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  1 / 11455 MEDLINE  
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PMID:29428046
Autor:Galbraith JD; Swann N; Cox B; LeTendre N; Recabaren J
Título:The Bethesda Classification for Thyroid Fine Needle Aspiration: A Predictor or an Alarmist?
Fonte:Am Surg; 84(1):161-164, 2018 Jan 01.
ISSN:1555-9823
País de publicação:United States
Idioma:eng
Resumo:Thyroid malignancies comprise only 2 per cent of all cancers. Yet the incidence of thyroid cancers has been increasing faster than other malignancies, likely due to increased screening and surveillance of thyroid nodules. The Bethesda system represents the preferred method of evaluating thyroid nodules for malignancy using fine needle aspiration (FNA). Many thyroidectomies are performed for small, asymptomatic nodules found on ultrasound. These small papillary cancers (<0.5 cm) are termed microcarcinomas and represent a more indolent natural history causing some to name them "occult papillary tumors." The objective is to assess the relationship between the Bethesda classification and pathologic stage of thyroid cancer with attention to T1a lesions. A single institution, retrospective study of thyroidectomy patients who had a preoperative FNA and a final pathology of thyroid malignancy were performed. The distribution of stage relative to Bethesda classification was significantly different than expected (P = 0.00382). The low risk Bethesda II, (odds ratio;OR 9.15, 2.7931-29.97, P = 0.0003) and the intermediate group, Bethesda III, (OR 3.48, 1.4436-8.4124, P = 0.0055) had a statistically significant higher incidence of T1a. The Bethesda classification for thyroid FNA falls short in the accuracy of intermediate stage malignancies. Patients whose FNA were Bethesda II or III had a higher likelihood of indolent T1a disease.
Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE


  2 / 11455 MEDLINE  
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PMID:29428041
Autor:Marrero AP; Gracia A; Méndez W
Título:The Sonographic Subcentimeter Malignant Thyroid Nodule: What Does It Stand for?
Fonte:Am Surg; 84(1):137-139, 2018 Jan 01.
ISSN:1555-9823
País de publicação:United States
Idioma:eng
Resumo:Thyroid cancer management has moved to less extensive surgery in lesions with favorable criteria. Our study evaluated if the sonographic (US) size of thyroid nodules is a reliable criterion to determine the extent of surgery in patients with papillary thyroid carcinoma (PTC). A retrospective study was performed to evaluate thyroid nodules measuring <10 mm in the preop sonogram with a permanent pathology of PTC. Patients were subdivided into two groups based on the US size: A (1-5 mm) and B (6-10 mm). Statistical correlations were made for the presence of the following unfavorable criteria: multifocality, capsular invasion, angio/lymphatic invasion, extrathyroidal invasion, and presence of metastases. A total of 1901 thyroidectomies were performed: 722 (38%) for PTC. 182 (25%) patients met the inclusion criteria. There were 30 patients in Group A (1-5 mm) and 152 patients in Group B (6-10 mm). Five (17%) patients in Group A and 53 (35%) patients in Group B presented unfavorable criteria (P < 0.005). Malignant thyroid nodules with the US size of <5 mm can in theory be candidates for partial thyroidectomy, but 17 per cent of them might still need further surgical intervention. Lesions with the US size of 6 to 10 mm still have a moderate risk of presenting unfavorable pathological criteria.
Tipo de publicação: JOURNAL ARTICLE


  3 / 11455 MEDLINE  
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PMID:29275831
Autor:Troussier I; Klausner G; Morinière S; Blais E; Jean-Christophe Faivre; Champion A; Geoffrois L; Pflumio C; Babin E; Maingon P; Thariat J
Endereço:CHRU Pitié-Salpêtrière, radiothérapie, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Título:[Advances in the management of cervical lymphadenopathies of unknown primary: advances in diagnostic imaging and surgical modalities and new international staging system].
Título:Évolutions dans la prise en charge des métastases ganglionnaires cervicales sans cancer primitif retrouvé : avancées diagnostiques et nouvelle classification TNM..
Fonte:Bull Cancer; 105(2):181-192, 2018 Feb.
ISSN:1769-6917
País de publicação:France
Idioma:fre
Resumo:INTRODUCTION: Cervical lymphadenopathies of unknown primary represent 3 % of head and neck cancers. Their diagnostic work up has largely changed in recent years. This review provides an update on diagnostic developments and their potential therapeutic impact. MATERIALS AND METHODS: This is a systematic review of the literature. RESULTS: In recent years, changes in epidemiology-based prognostic factors such as human papilloma virus (HPV) cancers, advances in imaging and minimally invasive surgery have been integrated in the management of cervical lymphadenopathies of unknown primary. In particular, systematic use of PET scanner and increasing practice of robotic or laser surgery have contributed to increasing detection rate of primary cancers. These allow more adapted and personalized treatments. The impact of changes in the eighth TNM staging system is discussed. CONCLUSION: The management of cervical lymphadenopathies of unknown primary cancer has changed significantly in the last 10 years. On the other hand, practice changes will have to be assessed.
Tipo de publicação: JOURNAL ARTICLE; REVIEW
Nome de substância:0 (Antineoplastic Agents)


