the heterogeneity was greatly reduced in small nodules group (≤ 1 cm) (I2 = 0.0%), while heterogeneity was still observed in the group of variable sizes group (I2 = 69.5%). However, meta-regression analysis revealed that only diagnostic criterion was the major source of heterogeneity (p = 0.0259). The risk of publication bias was negligible (p = 0.35). CEUS exhibited high accuracy for the identification of thyroid nodules and might provide additional perfusion information for the current US imaging reporting systems.


Assuntos
Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Adulto , Meios de Contraste/análise , Diagnóstico Diferencial , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Ultrassonografia/métodos
8.
Korean J Radiol ; 21(5): 605-613, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32323506

RESUMO

OBJECTIVE: To determine the malignancy risk of isolated macrocalcifications (a calcified nodule with complete posterior acoustic shadowing) detected on ultrasonography (US) and to evaluate the postoperative American Thyroid Association (ATA) risk stratification of malignant tumors manifesting as isolated macrocalcifications. MATERIALS AND METHODS: A total of 3852 thyroid nodules (≥ 1 cm) of 3061 consecutive patients who had undergone biopsy between January 2011 and June 2018 were included in this study. We assessed the prevalence, malignancy rate, and size distribution of isolated macrocalcifications and evaluated the histopathologic features and postoperative ATA risk stratification of malignant tumors manifesting as isolated macrocalcifications. RESULTS: Isolated macrocalcifications were found in 38 (1.2%) of the 3061 patients. Final diagnosis was established in 30 (78.9%) nodules; seven malignant tumors were diagnosed as papillary thyroid carcinomas (PTCs). The malignancy rate of the isolated macrocalcifications was 23.3% in the 30 nodules with final diagnoses and 18.4% in all nodules. Among the six surgically-treated malignant tumors, five (83.3%) had an extrathyroidal extension (ETE) (minor ETE 1, gross ETE 4), and two (33.3%) had macroscopic lymph node metastasis. Four (66.7%) malignant tumors were categorized as high-risk tumors, one as an intermediate-risk tumor, and one as a low-risk tumor using the ATA risk stratification. Histopathologically, out of the six malignant tumors, ossifications were noted in four (66.7%) and predominant calcifications in two (33.3%). CONCLUSION: The US pattern of isolated macrocalcifications (≥ 1 cm) showed an intermediate malignancy risk (at least 18.4%). All malignant tumors were PTCs, and most showed an aggressive behavior and a high or intermediate postoperative ATA risk.


Assuntos
Calcinose/patologia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Ultrassonografia/métodos , Adulto , Idoso , Biópsia por Agulha Fina , Feminino , Humanos , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Medição de Risco , Estados Unidos
9.
Artigo em Chinês | MEDLINE | ID: mdl-32268696

RESUMO

Objective: To analyze the data of the Bethesda system for reporting thyroid cytopathology applied in a comprehensive cancer center and to evaluate the diagnostic ability of fine needle aspiration (FNA). Methods: We retrospectively reviewed the medical records of 5 729 cases applying this reporting system at Cancer Hospital, Chinese Academy of Medical Sciences. The series were from 5 011 patients including 1 174 men and 3 837 women, and their median age was 45 years (range, 7-88 years). FNA results were correlated with final histological diagnosis after surgery and the accuracy of FNA diagnosis and the malignancy rates for each of categories were also analyzed. Results: Among 5 729 thyroid aspirates, aside from 456 (8.0%) cases with nondiagnostic or unsatisfactory (ND/UNS) outcomes, 1 055 (18.4%) cases were benign, 409 (7.1%) cases showed atypical of undetermined significance or follicular lesions with undetermined significance (AUS/FLUS), 80 (1.4%) cases were follicular neoplasm or suspicious for follicular neoplasm (FN/SFN), 982 (17.1%) cases were suspicious for malignancy (SUS), and 2 747 cases were malignant (47.9%). Of 5 729 cases, 3 239 had received thyroidectomies after FNA, 95.99% of them were proven histologically to be malignant, with following malignancy rates in individual FNA categories: ND/UNS 75.00%; benign 40.91%; AUS/FLUS 77.67%; FN/SFN 41.67%; SUS 96.86%; and malignant 99.96%. FNA predicted malignancy with sensitivity, specificity, accuracy, positive predictive value and negative predictive values of 98.8%, 60.5%, 97.7%, 98.9% and 59.1%, respectively. Conclusions: The data of the Bethesda reporting system indicates high proportion of malignant diagnosis and high risk of malignancy at all FNA diagnostic categories. FNA offers high diagnostic accuracy and positive predictive value for the diagnosis of thyroid diseases.


