[Autonomous functioning thyroid nodule].
Explore the source record for details and available documents.
Diagnosis, Differential↗
Biomedical subjects
Nobuhiro Fukunari
Publications and source records attributed to Nobuhiro Fukunari.
Distinct diagnostic criteria for ultrasonographic examination of papillary thyroid carcinoma: a multicenter study.
Recent advances permitting high-resolution ultrasonography have made ultrasonographic examination of nodular thyroid diseases an accessible examination for routine practice. However, diagnostic criteria for ultrasonographic examination of thyroid nodules are not surely established. To identify the optimal strategy for well standardized differential diagnosis of papillary thyroid carcinoma and benign nodules, we evaluated the significance of individual ultrasonographic characteristics of thyroid nodules in a multicenter study. Ten characteristics in ultrasonograms from 53 patients scored by 17 investigators from 15 centers were analyzed by t tests and logistic regression analyses. Between benign and papillary thyroid cancer groups, all characteristics but not size or multiplicity of strong echoes, which suggest calcifications, were significant parameters. Logistic regression analyses showed that border character, shape, and internal echo level are highly significant parameters (p < 0.0005). A multiple logistic regression showed to be the most important predictors of pathologic diagnosis. The diagnostic criterion with border character and internal echo level yielded 93% sensitivity and 92% specificity. In conclusion, univariate and multivariate analyses identified border character, shape, internal echo level, but not strong echoes (calcifications), as important characteristics in differentiating papillary thyroid carcinoma from benign nodules. These results will contribute to standardization of accurate ultrasonographic diagnosis of papillary thyroid carcinoma.
Adenocarcinoma, Papillary↗
Clinical evaluation of color Doppler imaging for the differential diagnosis of thyroid follicular lesions.
Ultrasonography (US) of the thyroid gland has recently proved to be a useful clinical diagnostic method, and the newly developed high-resolution US with a color Doppler flow mapping function can reveal fine details of the thyroid gland and the hemodynamic features of a thyroid neoplasm. US can yield a diagnostic accuracy of more than 90% for thyroid carcinoma, especially papillary carcinoma. However, neither conventional B-mode US imaging nor aspiration biopsy cytology has delivered satisfactory results for follicular carcinoma. The aim of this study was to evaluate the clinical usefulness of color Doppler imaging for the differential diagnosis of thyroid follicular lesions. A color Doppler scan was performed in 310 patients with a solitary cold nodule, and a combination of B-mode US and color Doppler findings, including tumor vascularity and results of a fast Fourier transform (FFT) analysis were used to create the following diagnostic grading system for differential diagnosis of follicular lesions: grade 1, benign follicular lesion [no color flow mapping (CFM) inside the nodule]; grade 2, benign peripheral type [CFM only in peripheral area, pulsatility index (PI) < 1.0]; grade 3, suspected follicular carcinoma (penetrating CFM, vascularity moderate); grade 4, follicular carcinoma (high-velocity penetrating CFM, PI = 1.0). All patients were subjected to surgical resection, and histologic examination was used to confirm the diagnosis. The grades of the 177 adenomatous nodules were as follows: grade 1, 46.9%; grade 2, 48.0%; grade 3, 5.1%; grade 4, 0%. The corresponding percentages for the 89 follicular adenomas were 16.9%, 49.4%, 30.3%, and 3.4%; and for the 44 follicular carcinomas they were 0%, 13.6%, 45.5%, and 40.9%. On the assumption that grade 1 and 2 lesions are benign and grade 3 and 4 lesions are malignant, 38 of the 44 follicular carcinomas and 227 of the 266 benign tumors had been accurately diagnosed, yielding a sensitivity of 88.9%, a specificity of 74.2%, and an accuracy of 81.0% for the grading system. Color Doppler imaging of 310 follicular tumors has revealed that high-velocity pulsatile blood flow penetrating the tumor is a characteristic finding of follicular carcinoma and is a new diagnostic criterion for performing color Doppler imaging. The differential diagnostic grading scores for color Doppler examinations and the results of FFT analysis demonstrate that US with the color Doppler function can play an important role in the differential diagnosis of thyroid tumors.
Adenoma↗
Surgical treatment of Graves' disease in children.
Thyroidectomy may be indicated in children with Graves' disease who have adverse reactions to antithyroid drugs or who relapse after antithyroid drug therapy. We investigated the characteristics of childhood Graves' disease from the standpoint of surgical outcome. Between 1989 and 1998, 1897 patients with Graves' disease underwent thyroidectomy and their thyroid function could be evaluated 2 to 3 years after thyroidectomy. The patients were divided into three groups according to age at thyroidectomy: 74 patients were 15 years old or less (children), 345 patients 16 to 20 years of age (adolescents), and 1478 patients 21 years of age or more (adults). The children included higher proportions of patients who had a large goiter (> 100 g), high thyrotropin-binding inhibitory immunoglobulin (TBII) level (> 50%), and small remnant thyroid (< 4 g). At 2 to 3 years after thyroidectomy, the overt recurrence rate of the children, adolescents, and adults was 9.5%, 4.9%, and 5%, respectively. The cumulative recurrence-free rate of the children, adolescents, and adults at 5 years after thyroidectomy was 82%, 90%, and 92%, respectively. Surgical complications were more frequently observed in children. Considering the aggressiveness of childhood Graves' disease, subtotal thyroidectomy with thyroid remnant less than 3 g is the procedure of choice for preventing recurrent hyperthyroidism.
