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PubMed2002

Cyclooxygenase-2 expression in thyroid nodules.

Factors contributing to the development of thyroid neoplasia remain poorly understood. Recent evidence indicates that overexpression of the inducible cyclooxygenase, COX-2, is important in the pathogenesis of epithelial carcinomas. These studies were undertaken to evaluate whether COX-2 is up-regulated in human thyroid neoplasia. Benign (n = 14), and malignant (n = 14) thyroid nodules were analyzed for expression of COX-2 mRNA by quantitative RT-PCR. Immunoblotting and immunohistochemistry were performed on representative samples. Three human thyroid cancer cell lines were similarly analyzed for COX-2 expression. Levels of COX-2 mRNA were significantly increased in thyroid nodule samples compared with adjacent thyroid tissue in the malignant specimens but not in the benign specimens. Additionally, COX-2 mRNA levels were significantly increased in malignant nodule samples compared with benign nodule samples. COX-2 protein expression was higher in 8 of 10 thyroid nodules compared with the adjacent tissue. Immunohistochemical analysis localized expression of COX-2 to the malignant epithelial cells. Immunofluorescence demonstrated COX-2 protein expression in all three thyroid cell lines. Finally, COX-2 expression could be detected by RT-PCR in fine needle aspiration specimens of thyroid nodules. These data indicate that COX-2 is up-regulated in human thyroid cancer, but not in benign thyroid nodules, and suggest that COX-2 expression may serve as a marker of malignancy in thyroid nodules.

Biomarkers, Tumor↗

PubMed1999

Role of radiology for imaging and biopsy of solitary pulmonary nodules.

Both imaging and image-directed biopsy play a major role in evaluating solitary pulmonary nodules. Imaging is used to determine whether the nodule is actually solitary or if multiple nodules are present. Once a nodule has been detected, imaging techniques can be used to characterize the nodule in terms of whether it is likely benign or malignant. As technology has improved, smaller nodules are now more easily detected, which may create a management dilemma. With the advent of video-assisted thoracoscopic techniques, however, sampling of these lesions has become much easier. Once a solitary pulmonary nodule is detected, image-guided biopsy is often considered, which can be undertaken using CT or fluoroscopy. Technical limitations, the location of the solitary pulmonary nodules, and clinical conditions must be considered when determining the role of image-guided biopsy. Other concerns include the role of on-site cytology and the use of more recent technical advances. Image-guided biopsy should be used as part of a multimodality approach to patient management, and decisions should be discussed with the radiologist and other caregivers to determine the cost-effectiveness and safety of the procedure for each patient.

Biopsy, Needle↗

PubMed2005

Effect of ultrasound-guided interstitial laser photocoagulation on benign solitary solid cold thyroid nodules - a randomised study.

AIM: To evaluate the efficacy of ultrasound (US)-guided interstitial laser photocoagulation (ILP) on thyroid function, nodule size and patient satisfaction in benign solitary solid cold thyroid nodules by comparing one ILP session with no treatment in a prospective randomised study. MATERIALS AND METHODS: Thirty euthyroid outpatients with a benign solitary solid and a scintigraphically cold thyroid nodule causing local discomfort were assigned to one session of ILP (n = 15) or observation (n = 15) and followed for 6 months. Thyroid nodule volume and total thyroid volume were assessed by US and thyroid function was determined by routine assays before and during follow-up. Pressure and cosmetic complaints before and at 6 months were evaluated on a visual analogue scale. ILP was performed under US guidance and with an output power of 2.5-3.5 W. RESULTS: In the ILP group, the nodule volume decreased from 8.2 ml (6.1; 11.9) (median; quartiles) to 4.8 ml (3.0; 6.6) after 6 months (P = 0.001). The overall median reduction was 44% (37; 52), which correlated with a significant decrease in pressure symptoms as well as cosmetic complaints. In the control group, a non-significant increase in median nodule volume of 7% (0; 34) after 6 months was seen. No major side-effects were seen in the ILP group. There was no correlation between thermal energy deposition and nodule volume reduction. Thyroid function was unaltered throughout. CONCLUSION: US-guided ILP, given as a single treatment, resulted in a satisfactory clinical response in the majority of patients with a benign solitary solid cold thyroid nodule, and may become a clinically relevant alternative to surgery in selected patients.

