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العنوان
EVALUATION OF RISK FACTORS FOR
MALIGNANCY IN A SOLITARY
THYROID NODULE /
المؤلف
MORCOS, RAMI KAMAL ATIYA.
هيئة الاعداد
باحث / RAMI KAMAL ATIYA MORCOS
مشرف / Ibrahim Muhammad Hassanein El-Ghazawy
مشرف / Fawzi Salah Fawzi
مناقش / Fawzi Salah Fawzi
تاريخ النشر
2019.
عدد الصفحات
203 P. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
جراحة
تاريخ الإجازة
1/1/2019
مكان الإجازة
جامعة عين شمس - كلية الطب - قسم الجراحة العامة
الفهرس
Only 14 pages are availabe for public view

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from 203

Abstract

T
he incidence of malignancy in STNs is quite significant and it is not very low as was thought before.
Thyroid cancer may be less frequent in MNG compared to STNs. No significant increase in the rate of carcinoma was observed in patients with STNs.
Multinodularity does not increase the risk of thyroid malignancy. However, patients with MNG who develop PTC are at an increased risk of cancer multifocality.
STNs with suspicious US criteria can be evaluated by elastography that seems to be a useful addition for the assessment of such indeterminate nodules.
Taking individual risk factors in isolation is not always reliable. Using a predictive model, one can anticipate a patient’s risk of malignancy when the diagnosis is unclear.
Nodule size does not appear to be a reliable parameter to improve the clinical management of a nodular goiter because of a high variability between size of nodular area and tumor diameter.
Clinical examination is not useful in assessing malignancy risk, as corroborated by previous studies.
FNA is sensitive in clinical suspicion of PTC, according to our results it should be complemented with extemporaneous biopsy due to its higher Specificity.
STNs should be investigated thoroughly with a high index of suspicion because there is a high probability of malignancy, more than 30%.
US-detected thyroid calcifications are strongly associated with malignancy, especially in certain groups, such as young patients or patients with a STN.
With age, the prevalence of clinically relevant STNs increases, whereas the risk that such nodules are malignant decreases.
TSH alone is not as useful as US features in deciding whether or not to perform FNA in patients with STNs.
FNAC is a simple, easy-to-perform, cost-effective, and easily-repeated procedure for the diagnosis of thyroid cancer.
The overall prevalence of thyroid carcinoma in this study population with STNs was 12%. US characteristics are extremely important in evaluating STNs.
Radiological evaluation of lesions for the differentiation of benign versus malignant nature is important because unnecessary surgical procedures may lead to complications.
FNAC should be performed on ALL STNs classified as positive, regardless of palpability. It is concluded from the study that a remarkable proportion of STNs (12%) was malignant.
Clinical, Laboratory, and Ultrasound features of STNs can be used as predictors of malignancy in children. Although none has diagnostic accuracy as high as that of FNA.
While malignancy is associated with positive family history of thyroid cancer and hypoechoic lesions, palpable lymphadenopathy had the greatest risk.
There are significant predictors of malignancy in STNs such as: Male gender, Solitary nodules, Size between 2-4 cm, Microcalcifications, Hypoechogenic pattern, Solid pattern, Ill-defined edges and Increased intranodular vascularity.
This study concluded female predominance was observed, peak incidence was in the age group 31-50 years. Most common presenting complaint was painless neck swelling.
The management of a STN remains a clinical challenge despite guidelines. Clinically, STNs should be investigated thoroughly with a high index of suspicion because there is at least a 10–20% probability of malignancy.