scholarly journals Thyroid Swellings Undergoing Thyroidectomy in a Tertiary Hospital of Nepal: A Retrospective Study of Distribution and Prevalence of Malignancy

2021 ◽  
Vol 1 (2) ◽  
pp. 27-33
Author(s):  
Mudit Gupta ◽  
Rajeev Kumar Mahaseth ◽  
Sajish Khadgi ◽  
Asmita Shrestha ◽  
Neeti Bhat ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Thyroid Nodule ◽  
Papillary Carcinoma ◽  
Thyroid Nodules ◽  
Benign Lesion ◽  
Needle Aspiration ◽  
Tertiary Hospital ◽  
Common Finding ◽  
Age Group ◽  
Histopathological Evaluation

Introduction: Thyroid nodules brought to a hospital are checked for cancer. A post-operative histological examination is a gold standard for diagnosing thyroid lesions. Treatment is aided by a prior understanding of the disease’s underlying pattern. Objective: A retrospective study was done to determine the prevalence and distribution of malignancy in suspicious thyroid nodules. Methods: The study was conducted at Ganesh Man Singh Memorial Academy of ENT- Head and Neck studies from August 2017 to March 2020. All the subjects (n=183) presenting with a thyroid nodule and who had post-operative histopathological evaluation available were recruited in the study. The proportion and percentage of findings of Fine Needle Aspiration Cytology (FNAC) and histopathological evaluation were done. The distribution of histopathological observation was also analyzed in terms of age group and gender. Results: The mean age of study participants was 40.23 ± 13.77 years (n=183). The predominance of women was notable. In about 98 (53.55%) of the patients who underwent thyroidectomy, a benign lesion was found, but the most common finding was papillary carcinoma (40.98%). In the age group below 50 years, papillary carcinoma was most common. Among people older than 50, colloid goiter was more common. Follicular and medullary carcinomas were only observed in female participants. Gender did not appear to be associated with malignancy (p=0.99). Follicular adenomas were noted to have the youngest mean age. Conclusions: We observed a high prevalence of malignancy, particularly papillary carcinoma in clinically suspected thyroid nodules of a tertiary hospital in Nepal. Keywords: Colloid Goiter; malignancy; papillary carcinoma; thyroid cancer; thyroid nodule.

scholarly journals Clinical and Ultrasound Thyroid Nodule Characteristics and Their Association with Cytological and Histopathological Outcomes: A Retrospective Multicenter Study in High-Resolution Thyroid Nodule Clinics

2019 ◽  
Vol 8 (12) ◽  
pp. 2172
Author(s):  
María Molina-Vega ◽  
Carlos Antonio Rodríguez-Pérez ◽  
Ana Isabel Álvarez-Mancha ◽  
Gloria Baena-Nieto ◽  
María Riestra ◽  
...  
Keyword(s):  
High Resolution ◽  
Thyroid Nodule ◽  
Multicenter Study ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Solid Component ◽  
Common Finding ◽  
Cross Sectional ◽  
Increased Risk ◽  
Design And Methods

Introduction: Thyroid nodules are a common finding. A high-resolution thyroid nodule clinic (HR-TNC) condenses all tests required for the evaluation of thyroid nodules into a single appointment. We aimed to evaluate the clinical outcomes at HR-TNCs. Design and Methods: A retrospective cross-sectional multicenter study including data from four HR-TNCs in Spain. We evaluated fine-needle aspiration (FNA) indications and the association between clinical and ultrasound characteristics with cytological and histopathological outcomes. Results: A total of 2809 thyroid nodules were included; FNA was performed in 82.1%. Thyroid nodules that underwent FNA were more likely larger, isoechoic, with microcalcifications, and in younger subjects. The rate of nondiagnostic FNA was 4.3%. A solid component, irregular margins or microcalcifications, significantly increased the odds of Bethesda IV-V-VI (vs. Bethesda II). Irregular margins and a solid component were independently associated with increased odds of malignancy. Thyroid nodules <20 mm and ≥20–<40 mm had a 6.5-fold and 3.3-fold increased risk for malignancy respectively in comparison with those ≥40 mm. Conclusion: In this large multicenter study, we found that the presence of a solid component and irregular margins are factors independently related to malignancy in thyroid nodules. Since nodule size ≥40 mm was associated with the lowest odds of malignancy, this cut-off should not be a factor leading to indicate thyroid surgery. HR-TNCs were associated with a low rate of nondiagnostic FNA.