Assuntos
Adenocarcinoma Folicular/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/patologia , Adenocarcinoma Folicular/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Adulto Jovem
10.
Br J Radiol ; 93(1111): 20190923, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32242748

RESUMO

OBJECTIVE: To evaluate the performance of contrast-enhanced ultrasound in the diagnosis of small, solid, TR3-5 benign and malignant thyroid nodules (≤1 cm). METHODS: From January 2016 to March 2018, 185 thyroid nodules from 154 patients who underwent contrast enhanced ultrasound (CEUS) and fine-needle aspiration or thyroidectomy in Shanghai General Hospital were included. The χ2 test was used to compare the CEUS characteristics of benign and malignant thyroid nodules, and the CEUS features of malignant nodules assigned scores. The total score of the CEUS features and the scores of the above nodules were evaluated according to the latest 2017 version of the Thyroid Imaging Reporting and Data System (TI-RADS). The diagnostic performance of the two were compared based on the receiver operating characteristic curves generated for benign and malignant thyroid nodules. RESULTS: The degree, enhancement patterns, boundary, shape, and homogeneity of enhancement in thyroid small solid nodules were significantly different (p<0.05). No significant differences were seen between benign and malignant thyroid nodules regarding completeness of enhancement and size of enhanced lesions (p>0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the TI-RADS classification TR5 in diagnosis of malignant nodules were 90.10%, 55.95%, 74.59%, 72.22%, and 82.46%, respectively (area under the curve [AUC]=0.738; 95% confidence interval[CI], 0.663-0.813). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the total score of CEUS qualitative analysis indicators were 86.13%, 89.29%, 87.57%, 90.63%, and 84.27% respectively (AUC = 0.916; 95% CI, 0.871-0.961). CONCLUSION: CEUS qualitative analysis is superior to TI-RADS in evaluating the diagnostic performance of small, solid thyroid nodules. Qualitative analysis of CEUS has a significantly higher specificity for diagnosis of malignant thyroid nodules than TI-RADS. ADVANCES IN KNOWLEDGE: The 2017 version of TI-RADS has recently suggested the malignant stratification of thyroid nodules by ultrasound. In this paper we applied this system and CEUS to evaluate 185 nodules and compare the results with pathological findings to access the diagnostic performance.


Assuntos
Meios de Contraste , Nódulo da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Biópsia por Agulha Fina , Distribuição de Qui-Quadrado , Feminino , Bócio Nodular/diagnóstico por imagem , Bócio Nodular/patologia , Doença de Hashimoto/diagnóstico por imagem , Doença de Hashimoto/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Tireoidectomia , Tireoidite/diagnóstico por imagem , Tireoidite/patologia , Carga Tumoral
11.
Postgrad Med ; 132(6): 506-511, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32133896

RESUMO

Objective: Thyroid nodules are highly prevalent and a common clinical problem worldwide. How to identify the nature of a nodule is a major concern of clinicians. Fine needle aspiration cytology (FNAC) has an established role and is well-utilized in nodule management. However, the unsatisfactory nondiagnostic and indeterminate rates limit its usage and lead to some unnecessary surgery. Hashimoto thyroiditis (HT) is prevalently found concurrent with thyroid nodules. Whether HT can influence the accuracy of cytopathological diagnosis of nodules is still controversial. Methods: We collected medical records of 1,063 patients with thyroid nodules who had done FNAC in our hospital from 2015 to 2016. Thyroid function, anti-thyroid autoantibody levels, thyroid ultrasound records, and cytological and histopathological results of nodules were reviewed to analyze the impact of HT on FNAC outcome. Results: A total of 1,063 patients with an average age of 44 ± 13 years old were retrospectively reviewed for pathological and clinical data. Patients with different cytological diagnoses had comparable positive rates of anti-thyroid autoantibodies. One hundred patients were confirmed to have concurrent HT by histopathology after surgery. The overall nondiagnostic and indeterminate cytology rates were 11.9% and 25% respectively. No statistical difference was found either in the rate of a nondiagnostic cytology results or in the rate of indeterminate cytology results between patients with positive anti-thyroid autoantibodies and patients with negative test for anti-thyroid autoantibodies (P > 0.05). The same was true between patients with histopathologically confirmed HT and HT-negative ones (P > 0.05). Conclusions: The presence of concurrent HT, whether clinically implied with positive anti-thyroid autoantibodies or pathologically confirmed, is unlikely to predispose an FNAC diagnosis of thyroid nodules to be non-diagnostic or indeterminate.


