Ultrasound plays an important role in the diagnosis and management of thyroid cancer. It can detect thyroid nodules and characterize features that may indicate cancer. Ultrasound is also used to guide fine-needle aspiration biopsy of suspicious nodules. After diagnosis, ultrasound helps stage cancer by identifying metastatic lymph nodes. It continues to be used post-operatively to monitor for recurrence. Papillary thyroid cancer is the most common type and usually has a good prognosis, while anaplastic is the most aggressive. Ultrasound features can suggest but not definitively diagnose different cancer types.
This document discusses the ultrasound characteristics of various thyroid cancers and lesions. It notes that papillary carcinoma is the most common thyroid cancer, often appearing as a solid, hypoechoic nodule with punctate microcalcifications and intranodular vascularity. Anaplastic carcinoma grows rapidly with areas of necrosis. Medullary carcinoma contains echogenic foci related to amyloid and calcification. Follicular lesions cannot be distinguished as benign or malignant without biopsy. Metastases to the thyroid typically appear as a well-defined hypoechoic mass, most often in the lower pole.
This document discusses several types of thyroid cancer including anaplastic carcinoma, medullary carcinoma, and malignant lymphoma. Anaplastic carcinoma is very aggressive with a median survival of 6 months. Medullary carcinoma can be sporadic, familial, or associated with MEN 2A/2B syndromes. Malignant lymphoma of the thyroid usually arises in pre-existing Hashimoto's thyroiditis. Diagnosis of these cancers involves physical exam, imaging, biopsy, and tumor markers. Treatment options depend on the cancer type and stage but may include surgery, radiation, chemotherapy, and monitoring of tumor markers.
Thymic tumors arise from the thymus gland in the anterior mediastinum. Thymomas are the most common type of thymic tumor and generally have an indolent growth pattern. Complete surgical resection is the primary treatment for thymomas. Adjuvant radiation and chemotherapy may be considered depending on the stage and completeness of resection. Thymic carcinomas are more aggressive and have a poorer prognosis than thymomas. Treatment involves surgical resection when possible along with chemotherapy and radiation.
This document discusses thyroid cancer, including its various types and treatment. It notes that thyroid cancer accounts for less than 1% of all cancers. The main types are differentiated (papillary and follicular) and undifferentiated (anaplastic and medullary) cancers. Risk factors include radiation exposure, genetic mutations, and autoimmune thyroiditis. Symptoms include a thyroid mass or enlarged lymph nodes in the neck. Treatment involves surgical resection of the thyroid and potentially lymph nodes, with total thyroidectomy performed for differentiated cancers. Prognostic factors help determine cancer risk and guide further treatment.
Papillary and follicular thyroid cancers are the most common types of thyroid cancer. Papillary cancer often presents as a small occult tumor and spreads via lymphatics, while follicular cancer presents as a growing nodule and spreads hematogenously to the skull. Diagnosis involves ultrasound, biopsy, and scans. Treatment consists of surgery to remove all or part of the thyroid followed by radioactive iodine and thyroid hormone therapy. Medullary cancer does not take up iodine and surgery is the main treatment. Anaplastic cancer is very aggressive and usually fatal within 6 months.
This document discusses the ultrasound characteristics of various thyroid cancers and lesions. It notes that papillary carcinoma is the most common thyroid cancer, often appearing as a solid, hypoechoic nodule with punctate microcalcifications and intranodular vascularity. Anaplastic carcinoma grows rapidly with areas of necrosis. Medullary carcinoma contains echogenic foci related to amyloid and calcification. Follicular lesions cannot be distinguished as benign or malignant without biopsy. Metastases to the thyroid typically appear as a well-defined hypoechoic mass, most often in the lower pole.
This document discusses several types of thyroid cancer including anaplastic carcinoma, medullary carcinoma, and malignant lymphoma. Anaplastic carcinoma is very aggressive with a median survival of 6 months. Medullary carcinoma can be sporadic, familial, or associated with MEN 2A/2B syndromes. Malignant lymphoma of the thyroid usually arises in pre-existing Hashimoto's thyroiditis. Diagnosis of these cancers involves physical exam, imaging, biopsy, and tumor markers. Treatment options depend on the cancer type and stage but may include surgery, radiation, chemotherapy, and monitoring of tumor markers.
Thymic tumors arise from the thymus gland in the anterior mediastinum. Thymomas are the most common type of thymic tumor and generally have an indolent growth pattern. Complete surgical resection is the primary treatment for thymomas. Adjuvant radiation and chemotherapy may be considered depending on the stage and completeness of resection. Thymic carcinomas are more aggressive and have a poorer prognosis than thymomas. Treatment involves surgical resection when possible along with chemotherapy and radiation.
This document discusses thyroid cancer, including its various types and treatment. It notes that thyroid cancer accounts for less than 1% of all cancers. The main types are differentiated (papillary and follicular) and undifferentiated (anaplastic and medullary) cancers. Risk factors include radiation exposure, genetic mutations, and autoimmune thyroiditis. Symptoms include a thyroid mass or enlarged lymph nodes in the neck. Treatment involves surgical resection of the thyroid and potentially lymph nodes, with total thyroidectomy performed for differentiated cancers. Prognostic factors help determine cancer risk and guide further treatment.
Papillary and follicular thyroid cancers are the most common types of thyroid cancer. Papillary cancer often presents as a small occult tumor and spreads via lymphatics, while follicular cancer presents as a growing nodule and spreads hematogenously to the skull. Diagnosis involves ultrasound, biopsy, and scans. Treatment consists of surgery to remove all or part of the thyroid followed by radioactive iodine and thyroid hormone therapy. Medullary cancer does not take up iodine and surgery is the main treatment. Anaplastic cancer is very aggressive and usually fatal within 6 months.
This document provides information on thyroid cancer and the thyroid gland. It discusses the anatomy of the thyroid gland and its blood supply. It describes the different types of thyroid cancer such as papillary thyroid carcinoma, follicular thyroid carcinoma, and Hurthle cell carcinoma. It covers the pathology, risk factors, diagnostic process, treatment options, and prognosis for each cancer type. The main treatment approaches discussed are surgery, radioactive iodine therapy, and TSH suppression.
Anaplastic and medullary thyroid carcinomas are rare and aggressive forms of thyroid cancer. Anaplastic carcinoma comprises 1-2% of thyroid cancers and has a median survival of 4-12 months. It can arise from pre-existing well-differentiated thyroid cancer and is characterized by a rapidly growing neck mass. Medullary carcinoma is derived from parafollicular C-cells and can be sporadic or familial, associated with mutations in the RET proto-oncogene. It comprises 5% of thyroid cancers and secretes calcitonin. Total thyroidectomy is the primary treatment for both aggressive forms.
Testicular cancer is one of the most curable cancers, with a 5-year survival rate now over 95% due to improved treatments. It typically affects young men between puberty and age 35. Successful treatment involves radical orchiectomy, chemotherapy, and sometimes radiation or retroperitoneal lymph node dissection. A radical orchiectomy surgically removes the testicle and is the standard treatment for suspected testicular cancer based on findings such as a painless testicular mass. While scrotal violations during surgery were once thought to worsen prognosis, evidence now suggests this is not the case if there is no tumor spillage.
The document provides information on a seminar about cancer of the thyroid gland including:
1. Brief embryology, surgical anatomy, blood supply, lymph drainage and histology of the thyroid gland.
2. Introduction and classification of thyroid cancer focusing on differentiated thyroid cancer including papillary and follicular thyroid carcinoma.
3. Discussion of the epidemiology, risk factors, pathology, molecular genetics, clinical assessment, investigations and staging of differentiated thyroid cancer.
4. Overview of treatment approaches for differentiated thyroid cancer including surgery, radioactive iodine ablation and thyroxine suppressive therapy.
Meningeal hemangiopericytoma is an aggressive brain tumor that originates from meningeal cells. While sometimes misdiagnosed as meningioma, it is distinct in that it can metastasize outside the brain. The document discusses the clinical, radiographic, and pathological features of meningeal hemangiopericytoma. Treatment involves surgical resection along with radiation and chemotherapy, but recurrence and metastasis remain high. Prognosis is generally poor with 5-year survival rates around 60%.
This document summarizes thyroid malignancies. It discusses that thyroid cancer accounts for 1.5% of cancers and is most commonly papillary carcinoma. Risk factors include neck irradiation, genetic syndromes, and goiter history. Diagnosis involves clinical exam, radiological imaging like ultrasound and radioactive iodine scans, and histopathological analysis of biopsies. Treatment depends on cancer type but generally involves surgical resection with or without radioactive iodine therapy and monitoring of thyroglobulin levels.
