Indeterminate neoplasms (IN) represent the gray zone of thyroid cytology in which malignant and benign tumors cannot be discriminated. Recently, the approach by thin core needle biopsy has been proposed. Here we report a new thin core needle biopsy approach in 40 consecutive patients with thyroid IN at cytology. In this study, a 21-G needle was inserted into the nodule, advanced within the lesion, and moved ahead reaching extranodular tissue. The resulting sample allowed to evaluate the cytomorphology of nodular tissue, its relationship with extranodular parenchyma, and the nodule's capsule when present. All biopsies were adequate for diagnosis but one. Of the 39 adequate samples, 5 cases were papillary cancer as confirmed at histology, while 14 nodules avoided surgery because of Hürthle cell hyperplasia in thyroiditis (n = 6) and microfollicular adenomatous hyperplasia (n = 8). The remaining 20 cases were assessed as follicular neoplasms because of encapsulation and were evaluated by immunohistochemistry. Of these, 6 had positive markers in different degree and 1/6 has follicular cancer at histology, while the other 14 were benign after surgery. Overall, this approach by thin core needle biopsy identified benignancy in 14/40 (35 %) IN avoiding surgery. As a conclusion, thin core biopsy should help to discern the nature of thyroid lesions cytologically classified as indeterminate, and it should be used as a complementary test in thyroid nodule assessment.

The present study results link the systemic effects of induced periodontitis with changes in hepatic tissues such as microvesicular steatosis, likely caused by an increase in oxidative stress and lipid peroxidation. The findings from the present study implicate an association between a decrease of pericytes and liver disease caused by ligature-induced periodontitis in rats.

This study shows, as the first in a multicentre series, that FNA-CT sensitivity is higher than that of cytology in diagnosing MTC. To avoid false-negative MTC by cytology, CT measurement in aspiration needle washout is to be performed in all patients undergoing biopsy following high serum CT.

Recently, the core needle biopsy (CNB) has been proposed as a complementary test for thyroid nodules with inconclusive cytology by fine-needle aspiration (FNA). However, there have been no reports regarding patient comfort during and after CNB or tolerability of this procedure. Here we aimed to investigate and compare comfort with and tolerability of the CNB and FNA procedures. A 21 gauge needle was used for collection in CNB procedures, and a 23 gauge needle was used for collection in FNA procedures. Sixty-one consecutive patients underwent both biopsies and were asked to evaluate their comfort during and after these procedures by a structured questionnaire. A total of 58 (95 %) patients reported local pain during both biopsies. Two patients reported pain only during CNB, and one reported no pain. Mild pain was reported in 87 % of CNB cases. Local pain after biopsy was reported in 29 % of FNA and 45 % of CNB. The occurrence of pain in the first minutes following CNB was significantly higher than FNA (p = 0.008), while there was not a significant difference in pain at later time points after the procedures. Finally, patients were asked to evaluate the degree of tolerability of the two sampling techniques, and FNA and CNB were reported as tolerable in 82 and 83 %, respectively. The results from a questionnaire evaluating patients' comfort level showed no significant difference between the tolerability of CNB and FNA. This finding suggests that CNB may be performed with a reasonable level of patient comfort.

In thyroid nodule management, ultrasound (US) features, such as hypoechogenicity of the lesion, irregular\ud margins, microcalcifications, and intralesional vascular signal, alone or combined, have to be considered as suggestive for\ud malignancy. Because of the low prevalence of medullary thyroid cancer (MTC), a few papers analyzed US characteristics\ud associated with this cancer in small series, with controversial results. Aim of this study was to evaluate in MTC the US risk\ud factors of thyroid nodule. In this order, a series of nodules histologically proven as MTC and a group of nodules with\ud histology of papillary cancer (PTC) were retrospectively compared with a control group of benign nodule. Fifty percent\ud MTC were solid hypoechoic and 16% showed microcalcifications with significant difference with respect to the benign\ud group (p<0.05 for both parameters), while no significant difference was recorded regarding margins nor nodular\ud vascularization. The presence of at least one US risk feature was almost equal in MTC (58.3%) and controls (55.5%). On\ud the contrary, at least one US risk factor was significantly (p<0.001) more frequent in PTC than in benign group or MTC\ud series. This study showed low frequency of ultrasound features associated to PTC when analyzed in medullary cancer.\ud Because of the poor literature focusing on this topic, and the herein used design, these data contribute to the knowledge\ud about presentation of MTC at US. We advice for further prospective studies on larger series to define the US presentation\ud of this cancer type