1,720,973 research outputs found
Role of the conventional ultrasonography and color doppler in predicting malignancy in the neck lymphonodes
No full textGray-scale analysis nella valutazione del nodulo tiroideo
No full textObiettivi dello studio: La gray-scale analysis è stata proposta per la caratterizzazione della patologia tiroidea diffusa. Lo scopo dello studio è validare una tecnica ecografica basata sull’analisi dei livelli di grigio al fine di standardizzare la valutazione di ecogenicità ed ecostruttura di parenchima e lesioni focali tiroidee. Metodi: Sono stati esaminate le immagini ecografiche di 521 noduli solidi, candidati all’esecuzione di agoaspirato. Per ogni immagine, è stata selezionata un’area di interesse comprendente il nodulo. E’ stata inoltre considerata un’area di interesse delle stesse dimensioni e morfologia comprendente parenchima tiroideo normale ed una comprendente, per riferimento, i muscoli pretiroidei. Dati i valori di grigio medio e mediano e la deviazione standard dell’istogramma dei grigi del nodulo, del parenchima e del muscolo, sono stati calcolati: rapporto valore mediano di grigio nodulo/parenchima e parenchima/muscolo, coefficiente di variazione dei grigi sul parenchima e sul nodulo, come misura di disomogeneità ecostrutturale (indice di disomogeneità). Risultati: Il rapporto valore mediano di grigio nodulo/parenchima risulta significativamente più basso (come misura oggettiva di ipoecogenicità) nei noduli sospetti per malignità (categorie SIAPEC TIR4/TIR5 o sospetti per carcinoma midollare) alla citologia (p=0.006). Il dato è confermato sui noduli maligni confermati all’istologia definitiva rispetto ai benigni seguiti nel tempo (p=0.02). Un rapporto del valore mediano di grigio nodulo/parenchima <0.46, ottenuto mediante analisi della curva ROC, ha una sensibilità del 53.6% e una specificità del 71.1% nel predire la malignità (OR 2.84; p=0.01). A differenza della descrizione qualitativa, può inoltre essere utilizzato come una misura continua di ipoecogenicità e rischio di malignità (OR 0.20; p=0.02). Per validare la bontà del valore del coefficiente di variazione come misura di disomogeneità, si è confermato che esso è significativamente maggiore nel parenchima di pazienti con anti-TPO positivi rispetto ai negativi (p=0.035), mentre non è risultato essere un predittore significativo di malignità dei noduli. Conclusioni: La gray-scale analysis è una metodica a basso costo, facilmente applicabile per la valutazione oggettiva delle caratteristiche ecografiche, in particolare dell’ecogenicità, delle lesioni focali tiroidee, fornendone una stima quantitativa. I coefficienti ottenuti con questo metodo correlano con il rischio di malignità alla citologia ed all’istologia
Serum calcitonin, thyrotropin, and goiter
No full textObjective: Recent papers reported that basal calcitonin (CT) level may be related to thyroid volume. This study aims to evaluate if this finding is confirmed in patients undergoing ultrasonography-guided fine-needle aspiration cytology (FNAC) for thyroid nodules. Design: Retrospective university-center study. Methods: From February 2010 to September 2012, 561 patients underwent ultrasonography-guided FNAC and a complete evaluation including basal serum FT4, FT3, TSH, CT and estimation of thyroid volume. Results: The mean thyroid volume was 21.10±9.58 ml in males and 13.42±6.48 ml in females (P<0.001). Thyroid was found to be atrophic in 18 cases and goiter was diagnosed in 128 patients. A linear regression analysis was performed between serum CT levels and thyroid volume, showing a weak direct relationship (R2=0.023, P<0.001). There is no correlation between serum TSH and CT levels. In patients grouped according to morphologic diagnosis (atrophy, normal volume and goiter), CT levels are slightly higher in the high-volume groups: the mean value was 2.02±0.09 in the atrophy group, 2.86±1.73 in the normal volume group, and 3.00±1.66 in the goiter group (P=0.02). When males and females are computed separately, the statistical significance is lost. Conclusions: The small difference in basal CT levels is probably due to a genetically determined higher thyroid volume and increased number of C-cells rather than to acquired goiter. Gender may act as a ‘surrogate marker’ of thyroid volume and the application of a gender-specific cut-off can probably overcome this issue
Influence of Thyrotropin and Thyroid Volume on Basal Serum Calcitonin.
