Fine needle aspiration of thyroid nodules in a general teaching hospital setting performing moderate number of biopsies: Outcome of indeterminate cytologic results

Introduction: Our aim was to assess the usefulness of fine-needle aspiration cytologic biopsy (FNA) of the thyroid in our general teaching hospital with average health care facility performing moderate number of such procedures and to evaluate the outcome of Indeterminate Cytologic Results. Material and method: We studied on all consecutive patients referred for FNA of the thyroid nodule. All samplings were performed primarily by one endocrinologist performing moderate number of samplings and interpreted by one pathologist. Cytological findings were classified as malignant, histologic control recommended (suspicious or indeterminate), benign, and unsatisfactory. Results: Four hundred and seventy six biopsies were performed. Patient acceptance of this procedure was good and no complication was encountered. 64/476 of samples were considered as insufficient (13.4%). Of the remaining samples (355 F, 57 M), 321 specimens (67.4%) were reported to be non-neoplastic lesions, including 251 (52.7%) colloid nodules, 39 (8.2%) hemorrhagic nodules and 31 (6.5%) cases of thyroiditis. A neoplastic nodule was confirmed in 91/476 of cases (19.1%), of which 14 were cytologically malignant (3.0%). Follicular lesions were identified in the remaining 77/476 cases (16.1%). Excluding 21 patients who were lost to follow-up, the remaining 56 patients (72.7%) were surgically followed up. Upon excision, benign lesions were diagnosed in 47/56 (83.8%), of which 32 lesions (57.1%) were follicular adenoma and 15 cases (26.7%) of colloid nodules. Malignancy was confirmed histopathologically in 9 cases (16.2%), including 4 follicular variant papillary carcinomas and 5 follicular carcinomas. Conclusions: FNA is an inexpensive, safe, practical, well tolerated, and easily applied method, even in not fully-experienced hands and provides useful information. Based on our study findings, suspicious cytologic results (cytologically follicular neoplasms) are inconclusive and are associated with a remarkable chance of malignant involvement; hence surgical treatment is necessary for clarification

Appropriateness of referrals for single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in a developing community: A comparison between 2005 and 2009 versions of ACCF/ASNC appropriateness criteria

Appropriateness of referrals for myocardial perfusion imaging (MPI) in developing countries has not been extensively studied. Our study was conducted to describe the ordering practices of physicians and appropriateness of MPI referrals in Iran. We prospectively applied 2005 and 2009 versions of the Appropriateness Use Criteria published by the American College of Cardiology Foundation (ACCF) and the American Society of Nuclear Cardiology (ASNC) to 291 consecutive patients (age 55.3 ± 10.3 years) who underwent SPECT-MPI. For this purpose, we convened a panel, consisting of two academic cardiologists, one academic clinician in internal medicine, and one academic clinician in nuclear medicine. The panelists were invited for a face-to-face meeting to judge appropriateness of SPECT-MPI and independently assign a specific indication (scenario), whenever possible, for each case in accordance with ACCF/ASNC appropriateness scenarios. Based on the 2005 ACCF/ASNC criteria, SPECT-MPI studies were judged appropriate for 211 (72.5%), uncertain for 36 (12.4%), inappropriate for 32 (11.0%), and unclassifiable for 12 (4.1%) referrals. The same figures based on the 2009 version were 219 (75.3%), 15 (5.2%), 49 (16.8%), and 8 (2.7%) patients, respectively. Overall agreement between the 2005 and 2009 versions was good (κ 0.63). Lack of chest pain and age below 60 years were significant indicators increasing the likelihood of inappropriate referrals by 2.9-3.4 fold. Absence of diabetes mellitus and hypertension, a normal lipid profile, lack of a past history of myocardial infarction or cardiovascular interventions (CABGs or PCI), as well as lack of application and exercise ECG stress test as the gate keeper (keeping abnormal ETT or inability of the patient to perform exercise as the appropriate indication for SPECT-MPI referral) were significant indicators, decreasing the odds of appropriate referrals. Generally a higher percentage of referrals with inappropriate indications had normal MPI. Our study provides an evidence for the fact that SPECT-MPI ordering practices in our developing community largely parallel the ACCF/ASNC recommendations. The implementation of appropriateness criteria is feasible in clinical settings and might provide an alternative to utilization management. © 2011 American Society of Nuclear Cardiology