scholarly journals Surgical Outcome and Malignant Risk Factors in Patients With Thyroid Nodule Classified as Bethesda Category III

2021 ◽  
Vol 12 ◽  
Author(s):  
Jianhao Huang ◽  
Hongyan Shi ◽  
Muye Song ◽  
Jinan Liang ◽  
Zhiyuan Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Common Finding ◽  
Thyroid Peroxidase ◽  
Fine Needle ◽  
Preoperative Serum ◽  
Thyroid Peroxidase Antibody

BackgroundThyroid nodules are a very common finding in the general population. Fine-needle aspiration (FNA) has been recommended as the initial test for the evaluation of thyroid nodules. The trend on reporting as atypia of undetermined significance (AUS) has been significantly increased, but the malignant risk is still controversial among different studies. The aim of this study is to investigate the malignancy risk of thyroid nodules reported as Bethesda category III (AUS/FLUS) on initial FNA.MethodWe reviewed 272 papillary thyroid cancer (PTC) patients with suspicious thyroid nodules who underwent fine-needle aspiration and received surgical treatment during 2019 to 2020.ResultsOne hundred ten (40.4%) patients were diagnosed with PTC. Multivariate analysis showed that microcalcification (p = 0.037, OR = 2.260, 95% CI: 1.051–4.860), shape (p = 0.003, OR = 4.367, 95% CI: 1.629–11.705), diameters (p = 0.002, OR = 0.278, 95% CI: 0.123–0.631), anti-thyroglobulin antibodies (TGAb) (p = 0.002, OR = 0.150, 95% CI: 0.046–0.494), anti-thyroid peroxidase antibody (A-TPO) (p = 0.009, OR = 4.784, 95% CI: 1.486–15.401), and nodule goiter (p &lt; 0.001, OR = 0.100, 95% CI: 0.046–0.217) were independent malignant risk factors in patients with thyroid nodule classified as Bethesda category III.ConclusionIn this study, malignant risk factors in patients with thyroid nodule classified as Bethesda category III were significantly associated with preoperative serum TGAb, A-TPO, microcalcification, irregular shape, and nodule diameters. Nodules with malignant factors should be carefully elevated; surgery may be the better option for those patients.

scholarly journals TSH measurement is not an appropriate screening test for autonomous functioning thyroid nodules: a retrospective study of 368 patients

2014 ◽  
Vol 170 (4) ◽  
pp. 593-599 ◽  
Author(s):  
Rayan Chami ◽  
Rodrigo Moreno-Reyes ◽  
Bernard Corvilain
Keyword(s):  
Retrospective Study ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Screening Tool ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Thyroid Scan ◽  
Autonomous Functioning ◽  
Needle Aspiration Cytology ◽  
Serum Tsh

ObjectiveBased on the assumption that normal TSH concentration rules out the presence of autonomous functioning thyroid nodules (AFTNs), clinical guidelines on the management of thyroid nodules only recommend a thyroid scan if TSH concentration is subnormal. However, the proportion of AFTN presenting with a normal TSH is unknown. Our objective is therefore to determine the proportion of AFTNs with a normal TSH level to ascertain whether a normal TSH really rules out an AFTN.DesignRetrospective study on 368 patients with an AFTN.MethodsThyroid scans with a diagnosis of AFTN were reviewed retrospectively by one of us (R Moreno-Reyes), blinded to the clinical data. The diagnosis of solitary AFTN was confirmed in 368 patients. Among them, we selected 217 patients based on the absence of another thyroid nodule >10 mm, the absence of medical conditions able to interfere with thyroid function, and the completeness of the data.ResultsThe proportion of AFTNs with normal TSH was 49%. This proportion increased to 71% in patients for whom thyroid scan was performed in the workup of a thyroid nodule.ConclusionsOur data suggest that serum TSH is not an effective screening tool to diagnose AFTNs. Using ‘TSH-only’ screening, as recommended by the majority of guidelines, the diagnosis of AFTN would have been missed in 71% of our patients in the workup of a thyroid nodule. Thyroid scan remains the gold standard for detecting AFTN and should be considered before performing fine-needle aspiration cytology (FNAC), as the reliability of FNAC in an unsuspected AFTN remains unclear.

