The Cost-effectiveness of Iodine 131 Scintigraphy, Ultrasonography, and Fine-Needle Aspiration Biopsy in the Initial Diagnosis of Solitary Thyroid Nodules

Khalid, Ayesha N.; Hollenbeak, Christopher S.; Quraishi, Sadeq A.; Fan, Chris; Stack, Brendan C.

doi:10.1001/archotol.132.3.244

Cited by 25 publications

(18 citation statements)

References 18 publications

(30 reference statements)

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“…Some clinical and epidemiologic features, among other factors, have proved to be important in the identification of individuals at risk. However, an appropriate management algorithm should balance sensitivity in detecting malignancy against the costs of an additional evaluation, which poses considerable costs to the patient and to society (96,97). Likewise, the management of patients diagnosed with thyroid tumors demands the understanding of the factors that drive follicular cells towards a non-return path of dedifferentiation.…”

Section: Resultsmentioning

confidence: 99%

Identifying a risk profile for thyroid cancer

Ward

Morari

Leite

et al. 2007

Arq Bras Endocrinol Metab

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The large use of simple and effective diagnostic tools has significantly contributed to the increase in diagnosis of thyroid cancer over the past years. However, there is compelling evidence that most micropapillary carcinomas have an indolent behavior and may never evolve into clinical cancers. Therefore, there is an urgent need for new tools able to predict which thyroid cancers will remain silent, and which thyroid cancers will present an aggressive behavior. There are a number of well-established clinical predictors of malignancy and recent studies have suggested that some of the patient's laboratory data and image methods may be useful. Molecular markers have also been increasingly tested and some of them appear to be very promising, such as BRAF, a few GST genes and p53 polymorphisms. In addition, modern tools, such as immunocytochemical markers, and the measure of the fractal nature of chromatin organization may increase the specificity of the pathological diagnosis of malignancy and help ascertain the prognosis. Guidelines designed to select nodules for further evaluation, as well as new methods aimed at distinguishing carcinomas of higher aggressiveness among the usually indolent thyroid tumors are an utmost necessity. O uso cada vez mais freqüente de métodos diagnósticos simples e efetivos tem contribuído significativamente para um aumento no diagnóstico de câncer da tiróide nos últimos anos. Entretanto, existem importantes evidências de que muitos dos microcarcinomas papilíferos têm um comportamento indolente e podem nunca evoluir para cânceres clínicos. Existe, portanto, uma necessidade urgente de desenvolver novas ferramentas capazes de predizer quais os tumores tiroidianos que permanecerão silenciosos e quais desenvolverão comportamento agressivo. Há uma série de marcadores clínicos de evolução bem estabelecidos e alguns estudos recentes sugerem que dados laboratoriais e métodos de imagem podem ser úteis. Marcadores moleculares também vêm sendo ativamente investigados e alguns, como BRAF, os genes GST e polimorfismos de p53, parecem promissores. Além disso, marcadores imunocitoquímicos e a medida da natureza fractal da cromatina podem aumentar a especificidade do diagnóstico anatomopatológico e ajudar a predizer o prognóstico. Existe uma necessidade imperiosa de elaborarmos diretrizes destinadas a selecionar os nódulos que merecem prosseguimento em sua avaliação, assim como novos métodos capazes de identificar lesões mais agressivas entre os geralmente indolentes tumores tiroidianos.

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Section: Resultsmentioning

confidence: 99%

Identifying a risk profile for thyroid cancer

Ward

Morari

Leite

et al. 2007

Arq Bras Endocrinol Metab

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“…Given the low risk for thyroid cancer, the technology of FNAB performed on all nodules detected by imaging was not feasible or advisable (21,22). Thereafter, a serious of imaging modalities was developed, including ultrasound, carotid duplex scan, CT, magnetic resonance imaging (MRI) or positron emission tomography (PET).…”

Section: Discussionmentioning

confidence: 99%

Multidetector computed tomography analysis of benign and malignant nodules in patients with chronic lymphocytic thyroiditis

et al. 2016

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Abstract. The aim of the present study was to compare the multidetector computed tomography (MDCT) features of benign and malignant nodules in patients with chronic lymphocytic thyroiditis (CLT). MDCT findings, including the size, solid percentage, calcification, margin, capsule, anteroposterior-transverse diameter ratio as well as the mode and the degree of enhancement of 137 thyroid nodules in 127 CLT cases were retrospectively analyzed. Furthermore, the correlation between MDCT findings and pathological results combined with the CT perfusion imaging was analyzed for the differences between benign and malignant nodules. A total of 77.5% (31/40) of malignant nodules were completely solid, and 33% (32/97) of benign nodules were predominantly cystic. Compared with the benign nodules, micro-calcification and internal calcification were more frequently observed in the malignant nodules (P<0.05). MDCT features such as ill-defined margin, absence of capsule or incomplete capsule or homogeneous enhancement were more likely to be present in the malignant nodules (P<0.05). Nevertheless, no significant difference was observed in the enhancement degree at arterial or venous phase between benign and malignant nodules (P>0.05). MDCT features are useful in differentiating the benign and malignant nodules in CLT patients, and it may be essential for a radiologist to review the MDCT characteristics of nodules in the clinical practice.

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“…In one study of solitary thyroid nodule, the specificity of scan turns out to be only 21.1%. So advice is there to avoid this technique as a routine test in patients with nontoxic thyroid nodules [6, 7] (6, 8).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Fine Needle Aspiration Cytology and Thyroid Scan in Solitary Thyroid Nodule

Basharat

Bukhari

Saeed

et al. 2011

Pathology Research International

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Objective. This was a comparative study between FNAC and thyroid scan used to diagnose the solitary thyroid nodule and histopathology was used as gold standard to compare the results of both modalities. We hypothesized that Fine needle aspiration cytology and thyroid scan diagnose solitary thyroid nodule (STN) as accurately as histopathology. Materials and Methods. This study comprised of 50 patients with solitary thyroid nodules (STN) presented to OPD. After clinical examination these patients were referred to Centre for Nuclear Medicine, Mayo Hospital Lahore for thyroid function tests and thyroid scan (TS). These patients underwent FNAC in the department of Pathology and surgery in Mayo Hospital. The cases were operated and evaluated for histopathological changes. Results. On thyroid scan, 40 patients (80%) having cold nodule were labeled as suspicious 10 patients (20%) had hot nodule. On FNAC 23 patients (46%) had benign lesion, 22 patients (44%) had indeterminate lesion and 5 patients (10%) had malignant lesions. On histopathology, 45 patients (90%) were confirmed to have benign lesions and 5 patients (10%), malignant lesions. After comparison of results of thyroid scan and FNAC with histopathology, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of thyroid scan were 80%, 20%, 10%, 90% and 26%, respectively whereas those of FNAC were 80%, 97.7%, 80%, 97.7% and 96%, respectively. Conclusion. Fine needle aspiration was a significantly better predictor of malignancy than thyroid scan and resulted in a smaller proportion of excisions for benign nodules.

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The Cost-effectiveness of Iodine 131 Scintigraphy, Ultrasonography, and Fine-Needle Aspiration Biopsy in the Initial Diagnosis of Solitary Thyroid Nodules

Cited by 25 publications

References 18 publications

Identifying a risk profile for thyroid cancer

Identifying a risk profile for thyroid cancer

Multidetector computed tomography analysis of benign and malignant nodules in patients with chronic lymphocytic thyroiditis

Comparison of Fine Needle Aspiration Cytology and Thyroid Scan in Solitary Thyroid Nodule

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