Cytologic evaluation of solitary thyroid nodules

Fine-needle aspiration is a low-cost diagnostic tool with principal value in determining which patients with thyroid nodules should undergo surgery. Team work and close cooperation among endocrinologists, surgeons, and pathologists are essential for success. Cytologic criteria for diagnosis of the most frequent conditions (benign cystic lesions), Hashimoto thyroiditis and malignancies found in thyroid aspirates have been provided. The unsolved problem of the so-called "follicular" or oxyphilic lesion or neoplasia will be investigated by immunocytochemistry.     

TSH suppression in the management of thyroid nodules and thyroid cancer

Clinical and experimental data concerning TSH suppression, by giving exogenous thyroid hormone, in patients with goiter and in patients with thyroid cancer show a beneficial effect. In the goiter patients, TSH suppressive therapy seems most effective in young patients with diffuse or newly discovered goiters, in hypothyroid patients, and in patients with chronic lymphocytic thyroiditis or compensatory thyroid hypertrophy after partial thyroidectomy. With TSH suppressive therapy about 2/3 of thyroid nodules become smaller, but only about 5% to 10% disappear. In patients with differentiated thyroid cancer (papillary, mixed papillary-follicular, and follicular), tumor recurrence, tumor progression, and long-term survival all seem to be influenced favorably by TSH suppressive therapy. Experimental investigations demonstrate that both benign thyroid adenomas and differentiated thyroid carcinomas have TSH receptors situated on the plasma membranes. These TSH receptors appear to be coupled to the activation of adenylate cyclase in a one-to-one relationship. Experimental and clinical studies strongly support the use of thyroid hormone both for the treatment of patients after thyroidectomy for thyroid cancer and as prophylaxis to prevent the development of thyroid cancer in high-risk irradiated patients. The dose of thyroxine recommended for adequate TSH suppression is the lowest dose of thyroxine that will completely block the TSH response to TRH (usually 0.2 to 0.25 mg).Supported in part by a grant from the Veterans Administration.     

Problems of cancer diagnosis in thyroid nodules

During a ten-year period from 1977 to 1986 75 thyroid malignancies were found. The most common carcinomas were papillary (43%), follicular (39%) and anaplastic forms (7%). All 66 thyroids imaged with 99mTc-pertechnetate showed at least one cold nodule. Two or more cold nodules were seen in 52% of thyroids. In 63 of 66 cases the carcinoma was located in a cold nodule. The location of the carcinoma was not possible to find out accurately in the remaining three cases. 40% of frozen sections obtained at surgery showed benign and 60% malignant finding. Fine needle aspiration biopsy showed benign finding in 10 of 20 patients, suspicious for malignancy in 6 and malignant finding only in 4 cases.     

Solitary thyroid nodules in 71 children and adolescents.

Seventy-one children and adolescents with a solitary nodule of the thyroid gland were seen over a 27-year period and all had their nodules removed surgically. All of the patients had preoperative thyroid scintiscans, 55 of which showed a cold nodule. The most common cause of solitary thyroid nodules was follicular adenoma. Fourteen of the 55 cold nodules were malignant (25.5%) while no malignancies were present in warm or hot nodules. Available diagnostic methods for attempting differentiation of benign from malignant solitary nodules are reviewed and recommendations to their clinical management as derived from our experience are presented.     

The utility of peripheral thyrotropin mRNA in the diagnosis of follicular neoplasms and surveillance of thyroid cancers

BACKGROUND: Thyroid cells in peripheral circulation express uniquely thyrotropin receptor (TSHR) mRNA, and their detection may aid thyroid cancer management. METHODS: Since 2002, 258 patients had prospective TSHR mRNA measurement by quantitative RT-PCR from peripheral blood before and/or after thyroidectomy. Thyroid cancer detection was assessed from known clinical diagnostic criteria and mRNA for patients with follicular neoplasms (n = 64) and long-term cancer follow-up (n = 13). RESULTS: Adding TSHR mRNA to fine-needle aspiration biopsy (FNAB) maintained high sensitivity (90%) but improved specificity (73%) for thyroid cancer diagnosis. When FNAB specimens indicated follicular neoplasm, a decision algorithm combining TSHR mRNA and abnormal thyroid ultrasound features correctly diagnosed all cancer patients (100% sensitivity) and would have spared operation for benign disease in 38%. Elevated TSHR mRNA on postoperative day 1 predicted persistent/recurrent cancer. During long-term thyroid cancer surveillance, TSHR mRNA had a 91% concordance with radioactive iodine whole body scan (WBS)-detectable disease, agreed with thyroglobulin (Tg) levels in 64% of patents, missed disease in 5%, but was more sensitive to detecting disease than Tg levels in 31% of patients, including all patients with Tg antibodies. CONCLUSIONS: Detecting circulating thyroid cancer cells is useful for initial thyroid cancer diagnosis and postoperatively predicts recurrent cancer. This novel test promises to enhance thyroid cancer patient care by management algorithms that combine histologic, genomic, and clinical criteria.     

