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G Di Coscio

Publications and source records attributed to G Di Coscio.

At least 19 recordsLinked to original sources
PubMed2007

Combined clinical, thyroid ultrasound and cytological features help to predict thyroid malignancy in follicular and Hupsilonrthle cell thyroid lesions: results from a series of 505 consecutive patients.

OBJECTIVE: The cytological patterns of follicular and Hupsilonrthle cell nodules are included among the indeterminate results of fine-needle aspiration cytology, because distinction between benign and malignant lesion can only be made on histological criteria. The diagnostic value of atypia at cytology, clinical parameters and echographic patterns were examined to establish the risk of malignancy in 505 patients with follicular and Hupsilonrthle cell thyroid nodules at cytology. DESIGN AND PATIENTS: The study included 505 consecutive patients who had undergone thyroidectomy from the period 2002-2005. RESULTS: Histological diagnosis of malignancy was carried out in 125 of 505 (25%) patients, the follicular variant of papillary carcinoma being the most frequent histotype. Only atypia at cytology (P < 0.0001) and spot microcalcifications at ultrasound (P = 0.009) were predictive of malignancy. Male gender, normal thyroid volume, single nodularity, nodule hypoechogenicity, size and blurred margins were associated with malignancy, although not significantly. An arbitrary clinical score allowed the identification of patients with high (41%, 110 patients) and low (16%, 242 patients) risk of malignancy. Combining the clinical score with the presence of atypia at cytology we could identify 30 patients (6%) in whom the risk of malignancy was as high as 63%. CONCLUSIONS: Twenty-five per cent of patients with a cytological result of follicular and Hupsilonrthle cell thyroid lesion had a final diagnosis of malignancy. Only atypia at cytology and spot microcalcifications at thyroid ultrasound were significantly associated with malignancy. Other clinical parameters and thyroid ultrasound patterns can be used to set up a clinical score useful for predicting the individual risk of malignancy before surgery.

Adenocarcinoma, Follicular↗
PubMed2000

Large-needle aspiration biopsy for the preoperative selection of palpable thyroid nodules diagnosed by fine-needle aspiration as a microfollicular nodule or suspected cancer.

The palpable thyroid nodules with a fine-needle aspiration (FNA) diagnosis of microfollicular nodule or suspected cancer usually are excised; however, most of them are proved benign by postoperative histologic examination. We reviewed the clinical and pathologic data for patients with thyroid nodules with an FNA diagnosis of microfollicular nodule or suspected cancer; nodules also were examined by large-needle aspiration biopsy (LNAB) to assess whether the distinction achieved by LNAB into pure microfollicular or mixed microfollicular-macrofollicular nodules could be used preoperatively to better predict malignancy. One hundred fourteen nodules of this type were excised. The prevalence of cancer was 22% (14/63) among the microfollicular and 4% (2/51) among the microfollicular-macrofollicular nodules at LNAB. These data indicate that histologic examination of the LNAB specimen can be used for preoperative selection of thyroid nodules diagnosed by FNA as a microfollicular nodule or suspected cancer.

Adenocarcinoma, Follicular↗
PubMed1999

Aspiration needle biopsy in preoperative selection of thyroid nodules defined at fine-needle aspiration as microfollicular lesions.

