False-positive cytopathology results for papillary thyroid carcinoma: A trap for thyroid surgeons

Abstract

Objectives

Current preoperative diagnosis of thyroid nodules remains imperfect despite recent advances in cytopathology and molecular diagnostics. False-positivity in preoperative fine needle aspiration cytology (FNAC) may lead to overtreatment of patients, including total thyroidectomy, and sometimes to lawsuits for misdiagnosis and malpractice. In this study, we analyzed clinical characteristics and pathologic findings in patients with false-positivity for papillary thyroid carcinoma (PTC) in FNAC.

Methods

We retrospectively reviewed permanent pathology results from 3788 patients who underwent thyroid surgery. Among them, 48 patients had lesions that were deemed suspicious or positive (Bethesda class V or VI) for PTC in preoperative FNAC. We reviewed clinic-pathologic data, radiologic findings and surgical planning in these patients.

Results

The prevalence of pathologic thyroiditis was significantly higher among patients with false-positive FNAC results than in those with confirmed PTC (54.2% versus 9.2%, P < 0.001). The analysis of the permanent pathology reports showed that 26 patients had chronic lymphocytic thyroiditis and 22 patients had no evidence of thyroiditis. Among the patients without pathologic thyroiditis, 19 patients (86.4%) had nodular hyperplasia and 3 (13.6%) had follicular adenoma, while among the patients with pathologic thyroiditis, 7 (26.9%) had no nodule, 14 (53.8%) had nodular hyperplasia, 2 (7.7%) had hyalinized nodules, 2 (7.7%) had follicular adenoma, and 1 (3.8%) had a hyalinizing trabecular tumor. In 42 patients, the extent of surgery (total thyroidectomy or hemithyroidectomy) was to be determined according to intraoperative frozen section biopsy results. Among them, 4 (10.5%) had inconclusive frozen section results, and 38 (90.5%) had benign results on frozen section.

Conclusions

Patient counseling about the possibility of false-positivity is still important. And the presence of thyroiditis might create confusion in the interpretation of cytopathologic results.

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A Retrospective Analysis of Seven Patients with Acquired Immunodeficiency Syndrome and Pharyngeal and/or Laryngeal Talaromyces marneffei Infection

Abstract

1.Talaromyces marneffei, formerly known as Penicillium marneffei, usually affects the monocyte-macrophage system and can cause fatal systemic mycosis in immunocompromised individuals. This retrospective study is the first to describe the clinical and endoscopic (nasal endoscopy, flexible endoscopy) features of penicilliosis with pharynx and/or larynx infection in patients with acquired immunodeficiency syndrome (AIDS).

2.During the study period, 126 patients were diagnosed with penicilliosis. Among them, only seven who presented with culture and/or histopathological evidence of pharyngeal and/or laryngeal T. marneffei infection were included; notably, all of these patients also had AIDS.

3.The most common specific pharyngeal and laryngeal features were sore throat, hoarseness, dysphagia, a pharyngeal and laryngeal mass and/or mucosal ulcerations, and enlargement of multiple cervical and axillary lymph nodes. Evaluation using nasal endoscopy and flexible endoscopy revealed pharyngeal and laryngeal ulcers and/or a mass.

4.Histopathological analysis of all pharyngeal and/or laryngeal tissue samples in our retrospective study revealed positivity for T. marneffei. The most common pathological type was non-reactive necrosis.

5.Histopathology and fungal culture of pharyngeal and laryngeal secretions and tissues are important and safe methods that allow determination of an accurate etiological basis for penicilliosis with pharyngeal and/or laryngeal infection, as well as differentiation from other diseases such as tuberculosis, lymphoma, pharyngeal cancer, and Kaposi's sarcoma.

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Workload and Costs of Audiological Assessment on Tertiary Settings: Data Analysis and Audit

Abstract

It is estimated that hearing impairment affects 850,000 people in Scotland. In a tertiary, referral centre this number reflects over 32,000 of referrals to the department of audiology per annum.

The number of referrals has increased reaching a plateau; in 2015 the number of referrals reached 32,422. The total number of hearing aid fittings carried out each year is on the rise.

Within this tertiary centre covering eight hospitals and a catchment area of 1.16 million people, the annual cost of hearing aids exceeds £1.5 million, not including repairs, batteries and accessories.

Referral to hearing aid ratio varies between different hospitals; this possibly indicates a significant impact of the socioeconomic status to hearing aid acceptance/ provision/ follow up appointments.

The consistently high numbers are likely to place a substantial burden upon the workload within the tertiary centre itself and have corresponding financial implications upon the NHS budget.