Assuntos
Autoanticorpos/sangue , Biópsia por Agulha Fina/métodos , Doença de Hashimoto , Utilização de Procedimentos e Técnicas/normas , Glândula Tireoide , Nódulo da Glândula Tireoide , Adulto , Confiabilidade dos Dados , Diagnóstico Diferencial , Feminino , Doença de Hashimoto/diagnóstico , Doença de Hashimoto/imunologia , Humanos , Imuno-Histoquímica , Masculino , Registros Médicos Orientados a Problemas , Melhoria de Qualidade , Testes de Função Tireóidea/métodos , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/imunologia , Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/sangue , Nódulo da Glândula Tireoide/patologia , Ultrassonografia/métodos , Procedimentos Desnecessários/estatística & dados numéricos
12.
Anticancer Res ; 40(3): 1779-1786, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32132087

RESUMO

BACKGROUND/AIM: The purpose of this study was to evaluate the diagnostic value of preoperative ultrasound (US) in the assessment of synchronous thyroid nodules in patients with papillary thyroid cancer (PTC) for determination of surgical extent. PATIENTS AND METHODS: A total of 210 consecutive patients who were surgically diagnosed with PTC were included in this study. Synchronous nodules, divided into probably benign and suspicious nodules based on US findings, were correlated with pathologic results using a nodule-by-nodule analysis. RESULTS: Among the 302 synchronous nodules in 129 patients, 83 (27.5%) synchronous nodules in 73 patients were diagnosed as malignant after surgery. Ipsilateral probably benign nodules on US were more likely to be malignant than contralateral probably benign nodules (ipsilateral, 10.6%; contralateral, 2.0%, p=0.015). The presence of suspicious contralateral nodules on US and the number of synchronous nodules were significant factors related to contralateral cancer (p<0.001 and 0.030). CONCLUSION: For evaluation of synchronous nodules in PTC patients, US assessment for synchronous nodules can be applied for preserving the contralateral lobe.


Assuntos
Câncer Papilífero da Tireoide/complicações , Nódulo da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Câncer Papilífero da Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Adulto Jovem
13.
J Surg Oncol ; 121(7): 1053-1057, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32115718

RESUMO

BACKGROUND AND OBJECTIVES: The Afirma gene expression classifier (AGEC) has not been tested or validated in a high-risk group, such as patients with Hashimoto's thyroiditis (HT). We hypothesized that AGEC would perform worse in patients with HT. METHODS: A retrospective review of patient charts in a single academic institution who underwent thyroidectomy between 2012 and 2017 was conducted. Patients with HT who underwent AGEC were identified to calculate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: We identified 69 patients with HT and atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) on cytology who underwent AGEC analysis. The mean age of AGEC cohort was 50 years (range, 26-77 years) with 90% female. The median nodule size was 1.9 cm (interquartile range [IQR], 1.2-2.7 cm). Of the 69 patients, 62 showed suspicious AGEC of which 26 showed TC on surgical pathology. Of the seven benign AGEC, two showed TC on surgical pathology. The sensitivity, specificity, PPV, and NPV were 93%, 12%, 42%, and 71%, respectively. Of the entire AGEC cohort, 17 (43%) showed multicentric disease. CONCLUSIONS: We observed a lower NPV for AGEC to rule out thyroid cancer in patients with HT, which reduces the utility of the test for this population.


Assuntos
Doença de Hashimoto/genética , Neoplasias da Glândula Tireoide/genética , Adulto , Idoso , Estudos de Coortes , Feminino , Perfilação da Expressão Gênica/métodos , Doença de Hashimoto/patologia , Doença de Hashimoto/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/genética , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia
14.
Cancer Cytopathol ; 128(4): 287-295, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32012493

