Search Results

You are looking at 1 - 7 of 7 items for

  • Author: Gilles Russ x
Clear All Modify Search
Gilles Russ Thyroid and Endocrine Tumor Unit, Department of Nuclear Medicine, Pitié Salpêtrière Hospital, University Pierre et Marie Curie, Paris, France

Search for other papers by Gilles Russ in
Google Scholar
PubMed
Close
,
Sophie Leboulleux Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy, University Paris-Sud, Villejuif, France

Search for other papers by Sophie Leboulleux in
Google Scholar
PubMed
Close
,
Laurence Leenhardt Thyroid and Endocrine Tumor Unit, Department of Nuclear Medicine, Pitié Salpêtrière Hospital, University Pierre et Marie Curie, Paris, France

Search for other papers by Laurence Leenhardt in
Google Scholar
PubMed
Close
, and
Laszlo Hegedüs Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark

Search for other papers by Laszlo Hegedüs in
Google Scholar
PubMed
Close

A thyroid incidentaloma is an unexpected, asymptomatic thyroid tumor fortuitously discovered during the investigation of an unrelated condition. The prevalence rate is 67% with ultrasonography (US) imaging, 15% with computed tomography (CT) or magnetic resonance imaging (MRI) of the neck, and 1-2% with fluorodeoxyglucose (FDG) positron emission tomography. In the absence of a history of external beam radiation or familial medullary thyroid cancer, the risk of malignancy ranges between 5 and 13% when discovered with US, CT or MRI, but is much higher if based on focal FDG uptake (30%). All patients with a thyroid incidentaloma, independent of the mode of detection, should undergo a dedicated neck US with risk stratification: US imaging allows a quantitative risk stratification of malignancy in thyroid nodules, named ‘reporting system' or ‘TIRADS' (thyroid imaging reporting and data system). The reported sensitivity ranges from 87 to 95% for the detection of carcinomas and the negative predictive value from 88 to 99.8%. We suggest that the indications for fine-needle aspiration be based mainly on size and US risk stratification. However, the diagnosis and workup of thyroid incidentalomas leads to superfluous surgery for benign conditions, and excess diagnosis and treatment of papillary microcarcinomas, the vast majority of which would cause no harm. Recognizing this must form the basis of any decision as to supplementary investigations and whether to offer therapy, in a close dialogue between patient and physician. The current use of minimally invasive nonsurgical ablation options, as alternatives to surgery, is highlighted.

Free access
Aglaia Kyrilli A Kyrilli, Endocrinology, , Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), 808 Route de Lennik, 1070 Brussels, Brussels, Belgium

Search for other papers by Aglaia Kyrilli in
Google Scholar
PubMed
Close
,
Nunzia Tacelli N Tacelli, Radiology, , Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), 808 Route de Lennik, 1070 Brussels, Brussels, Belgium

Search for other papers by Nunzia Tacelli in
Google Scholar
PubMed
Close
,
Laetitia Lebrun L Lebrun, Pathology, , Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), 808 Route de Lennik, 1070 Brussels, Brussels , Belgium

Search for other papers by Laetitia Lebrun in
Google Scholar
PubMed
Close
,
Isabelle Salmon I Salmon, Pathology, , Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), 808 Route de Lennik, 1070 Brussels, Brussels , Belgium

Search for other papers by Isabelle Salmon in
Google Scholar
PubMed
Close
,
Gilles Russ G Russ, Centre de Pathologie et d'Imagerie, 75014 - PARIS 14, France

Search for other papers by Gilles Russ in
Google Scholar
PubMed
Close
,
Rodrigo Moreno-Reyes R Moreno-Reyes, Department of Nuclear Medicine, , Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), 808 Route de Lennik, 1070 Brussels, Brussels, Belgium

Search for other papers by Rodrigo Moreno-Reyes in
Google Scholar
PubMed
Close
, and
Bernard Corvilain B Corvilain, Endocrinology, , Hôpital Universitaire de Bruxelles (H.U.B.)– Hôpital Erasme, Université Libre de Bruxelles (ULB), 808 Route de Lennik, 1070 Brussels, Brussels, Belgium

Search for other papers by Bernard Corvilain in
Google Scholar
PubMed
Close

Objectives:

To evaluate in consecutive patients the clinical, ultrasound (US) and when indicated the cytological and histological characteristics of autonomously functioning thyroid nodules (AFTN).