The palpable thyroid nodules that are diagnosed as microfollicular by fine-needle aspiration cytologic analysis are usually excised for the low probability that the nodule is a well-differentiated follicular cancer. The authors retrospectively assess the use of aspiration needle biopsy (either 16- or 18-gauge needles) in the preoperative selection of the nodules diagnosed as microfollicular at fine-needle aspiration (either 20- or 22-gauge needles). Aspiration needle biopsy is a type of large needle biopsy that is a relatively easy and innocuous method of obtaining tissue fragments for preoperative histologic examination of palpable thyroid nodules. From 1980 through 1996, 6,314 patients with palpable thyroid nodules were examined by fine-needle aspiration; 29.5% of these nodules were also examined preoperatively by aspiration needle biopsy. Of all the patients with nodules, 6% received a fine-needle aspiration diagnosis of microfollicular nodule. Two hundred sixty of the 380 nodules (68%) that were diagnosed as microfollicular at fine-needle aspiration were also examined by aspiration needle biopsy; inadequate specimens were obtained in 17% of cases; pure microfollicular structure was confirmed by aspiration needle biopsy in 35% of the nodules; and aspiration needle biopsy showed the remaining 48% to contain a macrofollicular component suggesting a benign hyperplastic lesion. Seventeen nodules that were found to be microfollicular at fine-needle aspiration cytologic analysis and micromacrofollicular at aspiration needle biopsy were excised and the postoperative result was benign in all cases. Twenty-five nodules diagnosed as microfollicular either on both fine-needle aspiration and aspiration needle biopsy were excised and the postoperative diagnoses were benign (20 nodules) or malignant (5 nodules). These data indicate that aspiration needle biopsy can be used for preoperative selection of the nodules that are microfollicular at fine-needle aspiration by identifying the nodules with high probability of being malignant and thus contributing to the reduction in the number of surgical operations for benign nodules.

Adenocarcinoma, Follicular↗
PubMed1998

Large needle aspiration biopsy for reducing the rate of inadequate cytology on fine needle aspiration specimens from palpable thyroid nodules.

From 1980 to 1996, 1,907 consecutive euthyroid subjects with palpable thyroid nodules were examined by fine needle aspiration (FNA) cytology plus large needle aspiration biopsy (LNAB) histology. There were 1,630 (85%) women and 277 (14.5%) men aged from 17 to 80 years. A single nodule was palpated in 1,419 subjects (74.4%) while 488 (25.6%) showed multiple nodules. The nodule size ranged between 1 and 7.5 cm. The number of inadequate specimens at the first examination, FNA cytology of LNAB histology, were 261 (13%) or 398 (20.8%), respectively. LNAB performed on the 261 nodules with nondiagnostic cytology showed findings which were adequate for diagnosis in 130 (49.8%) and inadequate in 131 (50.2%). Among the 261 patients with inadequate initial cytological findings 61 were subjected to repeated FNA and 36 repeated LNAB. More than 60% of the nodules on which FNA was repeated achieved a cytological diagnosis; more than 80% of the nodules reinvestigated by LNAB were finally diagnosed by histology. The mean nodule size was larger in the group with inadequate result than in that with adequate FNA or LNAB result. Among the 261 patients with inadequate cytological finding at the first FNA 28 were operated on; 20 were in the group with adequate LNAB histological findings and eight in the group with an inadequate LNAB. Two papillary cancers, one per group, were found at postoperative histology. However, one was diagnosed by LNAB and one at the second FNA. The remaining 26 nodules were all found to be benign postoperatively. This study shows that the addition of LNAB to FNA leads to a histological diagnosis in 50% of the palpable thyroid nodules with inadequate cytology at the first FNA and that LNAB can be used even for those nodules which remain uncharacterized after repeat FNA.

Adolescent↗
PubMed1996

Aspiration needle biopsy refines preoperative diagnosis of thyroid nodules defined at fine needle aspiration as microfollicular nodule.

The aim of this paper was to verify the hypothesis that large needle biopsy performed preoperatively can refine preoperative fine needle aspiration (FNA) cytological diagnoses of microfollicular nodules. Since 1980 we have been using FNA and aspiration needle biopsy (ANB) (18 or 16 gauge needles) to select for surgery all euthyroid patients with palpable thyroid nodules referred to our department. From 1980 to 1994, 6,124 patients (12% male, 88% female) with thyroid nodules (71% single, 29% multiple) were examined by FNA; 29% of these patients were also examined preoperatively by ANB histology. Of all the nodule patients examined, 371 received a preoperative FNA diagnosis of microfollicular nodule. Two hundred and fifty-four of these nodules (68%) were also examined preoperatively by ANB. Unsatisfactory ANB specimens constituted 17% of cases; pure microfollicular structure was confirmed by ANB in 36% of the nodules; ANB showed the remaining 47% to contain a macrofollicular component, thus suggesting a benign hyperplastic lesion. Twelve nodules which were found to be microfollicular at FNA cytology and micro-macrofollicular at ANB were excised and were subsequently determined as benign at definitive postoperative histology. These data indicate the utility of ANB in refining the preoperative FNA diagnosis of microfollicular nodule and in preoperatively identifying benign hyperplastic mixed micro-macrofollicular lesions which can be followed by observation.

