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Approach to a thyroid nodule

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https://www.readbyqxmd.com/read/29336606/update-on-molecular-testing-for-cytologically-indeterminate-thyroid-nodules
#1
Michiya Nishino, Marina Nikiforova
CONTEXT: - Approximately 15% to 30% of thyroid nodules that undergo fine-needle aspiration are classified as cytologically indeterminate, presenting management challenges for patients and clinicians alike. During the past several years, several molecular tests have been developed to reduce the diagnostic uncertainty of indeterminate thyroid fine-needle aspirations. OBJECTIVE: - To review the methodology, clinical validation, and recent peer-reviewed literature for 4 molecular tests that are currently marketed for cytologically indeterminate thyroid fine-needle aspiration specimens: Afirma, ThyroSeq, ThyGenX/ThyraMIR, and RosettaGX Reveal...
January 16, 2018: Archives of Pathology & Laboratory Medicine
https://www.readbyqxmd.com/read/29307098/a-single-incision-thoracoscopic-and-robotic-hybrid-procedure-via-the-axillary-approach-in-a-patient-with-thyroid-lung-and-mediastinal-tumors
#2
Norihiko Ishikawa, Yumiko Ohtake, Go Watanabe
A 66-year-old woman was referred to our institute for an enlarging tumor of the thyroid, and neck and chest computed tomography scan showed not only a thyroid tumor, but also an anterior mediastinal tumor and ground-glass nodules in the lung. Because of persisting symptoms, an enlarging thyroid mass, and the possibility of cancer, excision of the tumors was proposed. A 6-cm-long vertical skin incision was made in the right axilla, a mini-thoracotomy was made in the third intercostal space, and an additional port was placed in the fifth intercostal space...
January 6, 2018: Journal of Robotic Surgery
https://www.readbyqxmd.com/read/29300866/diagnostic-utility-of-molecular-and-imaging-biomarkers-in-cytological-indeterminate-thyroid-nodules
#3
Elizabeth J de Koster, Lioe-Fee de Geus-Oei, Olaf M Dekkers, Ilse van Engen-van Grunsven, Jaap Hamming, Eleonora P M Corssmit, Hans Morreau, Abbey Schepers, Jan Smit, Wim J G Oyen, Dennis Vriens
Indeterminate thyroid cytology (Bethesda III and IV) corresponds to follicular-patterned benign and malignant lesions, which are particularly difficult to differentiate on cytology alone. As approximately 25% of these nodules harbor malignancy, diagnostic hemithyroidectomy is still custom. However, advanced preoperative diagnostics are rapidly evolving.This review provides an overview of additional molecular and imaging diagnostics for indeterminate thyroid nodules in a pre-operative clinical setting, including considerations regarding cost-effectiveness, availability, and feasibility of combining techniques...
January 2, 2018: Endocrine Reviews
https://www.readbyqxmd.com/read/29243180/transoral-thyroidectomy-a-viable-surgical-option-with-unprecedented-complications-a-case-series
#4
S Bakkar, M Al Hyari, M Naghawi, C Corsini, P Miccoli
PURPOSE: To report the clinical implications of an initial experience with transoral endoscopic thyroidectomy vestibular approach (TOETVA). METHODS: From March to November 2017, five cases of TOETVA were performed. Data reported include patient demographics, indication for surgery, extent of surgery, operative time, the need to convert to cervicotomy, the length of hospital stay and post-operative pain and morbidity. Unconventional complications regarded as specific for TOETVA were reported...
December 14, 2017: Journal of Endocrinological Investigation
https://www.readbyqxmd.com/read/29208984/a-nonlinear-approach-to-identify-pathological-change-of-thyroid-nodules-based-on-statistical-analysis-of-ultrasound-rf-signals
#5
Huan Xu, Chunrui Liu, Ping Yang, Juan Tu, Bin Yang, Dong Zhang
In order to reassure the majority of patients with benign nodules from unnecessary needle biopsy, there is an increasing clinical requirement to identify benign and malignant thyroid nodules during ultrasound diagnosis. A nonlinear approach based on statistical analysis of ultrasound radio-frequency (RF) signals was developed for differential diagnosing the thyroid nodules to improve the diagnostic accuracy. Data from 44 patients with solitary thyroid nodules were collected, following with the ultrasound-guided fine needle aspiration (FNA) as the ground truth...
