Diagnosis Of Thyroid Malignancy Research Articles

Determination of Diagnostic Features of Serum Thyroid Hormones and Thyroglobulin Ratios in Normothyroid Differentiated Thyroid Carcinoma Cases.

Ultrasonography and fine-needle aspiration biopsy (FNAB) are the gold standard methods in the prediction of benign and malignant thyroid nodules. However, despite being easily applicable, FNAB is an invasive procedure. Less invasive biomarkers should be utilized in the diagnosis of thyroid malignancies. In this study, we aimed to determine the parameters that can be used in the diagnosis of differentiated thyroid cancer (DTC) based on the serum thyroid and thyroglobulin (TG) levels which are routinely checked in patients followed up for thyroid nodules. In the study, we evaluated patients who underwent thyroid surgery for nodular diseases between January 2015 and June 2022. Of the 1444 patients evaluated, 919 patients who met the inclusion criteria (normothyroid benign nodular disease or normothyroid DTC) were included in the study. Patients were divided into two groups as benign group (BG) and DTC group (DTCG). We compared patients' pre-operative serum thyroid and TG values and the diagnostic properties of their ratios. Of the 919 patients included, 517 (56.3%) were in BG and 402 (43.7%) were in DTCG. In DTCG, 318 patients were female and 84 patients were male. The mean age in the DTCG was 47.8 years. Comparison of DTCG and BG revealed a significant difference between T3/T4 ratio (p=0.002), T3/TSH ratio (p≤0.001), T4/TSH ratio (p≤0.001), TG/TSH ratio (p≤0.001), and TSH/TG ratio (p≤0.001). However, evaluation of the specified values by ROC analysis showed that the T3/T4 ratio did not make a significant difference between the two groups (p=0.1), whereas the other values displayed a significant difference (p≤0.001 for T3/TSH, p=0.001 for T4/TSH, p≤0.001 for TG/TSH, and p<0.001 for TSH/TG). T3/TSH (cutoff =2.183), T4/TSH (cutoff=0.6), and TG/TSH (cutoff=29.67) values were found to be significant tumor markers for the prediction of malignancy in thyroid nodules, and low values were found to be associated with malignancy. TSH/TG (cutoff=0.031) value was also significant in predicting malignancy while high values were found to be associated with malignancy. Thyroid hormone and TG ratios may alter the preferred treatment method for thyroid nodules.

Association of Fine-Needle Aspiration of Thyroid Nodules With Final Histopathology in Diagnosing Thyroid Malignancy: A Single Institute Retrospective Study.

Background Fine needle aspiration cytology (FNAC)is the gold standard for detecting thyroid nodules. It is a cost-efficient approach that affords prompt and accurate evaluation. It is crucial in deciding to treat patients with suspected malignancy of thyroid nodules that might have thyroid surgery. According to findings in cytology, patients may be observed when the cytology is benign, and surgery can be performed if the cytology is malignant, which leads to a reduction in the incidence of unneeded surgery. Aim The current study aims to assess the concordance between FNAC of thyroid nodules with final histopathology and identify the different types of detected thyroid lesions. Methodology A retrospective record-based study reviewed the medical files of all patients presenting to the Armed Forces Hospital, Southern region, with suspected thyroid nodules from April 2018 to January 2020. Data were extracted using pre-structured data extraction sheet to avoid inconsistency. Data extracted included patients' demographic data, swelling laterality, size, ultrasound, and histopathological findings. Results The baseline characteristics of studied samplesin the present study:Forty-seven samples had a mean age of 44.27 (SD=±13.5) years, and 85.1% were female gender. The study showed that 12.5% of benign samples were lymphocytic in histopathology, 25% suspicious for follicular neoplasm samples were benign multi-nodular goiter in histopathology, and all 100% of samples suspicious for malignancy were malignant in final histopathology. Conclusions The current study showed that the malignancy rate of the examined nodules was not uncommon in FNAC and histopathology. Where papillary carcinoma was the most detected malignancy, the diagnosis of malignancy using FNAC is a cost-efficient approach that affords prompt and accurate evaluation. Once diagnosed, these cases should be subjected to surgery.