自设评分标准用于甲状腺结节术中评估的研究

目的应用术中解剖甲状腺结节自设评分标准，分析甲状腺结节的良恶性可能，评估甲状腺结节术中自设评分的诊断价值。 方法选取2018年1月至12月在广东药科大学附属第一医院因甲状腺结节性质待查、恶性肿瘤、良性结节等行甲状腺手术治疗的患者共173例，以术后石蜡切片病理作为"金标准"，分析评估术中解剖甲状腺结节自设评分标准的诊断价值。 结果173例患者共238个结节均经术中冰冻病理及术后石蜡切片病理诊断。评分≤1分（39个）及>4分（67个）的结节与石蜡病理结果的符合率达到100.00%；评分为2、3及4分时，与术中冰冻病理结果符合率分别为87.50%、87.23%、94.34%，与术后石蜡切片病理结果的符合率则分别为81.25%、82.98%、92.45%。 结论我们设计的甲状腺结节术中评分标准是准确性高、相对客观、简单易学，能够有效筛选出阳性结节，降低漏诊率，帮助术中决策，是一个可靠的诊断方法。     

Differentiated thyroid cancer in children

Differentiated thyroid cancer in children remains a controversial disease entity. Its incidence has markedly declined over the last decade since the use of radiotherapy in the treatment of benign conditions of the head, neck, and thorax was abandoned. Other etiologic factors have become relatively more important. The clinical presentation of childhood thyroid cancer is similar to that found in adults, except for a higher frequency of local and distant metastases at the time of initial diagnosis. The specificity and sensitivity of diagnostic tests are limited; however, like in adults, fine-needle aspiration compares favorably with other available diagnostic methods. The therapeutic approach to a child with thyroid cancer represents the most controversial issue associated with the disease. This review provides a discussion of the rationale for the different therapeutic options and emphasizes the excellent prognosis and survival rates, especially when patients are subjected to aggressive treatment with total thyroidectomy followed by the administration of radioactive iodine.     

Management of thyroid nodules in children: a 20-year experience

The medical records and surgical slides of 58 patients with the diagnosis of thyroid nodules (solitary nodule in 50 patients) are reviewed. The most common cause of thyroid nodules in this series is follicular adenoma (27 patients or 46%). A nuclear scan (technetium or radioactive iodine) was performed in 55 patients, of which 40 showed a cold nodule. Twelve of the 40 cold nodules were malignant (30%). However, for solitary nodules the incidence of cancer is 27%. This last figure is significantly greater than the one recently reported by Hung et al (18.5%). Available diagnostic methods are reviewed and the clinical management as derived from our experience is presented.     

Preoperative evaluation of thyroid nodules with 18FDG-PET/CT

BACKGROUND: Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography ((18)FDG-PET/CT) has become an important tool in the postoperative management of de-differentiated thyroid cancer. The utility of this imaging modality in the preoperative assessment of thyroid nodules is unclear. This study was designed to determine whether (18)FDG-PET/CT improves the preoperative diagnosis of thyroid nodules. METHODS: A total of 31 patients with 48 lesions underwent fine-needle aspiration and (18)FDG-PET/CT before surgical resection of thyroid nodules. PET/CT images were obtained 1 hour after intravenous administration of (18)FDG. Standard uptake values were calculated for regions of increased (18)FDG uptake. CT scans were evaluated to identify thyroid pathology. Final pathologic diagnoses were compared with PET/CT findings. RESULTS: Fifteen of 48 lesions were malignant and 33 were benign. Nine of 15 malignant lesions were (18)FDG-avid (sensitivity 60%). Thirty of 33 benign lesions were (18)FDG-cold (specificity 91%). Positive and negative predictive values were 75% and 83%, respectively. CONCLUSIONS: (18)FDG-PET/CT provides a high negative predictive value for malignancy, making this a potentially useful tool in the evaluation of thyroid nodules with indeterminate fine-needle aspiration. However further studies with larger sample sizes are needed to determine the true efficacy of this test.     

Differentiated thyroid cancer in children and adolescents

Introduction: There have been only a few studies on differentiated childhood thyroid cancer (DTC) in children and adolescents. Methods: We analyzed the characteristics of DTC with respect to age, gender and histology in 114 patients under 18 years of age. In a questionnaire-based survey, data of 114 patients, aged between 3 years and 18 years, was collected from 65 clinical institutions in Germany. Characteristics of 80 females and 34 males were evaluated, and the prognostic effect of age, gender, histology, multicentric growth, tumor stage and N-status on distant metastases was tested using multivariate discriminant analysis. Between-group comparison was performed using student t-test and chi-squared test. Results: The incidence of DTC in females was higher than in males with a peak of female:male ratio at puberty, which was more pronounced in children with papillary thyroid cancer, but not with follicular thyroid cancer. Papillary thyroid cancer was associated with more advanced disease (P = 0.009), more lymph-node involvement (P = 0.007) and more distant metastases (P = 0.02) compared with follicular thyroid cancer. Multivariate analysis showed advanced tumor stage as the only significant factor (P = 0.02) associating with distant metastasis. Conclusion: It can be concluded that in children and adolescents: 1. The incidence of papillary thyroid cancer is higher in females than males, with a peak at puberty. 2. The only significant factor associated with distant metastases is the advanced tumor stage. 3. Childhood thyroid cancer is frequently associated with lymph-node involvement, distant metastases and advanced tumor stage. 4. Papillary childhood thyroid cancer is more aggressive than follicular type. Received: 31 January 1998