No abstract

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.

No abstract

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

Calcitonin measurement in washout of the needle after aspiration (WO-Ct) has been rarely evaluated. Here we analyzed the role of WO-Ct in a series of subjects who underwent fine needle aspiration (FNA) with suspicious medullary thyroid cancer (MTC). Twenty-one patients referred following elevated serum calcitonin (S-Ct) or suspicious MTC by cytology. All patients underwent re-evaluation of S-Ct, FNA, and measurement of WO-Ct. S-Ct and WO-Ct were assessed by chemiluminescence assay (IMMULITE 2000, Diagnostic Products Corporation, USA). S-Ct showed elevated value in six subjects (mean 368.8 ± 373.9 pg/ml), of which three cases were cytologically classified as Class 5. WO-Ct obtained in this group (304.0 ± 309.3 pg/ml) was no different from S-Ct. After surgery MTC was confirmed in all patients. In the other 15 patients MTC was excluded by cytology or histology. Two subjects had moderately skewed S-Ct with nonmedullary histology. In the remaining 13 patients S-Ct resulted normal (6.2 ± 5.6 pg/ml) and WO-Ct low (2.9 ± 2.2 pg/ml). Significant (two-tailed P < 0.05, r(2) = 0.27, 95% confidence interval = 0.017-0.81) correlation was found between S-Ct and WO-Ct in nonmedullary patients but not in MTC patients. This study showed that WO-Ct can play a role in diagnosing primary and metastatic MTC. The procedure is easy, cost effective, and should be used in patients undergoing FNA with elevated S-Ct. Further studies and guidelines for the method are needed to use this technique in clinical routine. Until this any institute should use itself cut-off.