Ultrasound-guided thyroid nodule fine-needle biopsies — comparison of sample adequacy with different sampling techniques, different needle sizes, and with/without onsite cytological analysis

  Wstęp: Celem niniejszego badania było porównanie diagnostycznej wydajności próbek guzków tarczycy otrzymanych metodą biopsji aspiracyjnej lub kapilarnej, wykonanej za pomocą igieł nr 22 lub nr 27 z lub bez analizy cytologicznej przeprowadzonej na miejscu. Materiały i metody: Czterystu pacjentów z guzkami tarczycy poddano biopsji cienkoigłowej pod kontrolą USG. Pacjentów podzielono na osiem grup, według wielkości zastosowanych igieł (nr 22 vs. nr 27), techniki biopsji (aspiracyjnej kontra kapilarnej), a także przeprowadzonej lub nie analizy cytologicznej na miejscu. Wskaźniki wydajności próbek obliczono dla każdej grupy i podgrupy oraz porównano je za pomocą testu chi-kwadrat. Wyniki: W grupie wszystkich ocenianych guzków (n = 400), wskaźnik wydajności był znacznie wyższy w grupie badanej techniką kapilarną niż w grupie badanej metodą aspiracyjną (97% vs. 91,5%, p = 0,032). Wskaźnik wydajności był również wyższy, gdy przeprowadzono analizę cytologiczną na miejscu niż gdy jej nie przeprowadzono (97% vs. 91,5%, p = 0,032). Wśród guzków litych (n = 205), wskaźnik wydajności również osiągnął wyższą wartość w grupie badanej techniką kapilarną względem grupy badanej techniką aspiracyjną (98,9% vs. 89,7%, p = 0,008), oraz gdy przeprowadzono analizę cytologiczną na miejscu (97,9% vs. 89,6%, p = 0,014). Inaczej niż dla powyższych wyników, wskaźnik wydajności był podobny dla igieł nr 22 i nr 27 (94,2% vs. 93,1%, p = 0,733). Wnioski: Wyniki optymalne uzyskano techniką kapilarną oraz wykonując analizę cytologiczną na miejscu. Technika kapilarna oraz analiza cytologiczna na miejscu powinny stanowić preferowane podejście w biopsji guzków tarczycy, optymalizując wskaźnik wydajności oraz samopoczucie pacjenta. (Endokrynol Pol 2015; 66 (4): 295–300)    Introduction: The aim of this study was to compare the diagnostic adequacy of thyroid samples obtained by aspiration or capillary biopsy techniques, with 22 or 27 gauge needles, and with or without onsite cytological analysis (OCA). Material and methods: Four hundred patients with thyroid nodules underwent ultrasound (US)-guided fine-needle biopsies. Patients were divided into eight groups according to needle size (22 vs. 27 gauge), biopsy technique (aspiration vs. capillary), and whether or not OCA was performed. Sample adequacy rates were calculated for each group and subgroups and compared using chi-square tests. Results: When all nodes were evaluated (n = 400), the adequacy rate was significantly greater with the capillary than with the aspiration technique (97% vs. 91.5%, p = 0.032) and when OCA was than was not performed (97% vs. 91.5%, p = 0.032). When only solid nodules were evaluated (n = 205) the adequacy rate was also significantly greater with the capillary than with the aspiration technique (98.9% vs. 89.7%, p = 0.008) and when OCA was than was not performed (97.9% vs. 89.6%, p = 0.014). In contrast, the adequacy rate was similar for 22 and 27 gauge needles (94.2% vs. 93.1%, p = 0.733). Conclusions: Optimal results were obtained with the capillary technique and OCA. The capillary technique and OCA should be the preferred approach in thyroid nodule biopsy, optimising adequacy rates and patient comfort. (Endokrynol Pol 2015; 66 (4): 295–300)

Evaluation of common carotid artery in type 1 diabetes mellitus patients through speckle tracking carotid strain ultrasonography