No full textThyroid volume was found to be a determinant of serum calcitonin levels in animal models and in thyroid-healthy subjects, as recently reported. This study aims to evaluate if this finding is confirmed in patients undergoing ultrasonography-guided fine-needle aspiration cytology of suspicious thyroid nodules. A dataset of 561 patients including basal serum FT4, FT3, TSH, calcitonin, thyroid volume, anti-thyroperoxidase antibodies (TPOAb), and cytology report, was retrospectively analysed. The median thyroid volume was 20.5 ml (14.5-26.8) in males and 12.0 ml (9.3-17.0) in females (p<0.001). The overall median serum calcitonin value was 2.00 pg/ml (2.00-3.10). A Spearman's correlation was performed between serum calcitonin levels and thyroid volume, showing a weak direct relationship (rs=0.173, p<0.001). This relationship is confirmed both in the smokers group (rs=0.337, p=0.003) and in non-smokers group (rs=0.115, p=0.012), and both in the TPOAb-positive patients (rs=0.419, p<0.001) and negative ones (rs=0.107, p=0.025). There is no correlation between serum TSH and calcitonin levels. In patients grouped according to morphologic diagnosis, calcitonin levels are slightly higher in the high-volume groups: the interquartile range was 2.00-2.00 pg/ml in the atrophy, 2.00-2.82 pg/ml in the normal volume, and 2.00-3.85 pg/ml in the goiter group (p=0.02). When males and females are computed separately, the statistical significance is lost. In conclusion, thyroid volume can mildly influence calcitonin levels. Gender acts as a "surrogate marker" of thyroid volume and the application of a gender-specific cut-off can probably overcome this issue in clinical practice.Thyroid volume was found to be a determinant of serum calcitonin levels in animal models and in thyroid-healthy subjects, as recently reported. This study aims to evaluate if this finding is confirmed in patients undergoing ultrasonography-guided fine-needle aspiration cytology of suspicious thyroid nodules. A dataset of 561 patients including basal serum FT4, FT3, TSH, calcitonin, thyroid volume, anti-thyroperoxidase antibodies (TPOAb), and cytology report, was retrospectively analysed. The median thyroid volume was 20.5 ml (14.5-26.8) in males and 12.0 ml (9.3-17.0) in females (p<0.001). The overall median serum calcitonin value was 2.00 pg/ml (2.00-3.10). A Spearman's correlation was performed between serum calcitonin levels and thyroid volume, showing a weak direct relationship (rs=0.173, p<0.001). This relationship is confirmed both in the smokers group (rs=0.337, p=0.003) and in non-smokers group (rs=0.115, p=0.012), and both in the TPOAb-positive patients (rs=0.419, p<0.001) an
Gray-scale analysis nella valutazione del nodulo tiroideo
No full textp 0.035).L’indice di disomogeneità del nodulo tiroideo risulta significativamente più alto nei noduli sospetti per malignità alla citologia (0,78 R.I. 0,58-1,44 vs 0,63 R.I. 0,47-0,87; p=0,02). Per validare la bontà del valore del coefficiente di variazione come misura di disomogeneità, si è confermato che esso è significativamente maggiore nel parenchima di pazienti con anti-TPO positivi rispetto ai negativi (mediana 0,38, R.I. 0,30-0,43 vs. 0,34, R.I. 0,29-0,41; Obiettivi dello studio: La gray-scale analysis è stata proposta per la caratterizzazione della patologia tiroidea diffusa (in particolare tiroidite autoimmune). Lo scopo dello studio è valutare se una tecnica basata sull’analisi dei livelli di grigio possa essere utilizzata per standardizzare la valutazione di ecogenicità ed ecostruttura del parenchima ed anche delle lesioni focali tiroidee.Materiali: Sono state esaminate le immagini ecografiche di 521 noduli solidi, candidati all’esecuzione di agoaspirato tiroideoecoassistito. Per ogni immagine, è stata selezionata un’area di interesse comprendente il nodulo. È stata inoltre considerataun’area di interesse delle stesse dimensioni e morfologia comprendente parenchima tiroideo normale ed una comprendente, per riferimento, i muscoli pretiroidei. Dati i valori di grigio medio e mediano e la deviazione standard dell’istogramma dei grigi del nodulo, del parenchima e del muscolo, sono stati calcolati: rapporto valore mediano di grigio nodulo/parenchima e parenchima/muscolo, coefficiente di variazione dei grigi sul parenchima e sul nodulo, come misura di disomogeneità ecostrutturale (indice di disomogeneità).Risultati: Il rapporto valore mediano di grigio nodulo/parenchima risulta significativamente più basso (come misura oggettiva di ipoecogenicità) nei noduli sospetti per malignità (categorie SIAPEC TIR4 e TIR5 oppure sospetti per carcinoma midollare) alla citologia (0,44 R.I. 0,38-0,60 vs 0,62 R.I. 0,43-0,93; p=0,003). Il dato è confermato sui noduli maligni confermati all’istologia definitiva rispetto ai benigni seguiti nel tempo (0,46 R.I. 0,39-0,75 vs 0,64 R.I. 0,43-0,93; p=0,03) e maligni all’istologia definitiva (0,73 R.I 0,52-1,21 vs 0,63 R.I.0.47-0,87; p=0,05).Conclusioni: La gray-scale analysis è una metodica a costo zero, facilmente applicabile da qualsiasi ecografista per la valutazione oggettiva delle caratteristiche ecografiche (ecogenicità ed anche ecostruttura) delle lesioni focali tiroidee, garantendo maggiore riproducibilità e minore variazione intra- ed interoperatore. I coefficienti ottenuti con questo metodo correlano con il rischio di malignità alla citologia ed all’istologia