Central nervous system tumors are the second most common type of cancer in children. 20-25% of childhood cancers are CNS tumors. The most common types are astrocytic tumors such as pilocytic astrocytoma and medulloblastoma. Medulloblastoma is an embryonal tumor that occurs most often in the cerebellum and has a high risk of spreading through the cerebrospinal fluid. Treatment involves maximal surgical resection followed by craniospinal radiation therapy and chemotherapy, with doses and regimens varying based on risk factors like age and extent of resection. Treatment planning for craniospinal irradiation aims to deliver a uniform dose to the entire target volume while minimizing risks of under-
The document discusses mediastinal tumors, which are masses or growths located in the mediastinum, the area within the chest between the lungs. It describes the different types of tumors that can occur in the various sections of the mediastinum and their causes. It also outlines some common symptoms, diagnostic tests, treatment options, and prognosis for different mediastinal tumors.
This document provides information on lymph node levels and classification of thyroid neoplasms. It describes the six levels of cervical lymph nodes and discusses papillary carcinoma and follicular carcinoma of the thyroid in detail. For papillary carcinoma, it covers presentation, histology, prognosis, treatment including surgery and radioactive iodine therapy. For follicular carcinoma, it discusses presentation, spread, histology and treatment. It also briefly summarizes other malignant thyroid tumors including medullary carcinoma, anaplastic carcinoma and thyroid lymphoma.
The document discusses the anatomy, blood supply, lymph drainage, etiology, pathological classification, clinical presentation, investigative workup, staging systems, and management of thyroid cancer. It provides details on the location and structure of the thyroid gland. It describes the different types of thyroid cancers including papillary, follicular, hurthle cell, and anaplastic carcinoma. It discusses the role of surgery, radioactive iodine therapy, and neck dissection in the treatment of thyroid cancer.
This document discusses thyroid cancer and its management. It begins with the anatomy and physiology of the thyroid gland. It then covers the classification, etiology, pathology, staging, prognostic indicators, and management of the main types of thyroid cancer - papillary carcinoma, follicular carcinoma, medullary carcinoma, and anaplastic carcinoma. The management sections discuss surgery, hormonal therapy, radioactive iodine therapy, external beam radiation therapy, chemotherapy, and follow-up care. Special considerations for medullary thyroid carcinoma are also covered.
1. The patient has a history of thyroid cancer with metastases to the lungs and skull, and underwent total thyroidectomy and parathyroidectomy.
2. Treatment options for recurrent or metastatic thyroid cancer include radioactive iodine treatment, surgery, external beam radiation, and molecularly targeted therapies.
3. Molecular targeted therapies that show promise for thyroid cancer work by inhibiting pathways involved in cell signaling and angiogenesis, such as the MAPK and PI3K pathways, or by restoring radioiodine uptake.
The document discusses thyroid anatomy, physiology, and surgical considerations.
It begins with thyroid embryology and anatomy, describing the development of thyroid follicles by the 8th week of gestation. It discusses the thyroid's location in the neck and its vascular, lymphatic, and neural anatomy.
It then covers thyroid physiology, including the synthesis and secretion of thyroid hormones T4 and T3. Iodine is taken up by the thyroid and incorporated into thyroglobulin to form T4 and T3, which are secreted into blood.
The document concludes with surgical considerations for the thyroid such as identification of recurrent laryngeal nerve and preservation of parathyroid glands during surgery. Proper surgical technique
Dr Vandana, cranio spinal irradiation, radiotherapy, medulloblastoma, cancer, radiation, treatment, diagnosis, management, natural history of medulloblastoma, signs & symptoms of medulloblastoma,
current approach, future advancements
1. Non-seminomatous germ cell tumors of the testis can be managed with surveillance, chemotherapy, surgery such as radical orchiectomy or RPLND, and radiotherapy for brain metastases.
2. Surveillance is indicated for early stage disease while chemotherapy is preferred for advanced stages or elevated tumor markers.
3. RPLND is performed for staging or residual masses after chemotherapy and can preserve ejaculation through nerve-sparing techniques.
4. Prognosis is generally excellent even for advanced stages, though toxicity from treatment needs monitoring.
Last update of thyroid cancer management from diagnosis till follow up
You can request other lectures by emailing me at salahmab76@yahoo.com or calling me 0020 100 408 1234
Dr Salah Mabrouk Khallaf
The document discusses tumors of the chest wall, pleura, and mediastinum. It describes the different types of benign and malignant tumors that can occur in the chest wall bones and soft tissues. It also outlines the common tumors found in the three compartments of the mediastinum and notes that while mediastinal tumors are rare, they usually present in people aged 30-50 and can be germ cell, lymphatic, thyroid, or neurogenic in origin. The pleura can host both benign fibrous tumors or the malignant mesothelioma.
The document summarizes key information about the thyroid gland and thyroid tumors:
- The thyroid is located in the neck, weighs around 25g, and has lobes connected by an isthmus. It is surrounded by capsules and has relationships to surrounding structures.
- Thyroid tumors are classified into several types including follicular, papillary, and medullary carcinomas. Papillary carcinoma is the most common type and has characteristic nuclear features.
- Follicular carcinoma is less common and is diagnosed based on evidence of invasion. Prognosis depends on tumor extent and response to treatment such as surgery and radioactive iodine.
- Accurate diagnosis relies on histopathological examination of tumor
Ultrasound, including Doppler ultrasound, is used to examine the thyroid gland. It can visualize the normal anatomy of the thyroid and detect any abnormalities. Doppler ultrasound provides additional information about blood flow within the thyroid and any lesions. It displays flow information using color flow mode for a qualitative overview or spectral analysis for quantitative velocity measurements. Several diseases can cause abnormalities in the thyroid that are detectable by ultrasound, such as nodules, diffuse enlargement, or malignancies.
This document discusses thyroid carcinoma and provides details on the anatomy, histology, types, staging, treatment, and prognosis of different thyroid cancers. It covers the embryology, blood supply, innervation and drainage of the thyroid gland. The main types discussed are papillary carcinoma, follicular carcinoma, hurthle cell carcinoma, and medullary carcinoma. Staging systems like TNM, University of Chicago, and MAICS scoring are explained. Treatment typically involves surgical excision and radioactive iodine for differentiated cancers. Prognosis depends on factors like age, histology, tumor size and invasion.
This document provides information on thyroid cancer and the thyroid gland. It discusses the anatomy of the thyroid gland and its blood supply. It describes the different types of thyroid cancer such as papillary thyroid carcinoma, follicular thyroid carcinoma, and Hurthle cell carcinoma. It covers the pathology, risk factors, diagnostic process, treatment options, and prognosis for each cancer type. The main treatment approaches discussed are surgery, radioactive iodine therapy, and TSH suppression.
Anaplastic and medullary thyroid carcinomas are rare and aggressive forms of thyroid cancer. Anaplastic carcinoma comprises 1-2% of thyroid cancers and has a median survival of 4-12 months. It can arise from pre-existing well-differentiated thyroid cancer and is characterized by a rapidly growing neck mass. Medullary carcinoma is derived from parafollicular C-cells and can be sporadic or familial, associated with mutations in the RET proto-oncogene. It comprises 5% of thyroid cancers and secretes calcitonin. Total thyroidectomy is the primary treatment for both aggressive forms.
Testicular cancer is one of the most curable cancers, with a 5-year survival rate now over 95% due to improved treatments. It typically affects young men between puberty and age 35. Successful treatment involves radical orchiectomy, chemotherapy, and sometimes radiation or retroperitoneal lymph node dissection. A radical orchiectomy surgically removes the testicle and is the standard treatment for suspected testicular cancer based on findings such as a painless testicular mass. While scrotal violations during surgery were once thought to worsen prognosis, evidence now suggests this is not the case if there is no tumor spillage.
The document provides information on a seminar about cancer of the thyroid gland including:
1. Brief embryology, surgical anatomy, blood supply, lymph drainage and histology of the thyroid gland.
2. Introduction and classification of thyroid cancer focusing on differentiated thyroid cancer including papillary and follicular thyroid carcinoma.
3. Discussion of the epidemiology, risk factors, pathology, molecular genetics, clinical assessment, investigations and staging of differentiated thyroid cancer.
4. Overview of treatment approaches for differentiated thyroid cancer including surgery, radioactive iodine ablation and thyroxine suppressive therapy.
Meningeal hemangiopericytoma is an aggressive brain tumor that originates from meningeal cells. While sometimes misdiagnosed as meningioma, it is distinct in that it can metastasize outside the brain. The document discusses the clinical, radiographic, and pathological features of meningeal hemangiopericytoma. Treatment involves surgical resection along with radiation and chemotherapy, but recurrence and metastasis remain high. Prognosis is generally poor with 5-year survival rates around 60%.
This document summarizes thyroid malignancies. It discusses that thyroid cancer accounts for 1.5% of cancers and is most commonly papillary carcinoma. Risk factors include neck irradiation, genetic syndromes, and goiter history. Diagnosis involves clinical exam, radiological imaging like ultrasound and radioactive iodine scans, and histopathological analysis of biopsies. Treatment depends on cancer type but generally involves surgical resection with or without radioactive iodine therapy and monitoring of thyroglobulin levels.