scholarly journals Clinicopathological study of solitary thyroid nodule in Kolhan belt of Jharkhand

2021 ◽  
Vol 7 (6) ◽  
pp. 959
Author(s):  
Rajeev Saxena ◽  
Shiwani Kanth ◽  
Rohit Kumar Jha ◽  
Devandra Jee
Keyword(s):  
Diagnostic Accuracy ◽  
Thyroid Nodule ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Histopathological Examination ◽  
Follicular Adenoma ◽  
Daily Practice ◽  
Needle Aspiration ◽  
Age Group ◽  
Solitary Thyroid Nodule

<p class="abstract"><strong>Background:</strong> Thyroid disorders are commonly encountered in our daily practice and specially in countries like India and Nepal (foothill areas). There are variety of lesions that can arise within thyroid gland. In such scenario it is important to diagnose neoplastic and non-neoplastic conditions accurately with minimum complications so that proper management can be done as early as possible. The aim of the study was to know clinical spectrum of solitary thyroid nodules and diagnostic accuracy of fine needle aspiration cytology as compared to histopathological examination.</p><p class="abstract"><strong>Methods:</strong> We conducted our study over a period of 21 months from July 2018 to March 2020. 74 patients who gave consent and presented with solitary thyroid swelling were included in the study.  </p><p class="abstract"><strong>Results:</strong> In our study, cases mostly presented in the age group of 31-40 years with a female preponderance. Colloid goiter was the most common pathology which presented as solitary thyroid nodule. Among neoplastic lesions, follicular adenoma was the most common benign neoplasia with papillary thyroid carcinoma being the most common malignancy. FNAC had sensitivity of 78%, specificity-100%, positive predictive value-100%, negative predictive value-88% and diagnostic accuracy-92%.</p><p class="abstract"><strong>Conclusions:</strong> Majority of solitary thyroid nodules are found in females of middle age group. In our study we found FNAC as valuable diagnostic tool specially in benign cases.</p><p class="abstract"> </p><p> </p>

scholarly journals Expression of Matrix Metalloproteinases in Thyroid Follicular Neoplasm Fnab

2020 ◽  
Vol 7 (09) ◽  
pp. 4965-4967
Author(s):  
Meta Oktora ◽  
Meta Zulyati Oktora ◽  
Anandia Putriyuni
Keyword(s):  
Proteolytic Enzyme ◽  
Thyroid Nodules ◽  
Fine Needle Aspiration Biopsy ◽  
Benign Lesion ◽  
Needle Aspiration ◽  
Follicular Neoplasm ◽  
Age Group ◽  
Fine Needle ◽  
Metalloproteinase 9 ◽  
Histopathology Examination

Fine-Needle Aspiration Biopsy (FNAB) thyroid nodules is difficult to distinguish betwen follicular malignancy and follicular benign lesion (1). The diagnosis of malignancy can only be made from histopathology examination by examing tumor invation to capsule and vascular (2,3). Matrix Metalloproteinase 9 (MMP-9) examination can be added to help making initial diagnosis. MMP-9 is a proteolytic enzyme that plays important role in cancer progressivity, especially in thyroid. High MMP-9 expression will lead to earlier degradation of thyroid and its will make the cell metastasist easier (4). This study aims to examine MMP-9 expression of thyroid follicular neoplasm FNAB. We used 42 sample of follicular thyroid neoplasm FNAB obtained from the Pathology Anatomic laboratories in RSUP M Djamil Padang, West Sumatera. Immunohistochemical was staining with primary antibody MMP-9 then its expression were assessed in stroma and cytoplasmic tumour. In this study FNAB follicular thyroid nodules were found in the age group 21-45 years (57.1%), women (88.1%), and MMP-9 expression was found as much as 80.9%.

