scholarly journals Clinical features and results of laboratory and instrumental examination of patients with nodular structures in the thyroid gland in real clinical practice

2017 ◽  
Vol 95 (4) ◽  
pp. 355-361
Author(s):  
I. S. Berezkina ◽  
T. V. Saprina ◽  
A. P. Zima ◽  
A. V. Isaeva ◽  
V. N. Latypova ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Clinical Practice ◽  
Thyroid Nodules ◽  
Statistical Data ◽  
Clinical Laboratory ◽  
Nodular Goiter ◽  
High Sensitivity ◽  
Cancer Research Institute ◽  
The City ◽  
Malignancy Potential

The ever increasing incidence of thyroid cancer throughout the world poses the problem of differential diagnosis of thyroid nodules at various stages of their formation. Objective: to determine the most important clinical, laboratory and instrumental parameters of thyroid nodules for the assessment of their malignancy potential and to identify "defects" of clinical and instrumental examination of patients with nodular goiter in clinical practice. Materials and methods: we analyzed the data of general clinical research, hormonal profile, and thyroid ultrasound studies performed on the basis of various clinics in the city of Tomsk (41%), Endocrinology Department of the OGAUZ TOKB consultative and diagnostic polyclinic (28 %), and Cancer Research Institute (31%) for the period from 2012 to 2014. The patients were selected for surgery. Pre-operative data were compared with histological features of the nodules. Results: we analyzed «defects» of patient examination, statistical data on clinical and laboratory-instrumental parameters of thyroid nodules. Conclusion: «defects» of description of ultrasound data significantly reduce sensitivity of the method for predicting malignancy of thyroid nodules. The description of the material obtained by US-FNA alone, in the absence of the conclusion of medical cytologists, has no informative value. Low specificity of a cytological study (48.4%) and its high sensitivity (95.8%) suggests overdiagnosis of thyroid cancer.

scholarly journals Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus

2013 ◽  
Vol 57 (4) ◽  
pp. 240-264 ◽  
Author(s):  
Pedro Weslley Rosário ◽  
Laura S. Ward ◽  
Gisah A. Carvalho ◽  
Hans Graf ◽  
Rui M. B. Maciel ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Clinical Practice ◽  
Mortality Rate ◽  
Disease Management ◽  
Clinical Relevance ◽  
Conventional Treatment ◽  
Differentiated Thyroid Cancer ◽  
Thyroid Nodules ◽  
Relevant Literature ◽  
Aggressive Disease

Thyroid nodules are frequent findings, especially when sensitive imaging methods are used. Although thyroid cancer is relatively rare, its incidence is increasing, particularly in terms of small tumors, which have an uncertain clinical relevance. Most patients with differentiated thyroid cancer exhibit satisfactory clinical outcomes when treatment is appropriate, and their mortality rate is similar to that of the overall population. However, relapse occurs in a considerable fraction of these patients, and some patients stop responding to conventional treatment and eventually die from their disease. Therefore, the challenge is how to identify the individuals who require more aggressive disease management while sparing the majority of patients from unnecessary treatments and procedures. We have updated the Brazilian Consensus that was published in 2007, emphasizing the diagnostic and therapeutic advances that the participants, representing several Brazilian university centers, consider most relevant in clinical practice. The formulation of the present guidelines was based on the participants' experience and a review of the relevant literature.

scholarly journals Modern concepts of the molecular pathogenesis of thyroid cancer

2021 ◽  
Vol 8 (2) ◽  
pp. 8-22
Author(s):  
A. A. Mikhailova ◽  
A. V. Shestakov ◽  
K. A. Chubakova ◽  
E. V. Kolokolova ◽  
V. Yu. Eliseev ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Tumor Markers ◽  
Molecular Mechanisms ◽  
Thyroid Nodules ◽  
Gene Mutations ◽  
Endocrine System ◽  
Nodular Goiter ◽  
Micro Rna ◽  
Diagnostic Methods ◽  
Patient Treatment