Adult↗
PubMed1996

Needle aspiration techniques in preoperative selection of patients with thyroid nodules: a long-term study.

PURPOSE: Long-term evaluation of the combination of two needle aspiration techniques (NAT) (fine-needle aspiration [FNA] and aspiration needle biopsy [ANB]) in performing an efficient preoperative selection of palpable thyroid nodules. PATIENTS AND METHODS: Eight years of extensive use of surgery for the detection of thyroid cancer was compared with 12 years of preoperative selection of by NAT. RESULTS: A total of 1,140 operations were performed from 1972 to 1979, and 35 malignant nodules were discovered (3.1%). Five thousand four hundred three patients were examined by NAT from 1980 to 1992; 483 (9%) underwent surgery and 158 malignant nodules were excised. The number of malignant nodules identified by NAT was 166 (eight were not excised) (3.1% of the total population examined). The principal clinical and pathologic features were similar in both groups. ANB yielded a definite benign diagnosis in 88 patients with inadequate FNA findings, it correctly identified four malignant nodules diagnosed as benign by FNA, it showed a macrofollicular component in 115 nodules diagnosed by FNA as microfollicular nodules, and it significantly changed the predictive value of 79 suspicions FNA diagnoses. CONCLUSION: Introduction of NAT reduced the number of operations for palpable thyroid nodules from 143 to 40 per year and increased from four to 13 the number of malignant nodules excised without any change in the overall incidence of malignant nodules. The combination of ANB to FNA significantly contributed to the high and efficient preoperative patient selection, principally by reducing the number of indeterminate or suspicious, as well as false-negative, preoperative FNA diagnoses.

Adolescent↗
PubMed1995

Presence of endothelin-1 in the normal and pathological human thyroid.

An immunohistochemical study with two rabbit polyclonal antibodies I-AR76 and CA-08-351 against Endothelin-1 (ET-1) was performed in 133 human thyroid specimens: 5 normal thyroids, 30 multinodular goiters (15 toxic and 15 nontoxic), 20 Graves' diseases, 5 Hashimoto's thyroiditis, 26 adenomas (6 Hürthle cell, 16 toxic and 4 nontoxic), 30 classic papillary carcinomas, 3 minimally invasive follicular carcinomas, 1 widely invasive follicular carcinoma, 3 undifferentiated carcinomas and 10 medullary carcinoma. All normal thyroids, non toxic multinodular goiters and non toxic adenomas, 4 (66%) Hürthle cell adenomas, 3 (15%) Graves' diseases, 1 (33%) case of minimally invasive follicular carcinoma showed rare follicular cells with weak cytoplasmic immunoreactivity. Many immunoreactive follicular cells, with or without oxyphilic changes, were observed in all specimens of Hashimoto's disease, while the lymphocytic infiltrate was always negative. Twenty-seven (90%) classic papillary carcinomas were positive. Immunoreactivity was intracytoplasmic, weak in 14 cases and intense in 13. The cells of toxic adenoma and toxic multinodular goiter were negative, whereas the acellular stroma was intensely positive in both cases. Medullary and undifferentiated carcinomas were negative. These results show ET-1 immunoreactivity in normal and pathological human thyroids. In particular, the high content of this peptide in the thyroid papillary carcinoma suggests that ET-1, whose mitogenic role has recently been emphasized, could be involved in the growth of this tumor.

Adenoma↗
PubMed1995

Role of neck ultrasonography in the follow-up of patients operated on for thyroid cancer.

