SFE-AFCE-SFMN 2022 consensus on the management of thyroid nodules: Synthesis and algorithms

The SFE-AFCE-SFMN 2022 consensus deals with the management of thyroid nodules, a condition that is a frequent reason for consultation in endocrinology. In more than 90% of cases, patients are euthyroid with benign and non-progressive nodules that do not warrant specific treatment. The clinician's objective is to detect malignant thyroid nodules at risk of recurrence and death, toxic nodules responsible for hyperthyroidism or compressive nodules warranting treatment. The diagnosis and treatment of thyroid nodules requires close collaboration between endocrinologists, nuclear medicine physicians and surgeons but also involves other specialists. Therefore, this consensus statement was established jointly by 3 societies, the French Society of Endocrinology (SFE), the French Association of Endocrine Surgery (AFCE) and the French Society of Nuclear Medicine (SFMN); the various working groups included experts from other specialties (pathologists, radiologists, pediatricians, biologists, etc.). This specific text is a summary chapter taking up the recommendations from specific sections and presenting algorithms for the exploration and management of thyroid nodules.     

Zinc chloride (smoke bomb) inhalation lung injury: clinical presentations, high-resolution CT findings, and pulmonary function test results

STUDY OBJECTIVES: Zinc chloride smoke inhalation injury (ZCSII) is uncommon and has been rarely described in previous studies. We hypothesized that structural changes of the lung might correlate with pulmonary function. To answer this question, we correlated findings from high-resolution CT (HRCT) scan and the results of pulmonary function tests (PFTs) in patients with ZCSII. DESIGN: Retrospective cohort study. SETTING: University hospital. PATIENTS: Twenty patients who had been hospitalized with ZCSII-related conditions. MEASUREMENTS: The study included HRCT scan scores (0 to 100), static and dynamic lung volumes, and diffusing capacity of the lung for carbon monoxide (D(LCO)). RESULTS: HRCT scans and PFTs were performed initially after injury (range, 3 to 21 days) in all patients and during the follow-up period (range, 27 to 66 days) in 10 patients. The predominant CT scan findings were patchy or diffuse ground-glass opacities with or without consolidation. The majority of patients showed a significant reduction of FVC, FEV1, total lung capacity, and D(LCO), but normal FEV1/FVC ratio values. Changes of functional parameters correlated well with HRCT scan scores. Substantial improvements in CT scan abnormalities and pulmonary function were observed at follow-up. CONCLUSIONS: The majority of our patients with ZCSII presented with a predominant parenchymal injury of the lung that was consistent with a restrictive type of functional impairment and a reduction in Dlco rather than with obstructive disease. Our results suggest that HRCT scanning and pulmonary function testing may reliably predict the severity of ZCSII.     

CT薄层影像特征制定的肺结节分级评估系统区分良恶性肺结节的应用价值

目的探究CT薄层影像特征制定的肺结节分级评估系统区分孤立性肺结节(SPN)良恶性的应用价值。方法回顾性分析我院2018年9月至2020年7月确诊的122例SPN患者的临床资料。采用CT薄层影像特征制定的肺结节分级评估系统进行分级评定,并以病理诊断结果为“金标准”,分析其准确性、敏感度及特异度,并通过Kappa检验分析其与病理诊断结果的一致性。结果病理诊断证实良性SPN 56例,占45.9%(56/122),多为不典型增生及错构瘤,占28.6%(16/56),恶性SPN 66例,占54.1%(66/122),多为腺癌及鳞癌;肺结节分级标准分类2级31例、3级29例、4A级9例、4B级53例;肺恶性结节中,空泡征、宝石征、肿瘤血管征、毛刺征的发生率明显高于肺良性结节(均P<0.05),而病灶周围有卫星病灶的发生率明显低于肺良性结节(P<0.05);将肺结节分级标准中3级及以下归为阴性结节,4级及以上归为阳性结节,诊断准确率为90.2%。肺结节分级标准诊断肺良性结节与病理结果表现出了较好的一致性(Kappa=0.803),以肺结节分级标准诊断肺良性结节的结果与“金标准”(病理诊断结果)比较,得到的敏感度87.9%(58/66)和特异度92.9%(52/56)。结论影像诊断时,合理利用基于CT薄层影像特征制定的肺结节分级评估系统能有效地分类CT筛查出的肺结节,较好区分SPN的良、恶性。     

