ARTICLE
TITLE

High resolution ultrasonography of thyroid nodules: can ultrasonographic assessment obviate the need for invasive aspiration cytology in ultrasonographically benign lesions?

SUMMARY

The use of high-resolution ultrasound (HRUS) thyroid imaging has resulted in a significant revolution in the treatment of thyroid nodules. The enigma of thyroid nodules has been a blind spot for radiologists for a long period. Reporting a thyroid nodule as benign or malignant is quite difficult and many times not accurate. The American Collage of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS) 2017 classification has solved this problem to a large extent. However, the classification needed pathological confirmation for it to be highly accurate. We compared our HRUS-based TIRADS labeling of thyroid nodules with thyroid cytopathology using revised Bethesda classification system. Patients detected with thyroid nodules by HRUS were categorized using ACR-TIRADS and further were taken for fine needle aspiration cytology (FNAC) in our department. The pathological results were compared with the initial TIRADS category of the nodule and the effectiveness of the TIRADS classification in categorizing nodules into benign and malignant was assessed using various statistical variables. The initial USG and the FNAC were performed by a single radiologist with over 10 years of experience. A total of 201 patients underwent HRUS followed by FNAC after obtaining written consent in our department. The thyroid nodules labeled as true benign on ACR-TIRADS (TIRADS 2) were all true benign on Bethesda cytopathology (less than Bethesda III), confirming the high accuracy of HRUS. The diagnostic accuracy of HRUS in cases of ACR-TIRADS 3 nodules was approximately 90.6% with an error rate of 9.4%. Nodules labeled as ACR-TIRADS 4 and 5 had error rates of 47% and 10% in labeling nodules as malignant. The ultrasound-based ACR-TIRADS system can accurately predict the likelihood of specific nodules being benign. There is a strong concordance between Bethesda cytology and ACR-TIRADS classification, particularly for benign nodules. In resource-constrained system like ours, patients with TIRADS 2 and 3 nodules can be safely followed obviating the need for an invasive procedure like FNAC.

PAGES

 Articles related

Sumartini Dewi,Waliyyuddin Robbani,Iceu Dimas Kulsum    

Background: Systemic sclerosis (SSc) is a multisystem autoimmune illness with  a wide range of clinical symptoms. The pulmonary organ manifestations  frequently occur, but the symptoms are non-specific. Radiological examination and pulmonary fu... see more


Relevancia del trabajo metodológico en el contexto de las Ciencias Básicas Biomédicas / Relevance of methodological work in the context of Basic Biomedical Sciences Relevancia del trabajo metodológico en el contexto de las Ciencias Básicas Biomédicas / Relevance of methodological work in the context of Basic Biomedical SciencesObjetivo: valorar la significación del trabajo metodológico en el proceso docente educativo de las Ciencias Básicas Biomédicas. Métodos: se empleó el método teórico análisis-síntesis en la interpretación de referentes que se localizaron mediante el promotor de búsqueda Google, así como el enfoque sistémico para el comportamiento de la realización de los tipos fundamentales de actividades. La revisión documental del programa de la disciplina Bases Biológicas de la Medicina y las resoluciones vigentes que legislan el trabajo metodológico en la Educación Superior.Resultados: el trabajo metodológico en los diferentes niveles organizativos ofrece diferentes vías para elevar la maestría pedagógica de forma escalonada y debe organizarse como parte de un sistema, que se interrelaciona con las formas propias de este trabajo. Una cultura profesional configurada desde los diferentes niveles de dirección, fomenta el compromiso de colaboración entre los docentes mediante la puesta en práctica del trabajo metodológico institucional y contextualizado en los departamentos.Conclusiones: el trabajo metodológico en el contexto de las Ciencias Básicas Biomédicas constituye uno de los aspectos que influye en la eficacia de la educación médica, una cultura profesional que fomente el compromiso de colaboración entre los docentes mediante su puesta en práctica desde el nivel institucional y contextualizado en losdepartamentos homologa los resultados como parte de una potencialidad alcanzada.ABSTRACTObjective: to assess the significance of methodological work in the educational process of the Basic BiomedicalSciences.Methods: the theoretical analysis-synthesis method was used in the interpretation of referents that were located bythe Google search promoter, as well as the systemic approach to the behavior of the realization of the fundamental types of activities. The documentary review of the program of the Biological Bases of Medicine discipline and the current resolutions that legislate methodological work in Higher Education.Results: the methodological work in the different organizational levels offers different ways to elevate the pedagogical mastery in a staggered way and it must be organized as part of a system, which is interrelated with theproper forms of this work. A professional culture configured from the different levels of management, fosters thecommitment of collaboration among teachers through the implementation of institutional methodological work and contextualized departments.Conclusions: the methodological work in the context of Basic Biomedical Sciences is one of the aspects that influence the effectiveness of medical education, a professional culture that fosters the commitment of collaborationamong teachers through its implementation from the institutional level and contextualized in the departments, the results are homologated as part of a potential achieved.Keywords: methodological work; Basic Biomedical Sciences; Discipline Biological Bases of Medicine.