December 5, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29201471/metastatic-renal-cell-cancer-to-thyroid-diagnosed-by-endoscopic-ultrasound-guided-fine-needle-aspiration-technique
#6
Yousef Abdel-Aziz, Tariq Hammad, Mohamad Nawras, Hayder Abdulwahid, Ali Nawras
Medical literature about the role of endoscopic ultrasound (EUS) in identifying thyroid lesions is limited. We present a case of secondary thyroid cancer from renal cell carcinoma (RCC) metastasis, diagnosed by thyroid EUS-fine needle aspiration (FNA) approach that was done for staging of esophageal adenocarcinoma, in a patient with 11-year history of complete right nephrectomy for RCC. An 81-year-old female patient underwent EUS for the evaluation of a newly discovered distal esophageal cancer. A hypoechoic, round, and well-demarcated mass that measured 26...
2017: Case Reports in Gastrointestinal Medicine
https://www.readbyqxmd.com/read/29201322/the-diagnostic-value-of-fine-needle-aspiration-in-comparison-with-frozen-section-in-thyroid-nodules-a-20-year-study
#7
Sepideh Siadati, Seyed Mozafar Rabiee, Ebrahim Alijanpour, Mohammad Ali Bayani, Novin Nikbakhsh
Background: Fine needle aspiration (FNA) is the most important method in the diagnosis of thyroid nodules before surgery. Recently, the efficiency of FNA in thyroid nodule management has been debatable. On the other hand, intraoperative frozen section (FS) has been used to confirm the diagnosis of FNA and select the proper surgical approach. In this regard, the present study aimed to assess the diagnostic value of FNA as compared to FS in the diagnosis of thyroid nodules. Methods: This retrospective study was performed on 69 patients with FNA and FS and histopathological examination from 1993 to 2014 in Babol, northern Iran...
2017: Caspian Journal of Internal Medicine
https://www.readbyqxmd.com/read/29198083/-robotic-assisted-transaxillary-thyroid-surgery-the-rabin-medical-center-experience
#8
Naomi Rabinovics, Gideon Bachar, Tom Raz-Yarkoni, Raphael Feinmesser
AIMS: To review the experience of a single-center with RATS and to assess its outcome, feasibility and safety. BACKGROUND: With the advent of minimally invasive techniques in thyroid surgery, robot-assisted transaxillary thyroid surgery (RATS) has become one of the most popular approaches. Its main advantages are improved cosmetic outcome, thereby increasing patient satisfaction, improved visualization and range of motion. Several large-scale studies, have demonstrated its safety and feasibility...
November 2017: Harefuah
https://www.readbyqxmd.com/read/29165886/pre-operative-features-of-non-invasive-follicular-thyroid-neoplasms-with-papillary-like-nuclear-features-an-analysis-of-their-cytological-gene-expression-classifier-and-sonographic-findings
#9
S J Song, V A LiVolsi, K Montone, Z Baloch
OBJECTIVE: To investigate the corresponding cytological diagnoses, Gene Expression Classifier (GEC) results and ultrasound features of thyroid nodules diagnosed as non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP), as well as any coexisting pathology. METHODS: We performed a retrospective review of thyroid nodules histologically diagnosed as NIFTP at our institution between 1st April 2016 and 1st April 2017. The following data points were collected: demographics, nodule size, ultrasound features, cytological diagnosis, GEC results, origin of sample (in-house vs outside hospital) and any additional pathology identified in the resection specimen...
December 2017: Cytopathology: Official Journal of the British Society for Clinical Cytology
https://www.readbyqxmd.com/read/29145466/serum-tsh-levels-as-a-predictor-of-malignancy-in-thyroid-nodules-a-prospective-study
#10
Lenara Golbert, Ana Patrícia de Cristo, Carlo Sasso Faccin, Mauricio Farenzena, Heloísa Folgierini, Marcia Silveira Graudenz, Ana Luiza Maia
BACKGROUND: The role of serum TSH concentrations as a predictor of malignancy of thyroid nodule remains unclear. OBJECTIVE: To prospectively evaluate the usefulness of serum TSH levels as a predictor of malignancy in thyroid nodules. METHODS: Patients with thyroid nodule(s) who underwent fine-needle aspiration biopsy under ultrasonographic guidance in a tertiary, university-based hospital were consecutively evaluated. Patients with known thyroid cancer and/or patients receiving thyroid medication were excluded...