Incidence and Malignancy Rates in Thyroid Nodules in North-East Indian Population by Bethesda System: A Single Institutional Experience of 3 Years.

Suvamoy ChakrabortyIntroduction Goiter is one of the most common conditions encountered clinically (up to 60% of population) with thyroid malignancy being one of the most common endocrine malignancies. The American Thyroid Association has advocated the need for validation of the Bethesda system of fine needle aspiration cytology (FNAC) in each center. The risk of malignancy (ROM) for Bethesda categories in the Indian population is limited. Objective As there are variations in the effectiveness of FNAC, this study aims to study the role of FNAC in evaluating thyroid nodules, estimating the risk of malignancy in thyroid nodules in the North-East Indian population, and correlating the FNAC findings with HPE (histopathological examination). Materials and Methods A total of 110 patients with thyroid nodules had visited the Department of Otorhinolaryngology during 2017-2020. Case records were retrieved, out of which only 66 patients had both FNAC and HPE reports. The FNAC of 66 patients were studied. Statistical Analysis Data were analyzed using STATA V14. Fischer's exact test was used to determine the association of Bethesda system in diagnosing thyroid malignancy. The percentage agreement between the FNAC and HPE was calculated using the Kappa statistics. The diagnostic validity of FNAC in the diagnosis of malignant thyroid nodule was reported. Results The sensitivity, specificity, PPV, and NPV of FNAC in diagnosing thyroid malignancy were 52%, 94.3%, 89%, and 69% respectively. The risk of malignancy (ROM) for Bethesda I to VI categories in our study was 20%, 25%, 67%, 40%, 78%, and 100% respectively ( p -value < 0.001, Fischer's exact test). Conclusion A specificity of 94.3% and PPV of 89% of FNAC makes it a good reliable tool in ruling in malignancy in our population. The higher ROM in indeterminate categories necessitates the need to consider thyroidectomy with or without intraoperative frozen section analysis in our population. Similar higher ROM has been reported in a few other Indian studies. These findings may suggest an increased ROM for Bethesda categories III and IV in the Indian population; however, the statement needs further validation from large multicentric studies with research to find the reason for the increased risk.

Diagnostic accuracy of fine needle aspiration biopsy versus postoperative histopathology for diagnosing thyroid malignancy.

Ultrasound-guided fine needle aspiration biopsy (FNAB) is currently widely used for the initial screening of patients with thyroid nodules enabling prevention of unnecessary surgery. The purpose of this study was to retrospectively analyse the diagnostic accuracy of thyroid FNAB compared with postoperative histopathology of a large cohort from Azerbaijan. We evaluated the FNAB results of 738 patients who underwent thyroid surgery at the National Centre of Oncology in Azerbaijan. The measures of diagnostic accuracy were calculated for the ultrasound-guided preoperative FNAB results (based on the six diagnostic categories of the Bethesda classification) compared with postoperative histopathologic results (benign or malignant) for correspondent areas. Considering both DC V and DC VI categories (387 cases) as 'cytologic-positive' and DC II category (72 cases) as 'cytologic-negative', we found 14 false-positive and 10 false-negative results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 97.4%, 86.1%, 96.4%, 81.6% and 94.8%, respectively. Conversely, when considering only the DC VI category as 'cytologic-positive', the sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNA were 93.2%, 100%, 100%, 81.6% and 97.1%, respectively. The results of our cohort demonstrated high levels of diagnostic accuracy, supporting FNAB's role as a reliable diagnostic tool in the preoperative evaluation of thyroid nodules. The sensitivity, specificity, NPV, PPV and accuracy of thyroid FNAB in our institution were comparable with those of other institutions.

The Value of Ultrasonography Using Thyroid Imaging Reporting and Data Systems (TIRADS) in the Diagnosis of Thyroid Cancer Among the Population of Ha'il, Saudi Arabia.