Orquidia Díaz Moreno,Odalys Salas San Juan,Carmen María Rosales Urquiza,Tania Acosta Elizastigui,Elisabet Vivar Reyes,Maritza González Bravo    

Resultados: el trabajo metodológico en los diferentes niveles organizativos ofrece diferentes vías para elevar la maestría pedagógica de forma escalonada y debe organizarse como parte de un sistema, que se interrelaciona con las formas propias de este tr... see more


Bagus Muhammad Ihsan,Cecep Dani Sucipto,Khayan Khayan    

Background: Filariasis patients can be a source of transmission if their blood still contains microfilariae. One of the Polymerase Chain Reaction (PCR) methods used is High Resolution Melting (HRM), using primary specificity testing. Purpose: To test the... see more


Sarcoma de Kaposi: a propósito de un caso clínico, actualización del tema / Kaposi 's sarcoma: a case report, update on the topicSarcoma de Kaposi: a propósito de un caso clínico, actualización del tema / Kaposi 's sarcoma: a case report, update on the topicEl sarcoma de Kaposi (KS por sus siglas en inglés) es una enfermedad similar al cáncer. Se relaciona con la infección del VIH, y se presenta en estadios avanzados de la enfermedad, afectando el 20% de las personas con VIH que no toman medicamentos antirretrovirales. En Pinar del Río existe una baja incidencia de infección por VIH/SIDA. Dada la infrecuencia del Sarcoma de Kaposi se presenta un caso. Paciente de 50 años de edad, que después de un cuadro de dolor en epigastrio comienza con lesiones en la piel similares a hematoma en resolución, con centro más oscuro y nodular, que toman prácticamente todo el cuerpo. El paciente presenta ligera pérdida de peso, pero no prurito, no fiebre, no lesiones en mucosa oral. Se determinó Hb: 112g/l  Hto: 0.34l/l  Leucocitos: 4.4x109/l. Se encontró aumento de células mononucleares en el diferencial con linfopenia asociada; velocidad de sedimentación, colesterol, transaminasas, función renal y proteínas totales, normales, pero trombocitopenia moderada, acido úrico elevado. En el aspirado medular aparece predominio de linfocitos atípicos, con depresión relativa de las series hematopoyéticas. Gastroscopia, negativa. Biopsia de piel: Compatible con Sarcoma de Kaposi. VIH: tres exámenes durante el estudio con tiempo de intervalo entre ellos 3 meses desde el inicio resultaron negativos. Último examen viral a los 7 meses de iniciado el estudio (positivo) con Western Blot. Palabras clave: Sarcoma de kaposi, VIH. ABSTRACT Kaposi´s Sarcoma (KS) is a cancer-like disease. It is most frequent related to HIV infection, present in late stages of the disease and affecting 20 % of HIV infected people having no Highly Active Antiretroviral Therapy (HAART). Since in Pinar del Rio Province a low incidence rate of HIV/AIDS is observed , Kaposi´s Sarcoma is very infrequent. A 50 year-old male who after presenting an epigastralgia suffers from hematoma-like skin lesions, in resolution and when palpated the darker center was nodular. These lesions take practically the whole body, observing loss of weight, no fever, no itching, no oral mucosa lesions. Determining Hb: 112 g/l, Hto; 0.34/L, Leukocytes: 4.4 x 4x109/l, increase of mononuclear cells, associated to lymphopenia, but erythrocyte sedimentation rate, seric cholesterol, transaminases, kidney function and total proteins were normal. Moderated thrombocytopenia and high levels of uric acid were observed. In the bone marrow aspiration atypical lymphocytes and relative depression of the hematopoietic series prevailed. Gastroscopy was negative. Skin biopsy: Compatible with Kaposi´s Sarcoma. HIV: three exams during the study at 3 months intervals being negative from the beginning. The last viral examination carried out at 7 months after the beginning of the study resulted positive when Western Blot technique was used. Key words: Kaposi´s sarcoma, HIV.

Anadely Gámez Pérez,Delia Rosa Díaz Rodríguez,Celia de los A. Rodríguez Orta,Ana Isabel Fernández Lara,Ibet Rodríguez Orta.    

ABSTRACT Kaposi´s Sarcoma (KS) is a cancer-like disease. It is most frequent related to HIV infection, present in late stages of the disease and affecting 20 % of HIV infected people having no Highly Active Antiretroviral Therapy (HAART). Since in P... see more


Gibran Syed Khurshid,Sasha Strul,Adam Boretsky,Massoud Motamedi,Praveena Gupta    

Purpose: To evaluate if high resolution adaptive optics confocal scanning laser ophthalmoscopy (AO-SLO) can be used as an adjunct complementary diagnostic tool to spectral domain optical coherent tomography (SD-OCT) in characterizing three macular diseas... see more