Central nervous system tumors are the second most common type of cancer in children. 20-25% of childhood cancers are CNS tumors. The most common types are astrocytic tumors such as pilocytic astrocytoma and medulloblastoma. Medulloblastoma is an embryonal tumor that occurs most often in the cerebellum and has a high risk of spreading through the cerebrospinal fluid. Treatment involves maximal surgical resection followed by craniospinal radiation therapy and chemotherapy, with doses and regimens varying based on risk factors like age and extent of resection. Treatment planning for craniospinal irradiation aims to deliver a uniform dose to the entire target volume while minimizing risks of under-
The document discusses mediastinal tumors, which are masses or growths located in the mediastinum, the area within the chest between the lungs. It describes the different types of tumors that can occur in the various sections of the mediastinum and their causes. It also outlines some common symptoms, diagnostic tests, treatment options, and prognosis for different mediastinal tumors.
This document provides information on lymph node levels and classification of thyroid neoplasms. It describes the six levels of cervical lymph nodes and discusses papillary carcinoma and follicular carcinoma of the thyroid in detail. For papillary carcinoma, it covers presentation, histology, prognosis, treatment including surgery and radioactive iodine therapy. For follicular carcinoma, it discusses presentation, spread, histology and treatment. It also briefly summarizes other malignant thyroid tumors including medullary carcinoma, anaplastic carcinoma and thyroid lymphoma.
The document discusses the anatomy, blood supply, lymph drainage, etiology, pathological classification, clinical presentation, investigative workup, staging systems, and management of thyroid cancer. It provides details on the location and structure of the thyroid gland. It describes the different types of thyroid cancers including papillary, follicular, hurthle cell, and anaplastic carcinoma. It discusses the role of surgery, radioactive iodine therapy, and neck dissection in the treatment of thyroid cancer.
This document discusses thyroid cancer and its management. It begins with the anatomy and physiology of the thyroid gland. It then covers the classification, etiology, pathology, staging, prognostic indicators, and management of the main types of thyroid cancer - papillary carcinoma, follicular carcinoma, medullary carcinoma, and anaplastic carcinoma. The management sections discuss surgery, hormonal therapy, radioactive iodine therapy, external beam radiation therapy, chemotherapy, and follow-up care. Special considerations for medullary thyroid carcinoma are also covered.
1. The patient has a history of thyroid cancer with metastases to the lungs and skull, and underwent total thyroidectomy and parathyroidectomy.
2. Treatment options for recurrent or metastatic thyroid cancer include radioactive iodine treatment, surgery, external beam radiation, and molecularly targeted therapies.
3. Molecular targeted therapies that show promise for thyroid cancer work by inhibiting pathways involved in cell signaling and angiogenesis, such as the MAPK and PI3K pathways, or by restoring radioiodine uptake.
The document discusses thyroid anatomy, physiology, and surgical considerations.
It begins with thyroid embryology and anatomy, describing the development of thyroid follicles by the 8th week of gestation. It discusses the thyroid's location in the neck and its vascular, lymphatic, and neural anatomy.
It then covers thyroid physiology, including the synthesis and secretion of thyroid hormones T4 and T3. Iodine is taken up by the thyroid and incorporated into thyroglobulin to form T4 and T3, which are secreted into blood.
The document concludes with surgical considerations for the thyroid such as identification of recurrent laryngeal nerve and preservation of parathyroid glands during surgery. Proper surgical technique
Dr Vandana, cranio spinal irradiation, radiotherapy, medulloblastoma, cancer, radiation, treatment, diagnosis, management, natural history of medulloblastoma, signs & symptoms of medulloblastoma,
current approach, future advancements
1. Non-seminomatous germ cell tumors of the testis can be managed with surveillance, chemotherapy, surgery such as radical orchiectomy or RPLND, and radiotherapy for brain metastases.
2. Surveillance is indicated for early stage disease while chemotherapy is preferred for advanced stages or elevated tumor markers.
3. RPLND is performed for staging or residual masses after chemotherapy and can preserve ejaculation through nerve-sparing techniques.
4. Prognosis is generally excellent even for advanced stages, though toxicity from treatment needs monitoring.
Last update of thyroid cancer management from diagnosis till follow up
You can request other lectures by emailing me at salahmab76@yahoo.com or calling me 0020 100 408 1234
Dr Salah Mabrouk Khallaf
The document discusses tumors of the chest wall, pleura, and mediastinum. It describes the different types of benign and malignant tumors that can occur in the chest wall bones and soft tissues. It also outlines the common tumors found in the three compartments of the mediastinum and notes that while mediastinal tumors are rare, they usually present in people aged 30-50 and can be germ cell, lymphatic, thyroid, or neurogenic in origin. The pleura can host both benign fibrous tumors or the malignant mesothelioma.
The document summarizes key information about the thyroid gland and thyroid tumors:
- The thyroid is located in the neck, weighs around 25g, and has lobes connected by an isthmus. It is surrounded by capsules and has relationships to surrounding structures.
- Thyroid tumors are classified into several types including follicular, papillary, and medullary carcinomas. Papillary carcinoma is the most common type and has characteristic nuclear features.
- Follicular carcinoma is less common and is diagnosed based on evidence of invasion. Prognosis depends on tumor extent and response to treatment such as surgery and radioactive iodine.
- Accurate diagnosis relies on histopathological examination of tumor
Ultrasound, including Doppler ultrasound, is used to examine the thyroid gland. It can visualize the normal anatomy of the thyroid and detect any abnormalities. Doppler ultrasound provides additional information about blood flow within the thyroid and any lesions. It displays flow information using color flow mode for a qualitative overview or spectral analysis for quantitative velocity measurements. Several diseases can cause abnormalities in the thyroid that are detectable by ultrasound, such as nodules, diffuse enlargement, or malignancies.
This document discusses thyroid carcinoma and provides details on the anatomy, histology, types, staging, treatment, and prognosis of different thyroid cancers. It covers the embryology, blood supply, innervation and drainage of the thyroid gland. The main types discussed are papillary carcinoma, follicular carcinoma, hurthle cell carcinoma, and medullary carcinoma. Staging systems like TNM, University of Chicago, and MAICS scoring are explained. Treatment typically involves surgical excision and radioactive iodine for differentiated cancers. Prognosis depends on factors like age, histology, tumor size and invasion.
This document discusses thyroid carcinoma and provides details on the anatomy, histology, types, staging, treatment, and prognosis of different thyroid cancers. It covers the embryology, blood supply, innervation and drainage of the thyroid gland. The main types discussed are papillary carcinoma, follicular carcinoma, hurthle cell carcinoma, and medullary carcinoma. Staging systems like TNM, University of Chicago, and MAICS scoring are explained. Treatment typically involves surgical excision and radioactive iodine for differentiated cancers. Prognosis depends on factors like age, histology, tumor size and invasion.
This document discusses the anatomy, physiology, pathology, staging, diagnosis, and treatment of thyroid cancer. Some key points:
- The thyroid gland is located in the neck and produces thyroid hormones which regulate metabolism. Thyroid cancers are classified based on their level of differentiation.
- Diagnostic evaluation includes laboratory tests, ultrasound of the thyroid, and fine needle aspiration if a nodule is detected. Prognostic factors like histology, stage, and tumor size help determine a patient's risk level.
- Surgical treatment typically involves total thyroidectomy. Lymph node dissection may also be performed. Postoperative radioactive iodine remnant ablation is recommended for intermediate- and high-risk
Presentation1, radiological imaging of anal carcinoma.Abdellah Nazeer
1) MRI is the preferred imaging modality for staging anal carcinoma due to its ability to accurately assess the size and extent of primary tumors as well as lymph node involvement.
2) Anal carcinoma is typically staged according to tumor size (T-stage), lymph node involvement (N-stage), and presence of distant metastases (M-stage). MRI allows for evaluation of these factors.
3) Additional imaging with PET/CT may be used to detect distant metastases and better define lymph node involvement, potentially changing staging in 20% of cases and treatment planning in 3-5% of cases.
Thyroid ultrasonography is a useful tool for risk stratification and interventional procedures of thyroid lesions. It can detect ultrasound features suggestive of malignancy and select lesions for biopsy. The main interventional procedures discussed are fine needle aspiration (FNA), percutaneous ethanol injection (PEI), and thermal ablation techniques like laser or radiofrequency ablation. FNA is useful for both diagnosis and cyst evacuation, while PEI involves injecting ethanol into cystic nodules. Thermal ablation procedures can reduce the volume of large nodules in patients who are not candidates for surgery.
This document provides information about testicular cancers, including:
- Testicular cancer accounts for 1% of cancers in males and is highly curable when detected early, often affecting young men.
- The testis has blood supply from the testicular artery and drains into the pampiniform plexus and internal spermatic veins. Lymphatic drainage is to retroperitoneal lymph nodes.