Thyroid cancer remains the most common malignancy of the endocrine system worldwide. The indicators of its morbidity and mortality rates have been increasing rapidly over the last decades. Most cases of differentiated thyroid cancer (follicular and papillary histotypes) are clinically manifested by nodular goiter frequently combined with uncertain results of cytological diagnosis (categories III and IV according to the Bethesda (Bethesda System for Reporting Thyroid Cytopathology) classification). All of that makes it difficult to choose a proper tactic for patient treatment. It is known that the development, progression, invasion, and metastasis of cancer cells are regulated by a variety of molecular mechanisms. This review describes several molecular aspects of thyroid nodules oncogenesis, as well as its most promising diagnostic tumor markers. Following molecular pathways are described in particular: gene mutations, protein tumor markers, and epigenetic effects of micro-RNA, histones, as well as DNA methylation. The study of the pathogenesis of this disease has a prognostic value and contributes to the search for effective therapeutic and diagnostic methods and their improvement. That is why we also reviewed modern test panels aimed at preoperative differential diagnosis of thyroid nodules. Summarizing the results of world research on this topic allows us not only to expand the understanding of the fundamental processes of oncogenesis, but also to outline promising areas for future experimental research projects. All of that together will contribute to developing new prognostic, diagnostic and therapeutic technologies, and as a result, will improve the quality of medical care for patients with thyroid cancer.

scholarly journals Papillary thyroid cancer in an adolescent with a toxic single nodular goiter

2017 ◽  
Vol 63 (2) ◽  
pp. 114-116 ◽  
Author(s):  
Olga S. Rogova ◽  
Goar F. Okminyan ◽  
Lubov N. Samsonova ◽  
Elena V. Kiseleva ◽  
Oleg Yu. Latyshev ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodule ◽  
Papillary Thyroid Cancer ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Nodular Goiter ◽  
Needle Aspiration ◽  
Papillary Thyroid ◽  
Risk Of Malignancy ◽  
Functional Autonomy

The rate of nodular goiter in children ranges from 0.05 to 5.1%; in this case, the risk of thyroid cancer in childhood amounts to 3―70% of all cases of thyroid pathology. Therefore, the main issue is the differential diagnosis of a nosological variant of a thyroid nodule, which defines the optimal therapeutic tactics for a particular patient. The risk of malignancy is traditionally believed to be low in the case of decompensated functional autonomy of a thyroid nodule; therefore, the need for fine needle aspiration biopsy (FNAB) followed by cytomorphological analysis of the aspirate is avoided in most cases. The presented clinical case demonstrates papillary cancer in an adolescent with a toxic single nodular goiter. A thyroid ultrasound examination revealed a nodular lesion in the boy. An increase in the thyroid size and thyrotoxicosis manifestation occurred 3 years later. A cytomorphological study identified follicular neoplasia; scintigraphy revealed a hot nodule. Surgical treatment was planned. Antithyroid therapy was prescribed to prepare for surgery. After compensation of thyrotoxicosis, hemithyroidectomy was performed. A histological examination diagnosed papillary thyroid cancer, which required repeated thyroidectomy followed by radioiodine I131 ablation. The postoperative period was uneventful; the patient well tolerated suppressive levothyroxine therapy. Therefore, the presence of a toxic single nodular goiter does not exclude thyroid cancer, which defines the need to discuss the indications for FNAB of thyroid nodules in children.

scholarly journals Shear Wave Elasticity by Tracing Total Nodule Showed High Reproducibility and Concordance with Fibrosis in Thyroid Cancer

2019 ◽  
Author(s):  
Myung Hi Yoo(New Corresponding Author) ◽  
Hye Jeong Kim(Former Corresponding Author) ◽  
In Ho Choi ◽  
Suyeon Park ◽  
Sang Jin Kim ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Clinical Practice ◽  
Shear Wave ◽  
Thyroid Nodules ◽  
Intraclass Correlation ◽  
Region Of Interest ◽  
Shear Wave Elastography ◽  
Circular Area ◽  
High Reproducibility ◽  
Wide Range

