American Association of ClinicalEndocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules: Executive Summary of Recommendations

Introduction: In genetically predisposed individuals, exogenous factors (including pollution) influence the development of Hashimoto's thyroiditis/chronic lymphocytic thyroiditis (CLT). CLT may also be a risk factor for associated thyroid cancer. Few data are available on the role of pollution from petrochemical complexes, one of which is located in the Siracusa province (South-Eastern Sicily), in the pathogenesis of CLT. Aims: i) To study the frequency of CLT in fine-needle aspiration cytology (FNAC)-interrogated thyroid nodules from patients who were stably resident in their zones, comparing it in patients living in the petrochemical complex area (zone A) with that of patients from a control area (zone B). ii) To study the frequency of CLT in the FNAC categories of malignancy risk, comparing the two zones. Patients and methods: We retrospectively evaluated cytologically adequate slides of 1323 nodules in 1013 outpatients who underwent ultrasound-guided FNAC from 2006 to 2012. We stratified by area of residence, gender, and FNAC categories of malignancy risk. Results: CLT was detected with significantly greater frequency in either patients or nodules from zone A compared with zone B (32.0% vs 23.1%, PZ0.002 or 28.2% vs 18.8%, PZ0.0001), with a female preponderance (FZ35.2% vs MZ21.1% or 30.4% vs 20.4%, zone A and FZ26.5% vs 12.3% or 21.6% vs 9.5%, zone B). Regardless of zone, CLT was approximately twofold more frequent in the suspiciously malignantCmalignant classes (TH4CTHY5Z47.6%, zone A and 32.4%, zone B) compared with the benignCintermediate classes (THY2CTHY3Z27.3%, zone A and 18.2%, zone B), but with a clear stepwise THY2 through THY5 increase only in zone A (THY2Z25.3%, THY5Z66.7%; THY2Z18.6%, THY5Z28.6% in zone B). Conclusions: The petrochemical complex-related pollution is an environmental factor involved in the development of CLT and, likely, in the CLT association with thyroid neoplasms.

Section: Methodsmentioning

confidence: 99%

Chronic lymphocytic thyroiditis: could it be influenced by a petrochemical complex? Data from a cytological study in South-Eastern Sicily

Arena

Latina

Baratta

et al. 2015

“…These last years, several singleinstitution articles reported the use of CNB as a secondline approach in these thyroid lesions with prior inadequate or indeterminate cytology (49). Data from these papers are interesting and, more recently, this option was included in thyroid AACE/AME/European Thyroid Association (ETA) guidelines and Italian consensus for thyroid cytology (8,48). The major evidence of the value of thyroid CNB has been obtained in lesions considered inadequate (nondiagnostic) on thyroid FNA (50,51,52,53,54).…”

Section: Core Needle Biopsymentioning

confidence: 99%

“…A paper by Nasrollah et al reported that a CNB sampling a nodule's capsule allowed reaching a high diagnostic accuracy, with results corroborated by other studies. Regardless of these data, CNB has not been recommended in nodules with indeterminate diagnosis (follicular lesion) due to low evidence obtained to date (3,48). Even if uncommon, in case of lesions suspicious of lymphoma and malignancies metastatic to the thyroid, CNB can be very useful.…”

Section: Core Needle Biopsymentioning

confidence: 99%

See 1 more Smart Citation

DIAGNOSIS OF ENDOCRINE DISEASE: High-yield thyroid fine-needle aspiration cytology: an update focused on ancillary techniques improving its accuracy

Bongiovanni

Trimboli

Rossi

et al. 2016

Thyroid fine-needle aspiration (FNA) cytology is a fast growing field. One of the most developing areas is represented by molecular tests applied to cytological material. Patients that could benefit the most from these tests are those that have been diagnosed as 'indeterminate' on FNA. They could be better stratified in terms of malignancy risk and thus oriented with more confidence to the appropriate management. Taking in to consideration the need to improve and keep high the yield of thyroid FNA, professionals from various fields (i.e. molecular biologists, endocrinologists, nuclear medicine physicians and radiologists) are refining and fine-tuning their diagnostic instruments. In particular, all these developments aim at increasing the negative predictive value of FNA to improve the selection of patients for diagnostic surgery. These advances involve terminology, the application of next-generation sequencing to thyroid FNA, the use of immunocyto-and histo-chemistry, the development of new sampling techniques and the increasing use of nuclear medicine as well as molecular imaging in the management of patients with a thyroid nodule. Herein, we review the recent advances in thyroid FNA cytology that could be of interest to the 'thyroid-care' community, with particular focus on the indeterminate diagnostic category.

“…Although several US features have been shown to identify thyroid nodules at higher risk of malignancy (e.g. marked hypoechogenicity, irregular margins and microcalcifications), no definitive evidence has been obtained, and US alone is not recommended in the clinical management of indeterminate thyroid lesions (1,6,7,8). In addition, although real-time elastography (RTE) has recently been reported to increase the sensitivity of US, it has suboptimal accuracy in diagnosing thyroid nodules previously classified as indeterminate (9).…”

Section: Introductionmentioning

confidence: 99%

Thyroid nodules with indeterminate cytology: prospective comparison between 18F-FDG-PET/CT, multiparametric neck ultrasonography, 99mTc-MIBI scintigraphy and histology

Piccardo

Puntoni

Treglia

et al. 2016

Purpose: To evaluate the role of 18 F-flurodeoxiglucose positron emission tomography/computed tomography ( 18 F-FDG-PET/CT) in predicting malignancy of thyroid nodules with indeterminate cytology. Patients and methods:We analysed 87 patients who have been scheduled to undergo surgery for thyroid nodule with indeterminate cytology. All patients underwent 18 F-FDG-PET/CT, multiparametric neck ultrasonography (MPUS), and 99m Tc-methoxyisobutylisonitrile scintigraphy ( 99m Tc-MIBI-scan). Histopathology was the standard of reference.We compared the sensitivity (SE), specificity (SP), accuracy (AC), positive (PPV) and negative predictive (