Methods:

We conducted a prospective, single-center study from March 2018 until September 2021, in 901 consecutive patients referred for thyroid work up with a total of 67 AFTN evaluated. All enrolled patients underwent 99mTcO4- scintigraphy, additional 123I scintigraphy only in case of normal serum TSH, evaluation of thyroid function, US examination using European Thyroid Imaging and Reporting Data System (EU-TIRADS), and US-guided fine needle aspiration (FNA) cytology when indicated. All indeterminate FNA samples were subjected to DNA sequencing analysis.

Results:

More than half of the evaluated patients with AFTN were euthyroid; median serum TSH was 0.41 (IQR: 0.03-0.97) mU/L. The median AFTN size measured by US was 27.0 (IQR: 21.1-35.0) mm. 28.4% of AFTN were classified as EU-TIRADS score 3 and 71.6% as EU-TIRADS score 4, indicating that the majority of AFTN had intermediate risk for malignancy according to US. Out of the 47 AFTN subjected to cytological evaluation, 24 (51%) yielded indeterminate FNA results. DNA sequencing revealed pathogenic TSHR and GNAS mutations in 60% of cases. No malignancy was detected at final histology in surgically excised AFTN (N=12).

Conclusions:

Among the 67 AFTN evaluated in this study, 50% presented with normal serum TSH, 70% displayed ultrasound features suggesting an intermediate malignancy risk and 50% of the AFTN submitted to cytology yielded indeterminate results. No malignant AFTN was detected.

Open access
Giovanni Mauri Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy

Search for other papers by Giovanni Mauri in
Google Scholar
PubMed
Close
,
Laszlo Hegedüs Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark

Search for other papers by Laszlo Hegedüs in
Google Scholar
PubMed
Close
,
Steven Bandula Interventional Oncology Service, University College Hospital, London, United Kingdom

Search for other papers by Steven Bandula in
Google Scholar
PubMed
Close
,
Roberto Luigi Cazzato Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France

Search for other papers by Roberto Luigi Cazzato in
Google Scholar
PubMed
Close
,
Agnieszka Czarniecka The Oncologic and Reconstructive Surgery Clinic, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland

Search for other papers by Agnieszka Czarniecka in
Google Scholar
PubMed
Close
,
Oliver Dudeck Center for Microtherapy, Klinik Hirslanden, Zurich, Switzerland

Search for other papers by Oliver Dudeck in
Google Scholar
PubMed
Close
,
Laura Fugazzola Department of Endocrinology and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

Search for other papers by Laura Fugazzola in
Google Scholar
PubMed
Close
,
Romana Netea-Maier Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands

Search for other papers by Romana Netea-Maier in
Google Scholar
PubMed
Close
,
Gilles Russ Thyroid and Endocrine Tumors Unit, La Pitie-Salpetriere Hospital, Sorbonne University, Paris, France

Search for other papers by Gilles Russ in
Google Scholar
PubMed
Close
,
Göran Wallin Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

Search for other papers by Göran Wallin in
Google Scholar
PubMed
Close
, and
Enrico Papini Department of Endocrinology & Metabolism, Ospedale Regina Apostolorum, Albano, Italy

Search for other papers by Enrico Papini in
Google Scholar
PubMed
Close

The growing detection of papillary thyroid microcarcinomas (PTMCs) is paralleled by an increase in surgical procedures. Due to the frequent indolent nature, cost, and risk of surgery, active surveillance (AS) and ultrasound-guided minimally invasive treatments (MITs) are in suitable cases of incidental PTMC proposed as alternatives to thyroidectomy. Surgery and radioiodine are the established treatments for relapsing cervical differentiated thyroid carcinoma (DTC) metastases. But radioiodine refractoriness, risk of surgical complications, adverse influence on quality of life, or declining repeat surgery have led to AS and MIT being considered as alternatives for slow-growing DTC nodal metastases. Also, for distant radioiodine-refractory metastases not amenable to surgery, MIT is proposed as part of a multimodality therapeutic approach. The European Thyroid Association and the Cardiovascular and Interventional Radiological Society of Europe commissioned these guidelines for the appropriate use of MIT. Based on a systematic PubMed search, an evidence-based approach was applied, and both knowledge and practical experience of the panelists were incorporated to develop the manuscript and the specific recommendations. We recommend that when weighing between surgery, radioiodine, AS, or MIT for DTC, a multidisciplinary team including members with expertise in interventional radiology assess the demographic, clinical, histological, and imaging characteristics for appropriate selection of patients eligible for MIT. Consider TA in low-risk PTMC patients who are at surgical risk, have short life expectancy, relevant comorbidities, or are unwilling to undergo surgery or AS. As laser ablation, radiofrequency ablation, and microwave ablation are similarly safe and effective thermal ablation (TA) techniques, the choice should be based on the specific competences and resources of the centers. Use of ethanol ablation and high-intensity focused ultrasound is not recommended for PTMC treatment. Consider MIT as an alternative to surgical neck dissection in patients with radioiodine refractory cervical recurrences who are at surgical risk or decline further surgery. Factors that favor MIT are previous neck dissection, presence of surgical complications, small size metastases, and <4 involved latero-cervical lymph nodes. Consider TA among treatment options in patients with unresectable oligometastatic or oligoprogressive distant metastases to achieve local tumor control or pain palliation. Consider TA, in combination with bone consolidation and external beam radiation therapy, as a treatment option for painful bone metastases not amenable to other established treatments.