PURPOSEWe aimed to evaluate the effectiveness of speckle tracking carotid strain (STCS) technique, which enables measurement of arterial stiffness and strain parameters, in the detection of early atherosclerotic findings in type 1 diabetes mellitus (T1DM).METHODSWe prospectively enrolled 30 T1DM patients and 30 age- and sex-matched control participants with no history of cardiovascular disease. All study population underwent carotid ultrasonography. Radial and circumferential movement of the common carotid artery (CCA) in the transverse plane as the well as the radial movement of the CCA in the longitudinal plane were calculated automatically by using the STCS method. In addition, the strain (%), strain rate (per second), and peak circumferential and radial displacements (mm) were calculated. Arterial stiffness parameters, such as elastic modulus, distensibility, arterial compliance, and β-stiffness index, were calculated using the radial measurements. The mean value of the carotid intima media thickness (CIMT) was calculated semi-automatically for each CCA, in the longitudinal plane. We also analyzed the patients’ overall body composition.RESULTST1DM and control groups were compared in terms of strain and stiffness parameters and no statistically significant difference was found (p > 0.05). CIMT was higher in diabetic patients than in the control group (p = 0.039). In both groups, age was correlated with all arterial stiffness and strain parameters (p < 0.05). The duration of diabetes was also correlated with β-stiffness index, distensibility, and elastic modulus in the longitudinal plane (p < 0.05). In the diabetic group, abdominal fat ratio, whole body fat ratio, and fat mass were correlated with radial and circumferential displacement and strain parameters in transverse plane, and radial displacement in longitudinal plane (p < 0.05, for each). Diabetic patients were divided into subgroups according to the presence of nephropathy and dyslipidemia. Although no significant difference was found between the groups in terms of CIMT, patients with nephropathy had higher values for transverse and longitudinal elastic modulus, pulse-wave velocity, and longitudinal β-stiffness index, as well as lower values for longitudinal arterial compliance and distensibility, compared with patients without nephropathy (p < 0.05). Also, patients with dyslipidemia had higher longitudinal β-stiffness and elastic modulus values compared with patients without dyslipidemia (p < 0.05).CONCLUSIONSTCS ultrasonography is an effective, easy, and noninvasive method for evaluating the arterial elasticity. It may provide an early assessment of atherosclerosis in patients with T1DM, especially in the presence of nephropathy and dyslipidemia; thus, together with CIMT measurement, it may be used more frequently to detect subclinical damage and stratify atherosclerosis

A Case Report of Bilateral Adrenal Sarcomatoid Carcinoma

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy. Sarcomatoid adrenal carcinoma is even more aggressive type of ACC. Bilateral malignant adrenal tumors are extremely rare except for those that represent metastasis from an extra-adrenal organ. Here we report a 53-year-old woman who presented with abdominal pain and weight loss. Abdominal computed tomography revealed bilateral adrenal masses and a mass in her liver. Surgical specimens showed pleomorphic tumor cells with epithelial and spindle cell morphology and immunohistochemical staining was compatible with sarcomatoid carcinoma. Sarcomatoid adrenal carcinoma should be kept in mind during the management of bilateral adrenal masses

Long-Term Results of Cabergoline Add-on Long-Acting Somatostatin Analogue Therapy in Acromegaly Patients

Objective: To investigate the efficacy of the dopamine agonist cabergoline in uncontrolled acromegaly despite long-acting somatostatin analog (SSA). Methods: Thirty-five patients with acromegaly who were followed up in the department of endocrinology and metabolism of our university were analyzed. Thirty-five patients with acromegaly who did not respond adequately to postoperative SSA and in whom cabergoline was added to the treatment were analyzed. Patients were retrospectively evaluated in terms of age, gender, insulin-like growth factor-1 (IGF-1) values before and after cabergoline, disease duration, treatment dose, adenoma size, growth hormone level, and prolactin staining on pathologic examination. Results: Seventeen (48.6%) patients were female. The median age was 46.0 (41-53) years, and the median disease age was 10 (3-43) years. Twenty-eight (80.0%) were macroadenomas, 7 (20.0%) were microadenomas, and prolactin staining was observed in 10 (27.8%) cases. The IGF-1 level was 443 (346-628) ng/mL before cabergoline treatment and 27.4% decrease in IGF-1 was observed after treatment (p<0.001). There was no correlation between IGF-1 decrease and cabergoline dose. The change in IGF-1 was not correlated with tumor size and age but was correlated with pre-cabergoline IGF-1 level (r=0.364, p=0.03). 8 (22.9%) patients went into remission with cabergoline treatment. There was no difference in age, gender, tumor size, or pre-treatment IGF-1 levels between those who went into remission with cabergoline treatment and those who did not. When these 8 patients were analyzed, it was observed that cabergoline treatment was continued throughout the follow-up period; remission was maintained in one patient by discontinuing SSA treatment, in three patients by decreasing the SSA dose, in two patients without treatment change, and in two patients by changing the SSA preparation. Conclusion: Cabergoline is used in the treatment of acromegaly due to its antiproliferative and proapoptotic effects on pituitary adenoma cells. The efficacy of cabergoline added to SSA treatment is controversial in the literature. In our study, remission was achieved in 22.9% and IGF-1 reduction was observed in 27.4% with cabergoline treatment in patients with inadequate response to SSA treatment. Cabergoline added to SSA is an effective treatment in terms of IGF-1 control. This effect may continue in the long-term

Evaluation of the relationship between epicardial adipose tissue, omentin-1 levels, atherosclerosis markers and body composition in hypothyroidism