Adult↗

PubMed2004

[Ultrasonographic evaluation of thyroid nodules: comparison with cytologic and histologic diagnosis].

The purpose of this study was to evaluate our ultrasonographic classification of thyroid nodules, based on echo structure, echogenicity, calcification, margin and analysis of the surrounding parenchyma. From January 1998 to January 2002, 2,468 consecutive patients with thyroid nodules were referred for thyroid ultrasonography and ultrasound-guided fine needle aspiration biopsy (USFNAB) in our Thyroid Unit. Among 1,039 nodules classified as benign on ultrasound, 998 (96.1%) were also benign on cytology, 37 (3.6%) were suspicious and only 4 (0.4%) were malignant. On the other hand, among 153 nodules classified as suspicious on ultrasound, 20 (13.1%) were suspicious and 88 (57,5%) were malignant on cytology. Of the 71 nodules suspicious on ultrasound submitted to surgery, 67 (94.3%) were malignant and 56 (96.6%) of 58 nodules considered benign were benign on pathologic studies. In conclusion, we advocate USFNAB in nodules classified as indeterminate or suspicious. Nodules classified as benign may be followed up at periodic intervals.

Adolescent↗

PubMed1999

Helical CT of pulmonary nodules in patients with extrathoracic malignancy: CT-surgical correlation.

OBJECTIVE: Our aim was to assess the sensitivity of helical CT for revealing pulmonary nodules. Thoracotomy with palpation of the deflated lung, resection, and histologic examination of palpable nodules was used as the gold standard. SUBJECTS AND METHODS: Thirteen patients underwent helical CT (slice thickness, 5 mm; reconstruction intervals, 3 mm and 5 mm; interpreted by two independent observers). Subsequently, patients underwent unilateral (n = 6) or bilateral (n = 7) surgical exploration, and CT-surgical correlation of 20 lungs was performed. RESULTS: Ninety nodules were resected (61 were smaller than 6 mm; 13 were 6-10 mm; 11 were larger than 10 mm; in five nodules, the size was not recorded at surgery). Sixty-nine nodules were located in the pulmonary parenchyma and 21 in the visceral pleura. Of the 90 lesions, 43 (48%) were found on histology to represent metastases. For lesions detected by at least one observer, the sensitivity of helical CT was 69% for intrapulmonary nodules smaller than 6 mm, 95% for intrapulmonary nodules larger than or equal to 6 mm, and 100% for histologically proven intrapulmonary metastases larger than or equal to 6 mm. For lesions smaller than or equal to 10 mm, sensitivity was better using a reconstruction interval of 3 mm rather than of 5 mm. CONCLUSION: In this study, the sensitivity of helical CT exceeded the sensitivity of conventional CT in previous reports. However, because of limitations in the detection of intrapulmonary nodules smaller than 6 mm and of pleural lesions, complete surgical exploration should remain the procedure of choice in patients undergoing pulmonary metastasectomy. Preoperative helical CT should be used to guide the surgeon to lesions that are difficult to palpate.

Adult↗

PubMedDate not supplied

Assay of free thyroxine and free triiodothyronine in fine-needle aspiration of thyroid nodules: a useful and low-cost assessment.