scholarly journals Choosing the best algorithm among five thyroid nodule ultrasound scores: from performance to cytology sparing—a single-center retrospective study in a large cohort

2021 ◽  
Author(s):  
Clotilde Sparano ◽  
Valentina Verdiani ◽  
Cinzia Pupilli ◽  
Giuliano Perigli ◽  
Benedetta Badii ◽  
...  
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Real Life ◽  
Scoring Systems ◽  
Diagnostic Procedures ◽  
Needle Aspiration ◽  
Common Disease ◽  
Single Center ◽  
Thyroid Microcarcinoma ◽  
Thyroid Malignancies

Abstract Objective Incidental diagnosis of thyroid nodules, and therefore of thyroid cancer, has definitely increased in recent years, but the mortality rate for thyroid malignancies remains very low. Within this landscape of overdiagnosis, several nodule ultrasound scores (NUS) have been proposed to reduce unnecessary diagnostic procedures. Our aim was to verify the suitability of five main NUS. Methods This single-center, retrospective, observational study analyzed a total number of 6474 valid cytologies. A full clinical and US description of the thyroid gland and nodules was performed. We retrospectively applied five available NUS: KTIRADS, ATA, AACE/ACE-AME, EUTIRADS, and ACRTIRADS. Thereafter, we calculated the sensitivity, specificity, PPV, and NPV, along with the number of possible fine-needle aspiration (FNA) sparing, according to each NUS algorithm and to clustering risk classes within three macro-groups (low, intermediate, and high risk). Results In a real-life setting of thyroid nodule management, available NUS scoring systems show good accuracy at ROC analysis (AUC up to 0.647) and higher NPV (up to 96%). The ability in FNA sparing ranges from 10 to 38% and reaches 44.2% of potential FNA economization in the low-risk macro-group. Considering our cohort, ACRTIRADS and AACE/ACE-AME scores provide the best compromise in terms of accuracy and spared cytology. Conclusions Despite several limitations, available NUS do appear to assist physicians in clinical practice. In the context of a common disease, such as thyroid nodules, higher accuracy and NPV are desirable NUS features. Further improvements in NUS sensitivity and specificity are attainable future goals to optimize nodule management. Key Points • Thyroid nodule ultrasound scores do assist clinicians in real practice. • Ultrasound scores reduce unnecessary diagnostic procedures, containing indolent thyroid microcarcinoma overdiagnosis. • The variable malignancy risk of the “indeterminate” category negatively influences score’s performance in real-life management of thyroid lesions.

scholarly journals Can sonographic features of microcalcification predict thyroid nodule malignancy? a prospective observational study

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Mehrdad Nabahati ◽  
Rahele Mehraeen ◽  
Zoleika Moazezi ◽  
Naser Ghaemian
Keyword(s):  
Thyroid Nodule ◽  
Roc Analysis ◽  
Thyroid Nodules ◽  
Area Under The Curve ◽  
Positive Association ◽  
Needle Aspiration ◽  
Northern Iran ◽  
Significant Positive Association ◽  
Irregular Margin ◽  
Benign Nodules

Abstract Background The aim of this study was to investigate the diagnostic accuracy of microcalcification, as well as its associated sonographic features, for prediction of thyroid nodule malignancy. We prospectively assessed the patients with thyroid nodule, who underwent ultrasound-guided fine-needle aspiration during 2017–2020 in Babol, northern Iran. The ultrasonographic characteristics of the nodules, as well as their cytological results, were recorded. We used regression analysis to evaluate the relation between sonographic findings and nodule malignancy. A receiver operator characteristics (ROC) analysis was also used to estimate the ability of ultrasound to predict the characteristic features of malignancy, as estimated by the area under the curve (AUC). Results Overall, 1129 thyroid nodules were finally included in the study, of which 452 (40%) had microcalcification. A significant positive association was found between nodule malignancy and microcalcification in both univariate (OR=3.626, 95% CI 2.258–5.822) and multivariable regression analyses (OR=1.878, 95% CI 1.095–3.219). In the nodules with microcalcification, significant positive relations were seen between malignancy and hypoechogenicity (OR=3.833, 95% CI 1.032–14.238), >5 microcalcification number (OR=3.045, 95% CI 1.328–6.982), irregular margin (OR=3.341, 95% CI 1.078–10.352), and lobulated margin (OR=5.727, 95% CI 1.934–16.959). The ROC analysis indicated that AUC for hypoechogenicity, >5 microcalcification number, irregular margin, and lobulated margin were 60%, 62%, 55%, and 60%, respectively, in predicting malignant thyroid nodules. Conclusion The findings indicated that microcalcification can be a potential predictor of thyroid nodule malignancy. Also, the presence of irregular or lobulated margins, multiple intranodular microcalcification (>5 microcalcifications), and/or hypoechogenicity can improve the ability of microcalcification in distinguishing malignant from benign nodules.