The aim of the study was to evaluate the role of neck ultrasonography in follow-up of patients with differentiated thyroid cancer. Sixty-three patients had total thyroidectomy and 131I ablation for differentiated thyroid cancer and had a negative whole body scan during follow-up. They were admitted for a high resolution neck ultrasound examination. Sixteen of 63 patients presented images suspicious for lymph node metastasis and/or for local recurrences (4 cases). Fine needle aspiration confirmed the suspicion of malignancy in 12 patients: only lymph node metastasis in 8 cases, local recurrence and lymph node metastasis in 3 cases, and in one case only local recurrence. Fine needle aspiration was suspicious for lymphadenitis in 4 cases. Thyroglobulin levels were very high in all patients with local recurrence and/or lymph node metastasis but undetectable in 2 cases presenting node metastasis and in 4 cases with lymphadenitis. All but one patient were admitted for surgery and the cytological diagnosis was confirmed. Early identification of a pathologic mass in the neck is a desirable goal; high resolution echography can play an important role in the follow-up of these patients and can detect local recurrences even when there is a negative whole body scan or undetectable thyroglobulin level.

Adenocarcinoma, Follicular↗
PubMed1994

Routine measurement of serum calcitonin in nodular thyroid diseases allows the preoperative diagnosis of unsuspected sporadic medullary thyroid carcinoma.

To assess whether routine measurement of serum calcitonin (CT) could improve the preoperative diagnosis of sporadic medullary thyroid carcinoma (MTC), 1385 consecutive patients presenting for nodular thyroid disease during the year 1991 were submitted to serum CT determination and fine needle aspiration cytology (FNAC). The clinical diagnosis was nontoxic nodular goiter in 1197 (86.4%) patients, toxic multinodular goiter in 65 (4.7%), autonomously functioning thyroid nodule (AFTN) in 64 (4.6%), and autoimmune thyroid disease (Graves' disease or Hashimoto's thyroiditis) with nodule(s) in 59 (4.3%). As controls, 177 patients with nonnodular thyroid disease and 32 normal subjects were also studied. Patients with FNAC suspicious of any kind of thyroid carcinoma and patients with elevated basal and pentagastrin-stimulated serum CT, regardless of the results of FNAC, were submitted to surgery. Eight (0.57%) patients (7 with nontoxic nodular goiter and 1 with AFTN) had elevated basal serum CT levels, ranging between 55-10,000 pg/mL. The pentagastrin test was abnormal in all of them. FNAC was suggestive of MTC in 2, thyroid carcinoma in 1, benign nodule in 3, and inadequate in 2. By histology, immunohistochemistry, and Northern blot analysis of total tumor RNAs, MTC was confirmed in all patients, including the 1 with AFTN, who had the association of microfollicular adenoma and a small MTC in the same lobe. After surgery, serum CT decreased to undetectable levels in 7 patients and remained undetectable in 6 of them during a mean follow-up of 22 months, although 1 of them had a positive response to pentagastrin. Forty-four patients in the group with normal serum CT levels had FNAC suspicious for differentiated thyroid carcinoma and were treated by surgery. Differentiated thyroid carcinoma, mostly papillary, was confirmed at histology in 43 subjects (3.1% of all thyroid nodules). In conclusion, the results of our study indicate that serum CT measurement is useful for the screening of sporadic MTC in patients with thyroid nodule(s). The prevalence of MTC, diagnosed by serum CT measurement in a 12-month period, among an unselected series of 1385 patients with nodular thyroid disease was surprisingly high: 0.57% of all thyroid nodules and 15.7% of all thyroid carcinomas. Serum CT measurement was superior to FNAC in suggesting the diagnosis of MTC and was devoid of falsely positive results. Increasing the diagnostic accuracy helped the surgeon to perform more radical treatment of MTC, thus achieving frequent normalization of postoperative serum CT levels. Whether this result indicates definitive cure remains to be established on the basis of longer follow-up.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1994

Long-term follow-up study of adenomatous hyperplasia in liver cirrhosis.

The purpose of this study was to investigate the natural history of adenomatous hyperplasia (AH) in liver cirrhosis, which is suspected of being a precancerous condition of hepatocellular carcinoma (HCC). Sixteen patients with 19 histologically proven AH nodules were followed-up over time with ultrasonographic (US) examinations performed every 3-4 months. The biopsy was repeated whenever the volume of the lesion increased, its US pattern changed, or there was a change in the alpha-fetoprotein values. Thirteen out of 19 AH (68.4%) evolved toward HCC after 8-31 months (mean 14.2 months). Malignant transformation was proved in 7/18 AH within 1 year of its initial detection, in 12/15 AH within 2 years, and in 13/14 AH within 4 years. Six AH remained unchanged in size and US pattern for 9-70 months (mean 29.5 months). Long term follow-up of AH confirms that this lesion is a precursor of HCC.