OBJECTIVE: To evaluate whether analysis of thyroid hormones in fine-needle aspiration (FNA) of thyroid nodules can provide information about the functional status and the nature of the nodules. METHODS: We studied 4 groups of patients: group 1, 17 patients with autonomous hyperfunctioning thyroid nodules; group 2, 52 patients with cold nonfunctioning thyroid nodules; group 3, 12 patients with malignant thyroid nodules; and group 4 (control group), 10 patients with nonthyroid nodular lesions (enlarged parathyroid glands or lymph nodes). The assay of thyroid hormones was performed in FNA after the washing of needles and, with patient consent, also in normal thyroid parenchyma. RESULTS: The free thyroxine (FT(4)) and free triiodothyronine (FT(3)) values were remarkably high in group 1 (mean, 5.5 +/- 0.53 ng/dL and 27.6 +/- 3.1 pg/mL, respectively; P<0.05 versus group 2 and group 4, the control group). The levels of FT(4) and FT(3) were very low in group 3 (<0.2 ng/dL and <1.0 pg/mL, respectively; P<0.05 versus group 2). Thyroglobulin values in FNA specimens were much higher than the normal range in human serum, but no significant differences were found between the various groups. The control group had low levels of FT(4) and FT(3) (<0.2 ng/dL and <1.0 pg/mL, respectively) in conjunction with low levels of thyroglobulin, whereas parathyroid hormone levels were high in parathyroid nodules. CONCLUSION: These results show that assay of FT(4) and FT(3) in FNA can yield information about the functional status of thyroid nodules and, indirectly, about the nature of nodules. In this era of sophisticated new molecular markers in FNA cytology, this low-cost diagnostic method can be readily performed in every laboratory.

Adult↗

PubMed1997

Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging.

BACKGROUND: The introduction of highly sensitive imaging techniques has made it possible to detect many non-palpable nodules, or "incidentalomas," in the thyroid. Discovery of these lesions raises concerns about their malignancy, but the optimal strategy for managing these lesions has not been clearly established. PURPOSE: To review evidence about incidentalomas, including prevalence and risk for malignancy, and to provide recommendations for their evaluation and treatment. DATA SOURCES: Literature searches for relevant articles published in the past 15 years in major English-language medical journals, review of selected articles published before this period, and reviews of bibliographies in text-books. STUDY SELECTION: Three studies on autopsy findings, 11 studies on ultrasonographic findings, and other reports on nonpalpable thyroid nodules were included. DATA EXTRACTION: Data on the prevalence of nodules on autopsy and in ultrasonographic series, palpation compared with ultrasonography, the risk for malignancy in nodules found in irradiated glands, the natural history of thyroid nodules, and the prevalence of occult cancer were collated and reviewed. DATA SYNTHESIS: Prevalence of thyroid incidentalomas estimated from autopsy studies ranges from 30% to 60%. Studies comparing clinical palpation with thyroid imaging show a prevalence of 13% to 50%. Prospective studies of randomly selected patients have reported a prevalence of 19% to 67%. The risk for malignancy in asymptomatic nodules found in nonirradiated glands is 0.45% to 13% (mean +/- SD, 3.9% +/- 4.1%). CONCLUSIONS: High-resolution ultrasonography is sensitive and capable of detecting many small, nonpalpable thyroid nodules. Most of these lesions are benign. For most patients with nonpalpable nodules that are incidentally detected by thyroid imaging, simple follow-up neck palpation is sufficient.

Autopsy↗

PubMed1999

[Neural network based detection of pulmonary nodules on chest radiographs].

PURPOSE: We investigated the capabilities of an artificial neural network-based Computer-Aided Diagnosis (CAD) system in improving early detection of pulmonary nodules on chest radiographs. MATERIAL AND METHODS: We used a data-set of 145 digitized chest films. Two different radiologists read the radiographs to detect the sites of possible nodules. The system uses two neural networks trained on a training-set of 100 radiographs selected from the data-set. The first network is used to focus attention on the sites of potential nodules while the second calculates the likeliness of nodule presence in ROIs. The clinical test was performed on 45 more radiographs from the training-set, but different from those in the data-set, which were positive for both benign and malignant nodules. These latter plain films showed 65 nodular lesions which differed by shape and acquisition technique. RESULTS: Sensitivity was 89% in all radiographs while specificity, evaluated by ROI, and accuracy, were 98%. CONCLUSIONS: There are potential limitations in nodule detection on plain radiographs. Some of them are operator-dependent, such as nonsystematic investigation, lesion underestimation, and poor reading, and some are technique-dependent, such as X-ray beam/tube, low voltage, patient positioning, focus-film distance and development process. CADs may contribute to improving detection of pulmonary nodules because the false-negative rate is decreased and sensitivity consequently increased. The high sensitivity and specificity rates of neural networks encourage further trials on wider data-sets to help the radiologist in the early detection of pulmonary nodules.