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Fibrin sealants in soft-tissue surgery of the head and neck: a systematic review and meta-analysis of randomised controlled trials

Abstract

Background

Fibrin sealants (FS) are commercially available products used in surgical wounds as adjuncts to haemostasis and closure of dead space. The role of FS in soft-tissue head and neck surgery has not been established.

Objectives

To assess if FS improves wound related outcomes in patients undergoing soft-tissue surgery of the head and neck anatomical region that would commonly require a drain.

Type Of Review

Systematic review and meta-analysis of randomised controlled trials (RCTs).

Search Strategy

Medline (1946 – 2016), EMBASE (1974 – 2016), PubMed (2016), CENTRAL (2016), ClinicalTrials. gov (2016), WHO International Clinical Trials Registry and Platform (2016), Research Gate (2016).

Evaluation Method

Two independent reviewers screened and selected studies. Included studies were assessed for risk of bias and data extracted using a predetermined data collection form.

Results

Of the 421 studies that were screened 11 RCTs met the inclusion criteria. There were 2 RCTs on thyroidectomy, 3 on 'surgery involving neck dissection' (central or lateral), 5 on rhytidectomy and 1 on parotidectomy. There was a tendency for FS to reduce 'mean total drainage volume' (mean difference -26.86ml, 95%CI -43.41 to -10.31, I²=97%, p=0.001). Sub-group analysis of thyroidectomy (mean difference -36.36ml, 95%CI -72.82 to 0.10, I²=79%, p=0.05), 'surgery involving neck dissection' (mean difference -33.21ml, 95%CI -70.01 to 3.59, I²=94%, p=0.08) and rhytidectomy (mean difference -13.79ml, 95%CI -17.57 to -10.01, I²=0%, p<0.00001) concurred with the overall analysis. There was a suggestion that FS may reduce 'mean retention time of drains' by 1.24 days (95%CI -3.32 to 0.85, I²=99%, p=0.25) and 'hospital length of stay' by 2.09 days (95% CI -5.18 to 0.99, I²=97%, p=0.18) but this was not statistically significant. There was also a suggestion that FS may protect against adverse events (RR 0.69, 95%CI 0.35 to 1.38, I²=0%, p=0.29) and haematoma/seroma formation (RR 0.49, 95%CI 0.22 to 1.07, I²=0%, p=0.07).

Conclusions

There was considerable heterogeneity within the RCTs included in this study thus restricting definitive conclusions. FS has however shown a definite benefit in rhytidectomy and potential benefit in other soft-tissue head and neck surgical procedures. Further pragmatic trials are required particularly in the field of lateral neck dissection.

This article is protected by copyright. All rights reserved.

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Editorial Board/Reviewing Committee

Publication date: March 2017
Source:International Journal of Oral and Maxillofacial Surgery, Volume 46, Issue 3





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Influence of temporomandibular joint disc displacement on mandibular advancement in patients without pre-treatment condylar resorption

Publication date: March 2017
Source:International Journal of Oral and Maxillofacial Surgery, Volume 46, Issue 3
Author(s): Z. Miao, X.-d. Wang, L.-x. Mao, Y.-h. Xia, L.-j. Yuan, M. Cai, J.-q. Liu, B. Wang, X. Yang, L. Zhu, H.-b. Yu, B. Fang
The purpose of this study was to clarify the correlation between pre-treatment anterior disc displacement and mandibular stability after orthognathic and orthodontic treatment among patients with a skeletal class II malocclusion and without pre-treatment condylar resorption. Thirty-seven patients were included (7 male, 30 female). The mean length of follow-up was 6.76±3.06 years. Patients with condylar resorption before treatment were excluded. Magnetic resonance images and lateral cephalometric radiographs were taken before treatment (T0), after treatment (T1), and at follow-up (T2). Patients were classified according to the degree of disc displacement: −10–10° 'normal', 11–50° 'slight to mild', ≥51° 'moderate to severe'. Results showed the condyle moved posterosuperiorly after treatment, and then moved anteriorly to a more concentric location during the long follow-up period. Condylar movement was found not to correlate with disc displacement. The degree of disc displacement before treatment did not correlate with the post-surgical mandibular positional change in either the sagittal or vertical direction. To conclude, the mandibular bilateral sagittal split ramus osteotomy was stable in the long-term after orthognathic and orthodontic treatment. In the absence of pre-treatment condylar resorption, the degree of initial anterior disc displacement did not have a significant influence on the stability of mandibular advancement.



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Calendar of Events

Publication date: March 2017
Source:International Journal of Oral and Maxillofacial Surgery, Volume 46, Issue 3





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