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Il nodulo tiroideo. Definizione citomorfofunzionale e orientamenti terapeutici
No full textISSN 0034-119
Signal transduction and neoplastic transformation in endocrine systems: molecular mechanisms and clinical aspects.
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[Thyroid nodule: morphostructural diagnosis and molecular substrate]
No full textThis survey offers an up-to-date overview of the latest findings relevant to molecular mechanisms of thyroid carcinogenesis, also based on our considerable experience with regard to the paradigmatic and atypical cytohistogenetic alterations specific to the various forms of thyroid proliferation, both malignant and benign. We have, moreover, illustrated the most recent applicative interchanges of the biomolecular methodologies relating to the diagnostic protocols to be carried out, in order to characterize the tumorous lesions. Particular emphasis has been focused on the role played by the molecular diagnosis of those lesions which cannot be pinpointed using traditional cytologic analysis and which are called "follicular proliferations". Among the innovative, diagnostic methodologies centered on the applications of the latest biomolecular findings relevant to thyroid oncogenesis, the immunocytochemical method, involving galectina-3 staining, plays a pivotal, diagnostic role as a marker of malignancy. In our experience this modern immunohistochemical methodology provides an extremely selective diagnostic support, possessing considerable sensitivity. This molecular approach is able to solve the diagnostic issue raised by the uncertainty of the neutral cytologic diagnostic report which demands a precise biomolecular specification of the nature of the nodules, cytologically set within the framework of the lesions described as aspecific, follicular structure anomalies. Furthermore, the new findings relating to the molecular mechanisms involved in the formation and neoplastic progression of the proliferous thyroid anomalies offer useful elements for the development and application of further genetic-molecular markers for diagnostic and prognostic purposes
An introduction to benign thyroid disease: Pathophysiologic, epidemiologic aspects and diagnostic methodology
No full textThe role of preoperative noninvasive diagnostic procedures in the management of benign thyroid diseases is critically reviewed and on the basis of a series of more than 13,000 thyroid nodules, sequentially examined, the role of preoperative fine needle aspiration (FNA) cytology in discriminating benign from malignant lesions, is assessed. Retrospective studies were performed to determine the diagnostic accuracy of FNA adopted as routine preoperative screening procedure as compared to intraoperative frozen section (FS) analysis. US-guided FNA was shown to be more accurate allowing the preoperative identification of occult or minimal carcinoma: in fact about 3% of malignant thyroid nodules were detected. Moreover, the operation time is reduced, and unnecessary surgical treatments for benign lesions are eliminated, preventing the need of two-stage cancer surgery. FNA is a cost- effective diagnostic tool with about 20% reduction in the cost of care of patients with thyroid nodules. Most recent methods of molecular biology which seem promising in thyroid tissue sampled by FNA to detect malignant lesions missed by conventional cytology and included in the generic category of 'follicular proliferation', are analyzed
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