Humans↗

PubMed1999

[Percutaneous localization and marking of small solitary pulmonary nodules in CT imaging before video thoracoscopy surgery].

BACKGROUND: The localization of small lung nodules by palpation is not possible when videothoracoscopic surgery is performed. Transparietal fine needle biopsy is frequently not successful in small lung nodules. METHODS AND RESULTS: The authors describe their experiences with percutaneous CT controlled marking of small lung parenchyma around small lung nodules by patent blue and contrast medium mixture. The method was used in 7 patients with nodule size from 7 mm to 25 mm. In all patients the surgeon was able to localize the nodule. Operation followed localization as soon as possible, the interval was from 60 to 120 minutes. Four of 7 nodules were benign, 3 nodules were malignant. CONCLUSIONS: New method of marking of small lung nodules makes a minimal invasive operation possible. The operation stress is lower and the time of hospitalization is shorter.

Coloring Agents↗

PubMedDate not supplied

Thyroid nodules in Graves' disease: implications in an endemically iodine deficient area.

BACKGROUND AND AIM: The presence of thyroid nodules with Graves' disease raises concern about co-existent thyroid malignancy. The objective of this study is to evaluate the risk of thyroid carcinoma and the need for surgical intervention in, patients with Graves' disease with co-existent nodules in an endemically iodine deficient area (IDA). SUBJECTS AND METHODS: Retrospective study of 130 surgically managed patients of Graves' disease (1990-1999). Out of these 35 (26.9%) cases had palpable nodules. No patient had history of previous head and neck irradiation or radioiodine therapy. The clinico-pathological findings and follow-up of these cases were noted. RESULTS: Mean age of patients with nodules was 40.2 +/- 9.5 years and male to female ratio was 1:2.2. The overall incidence of thyroid carcinoma in Graves' disease was 6.2% (8/130 cases), while the incidence, in cases having nodule with Graves' disease was 17.1% (6/35 cases). The median age of patients with carcinoma was 45 years (5 women and 1 man). Besides laboratory investigations for hyperthyroidism, preoperative investigations included fine needle aspiration cytology (FNAC) and thyroid scintigraphy in 29 and 25 cases respectively. Incidence of malignancy in palpable cold nodules was 20%. FNAC could not predict malignancy with certainty in any of these cases. Five patients had papillary thyroid carcinoma while one had follicular carcinoma. Median tumour diameter was 10 mm. Tumour was multi-centric in two cases while one case had metastases to cervical lymph node. In follow-up (median =5.5 years) one patient died of unrelated cause, while rest are alive with no evidence of disease. CONCLUSIONS: Nodules are frequently associated with Graves' disease in IDA. Incidence of carcinoma is high in palpable cold nodule. We recommend early thyroidectomy in these cases.

Adult↗

PubMed2002

[Thyroid nodule, cancer and pregnancy].

Pregnancy is a favorable condition for thyroid nodule formation and growth since iodine balance may be negative in addition to increasing production of hormones with thyroid stimulatory activity. Thyroid nodules may be discovered in pregnant women on routine examination: what is the risk for a nodule to be malignant, how should it be investigated? In case thyroid cancer is suspected, is there an impact of pregnancy on the tumor outcome and what treatments are available? Infrequently, diagnoses of toxic autonomous nodules or medullary carcinomas may be supported by elevated serum calcitonin or suppressed TSH value. Ultrasonography scanning and fine-needle aspiration biopsy (FNAB) best help to monitor thyroid nodules and guide their management. Toxic autonomous nodules can be either surgically resected in the second trimester of pregnancy or treated by percutaneous alcohol injection. When cytology findings are benign or indecisive, solid nodules require follow-up by neck palpation, in association to repeat ultrasonographic study and nodule aspiration as necessary. In this setting, thyroxine administered in small doses or iodine supply merit consideration. If FNAB samples are suggestive of suspicious or malignant lesions, thyroidectomy can be performed through the second trimester or delayed after delivery, depending on the pregnancy term. Observations of pregnant women with a rapid growing differentiated thyroid cancer have been reported. However, in matched studies comparing pregnant and nonpregnant women recurrence risk and cancer mortality are not significantly different.