- The majority (95%) are germ cell tumors, including seminomas and non-seminomas. Staging involves tumor markers, imaging scans, and lymph node dissection. Treatment depends on the type and stage but may include surgery, chemotherapy, and radiation therapy.
Presentation1.pptx, radiological imaging of extra nodal lymphoma.Abdellah Nazeer
This document discusses extranodal lymphoma, which refers to lymphomatous infiltration of sites other than lymph nodes. It provides examples of extranodal lymphoma in many organs and tissues throughout the body, as seen on various imaging modalities like CT, MRI, PET, and ultrasound. Extranodal lymphoma can mimic other diseases, so it should be considered in the differential diagnosis of mass lesions and focal abnormalities. Biopsy is often needed for definitive diagnosis.
This document provides an overview of thyroid cancer, including the anatomy and physiology of the thyroid gland, epidemiology, risk factors, clinical presentation, diagnostic evaluation, staging, surgical management, and role of radioactive iodine treatment. Key points include that thyroid cancer is most commonly diagnosed through incidental finding of a thyroid nodule, surgical removal of the thyroid (total thyroidectomy) is the primary treatment, and radioactive iodine ablation may be used post-operatively depending on risk level. Prognostic factors include histologic classification and cancer stage at diagnosis.
Management of differentiated thyroid canncer.pptxMohammed rabei
Differentiated thyroid cancers include papillary, follicular, and Hürthle cell cancers. Thyroid nodules are common, and thyroid cancer incidence is rising, though deaths have remained stable. Most thyroid cancers have an indolent course. Evaluation involves history, exam, ultrasound, thyroid function tests, and fine needle aspiration if indicated. Treatment depends on risk stratification based on staging, with options including active surveillance, hemithyroidectomy, or total thyroidectomy.
This document discusses oropharyngeal cancers. It begins with the anatomy of the oropharynx and its boundaries. It then discusses the epidemiology, risk factors, clinical features, staging, workup, and management of oropharyngeal cancers. Early stage cancers are often treated with either radiotherapy or surgery alone, while locoregionally advanced cancers may be treated with surgery followed by radiation and chemotherapy or with primary chemoradiation. HPV-associated oropharyngeal cancers often have a better prognosis than HPV-negative cancers.
The document provides information on evaluating and managing solitary thyroid nodules. It discusses obtaining a detailed history, performing a physical exam focusing on the thyroid and lymph nodes, and using diagnostic tests like ultrasound, biopsy, and bloodwork. Fine-needle aspiration biopsy is the most important test, and can determine if a nodule is benign, suspicious, malignant, or nondiagnostic. Treatment depends on biopsy results and risk factors, and may include observation, surgery, radiation, or medication. The document outlines common thyroid cancers like papillary and follicular carcinoma.
This document discusses spinal tumors, including:
1. Spinal tumors can be primary or secondary, extradural or intradural. The most common symptoms are pain and neurological deficits.
2. Common primary tumors include hemangiomas, aneurysmal bone cysts, and chordomas. Metastatic tumors are most frequently from breast, prostate and lung cancers.
3. Imaging like CT, MRI and bone scans are used to identify the location and extent of tumors. Tissue biopsy is needed to confirm diagnosis.
4. Treatment involves a multidisciplinary approach with surgery, radiation, chemotherapy and steroid/medical management. The goal of surgery is wide or en bloc resection with spinal reconstruction and stabilization
Tobacco and alcohol use are major risk factors for head and neck cancers. Cigarette smokers have a 5-25 times higher lifetime risk of developing these cancers compared to the general population. Other risk factors include leukoplakia, betel nut chewing, and certain occupational exposures. Symptoms depend on the location of the primary tumor but may include neck masses, hoarseness, ear pain, and difficulty swallowing. Treatment involves surgery, radiation therapy, and chemotherapy depending on the cancer's stage and grade. The level of lymph node involvement is a key prognostic indicator.
This document discusses radiological imaging modalities for assessing salivary gland diseases. It describes several imaging techniques including ultrasound, CT, MRI, nuclear scintigraphy and their roles in evaluating patients with salivary gland symptoms. Ultrasound can assess gland vascularity and guide biopsies. CT and MRI help determine lesion extent and involvement of surrounding structures. Nuclear scintigraphy uses radioactive tracers to identify tumors. The document also discusses common benign and malignant salivary gland tumors seen on imaging, including Warthin's tumor, oncocytoma, mucoepidermoid carcinoma and adenoid cystic carcinoma. Imaging features vary depending on tumor type and grade. In summary, various radiological imaging techniques play an important role in
This document provides information about germ cell tumors, specifically testicular tumors. It discusses the incidence, classification, etiology, spread, clinical staging, clinical features, differential diagnosis, investigations, treatment, and follow up schedule for testicular tumors. Key points include that testicular tumors are most common in men ages 20-40, with seminomas being the most common type. Risk factors include cryptorchidism and intersex disorders. Staging involves assessing the primary tumor, lymph node involvement, distant metastasis, and serum tumor markers. Clinical features may include a lump in the testis or metastatic signs such as cough or bone pain. Differential diagnoses include epididymo-orchitis.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
1. The Role of Sonography
in Thyroid Cancer
Stephanie F. Coquia, MD*, Linda C. Chu, MD, Ulrike M. Hamper, MD, MBA
KEYWORDS
Thyroid nodules Thyroid cancer Fine-needle aspiration biopsy
Cervical lymph node metastases Lateral neck compartment Central neck compartment
KEY POINTS
Thyroid nodules are commonly detected on ultrasound (US).
Specific sonographic features are found in many malignant nodules and lymph nodes.
Identification of cervical nodal metastasis is important for accurate staging and surgical manage-ment
of de novo thyroid cancer.
Pathologic diagnosis of a thyroid nodule requires fine-needle aspiration (FNA).
US accurately provides imaging guidance for FNA of indeterminate or suspicious thyroid nodules
and cervical lymph nodes.
US is routinely used in the postoperative surveillance of the neck for tumor recurrence in the thyroid
bed or nodal stations.
INTRODUCTION
According to the National Cancer Institute, an
estimated 63,000 cases of thyroid cancer will be
diagnosed in 2014.1 When pathologically well
differentiated and diagnosed early, the disease is
highly treatable and can be curable. The 5-year
relative survival rate of most types of stage I
thyroid cancer approaches 100%.2
US is used routinely in the diagnosis and man-agement
of thyroid cancer, from initial detection
and diagnosis to preoperative planning to post-operative
surveillance. This review discusses
the various roles of sonography in managing
patients with thyroid cancer and reviews the sono-graphic
appearance of thyroid cancer and nodal
metastases.
NORMAL ANATOMY AND IMAGING
TECHNIQUE
The thyroid gland is a bilobed gland that sits
atop the trachea within the anterior-inferior neck
(Fig. 1). The isthmus connects the right and left
thyroid lobes. Each lobe measures approximately
4 to 6 cm in length and less than 2 cm in width
and in the anterior-posterior dimension.3 The
normal isthmus measures less than 6 mm in the
anterior-posterior dimension. The normal gland is
homogeneous in echotexture and hyperechoic
compared with the adjacent strap muscles (see
Fig. 1).
After documentation of any thyroid lesion that
has suspicious features for primary thyroid cancer,
the cervical lymph nodes are imaged. A normal
lymph node has an elongated shape (a 2:1 ratio
between length and short-axis dimensions) and
demonstrates an echogenic fatty hilum. Vascular
flow is seen entering into the lymph node via the
fatty hilum (Fig. 2) and the cortex is symmetrically
hypoechoic.
The neck can be divided into nodal levels or
stations by anatomic landmarks. The numeric
classification system of the neck nodal stations is
outlined in Table 1 and depicted in Fig. 3.4 Using
this classification, the neck can be divided into
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of
Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
* Corresponding author. 601 North Caroline Street, JHOC 3142, Baltimore, MD 21287.
E-mail address: scoquia1@jhmi.edu
Radiol Clin N Am - (2014) -–-
http://dx.doi.org/10.1016/j.rcl.2014.07.007
0033-8389/14/$ – see front matter 2014 Elsevier Inc. All rights reserved.
radiologic.theclinics.com
2. 2 Coquia et al
Fig. 1. Normal sonographic appearance of the thyroid.
The thyroid (arrows) sits atop the trachea (T) and is
a bilobed structure echogenic to the adjacent muscula-ture
(M).
central and lateral neck compartments. Stations I,
VI, and VII are considered central neck compart-ments
and stations II to V are considered lateral
neck compartments. The medial edge of the com-mon
carotid artery serves as a landmark to divide
the central from the lateral compartment. The
distinction between the central and lateral neck
compartments is important for the surgical man-agement
of thyroid cancer if nodal metastases
are present (discussed later).
IMAGING PROTOCOLS
Thyroid
The thyroid gland is imaged with a linear high-frequency
transducer (7–15 MHz). Occasionally,
if the thyroid gland is enlarged, a curved, lower-frequency
transducer may be used to fully image
the thyroid.
