Porównanie skuteczności elastografii w diagnostyce zmian pęcherzykowych tarczycy i ognisk z jednoznacznym wynikiem BAC

Introduction: The aim was to assess the usefulness of strain elastography (SEG) in the diagnostics of two groups of thyroid nodules (TNs): follicular lesions (FL) with low malignancy risk (< 20.0%) and low percentage of papillary carcinomas (PTCs) among cancers as well as TNs with unequivocal cytology (UC) and high percentage of PTCs among cancers. Material and methods: 168 TNs were analysed and eventually surgically treated: 100 UC (50 benign and 50 malignant — 90.0% PTCs) and 68 FL (60 benign, 8 malignant — 50.0% PTCs). Elasticity score (ES) and strain ratio (SR) were evaluated, and their effectiveness was compared with the evaluation of the number of ultrasound malignancy risk features (NoUMRFs). Results: In the UC group the evaluation of mean values of SR and ES in both sections (meanSR, meanES) was more efficient than NoUMRFs analysis (AUC: 0.903 and 0.869 vs. 0.754, p 0.7, and only the set of features: tSR ≥ 1.7 and NoUMRFs ≥ 1 increased the malignancy risk in nodules (OR: 12.0; SEN: 75.0%, SPC: 75.0%). Conclusions: SEG is more reliable than conventional US in the diagnostics of TNs. The efficacy of SEG decreases with lowering percentage of PTCs among cancers. But in FL nodules SEG may support the selection of nodules for surgical treatment.  Wstęp: Celem pracy była ocena przydatności elastografii uciskowej (SEG) w diagnostyce 2 grup guzków tarczycy (TNs): zmian pęcherzy­kowych (FL) z niskim ryzykiem złośliwości (&lt; 20,0%) i niskim odsetkiem raków brodawkowatych (PTCs) wśród nowotworów złośliwych oraz TNs z jednoznaczną cytologią (UC) i wysokim odsetkiem PTCs wśród nowotworów złośliwych. Materiał i metody: Analizowano 168 TNs, wszystkie ostatecznie były leczone operacyjnie, 100 UC: 50 łagodnych i 50 złośliwych (90,0% PTCs) i 68 FL: 60 łagodnych i 8 złośliwych (50,0% PTCs). Oceniano klasę elastogramu (ES) i wskaźnik odkształenia (SR) oraz porównywano ich skuteczność z oceną liczby ultrasonograficznych cech ryzyka złośliwości (NoUMRFs). Wyniki: W grupie UC ocena średnich wartości SR i ES (meanSR i meanES) z obu przekrojów była bardziej skuteczna niż ocena No­UMRFs (AUC: 0,903 i 0,869 v. 0,754, &lt; 0,05). Przekroczenie progów: meanSR ≥ 2,01, meanES ≥ 2,5, NoUMRFs ≥ 2 powodowało istotny wzrost ryzyka złośliwości zmiany (odpowiednio OR: 45,0; 23,2; 5,4), ale tylko meanSR ≥ 2,01 był niezależnym czynnikiem ryzyka złośliwości (OR: 20,3; SEN: 86,0%, SPC: 88,0%). W grupie FL tylko dla tSR (SR analizowane na przekroju poprzecznym) stwierdzono wartość AUC &gt; 0,7. Jednoczesne występowanie tSR ≥ 1,7 i NoUMRFs ≥ 1 istotnie zwiększało ryzyko złośliwości zmiany (OR: 12,0; SEN: 75,0%, SPC: 75,0%). Wnioski: SEG jest bardziej wiarygodna niż klasyczna ultrasonografia w diagnostyce TNs. Skuteczność SEG spada z obniżaniem się odsetka PTCs wśród nowotworów złośliwych. Ale także w grupie FL SEG może pomóc wyodrębnianiu TNs, które powinny być leczone chirurgicznie.