RESUMO

BACKGROUND: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) comprises 6 categories used for the diagnosis of thyroid fine-needle aspiration biopsy (FNAB). Each category has an associated risk of malignancy, which is important in the management of a thyroid nodule. More accurate predictions of malignancy may help to reduce unnecessary surgery. A machine learning algorithm (MLA) was developed to evaluate thyroid FNAB via whole slide images (WSIs) to predict malignancy. METHODS: Files were searched for all thyroidectomy specimens with preceding FNAB over 8 years. All cytologic and surgical pathology diagnoses were recorded and correlated for each nodule. One representative slide from each case was scanned to create a WSI. An MLA was designed to identify follicular cells and predict the malignancy of the final pathology. The test set comprised cases blindly reviewed by a cytopathologist who assigned a TBSRTC category. The area under the receiver operating characteristic curve was used to assess the MLA performance. RESULTS: Nine hundred eight FNABs met the criteria. The MLA predicted malignancy with a sensitivity and specificity of 92.0% and 90.5%, respectively. The areas under the curve for the prediction of malignancy by the cytopathologist and the MLA were 0.931 and 0.932, respectively. CONCLUSIONS: The performance of the MLA in predicting thyroid malignancy from FNAB WSIs is comparable to the performance of an expert cytopathologist. When the MLA and electronic medical record diagnoses are combined, the performance is superior to the performance of either alone. An MLA may be used as an adjunct to FNAB to assist in refining the indeterminate categories.


Assuntos
Adenocarcinoma Folicular/patologia , Algoritmos , Aprendizado de Máquina , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Adenocarcinoma Folicular/diagnóstico , Biópsia por Agulha Fina/métodos , Citodiagnóstico/métodos , Humanos , Patologistas/estatística & dados numéricos , Curva ROC , Reprodutibilidade dos Testes , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico
15.
J Pediatr Surg ; 55(5): 950-953, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32081357

RESUMO

PURPOSE: The purpose of this study was to evaluate the management of thyroid nodules in children and assess clinical practice variation (CPV) using the 2015 American Thyroid Association (ATA) guidelines as a standard. METHODS: Pediatric patients presenting to a tertiary care pediatric centre with a thyroid nodule from 2007 to 2017 were retrospectively analyzed. Demographic and disease specific information were collected. CPV and adherence to ATA guidelines were explored. RESULTS: Of 86 patient records reviewed, 47 (55%) were managed operatively (mean age 14.4, 59F:27M). Fifteen patients (17%) had malignant pathology, and 11/15 (73%) were papillary carcinoma. Of the 47 operative patients, 7 (15%) had no preoperative ultrasound, and 12 patients (26%) did not have preoperative cytology. All patients with low TSH had scintigraphy appropriately performed, and 1 patient with high/normal TSH did not have a preoperative FNA obtained. All differentiated thyroid cancers were appropriately managed with hemithyroidectomy or total thyroidectomy based on pathology. Where CPV from the guidelines was noted, it was associated with complex presentation, the surgeon's decision to proceed to surgery directly, and/or rare pathologies. CONCLUSION: The ATA guidelines provide a valuable framework for the management of pediatric thyroid nodules, but CPV persists given patient/disease complexity and heterogeneity. TYPE OF STUDY: Case Series with No Comparison Groups. LEVEL OF EVIDENCE: Level VI: Case series with no comparison groups.


Assuntos
Padrões de Prática Médica/estatística & dados numéricos , Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia/estatística & dados numéricos , Adolescente , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/cirurgia , Criança , Tomada de Decisões , Feminino , Humanos , Masculino , Cintilografia , Projetos de Pesquisa , Estudos Retrospectivos , Cirurgiões , Centros de Atenção Terciária , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/patologia
16.
AJR Am J Roentgenol ; 214(5): 1152-1157, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32097031