Hipotiroidide hastaların kilo aldıkları bilinmektedir, ancak bu artıştan sorumlu olan faktörün ne olduğu (yağ doku artışı veya su-tuz tutulumu) konusu tartışmalıdır. Çalışmamızda hipotiroidizmde artan vücut ağırlığından sorumlu olan vücut kompozisyonu değişiminin belirlenmesi yanında, epikardiyal yağ dokusu ve omentin-1 ve H-FABP, ateroskleroz için bazı risk faktörü ve göstergelerin (hsCRP, homosistein, KİMK, FMD vb) düzeyindeki değişimin incelenmesi amaçlanmıştır. Bu amaçla, bilinen başka bir hastalığı olmayan, yeni tanı konmuş 28 aşikar hipotiroidili hasta ile yaş, cinsiyet ve beden kitle indeksi açısından benzer 28 sağlıklı gönüllü kişi kontrol grubu olarak incelenmiştir. Hasta grubu hem tedavi öncesi, hem de tedavi sonrası 6. ayda, en az son iki kontrolde ötiroidi sağlandığı görüldükten sonra değerlendirilmiştir. Vücut kompozisyonu ölçümü dual enerji x-ray absorbsiyometri ile, epikardiyal yağ doku kalınlığı transtorasik ekokardiyografi ile ölçülmüştür. Serum Omentin-1 ve H-FABP düzeyleri sandwich elisa prensibine göre çalışılmış, diğer rutin parametreler standart labaratuvar yöntemleri ile ölçülmüştür. Aşikar hipotiroidisi olan hastalarda tedavi sonrasında 6. ayda vücut ağırlığı ve beden kitle indeksinde azalma olmuş ve bu azalmadan yağ dokudaki azalmanın değil, yağsız vücut kitlesindeki azalmanın sorumlu olduğu görülmüştür. Hipotiroidide azalan ve ötiroidinin sağlanmasıyla düzelen glomerüler filtrasyon hızı ve artan serbest su klirensi bunu açıklayacak bir neden olarak düşünülebilir. Aşikar hipotiroidisi olan grupta epikardiyal yağ doku kalınlığı, sağlıklı kontrol grubundan yüksek saptanmış ve tedavi ile anlamlı düzeyde azalmıştır. Omentin-1 düzeyi de sağlıklı kontrol grubuna göre düşükken, tedavi sonrasında artarak sağlıklı kontrol grubu ile benzer düzeye yükselmiştir. H-FABP düzeylerinde ise hem tedavi sonrasında hem de sağlıklı kontrol grubu ile karşılaştırıldığında bir fark izlenmemiştir. Hipotiroidide serbest T4 düzeyinin, epikardiyal yağ doku kalınlığını öngören bağımsız bir faktör olduğu sonucuna ulaşılmıştır. Hipotiroidide gelişen ateroskleroz patogenezini açıklayan bilinen mekanizmalar dışında artan epikardiyal yağ doku miktarı ve azalan omentin-1 düzeyinin de sorumlu bir faktör olabileceği düşünülebilir.It is known that patients with hypothyroidism gain weight but the factors (increase in adipose tissue or water-salt uptake) responsible for this increase is controversial. In order to determine which factor is responsible for weight gain, we aimed to investigate body composition changes in our patients. Furthermore epicardial adipose tissue thickness, serum omentin-1 and H-FABP, some risk factors and indicators for coronary atherosclerosis (hsCRP, homocysteine, CIMT, FMD, etc) were examined both pre and post treatment in hypothyroid patients and compared with euthyroid healty control group. For this purpose, 28 newly diagnosed overt hypothyroid patients and the age, sex and body mass index matched control group of 28 healthy euthyroid volunteers were examined. The hypothyroid group were evaluated before the treatment and 6 months after replacement therapy when they were euthyroid for at least two visit. Body composition was measured by dual energy x-ray absorptiometry and epicardial adipose tissue thickness was measured by transthoracic echocardiography. Serum Omentin-1 and H-FABP levels were studied on the principle of sandwich ELISA. Other hematological parameters were measured by standard laboratory methods. Six months after replacement therapy, body weight and body mass index were decreased in patients with overt hypothyroidism. The decrease in lean body mass (not adipose tissue mass) were found to be responsible for this reduction. Increased glomerular filtration rate and free water clearance, with the correction of hypothyroidism, can be considered as a reason to explain it. In hypothyroid patients, epicardial adipose tissue thickness was higher than the healty control group and significantly decreased 6 months after replacement therapy. Serum omentin-1 levels were lower than the healthy control group. However serum omentin-1 levels were found to be increased and reached the similar level with the control group 6 months after the replacement therapy. H-FABP levels showed no difference after treatment as well as with healty control group. In our study, free T4 level was found to be an independent factor to predict epicardial adipose tissue thickness in overt hypothyroid patients. In addition to well-known pathways, increased the amount of epicardial adipose tissue and decreased serum omentin-1 levels can be considered as a factor responsible for the pathogenesis of atherosclerosis in hypothyroidism