Estructura diagnóstica y funcional de una consulta de alta resolución de nódulo tiroideo

Fernández‐García, José Carlos; Mancha-Doblas, Isabel; Ortega-Jiménez, María Victoria; Ruiz-Escalante, José Francisco; Castells-Fusté, Ignasi; Tofé, Santiago; Argüelles, Iñaki; Tinahones, Francisco J.

doi:10.1016/j.endonu.2013.09.004

Cited by 26 publications

(5 citation statements)

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“…High-resolution clinical units have been widely implemented in some areas of medicine [27,28], especially in the cardiology area, showing positive results, with 70% of patients obtaining a diagnosis and treatment of their medical condition on the same day [29]. Similarly, these high-resolution nodule clinics have been shown not only to be cost-effective [29] but also to reduce the delay in diagnosis and to improve patients' satisfaction [9,29]. Along this line, our nondiagnostic FNA (Bethesda I) rate (4.3%) was lower than the usually reported rate of 8%-20% in several studies [30].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, in some centers, the diagnostic workup of a thyroid nodule involves a significant number of medical visits, a long delay, and a significant inconvenience for patients (loss of working hours, economic impact, and anxiety due to diagnosis delay). The implementation of high-resolution thyroid nodule clinics (HR-TNC) provide a one-stop thyroid nodule evaluation that includes focused medical assessment, US examination, and FNA, all performed within a 60 min appointment [9].…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Ultrasound Thyroid Nodule Characteristics and Their Association with Cytological and Histopathological Outcomes: A Retrospective Multicenter Study in High-Resolution Thyroid Nodule Clinics

Molina-Vega

Rodríguez-Pérez

Álvarez-Mancha

et al. 2019

JCM

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Introduction: Thyroid nodules are a common finding. A high-resolution thyroid nodule clinic (HR-TNC) condenses all tests required for the evaluation of thyroid nodules into a single appointment. We aimed to evaluate the clinical outcomes at HR-TNCs. Design and Methods: A retrospective cross-sectional multicenter study including data from four HR-TNCs in Spain. We evaluated fine-needle aspiration (FNA) indications and the association between clinical and ultrasound characteristics with cytological and histopathological outcomes. Results: A total of 2809 thyroid nodules were included; FNA was performed in 82.1%. Thyroid nodules that underwent FNA were more likely larger, isoechoic, with microcalcifications, and in younger subjects. The rate of nondiagnostic FNA was 4.3%. A solid component, irregular margins or microcalcifications, significantly increased the odds of Bethesda IV-V-VI (vs. Bethesda II). Irregular margins and a solid component were independently associated with increased odds of malignancy. Thyroid nodules <20 mm and ≥20–<40 mm had a 6.5-fold and 3.3-fold increased risk for malignancy respectively in comparison with those ≥40 mm. Conclusion: In this large multicenter study, we found that the presence of a solid component and irregular margins are factors independently related to malignancy in thyroid nodules. Since nodule size ≥40 mm was associated with the lowest odds of malignancy, this cut-off should not be a factor leading to indicate thyroid surgery. HR-TNCs were associated with a low rate of nondiagnostic FNA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical and Ultrasound Thyroid Nodule Characteristics and Their Association with Cytological and Histopathological Outcomes: A Retrospective Multicenter Study in High-Resolution Thyroid Nodule Clinics

Molina-Vega

Rodríguez-Pérez

Álvarez-Mancha

et al. 2019

JCM

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“…Informa con exactitud acerca del tamaño, así como de su estructura anatómica normal, fibrosa, ecogenicidad, posibles nódulos no apreciables a la palpación por su tamaño, localización posterior o incluso los retroesternales. Se realiza con cortes transversales y longitudinales de la tiroides y la exploración de las áreas vecinas, especialmente zonas carotideas y yugulares 35 . Describe el tamaño exacto de los nódulos con una sensibilidad de 2cm a 3mm, su localización intratiroidea y su naturaleza sólida, quística o mixta, así como su delimitación o no del resto del parénquima.…”