Abstract Background Although shear wave elastography (SWE) is reported to be useful in detecting malignant thyroid nodules, it shows a wide range of cut-off values of elasticity index (EI) in detecting malignant nodules. The cause of discrepancy remains unclear. Fibrosis of the tumors is known to increase the EI in SWE, and matching of SWE and surgical histopathology has not been fully illustrated in thyroid cancer. We aimed to evaluate the reproducibility of the new total nodular region of interest (ROI) method excluding the subjective features of focal circular ROI placement and to determine the lesion that causes the elevation of EI on SWE and on histopathology. Methods A total of 29 thyroid cancers from 28 patients were included. We evaluated the reproducibility of EI in the new total nodular ROI using Q-Box Trace program and compared the EI in focal nodular ROI using a 3-mm circular area. We analyzed the correlation between fibrosis and EI. Result The coefficient of variation (CV) of the intrarater assay was significantly lower in total nodular ROI than in focal nodular ROI within the image in rater 1 (1.7% vs. 13.4%, p<0.001) and in rater 2 (1.4% vs. 16.9%, p<0.001) and in different images in rater 1 (7.6% vs. 12.3%, p=0.040) and in rater 2 (7.5% vs. 19.8%, p=0.004). Moreover, CV of the interrater assay showed similar results (14.9% vs. 19%, p=0.030). Interrater intraclass correlation coefficient showed better agreement in total nodular ROI than in focal nodular ROI (0.863 vs. 0.783). The degree of fibrosis on histopathology showed significant correlations with EI (E Mean , p<0.001; E Max , p=0.027), and the location of fibrosis was concordant with the high EI area on SWE. Conclusion Our study revealed that the new total nodular ROI method showed higher reproducibility and better agreement in intra- and interrater assay than the focal nodular ROI method, suggesting a valuable and standardized method in clinical practice. Moreover, our results showed that fibrosis in the histopathology increased EI on SWE and might lead to the discrepancy of the cut-off values in detecting thyroid cancer.

Transforming Healthcare Means Zero Harm: Laboratory Testing Matters

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S110-S111
Author(s):  
A Mina
Keyword(s):  
Clinical Practice ◽  
Secondary Prevention ◽  
Role Model ◽  
Clinical Laboratory ◽  
Diagnostic Testing ◽  
High Sensitivity ◽  
Care Patient ◽  
Screening Tests ◽  
High Risk Population ◽  
Extensive Experience

Abstract Introduction/Objective My role model when I was a medical technologist intern was a chief pathologist who taught me to speak up when something is unsafe and to serve willingly, do what is right, be fair and excellent in work. His character impacted my whole life and career. Every moment matters; life is precious and something to protect. The patient and their care teams depend upon accurate, safe and high-quality clinical laboratory tests result to achieve positive patient outcomes. Methods/Case Report Clinical Practice Results (if a Case Study enter NA) We can do better. Everybody can be surveyors with greater understanding of pathophysiologic processes in disease, extensive experience working in laboratories and in-depth knowledge about complaince, quality, mistake-proofing care, patient-focused and laboratory management. Diagnostic testing would be the method to screen for disease, confirm disease, and monitor disease in hopes of secondary prevention - to identify latent disease to “catch it early.” The screening tests could be anything from newborn screening for inborn metabolism errors, adult screening tests (like mammograms, pap smears, and colonoscopies), to high-risk population screenings to detect HIV, RPR, and gonorrhea. The disease must have a high prevalence to justify the expense of therapy and should be detectable before symptoms arise. The test must not have many false positives but extremely high sensitivity. The results of these tests could lead to the three different methods of prevention. Primary prevention would reduce the risk of developing cardiovascular disease or stroke. Secondary prevention would detect the disease early to prevent progression of the disease. Tertiary prevention would reduce disabilty and promotion of rehabilitation from the disease like strokes or rehab programs. Conclusion In conclusion, this information provides clinicians with a laboratory test menu guidelines to improve clinical practice. We can all learn well to focus on what really matters. Together, we can make healthcare better, more patient-centered, less costly, and safer.

scholarly journals A multicenter survey of current practices of 99mTc-methoxy-isobutyl-isonitrile (MIBI) imaging for the diagnosis of thyroid nodules: more standardization is essential

2021 ◽  
Author(s):  
Simone Agnes Schenke ◽  
Alfredo Campenni ◽  
Murat Tuncel ◽  
Arnoldo Piccardo ◽  
Sait Sager ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Thyroid Nodules ◽  
Nodular Goiter ◽  
Clinical Results ◽  
Needle Aspiration ◽  
Heterogeneous Data ◽  
Interpretation Criteria ◽  
Multicenter Survey ◽  
Needle Aspiration Cytology ◽  
Selection Of