Free access
Gilles Russ Thyroid and Endocrine Tumors, Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France

Search for other papers by Gilles Russ in
Google Scholar
PubMed
Close
,
Steen J. Bonnema Department of Endocrinology, Odense University Hospital, Odense, Denmark

Search for other papers by Steen J. Bonnema in
Google Scholar
PubMed
Close
,
Murat Faik Erdogan Department of Endocrinology and Metabolism, University of Ankara School of Medicine, İbni Sina Hastanesi, Ankara, Turkey

Search for other papers by Murat Faik Erdogan in
Google Scholar
PubMed
Close
,
Cosimo Durante Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy

Search for other papers by Cosimo Durante in
Google Scholar
PubMed
Close
,
Rose Ngu Head Neck and Thyroid Imaging, Department of Radiology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom

Search for other papers by Rose Ngu in
Google Scholar
PubMed
Close
, and
Laurence Leenhardt Thyroid and Endocrine Tumors, Institute of Endocrinology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France

Search for other papers by Laurence Leenhardt in
Google Scholar
PubMed
Close

Thyroid ultrasound (US) is a key examination for the management of thyroid nodules. Thyroid US is easily accessible, noninvasive, and cost-effective, and is a mandatory step in the workup of thyroid nodules. The main disadvantage of the method is that it is operator dependent. Thyroid US assessment of the risk of malignancy is crucial in patients with nodules, in order to select those who should have a fine needle aspiration (FNA) biopsy performed. Due to the pivotal role of thyroid US in the management of patients with nodules, the European Thyroid Association convened a panel of international experts to set up European guidelines on US risk stratification of thyroid nodules. Based on a review of the literature and on the American Association of Clinical Endocrinologists, American Thyroid Association, and Korean guidelines, the panel created the novel European Thyroid Imaging and Reporting Data System, called EU-TIRADS. This comprises a thyroid US lexicon; a standardized report; definitions of benign and low-, intermediate-, and high-risk nodules, with the estimated risks of malignancy in each category; and indications for FNA. Illustrated by numerous US images, the EU-TIRADS aims to serve physicians in their clinical practice, to enhance the interobserver reproducibility of descriptions, and to simplify communication of the results.

Free access
Tamas Solymosi Endocrinology and Metabolism Clinic, Bugat Hospital, Gyöngyös, Hungary

Search for other papers by Tamas Solymosi in
Google Scholar
PubMed
Close
,
Laszlo Hegedüs Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark

Search for other papers by Laszlo Hegedüs in
Google Scholar
PubMed
Close
,
Steen Joop Bonnema Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark

Search for other papers by Steen Joop Bonnema in
Google Scholar
PubMed
Close
,
Andrea Frasoldati Endocrinology Unit of Arcispedale S. Maria Nuova, Reggio Emilia, Italy

Search for other papers by Andrea Frasoldati in
Google Scholar
PubMed
Close
,
Laszlo Jambor Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

Search for other papers by Laszlo Jambor in
Google Scholar
PubMed
Close
,
Gabor Laszlo Kovacs 1st Department of Medicine, Flohr Ferenc Hospital, Kerepestarcsa, Hungary

Search for other papers by Gabor Laszlo Kovacs in
Google Scholar
PubMed
Close
,
Enrico Papini Regina Apostolorum Hospital in Albano, Rome, Italy

Search for other papers by Enrico Papini in
Google Scholar
PubMed
Close
,
Karoly Rucz 1st Department of Medicine, University of Pecs, Pecs, Hungary

