Thyroid Nodules in the Follow-Up of Irradiated Individuals: Comparison of Thyroid Ultrasound with Scanning and Palpation1

In 1974 we began a prospective study of a cohort of 4296 individuals exposed to therapeutic head and neck irradiation during childhood for benign conditions. To define the role of thyroid ultrasonography in following irradiated individuals, we studied a subgroup of 54 individuals. They all had been screened between 1974–1976 and had normal thyroid scans and no palpable nodules at that time. Thyroid ultrasonography, thyroid scanning, physical examination, and serum thyroglobulin measurements were performed. One or more discrete ultrasound-detected nodules were present in 47 of 54 (87%) subjects. There were a total of 157 nodules, 40 of which were 1.0 cm or larger in largest dimension. These 40 nodules occurred in 28 (52%) of the subjects. Thirty (75%) of these 1.0-cm or larger nodules matched discrete areas of diminished uptake on corresponding thyroid scans. The 10 that did not match (false negative scans for ≥1.0-cm nodules) were the only nodules of this size in 7 subjects. Of 11 nodules 1.5 cm or larger, only 5 were palpable. Serum thyroglobulin correlated to the number (P = 0.04; r2 = 0.10), but not the volume of the thyroid nodules (P = 0.07; r2 = 0.08). We conclude that thyroid nodules are continuing to occur and are exceedingly common in this irradiated cohort of individuals. The results confirm that thyroid ultrasonography is more sensitive than physical examination and scanning. However, thyroid ultrasound is so sensitive and nodules so prevalent that great caution is needed in interpreting the results.

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Will Real Time Visualization of Needle in Target Thyroid Nodules Minimize False Negative FNA Results?

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1846 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A904-A905

Author(s):

Vijaykumar Sekar ◽

Panadeekarn Panjawatanan ◽

Sofia Junaid Syed

Keyword(s):

Thyroid Cancer ◽

Thyroid Nodule ◽

Thyroid Nodules ◽

False Negative ◽

Thyroid Ultrasound ◽

Papillary Thyroid ◽

Ultrasound Guided ◽

Real Time Visualization ◽

The Right

Abstract Introduction: Prevalence of thyroid nodules in the adult population based on detection by ultrasonography is about 20-76% of which only 5% account for thyroid cancer. All patients with a suspected thyroid nodule either on physical examination or noted incidentally on other imaging should be evaluated with thyroid ultrasound. Any thyroid nodule >= 1 cm on ultrasound should be investigated with FNAC. Ultrasound guided FNAC techniques are used to reduce false negative results. We present a patient with suspicious finding on initial thyroid ultrasound and subsequent negative FNAC presenting a few years later with papillary thyroid cancer. Case Presentation: A 32 y.o. female with history of thyroid nodule and thyroiditis presented to the endocrine clinic for follow-up of her thyroid nodule. 5 years ago, she was diagnosed with thyroid nodule, which was found on an ultrasound scan for workup of her dysphagia. The thyroid ultrasound then showed diffusely heterogeneous thyroid gland with an ill-defined area of decreased echogenicity in the right lobe and left superior lobe and possible nodule in the lower pole left thyroid. Blood work showed TSH of 1.71 (n 0.34-3.00 uIU/ml) and thyroid peroxidase antibody levels was 27.8 (n < 9.0 IU/ml). A CT scan of neck with contrast was done and no concerning mass was seen. The patient had a follow-up ultrasound after 8 months which showed small bilateral thyroid lesions, somewhat ill-defined. The patient had an FNA biopsy of the right thyroid nodule: the results were consistent with a benign follicular nodule. A follow-up thyroid ultrasound was done in a year, and the findings were unchanged. The patient came back 3 years later for follow-up with complaints of a new palpable nodule in the neck. Ultrasound showed unchanged right thyroid nodule and some new cervical adenopathy. The ultrasound showed a 2.2 cm heterogeneous lymph node with punctate echogenic foci along the right lateral margin of the right internal jugular vein at the level of the thyroid gland, Subsequently FNA biopsy of the right cervical node and right thyroid node were done. The cells from lymph nodes were positive for malignancy and cells from the right thyroid nodule were atypical. Overall the appearance was consistent with papillary thyroid carcinoma. Subsequently the patient underwent total thyroidectomy and right modified lymph node dissection and the pathology results came back as multifocal papillary thyroid cancer right side 1.2 cm and left side 0.4 cm, with metastasis to 2 lymph nodes. Conclusion: The reported false negative rate of ultrasound-guided FNAC is variable. Success of US-FNA depends on experience of operator and cyto-pathologist and the intrinsic nature of the nodule. Malignancy rates of only 1-2% are reported with repeat FNA in prior benign nodules. Good FNA techniques and real-time visualization of needle in target nodules can further decrease false negatives.