Adenoma, Liver Cell↗
PubMed1994

The value of aspiration needle biopsy in evaluating thyroid nodules.

From 1980 to 1990 4,229 consecutive euthyroid patients with thyroid nodule (73% with single and 27% with multiple nodules) were examined by FNA cytology for preoperative selection. One thousand four hundred and eight of these patients (33%) had nodules also suitable for evaluation by large needle biopsy histology (Aspiration Needle Biopsy, ANB). No significant complications occurred following ANB. The proportion of inadequate specimens was 25% for ANB and 15% for FNA, however a definite diagnosis was obtained with ANB in 62 patients with inadequate FNA finding. Diagnostic sensitivity was higher (93%) for FNA than for ANB whereas specificity was better (82%) for ANB diagnoses. Nonetheless ANB contributed to the increase of overall sensitivity as four of all the malignant nodules diagnosed as benign by FNA were correctly identified by ANB. Analysis of the postoperative results of 102 nodules with FNA and ANB finding of benign nodule or of suspected cancer showed that the addition to the same FNA finding (benign nodule or suspected cancer) of a different ANB diagnosis (suspected cancer or benign nodule) greatly changed the probability of finding a malignant nodule at postoperative histology. ANB was also useful in showing a macrofollicular component in 52% of 150 nodules diagnosed by FNA as pure microfollicular nodules.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Percutaneous ethanol injection therapy of adenomatous hyperplastic nodules in cirrhotic liver disease.

Adenomatous hyperplastic nodules (AHNs) in cirrhotic liver are considered a precancerous condition which may lead to hepatocellular carcinoma (HCC). In this study, we treated a total of 23 AHNs in 15 patients with percutaneous ethanol injection (PEI). The treatment included 6 to 8 PEIs, performed on an out-patient basis under sonographic guidance. A 22 G (0.7 mm) spinal needle was used. The total amount of alcohol delivered into each lesion was 8 to 25 ml (mean 14.9 ml). At the end of treatment, complete necrosis of the nodule was proved in all cases by multiple fine-needle biopsies and confirmed by CT and MR findings. During follow-up (9-41 months, mean 24 months) no recurrences were demonstrated. However, HCC occurred elsewhere in the liver of 4 patients and additional AHNs were detected in 2 patients. Thus, PEI proved able to cause complete ablation of AHNs, presumably preventing their malignant transformation. However, patients with AHN remain at high risk for developing HCC.

Aged↗
PubMed1993

Management of adenomatous hyperplastic nodules in the cirrhotic liver: US follow-up or percutaneous alcohol ablation?

In order to investigate the most appropriate management of adenomatous hyperplastic nodules in cirrhosis (AHNs), retrospective and prospective studies were undertaken. The retrospective study included 11 AHNs detected in nine patients, who were followed with ultrasonography (US) and fine-needle biopsy (FNB); seven of these lesions evolved into hepatocellular carcinoma (HCC) after a mean follow-up period of 11.4 months. The prospective study involved 19 AHNs (in 12 patients) that were submitted to percutaneous ethanol injection (PEI); all lesions underwent necrosis at the dynamic computed tomographic (CT) examination and at multiple FNBs performed 1 month after the end of treatment. In four patients studied with magnetic resonance (MR), all treated lesions were markedly hypointense in the T2-weighted images. No complications occurred after a total number of 114 alcohol injections. No local recurrences were observed after a mean follow-up period of 16.9 months. PEI should therefore be considered mandatory in the management of AHNs.

Aged↗
PubMed1993

The combination of aspiration needle biopsy with fine needle aspiration in the preoperative evaluation of breast tumors.

