Preoperative prediction of non-invasive follicular thyroid neoplasm with papillary-like nuclear features: A Canadian single-Centre experience

Abstract

BackgroundAn international group of experts recommended reclassifying non-invasive follicular variant of papillary thyroid cancers (FVPTC) as ‘non-invasive follicular thyroid neoplasm with papillary-like nuclear features’ (NIFTP) in April 2016. The purpose of this study was to establish preoperative clinical, laboratory, ultrasonographic, and cytological variables, which can differentiate NIFTP from FVPTC.MethodsWe conducted a retrospective chart review of consecutive patients from a single institution evaluated between January 2012 and December 2017. 203 adult patients underwent lobectomy or total thyroidectomy for a FVPTC during that period. Each patient’s medical chart was reviewed and information on pre-operative variables was recorded. An expert pathologist reviewed all surgical specimens and reclassified a subset of FVPTC as NIFTP according to the specific criteria.ResultsOverall, 44 patients were included in the NIFTP group and 159 in the non-NIFTP group. Mean age was 50.1 years in the NIFTP group and 50.7 in the non-NIFTP group. Most patients were female (86.4% (38/44) in the NIFTP group vs 79.8% (127/159) in the non-NIFTP group). More patients underwent lobectomy in the NIFTP group (50% (22/44) vs 16.4% (26/159) in the non-NIFTP group, p = < 0.0001). Less patients received radioactive iodine in the NIFTP group (31.8% (14/44) vs 52.2% (83/159) in the non-NIFTP group, p = 0.0177). Preoperative thyroglobulin levels were lower in NIFTP patients (Median 25.55 mcg/L +/− 67.8 vs 76.06 mcg/L +/− 119.8 in Non-NIFTP, p = 0.0104). NIFTP nodules were smaller (Mean size 22.97 mm +/− 12.3 vs 25.88 mm +/− 11.2 for non-NIFTP, p = 0.0448) and more often solid than non-NIFTP (93.2% (41/44) vs 74.8% (119/159) for non-NIFTP, p = 0.0067). 2017 ACR TIRADS nodule category of 1–4 on ultrasound had a negative predictive value and a sensitivity of 100% for NIFTP. ROC Curve Analysis demonstrated that a preoperative thyroglobulin level of 31.3 mcg/L had a sensitivity of 75% and a specificity of 62.5% to differentiate NIFTP from non-NIFTP cancers.ConclusionLower preoperative thyroglobulin levels, smaller nodule size, solid texture and 2017 ACR TIRADS Category of 1–4 are more strongly associated with NIFTP than FVPTC and can favour less invasive surgical options such as lobectomy.

The Association of Smell and Taste Dysfunction with COVID19, And Their Functional Impacts

“…Another study showed that on an initial and 1 week follow-up surveys, patients’ sense of taste was reduced at the initial one, but this had fallen to 75% when they filled the second survey one week after. 60% of the whole group reported that they could still differentiate between sweet, salty, sour, and bitter tastes at the time of the first survey, improving to 88.9% in the second survey [ 17 ].…”

COVID-19 infection in the palatine tonsil tissue and detritus: the detection of the virus compartment with RT-PCR

“…9 More recent guidelines have allowed elective surgery to be performed with extra precaution to maintain protection at a high level for both patients and medical staff involved in the surgery. 2 Therefore, a tonsil surgery is possible during the COVID-19 pandemic with sufficient preparation and safety measures.…”

A novel aerosolisation mitigation device for endoscopic sinus and skull base surgery in the COVID-19 era

“…Healthcare providers are at the front line of the response to the pandemic and as such are exposed to several hazards that put them at risk of infection. Physicians and surgeons must assume responsibility to ensure that all necessary preventive and protective measures are taken to minimise occupational safety and health risks [ 19 , 20 ]. There is increasing concern among sinus and skull base surgeons in the neurosurgery and otolaryngology community due to exposure to a high viral load reservoir during endoscopic procedures in the nasal cavity and the nasopharynx [ 21 ].…”

“…However, there is also a risk of virus spread in smaller aerosols generated during various medical procedures that can cause airborne transmission over extensive distances [ 2 – 5 ]. Aerosol-generating medical procedures have been recognised as an important source for nosocomial transmission of emerging viruses [ 6 – 8 ]. It has been observed that once aerosolized, SARS-CoV-2 particles may remain viable and infectious in the air for at least 3 h [ 4 ].…”