Background: Thyroid cancer is one of the common malignant conditions of the head and neck region, and it is considered as one of the most common cancers among endocrine tumors. Ultrasonography is widely used in order to assess thyroid nodules, Therefore, the aim of our study is to determine the accuracy of ultrasonography and fine needle aspiration biopsy (FNAB)-guided by ultrasonography in the diagnosis of thyroid malignancy among the population in the Ha'il region of Saudi Arabia.Methods: A retrospective evaluation of 137 patients was undertaken at King Salman Specialist Hospital, Ha'il, Kingdom of Saudi Arabia. Patients who presented with thyroid swellings underwent ultrasonography and FNAB.Result: Our study results have concluded that the sensitivity of the ultrasonography in the confirmation of a malignant thyroid lesion is 59.4% and its specificity was found to be 74.3%.Conclusion: The study showed that ultrasonography using Thyroid Imaging Reporting and Data Systems (TIRADS) is a significant step in evaluating a thyroid nodule. Also, it is highly sensitive and specific, cost-effective, and convenient for the patient.

Distinguish Thyroid Malignant from Benign Alterations using Neutron Activation Analysis of Chemical Element Contents in Nodular Tissue

Thyroid benign (TBN) and malignant (TMN) nodules are a common thyroid lesion. The differentiation of TMN often remains a clinical challenge and further improvements of TMN diagnostic accuracy are warranted. The aim of present study was to evaluate possibilities of using differences in chemical elements (ChEs) contents in nodular tissue for diagnosis of thyroid malignancy. Contents of eight ChEs including bromine (Br), calcium (Ca), chlorine (Cl), iodine (I), potassium (K), magnesium (Mg), manganese (Mn), and sodium (Na) were prospectively evaluated in nodular tissue of thyroids with TBN (79 patients) and to TMN (41 patients). Measurements were performed using instrumental neutron activation analysis. It was observed that in TMN tissue the mass fractions of Br and I are approximately 2.9 and 14 times, respectively, lower, while the mass fraction of Ca, K, and Mg are 94%, 56%, and 36%, respectively, higher than in TBN tissue. Contents of Cl, Mn, and Na found in the TBN and TMN groups of nodular tissue samples were similar. Finally, it was proposed to use the I mass fraction and I/Ca, I/K, and I/Mg mass fraction ratios in a needle-biopsy of thyroid nodules as a potential tool to diagnose thyroid malignancy. Further studies on larger number of samples are required to confirm our findings and proposals.

THE BETHESDA SYSTEM FOR REPORTING THYROID CYTOPATHOLOGY WITH HISTOPATHOLOGIC CORRELATION: A RETROSPECTIVE STUDY AT A TERTIARY CARE HOSPITAL OF LOWER ASSAM

Background: Fine needle aspiration is currently the preferred screening test for guiding the diagnosis and treatment of thyroid nodules as it is quick, assessible, inexpensive, relatively painless with quite accurate diagnosis. The Bethesda system for reporting thyroid cytopathology (TBSRTC) was introduced in 2007 in an attempt to standardize international terminology and to categorize morphological criteria in ne-needle aspirations (FNAs) from patients with thyroid nodules. It introduced 6 diagnostic categories for FNA results and assigns a malignancy risk and recommendations for patient management for each category. To categorize theObjectives: thyroid swelling following The Bethesda system for reporting Thyroid Cytopathology (TBSRTC) and to correlate with nal histopathological reports wherever available. : 99 patients underwent FNAC in our institute from the period of January 2019 to July 2020,Materials and Methods and were categorized according to the Bethesda system for reporting thyroid cytopathology. Results: The 99 cases taken up for FNAC were categorized according to The Bethesda system for reporting Thyroid Cytopathology (TBSRTC) as Non-diagnostic or unsatisfactory at 6.06%, Benign at 81.81%, Atypia of undetermined signicance at 0%, Suspicious for a follicular neoplasm at 4.04%, Suspicious for malignancy at 2.02%, Malignant at 6.06%. The sensitivity, specicity, positive predictive value (PPN), negative predictive value (NPN), and accuracy of FNAC in diagnosing thyroid malignancy were calculated as 66.67%, 100%, 100%, 93.33% and 94.12% respectively. The BethesdaConclusion: system for reporting Thyroid Cytopathology (TBSRTC) helps in standardization of thyroid ne needle aaspiration reporting. This leads to timely and adequate intervention for the patient and also minimizes unnecessary thyroid surgeries