A comprehensive score to diagnose Hashimoto's thyroiditis: a proposal
No full textThe heterogeneity of diagnostic criteria of Hashimoto’s thyroiditis leads to overdiagnosis and prevents strong conclusions from being drawn in clinical studies. The aim of this study is to propose a comprehensive scoring system. A case–control study compared a set of presurgical features of patients with lymphocytic infiltration of the thyroid (Hashimoto’s thyroiditis) and controls, in order to design a multi-criteria scoring system. Given a dichotomous outcome (lymphocytic infiltration of the thyroid), a set of covariates was analyzed in 180 patients after total thyroidectomy. A different validation cohort of 1,171 patients was reviewed and classified according to the score. Variables associated with the diagnosis of Hashimoto’s thyroiditis were first assessed by univariate analysis. Analysis showed that TPOAb (area under the ROC curve (AUC), 0.67; 95 % CI 0.57–0.77) and TgAb (0.63; 95 % CI 0.54–0.74) were univariate predictors of the diagnosis of HT, which is largely recognized. Combined covariates were then tested using stepwise logistic regression analysis. The final regression model included TPOAb, TgAb, and thyroid vascularity (AUC 0.72; 95 % CI 0.62–0.81). A scoring system was developed, which has a sensitivity of 45.5 % and a specificity of 89.0 %, with a cutoff of 1.7. The likelihood of incident hypothyroidism was higher (OR 2.30; p = 0.004) in the positive (≥1.7) score group. A scoring system has a better performance than any single predictor and is able to identify the subgroup of individuals at higher risk to develop subsequent hypothyroidism
Diagnostic Accuracy of rhTSH Test with Neck Ultrasonography in Differentiated Thyroid Cancer Follow-up
No full textSerum thyroglobulin levels measurement after injection of recombinant human thyrotropin (rh-TSH) represents the most important advance in the follow-up of patients with differentiated thyroid cancer, obtaining TSH elevation without L-thyroxine withdrawal, avoiding marked hypothyroidism symptoms. During a 4-yr period (2004-2008), 66 consecutive patients with DTC (59 papillary and 7 follicular carcinomas) were examined after rh-TSH Tg test and neck ultrasonography. In all patients basal Tg was 0.25 ng/ml, and in seven (58.3%) of these was demonstrated persistent or recurrent disease. These data indicate that rhTSH-Tg >0.25 ng/ml should be considered diagnostic for persistent or recurrent disease and suggests further exams (neck ultrasonography, whole body scan or cytology) to localize the disease. Furthermore, neck ultrasonography has demonstrated high accuracy in detecting lymph nodal metastases and should be always combined with rh-TSH test
A clinical-radiological score to diagnose Hashimoto’s thyroiditis: a proposal
No full textIntroduction. Early diagnosis of Hashimoto’s thyroiditis (HT) may be difficult. The heterogeneity of criteria used to diagnose HT may prevent strong conclusions from being drawn in studies focusing on clinical aspects of HT. The aim of this study is to design a simple score to diagnose chronic autoimmune thyroiditis.
Methods. 1021 consecutive patients that were advised to undergo total thyroidectomy at an University thyroid referral center. Given a dichotomous outcome, a set of 2 demographic (sex and age), 3 biochemical (overt or subclinical hypothyroidism, positive anti-Tg Ab, and positive anti-TPO Ab) and 4 imaging covariates (hypoechogenic parenchyma, heterogeneous thyroid echopattern, color-Doppler pattern and estimated thyroid volume) was analyzed.
Results. Analysis showed that anti-TPO Ab [area under the curve (AUC) under the ROC curve, 0.67], and anti-Tg Ab (0.63) were univariate predictors of the diagnosis of HT, which is largely recognized. Combined covariates were then tested using stepwise logistic regression. A model to predict the final diagnosis was calculated by using multivariate logistic regression analysis. The final model included anti-TPO Ab, anti-Tg Ab and thyroid vascularity (AUC 0.72). A second scoring system was developed to diagnose HT, with the addition of heterogeneous echopattern and goiter (AUC 0.76).
Conclusions. A simple scoring system for the early diagnosis of HT could easily be applied in clinical practice and research. The better proposed score has been shown to have an overall low degree of sensitivity and speci?city, but higher than the single predictors alone (sensitivity 45.5% and specificity 89.0%, with a cutoff value of 1.7). International multicenter studies can recruit a higher number of patients and provide a sufficient amount of data to integrate all features of HT into a consensus diagnostic score
Medullary Thyroid Carcinoma and Tuberous Sclerosis
No full textMedullary thyroid carcinoma (MTC) is a rare tumor and accounts for 5-10% of thyroid cancers. Tuberous sclerosis (TS) is a complex autosomal dominant neurocutaneous syndrome. In literature, a few endocrine neoplasias have been reported in association with TS, but never a case of TS associated with sporadic MTC. We describe a unique case, which has never been reported previously, of MTC associated with TS. The MTC up to today has been associated with other endocrine neoplasia, and TS increases risk of neoplasia in various organs. The case reported shows one more circumstance and suggests thyroid screening in patients with diagnosis of TS
- …