Erratum: Incidental Detections Suggestive of COVID-19 in Asymptomatic Patients Undergoing 68Ga-DOTATATE and 68Ga-PSMA-11 PET-CT Scan for Oncological Indications (Nuklearmedizin (2020) DOI: 10.1055/a-1311-2856)

In the above article, an incorrect figure 2 was depicted. The mistake has been fixed in the meantime. The corrected figure presents below. (Figure Presented)

Diagnostic Utility of Multidetector Ct Scan in Penetrating Diaphragmatic Injuries: a Systematic Review and Meta-analys

Penetrating diaphragmatic injuries pose diagnostic and management challenges. Computed tomography (CT) scans are valuable for stable patients, but concern exists for missed injuries and complications in nonoperatively managed cases. The objective of this study was to explore the diagnostic utility of multidetector CT scan (MDCT) in identifying diaphragmatic injuries resulting from penetrating trauma. A systematic review and meta-analysis were conducted, following established guidelines, by searching PubMed, Scopus, Web of Science, and Embase databases up to July 6, 2023. Eligible studies reporting MDCT\u27s diagnostic accuracy in detecting penetrating diaphragmatic injuries were included. Relevant data elements were extracted and analyzed using STATA software. The study included 9 articles comprising 294 patients with confirmed penetrating diaphragmatic injuries through surgical procedures. MDCT\u27s diagnostic performance revealed a pooled sensitivity of 74% (95% CI: 56%-87%) and a pooled specificity of 92% (95% CI: 79%-97%) (Fig. two), with significant heterogeneity in both sensitivity and specificity across the studies. The Fagan plot demonstrated that higher pre-test probabilities correlated with higher positive post-test probabilities for penetrating diaphragmatic injury diagnosis using MDCT, but even with negative results, there remained a small chance of having the injury, especially in cases with higher pre-test probabilities. This study highlights MDCT\u27s effectiveness in detecting diaphragmatic injury from penetrating trauma, with moderate to high diagnostic accuracy. However, larger sample sizes, multicenter collaborations, and prospective designs are needed to address observed heterogeneity, enhancing understanding and consistency in MDCT\u27s diagnostic capabilities in this context

[Somatostatin receptor scintigraphy in a patient with myocarditis] [Miyokarditli bir hastada somatostatin reseptör sintigrafisi]

We report a case of myocarditis imaged with technetium-99m octreotide cardiac single-photon emission computed tomography which showed diffuse uptake in the myocardium, indicating inflammatory reaction to myocardial damage. Somatostatin receptor scintigraphy of the heart could be considered in patients with suspected cardiac inflammation. This could facilitate early diagnosis and guide appropriate treatment

Radioimmunotherapy (RIT) in Brain Tumors

Annually, the incidence of brain tumors has slightly increased and also the patient prognosis is still disappointing, especially for high-grade neoplasms. So, researchers seek methods to improve therapeutic index as a critical aim of treatment. One of these new challenging methods is radioimmunotherapy (RIT) that involves recruiting a coupling of radionuclide component with monoclonal antibody (mAb) which are targeted against cell surface tumor–related antigens or antigens of cells within the tumor microenvironment. In the context of cancer care, precision medicine is exemplified by RIT; precision medicine can offer a tailored treatment to meet the needs for treatment of brain tumors. This review aims to discuss the molecular targets used in radioimmunotherapy of brain tumors, available and future radioimmunopharmaceutics, clinical trials of radioimmunotherapy in brain neoplasms, and eventually, conclusion and future perspective of application of radioimmunotherapy in neurooncology cancer care. © 2019, Korean Society of Nuclear Medicine

Imaging of the muscle and bone from benchtop to bedside

Studies have begun to show that muscles and bones play a role in the regulation of biological functions through a combination of biomechanical and biochemical signals. In vivo and ex vivo imaging techniques are crucial in the understanding of the morphology and architecture of muscle and bone for further understanding of musculoskeletal physiology and pathophysiology. This systematic review of the literature summarizes current knowledge and outlines new insights into the functions of muscle and bone elucidated by imaging techniques, with a focus on the recent advances in the musculoskeletal system enabled by novel technologies, such as CLARITY, Fast Free-of-Acrylamide Clearing Tissue (FACT), computed tomography (CT), and positron emission tomography (PET). This may serve as guidance for the development of new strategies to prevent and diagnose motor or metabolism disorders related to the malfunction of muscle and bone