Biomedical subjects

M Regina Castro

Publications and source records attributed to M Regina Castro.

3 recordsLinked to original sources

PubMed2005

Continuing controversies in the management of thyroid nodules.

Although thyroid nodules are common, few are malignant and require surgical treatment. A systematic approach to their evaluation is important to avoid unnecessary surgery. Fine-needle aspiration biopsy has resulted in substantial improvements in diagnostic accuracy, cost reductions, and higher malignancy yield at time of surgery. The preferred approach when repeated fine-needle aspiration biopsy fails to yield an adequate specimen remains a challenge. Management of patients with nodules "suspicious for follicular neoplasm" is difficult, since only 15% to 20% of such lesions have been shown to be malignant. Immunohistochemical markers, such as galectin-3 and human bone marrow endothelial cell (HBME-1), have shown promise in preliminary studies. Routine calcitonin measurement in patients with thyroid nodules has been advocated for early detection of medullary thyroid cancer. However, the low frequency of this cancer, coupled with the high cost associated with case detection, has resulted in a lack of general acceptance of this recommendation.

Biopsy, Fine-Needle↗

PubMed2002

Effectiveness of thyroid hormone suppressive therapy in benign solitary thyroid nodules: a meta-analysis.

The effectiveness of thyroid hormone suppressive therapy in reducing the volume of benign thyroid nodules is controversial. It is important to clarify this therapeutic effect of thyroid hormone, because its prolonged use needs to be carefully weighed against its potential deleterious effects in the skeletal and cardiovascular systems. To evaluate the best available evidence, we conducted a systematic review and meta-analysis of the randomized controlled trials that fulfill the following inclusion criteria: single thyroid nodules proven benign by fine needle aspiration, treatment, and follow-up of at least 6 months; documented suppression of TSH; measurement of thyroid nodule volume by ultrasound; and response to therapy defined as more than 50% volume reduction from baseline. Six randomized clinical trials published between 1987 and 1999, with 346 patients, were included in the meta-analysis. Ninety percent of the participants were female. Using a random effects model, the overall effect size showed a relative risk of 1.9 (95% confidence interval, 0.95-3.81) favoring a treatment effect. A sensitivity analysis showed significant changes in the results. Suppressive thyroid hormone therapy for longer than 6 months is associated with a trend toward a reduction of more than 50% in volume of benign thyroid nodules, without achieving statistical significance. The results are highly sensitive to changes in the statistical analysis, especially if the method used ignores heterogeneity among the effect sizes. More studies are needed before this therapy can be widely recommended.

Humans↗

PubMedDate not supplied

Thyroid fine-needle aspiration biopsy: progress, practice, and pitfalls.

OBJECTIVE: To provide an updated review of the current progress in, and the practice and pitfalls of, thyroid fine-needle aspiration (FNA) biopsy. METHODS: The medical literature on the topic was reviewed, and the current methods, advantages, and controversies concerning FNA biopsy of thyroid nodules are summarized. RESULTS: Thyroid nodules are a common clinical problem, with an estimated prevalence ranging from 19 to 35%. Most thyroid cancers manifest as thyroid nodules; however, only a small fraction of all thyroid nodules harbor malignant disease. Certain clinical features increase the likelihood of malignant involvement, but the absence of such features does not exclude the possibility of cancer. Of all currently available methods of evaluating nodular thyroid disease, FNA biopsy has been found to have the greatest diagnostic accuracy, approaching 95%, and its widespread use has resulted in substantial cost savings and has allowed a much better selection of patients in need of surgical treatment. The procedure, however, has two major limitations: nondiagnostic yield and indeterminate results. The approach to the management of patients with thyroid nodules is summarized. CONCLUSION: FNA is the most reliable and cost-effective method of distinguishing benign from suspicious or malignant thyroid nodules.

Biopsy, Needle↗