Distinguish Thyroid Malignant from Benign Alterations using Trace Element Contents in Nodular Tissue determined by Neutron Activation and Inductively Coupled Plasma Mass Spectrometry

Background Thyroid benign (TBN) and malignant (TMN) nodules are a common thyroid lesion. The differentiation of TMN often remains a clinical challenge and further improvements of TMN diagnostic accuracy are warranted. The aim of present study was to evaluate possibilities of using differences in trace elements (TEs) contents in nodular tissue for diagnosis of thyroid malignancy. Methods Contents of TEs such as silver (Ag), aluminum (Al), boron (B),, beryllium (Be), bismuth (Bi), cadmium (Cd), cerium (Ce), cobalt (Co), chromium (Cr), cesium (Cs), iron (Fe), gallium (Ga), mercury (Hg), iodine (I), lanthanum (La), lithium (Li), manganese (Mn), molybdenum (Mo), neodymium (Nd), nickel (Ni), lead (Pb), praseodymium (Pr), rubidium (Rb), antimony (Sb), scandium (Sc), selenium (Se), samarium (Sm), tin (Sn), thallium (Tl), uranium (U), yttrium (Y), and zinc (Zn) were prospectively evaluated in nodular tissue of thyroids with TBN (79 patients) and to TMN (41 patients). Measurements were performed using a combination of non-destructive instrumental neutron activation analysis with high resolution spectrometry of short- and long-lived radionuclides (INAA-SLR and INAA-LLR, respectively) and destructive method such as inductively coupled plasma mass spectrometry (ICP-MS). Results It was observed that in TMN tissue the mean mass fractions of Be, Fe, I, Sc, and Se are approximately 1.9, 1.7, 14, 3.1, and 1.6 times, respectively, lower while the mass fraction of Ga, Mo, and Rb 62%, 51%, and 33%, respectively, higher than those in TBN tissue. Contents of Ag, Al, B, Bi, Cd, Ce, Co, Cr, Cs, Hg, La, Li, Mn, Nd, Ni, Pb, Pr, Sb, Sm, Sn, Tl, U, Y, and Zn found in the TBN and TMN groups of nodular tissue samples were similar. Conclusions It was proposed to use the I mass fraction, as well as I/Ga, I/Mo, and I/Rb mass fraction ratios in a needle-biopsy of thyroid nodules as a potential tool to diagnose thyroid malignancy. Further studies on larger number of samples are required to confirm our findings and proposals.

Diagnosis of thyroid malignancy using trace elements of nodular tissue determined by neutron activation analysis

Diagnosis of thyroid malignancy using trace elements of nodular tissue determined by neutron activation analysis

Diagnosis of thyroid malignancy using levels of trace element contents in nodular tissue

Diagnosis of thyroid malignancy using levels of trace element contents in nodular tissue