During a period of 10 years, 2906 women (mostly asymptomatic) were referred to us for physical breast examination. Fine needle aspiration (FNA) was used to examine a nodule or a breast thickening in 860 of these patients. One hundred and ten of these patients also underwent a large needle biopsy (LNB) to add a pre-operative histological evaluation. LNB was performed with 18-20 gauge needles, without cutting the skin and without adding any significant pain or discomfort to that caused by FNA (aspiration needle biopsy, ANB). Diagnostic sensitivity for cancer was 89% for FNA and 100% for ANB. ANB allowed us to correctly identify two cancers with post-operative stage T1N0M-0, which were diagnosed pre-operatively as benign by FNA. The combination of the two needle aspiration techniques (FNA and ANB) allowed us to diagnose 51 of all the 54 cancers (95%). The predictive value of a diagnosis of definite malignancy was 100% for either FNA or ANB. The predictive value of a diagnosis of suspected malignancy showed a predictive value of 72% for FNA and 70% for ANB. Three benign nodules with pre-operative ANB findings of suspected cancer were correctly diagnosed by FNA. Of the 12 cancers with inadequate ANB findings, 11 were correctly diagnosed by FNA. Sixteen of the cancers correctly identified by ANB showed a post-operative size of 2 cm or less (ten cases) or no metastatic axillary lymph-nodes (nine cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy, Needle↗
PubMed1992

[Ultrasound-guided biopsy of small abdominal lesions. Methodology implications].

In the present study the diagnostic accuracy of US-guided fine-needle biopsy was evaluated in a series of 219 abdominal lesions < or = 3 cm in diameter (21 between 0.6 and 1 cm; 83 between 1.1 and 2 cm; 115 between 2.1 and 3 cm). One-hundred-eighty-three of them were located in the liver and 36 in other abdominal organs (pancreas, 10, adrenals 9, lymphnodes 9, kidney 5, spleen 3). Biopsies were performed with "free-hand" technique using up-to-date ultrasound equipment. The demonstration of the correct location of the needle tip at the time of sampling was looked for with great care. The sensitivity rate was 93%, with a progressive improvement with the increase of the lesion size (83.3% between 0.6 and 1 cm; 91.1% between 1.1 and 2 cm; 95.4% between 2.1 and 3 cm). The specificity rate was 100%. In 207 cases in which the location of the needle tip was clearly demonstrated, the sensitivity reached 97.3% and the negative predictive value 93%. No noteworthy complications were observed. Ultrasonography is a highly reliable guidance modality also in biopsies performed on small abdominal lesions; if the correct location of the needle tip is clearly shown, even a diagnosis of benignity can be confidently made.

Abdominal Neoplasms↗
PubMed1991

The thyroid nodule: diagnostic strategy.

This paper comments on the principal techniques (nuclear imaging echography and needle aspiration) and the most widely used protocols available for preoperative selection of thyroid nodule patients. Successively, the authors report the principles to define a new appropriate protocol based on needle aspiration and hormone assays and evaluate their experience with this new simple protocol. Long term clinical practices shows that surgical excision can be avoided for more than 90% of the nodule patients and that thyroid scintigraphy can be avoided for most of these patients, without appreciable disadvantage.

Adult↗
PubMed1988

Needle aspiration of thyroid nodule: long-term control of its efficiency in preoperative selection.

Eight years extensive use of surgery for detecting thyroid cancer in euthyroid patients with palpable nodule was compared to 8 years preoperative selection by needle aspiration techniques to the same purpose. One thousand one hundred and forty operations were performed from 1972 to 1979; 3079 patients were examined by needle aspiration from 1980 to 1987. The female to male and single to multiple palpable nodule ratios were 5.2, 2.5 in the former and 6.8, 2.7 in the latter group respectively. Postoperative histology showed that nodules were malignant in 35 subjects and benign in 1105 patients of the first group. Two hundred thirty eight patients of the 3079 patients of the second group were operated upon mainly following aspiration findings. Postoperative histology showed primary malignant tumors in 88 patients. Therefore, introduction of needle aspiration techniques reduced the number of operations from 143 per year to 30 per year and increased from 4 to 11 per year the number of malignant nodules detected without any change of the incidence of cancer (about 3% in each group).

Biopsy, Needle↗