2017: PloS One
https://www.readbyqxmd.com/read/29108474/molecular-testing-for-oncogenic-gene-alterations-in-pediatric-thyroid-lesions
#11
Sogol Mostoufi-Moab, Emmanuel Labourier, Lisa Sullivan, Virginia A LiVolsi, Yimei Li, Rui Xiao, Sylvie Beaudenon-Huibregtse, Ken Kazahaya, N Scott Adzick, Zubair W Baloch, Andrew J Bauer
BACKGROUND: Thyroid nodules are less common in pediatric patients (≤18 years) than in adults. The Bethesda System for Reporting Thyroid Cytopathology allows for individual risk stratification, but a significant number of nodules are indeterminate. Incorporating gene mutation panels and gene expression classifiers may aid in pre-operative diagnosis. The overall aim of this study was to assess the prevalence of oncogene alterations in a representative pediatric population and across a broad-spectrum of thyroid tumor diagnoses...
November 6, 2017: Thyroid: Official Journal of the American Thyroid Association
https://www.readbyqxmd.com/read/29099711/braf-antibody-expression-in-different-types-of-thyroid-nodular-lesions
#12
E Barabadze, V Munjishvili, G Burkadze
Major problems haunt the physicians who need to delineate the best management strategy for their patients with thyroid nodule is the identification of the most aggressive cases, especially among papillary thyroid cancers, which would benefit from more aggressive therapy and follow up. Beyond its strong correlation with PTC, the BRAF mutation is well described to associate with poor prognosis. The aim of our study was to identify BRAF antibody expression in different hystotypes of the thyroid nodules and assessment of it expression according to the tumor aggressiveness...
October 2017: Georgian Medical News
https://www.readbyqxmd.com/read/29083503/risk-factors-stratifying-malignancy-of-nodules-in-contralateral-thyroid-lobe-in-patients-with-pre-operative-ultrasound-indicated-unilateral-papillary-thyroid-carcinoma-a-retrospective-analysis-from-single-centre
#13
Tian Lv, Changbin Zhu, Zhongmin Di
OBJECTIVE: Papillary thyroid carcinoma (PTC) is the most common thyroid carcinoma with a favourable clinical outcome. For unilateral PTC patients with thyroid nodules in the contralateral lobes, the necessity of total thyroidectomy (TT) is still in doubt. In this study, we aimed to define clinical factors that could be indicators for malignancy in nodules in the contralateral thyroid lobe, which could aid the clinician in selecting the appropriate operation approach. DESIGN, PATIENTS AND MEASUREMENTS: This is a retrospective study from January 2014 to December 2016 conducted in Shanghai Ruijin Hospital...
October 30, 2017: Clinical Endocrinology
https://www.readbyqxmd.com/read/29067943/transoral-endoscopic-total-thyroidectomy-vestibular-approach-a-case-series-and-literature-review
#14
T Sivakumar, R A Amizhthu
Conventional open thyroidectomy is often associated with post-operative complications including nerve damage, voice disturbances, paraesthesias, adhesions and prominent scarring. Several endoscopic surgical techniques have been reported as alternatives to conventional thyroidectomy. Natural orifice transluminal endoscopic surgery is a promising approach which leaves no scar, produces few complications and affords faster discharge from care. Several studies have explored its utility in total thyroidectomy in patients with benign or malignant thyroid disease...
October 23, 2017: Journal of Minimal Access Surgery
https://www.readbyqxmd.com/read/29044289/preoperative-diagnostics-in-differentiated-thyroid-carcinoma
#15
Philipp Seifert, Martin Freesmeyer
AIM: The preoperative diagnosis of differentiated thyroid carcinomas (DTC) is particularly challenging in view of the high prevalence of thyroid nodules in the general population. Incidental diagnosis of DTC, on the other hand, can lead to reoperations and increased risk of morbidity. This study aimed to assess the prediction value of preoperative DTC dignity assessment and it's impact on surgical approaches. METHODS: We retrospectively reviewed 107 cases of DTC and subdivided them in three groups based on the preoperative dignity assessment: suspected malignancy (SM), unclear dignity (UD), and incidental findings (IF)...