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Follow-up after inguinal hernia repair. Questionnaire compared with physical examination: a prospective study in 299 patients

The European Journal of Surgery ◽

10.1080/110241598750005903 ◽

2003 ◽

Vol 164 (7) ◽

pp. 533-536 ◽

Cited By ~ 26

Author(s):

Patrick M. Vos ◽

Maarten P. Simons ◽

Jan S. K. Luitse ◽

Dick van Geldere ◽

Mark J. W. Koelemaij ◽

...

Keyword(s):

Inguinal Hernia ◽

Physical Examination ◽

Hernia Repair ◽

Prospective Study ◽

Inguinal Hernia Repair ◽

A Prospective Study

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Role of computed tomography in the follow-up of hepatic and peritoneal metastases of GIST under imatinib mesylate treatment: a prospective study of 54 patients

Clinical Imaging ◽

10.1016/j.clinimag.2005.07.015 ◽

2005 ◽

Vol 29 (6) ◽

pp. 446

Author(s):

D. Vanel ◽

M. Albiter ◽

L. Sapeero ◽

A. Le Cesne ◽

S. Bonvalot ◽

...

Keyword(s):

Computed Tomography ◽

Prospective Study ◽

Imatinib Mesylate ◽

Peritoneal Metastases ◽

A Prospective Study

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Role of biomarkers in predicting the occurrence of thyroid neoplasms in radiation-exposed children

Endocrine Related Cancer ◽

10.1530/erc-17-0408 ◽

2018 ◽

Vol 25 (4) ◽

pp. 481-491

Author(s):

Joseph M Shulan ◽

Leonid Vydro ◽

Arthur B Schneider ◽

Dan V Mihailescu

Keyword(s):

Thyroid Cancer ◽

Thyroid Nodules ◽

Subsequent Development ◽

Thyroid Neoplasms ◽

Childhood Cancer Survivors ◽

Malignant Neoplasms ◽

Increased Risk ◽

Need To Evaluate

With increasing numbers of childhood cancer survivors who were treated with radiation, there is a need to evaluate potential biomarkers that could signal an increased risk of developing thyroid cancer. We aimed to examine the relationships between thyrotropin and thyroglobulin levels and the risk of developing thyroid nodules and cancer in a cohort of radiation-exposed children. 764 subjects who were irradiated in the neck area as children were examined and followed for up to 25 years. All subjects underwent a clinical examination, measurements of thyrotropin, thyroglobulin levels and thyroid imaging. At baseline, 216 subjects had thyroid nodules and 548 did not. Of those with nodules, 176 underwent surgery with 55 confirmed thyroid cancers. During the follow-up, 147 subjects developed thyroid nodules including 22 with thyroid cancer. Thyroglobulin levels were higher in subjects with prevalent thyroid nodules (26.1 ng/mL vs 9.37 ng/mL; P < 0.001) and in those who had an initial normal examination but later developed thyroid nodules (11.2 ng/mL vs 8.87 ng/mL; P = 0.017). There was no relationship between baseline thyrotropin levels and the prevalent presence or absence of thyroid nodules, whether a prevalent neoplasm was benign or malignant, subsequent development of thyroid nodules during follow-up or whether an incident nodule was benign or malignant. In conclusion, in radiation-exposed children, higher thyroglobulin levels indicated an increased risk of developing thyroid nodules but did not differentiate between benign and malignant neoplasms. There was no association between the baseline TSH level and the risk of developing thyroid nodules or cancer.

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The role of a new polyclonal competitive thyroglobulin assay in the follow-up of patients with differentiated thyroid cancer with structural disease but low levels of serum thyroglobulin by immunometric and LC-MS/MS methods

Endocrine ◽

10.1007/s12020-020-02526-8 ◽

2020 ◽

Author(s):

Leila Guastapaglia ◽

Teresa S. Kasamatsu ◽

Claudia Cristina D. Nakabashi ◽

Cléber P. Camacho ◽

Rui M. B. Maciel ◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Serum Thyroglobulin ◽

Low Levels ◽

Structural Disease

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Workplace bullying and depressive symptoms among employees in Germany: prospective associations regarding severity and the role of the perpetrator

International Archives of Occupational and Environmental Health ◽

10.1007/s00420-019-01492-7 ◽

2019 ◽

Vol 93 (4) ◽

pp. 433-443 ◽

Cited By ~ 1

Author(s):

Stefanie Lange ◽

Hermann Burr ◽

Uwe Rose ◽

Paul Maurice Conway

Keyword(s):

