Differential profile of ultrasound findings associated with malignancy in mixed and solid thyroid nodules in an elderly female population

Objective. Ultrasonographic characteristics are associated with thyroid malignancy. Our aim was to compare the diagnostic value of ultrasound features in the detection of thyroid malignancy in both solid and mixed nodules. Methods. We prospectively studied female patients (≥50 years) referred to ultrasound-guided fine needle aspiration biopsy. Ultrasound features considered suspicious were hypoechogenicity, microcalcifications, irregular margins, high anteroposterior (AP)/axial-ratio, and absent halo. Associations were separately assessed in mixed and solid nodules. Results. In a group of 504 elderly female patients (age =  years), the frequency of malignant cytology was 6%. Thirty-one percent of nodules were mixed and 60% were solid. The rate of malignant cytology was similar for mixed and solid nodules (7.4 versus 5.8%, : 0.56). While in mixed nodules none of the ultrasound characteristics were associated with malignant cytology, in solid nodules irregular margins and microcalcifications were significant (all ). The combination of irregular margins and/or microcalcifications significantly increased the association with malignant cytology only in solid nodules (OR: 2.76 (95% CI: 1.25–6.10), : 0.012). Conclusions. Ultrasound features were of poor diagnostic value in mixed nodules, which harbored malignant lesions as often as solid nodules. Our findings challenge the recommended minimal size for ultrasound-guided fine needle aspiration biopsy in mixed nodules.Fil: Vera, María Inés. Dr. Cesar Milstein Hospital; ArgentinaFil: Meroño, Tomás. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Urrutia, María Agustina. Dr. Cesar Milstein Hospital; ArgentinaFil: Parisi, Carina. Dr. Cesar Milstein Hospital; ArgentinaFil: Morosan, Yanina. Dr. Cesar Milstein Hospital; ArgentinaFil: Rosmarin, Melanie. Dr. Cesar Milstein Hospital; ArgentinaFil: Schnitman, Marta. Dr. Cesar Milstein Hospital; ArgentinaFil: Brites, Fernando Daniel. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Grisendi, Silvio. Dr. Cesar Milstein Hospital; ArgentinaFil: Serrano, María Sol. Dr. Cesar Milstein Hospital; ArgentinaFil: Luciani, Wilfredo. Dr. Cesar Milstein Hospital; ArgentinaFil: Serrano, Leonardo. Dr. Cesar Milstein Hospital; ArgentinaFil: Zuk, Carlos. Dr. Cesar Milstein Hospital; ArgentinaFil: de Barrio, Guillermo. Dr. Cesar Milstein Hospital; ArgentinaFil: Cejas, Claudia. Dr. Cesar Milstein Hospital; ArgentinaFil: Faingold, María Cristina. Dr. Cesar Milstein Hospital; ArgentinaFil: Brenta, Gabriela. Dr. Cesar Milstein Hospital; Argentin

Comparison of different systems of ultrasound (US) risk stratification for malignancy in elderly patients with thyroid nodules. Real world experience

To comparatively assess the performance of three sonographic classification systems, American Thyroid Association (ATA), the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS), and American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE)/Associazione Medici Endocrinologi (AME) in identifying malignant nodules in an elderly population. Methods: Cross-sectional study of patients referred for fine needle aspiration biopsy in an academic center for the elderly. One nodule/patient was considered. Nodules classified Bethesda V/VI were considered malignant. Receiver operating characteristics (ROC) curves were established and compared to evaluate diagnostic performance. Malignancy among biopsies below the size cutoff for each ultrasound classification was also compared. Results: One thousand, eight hundred sixty-seven patients (92% females); median (Q1-Q3), age 71 (67-76) years, were studied showing 82.8% benign (Bethesda II) and 2.6% malignant cytology. The three classifications correctly identified malignancy (P < 0.01). Nonetheless, in the ATA and AACE/ACE/AME 16 and 2 malignant nodules, respectively, were unclassifiable. Including unclassified malignant nodules (n = 1234, malignant = 50), comparison of the ROC curves showed lower performance of ATA [area under the curve (AUC) = ATA (0.49) vs. ACR TI-RADS (0.62), p = 0.008 and ATA vs. AACE/ACE/AME (0.59), p = 0.022]. Proportion of below size cutoff biopsies for ATA, ACR TI-RADS, and AACE/ACE/AME was different [16, 42, and 29% (all p < 0.001)], but no differences in malignancy rate were observed in these nodules. Conclusion: The present study is the first to validate in elderly patients these classifications showing that AACE/ACE/AME and ACR TI-RADS can predict thyroid malignancy more accurately than the ATA when unclassifiable malignant nodules are considered. Moreover, in this aged segment of the population, the use of ACR TI-RADS avoided more invasive procedures. Keywords: Elderly patients; Malignant cytology; Thyroid nodules; Ultrasound characteristics