Biomarkers↗

PubMed2003

[Value of serum-vascular endothelial growth factor in the differential diagnosis of solitary pulmonary nodule].

OBJECTIVE: To evaluate serum-vascular endothelial growth factor (S-VEGF) in the differentiation of solitary pulmonary nodule (SPN). METHODS: Serum level of VEGF of 68 patients with SPN was measured by ELISA kit, and compared with the control group of 20 normal subjects. The nodules were diagnosed by operation and pathology. RESULTS: The median level of S-VEGF was 42.5 (range from 10 to 170) pg/ml in the control, 44 (range from 18 to 360) pg/ml in benign nodule group and 75 (range from 18 to 890) pg/ml in lung cancer group, with significant difference observed between the nodule group and control (P < 0.01), and between the lung cancer group and the benign nodule group (P < 0.05), but not between the benign nodule group and the control. In addition, when S-VEGF in different pathologic types of the limited number of lung cancer patients were compared, no significant difference was observed. CONCLUSION: S-VEGF is valuable in the differential diagnosis of solitary pulmonary nodule. An elevated S-VEGF level >or= 100 pg/ml in patients with SPN may strongly speak for a malignant nodule. Operation is suggested.

Adult↗

PubMed2003

[Comparison of digital radiography and conventional X-ray in the diagnosis of solitary pulmonary nodule with receiver operating characteristic analysis].

OBJECTIVE: To compare digital radiographs with conventional radiographs in the detection of solitary pulmonary nodules. METHODS: Thirty patients with solitary pulmonary nodule and 30 cases without pulmonary nodules were enrolled in the study. The existence of solitary pulmonary nodule was confirmed by chest computed tomography (CT) as well as biopsy. All patients examined by both digital radiography (group A) and conventional radiographs (group B) were reviewed by four experienced chest radiologists and four residents. Assessment was performed with receiver operating characteristic (ROC) analysis of the images in both groups. RESULTS: (1) Observer performance of the experienced radiologists in group B (Az=0.838) was superior to that in group A (Az=0.816) (P<0.05) in detection of solitary pulmonary nodule. For the residents, observer performance in group B (Az=0.842) was superior to that in group A (Az=0.712) (P<0.05). (2) There was no difference between the two groups (P=0.272), for the judgement of benign or malignant solitary pulmonary nodule. CONCLUSIONS: Digital radiographs is superior to conventional radiographs in detection of solitary pulmonary nodule. However, there was no significant differences in discrimination between benign and malignant solitary pulmonary nodules in the two groups.

Adolescent↗

PubMed2003

[Detection of malignancy markers in thyroid nodules by reverse transcriptase polymerase chain reaction (RT-PCR)].

BACKGROUND: Nodular thyroid disease is a very common disorder with a low frequency of malignancy. The most accurate diagnostic test is fine needle aspiration biopsy (FNAB) of nodules with cytological analysis of the sample. However, this procedure has some limitations in the diagnosis of follicular and papillary thyroid carcinoma. AIM: To detect mRNA from specific malignancy markers in thyroid nodules and to evaluate their potential correlation with cytological and pathological diagnosis. PATIENTS AND METHODS: In 20 patients with thyroid nodules FNAB was performed prior to surgery. The main part of the FNAB sample was used to perform classical cytology. In the remaining of the sample were detected MUC-1, CD26, galectin-3 and TSH receptor mRNAs by RT-PCR technique. RESULTS: Eight patients had positive cytology for papillary cancer, which was confirmed by pathology. Nine had suspicious or non conclusive cytological findings and 3 were negative for neoplastic cells; all 12 were pathologically benign. We detected TSH receptor and galectin-3 mRNA in almost all benign and malignant nodules. MUC-1 was present in 5/8 papillary carcinoma (62.5%), and 1/12 benign nodules (8.3%). CD26 was detected in 7/8 papillary carcinomas but also in 8/12 benign nodules. CONCLUSIONS: RT-PCR can be performed in very small samples of thyroid tissue to detect several mRNA markers. MUC-1 can be a potentially useful marker of malignancy in thyroid nodules. It can be detected by RT-PCR as a complementary technique in the diagnostic evaluation of thyroid nodules.