RESUMO

OBJECTIVE. The objective of this article is to assess radiologist concordance in characterizing thyroid nodules using the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS), focusing on the effect of radiologist experience on reader concordance. MATERIALS AND METHODS. Three experienced and three less experienced radiologists assessed 150 thyroid nodules using the TI-RADS lexicon. Percent concordance was determined for various endpoints. RESULTS. Interreader concordance for the five TI-RADS categories was 87.2% for shape, 81.2% for composition, 76.1% for echogenicity, 72.9% for margins, and 69.8% for echogenic foci. Concordance for individual features was 96.3% for rim calcifications, 90.8% for macrocalcifications, 90.1% for spongiform, 83.5% for comet tail artifact, and 77.7% for punctate echogenic foci. Concordance for the TI-RADS level and recommendation for fine-needle aspiration (FNA) were 50.4% and 78.9%, respectively. Concordance was significantly (p < 0.05) higher for less experienced readers in identifying margins (84.3% vs 67.4%), echogenic foci (76.9% vs 69.3%), comet tail artifact (89.6% vs 79.2%), and punctate echogenic foci (85.3% vs 75.5%), and lower for peripheral rim calcifications (95.0% vs 97.8 %), but was not different (p > 0.05) for the remaining categories and features. CONCLUSION. A range of TI-RADS categories, features, and recommendations for FNA had generally moderate interreader agreement among six radiologists. Our results show that concordance for numerous characteristics was significantly higher for the less experienced versus the more experienced readers. These results suggest that less experienced readers relied more on the explicit TI-RADS criteria, whereas the experienced radiologists partially relied on their accumulated experience when forming impressions. However, the overall TI-RADS level and recommendation for FNA were unaffected, supporting the robustness of the TI-RADS lexicon and its continued use in practice.


Assuntos
Competência Clínica , Radiologistas/normas , Sistemas de Informação em Radiologia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artefatos , Biópsia por Agulha Fina , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Nódulo da Glândula Tireoide/patologia
17.
AJR Am J Roentgenol ; 214(4): 900-906, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32069084

RESUMO

OBJECTIVE. The objective of our study was to compare diagnostic accuracy and reliability of the 2017 American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) and 2015 American Thyroid Association (ATA) classifications for thyroid nodules. MATERIALS AND METHODS. This study was a retrospective cohort study of 1947 consecutive thyroid nodules sampled with fine-needle aspiration (FNA) from 2007 to 2016. Reviewers assigned TI-RADS scores to all nodules while blinded to clinical outcome and histologic diagnosis and compared TI-RADS scores with nodule-specific ATA scores from the same cohort. Five blinded radiologists independently assigned TI-RADS scores to a subset of 151 nodules (interrater agreement). The primary outcome was a comparison of the diagnostic accuracy of the TI-RADS and ATA classifications using ROC curve analysis. The reference standard was cytopathologic diagnosis according to the Bethesda system. Interrater agreement was determined using intraclass correlation (ICC) and kappa statistics. RESULTS. Of 1947 sampled thyroid nodules, 31.8% (n = 620) met TI-RADS criteria for FNA, 28.0% (n = 545) met TI-RADS criteria for follow-up, and 40.2% (n = 782) met TIRADS criteria to be ignored. Applying the 2015 ATA criteria resulted in recommendations of immediate FNA procedures for more nodules than applying the 2017 TI-RADS (ATA vs TIRADS: 62.3% [1213/1947] vs 31.8% [620/1947], p < 0.0001). Diagnostic accuracies (AUCs: TI-RADS score, 0.684 [95% CI, 0.644-0.724]; ATA, 0.686 [95% CI, 0.646-0.725]) and false-negative rates (TI-RADS, 2.2% [43/1947]; ATA, 2.4% [47/1947]) for the two classifications were similar (p = 0.75). Overall interrater agreement was fair for both (ICCs: TI-RADS, 0.437 [95% CI, 0.357-0.520]; ATA classification, 0.460 [95% CI, 0.391-0.533]). CONCLUSION. The 2017 ACR TI-RADS and 2015 ATA classifications have similar diagnostic accuracies and interrater agreement, but TI-RADS results in fewer nodules being recommended for immediate FNAs and more nodules being recommended for imaging surveillance.


Assuntos
Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/patologia , Ultrassonografia/métodos , Biópsia por Agulha Fina , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade , Sociedades Médicas , Estados Unidos
18.
J Clin Ultrasound ; 48(3): 127-133, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31957032

RESUMO

PURPOSE: This rapid scoping review addresses the commentary titled the ACR TI-RADS™: An Advance in the Management of Thyroid Nodules or Pandora's Box of Surveillance? suggesting that the 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS™-2017) adds to a plethora of existing guidelines, incorporates an inconsistent lexicon, and potentially contradicts recommendations. MATERIALS AND METHODS: The author performed a rapid scoping review using a combination of English keywords to identify and review peer reviewed articles contained in electronic databases (e-databases) comparing 2 or more guidelines for managing adult thyroid nodules (GMTNs) with (UGMTNs) and without (non-UGMTNs) ultrasound. E-databases included Medline (PubMed), EBSCO, Google, and Google Scholar published (2010-2019). RESULTS: The search returned 28 articles, where the author identified 12 different guidelines. Most articles evaluated diagnostic performance (N = 26), not quality (N = 2) measures. The most commonly reviewed UGMTNs were in descending order ATA-2015, ACR TI-RADS™-2017, South Korean, and EU TI-RADS. No article reviewed all GMTNs or identified a generally accepted UGMTNs or non-UGMTNs. Primary origin continents were: North America (U.S.A), Asia (Japan, South Korea, Thailand), Europe (France, Italy, U.K.), and South America (Chile). CONCLUSION: A plethora of UGMTNs may exist. No guideline enjoys general acceptance and evaluations of performance and quality vary.