scholarly journals Thyroid and Molecular Testing. Advances in Thyroid Molecular Cytopathology

2021 ◽  
Vol 2 (2) ◽  
pp. 77-92
Author(s):  
Esther Diana Rossi ◽  
Philippe Vielh
Keyword(s):  
Thyroid Nodules ◽  
Adult Population ◽  
Needle Aspiration ◽  
Common Finding ◽  
Molecular Testing ◽  
Additional Tool ◽  
Thyroid Cytology ◽  
Hürthle Cell ◽  
Cell Neoplasm ◽  
Undetermined Significance

Thyroid nodules are a common finding in the adult population including the fact that more than 50% of individuals, over the age of 60, have thyroid nodules. The majority have been mostly detected with ultrasonography and 10% by palpation. The majority of these nodules are benign, whereas 5–15% of them are malignant. The pre-operative diagnosis of cancer is a critical challenge in order to ensure that each patient can be treated with the best tailored management with a reduction of unnecessary surgery for benign lesions. Fine needle aspiration cytology (FNAC) represents the first and most important diagnostic tool for the evaluation of thyroid lesions. According to the literature, FNAC is able to render a conclusive diagnosis in up to 70–80% of all cases. For the remaining 20–30% of nodules, cytological diagnoses fall into the category of indeterminate lesions mostly due to the lack of specific morphological features. According to the Bethesda system for reporting thyroid cytopathology (TBSRTC), indeterminate lesions can be sub-stratified into three different subcategories including “atypia of undetermined significance/follicular lesion of undetermined significance-AUS/FLUS”; “follicular or Hürthle cell neoplasm/suspicious for follicular or Hürthle cell neoplasm-FN/SFN”; and “suspicious for malignancy-SFM”. Many of these indeterminate lesions undergo repetition or diagnostic lobectomy. Nonetheless, the majority of these cases will have a benign diagnosis due to the fact that the rate of cancer ranges between 6 and 30%. It stands to reason that the application of ancillary technique, mostly molecular testing, emerged as a critical additional tool for those thyroid indeterminate lesions. Since the early 1990s, material collected from cytological samples yields sufficient and adequate cells for the detection of point mutation or gene fusions. Nonetheless, the further availability of new sequencing technologies such as next-generation sequencing (NGS) has led to more comprehensive molecular applications adopted now in clinical use. The current review investigates the multiple advances in the field of molecular testing applied in thyroid cytology.

NO BENEFIT OF DEDICATED THYROID NODULE SCREENING IN PATIENTS WITH ACROMEGALY

2020 ◽  
Vol 26 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Ngan Betty Lai ◽  
Dave Garg ◽  
Anthony P. Heaney ◽  
Marvin Bergsneider ◽  
Angela M. Leung
Keyword(s):  
United States ◽  
Growth Hormone ◽  
Thyroid Cancer ◽  
Growth Factor ◽  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Papillary Thyroid ◽  
Fine Needle