老年甲状腺结节的发病特点

目的 了解老年人甲状腺结节的检出情况及发病特点.方法 对2013年4月-2014年5月在河北联合大学附属唐山工人医院体检中心进行健康检查的698例老年人甲状腺超声结果进行分析,并对各年龄组结节的发病率、大小、数目及性质进行比较.结果 ①老年人甲状腺结节发病率为70.9％,随年龄增长甲状腺结节发病率逐渐增加(x2＝11.97,P＜0.01),其中女性结节发病率(77.3％)明显高于男性(64.0％),差异有统计学意义(x2=15.080,P＜0.01).②检出甲状腺结节的老年人群中,小结节所占比例达72.3％,大结节占27.7％,随年龄增长,大结节所占比例逐渐增加(x2=4.840,P＜0.05).不同性别间甲状腺大小构成比比较,差异无统计学意义(x2=0.092,P＞0.05).③检出甲状腺结节老年人群中,单发结节占26.7％,多发结节占73.3％,且多发结节比例随年龄增长逐渐增加(x2=9.297,P＜0.01).不同性别间甲状腺数量构成比比较,差异无统计学意义(x2=1.869,P＞0.05).④根据甲状腺高分辨彩超声显示的结节内部回声特点,实性结节所占比例为79.8％,囊实性结节占18.4％,囊性结节占1.8％.结节性质在不同年龄组和不同性别之间比较,差异均无统计学意义(均P＞0.05).结论 老年人甲状腺结节发病率较高,应重视甲状腺结节的早期诊治.     

Prediction model that combines with multidisciplinary analysis for clinical evaluation of malignancy risk of solid breast nodules

ObjectiveFew studies have systematically developed predictive models for clinical evaluation of the malignancy risk of solid breast nodules. We performed a retrospective review of female patients who underwent breast surgery or puncture, aiming to establish a predictive model for evaluating the clinical malignancy risk of solid breast nodules.MethodMultivariable logistic regression was used to identify independent variables and establish a predictive model based on a model group (207 nodules). The regression model was further validated using a validation group (112 nodules).ResultsWe identified six independent risk factors (X₃, boundary; X₄, margin; X₆, resistive index; X₇, S/L ratio; X₉, increase of maximum sectional area; and X₁₄, microcalcification) using multivariate analysis. The combined predictive formula for our model was: Z=−5.937 + 1.435X₃ + 1.820X₄ + 1.760X₆ + 2.312X₇ + 3.018X₉ + 2.494X₁₄. The accuracy, sensitivity, specificity, missed diagnosis rate, misdiagnosis rate, negative likelihood ratio, and positive likelihood ratio of the model were 88.39%, 90.00%, 87.80%, 10.00%, 12.20%, 7.38, and 0.11, respectively.ConclusionThis predictive model is simple, practical, and effective for evaluation of the malignancy risk of solid breast nodules in clinical settings.     

Combination of Radiological and Gray Level Co-occurrence Matrix Textural Features Used to Distinguish Solitary Pulmonary Nodules by Computed Tomography

The objective of this study was to investigate the method of the combination of radiological and textural features for the differentiation of malignant from benign solitary pulmonary nodules by computed tomography. Features including 13 gray level co-occurrence matrix textural features and 12 radiological features were extracted from 2,117 CT slices, which came from 202 (116 malignant and 86 benign) patients. Lasso-type regularization to a nonlinear regression model was applied to select predictive features and a BP artificial neural network was used to build the diagnostic model. Eight radiological and two textural features were obtained after the Lasso-type regularization procedure. Twelve radiological features alone could reach an area under the ROC curve (AUC) of 0.84 in differentiating between malignant and benign lesions. The 10 selected characters improved the AUC to 0.91. The evaluation results showed that the method of selecting radiological and textural features appears to yield more effective in the distinction of malignant from benign solitary pulmonary nodules by computed tomography.     

Evaluating the validity of model for end‐stage liver disease exception points for hepatocellular carcinoma patients with multiple nodules <2 cm

Liver transplant allocation policy does not give model for end‐stage liver disease (MELD) exception points for patients with a single hepatocellular carcinoma (HCC) <2 cm in size, but does give points to patients with multiple small nodules. Because standard‐of‐care imaging for HCC struggles to differentiate HCC from other nodules, it is possible that a subset of patients receiving liver transplant for multiple nodules <2 cm in size does not have HCC. We evaluate risk of post‐transplant HCC recurrence and wait‐list dropout for patients with multiple small nodules using competing risks regression based on the Fine and Gray model. We identified 5002 adult HCC patients in the OPTN/UNOS dataset diagnosed and transplanted between January 2006 and September 2010. Compared to patients with >1 tumor <2 cm, risk of developing recurrence was significantly higher in patients with one or more tumors with only one tumor ≥2 cm (SHR 1.63, p = 0.009), as well as in patients with 2–3 tumors ≥2 cm (SHR 1.84, p = 0.02). Dropout risk was not significantly different among size categories. HCC recurrence risk was significantly lower in patients with multiple nodules <2 cm in size than in those with larger tumors, supporting the possibility that some patients received unnecessary transplants. The priority given to these patients must be re‐examined.