1,721,225 research outputs found
Performance of Italian Consensus for the Classification and Reporting of Thyroid Cytology (ICCRTC) in discriminating indeterminate lesions at low and high risk of malignancy. A systematic review and meta-analysis
No full textBackground: Italian consensus for the classification and reporting of thyroid cytology was published in 2014 and it has been used in almost all Italian institutions. To date, there are not solid data on the reliability of Italian consensus for the classification and reporting of thyroid cytology in classifying low and high risk indeterminate nodules (Tir 3A and Tir 3B, respectively). Here, we reviewed and meta-analyzed the results of published articles to obtain evidence-based information on this topic. Research design and methods: A comprehensive literature exploration of online databases was conducted by searching all published papers citing Italian consensus for the classification and reporting of thyroid cytology. The search was updated until June 2017, and references of the retrieved articles were also screened. Only original articles reporting histologic follow-up of nodules cytologically classified as Tir 3A and Tir 3B were eligible for inclusion. Results: The literature search revealed 62 articles and six of these were eligible for the study. All papers were retrospective and published very recently. Overall, 423 indeterminate lesions, of which 180 Tir 3A and 243 Tir 3B, were found. Of these, 29 cancers were recorded in Tir 3A and 127 in Tir 3B. The pooled rate of malignancy was 17% (95% CI = 12 to 22%) in Tir 3A and 52% (95% CI = 46 to 58%) in Tir 3B. No significant publication bias was evident. Conclusions: Italian consensus for the classification and reporting of thyroid cytology 2014 shows high reliability in discriminating indeterminate lesions at low risk of malignancy from those at high risk
Endocrinology application of molecular imaging: current role of PET/CT
Full text linkBackground: In recent years, nuclear medicine imaging methods have proven to be of paramount importance in a wide variety of diseases, particularly in oncology, where they are crucial for assessing the extent of disease when conventional methods fall short. Moreover, nuclear imaging modalities are able to better characterize lesions using target agents related to specific pathways (e.g. glucose metabolism, cellular proliferation, amino acid transport, lipid metabolism, specific receptor ligands). The clinical presentation of endocrine diseases encompasses a broad spectrum of sign and symptoms. Moreover, endocrine tumors show varying degrees of aggressiveness from well differentiated and indolent to highly aggressive cancers, respectively. Rationale: With the application of new medicinal radio-compounds and increasingly advanced tomographic imaging technology, the utility of Positron Emission Tomography/Computed Tomography (PET/CT) in the field of endocrine diseases is expanding. Aim: This review aims to analyze and summarize the primary indications of PET/CT, providing a practical approach for clinicians. A comprehensive literature search on PubMed was conducted to provide an updated overview of the available evidence regarding the use of PET/CT in endocrinology. Within this review, we will discuss the applications of PET/CT, compare different radiopharmaceuticals and highlight the uptake mechanism, excluding neuroendocrine carcinomas from discussion. Conclusions: PET/CT is a valuable tool in diagnosing and managing endocrine disorders due to its capacity to furnish both functional and anatomical information, facilitate early lesion detection, guide treatment decisions, and monitor treatment response. Its non-invasive nature and precision make it an integral component of modern endocrine healthcare. This review aims to provide physicians with a clear perspective on the role of PET/CT imaging, discussing its emerging opportunities and appropriateness of use in endocrinological diseases
Biochemical Diagnosis of Thyroid Dysfunctions
Full text linkThyroid dysfunctions are among the most common endocrine disorders and accurate biochemical testing is integral to assess thyroid patients. Notably, true hyperthyroidism and hypothyroidism in the setting of a normal thyroid-stimulating hormone level are highly unlikely, making the assessment of free thyroxine (FT4) inappropriate in most new cases. However, FT4 measurement is pivotal in both the diagnosis and management of relevant central dysfunctions (central hypothyroidism and central hyperthyroidism) as well as for monitoring therapy in hyperthyroid patients treated with antithyroid drugs or radioiodine. Serum free triiodothyronine (FT3) measurement, however, rarely adds clinically relevant information with the exception of patients with suppressed TSH and normal FT4 levels, in order to confirm or exclude the so-called T3-toxicosis, generally observed in patients with autonomously functioning thyroid nodules and potentially associate with an increased risk of atrial fibrillation. However, technical and interpretative challenges still remain making bidirectional communication between the laboratory and clinical specialists pivotal to properly select reliable methods, establish clinically appropriate reference intervals, investigate discordant results, and monitor the analytical and clinical performances of different methods over time
Novel acquisitions in the diagnosis of medullary thyroid carcinoma
