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Factors influencing the length of the incision and the operating time for total thyroidectomy
No full textBackground: The incision used for thyroid surgery has become shorter over time, from the classical 10 cm long Kocher incision to the shortest 15 mm access achieved with Minimally Invasive Video-Assisted Thyroidectomy. This rather large interval encompasses many different possible technical choices, even if we just consider open surgery. The aim of the study was to assess the correlation between incision length and operation duration with a set of biometric and clinical factors and establish a rationale for the decision on the length of incision in open surgery. Methods: Ninety-seven consecutive patients scheduled for total thyroidectomy were prospectively evaluated. All operations were performed by the same team and the surgeon decided the length of the incision according to his personal judgement. Patients who had previously undergone neck surgery were excluded. Results: The length of the incision was strongly correlated with gender, thyroid volume, neck circumference and clinical diagnosis and weakly correlated with the body mass index. Operation duration was only weakly correlated with gender and neck circumference. Multiple linear regression revealed that the set of factors assessed explained almost 60 % of the variance in incision length but only 20 % of the variance in operation duration. When patients were classified according to the distribution of their thyroid volume, cases within one standard deviation of the mean did not show a significant difference in terms of operation duration with incisions of various lengths. Conclusions: Although thyroid volume was a major factor in driving the decision with respect to the length of the incision, our study shows that it had only minor effect on the duration of the operation. Many more open thyroidectomies could therefore be safely performed with shorter incisions, especially in women. Duration of the operation is probably more closely linked to the inherent technical difficulty of each case
Microcarcinoma and incidental carcinoma of the thyroid in a clinical series: Clinical behaviour and surgical management
No full textObjectives. Papillary thyroid microcarcinomas (PTM) have not yet an agreed clinical management. The Authors compared PTMs with papillary thyroid carcinoma of larger size (LPTC) and incidental and not-incidental carcinomas. Materials and Methods. Review of clinical data of 67 patients (54 women, 13 men) prospectively stored in a standardised way in an electronic patient record system. Results. There were 36 cases of microcarcinoma (53.7%). Differences were not significant between PTM and LPTC groups as to patients personal data, TNM and MACIS staging, nodal involvement (8.3% vs 19.3%) and multifocality (25% vs 38.7%) while capsular invasion was significantly higher in LPTC (25% vs 54.8%). Nineteen incidental tumors were detected at pathological examination and they were all microcarcinomas. They were smaller than the remaining 17 not-incidental microcarcinomas but showed a similar clinical behaviour. There were not cancer related deaths nor recurrences in the follow up period in any group. Conclusions. Despite the excellent prognosis of PTM, a subset of these tumours shows aggressive biological and clinical features, like nodal or capsular invasion and multifocality. Actually, with the exclusion of size, they do not show any relevant difference from differentiated thyroid carcinoma of larger size. Since predictive cytogenetic markers are still missing, their treatment should then be the same as for conventional thyroid cancers
L’alcoolizzazione percutanea del plesso celiaco per il trattamento del dolore addominale: proposta di un nuovo approccio sotto guida ecografica
No full textComunicazione premiat
Un modello multivariato integrato di previsione del rischio neoplastico dei noduli della tiroide
No full textRiassunto
Obiettivo: la diagnosi di natura di un nodulo della tiroide è ancora oggi un problema non
completamente risolto e spesso vengono eseguiti interventi a solo scopo di conferma istologica.
Lo studio si propone di definire un modello integrato predittivo del rischio neoplastico per un
nodulo tiroideo: Tale modello può essere complementare all’attuale approccio sequenziale di
attività diagnostiche, governato da criteri mono-dimensionali.
Materiali: sono stati raccolti i dati clinici, ecografici e citologici preoperatori di 168 pazienti
consecutivi (per un totale di 197 noduli studiati), operati successivamente di tiroidectomia totale. I
dati sono stati analizzati con statistica monovariata e quindi integrati in un modello statistico
multivariato. Sono stati esclusi pazienti con referto citologico inadeguato (classe Th 1 secondo la
British Thyroid Ass.) o con diagnosi citologica certa di neoplasia (classe Th 5).