Study on the implementation of conformity checks in the olive oil sector throughout the European Union

This report has been prepared by Areté s.r.l. – Research & Consulting in Economics in cooperation with Arcadia Int., Agra CEAS Consulting Ltd and Directorate-General for Agriculture and Rural Development (EuropeanOlive oil is considered as a food category at high risk of non-compliances and frauds, due to its high economic value compared to other food products. Conformity checks performed by national competent authorities aim at ensuring that marketing standards for olive oils are complied with on the EU market. This study investigates how conformity checks in the olive oil sector are conducted at Member State level across the EU, to identify the related problems and bottlenecks and to propose solutions to improve their effectiveness and efficiency. Member States generally consider that the EU conformity checks system for olive oils is globally fit for purpose. However, the study identifies some challenges and difficulties in implementing conformity checks on olive oils at Member State level: these derive from national specificities (e.g. multiple competent authorities involved in the system; insufficient funding; lack of skilled staff; etc.), or concern the overall timing to perform the checks and in particular the organoleptic assessment of olive oils through tasting panels. The proposed solutions aim at improving the training of staff, the performance of organoleptic assessment and the labelling of olive oils. Potential solutions to ensure traceability in the olive oil sector are also discussed.Peer reviewe

¿Es posible el diagnóstico de la neoplasia folicular no invasiva con características nucleares de tipo de carcinoma papilar de tiroides (NIFTP) en nuestro medio?