Adolescent↗
Composite metastatic carcinoma in lymph nodes of patients with concurrent medullary and papillary thyroid carcinoma: a report of two cases.
Synchronous occurrence of medullary and papillary carcinoma of the thyroid gland is very rare. We describe two cases of synchronous medullary and papillary carcinoma of the thyroid. In both cases, medullary carcinoma and papillary carcinoma were separate in the thyroid but mixed in some of the lymph node metastases. A review of the literature and our own cases revealed that composite medullary and papillary carcinoma metastases in the lymph nodes is a common feature of patients with synchronous medullary and papillary carcinoma of the thyroid gland.
Adult↗
Thyroid ultrasonography B-mode and color-Doppler.
Recently, ultrasonography of the thyroid gland has proved to be a useful clinical diagnostic method. The newly developed high-resolution ultrasonography with color-Doppler flow mapping function can reveal fine details of the thyroid gland and the hemodynamic features of thyroid neoplasmas. Ultrasonography can deliver a diagnostic accuracy of over 90% in thyroid carcinoma, especially papillary carcinoma. However, in the case of follicular carcinoma, neither conventional B-mode ultrasound imaging nor aspiration biopsy cytology can deliver satisfactory results. Color-Doppler imaging examination of 212 follicular tumors has been carried out, resulting in the characteristic finding that a high-velocity pulsative blood flow penetrates the tumor in the case of follicular carcinoma, which led to new diagnostic criteria with color-Doppler examination. The differential diagnostic grading score using color-Doppler examination and FFT analysis can show a dramatic diagnostic accuracy of 81.0%, a sensitivity of 88.9% and a specificity of 74.2%. Ultrasound with the color-Doppler function can play a more important role in the differential diagnosis of thyroid tumors.
Humans↗
PEI therapy for thyroid lesions.
PEI therapy has been applied clinically as a new treatment strategy for cystic lesions and autonomous functioning nodules of the thyroid. Some additional indications currently under consideration include cold benign tumors and inoperable advanced cancer of the thyroid, and postoperative recurrence of Graves' disease. At our institution, we have treated 2323 patients with thyroid disease by PEI therapy from 1999 to 2001. PEI is usually administered under ultrasound guidance in cases of cystic lesions, and under color-Doppler guidance in cases of solid lesions of the thyroid, with the goal of attenuating tumor blood flow. In consequence, of the total 2323 cases who received PEI therapy at our hospital, 1989 (85.6%) were classified as showing an effective response (ER) or partial response (PR). There were no major complications, such as recurrent laryngeal nerve palsy, uncontrollable pain, bleeding, or thyrotoxicosis. Our results also emphasize the importance of the use of color-Doppler guidance for control of the injection volume of ethanol to the minimum required for completely attenuating the tumor vascularity.
Administration, Cutaneous↗
The important role of operations in the management of anaplastic thyroid carcinoma.
BACKGROUND: Anaplastic thyroid carcinoma is a rare and highly lethal neoplasm. We investigated whether operations have an impact on the survival of patients who have anaplastic carcinoma without distant metastasis. METHODS: Between 1989 and 1999, 40 consecutive patients with anaplastic carcinoma, without distant metastasis at the time of presentation or during local treatment, were reviewed. The cumulative survival rates and 1-year survival rates were compared. RESULTS: Eleven patients had a small focus of anaplastic carcinoma in a differentiated carcinoma, and 29 patients had ordinary anaplastic thyroid carcinoma. Surgical debulking was performed in 26 patients. Radiotherapy was used for 31 patients and chemotherapy for 19 patients. The 1-year survival rates of the patients with incidental anaplastic carcinoma, ordinary anaplastic carcinoma who underwent operations, and ordinary anaplastic carcinoma who did not undergo operations were 73%, 60%, and 21%, respectively. A significantly higher cumulative survival rate was observed in patients with incidental anaplastic carcinoma than in those with ordinary anaplastic carcinoma. A significantly better outcome was obtained by surgical debulking of ordinary anaplastic carcinoma. CONCLUSIONS: Patients with incidental anaplastic carcinoma tended to have a good outcome, but some had a poor prognosis. Surgical debulking improved the outcome of patients with ordinary anaplastic carcinoma.
Carcinoma↗