The right and left thyroid lobes are imaged in the
transverse and sagittal planes. Anterior-posterior
dimension, width, and length are measured at
the mid thyroid gland. The isthmus is measured
in the anterior-posterior dimension. Nodules, if
present, are measured in the transverse and
sagittal planes in three dimensions and evaluated
with color Doppler to document vascularity.
Cervical Lymph Nodes
The neck nodes are imaged with the same trans-ducers
as the thyroid: a high-frequency linear
transducer for most of the nodal stations and oc-casionally
a curved transducer for the lower and,
therefore, deeper level IV and VI lymph nodes.
Each nodal station within the neck is evaluated
to assess for the presence of normal or abnormal
lymph nodes. Normal-appearing lymph nodes
can be documented for each level, with the fatty
hilum included in the image. Measurement of
sonographically normal-appearing lymph nodes
is not necessary. Abnormal lymph nodes (dis-cussed
later) should be imaged and measured in
the transverse and sagittal planes. The nodes
also should be interrogated with color Doppler
US to assess for abnormal and disorganized blood
flow.
General imaging protocols for the thyroid gland
and cervical lymph nodes are summarized in
Table 2.
IMAGING FINDINGS AND PATHOLOGY
Types of Thyroid Cancer
There are several types of primary thyroid cancer.
Papillary thyroid carcinoma (PTC) is the most
common, accounting for approximately 75% to
80% of thyroid cancers. PTC is multifocal in
approximately 20% of cases and more common
in females than males. PTC usually presents
before age 40 years, often with cervical nodal me-tastases.
It is also the most common thyroid malig-nancy
in children. PTC has the best prognosis and
highest survival rate of all thyroid cancers, reach-ing
a 20-year survival rate of approximately 90%
to 95%. Other types of thyroid carcinoma include
follicular carcinoma (10%–20%), medullary carci-noma
(5%–10%), and anaplastic carcinoma
Fig. 2. Normal lymph nodes. (A) Lymph node with smooth, homogeneous, hypoechoic cortex (arrow), and central
echogenic fatty hilum. (B) Another lymph node demonstrating normal central hilar flow (arrow).
3. (1%–2%).5 Follicular thyroid carcinoma most often
affects women in the 6th decade of life and may
present with metastatic lesions to bone, brain,
lung, and liver via hematogenous spread. FNA
biopsy (FNAB) cannot differentiate between fol-licular
adenoma and carcinoma and surgical
resection is required to make this distinction. Med-ullary
thyroid carcinoma arises from the parafollic-ular
cells (C cells) of the thyroid gland. It is often
familial in origin (vs sporadic) and is associated
with multiple endocrine neoplasia type 2 syndrome
in 10% to 20% of cases. Patients present with
Table 1
Cervical nodal stations: numeric classification
Nodal Station Location
IA Submental lymph nodes
IB Submandibular lymph nodes
II Internal jugular vein chain from base of skull to the inferior border of the hyoid bone
A: Anterior to the internal jugular vein
B: Posterior the internal jugular vein
III Internal jugular vein chain from the inferior border of the hyoid bone to the inferior
border of the cricoid cartilage
IV Internal jugular vein chain from the inferior border of the cricoid cartilage to the
supraclavicular fossa
V Posterior triangle lymph nodes, posterior to the sternocleidomastoid muscle
A: From the skull base to the inferior border of the cricoid cartilage
B: From the inferior border of the cricoid cartilage to the clavicle
VI Central compartment nodes from the hyoid bone to the suprasternal notch
VII Central compartment nodes inferior to the suprasternal notch in the superior
mediastinum
Note: The lateral compartments (II–V) are separated from the central compartments (I, VI, and VII) by the medial edge of
the common carotid artery.
From Som PM, Curtin HD, Mancuso AA. An imaging-based classification for the cervical nodes designed as an adjunct to
recent clinically based nodal classifications. Arch Otolaryngol Head Neck Surg 1999;125(4):391; with permission.
Fig. 3. Diagram of the neck nodal stations. (From Som PM, Curtin HD, Mancuso AA. An imaging-based classifica-tion
for the cervical nodes designed as an adjunct to recent clinically based nodal classifications. Arch Otolaryngol
Head Neck Surg 1999;125(4):394; with permission.)
The Role of Sonography in Thyroid Cancer 3
4. elevated calcitonin levels due to the secretion of
calcitonin by the parafollicular cells. Anaplastic
thyroid carcinoma is the rarest and most aggres-sive
of the primary thyroid carcinomas, often fatal.
Its dismal prognosis carries a 5-year survival rate
of only 5%.6 There is often local invasion of the
adjacent soft tissues, trachea, and lymph nodes.
Risk factors for the development of thyroid
carcinoma include a history of neck irradiation
and a family history of thyroid cancer. Additional
risk factors that increase the probability of cancer
within a given thyroid nodule include age under
30 years or over 60 years and male gender.7 Nod-ules
greater than 2 cm also are reported to have
an increased risk of cancer (Fig. 4).8
Lymphomatous involvement of the thyroid is
rare, accounting for less than 5% of thyroid malig-nancies.
It may present as a manifestation of
generalized lymphoma or be primary to the thyroid
gland, usually a non-Hodgkin lymphoma. Hashi-moto
thyroiditis is a risk factor for the development
of thyroid lymphoma. Metastatic disease to the
thyroid is also uncommon; primary malignancies
include lung, breast, and renal cell carcinomas as
well as melanoma.6
Thyroid Nodules
Thyroid nodules are common in the United States;
it has been estimated that approximately 50%
of the adult population has thyroid nodules,
although less than 7% of these nodules prove ma-lignant.
6 US features suspicious for malignancy
are reviewed in this section. They are also summa-rized
in Table 3.
Calcification
Calcification within the thyroid may be classified
as microcalcification, coarse calcification, or peri-pheral
rim calcification. Although calcification may
be seen in both benign and malignant processes
of the thyroid, it is the US feature most commonly
associated with malignancy. Of these various
types, microcalcifications are the most specific
for thyroid malignancy, with a specificity of up to
95%.6 Microcalcifications are most commonly
found in PTC and appear as tiny punctate echo-genic
foci within the nodule (Fig. 5). Due to their
small size, they usually do not demonstrate poste-rior
acoustic shadowing. Colloid may also appear
on US as tiny echogenic foci but tends to appear
linear and demonstrates posterior ring-down or
comet-tail artifact (Fig. 6).9 Making this distinction
can be difficult, however, and biopsy should be
performed for indeterminate foci and for those
foci lacking the comet-tail artifact. Furthermore,
the presence of the ring-down artifact does
not necessarily preclude contemplating biopsy;
microcalcifications and colloid may coexist in the
same nodule.
Coarse calcification and peripheral rimlike
calcification may also be seen with thyroid malig-nancies;
however, they also may be found in multi-nodular
thyroids or goiters. Due to their larger size,
Table 2
Imaging protocols for thyroid and cervical
lymph node examinations
Thyroid imaging protocol
Transducer Linear 7–15 MHz (curved
lower-frequency
transducer as needed)
Gland
measurements
Lobes: anterior-posterior
dimension, width,
longitudinal dimension
Isthmus: anterior-posterior
dimension
Nodules Measurement of each
nodule in three
dimensions; color Doppler
interrogation of nodule
Cervical lymph node imaging protocol
Transducer Linear 7–15 MHz (curved
lower-frequency
transducer as needed)
Nodes Each nodal station
evaluated on each side of
the neck
Documentation of
abnormal lymph nodes:
Size measured in three
dimensions
Color Doppler
interrogation of node
Fig. 4. PTC. This nodule measured 5.2 cm and was
found in a 17-year-old girl who presented with neck
swelling. The patient’s age and the size of the nodule
increased the probability of this nodule being
malignant.
4 Coquia et al
5. these calcifications demonstrate posterior acous-tic
shadowing (Fig. 7). Coarse calcifications may
be seen in PTC; however, they are more com-monly
associated with medullary thyroid
carcinoma.6 Nodules with coarse calcifications
necessitate FNAB.
Solid hypoechoic nodule
Thyroid nodules may be completely cystic or solid
or a combination of both. Likewise, thyroid nodules
may be hyperechoic, isoechoic, or hypoechoic
to the remainder of the thyroid parenchyma. Most
PTCs are hypoechoic and nearly all medullary
thyroid carcinomas are hypoechoic.10 Some inves-tigators
believe the extremely hypoechoic nodule
The Role of Sonography in Thyroid Cancer 5
confers a higher risk of malignancy. Benign nodules
may also be hypoechoic; therefore, evaluation
for additional suspicious features, such as calcifi-cation,
should be performed. If no other suspicious
features are present, these hypoechoic nodules
can be biopsied when of sufficient size (discussed
later).