Risultati: sono risultate variabili predittive indipendenti di maggior valore la anisonucleosi, la
presenza di atipie e di proliferazione follicolare nell’esame citologico; la presenza di calcificazioni
interne al nodulo e l’unicità del nodulo stesso come caratteri ecografici.
Conclusioni: è stato possibile integrare in un unico modello predittivo di rischio a cinque elementi i
caratteri derivanti dall’ecografia e dalla citologia su FNA. Tale modello può essere la base per
ottenere un sistema di punteggio da affiancare alla strategia di semplice algoritmo sequenziale
raccomandata dalle linee guida attuali.
Summary
Objective: the diagnosis of nature of a thyroid nodule is still an unresolved problem and often
patients undergo surgery just to confirm an histological diagnosis. This study is aimed to define an
integrated model to predict the risk of malignancy for a thyroid nodule. This model should
complement the presently preferred approach, based on a sequential diagnostic workup ruled by
mono-dimensional criteria.
Materials: data from clinical exam, ultrasound and cytology were collected in the preoperative
period from 168 consecutive patients (for a total number of 197 considered nodules), who then
underwent total thyroidectomy. Data were analysed by monovariate statistics and then integrated in
a multivariate statistical model. Patients with an inadequate cytology (Th 1class, according to la
British Thyroid Ass.) or with a definite cytological diagnosis of malignancy (Th 5class) were
excluded.
Results: anisonucleosis, the presence of atipia and follicular proliferation resulted as independent
significant criteria for cytology; the presence of calcifications inside a nodule and the condition of
unique nodule were the ultrasonographic most significant characters.
Conclusions: it has been possible to integrate in a unique predictive model of risk with five
elements the information deriving from ultrasound and cytology. This model can be the starting
point to obtain a scoring system to improve the strategy of simple sequential algorithm
recommended by the present guidelines.
Introduzione
La diagnosi di natura di un nodulo della tiroide è ancora oggi un problema non completamente
risolto e poiché, nonostante l’alta prevalenza dei noduli della tiroide, solo in una piccola percentuale
di casi essi sono maligni, spesso vengono eseguiti interventi a solo scopo di conferma istologica.
Le più recenti linee guida (1, 2, 3) raccomandano un flusso sequenziale di attività diagnostiche,
governato da criteri mono-dimensionali (anamnesi-esame obiettivo ecografia FNA) e non
sembrano esistere in letteratura tentativi di costruire sistemi di punteggio di rischio, specie per
quella tipologia di noduli tiroidei con caratteristiche ecografie sospette o con citologia di tipo
“lesione follicolare”. Lo scopo dello studio è quello di confermare il valore diagnostico di alcune
delle caratteristiche della citologia e dell’ecografia citate in letteratura come predittive di malignità
(4, 5, 6) e integrarle in un unico modello statistico multivariato predittivo del rischio di neoplastico
L’alcoolizzazione del plesso celiaco nel trattamento del dolore da cancro del pancreas: proposta di un nuovo approccio sotto guida ecografica
No full textComunicazione premiata con il "Premio Giovani
Increasing diagnostic accuracy for thyroid nodules by an integrated multivariate approach: a methodological study.
No full textObjectives: Current guidelines for diagnostic management of thyroid nodules are based on a linear approach, using categorial classifications to cluster diagnostic findings and they still lead to unnecessary surgery. A diagnostic scoring system, based on clinical, cytological and ultrasound findings is described. Materials and Methods: Two groups of patients (168 and 55 pts) were used to compute a multivariate model and the discriminating threshold by ROC curves. The performance of the derived scoring system was assessed by a simulation on a third group of 60 patients, who had undergone surgery according to current guidelines. Results: The scoring system displayed a sensitivity of 100%, specificity 53.3%, positive and negative predictive values of 68.1% and 100%. According to the scoring system, 16 out of 60 operations would have been saved. Conclusions: A scoring system can take into account in a more accurate way the full informative content of the fine-grained description of diagnostic and clinical features
L’alcoolizzazione percutanea del plesso celiaco nel trattamento del dolore addominale: proposta di un nuovo approccio sotto guida ecografica
No full textIl Giornale di Ultrasonologia 1991; 3: 17
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