Biomarkers, Tumor↗

PubMed2004

Advances in imaging of the solitary pulmonary nodule.

OBJECTIVE: To review the radiological management of a solitary pulmonary nodule. DATA SOURCES: MEDLINE literature search (1958-2002). STUDY SELECTION: All review articles and original articles. Key words for the literature search were 'solitary pulmonary nodule' and 'imaging'. DATA EXTRACTION: All relevant information and data. DATA SYNTHESIS: The solitary pulmonary nodule remains a perennial problem in radiological practice, particularly with current trends using low-dose computed tomography to screen for lung cancer. Determining the likelihood of malignancy forms the basis of the radiological approach of a solitary pulmonary nodule. Several factors that influence risk analysis include morphological and enhancement characteristics of the solitary pulmonary nodule on imaging, stability of the nodule, age of patient, smoking history, and history of malignant disease. Other ancillary procedures and imaging techniques that assist in the evaluation of a solitary pulmonary nodule include fluorodeoxyglucose positron-emission tomography, technetium Tc 99m depreotide imaging, bronchoscopy with bronchioloalveolar lavage and biopsy, image-guided transthoracic needle aspiration biopsy, video-assisted thorascopic surgery, and thoracotomy. CONCLUSIONS: The success of any radiological management of a solitary pulmonary nodule rests on careful clinical evaluation and risk stratification for malignancy before the implementation of appropriate imaging techniques.

Adult↗

PubMed2006

The rational use of fine needle aspiration biopsy (FNAB) in diagnosing thyroid nodules.

AIM: Fine needle aspiration biopsy (FNAB) plays a crucial role in the diagnosis of thyroid nodules and enables the number of surgical operations to be reduced. Theoretically, FNAB should be carried out on all nodules, though currently only those displaying certain characteristics are biopsied. Indeed, to perform FNAB on all nodules may be regarded as an excess of zeal. Therefore, it seems advisable that the endocrinologist should be able to confirm on the spot the necessity and utility of FNAB. METHODS: We evaluated on a sample of 263 consecutive requests (209 female, 57 male; age 56.7+/-13.7 years) for FNAB in 2004: 1) the appropriateness of the investigation, 2) expected efficacy, 3) practical efficacy, 4) efficiency. FNAB was performed under echo-guidance in accordance with the standard technique. In 50%, 36%, 6%, 3%, 2% and 1% of cases, the echographic diagnosis was of MNG, UNG, pseudo-nodular lesion in ATD, lymph-node, neck cyst, suspected parathyroid lesion and tumefaction of the salivary glands, respectively. A pre-FNAB clinical risk score was assigned to each case on the basis of clinical and echographic data, with a maximum possible score of 11. The results of FNAB were subdivided into 5 categories according to the criteria of the BTA (Thy1-Thy5). After FNAB, a decisional category was assigned, ranging from ''observation'' to ''surgery''; this was subsequently (7-18 months) compared with the management strategy adopted by the attending physician. Information was gathered by means of telephone enquiry. RESULTS: 1) Appropriateness: on the basis of clinical and echographic findings, FNAB was not judged appropriate in 24% of cases because of either the lack of confirmation of a significant target (34%) or a low pre-FNAB risk score (range 0-2) (66%). The decisional category was ''observation'' in 87% of cases and ''further investigation'' in 13%. 2) Expected efficacy: FNAB was performed in 76% of cases. The biopsies (3%) performed on swollen lymph-nodes and extra-thyroid neck tumefactions, in which biochemical evaluation was positive, proved to be diagnostic but not classifiable according to the BTA. In 82% of the remaining cases, the result was Thy2 (observation) or Thy 4-5 (surgery). Thy3 results (surgery) were rare (1%). Thy1 results (16%) were yielded by the aspiration of colloid cysts (29%), solid lesions (10%) characterised by means of PTH-FNAB and Tg-FNAB, nodules (9%) no longer detectable on repetition of FNAB, nodules (16%) in which FNAB was already a repetition of a non-diagnostic investigation (2003), and nodules (9%) in which the presence of normal thyrocytes, ''hot'' scintigraphic image and prior decision of the surgeon advised against repeating FNAB. Of the patients with Thy1 results, 26% refused to repeat FNAB. In all, 95% of FNAB supported by biochemical evaluation yielded results that usefully contributed to patient management. The correlation between pre-FNAB clinical risk and cytological score according to the BTA proved significant (P<0.001). No difference in diameter was recorded between nodules with adequate cytology (23.3+/-0.9 mm) and those with inadequate cytology (25.2+/-1.6 mm). 3) Practical efficacy: 75% of patients were reached by telephone. In most cases, observation was the most frequent clinical choice, after echography and/or FNAB. The decisional category assigned after FNAB correlated significantly (P<0.001) with the approach adopted by the attending physician. d) Efficiency: following FNAB, 11 patients were assigned to surgery. DTC was detected in 100% of these cases (1 follicular carcinoma, 1 insular carcinoma, 9 papillary carcinoma). The success of FNAB (9/11) in detecting lesions that proved malignant on histological examination (11/11) was significant (P<0.05). Of the 2 Thy 3 cases, 1 was follicular carcinoma and 1 was follicular adenoma with adjacent papillary carcinoma. The incidence of thyroid carcinomas in the population studied was 5.5%. CONCLUSIONS: 1) Together with clinical-biochemical evaluation, echo-guided FNAB re-mains the first-line diagnostic test in the management of thyroid nodules; 2) a pre-FNAB clinical risk score is useful in limiting the number of probably inappropriate investigations; 3) efficacy, in terms of cytology results that are useful for patient management after FNAB (and after biochemical evaluation, when indicated) is high, enabling patients to be stratified in classes with different subsequent pathways; 4) in the vast majority of cases, FNAB influences subsequent clinical decisions; 5) false negatives cannot be excluded, while false positives are practically nil; 6) further indications may be yielded by studies on larger populations, and new prospects may emerge from the application of other techniques associated to FNAB.