Follicular neoplasms (adenoma and carcinoma)
can also appear as solid, well-marginated, hypoe-choic
nodules with thin hypoechoic halos10 and
central linear hypoechoic striations or areas
(Fig. 8). Because the distinction between follicular
adenoma and carcinoma can only be made based
on vascular and capsular invasion, the diagnosis
can only be made by surgical resection. As such,
once a nodule is diagnosed as a follicular
neoplasm via FNAB, surgical management is the
next step.
Local invasion
Anaplastic thyroid carcinoma and thyroid lym-phoma
may present as large, rapidly growing
masses. The masses may be discrete or infiltra-tive.
Extracapsular extension into the soft tissues
is common with invasion into the trachea, neck
vessels, and strap muscles. There is usually asso-ciated
cervical lymphadenopathy.
Edge refraction shadow
Posterior acoustic shadowing from the edges of a
solid nodule has also been associated with PTC. It
is thought that the fibrotic reaction around the
edge of the tumor is responsible for the edge
refraction shadow.10
Other features suggesting malignancy in
thyroid nodules
Additional suspicious features include nodules
that are taller than they are wide,11 have irregular
shape or margins,11 demonstrate posterior acous-tic
shadowing in the absence of edge refraction, or
are accompanied by sonographically suspicious
lymph nodes, such as lymph nodes with
Table 3
Diagnostic criteria: sonographic features
suggestive of malignancy
US Feature Comment
Calcification Micro-, macro-,
coarse, peripheral
(especially micro)
Solid hypoechoic
nodule
Especially if very
hypoechoic
Local invasion More common in
anaplastic and
lymphoma
Edge refraction
shadow
Taller than wide Nodule anterior-posterior
dimension greater
than width
Irregular margins
Adjacent suspicious
lymph nodes
Size 2 cm
Posterior acoustic
shadowing
Fig. 5. (A, B) Examples of microcalcification. Multiple punctate echogenic foci (arrows) are seen within each of
the hypoechoic nodules. Both of these nodules are markedly hypoechoic with irregular borders. These nodules
were pathologically proved to be PTC.
6. calcification, cystic change, or abnormally in-creased
or disorganized blood flow. A more
detailed discussion of the sonographic findings
suspicious for cervical lymph node metastasis
from thyroid carcinoma follows.
Although these features can be seen in thyroid
malignancies, they are by no means pathogno-monic;
benign nodules may also demonstrate
these features. The differential diagnosis of thyroid
nodules is found in Table 4. Therefore, when nod-ules
present with features suspicious or sugges-tive
of malignancy, these should proceed to
biopsy when of sufficient size.
Size criteria for biopsy
Multiple guidelines for FNAB of thyroid nodules
exist because multiple medical specialties and
organizations are involved in the care of patients
with thyroid nodules. These include recommenda-tions
from the American Thyroid Association
(ATA), the Society of Radiologists in Ultrasound,
and the American Association of Clinical Endocri-nologists
(AACE).5,12,13 Regardless of the recom-mending
body, the guidelines take into account
the nodule’s sonographic appearance as well as
size. In addition, the ATA uses clinical risk stratifi-cation,
providing differing guidelines for high-risk
and low-risk patients. In general, for low-risk
patients, the various guidelines recommend
biopsy of solid nodules at sizes greater than 1 to
1.5 cm and mixed cystic and solid nodules at sizes
greater than 1.5 to 2 cm. The ATA decreases its
minimum size threshold to 5 mm in high-risk pa-tients
who have nodules with suspicious features
or nodules accompanied by suspicious lymph no-des,
whereas the AACE decreases its size
threshold below 1.0 cm if there are suspicious
sonographic features present.
Due to the multitude of guidelines available,
it may be confusing as to which specific recom-mendations
to follow. Each department or practice
should meet with the referring endocrinologists
and surgeons to decide which of the guidelines
is to be used by all members of the clinical team
to provide seamless care to patients.
Pitfalls of thyroid US in the detection of
nodules
Parathyroid adenomas may be confused with
thyroid nodules. Most parathyroid adenomas are
extrathyroidal in location; evaluation for the echo-genic
thyroid capsule separating the adenoma
from the thyroid tissue is helpful in making this
distinction. Parathyroid adenomas are usually
located posterior to the mid gland or inferior to
the thyroid gland (Fig. 9A). Adenomas are quite
vascular and obtain their vascular supply from
the thyroid (see Fig. 9B).
Fig. 6. Example of colloid within a predominately
cystic thyroid nodule. The punctate echogenic foci
demonstrate comet-tail artifact (arrow).
Fig. 7. Coarse calcification. Hypoechoic nodule
with slightly indistinct and irregular border demon-strates
a cluster of coarse echogenic calcifications
demonstrating posterior acoustic shadowing (arrow).
Pathology was PTC.
Fig. 8. Hypoechoic nodule. The nodule is well defined
and homogeneously hypoechoic with a thin hypoe-choic
halo. FNA resulted in pathology of follicular
neoplasm. The patient was scheduled for lobectomy
for definitive diagnosis.
6 Coquia et al
7. Hashimoto thyroiditis may also present with
nodules. The nodules are usually subcentimeter
in size (typically 2–3 mm and less than 6 mm)
and numerous (termed micronodulation or giraffe
pattern), however, causing diffuse heterogeneity
of the gland. This diffuse heterogeneity may
also create the appearance of larger nodules.
The borders of these apparent lesions are indis-tinct,
however. Moreover, because it is an auto-immune
process, prominent reactive cervical
lymph nodes, usually in level VI, may be present
and could be confused as suspicious lymph no-des.
These lymph nodes, however, usually have
fatty hila and maintain the morphologic appear-ance
of a benign lymph node. A truly discrete
nodule, however, in a patient with Hashimoto
thyroiditis should be viewed with concern
The Role of Sonography in Thyroid Cancer 7
because these patients are at increased risk for
both lymphoma and PTC.
Management of multiple thyroid nodules
Patients sometimes present with multiple nodules,
which may pose a dilemma regarding which nod-ules
to biopsy. Regardless of the number of nod-ules
present, the risk of thyroid cancer in a
patient is unchanged.5 Furthermore, it has been
found that although a majority of cancers found
in patients with multinodular thyroids are within
the dominant nodule, approximately one-third of
the cancers are found in the nondominant nodule.5
Therefore, each nodule should be evaluated inde-pendently,
evaluating for suspicious features and
then triaging the nodules for biopsy in the order
of most suspicious features and then by size.
Table 4
Differential diagnosis of thyroid nodules
Diagnosis Comment
Benign
Adenomatoid nodule
Follicular adenoma Surgical excision is required to differentiate adenoma from
carcinoma
Hashimoto thyroiditis Lymphocytic thyroiditis can be used as alternative nomenclature
Parathyroid adenoma Most are extrathyroidal in location; evaluate for capsule separating
lesion from thyroid; correlate with parathyroid hormone level
Malignant
PTC
Follicular thyroid carcinoma
Medullary thyroid carcinoma
Anaplastic thyroid carcinoma
Lymphoma Treat with systemic therapy rather than thyroidectomy
Metastatic disease
Note that benign and malignant nodules may have overlapping appearances and can only be differentiated by FNAB.
Different pathology laboratories may use slightly different cytologic descriptions.
Fig. 9. Parathyroid adenoma. (A) The inferior parathyroid gland is typically located posterior and inferior to the
thyroid. The echogenic thyroid capsule (arrow) separates the parathyroid adenoma (P) from the thyroid. (B) The
parathyroid adenoma is quite vascular and receives its blood supply from the thyroid gland. Unlike the central
hilar flow of a lymph node, the flow within a parathyroid adenoma is peripheral/polar in distribution.
8. Thyroid Nodule Fine-Needle Aspiration Biopsy
Biopsy and cytologic evaluation
Thyroid nodules can be sampled via US guidance
or by palpation; however, in this day and age,
they should be sampled with US guidance. After
sterilization of the skin at the needle entrance site
and administration of local anesthesia, FNA
samples are obtained with small-gauge needles
with a bevel tip, typically 25 or 26 gauge. Pathologic
evaluation can be performed on site or the samples
can be transported to a laboratory for off-site
testing. The presence of at least 6 groups of benign
follicular cells, with each group containing at least
10 cells, is required for a specimen to be consid-ered
adequate and benign, per the Bethesda
System criteria.14 Other alternative criteria for ade-quacy
include the presence of abundant colloid
(suggesting a benign macrofollicular nodule) or
enough cells to suggest an alternative diagnosis,
such as lymphocytic (or Hashimoto) thyroiditis or
atypia. Aspirated thyroid nodules are classified as
benign, atypia of undetermined significance/follic-ular
lesion of undetermined significance (AUS/
FLUS), follicular neoplasm, suspicious for malig-nancy,
or malignant, per the Bethesda System
classification.14 Approximately 10% of thyroid
FNAs from most laboratories are read, however,
as nondiagnostic or inadequate.14
Management
Benign nodules are managed conservatively with
clinical and imaging follow-up whereas nodules
classified as follicular neoplasm, suspicious for
malignancy, or malignant go on to surgical man-agement.
