[Role of preoperative ultrasonography in the management of thyroid nodules].

Service de Chirurgie Digestive, Générale et Endocrinienne, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France.
Annales de Chirurgie (Impact Factor: 0.35). 01/2007; 131(10):577-82. DOI: 10.1016/j.anchir.2006.01.008
Source: PubMed

ABSTRACT Ultrasonography is the evidence-based diagnostic method for thyroid nodules. The account has to specify the technical used, and has to exactly describe the echogenicity of the thyroid, the feature of the nodules (number, size, echostructure, echogenicity, edges), and the presence or absence of lymph nodes. The malignancy criteria of thyroid nodules are: (1) hypoechoic solid nodule, (2) presence of internal microcalicifications, (3) ill-defined-irregular edges or absence or breaking of the peripheral halo. The nodes' criteria of malignancy are: (1) diameter of 1 cm or more, (2) clear hypoechoic pattern or non-homogeneous pattern, with alternating hypoechoic and hyperechoic areas, (3) cystic appearance (4) presence of internal calcifications (5) rounded shape with increased anteroposterior diameter, (6) long/short diameter ratio higher than 0.7, (7) absence of hilum. When these criteria are present, a histological diagnosis has to be performed. They could change the operative procedure in the patients.

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    ABSTRACT: IntroductionLa pathologie thyroïdienne nodulaire est très fréquente dans la population générale, surtout dans les zones en carence en iode, et constitue un véritable problème de santé publique. Mais le vrai problème réside dans l’augmentation continue de l’incidence du cancer dans les goitres et des nodules thyroïdiens. ButÉtudier l’incidence du cancer dans les goitres thyroïdiens, en insistant sur les différents facteurs clinique, paraclinique et épidémiologique qui expliquent l’augmentation de cette incidence. MéthodesÉtude rétrospective ayant inclus 368 patients opérés pour une pathologie thyroïdienne nodulaire. Nous avons étudié l’incidence de malignité ainsi que ses principaux facteurs de risque. RésultatsSur les 368 patients opérés, on a découvert 23 cancers, soit 6,25 % des cas, l’âge moyen des cancéreux est de 48 ans, avec un sex-ratio de 2 en faveur des femmes, tous vivant dans des zones en carence en iode. L’association de plusieurs signes de présomption de malignité clinique et échographique a permis de confirmer le diagnostic chez 19 des 23 cas de cancer. ConclusionLes résultats de notre étude viennent conforter ceux de la littérature, l’incidence du cancer dans les goitres et nodules thyroïdiens est en augmentation continue ces dernières années. Cette augmentation est liée au développement des moyens diagnostiques, notamment l’échographie et la cytoponction à l’aiguille fine (CPAF). Elle donne au chirurgien une autre raison pour opérer un goitre nodulaire. IntroductionNodular thyroid disease is very common in the general population, especially in areas with iodine deficiency, and it represents a worldwide public health problem. The main point lies in the increasing incidence of cancer in goiter and thyroid nodules. PurposeTo study the incidence of cancer in thyroid goiters, focusing on various clinical, epidemiological, and paraclinical factors, which explain the increased incidence. Methods: Retrospective study that has included 368 patients operated for nodular thyroid disease. We have studied the incidence of malignancy and its main risk factors. ResultsOf the 368 surgical patients, 23 had cancer (6.25% of cases); the average age of cancer is 48 years, with a sex ratio of 2/1. All the 23 patients were living in an iodine deficiency area. The combination of several clinical and ultrasound signs of suspected malignancy has confirmed the diagnosis in 19 of 23 cases of cancer. ConclusionThe results of our study reinforce those of the literature. The incidence of cancer in thyroid nodules and goiter iscontinuously increasing worldwide in recent years. This finding is related to the development of diagnostic tools including ultrasound and fine needle aspiration cytology. This increasing incidence of cancer gives surgeon one more reason to operate a nodular goitre. Mots clésGoitre-Nodule thyroïdien-Cancer-Échographie-Cytoponction à l’aiguille fine KeywordsGoiter-Thyroid nodule-Thyroid carcinoma-Ultrasonography-Fine needle aspiration cytology
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    ABSTRACT: The objective of the study was to explore high-frequency ultrasound (HFUS) for noninvasive microimaging of thyroid in living mice. Thyroid examination was performed by HFUS in 10 normal C57BL/6 mice, eight mice treated by propylthiouracil, and 22 Tg-TRK-T1 transgenic mice. The dimension of the gland and the presence of nodules were evaluated. Nodules were classified as malignant (hypoechogenicity, poorly defined margins, internal microcalcification, irregular shapes, and extra glandular extension) or not, and the findings were compared with histological data. Thyroid images were successfully obtained in all the animals analyzed. Normal thyroid reached a volume of 4.92 microl (range 2.11-4.92 microl). Mice with propylthiouracil-induced goiter showed diffuse thyroid enlargement (median volume 6.67 microl, range 4.09-8.82 microl). In 19 of 22 Tg-TRK-T1 mice (86%), HFUS identified a nodular process (the smallest detected nodule had a diameter of 0.46 mm). Eleven nodules were classified as malignant and eight as benign. Compared with histological analysis, HFUS showed a sensitivity of 100% in the detection of thyroid nodules and a specificity of 60% (two of the nodules identified by HFUS were not confirmed at the histology). The specificity and sensitivity of HFUS in predicting the malignancy of the thyroid nodules were 83 and 91%, respectively. Thus, HFUS is an accurate imaging modality that can potentially replace more invasive techniques, and, therefore, it represents a significant advancement in phenotypic assessment of mouse models of thyroid cancer.
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