Analiza znaczenia klinicznego niejednoznacznych wyników biopsji tarczycy ze szczególnym uwzględnieniem kategorii ZPBN na podstawie 5 lat stosowania nowej klasyfikacji rozpoznań cytologicznych

  Introduction: The diagnostic category of follicular lesion of undetermined significance (FLUS) was intended to allow selection of cases with low risk of malignancy from all smears with indeterminate, suspicious cytology (ISC), which can potentially take advantage from repeat fine-needle aspiration (rFNA). Aim of the study was a comparison of the risk of malignancy related to FLUS nodules and other nodules with ISC: suspected follicular neoplasm (SFN) and suspected malignancy (SM), as well as analysis of the usefulness of assessing ultrasonographic malignancy risk features (UMRF) in nodules with ISC. Material and methods: We analysed UMRF, rFNA, and results of histopathological examination (H) in 441 FLUS, 135 SFN, and 72 SM nodules. Results: The frequency of exposing cancer in H in FLUS nodules was 5.9%, and when cytological follow up was also included it was 2.9%. rFNAs made the diagnosis more precise in 72.7% of FLUS, and in 5.2% it was diagnosis/suspicion of cancer. The incidence of cancer in SFN nodules was 8.2%, in SM nodules with suspicion of papillary cancer — 61.1%, and in nodules with suspicion of other or unspecified malignancy — 53.8% (p &lt; 0.0001 FLUS vs. both groups). The presence of calcifications is the only independent UMRF for nodules with ISC (OR 4.7). Features of importance are also microcalcifications (OR 3.8), especially in the SM group, and taller-than-wide-shape (OR 2.2). FLUS and SFN nodules are characterised by particularly low value of assessing suspicious margins; analysis of hypoechogenicity is of low value in SFN nodules, like suspected vascularisation in SFN and SM nodules. Conclusions: The risk of cancer in FLUS and SFN nodules is lower than in SM nodules. rFNAs of FLUS nodules make the diagnosis more precise in more than 70% of cases and are effective in revealing cancers. UMRFs present variable diagnostic value depending on the subcategory of ISC. (Endokrynol Pol 2016; 67 (1): 23–34)    Wstęp: Rozpoznanie zmiana pęcherzykowa bliżej nieokreślona (FLUS) miało wyodrębnić spośród rozmazów z niejednoznaczną, podejrzaną cytologią (ISC) przypadki z niskim ryzykiem złośliwości i potencjalną korzyścią z wykonania powtórnej FNA (rFNA). Celem pracy było porównanie ryzyka złośliwości guzków FLUS i innych guzków z ISC: podejrzenie nowotworu pęcherzykowego (SFN) i podejrzenie złośliwości (SM) oraz analiza przydatności oceny ultrasonograficznych cech ryzyka złośliwości (UMRF) w guzkach z ISC. Materiał i metody: Analizowano UMRF, rFNA i wyniki badania histopatologicznego (H) 441 guzków FLUS, 135 SFN i 72 SM. Wyniki: Częstość ujawniania raka w H w guzkach FLUS wynosiła 5,9%, a uwzględniając także cytologiczny follow up 2,9%. rFNAs uściśliły rozpoznanie w 72,7% guzków FLUS, w 5,2% ich wynik zawierał rozpoznanie/podejrzenie raka. Częstość raka w guzkach SFN wynosiła 8,2%, w guzkach SM z podejrzeniem raka brodawkowatego 61,1%, a z podejrzeniem innego nowotworu złośliwego lub bez określenia jego typu 53,8% (p &lt; 0,0001 vs. FLUS w obu przypadkach). Obecność zwapnień jest jedyną niezależną UMRF dla guzków z kategorii ISC (OR 4,7). Ponadto znaczenie mają ocena mikrozwapnień (OR 3,8), szczególnie w grupie SM, i podejrzanego kształtu (OR 2,2). W grupach FLUS i SFN szczególnie niską wartość ma ocena podejrzanych granic, ponadto w grupie SFN analiza hipoechogeniczności, a w grupie SFN i SM — podejrzanego unaczynienia. Wnioski: Ryzyko raka w guzkach FLUS i SFN jest niższe niż w kategorii SM. rFNA guzków FLUS uściśla rozpoznanie w ponad 70% przypadków i jest skuteczna w ujawnianiu raków. UMRF mają zróżnicowaną wartość diagnostyczną w zależności od podkategorii ISC. (Endokrynol Pol 2016; 67 (1): 23–34)

The Presence of Hypoechoic Micronodules in Patients with Hashimoto′s Thyroiditis Increases the Risk of an Alarming Cytological Outcome