  4 / 11455 MEDLINE  
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PMID:29182368
Autor:Mendes GF; Garcia MR; Falsarella PM; Rahal A; Cavalcante Junior FA; Nery DR; Garcia RG
Endereço:1 Department of Interventional Radiology, Hospital Israelita Albert Einstein , São Paulo , Brazil.
Título:Fine needle aspiration biopsy of thyroid nodule smaller than 1.0 cm: accuracy of TIRADS classification system in more than 1000 nodules.
Fonte:Br J Radiol; 91(1083):20170642, 2018 Feb.
ISSN:1748-880X
País de publicação:England
Idioma:eng
Resumo:OBJECTIVE: To identify whether or not the same ultrasound features can be applied and should be considered to support the decision as to which subcentimeter nodules should be biopsied with fine needle aspiration (FNAB). METHODS: Single-institution, IRB approved, retrospective study conducted from 2008 to 2016 that evaluated 1094 thyroid nodules smaller than 1.0 cm that were classified according to TIRADS and submitted for FNAB. RESULTS: The value of FNAB of thyroid nodules smaller than 1.0 cm were assessed and correlated with the sonographic criteria by comparing the obtained results with the cytological findings in 1094 thyroid nodules. In the analysis considering all nodules, the proportion of malignancies among nodules with TIRADS 2 is 0.91% and for TIRADS 3 is 2.87%. Among those classified as 4A, 12.26%; with 4B classification, 34.43%; with 4C classification, 66.6%; and among those with 5 classifications, 85.7%. CONCLUSION: In conclusion, the TIRADS classification system, based on the sonographic features reported herein, may help detect which nodules should be investigated for potential malignancies. Advances in knowledge: Few reports compare the efficacy of ultrasound-FNAB for thyroid nodules smaller than 1.0 cm in diameter. The findings of malignancy in this subgroup of nodules may help in the clinical follow-up of which patients should be submitted to an early imaging evaluation or intervention.
Tipo de publicação: JOURNAL ARTICLE


  5 / 11455 MEDLINE  
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PMID:29443748
Autor:Zhang F; Zhang J; Meng QX; Zhang X
Endereço:Department of Image Institute.
Título:Ultrasound combined with fine needle aspiration cytology for the assessment of axillary lymph nodes in patients with early stage breast cancer.
Fonte:Medicine (Baltimore); 97(7):e9855, 2018 Feb.
ISSN:1536-5964
País de publicação:United States
Idioma:eng
Resumo:This study aimed to explore the clinical usefulness of ultrasound-guided fine needle aspiration cytology (USG-FNAC) for the evaluation of axillary lymph nodes in patients with early stage breast cancer (BC) among the Chinese Han female population.Around 124 patients with early stage BC were included in this retrospective study. All patients underwent USG-FNAC (group A). Patients with proven metastasis also underwent axillary lymph node dissection (ALND) (group B). In addition, sentinel lymph node biopsy (SLNB) was performed 2 to 5 hours prior to the surgery.The sensitivity, specificity, accuracy, and positive predictive value (PPV) of axillary ultrasound were 75.0%, 75.0%, 75.0%, and 82.6%, respectively, while for USG-FNAC, they were 80.8%, 100.0%, 88.7%, and 100.0%, respectively. Significant differences were found in specificity, accuracy, and PPV between the 2 procedures (P < .05).The results of this study demonstrated that USG-FNAC was effective for selecting patients with early stage BC using ALND or SLNB among the Chinese Han female population.
Tipo de publicação: EVALUATION STUDIES; JOURNAL ARTICLE