English

BACKGROUND The diagnosis of thyroid malignancies continues to remain a challenge, due to lack of specificity with various modalities, and intrinsic variability with clinical examination. Although histopathological diagnosis is confirmatory, there is a need for pre-surgical assessment and confirmation, which will prove to be useful in decision making regarding the course of management. The present study was carried out to evaluate the validity of various modalities for detection of thyroid malignancies. METHODS This cross-sectional study was carried out among 40 patients who presented to the outpatient clinic with thyroid nodules. All the participants were evaluated by ultrasound, fine needle aspiration cytology (FNAC) and sestamibi scintigraphy. All the participants were taken up for surgery and the resected specimen was sent for histopathology for confirmatory diagnosis. RESULTS Ultrasound and FNAC detected malignancy in 25 % of the participants, while sestamibi scintigraphy detected malignancy in 30 % of the participants. Based on histopathology, the gold standard confirmatory test, malignancy was detected in 35 % of the participants. It was observed that the sensitivity was highest for FNAC (75 %) followed by TC methoxyisobutylisonitrile (TC MIBI) (50 %). Specificity was highest for FNAC (95 %) followed by ultrasound (88 %) (P &lt; 0.0001). CONCLUSIONS FNAC has the highest sensitivity and specificity while ultrasound and sestamibi have comparable specificity. There is a high probability of malignancy when the delayed image in sestamibi scintigraphy shows retention. MIBI may prove to be useful in differentiating benign and malignant follicular lesions. KEYWORDS Papillary Carcinoma, Histopathology, Thyroid Nodule, Sestamibi, FNAC

Impact of Ultrasonographic Features for Thyroid Malignancy in Patients With Bethesda Categories III, IV, and V: A Retrospective Observational Study in a Tertiary Center.

Introduction: Although fine-needle aspiration biopsy (FNAB) with cytologic interpretation using the Bethesda System for Reporting Thyroid Cytopathology has been widely used for thyroid nodules, its efficiency in Bethesda categories of III, IV, and V has been questioned due to variable risk of malignancy. We aimed to evaluate the impact of radiological parameters in Bethesda category III, IV, and V for thyroid malignancy.Methods: We performed a retrospective review of patients with Bethesda category III, IV, and V, and subsequent thyroidectomy. Demographic, ultrasonographic, and clinical variables were recorded. Independent variables for thyroid malignancy and the predictive power of imaging findings were analyzed.Results: There were 159 patients with a mean age of 48.1±13.4 years. Hypoechogenicity of the index nodule was the most common finding in 87 patients (54.7%). There were 74 (46.5%), 34 (21.4%), and 51 patients (32.1%) with Bethesda III, IV, and V categories, respectively. There were 91 patients (57.2%) with a diagnosis of thyroid malignancy. Overall malignant pathology was detected in 18 (24.3%), 25 (73.5%), and 48 patients (94.1%) in Bethesda III, IV, and V categories, respectively (p=0.001). The presence of solitary nodule, hypoechogenicity, and solid structure of index nodule and Bethesda category IV and V were significant variables for final malignant pathology (p<0.05 for all).Conclusion: Hypoechogenicity and solid structure in a solitary index nodule should be regarded as significant ultrasonographic findings for thyroid malignancy. Bethesda category IV and V were also significantly associated with malignancy.

Application of the Bethesda system for reporting thyroid cytopathology for classification of thyroid nodules: A clinical and cytopathological characteristics in Bhutanese population.

The existence of baseline data on the spectrum of thyroid nodules in Bhutanese patients is unknown. Fine-needle aspiration cytology (FNAC) is regarded as the gold standard diagnostic test for pre-op assessment of thyroid lesions. We conducted a retrospective study, involving 765 patients who underwent FNAC of the thyroid gland, at Jigme Dorji Wangchuck National Referral Hospital, Thimphu, between January-2018 to December-2020. We aimed to assess the cytomorphological spectrum of thyroid nodules, classify them as per The Bethesda system for reporting thyroid cytopathology (TBSRTC), assess risk of malignancy (ROM), and evaluate the accuracy of FNAC in diagnosing thyroid malignancy. Colloid nodule (37.4%) and papillary thyroid carcinoma (4.2%) constituted the majority of benign and malignant cytological diagnoses, respectively. According to TBSRTC, majority of the cases (82.0%) fell under the Bethesda II category. Bethesda III was the least common (1.4%) category. As compared to histopathological diagnosis; the sensitivity, specificity, positive and the negative predictive values of FNAC in diagnosing thyroid malignancy were 90.0%, 93.3%, 93.10%, and 90.32% respectively. The ROM increased concurrently with the grade of the Bethesda category and was more or less close to the ROM reference range, published in the TBSRTC. Benign thyroid nodules (82.0%) constituted a majority of thyroid nodules in Bhutanese patients. FNAC was found to be reliable in detecting thyroid malignancy. From the literature, TBSRTC was found to be a more convenient method for reporting thyroid cytology. Henceforth, as most institutes, we plan to implement TBSRTC for reporting thyroid cytopathology.