Assuntos
Guias de Prática Clínica como Assunto , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/terapia , Ultrassonografia/métodos , Adulto , Biópsia , Tomada de Decisão Clínica , Assistência à Saúde/economia , Feminino , Humanos , Masculino , Medição de Risco , Nódulo da Glândula Tireoide/patologia , Ultrassonografia/economia
19.
Clin Imaging ; 60(2): 222-227, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31927498

RESUMO

OBJECTIVES: Thyroid imaging reporting and data system (TIRADS) is a combination of ultrasonographic features developed to help physicians in predicting the malignancy risk of thyroid nodules based on sonographic characteristics. Thyroid nodule size is another factor in determining whether a nodule is malignant. The aim of this study was detecting the predictive value of TIRADS and nodule size based on Bethesda classification in prognostication of malignancy. METHODS: This was a cross-sectional study of 239 patients with thyroid nodules. The patients underwent ultrasonography using TIRADS classification and FNA biopsy based on Bethesda categorization. The results were analyzed using SPSS with the cut off points and predictive values measured. RESULTS: TIRADS ≥4 could detect malignant nodules with a sensitivity of 91.67% and specificity of 52.8%. An inverse relationship was observed between nodule size and malignancy risk and cutoff point of 12 mm was found for detecting malignant nodules. CONCLUSIONS: Thyroid nodules with TIRADS 4 and 5 and diameter lower than 12 mm, are highly suspicious for malignancy and should be considered as indications for fine needle aspiration biopsy. ADVANCES IN KNOWLEDGE: The study suggests TIRADS and thyroid nodule size as sensitive predictors of malignancy.


Assuntos
Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Adulto , Biópsia por Agulha Fina/métodos , Estudos Transversais , Cistografia , Coleta de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Ultrassonografia/métodos
20.
Korean J Radiol ; 21(1): 108-116, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31920034

RESUMO

OBJECTIVE: To investigate the concordance of three international guidelines: the Korean Thyroid Association/Korean Society of Thyroid Radiology, American Thyroid Association, and American College of Radiology for thyroid nodules classified by ultrasonography (US) and the diagnostic performance of simulated size criteria for malignant biopsies. MATERIALS AND METHODS: A total of 2586 thyroid nodules (≥ 1 cm) were collected from two multicenter study datasets. The classifications of the thyroid nodules were based on three different guidelines according to US categories for malignancy risk, and the concordance rate between the different guidelines was calculated for the classified nodules. In addition, the diagnostic performance of criteria related to four different simulated biopsy sizes was evaluated. RESULTS: The concordance rate of nodules classified as high- or intermediate-suspicion was high (84.1-100%), but low-suspicion or mildly-suspicious nodules exhibited relatively low concordance (63.8-83.8%) between the three guidelines. The differences in sensitivity, specificity, and accuracy between the guidelines were 0.7-19.8%, 0-40.9%, and 0.1-30.5%, respectively, when the original biopsy criteria were applied. The differences decreased to 0-5.9%, 0-10.9%, and 0.1-8.2%, respectively, when simulated, similar biopsy size criteria were applied. The unnecessary biopsy rate calculated with the original criteria (0-33.8%), decreased with the simulated biopsy size criteria (0-8.7%). CONCLUSION: We found a high concordance between the three guidelines for high- or intermediate-suspicion nodules, and the diagnostic performance of the biopsy criteria was approximately equivalent for each simulated size criterion. The difference in diagnostic performance between the three guidelines is mostly influenced by the various size thresholds for biopsies.


Assuntos
Biópsia por Agulha Fina , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/patologia , Ultrassonografia , Adolescente , Adulto , Idoso , Algoritmos , Bases de Dados Factuais , Feminino , Guias como Assunto , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Sociedades Médicas , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Estados Unidos , Adulto Jovem
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