The aim of the study was to identify a possible relation between various ultrasonographic (US) appearances of Hashimoto′s thyroiditis (HT) and the risk of obtaining an alarming cytology of coexisting nodules. The study included 557 patients with HT, who had been referred for fine needle aspiration biopsy (FNA). We divided US patterns of HT (UP-HT) into eight groups: (a) Hypoechoic (compared to submandibular glands), homogeneous/fine echotexture; (b) hypoechoic, heterogeneous/coarse echotexture; (c) marked hypoechoic (darker than strap muscles), heterogeneous/coarse echotexture; (d) heterogeneous echotexture with hyperechoic, fibrous septa; (e) multiple, discrete marked hypoechoic areas (sized as 1 to 6 mm); (f) normoechoic pseudo-nodular areas; (g) echostructure similar to connective tissue; (h) thyroid parenchyma with no signs of HT. Indications for a surgical treatment resulting from the FNA outcome (categories IV–VI of Bethesda System for Reporting Thyroid Cytopathology) were identified only in patients with variants b, c, and e of UP-HT, but merely the “multiple, discrete marked hypoechoic areas” variant significantly increased the odds of obtaining such cytology (OR:5.7). The presence of the “normoechoic pseudo-nodular areas” variant significantly increased the odds for the benign cytology (OR:1.7). There are significant differences in the frequency of obtaining an alarming cytology in relation to the UP-HT variant

Validation of Four Thyroid Ultrasound Risk Stratification Systems in Patients with Hashimoto’s Thyroiditis; Impact of Changes in the Threshold for Nodule’s Shape Criterion

The aim of the study was to validate thyroid US malignancy features, especially the nodule’s shape, and selected Thyroid Imaging Reporting and Data Systems (EU-TIRADS; K-TIRADS; ACR-TIRADS, ATA guidelines) in patients with or without Hashimoto’s thyroiditis (HT and non-HT groups). The study included 1188 nodules (HT: 358, non-HT: 830) with known final diagnoses. We found that the strongest indications of nodule’s malignancy were microcalcifications (OR: 22.7) in HT group and irregular margins (OR:13.8) in non-HT group. Solid echostructure and macrocalcifications were ineffective in patients with HT. The highest accuracy of nodule’s shape criterion was noted on transverse section, with the cut-off value of anteroposterior to transverse dimension ratio (AP/T) close to 1.15 in both groups. When round nodules were regarded as suspicious in patients with HT (the cut-off value of AP/T set to ≥1), it led to a three-fold increase in sensitivity of this feature, with a disproportionally lower decrease in specificity and similar accuracy. Such a modification was effective also for cancers other than PTC. The diagnostic effectiveness of analyzed TIRADS in patients with HT and without HT was similar. Changes in the threshold for AP/T ratio influenced the number of nodules classified into the category of the highest risk, especially in the case of EU-TIRADS

Metabolic syndrome is associated with similar long-term prognosis in non-obese and obese patients. An analysis of 45 615 patients from the nationwide LIPIDOGRAM 2004-2015 cohort studies

Aims We aimed to evaluate the association between metabolic syndrome (MetS) and long-term all-cause mortality. Methods The LIPIDOGRAM studies were carried out in the primary care in Poland in 2004, 2006 and 2015. MetS was diagnosed based on the National Cholesterol Education Program, Adult Treatment Panel III (NCEP/ATP III) and Joint Interim Statement (JIS) criteria. The cohort was divided into four groups: non-obese patients without MetS, obese patients without MetS, non-obese patients with MetS and obese patients with MetS. Differences in all-cause mortality was analyzed using Kaplan-Meier and Cox regression analyses. Results 45,615 participants were enrolled (mean age 56.3, standard deviation: 11.8 years; 61.7% female). MetS was diagnosed in 14,202 (31%) by NCEP/ATP III criteria, and 17,216 (37.7%) by JIS criteria. Follow-up was available for 44,620 (97.8%, median duration 15.3 years) patients. MetS was associated with increased mortality risk among the obese (hazard ratio, HR: 1.88 [95% CI, 1.79-1.99] and HR: 1.93 [95% CI 1.82-2.04], according to NCEP/ATP III and JIS criteria, respectively) and non-obese individuals (HR: 2.11 [95% CI 1.85-2.40] and 1.7 [95% CI, 1.56-1.85] according to NCEP/ATP III and JIS criteria respectively). Obese patients without MetS had a higher mortality risk than non-obese patients without MetS (HR: 1.16 [95% CI 1.10-1.23] and HR: 1.22 [95%CI 1.15-1.30], respectively in subgroups with NCEP/ATP III and JIS criteria applied). Conclusions MetS is associated with increased all-cause mortality risk in non-obese and obese patients. In patients without MetS obesity remains significantly associated with mortality. The concept of metabolically healthy obesity should be revised