Nodules classified as AUS/FLUS fall
into an indeterminate category, comprising be-tween
3% and 6% of total diagnoses.14 In these
cases, repeat FNA is recommended. However,
20% of these nodules remain AUS after repeat
biopsy. The risk of malignancy in these nodules is
between 5% and 15%.14
To avoid diagnostic surgery for what may ulti-mately
be a benign nodule, FNA samples can be
sent for genomic testing. The Afirma Gene Expres-sion
Classifier (AGEC) from Veracyte (South San
Francisco, California) classifies these cytologically
indeterminate nodules as either benign or malig-nant,
with a 95% negative predictive value.15
To minimize the need for a third FNA specifically
just to perform this test, additional FNA passes
are obtained at the time of the second FNA for
AGEC testing. This material is then reserved and
analyzed in the event that the repeat (or second)
FNA is also called indeterminate. A nodule classi-fied
as benign on AGEC is managed just as a
nodule classified as benign on cytology, with
imaging and clinical follow-up.15 A benign AGEC
result, therefore, negates the necessity of per-forming
surgery for diagnosis of cytologically inde-terminate
nodules. At one center, the number of
diagnostic surgeries performed for these nodules
dropped 10-fold after the implementation of
AGEC testing, and 1 surgery was avoided for
every 2 AGEC tests performed.15 A suspicious
for malignancy AGEC result correlates to a greater
than 50% risk of malignancy for the nodule, and
surgery should be performed for pathologic
diagnosis.
Preoperative Evaluation for Cervical Nodal
Metastases
Current best surgical practice in the United States
recommends central lymph node dissection at the
time of thyroidectomy as well as lateral neck
dissection if there are confirmed metastatic cervi-cal
lymph nodes. Therefore, prior to thyroidectomy,
the cervical lymph nodes should be evaluated for
lymph node metastases both with palpation and
US; if abnormal lymph nodes are suspected, FNA
should be performed. Stulak and colleagues16 in
2006 reported a sensitivity and specificity of
83.5% and 97.7% of preoperative US in the detec-tion
of lateral nodal metastasis in newly diagnosed
thyroid cancer patients, respectively. Hence, a
systematic sonographic evaluation of the neck
nodes is performed bilaterally to identify suspicious
nodes.
US features of suspicious nodes
Benign sonographic morphologic features of
lymph nodes include the presence of an echo-genic
fatty hilum, central regular hilar vascular
flow, and elongated shape. Deviations from this
appearance should be considered abnormal.
A node demonstrating cystic change or the
presence of calcification (mimicking the appear-ance
of the primary tumor) has been shown to be
100% specific for metastatic disease.17 Increased
or eccentric irregular vascularity, round shape
and/or loss of the normal elongated shape, hyper-echogenicity
of the node relative to the adjacent
strap muscles, and loss of a fatty hilum are all
features of abnormal lymph nodes. A summary of
suspicious features is in Box 1, and examples of
suspicious nodes are given in Figs. 10–12.
Metastatic disease from other primaries, how-ever,
such as squamous cell carcinoma, can pro-duce
cystic degeneration of a lymph node.
Management of suspicious nodes
Unlike the guidelines for thyroid nodule biopsy, no
specific size criteria are commonly used in regard
to lymph node biopsy. Some institutions may have
8 Coquia et al
9. their own size cutoff (ie, biopsy lymph nodes
8 mm or larger), formed by consensus between
their surgeons, endocrinologists, and radiolo-gists.
For example, at the authors’ institution,
because of the high specificity of lymph nodes
containing calcification or cystic areas in predict-ing
metastatic disease, these are biopsied
regardless of size. Those that are abnormal but
do not contain these features are usually biopsied
when 8 mm in size.
Lymph nodes that are homogeneously hypoe-choic
without an echogenic fatty hilum present
and do not demonstrate any other suspicious
features may be followed, with biopsy for those
that demonstrate interval growth or interval
The Role of Sonography in Thyroid Cancer 9
development of additional suspicious features.
Again, this particular management step may be
based on the consensus between the referring
physicians and the radiologists.
Suspicious lymph nodes can be biopsied preop-eratively
to confirm the necessity for lateral neck
dissection at the time of thyroidectomy. Because
these nodes are usually not palpable, they are
sampled under US guidance, using the same tech-nique
as described for FNA of thyroid nodules. If
the lymph node is cystic, such that it yields insuffi-cient
cells for diagnosis, the fluid can be aspirated
and sent for thyroglobulin.
Alternatively a surgeon may choose to proceed
to surgery and remove the suspicious lymph no-des
at the time of thyroidectomy. To help the sur-geon
find the nodes intraoperatively, preoperative
Fig. 10. Cystic replacement of a cervical lymph node.
The lymph node is enlarged and has a large anechoic
component, causing increased through transmission,
compatible with cystic change (C). A small area of re-sidual
soft tissue is seen within the node (arrow). A
punctate echogenic focus is seen within the soft tis-sue,
compatible with calcification.
Fig. 11. Calcifications within a lymph node. Multiple
echogenic foci (arrow) are seen within a lymph node
(arrowheads), compatible with calcification. The lymph
node is also round, another suspicious feature. The
node was biopsied, with pathology of metastatic PTC.
Box 1
Sonographic features suspicious for lymph
node metastasis
Cystic change
Calcification
Peripheral, increased, irregular, or eccentric
vascularity
Loss of the normal elongated shape (less than
2:1 ratio between long axis and short axis) or
round shape
Hyperechogenicity of the lymph node relative
to adjacent strap muscle
Loss of fatty hilum
Irregular, asymmetrically thickened cortex
Fig. 12. Abnormal lymph node vascularity. Instead of
central hilar flow, there is peripheral vascularity,
which is increased. A fatty hilum is also not seen.
This was biopsied with pathology of metastatic PTC.
10. US can be used to mark the suspicious nodes on
the skin. In more complex cases, intraoperative
US guidance can be provided.
Postoperative Surveillance
After thyroidectomy, in conjunction with laboratory
follow-up and nuclear medicine radioiodine imag-ing,
the neck is evaluated routinely with US for the
development of nodal metastases. The initial US
examination should be performed in the first 6 to
12 months and then periodically depending on
a patient’s risk for recurrence and thyroglobulin
level.12 The frequency and length of surveillance
may also be dependent on the institution, endocri-nologist,
or surgeon. The risk of recurrence either
within the thyroid bed or within the cervical lymph
nodes in PTC has been reported to between 15%
and 25%.18
The postoperative neck can be divided into
lateral and central compartments (right lateral
neck, right central neck, left lateral neck, and left
central neck), discussed previously. Disease found
in each separate compartment leads to its own
separate neck dissection. Therefore, if multiple
abnormal nodes are present in multiple compart-ments,
a suspicious node from each compartment
should be sampled to accurately plan surgical
management and decrease the extent of the
neck dissection.
Identification of thyroid cells within the lymph
node is confirmatory for lymph node metastasis.
In the event the lymph node sampling is nondiag-nostic
or indeterminate for metastatic disease,
the lymph node can be aspirated and the sample
sent for thyroglobulin assay. It is particularly help-ful
to aspirate and analyze the fluid within small
cystic areas. A thyroglobulin level in a lymph
node greater than the serum thyroglobulin level is
diagnostic for metastatic disease.
Pitfalls in the postoperative surveillance period
In one study, approximately 34% of postoperative
patients were found to have small thyroid bed nod-ules.
18 Of these nodules, only a small percentage
(9%) increased in size during the median 3-year
follow-up period, growing at a rate of 1.3 mm/y.
Furthermore, only one-third of those proved malig-nant
demonstrated interval growth. This behavior
demonstrates the slow indolent nature of papillary
thyroid cancer. Therefore, many small nodules in
the thyroid bed without suspicious features can
be observed over time.
In addition to recurrence, other masses can be
seen in the surgical bed on postoperative exami-nations,
such as residual thyroid tissue, scarring/
fibrosis, and suture granulomas. Residual thyroid
tissue may be focal and can be vascular, features
that make it difficult to differentiate from recur-rence
by imaging. FNA can be performed to differ-entiate
the mass as either malignant (compatible
with recurrence) or benign (normal residual thyroid
tissue). Scarring in the postsurgical bed can be
nonspecific in appearance but typically is nonvas-cular
and elongated, blending into the adjacent fat
and muscle. These areas can also be observed
over time for interval increase in size or develop-ment
of suspicious features that prompt biopsy.
Suture granulomas can present as focal masses
within the thyroid bed. The sonographic appear-ance
of suture granulomas has been described
as a hypoechoic lesion with central echogenic
lines or foci.19 Although echogenic foci within a
lesion may suggest microcalcification and, there-fore,
imply recurrence, features that support su-ture
granuloma include centrality of the foci,
paired foci, and foci larger than 1 mm.19 Suture
granulomas also tend to regress or resolve over
time.19
Suture granulomas also may present within the
neck, buried within the sternocleidomastoid mus-cle
or subcutaneous tissue. Neuromas may also
be seen within the neck, typically presenting as hy-poechoic
masses in close relation to the carotid
artery. Traumatic neuromas may develop after
neck dissection.20
Because many of these masses in the thyroid
bed and neck can demonstrate either no growth
or minimal growth over time, it is important to
correlate with a patient’s thyroglobulin level over
time because this may indicate residual or pro-gressive
disease.