October 18, 2017: Nuklearmedizin. Nuclear Medicine
https://www.readbyqxmd.com/read/29039253/stakeholder-driven-quality-improvement-a-compelling-force-for-clinical-practice-guidelines
#16
Richard M Rosenfeld, Peter C Wyer
Clinical practice guideline development should be driven by rigorous methodology, but what is less clear is where quality improvement enters the process: should it be a priority-guiding force, or should it enter only after recommendations are formulated? We argue for a stakeholder-driven approach to guideline development, with an overriding goal of quality improvement based on stakeholder perceptions of needs, uncertainties, and knowledge gaps. In contrast, the widely used topic-driven approach, which often makes recommendations based only on randomized controlled trials, is driven by epidemiologic purity and evidence rigor, with quality improvement a downstream consideration...
October 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/29039144/transoral-endoscopic-thyroidectomy-via-a-vestibular-approach-why-and-how
#17
Gianlorenzo Dionigi, Young Jun Chai, Ralph P Tufano, Angkoon Anuwong, Hoon Yub Kim
The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel, scar-free surgical procedure that does not require visible incisions. Indications for TOETVA are as follows: predicted gland width on diagnostic imaging ≤10 cm; a thyroid volume outline of <45 mL or dominant nodule dimension of ≤50 mm; three or four Bethesda lesions; a primary papillary microcarcinoma without local or distant metastasis; and patient request for optimal esthetic results. Contraindications are as follows: patients unfit for general anesthesia; precedent radiation in the head, neck, upper mediastinum; antecedent neck surgery; recurrent goiter; a gland volume of >45 mL or main nodule diameter of >50 mm; and documentation of lymph node or distant metastases, tracheal/esophageal infiltration, preoperative laryngeal nerve palsy, hyperthyroidism, mediastinal goiter, or an oral abscess...
October 16, 2017: Endocrine
https://www.readbyqxmd.com/read/29025986/-18-f-fluorodeoxyglycose-avid-thyroid-incidentalomas-the-importance-of-contextual-interpretation
#18
David A Pattison, Michael Bozin, Alexandra Gorelik, Michael S Hofman, Rodney J Hicks, Anita Skandarajah
Background: FDG-avid thyroid incidentalomas (TI) are seen in approximately 2.5% of patients imaged for staging or response assessment of malignancy and represent thyroid cancer in approximately 35% of cases. Consequently, the 2015 ATA guidelines strongly recommend investigation of all FDG-avid nodules ≥1cm with US and fine needle aspiration cytology (FNA). This study aims to assess the overall and thyroid cancer specific survival in a large cohort of patients with FDG-avid TI with long-term follow-up to assess the validity of this approach...
October 12, 2017: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
https://www.readbyqxmd.com/read/29019758/sonographic-evaluation-of-pediatric-thyroid-nodules
#19
Alex C Essenmacher, Peter H Joyce, Simon C Kao, Monica Epelman, Liuska M Pesce, Michael P D'Alessandro, Yutaka Sato, Craig M Johnson, Daniel J Podberesky
A thyroid nodule detected clinically or incidentally at medical imaging is a common indication for ultrasonography (US) in the adult population. This scenario is less frequently the case in pediatric patients, and the approach to evaluation of thyroid nodules deserves modification in these patients because of the increased probability of malignancy in children, compared with adults. Evaluating a thyroid nodule with US in a systematic way requires familiarity with a number of features that can be assessed and the terms that the radiologist uses in each category...
October 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/29017861/propensity-score-matched-analysis-of-the-endoscopic-bilateral-axillo-breast-approach-baba-versus-conventional-open-thyroidectomy-in-patients-with-benign-or-intermediate-fine-needle-aspiration-cytology-results-a-retrospective-study
#20
Mansoor Alramadhan, Jun Ho Choe, Jun Ho Lee, Jung Han Kim, Jee Soo Kim
BACKGROUND: The purpose of this study was to compare the surgical outcomes of endoscopic bilateral axillo-breast approach (BABA) to conventional open thyroidectomy (COT) in patients who had thyroid nodule(s) with a benign or intermediate fine-needle aspiration cytology (FNAC) results. MATERIALS AND METHODS: All patients with benign or intermediate thyroid nodule(s) who underwent BABA (n = 95) or COT (n = 262) between 2008 and 2015 were reviewed. Then, 1:1 propensity score matching was performed, and 66 matched pairs were obtained...
October 7, 2017: International Journal of Surgery
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