No full textINTRODUCTION: The correct identification of medullary thyroid carcinoma (MTC) has been a challenge since its first description. In the last few years, some advances in this context have been achieved. Here we aimed to review and discuss published data on the more recent acquisition in the diagnosis of MTC. EVIDENCE ACQUISITION: A literature search of the medical databases was conducted by searching papers reporting tool for diagnosis of MTC published in the last years. The search was updated until July 2016. EVIDENCE SYNTHESIS: The literature search revealed several relevant articles which focused on different topics of the diagnosis of MTC. The results are reported by four paragraphs, such as 1) fine-needle aspiration; 2) molecular analysis; 3) serum markers; 4) imaging. CONCLUSIONS: The measurement of calcitonin in FNA washout fluids is essential due to poor accuracy of conventional cytology to detect MTC. Genetic analysis can help to identify those advanced MTC with poorer prognosis who do not respond to chemotherapy. Procalcitonin may in the next future replace calcitonin as serum diagnostic marker of MTC. Recent evidence based data seem to suggest the emerging role of functional imaging in recurrent MTC in patients with calcitonin serum levels >150 pg/mL
Detecting N-RAS Q61R Mutated Thyroid Neoplasias by Immunohistochemistry
No full textRecently, the immunohistochemistry (IHC) for N-RAS Q61R has been developed and commercialized for clinical practice. Here, we investigated the reliability of IHC to identify N-RAS Q61R mutated thyroid neoplasia. A series of 24 consecutive thyroid lesions undergone surgery following indeterminate cytology were enrolled. Paraffin sections were stained for IHC using the rabbit monoclonal anti-human N-RAS Q61R, clone SP174. N-RAS mutations in codon 61 were also investigated by automated sequencing. At histology, 12 cases of follicular carcinoma, cytologically defined as follicular lesions, 1 papillary cancer, 7 follicular adenomas, and 4 hyperplastic nodules were found. Of these, 4 showed a positive IHC for anti N-RAS antibody where N-RAS expression was detected mainly at cytoplasmic level with similar intensity of reaction. The remaining cases had negative IHC. A 100% concordance between IHC and molecular analysis for N-RAS Q61R was observed. In conclusion, this study shows high reliability of IHC to identify N-RAS Q61R mutated thyroid lesions with high cost-effectiveness. These data indicate the reliability of IHC to identify N-RAS Q61R mutated thyroid neoplasia and suggest to adopt this approach for a more accurate management of patients, when indicated
High-intensity focused ultrasound (HIFU) for benign thyroid nodules: 2-year follow-up results
No full textBackground: High-intensity focused ultrasound (HIFU) is the last introduced thermal treatment of thyroid nodules. Here we evaluated the results at 24 months after HIFU. Methods: Since 2016, HIFU was considered as a therapeutic option at our institute in patients with benign thyroid nodules presenting local symptoms. We searched in our database all patients who had undergone thyroid HIFU and selected for the study only cases followed-up for at least 24 months after the treatment. Volume reduction rate (VRR) was evaluated. A reduction above 50% defined the success of HIFU. Results: Thirty-one nodules of 31 patients (24 females and 7 males, median age 67 years) with median major diameter from 17 to 34 mm and estimated nodule volume of 5.48 mL were included. HIFU was performed with median power of 42 W/site (interquartile range 25–45) and median energy of 263 J/site (interquartile range 225–273). Median duration of the procedure was 6 min (interquartile range 5–7). At 2 years after HIFU, nodule volume was significantly (p < 0.0001) lower (i.e., 3.40 mL) with VRR of 43.3%, and 26 (83.9%) lesions were reduced. A reduction by at least 50% was observed at 6, 12, and 24 months in 2 (6.4%), 5 (16.1%), and 7 (22.5%) nodules, respectively. Visual analog score showed a significant improvement (p < 0.0001). No complications were recorded. Conclusions: A reduction of benign thyroid nodule by more than 40% could be reached within 1 year by HIFU. Given the non-significant size increase of some lesions later, a larger study with a longer follow-up is necessary
Reliability of real-time elastography to diagnose thyroid nodules previously read at FNAC as indeterminate: a meta-analysis
No full textThe main limit of thyroid fine-needle aspiration cytology (FNAC) is represented by indeterminate report. Recently, real-time elastography (RTE) has been described in the management of these cases. Here, we performed a meta-analysis of published studies specifically focused on the use of RTE in indeterminate thyroid nodules. A comprehensive literature search of PubMed/MEDLINE and Google Scholar databases was conducted by using the combination of the terms "thyroid" and "indeterminate" and "elastography." Pooled sensitivity, specificity, accuracy, PPV and NPV of RTE as predictor of malignancy in thyroid nodules with indeterminate FNAC were calculated, including 95 % confidence intervals (95 % CI). The area under the summary ROC curve (AUC) was also assessed. Databases found 572 papers, and eight were included in the meta-analysis. Of these, six studies had prospective design and two were retrospective. Pooled malignancy rate was 31 %. As common denominator, all studies set the prevalence of hardness within the nodule as risk factor for malignancy of the lesion. Sensitivity of RTE ranged from 11 to 89 % (pooled estimate of 69 %; 95 % CI 55-82 %), specificity varied from 6 to 100 % (pooled estimate of 75 %; 95 % CI 42-96 %), and accuracy was comprised between 35 and 94 % (pooled estimate of 73 %; 95 % CI 54-89 %). The AUC was 0.77. RTE has suboptimal diagnostic accuracy to diagnose thyroid nodules previously classified as indeterminate. Then, RTE alone should not be used for selecting these patients for surgery or not. We advice for further studies using other elastographic approaches and combined RTE and B-mode ultrasonograph
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