Introducción: La variante folicular encapsulada no invasiva del carcinoma papilar detiroides (CPT) se re-clasificó como neoplasia folicular de tiroides no invasiva concaracterísticas nucleares de tipo papilar (NIFTP). Estos tumores se consideran comoneoplasias de muy bajo potencial maligno, con riesgo casi nulo de recurrencia ymortalidad. Objetivos: i) valorar la prevalencia de NIFTP en pacientes con CPT, ii) evaluar laevolución de los mismos y, iii) determinar las alteraciones moleculares halladas en estetipo de neoplasia.Materiales y Métodos: Estudio multicéntrico retrospectivo, observacional,longitudinal, que incluyó a pacientes con diagnóstico de CPT mayores de 18 añospertenecientes a 11 centros asistenciales de Argentina, diagnosticados entre el 1 deenero de 2006 y el 31 de diciembre de 2016. El diagnóstico de NIFTP se efectuó segúnlos criterios referidos por Nikiforov en el año 2016 y fue confirmado por al menos dospatólogos. Se incluyeron 2677 muestras de pacientes con diagnóstico de carcinomapapilar de tiroides. De estos, 612 (22%) fueron carcinoma papilar variante folicular y33 (1,23%) reunieron criterios diagnósticos de NIFTP. Resultados: De las 2677 muestras analizadas, se diagnosticó NIFTP en 33 pacientes(1,23%), el total de pacientes evaluados habían sido tratados con tiroidectomía total y el51% recibió ablación con radioyodo (mediana 100 mCi). Ningún paciente presentómetástasis ganglionares, a distancia, o necesidad de re-intervención quirúrgica. Luegode un seguimiento promedio de 30,5 meses, la respuesta final se consideró excelente enel 82% y 3% presentó una respuesta indeterminada. En 5 casos (15%) no huboseguimiento para establecer respuesta. Se observaron mutaciones de RAS en 4 (17%) yde BRAF V600E en 3 (13%). Conclusiones: La prevalencia de NIFTP en esta serie se encuentra dentro de las másbajas reportadas. La respuesta excelente al tratamiento en la mayoría de pacientes conseguimiento confirma el carácter indolente de estos tumores. Los hallazgos molecularesdifieren de lo publicado, lo que podría deberse a particularidades geográficas y/o étnicas.Introduction: Non-invasive encapsulated follicular variant of papillary thyroid cancer was reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in 2016. These neoplasms have an extremely low potential of malignancy. Objectives: i) to assess the prevalence of NIFTP in patients with papillary thyroid carcinoma, ii) to evaluate their outcomes and iii) to determine their molecular profile. Materials and methods: Multicenter, descriptive, retrospective study. Patients from 11 referral centers with papillary thyroid cancer diagnosed from January 2006 to December 2016 were included. Diagnosis of NIFTP was based on criteria described by Nikiforov in 2016. At least two pathologists agreed on the diagnosis. Two thousand six hundred and seventy seven patients with papillary thyroid cancer were included; 612 (22%) of them were follicular variant papillary thyroid cancer, and 33 (1.23%) were classified as NIFTP. Results: Thirty three patients (1.23%) fulfilled diagnostic criteria for NIFTP. All patients underwent total thyroidectomy, and 51% were treated with radioiodine (median dose 100 mCi). No metastatic lymph nodes, distant metastases or recurrences were found. After a mean follow up of 30.5 months, 82% of patients had an excellent response, 3% had an indeterminate response and data was missing in the remaining 15%. RAS mutations were detected in 4 patients (17%) and BRAF V600E in 3 (13%). Discussion: The prevalence of NIFTP in our series is among the lowest reported. Excellent outcomes of patients underscore their low malignant potential. However, molecular findings differ from other series, which may be related to environmental or ethnic features of our population.Fil: Saban, Melina. Hospital Británico de Buenos Aires; ArgentinaFil: Orlandi, Ana Maria. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Deutsch, Susana I. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Pitoia, Fabián. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Lowenstein, Alicia Edita. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Calabrese, M. C.. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital General de Agudos Carlos Durand; ArgentinaFil: Cavallo, Andrea. Hospital de Alta Complejidad de Formosa; ArgentinaFil: Lotti, Alejandro. Hospital Británico de Buenos Aires; ArgentinaFil: Mosnteros Albi, M.. Hospital Dr. Arturo Oñativia - Salta Capital.; ArgentinaFil: Tolaba, N. Hospital Dr. Arturo Oñativia - Salta Capital.; ArgentinaFil: Nallar Dera, Marcelo. Hospital Dr. Arturo Oñativia - Salta Capital.; ArgentinaFil: Jaen, A.. Hospital Italiano; ArgentinaFil: Figurelli, Silvina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Carrizo, F.. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; ArgentinaFil: Colobraro, A.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Garcia Tascon, G.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Saccoliti, M.. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital General de Agudos Carlos Durand.; ArgentinaFil: Paes de Lima, A.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Lencioni, María Julia. Hospital de Alta Complejidad de Formosa; ArgentinaFil: Califano, Ines. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; ArgentinaFil: Cabezon, C.. Hospital Italiano; ArgentinaFil: Abelleira, E.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Alcaraz, G.. Hospital Privado Universitario de Córdoba; ArgentinaFil: Brenta, Gabriela. Hospital Cesar Milstein; ArgentinaFil: Bielski, Laila. Sanatorio Guemes Sociedad Anonima.; ArgentinaFil: Castro Jozami, Lorena. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Corino, M.. Hospital Italiano; ArgentinaFil: Faure, Eduardo. Complejo Medico Policial Bartolome Churruca Andres Visca; ArgentinaFil: Frascaroli, G.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Gauna, Alicia Teresa. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Guerra, Jorgelina. Universidad Austral. Hospital Universitario Austral; ArgentinaFil: Gutierrez, S.. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital General de Agudos Carlos Durand.; ArgentinaFil: Ilera, Veronica. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Iorcansky, S.. Hospital Italiano; ArgentinaFil: Martinez, Maria Paz. Hospital Alemán; ArgentinaFil: Moldes, Sofia. Complejo Medico Policial Bartolome Churruca Andres Visca; ArgentinaFil: Negueruela, M.. Universidad Austral. Hospital Universitario Austral; ArgentinaFil: Oneto, A.. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital General de Agudos Carlos Durand.; ArgentinaFil: Parisi, Carina. Hospital Italiano; ArgentinaFil: Reyes, Adriana. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Rosemblit, Cinthia. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; ArgentinaFil: Russo Picasso, Maria Fabiana. Hospital Italiano; ArgentinaFil: Salas, Monica Delia. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Sartorio, Mariana Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario. Instituto de Biología Molecular y Celular de Rosario. Universidad Nacional de Rosario. Facultad de Ciencias Bioquímicas y Farmacéuticas. Instituto de Biología Molecular y Celular de Rosario; ArgentinaFil: Schnitman, M.. Hospital Italiano; ArgentinaFil: Sklate, Roxana. Hospital Tornu; ArgentinaFil: Croome, Silva. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Storani, Maria Elena. Municipalidad de Vicente Lopez (buenos Aires); ArgentinaFil: Vazquez, A.. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital General de Agudos Carlos Durand.; ArgentinaFil: Zund, Santiago. Centro de Educaciones Médicas e Investigación Clínica "Norberto Quirno"; ArgentinaFil: Zunino, A.. Gobierno de la Ciudad de Buenos Aires; Argentin