Evaluation of thyroid nodules by shear wave elastography: a review of current knowledge.

Shear wave elastography (SWE), as a tool for diagnosing thyroid malignancy, has gathered considerable attention during the past decade. Diverging results exist regarding the diagnostic performance of thyroid SWE. A comprehensive literature review of thyroid SWE was conducted using the terms "Thyroid" and "shear wave elastography" in PubMed. The majority of studies found SWE promising for differentiating malignant and benign thyroid nodules on a group level, whereas results are less convincing on the individual level due to huge overlap in elasticity indices. Further, there is lack of consensus on the optimum outcome reflecting nodule elasticity and the cut-off point predicting thyroid malignancy. While heterogeneity between studies hinders a clinically meaningful meta-analysis, the results are discussed in a clinical perspective with regard to applicability in clinical practice as well as methodological advantages and pitfalls of this technology. Technological as well as biological hindrances seem to exist for SWE to be clinically reliable in assessing benign and malignant thyroid nodules. Structural heterogeneity of thyroid nodules in combination with operator-dependent factors such as pre-compression and selection of scanning plane are likely explanations for these findings. Standardization and consensus on the SWE acquisition process applied in future studies are needed for SWE to be considered a clinically reliable diagnostic tool for detection of thyroid cancer.

Ultrasound-Based Indications for Thyroid Fine-Needle Aspiration: Outcome of a TIRADS-Based Approach versus Operators’ Expertise

Background: Thyroid nodule image reporting and data systems (TIRADS) provide the indications for fine-needle aspiration (FNA) based on a combination of nodule sonographic features and size. We compared the TIRADS-based recommendations for FNA with those based on the personal expertise of qualified US investigators in the diagnosis of thyroid malignancy. Methods: Seven highly experienced ultrasound (US) investigators from 4 countries evaluated, online, the US video recordings of 123 histologically verified thyroid nodules. Technical resources provided the operators with a diagnostic approach close to the real-world practice. Altogether, 4,305 TIRADS scores were computed. The combined diagnostic potential of TIRADS (TIRSYS) and the personal recommendations of the investigators (PERS) were compared against 3 possible goals: to recognize all malignant lesions (allCA), nonpapillary plus non-pT1 papillary cancers (nPnT1PCA), or stage II-IV cancers (st2-4CA). Results: For allCA and nPnT1PCA, TIRSYS had lower sensitivity than PERS (69.8 vs. 87.2 and 83.5 vs. 92.6%, respectively, p <0.01), while in st2-4CA the sensitivities were the same (99.1 vs. 98.6% and TIRSYS vs. PERS, respectively). TIRSYS had a higher specificity than PERS in all 3 types of cancers (p < 0.001). PERS recommended FNA in a similar proportion of lesions smaller or larger than 1 cm (76.9 vs. 82.7%; ns). Conclusions: Recommendations for FNA based on the investigators’ US expertise demonstrated a better sensitivity for thyroid cancer in the 2 best prognostic groups, while TIRADS methodology showed superior specificity over the full prognostic range of cancers. Thus, personal experience provided more accurate diagnoses of malignancy, missing a lower number of small thyroid cancers, but the TIRADS approach resulted in a similar accuracy for the diagnosis of potentially aggressive lesions while sparing a relevant number of FNAs. Until it is not clearly stated what the goal of the US evaluation is, that is to diagnose all or only clinically relevant thyroid cancers, it cannot be determined whether one diagnostic approach is superior to the other for recommending FNA.