Abstract Purpose Molecular imaging with 99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI, MIBI) has been used in the assessment of thyroid nodules (TNs) for more than two decades. Many studies showed that MIBI imaging is a suitable tool to rule-out malignancy when negative. However, relatively low specificity and accuracy have been described, thus, limiting its acceptance in clinical practice. Additionally, different technologies, protocols, and interpretation criteria are adopted accounting for heterogeneous data reported in the literature. Therefore, the present study was undertaken to assess the clinical use and methodology of MIBI imaging in patients with nodular thyroid disease in Europe. Methods A questionnaire was sent to 12 European centers of Nuclear Medicine. The questionnaire encompassed ultrasound (US) and fine-needle aspiration cytology (FNAC) procedures and their evaluation as well scintigraphy imaging indications, technical procedures, and interpretation criteria of MIBI imaging. Results The survey showed a good agreement of different centers in approaching TNs by TSH measurement, US evaluation and 99mTc-pertechnetate thyroid scintigraphy. MIBI imaging is mainly used to assess TNs with inconclusive/indeterminate cytological findings and selection of target nodule(s) for FNAC in patients with multi-nodular goiter. Technical procedures adopted in different centers are globally comparable and the recorded differences are unlikely to impact clinical results. However, as the main result of the present study, substantial differences were found in interpretation criteria adopted in different centers. Conclusions Our survey supports the urgent need of standardized interpretation criteria of thyroid MIBI imaging in order to improve its diagnostic performance and make results comparable in clinical practice.

scholarly journals Estimation of The Fractal Dimension of Thyroid Nodules As A Complementary Diagnostic Tool For Predicting Malignancy

2021 ◽  
Author(s):  
Philippe Lothaire ◽  
Pierrick Uzureau ◽  
Karim Zouaoui Boudjelta ◽  
Nathalie Nagy ◽  
Carine Michiels ◽  
...  
Keyword(s):  
Fractal Dimension ◽  
Thyroid Cancer ◽  
Thyroid Nodules ◽  
Thyroid Tissue ◽  
High Sensitivity ◽  
Needle Aspiration ◽  
Ultrasound Images ◽  
Visual Interpretation ◽  
Normal Tissues ◽  
Benign Nodules

Abstract PurposeUltrasound-guided fine-needle aspiration is the most sensitive investigation procedure in the evaluation of patients with thyroid nodules; however, despite the level of achieved precision, it is still impossible to preoperatively discriminate between follicular adenomas and carcinomas. Thus, no current detection tool of thyroid nodule has both high sensitivity and high positive predictive value for the diagnosis of thyroid cancer. Ultrasound images provide information that are currently missed due to visual interpretation, including the roughness of the echotexture. However, such information can be retrieved using the measurement of the fractal dimension (FD).Material and methodsAccording to the box-counting method, we measured the FD of the echotexture of ultrasound images of 13 benign thyroid nodules and 14 malignant thyroid nodules compared to normal thyroid tissue from 10 men and 16 women (mean age 40).ResultsThe difference of the FD value between malignant nodules (median FD 2.31) and corresponding normal tissues (median FD 2.184) was significant (p<0.001) while the FD values for the benign nodules (median FD 2.21) and for corresponding normal tissues (median FD 2.231) could not be distinguished (p=0.78).ConclusionsThis preliminary work revealed that FD would be an additional feature to discriminate benign from malignant nodules. A larger sampling is now required to confirm the possible utilization of FD in the thyroid cancer diagnosis in clinical practice.

scholarly journals Shear Wave Elasticity by Tracing Total Nodule Showed High Reproducibility and Concordance with Fibrosis Leading to Discrepant Cut-off Values in Thyroid Cancer

2019 ◽  
Author(s):  
Myung Hi Yoo ◽  
Hye Jeong Kim ◽  
In Ho Choi ◽  
Suyeon Park ◽  
Sang Jin Kim ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Clinical Practice ◽  
Shear Wave ◽  
Thyroid Nodules ◽  
Intraclass Correlation ◽  
Region Of Interest ◽  
Shear Wave Elastography ◽  
Circular Area ◽  
High Reproducibility ◽  
Wide Range