Objective: Acromegaly results from the excessive production of growth hormone and insulin-like growth factor-1. While there is up to a 2-fold increased prevalence of thyroid nodules in patients with acromegaly, the incidence of thyroid cancer in this population varies from 1.6 to 10.6% in several European studies. The goal of our study was to determine the prevalence of thyroid nodules and thyroid cancer among patients with acromegaly at a large urban academic medical center in the United States (U.S.). Methods: A retrospective chart review was performed of all patients with acromegaly between 2006–2015 within the University of California, Los Angeles health system. Data were collected regarding patient demographics, thyroid ultrasounds, thyroid nodule fine needle aspiration (FNA) biopsy cytology, and thyroid surgical pathology. Results: In this cohort (n = 221, 49.3% women, mean age 53.8 ± 15.2 [SD] years, 55.2% Caucasian), 102 patients (46.2%) underwent a thyroid ultrasound, from which 71 patients (52.1% women, mean age 52.9 ± 15.2 [SD] years, 56.3% Caucasian) were found to have a thyroid nodule. Seventeen patients underwent a thyroid nodule FNA biopsy and the results revealed 12 benign biopsies, 1 follicular neoplasm, 3 suspicious for malignancy, and 1 papillary thyroid cancer (PTC), from which 6 underwent thyroidectomy; PTC was confirmed by surgical pathology for all cases (8.5% of all nodules observed). Conclusion: In this sample, the prevalence of thyroid cancer in patients with acromegaly and coexisting thyroid nodules is similar to that reported in the general U.S. population with thyroid nodules (7 to 15%). These findings suggest that there is no benefit of dedicated thyroid nodule screening in patients newly diagnosed with acromegaly. Abbreviations: AACE = American Association of Clinical Endocrinologists; ATA = American Thyroid Association; DTC = differentiated thyroid cancer; FNA = fine needle aspiration; GH = growth hormone; IGF-1 = insulin-like growth factor-1; PTC = papillary thyroid cancer; U.S. = United States

scholarly journals Comparison on the Use of Spinal (Stylet) Needle and Simple Needle in Ultrasound Guided Thyroid Nodule FNA; Does the Needle Affect Thyroid FNA Result?

2020 ◽  
Vol 17 (2) ◽  
Author(s):  
Alireza Aziz Ahari ◽  
Mohammad Ali Mohammadi Vajari ◽  
Navid Khatibi Moghadam ◽  
Hassan Hashemi ◽  
Mahmoud Parvin ◽  
...  
Keyword(s):  
Thyroid Nodule ◽  
Fine Needle Aspiration ◽  
Significant Relationship ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Needle Type ◽  
Expert Radiologist ◽  
Diagnostic Samples ◽  
Thyroid Fna

Background: Thyroid fine needle aspiration (FNA) is currently the most acceptable method for evaluating thyroid nodules. Non-satisfactory sample is the main limitation of FNA. It has been shown that spinal needles can reduce the number of non-diagnostic samples. Objectives: In this study, we decided to compare the results obtained using spinal (stylet) needle and simple needle in thyroid nodule FNA according to the agreement between them and with the pathology results as the gold standard. Patients and Methods: Sampling of thyroid nodules of 156 patients was performed by a simple non-stylet 23 gauge needle (A) and a spinal 22 gauge needle with stylet (B). The samples were provided to the pathologist for blind examination. All samples were obtained by an expert radiologist and the pathology examination was also performed by a pathologist expert in thyroid gland diseases. Blind analysis was done using SPSS Statistics for Windows, version 16 (SPSS Inc., Chicago, Ill., USA). Results: The results of FNA with needles A and B were reported unsatisfactory in 11.51 (18 subjects) and 3.84 (six subjects), respectively (P = 0.01). The result in 63.46% (99 subjects) of the participants, in whom FNA was obtained by needle B was introduced as a better sample by the pathologist in comparison with 36.44% (57 subjects) (P < 0.001). Cancer was diagnosed in 9.56 and 7.66 of the samples yielded by needles B and A, respectively, which was not statistically significant (P = 0.54). There was also a significant relationship between thyroid imaging reporting and data system (TI-RADS) score and FNA result. Conclusion: A significant relationship between the adequate sampling results, the qualitative examination result, TI-RADS score and the needle type indicates the importance of needle type on the results of thyroid FNA. Using spinal (stylet) needles may reduce the number of non-diagnostic samples in fine needle aspiration of thyroid nodules and therefore, can have a better effect on the results of this method.

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