Search for other papers by Karoly Rucz in
Google Scholar
PubMed
Close
,
Gilles Russ Unité Thyroïde et Tumeurs Endocrines – Pr Leenhardt Hôpital La Pitie Salpetriere, Sorbonne Université, Paris, France

Search for other papers by Gilles Russ in
Google Scholar
PubMed
Close
,
Zsolt Karanyi Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

Search for other papers by Zsolt Karanyi in
Google Scholar
PubMed
Close
, and
Endre V. Nagy Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

Search for other papers by Endre V. Nagy in
Google Scholar
PubMed
Close

Background: Thyroid nodule image reporting and data systems (TIRADS) provide the indications for fine-needle aspiration (FNA) based on a combination of nodule sonographic features and size. We compared the TIRADS-based recommendations for FNA with those based on the personal expertise of qualified US investigators in the diagnosis of thyroid malignancy. Methods: Seven highly experienced ultrasound (US) investigators from 4 countries evaluated, online, the US video recordings of 123 histologically verified thyroid nodules. Technical resources provided the operators with a diagnostic approach close to the real-world practice. Altogether, 4,305 TIRADS scores were computed. The combined diagnostic potential of TIRADS (TIRSYS) and the personal recommendations of the investigators (PERS) were compared against 3 possible goals: to recognize all malignant lesions (allCA), nonpapillary plus non-pT1 papillary cancers (nPnT1PCA), or stage II-IV cancers (st2-4CA). Results: For allCA and nPnT1PCA, TIRSYS had lower sensitivity than PERS (69.8 vs. 87.2 and 83.5 vs. 92.6%, respectively, p <0.01), while in st2-4CA the sensitivities were the same (99.1 vs. 98.6% and TIRSYS vs. PERS, respectively). TIRSYS had a higher specificity than PERS in all 3 types of cancers (p < 0.001). PERS recommended FNA in a similar proportion of lesions smaller or larger than 1 cm (76.9 vs. 82.7%; ns). Conclusions: Recommendations for FNA based on the investigators’ US expertise demonstrated a better sensitivity for thyroid cancer in the 2 best prognostic groups, while TIRADS methodology showed superior specificity over the full prognostic range of cancers. Thus, personal experience provided more accurate diagnoses of malignancy, missing a lower number of small thyroid cancers, but the TIRADS approach resulted in a similar accuracy for the diagnosis of potentially aggressive lesions while sparing a relevant number of FNAs. Until it is not clearly stated what the goal of the US evaluation is, that is to diagnose all or only clinically relevant thyroid cancers, it cannot be determined whether one diagnostic approach is superior to the other for recommending FNA.

Free access
Cosimo Durante Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy

Search for other papers by Cosimo Durante in
Google Scholar
PubMed
Close
,
Laszlo Hegedüs Department of Endocrinology, Odense University Hospital, Odense, Denmark

Search for other papers by Laszlo Hegedüs in
Google Scholar
PubMed
Close
,
Agnieszka Czarniecka M. Sklodowska-Curie National Research, Institute of Oncology Gliwice Branch, Gliwice, Poland

Search for other papers by Agnieszka Czarniecka in
Google Scholar
PubMed
Close
,
Ralf Paschke Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

Search for other papers by Ralf Paschke in
Google Scholar
PubMed
Close
,
Gilles Russ Thyroid and Endocrine Tumors Department, Pitié-Salpêtrière Hospital, Sorbonne University GRC N°16, Paris, France

Search for other papers by Gilles Russ in
Google Scholar
PubMed
Close
,
Fernando Schmitt Faculty of Medicine of University of Porto, CINTESIS@RISE and Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal

Search for other papers by Fernando Schmitt in
Google Scholar
PubMed
Close
,
Paula Soares Institute of Investigation and Innovation in Health (I3S), Faculty of Medicine of the University of Porto, Porto, Portugal

Search for other papers by Paula Soares in
Google Scholar
PubMed
Close
,
Tamas Solymosi Endocrinology and Metabolism Clinic, Bugat Hospital, Gyöngyös, Hungary

Search for other papers by Tamas Solymosi in
Google Scholar
PubMed
Close
, and
Enrico Papini Department of Endocrine and Metabolic Diseases, Regina Apostolorum Hospital, Albano, Rome, Italy