Abstract Background Although shear wave elastography (SWE) is reported to be useful in detecting malignant thyroid nodules, it showed a wide range of cut-off values of elasticity index (EI) in detecting malignant nodules. The cause of discrepancy has not been clarified yet. Fibrosis of the tumors is known to increase the EI in SWE, and matching of SWE and surgical histopathology has not been fully illustrated in thyroid cancer. We aimed to evaluate the reproducibility of the new total nodular region of interest (ROI) method excluding the subjective features of focal circular ROI placement and to determine the lesion that causes the elevation of EI on SWE and on histopathology. Methods A total of 29 thyroid cancers from 28 patients were included. We evaluated the reproducibility of EI in the new total nodular ROI using Q-Box Trace program and compared the EI in focal nodular ROI using a 3-mm circular area. We analyzed the correlation between fibrosis and EI. Result The coefficient of variation (CV) of the intrarater assay was significantly lower in total nodular ROI than in focal nodular ROI within the image in rater 1 (1.7% vs. 13.4%, p<0.001) and in rater 2 (1.4% vs. 16.9%, p<0.001) and in different images in rater 1 (7.6% vs. 12.3%, p=0.040) and in rater 2 (7.5% vs. 19.8%, p=0.004). Moreover, CV of the interrater assay showed similar results (14.9% vs. 19%, p=0.030). Interrater intraclass correlation coefficient showed better agreement in total nodular ROI than in focal nodular ROI (0.863 vs. 0.783). The degree of fibrosis on histopathology showed significant correlations with EI (EMean, p<0.001; EMax, p=0.027), and the location of fibrosis was concordant with the high EI area on SWE. Conclusion Our study revealed that the new total nodular ROI method showed higher reproducibility and better agreement in intra- and interrater assay than the focal nodular ROI method, suggesting a new, valuable, and standardized method in clinical practice. Moreover, our results showed that causes the elevation of EI leading to wide discrepant cut-off values of thyroid cancer was the formation of fibrosis.

scholarly journals Shear Wave Elasticity by Tracing Total Nodule Showed High Reproducibility and Concordance with Fibrosis in Thyroid Cancer

2019 ◽  
Author(s):  
Myung Hi Yoo ◽  
Hye Jeong Kim ◽  
In Ho Choi ◽  
Suyeon Park ◽  
Sang Jin Kim ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Clinical Practice ◽  
Shear Wave ◽  
Thyroid Nodules ◽  
Intraclass Correlation ◽  
Region Of Interest ◽  
Shear Wave Elastography ◽  
Circular Area ◽  
High Reproducibility ◽  
Wide Range

Abstract Background Although shear wave elastography (SWE) is reported to be useful in detecting malignant thyroid nodules, it showed a wide range of cut-off values of elasticity index (EI) in detecting malignant nodules. The cause of discrepancy has not been clarified yet. Fibrosis of the tumors is known to increase the EI in SWE, and matching of SWE and surgical histopathology has not been fully illustrated in thyroid cancer. We aimed to evaluate the reproducibility of the new total nodular region of interest (ROI) method excluding the subjective features of focal circular ROI placement and to determine the lesion that causes the elevation of EI on SWE and on histopathology. Methods A total of 29 thyroid cancers from 28 patients were included. We evaluated the reproducibility of EI in the new total nodular ROI using Q-Box Trace program and compared the EI in focal nodular ROI using a 3-mm circular area. We analyzed the correlation between fibrosis and EI. Result The coefficient of variation (CV) of the intrarater assay was significantly lower in total nodular ROI than in focal nodular ROI within the image in rater 1 (1.7% vs. 13.4%, p<0.001) and in rater 2 (1.4% vs. 16.9%, p<0.001) and in different images in rater 1 (7.6% vs. 12.3%, p=0.040) and in rater 2 (7.5% vs. 19.8%, p=0.004). Moreover, CV of the interrater assay showed similar results (14.9% vs. 19%, p=0.030). Interrater intraclass correlation coefficient showed better agreement in total nodular ROI than in focal nodular ROI (0.863 vs. 0.783). The degree of fibrosis on histopathology showed significant correlations with EI (EMean, p<0.001; EMax, p=0.027), and the location of fibrosis was concordant with the high EI area on SWE. Conclusion Our study revealed that the new total nodular ROI method showed higher reproducibility and better agreement in intra- and interrater assay than the focal nodular ROI method, suggesting a valuable and standardized method in clinical practice. Moreover, our results showed that fibrosis in the histopathology increased EI on SWE and might lead to the discrepancy of the cut-off values in detecting thyroid cancer.

Sign in / Sign up

Export Citation Format

Share Document