Alcohol ablation of lymph node metastases
As an alternative to surgical management, alcohol
(ethanol) ablation can be performed in the treat-ment
of cervical lymph node metastases, espe-cially
in patients who are either poor surgical
candidates or those who wish to avoid surgery.
The ethanol is administered through percutaneous
injection under US guidance.21
SUMMARY
US plays a crucial role in the diagnosis and
management of patients with thyroid cancer. Not
only is it the best imaging modality for the detec-tion
of suspicious thyroid nodules and cervical
nodal metastases but also the imaging modality
of choice to provide guidance during the perfor-mance
of thyroid and nodal biopsies. Knowledge
of the sonographic anatomy of the thyroid gland
and nodal stations as well as features commonly
seen in malignant thyroid nodules and nodal
metastases and experience with the use of the
10 Coquia et al
11. latest state-of the art high-resolution US equip-ment
is imperative to its effective use in the
evaluation of thyroid cancer patients. A summary
of the pearls, pitfalls, and variants and what radiol-ogists
need to know is found in Boxes 2 and 3.
Many groups of physicians (radiologists, sur-geons,
and endocrinologists) are involved in the
care of patients with thyroid cancer and the rec-ommendations
and management steps discussed
in this article may vary by institution. Therefore,
multidepartmental collaboration and meetings
are essential to keeping a practice up to date to
ensure satisfaction of the referring physicians
and providing optimal patient care.
The Role of Sonography in Thyroid Cancer 11
REFERENCES
1. General information about thyroid cancer. In: thyroid
cancer treatment PDQ. 2014. Available at: http://
www.cancer.gov/cancertopics/pdq/treatment/thyroid/
HealthProfessional. Accessed March 3, 2014.
2. Thyroid cancer survival by type and stage. In: thy-roid
cancer. 2014. Available at: http://www.cancer.
org/cancer/thyroidcancer/detailedguide/thyroid-cancer-survival-
rates. Accessed March 3, 2014.
3. Middleton WD, Kurtz AB, Hertzberg BS. Neck and
chest. In: Ultrasound: The Requisites. St Louis
(MO): Mosby; 2004. p. 244–77.
4. Som PM, Curtin HD, Mancuso AA. An imaging-based
classification for the cervical nodes designed
as an adjunct to recent clinically based nodal classi-fications.
Arch Otolaryngol Head Neck Surg 1999;
125(4):388–96.
5. Frates MC, Benson CB, Chrboneau JW, et al. Man-agement
of thyroid nodules detect at US: Society
of Radiologists in ultrasound consensus conference
statement. Ultrasound Q 2006;22(4):231–8.
Box 2
Pearls, pitfalls, and variants
Hashimoto thyroiditis can present with
diffuse small nodules (6 mm) or diffuse het-erogeneity
that can appear like nodules.
Parathyroid adenomas may be confused with
thyroid nodules or lymph nodes due to their
location:
Evaluate for an echogenic line denoting
the thyroid capsule to place the lesion as
extrathyroidal in location.
Parathyroid adenomas are usually located
posterior to the mid gland and inferior to
the inferior pole of the thyroid.
Parathyroid adenomas demonstrate polar/
peripheral vascular flow from the thyroid
rather than central hilar vascular flow on
color Doppler.
Microcalcifications within thyroid nodules
may not demonstrate posterior acoustic
shadowing.
Colloid can be confused with microcalcifica-tion:
evaluate for comet-tail artifact.
Rapid growth and invasion of adjacent struc-tures
can be seen in anaplastic thyroid carci-noma
and lymphoma.
The presence of cystic change and calcifica-tion
in cervical lymph nodes is 100% specific
for metastatic thyroid cancer. Occasionally,
metastases from other primaries, most
commonly squamous cell head and neck can-cer,
sometimes cause cystic degeneration in
cervical lymph nodes.
The differential diagnosis of thyroid bed and
neck masses seen postoperatively other than
recurrence includes residual thyroid tissue,
scarring/fibrosis, scar granuloma, and neu-romas.
Box 3
What the radiologist needs to know
In the adult population, 50% have thyroid
nodules, but only 7% are malignant.
Microcalcification has the highest specificity
for thyroid carcinoma.
Most malignant nodules are hypoechoic.
A thyroid nodule biopsy returning a diagnosis
of AUS/FLUS should be repeated with addi-tional
samples reserved for AGEC gene
testing.
Preoperative US of the neck is performed to
evaluate the need for lateral neck dissection.
The location and number of lymph node
biopsies to be performed are determined by
the number of neck compartments showing
suspicious lymph nodes (right and left lateral
neck, central neck—if postoperative). At least
1 biopsy in each compartment should be per-formed
to definitively diagnose metastatic
involvement prior to surgery.
In the post-thyroidectomy patient, indetermi-nate
or nondiagnostic lymph node biopsies,
especially with cystic areas, should be tested
for thyroglobulin.
Thryoid bed masses may be stable in size or
show minimal growth over time; correlation
with thyroglobulin levels is imperative to
assessing the risk of recurrence when the
sonographic appearance is indeterminate.
12. 6. Hoang JK, Lee WK, Lee M, et al. US features of thy-roid
malignancy: pearls and pitfalls. Radiographics
2007;27(3):847–61.
7. Polyzos SA, Kita M, Avramidis A. Thyroid nodules –
Stepwise diagnosis and management. Hormones
2007;6(2):101–19.
8. Kamran SC, Marqusee E, Kim MI, et al. Thyroid nodule
size and prediction of cancer. J Clin Endocrinol Metab
2013;98(2):564–70.
9. Beland MD, Kwon L, Delellis RA, et al. Nonshadowing
echogenic foci in thyroid nodules. J Ultrasound Med
2011;30(6):753–60.
10. Reading CC, Charboneau JW, Hay ID, et al. Sono-graphy
of thyroid nodules: a “classic pattern” diag-nostic
approach. Ultrasound Q 2006;21(3):157–65.
11. Kim JY, Lee CH, Kim SY, et al. Radiologic and path-ologic
findings of nonpalpable thyroid carcinomas
detected by ultrasonography in a Medical Screening
Center. J Ultrasound Med 2008;27(2):215–23.
12. Cooper DS, Doherty GM, Haugen BR, et al. Re-vised
American Thyroid Association Management
Guidelines for patients with thyroid nodules and
differentiated thyroid cancer. Thyroid 2009;19(11):
1167–217.
13. Gharib H, Papini E, Valcavi R, et al. American Asso-ciation
of Clinical Endocrinologists and Associa-zione
Medici Endocrinologi medical guidelines for
clinical practice for the diagnosis and management
of thyroid nodules. Endocr Pract 2006;12(1):63–102.
14. Cibas ES, Ali SZ. The Bethesda system for reporting
thyroid cytopathology. Am J Clin Pathol 2009;132:
658–65.
15. Duick DS, Klopper JP, Diggans JC, et al. The impact
of benign gene expression classifier test results on
the endocrinologist – patient decision to operate
on patients with thyroid nodules with indeterminate
fine-needle aspiration cytopathology. Thyroid 2012;
22(10):996–1001.
16. Stulak JM, Grant CS, Farley DR, et al. Value of pre-operative
ultrasonography in the surgical manage-ment
of initial and preoperative papillary thyroid
cancer. Arch Surg 2006;141:489–96.
17. Shin LK, Olcott EW, Jeffrey RB, et al. Sonographic
evaluation of cervical lymph nodes in papillary
thyroid cancer. Ultrasound Q 2013;29:25–32.
18. Rondeau G, Fish S, Hann LE, et al. Ultrasonograph-ically
detected small thyroid bed nodules identified
after total thyroidectomy for differentiated thyroid
cancer seldom show clinically significant structural
progression. Thyroid 2011;21(8):845–53.
19. Kim JH, Lee JH, Shong YK, et al. Ultrasound fea-tures
of suture granulomas in the thyroid bed after
thyroidectomy for papillary thyroid carcinoma with
an emphasis on their differentiation from locally
recurrent thyroid carcinomas. Ultrasound Med Biol
2009;35(9):1452–7.
20. Huang LF, Weissman JL, Fan C. Traumatic neuroma
after neck dissection: CT characterstics in four
cases. AJNR Am J Neuroradiol 2000;21:1676–80.
21. Lewis BD, Hay ID, Charboneau JW, et al. Percuta-neous
ethanol injection for treatment of cervical
lymph node metastases in patient with papillary
thyroid carcinoma. AJNR Am J Neuroradiol 2002;
178:699–704.
12 Coquia et al