Recurrent Laryngeal Nerve Injury After Thyroid Surgery: An Analysis of 11,370 Patients

BackgroundRecurrent laryngeal nerve (RLN) injury is a well-known, potentially serious complication of thyroid surgery. We investigated factors associated with RLN injury during thyroid surgery using a multi-institutional data set. Materials and methodsPatients who underwent either lobectomy or total thyroidectomy were abstracted from the American College of Surgeons National Surgical Quality Improvement Program thyroidectomy-specific database (2016-2017). Baseline and operative factors associated with RLN injury ≤30 d of surgery were analyzed using bivariate and multivariate methods. Secondary complications of interest included unplanned reintubation and hypocalcemia. ResultsRLN injury occurred in 6.0% (n = 677) of the 11,370 patients included in the study. The RLN injury rate varied significantly based on the primary indication for surgery, from 4.3% in patients undergoing surgery for a single nodule to 9.0% in patients undergoing surgery for differentiated cancer (P < 0.01). RLN injury occurred more often in thyroidectomies than lobectomies (6.9% versus 4.3%, P < 0.01) and in surgeries without intraoperative nerve monitoring (6.5% versus 5.6%, P = 0.01). After multivariate adjustment, RLN injury was independently associated with age ≥65 y [odds ratio (OR) 1.6, 95% confidence interval (CI) 1.3-2.0], total thyroidectomy (OR = 1.4, 95% CI 1.1-1.6), and diagnosis of thyroid malignancy (OR = 2.1, 95% CI = 1.6-2.7) (all P < 0.001) but not intraoperative RLN monitoring (OR = 0.9, 95% CI = 0.7-1.0, P = 0.06). ConclusionsIn this large multi-institutional study, RLN injury ≤30 d of surgery occurred in nearly 6% of thyroid surgeries. This comprehensive analysis of RLN injury can be used to guide informed consent discussions and aid surgeons in identifying candidates who may be at higher risk for injury.

Primary Thyroid Lymphoma in an Adolescent with Hashimoto’s Thyroiditis and Congenital Deafness

Background: Primary thyroid lymphoma is extremely rare in children and adolescents. The diagnosis of thyroid malignancies is often made secondary to other thyroid pathologies including Hashimoto’s thyroiditis (HT). Case Presentation: This case describes a 14-year-old girl with a background of HT and congenital deafness that presented with a rapidly enlarging multinodular thyroid mass. She underwent a total thyroidectomy and a diffuse, large B-cell lymphoma was diagnosed on pathology. Discussion: Primary thyroid disease is an extremely rare disease in childhood, usually presenting as a rapidly enlarging goitre. The correlation between Hashimoto’s thyroiditis and primary thyroid lymphoma is well-established in adults but has not been verified in the paediatric population. Our patient also has βthalassemia and Usher syndrome, however, no correlation between these and primary thyroid lymphoma could be found in the literature. Conclusion: It is important to include malignancy in the differential diagnosis of thyroid enlargement or unexplained symptoms, especially in the presence of syndromes. Further research into the relation between lymphomas and HT in the paediatric population is needed.

Diagnostic value of ultrasound in comparison with the pathologic results of fine-needle aspiration of thyroid nodules for rapid diagnosis of thyroid malignancies in patients referred to Baqiyatallah Hospital

