1,720,990 research outputs found
Progress in the preoperative diagnosis of thyroid nodules: managing uncertainties and the ultimate role for molecular investigation
No full textThe preoperative evaluation of thyroid nodules currently relies on a clinical assessment of risk factors and an algorithm based on imprecise tests. With serum TSH, thyroid ultrasound and fine-needle aspiration (FNA) with or without ultrasound guide, accounting for the routine initial evaluation, indeterminate aspirates remain the major obstacle for confidently advising patients whether to have surgery or not. Recent clinical guidelines have attempted to settle various controversies but many inherent errors of clinical testing result in delayed diagnosis and unnecessary surgery. A better solution may ultimately involve the use of molecular markers of thyroid carcinogenesis but further research is still needed regarding the basic biology of thyroid cancer
Thyroid cancer: the impact of emerging technologies on clinical practice guidelines
No full textClinical practice guidelines are available for the evaluation and management of thyroid nodules and thyroid cancer. Nevertheless, there are uncertainties associated with these protocols due to genomic variations among patients and an incomplete evidence base. In addition, deviations from these protocols are due to physician bias and different levels of training. These shortcomings may eventually disappear as emerging technologies enter mainstream medicine. These interventions include (1) better risk stratification with the routine use of diagnostic molecular marker panels in the cytological analysis of thyroid fine-needle aspiration specimens as well as hybridized imaging modalities, (2) less aggressive therapies in low- and intermediate-risk thyroid cancer patients, and (3) molecular targeted therapy, pretargeted radioimmunotherapy, and novel minimally invasive surgical techniques in high-risk thyroid cancer patients
The emerging role of percutaneous needle biopsy and molecular tumor marker analysis for the preioperative selection of thyroid nodules
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Galectin-3 detection on large-needle aspiration biopsy improbe preoperative selection of thyroid nodules: a prospective cohort study.
No full textBACKGROUND: New techniques of improving diagnostic reliability of thyroid nodules
are needed.
AIM AND METHODS: This prospective cohort study includes patients with one (201)
or multiple (22) palpable nodule(s). Preoperative fine-needle aspiration biopsy
(FNAB), large-needle aspiration biopsy (LNAB), and galectin-3 detection on LNAB
(GAL-3-LNAB) (total of 245 nodules) were compared when the FNAB finding was
'inadequate' or 'indeterminate'. The sizes of the needles used for FNAB and LNAB
were compared with the size of thyroid follicles. Forty nodules were surgically
excised according to current recommendation.
RESULTS: GAL-3-LNAB was inadequate in 4% of nodules, compared with 34% using FNAB
and 11% using LNAB (P < 0.0001). GAL-3-LNAB showed no indeterminate findings,
compared with 15% using FNAB and 13% using LNAB (P < 0.0001). Among the 40
excised nodules, GAL-3-LNAB showed the highest accuracy values. The sensitivity
(P = 0.011) and specificity (P < 0.000; P = 0.001) ranges were 40%-100% and
20%-40% for FNAB, 40%-100% and 50%-53.7% for LNAB, and 100% and 76.7%-80% for
GAL-3-LNAB, respectively. The largest needles used for LNAB, 20 or 18 gauge, with
an internal diameter of 0.6 or 0.91 mm, recorded the lowest rate of inadequate or
indeterminate FNAB findings.
CONCLUSIONS: GAL-3-LNAB reduced inadequate, abolished indeterminate findings, and
provided specificity values higher than FNAB or LNAB in palpable thyroid nodules
Skeletal morphofunctional considerations and the pituitary-thyroid axis
No full textThe past decade has unraveled novel molecular mechanisms not only of skeletal remodeling, which is the process by which the skeleton is restructured throughout adult life, but also the precision by which the skeleton is put together during embryogenesis and later modeled during growth. It is now possible to delete single genes in individual cells and during specified periods of life. This has allowed us to pin down specific molecular events that underlie individual cellular processes, and also importantly, to identify molecular defects underlying disorders of skeletal morphogenesis and remodeling. Particularly novel has been the demonstration of cross-talk, some of which is humoral, between the skeleton and organs as diverse as the brain, pituitary, and even adipose tissue and pancreas. The current review describes these molecular mechanisms in relation to the way thyroid hormones, and the pituitary hormone thyrotropin (TSH), regulate skeletal morphogenesis and remodelin
Larged needle aspirations biopsy histology for preoperative selection of Hurtle cell thyroid nodules
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