Adult↗

PubMed1994

Fundamental and clinical evaluation of chest computed tomography imaging in detectability of pulmonary nodule.

Fundamental and clinical evaluation of chest CT imaging in detectability of pulmonary nodules was carried out in comparison with projection chest radiography including conventional screen-film system, advanced multiple beam equalization radiography (AMBER System), and computed radiography with imaging plate (CR). Detectability of simulated nodules in the fundamental study and of metastatic pulmonary nodules in ten patients in the clinical study was analysed by five radiologists. CT found the greatest number of nodules and also showed the highest sensitivity in detecting nodules of less than 5 mm in both the fundamental and clinical studies. The ability of computed tomography to visualize small pulmonary nodules may make it a possible substitute for chest radiography as the primary mass screening method, and as the examination method for small metastatic nodules (less than 5 mm) in patients with extrathoracic malignancy. There was no significant difference between conventional radiography, AMBER, and CR in the number of detected nodules.

Humans↗

PubMedDate not supplied

Subcutaneous nodules in acute rheumatic fever--an analysis of age old dictums.

It is assumed that subcutaneous nodule (SCN), one of the major criteria in acute rheumatic fever (ARF), is rare and whenever these nodules appear, they are invariably associated with carditis. Further large number of nodules appear in crops and they are evanescent. This prospective study of 42 cases of ARF with SCN attempts to analyse the accuracy of such statements. The group comprised of 12.5% of 336 consecutive cases of ARF. Other major criteria associated with SCN were carditis in 38 (90.4%), arthritis in 33 (78.5%) and chorea in two (4.7%). No evidence of carditis could be found in 4 (9.5%). When a detailed study of SCN was done the average number of nodules found in the group was 18 (range 4-49). Thirteen (30.9%) had less than 10 nodules and 5 (11.9%) had only 4-5 nodules. With initiation of treatment SCN disappeared within 4 weeks in 29 (69%), within next 5-8 weeks in 8 (19%) and within 9-12 weeks in 3 (7.1%). In two cases (4.7%) multiple nodules were observed 12 weeks later when all other evidences of activity had disappeared. The study shows a comparative high incidence of SCN in ARF, not all being associated with carditis. Number of nodules appearing in ARF might be quite small and they could persist for long inspite treatment.

Adolescent↗