  6 / 11455 MEDLINE  
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PMID:29443775
Autor:Chen Q; Huang Q; Yan JX; Li C; Lang JY
Endereço:Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province.
Título:Primary undifferentiated pleomorphic sarcoma of the thyroid: A case report and review of the literature.
Fonte:Medicine (Baltimore); 97(7):e9927, 2018 Feb.
ISSN:1536-5964
País de publicação:United States
Idioma:eng
Resumo:RATIONALE: Primary undifferentiated pleomorphic sarcoma is extremely rare in the thyroid, and can be easily misdiagnosed as anaplastic thyroid cancer. PATIENT CONCERNS: We present a case of a 71-year-old woman who presented with a rapidly growing painless mass in the neck. DIAGNOSES-INTERVENTIONS-OUTCOMES: Computed tomography showed a large hypointense mass with hyperdense areas involving whole of the right lobe of thyroid gland and fine-needle aspiration cytology found a few atypical cells. Surgical exploration was performed subsequently and frozen section showed malignant tumor. Therefore, a total thyroidectomy, central, and bilateral lateral neck dissection were performed and adjuvant radiotherapy of 60 Gy was administered. The patient was alive and had no recurrence at 6-month follow-up. LESSONS: Although primary undifferentiated pleomorphic sarcoma in the thyroid is extremely rare, patients who presented with a rapidly growing painless mass in the neck should be considered and it is essential to excise the tumor completely as soon as possible.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE; REVIEW


  7 / 11455 MEDLINE  
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PMID:29381957
Autor:Ma A; Liu H
Endereço:Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, China.
Título:Ectopic thyroid of the pancreas: A case report and literature review.
Fonte:Medicine (Baltimore); 96(47):e8707, 2017 Nov.
ISSN:1536-5964
País de publicação:United States
Idioma:eng
Resumo:RATIONALE: Ectopic thyroid is commonly found in the neck region. Intra-abdominal ectopic thyroid is extremely rare, with only 2 cases reported in the pancreatic region. Very few reports have described detailed imaging findings of intra-abdominal ectopic thyroid. PATIENT CONCERNS: A 73-year-old woman with aggravated recurrent right upper quadrant pain was found to have a retroperitoneal mass at the head of pancreas. Abdominal computed tomography (CT) showed a well-defined, high attenuated (56HU) mass measured of 60 × 50 mm in diameter, that exhibited heterogeneous contrast enhancement throughout the 3 phases. DIAGNOSIS: Neuroendocrine neoplasm was suspected. INTERVENTIONS: Following discussions with the patient, she refused fine needle aspiration cytology; however, she underwent total resection of the mass and had an uneventful clinical course. Histopathological examination showed thyroid tissue with TTF-1 and TGB positivity, and BRAF negativity, indicating a benign variant. OUTCOMES: The patient had no signs of relapse with normal thyroid hormone levels after 2 years of follow up. LESSONS: Ectopic thyroid tissue should be considered when patients present with similar imaging findings in abdomen. We review all reported cases of abdominal ectopic thyroid tissue to provide specific evidence for the diagnosis and treatment of this rare entity.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE


  8 / 11455 MEDLINE  
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PMID:28748505
Autor:Ahn SH; Park SY; Choi SI
Endereço:Department of Otorhinolaryngology - Head and Neck Surgery, Seoul National University College of Medicine, Bundang Hospital, 300 Goomi-dong, Bundang-gu, Gyeonggi-do, 463-707, South Korea. ahnsh30@snu.ac.kr.
Título:Comparison of Consecutive Results from Fine Needle Aspiration and Core Needle Biopsy in Thyroid Nodules.
Fonte:Endocr Pathol; 28(4):332-338, 2017 Dec.
ISSN:1559-0097
País de publicação:United States
Idioma:eng
Resumo:There are papers suggesting the complementary role of core needle biopsy (CNB) in the diagnosis of thyroid nodules. By comparing the result of CNB and fine needle aspiration (FNA) cytology performed in consecutive cases of thyroid nodules, the role of CNB was evaluated. Retrospective reviews of 2131 FNA and 275 CNB which were performed as first-line biopsy for 2406 thyroid nodules in 2187 patients were performed. The ultrasound (US) feature of thyroid nodule was classified following the risk of malignancy suggested by American Thyroid Association (ATA) guideline. Rate of unsatisfactory and cellular atypia could be decreased significantly by first-line CNB in all US group, and the nodules with highly suspicious feature showed significant decrease in inconclusive result by first-line CNB. However, increased rates of architectural and follicular neoplasm (FN) were identified in CNB group especially in intermediate and low suspicious nodules, and the first-line CNB could not decrease the inconclusive result in these US groups. The diagnostic rate of neoplasm diagnosed by surgery following the result of architectural atypia or FN was not different between FNA and CNB even with significantly higher rate in CNB group. Furthermore, the sensitivity for follicular neoplasm (21.2 vs. 61.9%) was significantly higher in CNB group. The CNB can be considered in nodules with highly suspicious feature with advantage of significantly lower inconclusive diagnostic rate than FNA group. However, significantly increased diagnosis of architectural atypia or FN in other nodules by CNB is recognized and should be evaluated in future to understand the meaning.
Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE


  9 / 11455 MEDLINE  
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PMID:28448992
Autor:Acar Y; Dogan L; Güven HE; Aksel B; Karaman N; Özaslan C; Gülçelik MA
Título:Bethesda Made It Clearer: A Review of 542 Patients in a Single Institution.
Fonte:Oncol Res Treat; 40(5):277-280, 2017.
ISSN:2296-5262
País de publicação:Netherlands
Idioma:eng
Resumo:BACKGROUND: It is essential to interpret fine needle aspiration biopsy (FNAB) material correctly to create a common language among pathologists and surgeons, leading to a uniform approach to thyroid nodule management. We aimed to compare FNAB reports of patients at our institution who were treated with total thyroidectomy, before and after the Bethesda classification system. PATIENTS AND METHODS: Patients who underwent total thyroidectomy for thyroid nodules are reviewed. 226 patients who underwent total thyroidectomy before the Bethesda era (2006-2009) were classified as Group-I, and 316 patients in whom total thyroidectomy was performed after the Bethesda classification system was introduced (2010-2014) were classified as Group-II. RESULTS: Before Bethesda, 'nondiagnostic' or 'benign' lesions were reported in 16.4 and 45% of patients, respectively, which then significantly decreased to 4.7 and 32.9% as the Bethesda classification criteria came into use. In Group-II, the actual malignancy rates were 13.3, 2.8, 7.3, 15.5, 85.4, and 96.5% for Bethesda I, II, III, IV, V, and VI, respectively. CONCLUSION: Our experience confirms that the Bethesda classification system leads to a significant reduction in lesions that used to be reported as 'benign' without compromising the actual rates of malignancy. It ensures better classification of so-called suspicious lesions, and allows for more accurate predictions of suspicious or malignant lesions.
Tipo de publicação: JOURNAL ARTICLE; REVIEW


  10 / 11455 MEDLINE  
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PMID:29346358
Autor:Karalus M; Tamatea JA; Conaglen HM; Meyer-Rochow GY; Conaglen JV; Elston MS
Endereço:Medical Student, Waikato Clinical Campus, University of Auckland, Hamilton.
Título:Rates of unsuspected thyroid cancer in multinodular thyroid disease.
Fonte:N Z Med J; 131(1468):69-74, 2018 01 19.
ISSN:1175-8716
País de publicação:New Zealand
Idioma:eng
Resumo:BACKGROUND: Previously the risk of concomitant thyroid cancer in multinodular goitre (MNG) has been reported as approximately 4%. Cancer risk in toxic MNG was often considered lower than for non-toxic MNG, due to a possible protective effect of TSH suppression. However, recent American data suggest an approximately 18% risk of occult malignancy in both toxic and non-toxic MNG. AIMS: To assess malignancy risk in a New Zealand population undergoing thyroidectomy for MNG. METHODS: Single-centre study of patients undergoing thyroidectomy for MNG from 1 December 2006 to 30 November 2016. RESULTS: Six hundred and two patients underwent surgery for MNG (448 non-toxic and 154 toxic). Of these, 95/602 (16%) had thyroid cancer. After excluding patients operated for preoperative suspicion for cancer, 30/401 (8%) patients with non-toxic MNG and 15/151 (10%) with toxic MNG had unsuspected or occult thyroid cancer (p=0.358). Patients with toxic MNG were less likely to undergo preoperative fine needle aspiration than those with non-toxic MNG (34% vs 52%, respectively p=0.0001). Two-thirds of unsuspected thyroid cancers were incidental micropapillary carcinomas and unlikely to alter survival irrespective of therapy. CONCLUSION: Malignancy rates in MNG are higher than historically reported, although most unsuspected cancers are unlikely to alter mortality even if diagnosis is delayed.
Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T



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