Background: High-resolution real-time ultrasonography (US) can detect characteristics of thyroid nodules, but the US differentiation between malignant nodules and benign nodules is not well described. Hypothesis: Ultrasonography is useful for predicting malignancy of thyroid nodules. Design: A retrospective study of 329 thyroid nodules (Ն5 mm) in 309 patients comparing US characteristics and pathological results. Setting: A center for the treatment of thyroid diseases where about 1400 thyroid operations are performed per year. Patients: Between January 1 and June 30, 1999, 309 patients were examined by US before thyroidectomy. Main Outcome Measure: The US characteristics to predict malignancy for both follicular and nonfollicular neoplasms by means of multiple logistic regression analysis. Results: The sensitivity of preoperative US diagnosis was 86.5% for nonfollicular neoplasms and 18.2% for follicular neoplasms. The specificity was 92.3% and 88.7%, respectively. According to multiple logistic regression analysis, margin, shape, echo structure, echogenicity, and calcification were reliable indication of malignancy in nonfollicular neoplasms. According to a receiver operating characteristic curve constructed from this multiple logistic regression analysis, the best point not to overlook malignancy is the point at which sensitivity is 94% and specificity is 87%. The probability of malignancy at this point is greater than 0.2. For follicular neoplasms, ultrasonographic diagnosis was unreliable, even when multiple logistic regression analysis was applied. Conclusion: We can predict malignancy of nonfollicular neoplasms of the thyroid by using multiple logistic regression analysis based on only 5 features: margin, shape, echo structure, echogenicity, and calcification.

There is a continuous debate regarding the classification of thyroid follicular lesions and the term ''well-differentiated tumor of uncertain malignant potential (WDT-UMP)'' was recently introduced to cover this problematic spectrum of tumors. The objective of this study was to reappraise WDT-UMP using morphological, immunochemical, and molecular analysis and to shed more light on encapsulated thyroid follicular-patterned tumors. A total of 30 cases of WDT-UMP with equivocal papillary thyroid carcinoma-type nuclear changes (PTC-N) or focal unequivocal PTC-N were examined. As a control, follicular adenoma (n = 29), follicular carcinoma (n = 8), hyalinizing trabecular adenoma (n = 5), and PTC (n = 48) were included. HBME-1, cytokeratin 19, and galectin-3 were positive in 12 (40.0%), 10 (33.3%) and 11 (36.7%) cases of WDT-UMP, respectively. According to the positivity of those markers, significant differences were obtained between WDT-UMP and PTC encapsulated common type (P = 0.028, 0.010, and 0.004, respectively), infiltrative follicular variant (P = 0.020, 0.026, and 0.008, respectively), and infiltrative common type (P = 0.004, 0.001, and 0.005, respectively), but not between WDT-UMP and follicular adenoma or follicular carcinoma. BRAF V600E mutation was absent but RET ⁄ PTC1 rearrangement was found in only two (6.7%) cases of WDT-UMP. None of the 20 patients with WDT-UMP developed recurrence, with an average follow-up of 80 months. These findings indicate that WDT-UMP has a favorable outcome and is distinct from PTC in morphological, immunohistochemical, and molecular characteristics. We propose that WDT-UMP should be classified as ''welldifferentiated tumor with uncertain behavior ''. (Cancer Sci 2011; 102: 288-294) P apillary thyroid carcinoma-type nuclear changes (PTC-N) are the most reliable morphological features in the diagnosis of PTC, which include nuclear enlargement, nuclear overlapping, nuclear clearing, nuclear grooves, and cytoplasmic pseudoinclusions. In published reports and textbooks, nuclear changes are the diagnostic criteria for malignancy in thyroid tumor, regardless of whether or not the tumor has a capsule, is invasive, or has a papillary growth pattern. (1) However, there are exceptions, and PTC-N are not evident in columnar cell variant or cribriform-morular variant PTC. (2,3) They can be also found in benign lesions, such as hyalinizing trabecular adenoma (HTA) and Hashimoto thyroiditis. (4,5) We doubt that these PTC-N are the golden standard of malignancy, although the majority of PTC do have them. Many pathologists are also aware that the distinctions between follicular adenoma (FTA), encapsulated PTC, and follicular carcinoma (FTC) are not always clear-cut. When PTC-N are equivocal or incomplete, significant disagreement occurs in the diagnosis of those tumors. (6)(7)(8)(9)(10)(11)(12) Therefore, in 2000, Williams (13) proposed a new diagnostic terminology, that is, WDT-UMP for capsulated follicular-pattern tumors with equivocal PTC-N and without definite invasion. This gr...

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The disturbance of vitamin D metabolism plays an important role in determining the clinical presentation of hyperthyroidism. We studied 72 patients (65 women, 7 men) with primary hyperparathyroidism (pHPT). Clinical presentation, biochemical indices, and bone mineral density (BMD) were compared in three patient groups classified according to their serum 25-hydroxyvitamin D (25OHD) levels: 23 patients whose 25OHD level was <25 nmol/L comprised the low group, 26 whose level was 25 to 40 nmol/L made up the intermediate group, and 23 whose level was > 40 nmol/L comprised the high group. The mean serum calcium level was 10.8 +/- 0.9 mg/dl, and the mean weight of the resected parathyroids was 684 +/- 749 mg. The mean serum 25OHD level was 36.5 +/- 16.3 nmol/L (normal 25-100 nmol/L). Levels were below normal in 23 patients (32%). No between-group differences existed for clinical presentation, biochemistry, or BMD. Only differences in mean patient age were statistically significant between groups. Vitamin D deficiency is common among Japanese patients with pHPT, but the effects of HPT on clinical, biochemical, and densitometric indices are not pronounced. Our study population was at an early stage of pHPT, so the vitamin D deficiency may not be associated with the effects of HPT.

Hypothesis: Some controversy exists concerning the appropriate surgical management for patients with thyroid cancer invading the laryngotracheal wall. We have used shaving of the wall when cancer invasion was confined to the perichondrium, and extensive resection when it invaded further. Preoperative assessment of the depth and length of laryngotracheal invasion is important when choosing an appropriate surgical procedure.