Depressive Symptoms ◽

Workplace Bullying ◽

Longitudinal Design ◽

Panel Study ◽

Patient Health ◽

A Prospective Study ◽

Nonsignificant Effect ◽

Degree Of Severity

Abstract Objectives The aim of this study was to investigate the effect of self-reported workplace bullying on depressive symptoms in a prospective study among a representative sample of employees from Germany. We focused specifically on the role of the perpetrator (co-workers and superiors), which was never done before in a longitudinal design. Methods We used data from a nation-wide representative panel study with a 5-year follow-up (N = 2172). Data on bullying exposure were obtained separately for different perpetrators (co-workers and superiors) and degree of severity (severe bullying, i.e., at least weekly). Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ). We used logistic regression analyses to examine the effect of workplace bullying at baseline on depressive symptoms at follow-up. Results After adjusting for baseline depressive symptoms, severe bullying by co-workers significantly increased the 5-year risk of depressive symptoms (OR = 2.50). Severe bullying by superiors had a nonsignificant effect. Conclusions Workplace bullying is a risk factor for depressive symptoms among employees in Germany. The type of perpetrator seems to be an important factor to consider, as indicated by the elevated risk of depressive symptoms when bullying is perpetrated by co-workers.

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Octreotide for Malignant Bowel Obstruction (DRAFT)

10.1093/med/9780190658618.003.0026 ◽

2018 ◽

Author(s):

Shalini Dalal

Keyword(s):

Prospective Study ◽

Bowel Obstruction ◽

Clinical Case ◽

Malignant Bowel Obstruction ◽

Advanced Cancer Patients ◽

Symptomatic Management ◽

A Prospective Study ◽

Study Intervention

This chapter describes a prospective study published in 2002 evaluating the role of octreotide in the symptomatic management of advanced cancer patients with bowel obstruction that cannot be treated surgically. The chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case. Topics covered include octreotide, bowel obstruction, vomiting, and abdominal distention.

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Afirma Testing in Thyroid Nodules with Indeterminate Cytology: A single Medical Institute Experience

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.207 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S94-S95

Author(s):

Z Yang ◽

T Zhang ◽

L Layfield ◽

M Esebua

Keyword(s):

Predictive Value ◽

Thyroid Nodules ◽

False Negative ◽

Follicular Adenoma ◽

Follicular Carcinoma ◽

Medical Institute ◽

Cell Adenoma ◽

Indeterminate Cytology ◽

Thyroid Fna

Abstract Introduction/Objective About 10 to 30% of thyroid fine needle aspiration (FNA) nodules have indeterminate cytology, including Bethesda III, IV, and V. Afirma Gene Expression Classifier (GEC) measuring the expression of 167 mRNA was designed to classify the indeterminate thyroid nodules into benign and suspicious categories. This study aimed to evaluate the clinical performance of the Afirma GEC testing in these indeterminate thyroid lesions. Methods Medical records of patients with indeterminate thyroid FNA results and corresponding Afirma GEC results from November 2012 to December 2019 were retrieved. Subsequent surgical follow-up results were obtained. GEC results were compared to the histologic diagnoses. Results 1. There were 77 cases with indeterminate thyroid FNA results. Cytology diagnosis included 67 Bethesda III and 10 Bethesda IV. Afirma GEC results were benign for 41 cases (53%), suspicious for 32 cases (42%), and non- diagnostic for 4 cases (5%). Twenty seven of 32 cases (84%) with suspicious GEC results had surgical follow-up which revealed 12 malignant and 15 benign histologic diagnoses. Only 11 of 41 cases (27%) with benign GEC results had surgery which showed 8 benign and 3 malignant diagnoses. Based on the data, the sensitivity of this test is 80% and specificity is 65%. Positive predictive value (PPV) is 44% and negative predictive value (NPV) is 73%. The false positive cases include 5 Hurthle cell adenoma, 4 nodular hyperplasia, 3 follicular adenoma, 2 Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFPT), and 1 lymphocytic thyroiditis. The false negative cases include 2 minimally invasive follicular carcinoma (from same patient) and 1 papillary thyroid carcinoma. Conclusion 1. We demonstrated in this study that a little more than half of the cases with indeterminate thyroid cytology had negative Afirma GEC results. 2.Afirma test has relatively low specificity (65%) and PPV (44%). The sensitivity (80%) and NPV (73%) is relatively higher but is lower than the values in most literature. This could be due to the fact that majority of the Afirma GEC negative cases in this study did not have surgical follow-up and the sample size is small. 3.Afirma GEC test is a relatively good “rule-out” molecular test for indeterminate thyroid nodules but is not a reliable “rule-in” test due to the low specificity and PPV.

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