Background and Aim: Various studies have reported that 4-7 percent of adults with palpable thyroid nodules that 50-70 percent of it’s diagnosed with high-accuracy sonography. Although most thyroid nodules are non-cancerous and do not require treatment, a small percentage of them are associated with a potential risk of malignancy, which is an important early diagnosis by ultrasound or pathology. The present study aimed to compare the ultrasound with the pathologic results of fine-needle aspiration (FNA) of thyroid nodules for the rapid diagnosis of thyroid malignancies in patients referred to Baqiyatallah Hospital. Methods: The study population consisted of 100 (80 female, 20 male) patients with thyroid nodules in the age range of 19-82 years referred to the radiology ward of Baqiyatallah Hospital who were studied by the cross-sectional method. All patients were first scoring by ultrasound, then fine needle aspiration with thyroid nodule ultrasound was performed, and the specimens were referred to the pathology department for further evaluation. Results: The pathologic results from fine-needle aspiration showed that only 8 of the 100 patients studied had malignant nodules that, by ultrasound scoring, 7 patients had 4 scores and 1 patient had 3 scores. However, the other 92 patients with benign nodules 57.60% of patients had score 1, 30.43% of patients had score 2 and 11.97% of patients had score 3. Conclusion: According to the results of this study, it seems that ultrasound scoring is useful in the rapid diagnosis of thyroid nodules and prevent unnecessary thyroid nodule FNA.

Comparison of the Validity of Quantitative and Qualitative Methods of RASSF1A Gene Hypermethylation Molecular Test in the Diagnosis of Thyroid Malignancies.

Within the past two decades, the incidence of thyroid cancer has increased across the globe. In the differential diagnosis of benign tumors from malignant tumors in the thyroid gland, hypermethylation of the RASSF1A gene is used. The aim of this study is comparing the validity of quantitative and qualitative methods of the RASSF1A gene hypermethylation molecular test in the diagnosis of thyroid malignancies. One hundred sixty samples from patients with malignant thyroid tumors (80 samples) and benign thyroid tumors (80 samples) were entered into this study from all patients referred to Ahvaz Medical Centers. First DNA was extracted from samples embedded in paraffin. After DNA extraction, hypermethylation of the gene was done by COBRA method. Finally, to calculate the effects of sensitivity, specificity, predictive value and accuracy of the test, epidemiological calculations were done. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the qualita-tive method of the RASSF1A gene hypermethylation molecular test in the diagnosis of thyroid malignancies are: 91.25%, 15%, 51.77%, 63.15%, and 53.12%, respectively and for the qualitative method are: 27.5%, 98.75%, 95.65%, 57.66%, and 6.12%, respectively. The quantitative level of hypermethylation differentiated groups of benign tumors from malignant groups better than the qualitative evaluation but the qualitative studies are not applicable for this purpose.

Optical sonography in differential diagnosis of thyroid nodes

Objective To develop a non-invasive method for differential diagnosis of thyroid nodes. Material and methods Optical sonography was made in 623 patients with thyroid nodes including 374 women (60%) and 249 men (40%) aged 19-79 years (mean 64±15 years). All patients underwent ultrasound-assisted fine-needle aspiration biopsy. Cytological examination revealed cystic colloidal goiter (CCG) in 317 (51%) cases, follicular adenoma (FA) - in 197 (31.5%) cases, thyroid cancer - in 109 (17.5%) cases. All patients underwent surgery. Histological examination verified cystic colloidal goiter in 354 (56.8%) cases, follicular adenoma - 75 (12.0%) cases, thyroid cancer - 194 (31.2%) cases. Follicular cancer was diagnosed in 120 cases, papillary cancer - 70 cases, undifferentiated cancer - 4 cases. Results and conclusion Sensitivity, specificity and accuracy of optical ultrasonography in differential diagnosis of thyroid nodules were estimated. Sensitivity of ultrasonography in the diagnosis of thyroid malignancies was 0.75, specificity 0.62, accuracy 0.67. Sensitivity of ultrasonography in the diagnosis of thyroid adenoma was 0.85, specificity 0.62, accuracy 0.73. Sensitivity of optical sonography in the diagnosis of CCH was 0.62, specificity 0.61, accuracy 0.7. Optical sonography ensures differentiation of CCH and follicular adenoma, CCH and thyroid cancer, follicular adenoma and thyroid cancer. Sensitivity, specificity and accuracy of ultrasonography in differential diagnosis of FA and thyroid cancer are 0.85, 0.62, 0.73 and 0.8, 0.71, 0.7, respectively.