Search for other papers by Enrico Papini in
Google Scholar
PubMed
Close

With the widespread use of sensitive imaging techniques, which include neck visualization, a conspicuous number of thyroid nodules emerge and demand attention. Most lesions are benign, asymptomatic, and do not warrant treatment. In the case of cancer diagnosis, most are small, intrathyroidal and indolent neoplasms that can safely be managed conservatively. There is a pronounced need for more cost-effective, risk-adapted approaches to the management of this highly prevalent condition, taking the wishes of the patient into consideration. Thus, the present guidelines aim at providing a clinical practice guide for the initial workup and the subsequent management of adult individuals harboring thyroid nodules. Importantly, these guidelines are not intended to cover the management of thyroid malignancy. The manuscript and the specific recommendations were developed by reconciling the best available research evidence with the knowledge and clinical experience of the panelists and updating aspects of a number of previous European Thyroid Association guidelines.

Open access
Tamas Solymosi Endocrinology and Metabolism Clinic, Bugat Hospital, Gyöngyös, Hungary
Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

Search for other papers by Tamas Solymosi in
Google Scholar
PubMed
Close
,
Laszlo Hegedűs Department of Endocrinology, Odense University Hospital, Odense, Denmark

Search for other papers by Laszlo Hegedűs in
Google Scholar
PubMed
Close
,
Steen J Bonnema Department of Endocrinology, Odense University Hospital, Odense, Denmark

Search for other papers by Steen J Bonnema in
Google Scholar
PubMed
Close
,
Andrea Frasoldati Endocrinology Unit of Arcispedale S Maria Nuova, Reggio Emilia, Italy

Search for other papers by Andrea Frasoldati in
Google Scholar
PubMed
Close
,
Laszlo Jambor Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

Search for other papers by Laszlo Jambor in
Google Scholar
PubMed
Close
,
Zsolt Karanyi Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

Search for other papers by Zsolt Karanyi in
Google Scholar
PubMed
Close
,
Gabor L Kovacs 1st Department of Medicine, Flohr Ferenc Hospital, Kistarcsa, Hungary

Search for other papers by Gabor L Kovacs in
Google Scholar
PubMed
Close
,
Enrico Papini Regina Apostolorum Hospital in Albano, Rome, Italy

Search for other papers by Enrico Papini in
Google Scholar
PubMed
Close
,
Karoly Rucz 1st Department of Medicine, University of Pecs, Pecs, Hungary

Search for other papers by Karoly Rucz in
Google Scholar
PubMed
Close
,
Gilles Russ Unité Thyroïde et Tumeurs Endocrines – Pr Leenhardt Hôpital La Pitie Salpetriere, Sorbonne Université, Paris, France

Search for other papers by Gilles Russ in
Google Scholar
PubMed
Close
, and
Endre V Nagy Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

Search for other papers by Endre V Nagy in
Google Scholar
PubMed
Close

Objective

Thyroid nodule ultrasound characteristics are used as an indication for fine-needle aspiration cytology, usually as the basis for Thyroid Imaging Reporting and Data System (TIRADS) score calculation. Few studies on interobserver variation are available, all of which are based on analysis of preselected still ultrasound images and often lack surgical confirmation.

Methods

After the blinded online evaluation of video recordings of the ultrasound examinations of 47 consecutive malignant and 76 consecutive benign thyroid lesions, 7 experts from 7 thyroid centers answered 17 TIRADS-related questions. Surgical histology was the reference standard. Interobserver variations of each ultrasound characteristic were compared using Gwet’s AC1 inter-rater coefficients; higher values mean better concordance, the maximum being 1.0.

Results

On a scale from 0.0 to 1.0, the Gwet’s AC1 values were 0.34, 0.53, 0.72, and 0.79 for the four most important features in decision-making, i.e. irregular margins, microcalcifications, echogenicity, and extrathyroidal extension, respectively. The concordance in the discrimination between mildly/moderately and very hypoechogenic nodules was 0.17. The smaller the nodule size the better the agreement in echogenicity, and the larger the nodule size the better the agreement on the presence of microcalcifications. Extrathyroidal extension was correctly identified in just 45.8% of the cases.

Conclusions

Examination of video recordings, closely simulating the real-world situation, revealed substantial interobserver variation in the interpretation of each of the four most important ultrasound characteristics. In view of the importance for the management of thyroid nodules, unambiguous and widely accepted definitions of each nodule characteristic are warranted, although it remains to be investigated whether this diminishes observer variation.

Open access