Section: Ecografía Tiroideaunclassified

Punción aspiración con aguja fina de nódulos tiroideos

et al. 2017

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La punción aspirativa con aguja fina es una técnica muy habitual en las últimas décadas, que interpretada por un citólogo experto proporciona una información muy valiosa, se basa en un método simple, mínimamente invasivo y preciso para diagnosticar masas superficiales tales como los nódulos tiroideos; definidos por la Asociación Tiroidea Americana como discretas lesiones dentro de la glándula tiroidea imagenológicamente distintas del parénquima tiroideo. En los nódulos fríos indica si la citología es benigna, dudosa o maligna, con escasas probabilidades de error. En los carcinomas papilares su fiabilidad se acerca al 100% e igualmente en los carcinomas anaplásicos y carcinomas medulares; no así en los adenomas foliculares que son indiferenciables de los carcinomas, por lo cual el diagnóstico de proliferación folicular no es definitivo hasta después de la cirugía cuando esté el informe histopatológico de la biopsia por parafina, que sí es concluyente. En esta revisión bibliográfica se abordan los referentes teóricos más actuales sobre la importancia de la punción aspiración con aguja fina en el estudio de las lesiones nodulares de la glándula tiroides, tanto a nivel nacional como internacional, si se tiene en cuenta la tendencia al incremento del cáncer de tiroides en el Ecuador.

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“…For this reason, many high-resolution thyroid nodule clinics (HR-TNCs) have been created in several hospitals throughout Spain [ 7 , 8 , 9 , 10 ]. The organization of these clinics varies between hospitals according to the needs of every institution and are adapted to the most efficient way to evaluate this pathology [ 11 ]. In 2014, a clinical pathway for thyroid nodules that included an HR-TNC was organized in our hospital.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Clinical Pathway for Thyroid Nodular Disease: Timings and Delays in the Diagnosis and Treatment of Thyroid Cancer

Sifontes-Dubón

García-López

González-Ortega

et al. 2021

JCM

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Background: Due to the high prevalence of nodular thyroid disease in the general population and the need to rule out malignant tumours, a clinical pathway for nodular thyroid disease was created at our tertiary-level hospital. Our study aimed to quantify timings and delays in diagnosis and treatment in this clinical pathway, specifically for patients who were diagnosed with thyroid cancer. Methods: A retrospective review was conducted of patients who were newly diagnosed with thyroid cancer and who had been previously evaluated in the clinical pathway for nodular thyroid disease at our institution during 2015–2017. Patient demographics, previous diagnostic studies, cytological results, tumour details and key dates were analysed to identify wait times in diagnosis and treatment. Results: Forty patients with thyroid cancer were included. The diagnostic delay had a median time of 60 days, and the treatment delay was dependent on cytopathological results. The main cause for delay in the diagnostic phase was the timing of the thyroid ultrasound performed by the radiology department. In the treatment phase, patients with a cytological result of Bethesda III, V or VI underwent surgery at the suggested time, while those in the Bethesda II or IV category did not. Conclusions: The major delay found in the diagnostic phase was the timing of the thyroid ultrasound performed by the radiology department. We are not suggesting that this step must be eliminated, though the implementation of routine ultrasonography in a thyroid clinic can help identify patients who need more urgent evaluation for fine needle aspiration cytology. In our hospital, decision for surgery is based mainly on the cytopathological report. Imaging studies and/or molecular testing could be considered to reduce treatment delays.

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Estructura diagnóstica y funcional de una consulta de alta resolución de nódulo tiroideo

Cited by 26 publications

References 27 publications

Clinical and Ultrasound Thyroid Nodule Characteristics and Their Association with Cytological and Histopathological Outcomes: A Retrospective Multicenter Study in High-Resolution Thyroid Nodule Clinics

Clinical and Ultrasound Thyroid Nodule Characteristics and Their Association with Cytological and Histopathological Outcomes: A Retrospective Multicenter Study in High-Resolution Thyroid Nodule Clinics

Punción aspiración con aguja fina de nódulos tiroideos

Evaluation of a Clinical Pathway for Thyroid Nodular Disease: Timings and Delays in the Diagnosis and Treatment of Thyroid Cancer

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