A predictive model to distinguish malignant and benign thyroid nodules based on age, gender and ultrasonographic features

Publication date: Available online 4 November 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Fábio Muradás Girardi, Laura Mezzomo da Silva, Cecilia Dias Flores
IntroductionA discussion in literature about a standardized decision support tool for the management of thyroid nodules remains.ObjectiveThe purpose of this study was to create a statistical prediction model for thyroid nodules management.MethodsTwo hundred and four benign and 57 malignant thyroid nodules were selected for a retrospective study. The variables age, gender and ultrasonographic features were examined using univariate and multivariate models. A statistical formula was used to calculate the risk of cancer of each case.ResultsIn multivariate analysis, irregular shape, absence of halo, lower mean age, homogeneous echotexture, microcalcifications and solid content were associated with cancer. After applying the formula, 20 cases (7.6%) with a calculated risk for malignancy ≤3.0% were found, all of them benign. Setting the calculated risk in ≥80%, 21 (8.0%) cases were selected, and in 85.7% of them cancer was confirmed in histopathology. Internal accuracy of the prediction formula was 92.5%.ConclusionsThe prediction formula reached high accuracy and may be an alternative to other decision support tools for thyroid nodule management.



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Metastatic non-small cell lung carcinoma a mimic of primary breast carcinoma—case series and literature review

Abstract

Metastatic tumors to the breast are rare but constitute a major diagnostic dilemma. Of these, non-mammary carcinomatous metastases to the breast are particularly challenging and, without a clinical history, may be extremely difficult to distinguish from primary breast carcinoma (PBC). We specifically studied metastatic tumors of pulmonary origin, as the lung is one of the major primary sites for carcinomatous metastasis to breast. Sixteen metastatic lung tumors to the breast were identified in our archives between 1996 and 2017 including 12 non-small cell lung carcinomas (NSCLC), one large-cell neuroendocrine, one atypical carcinoid, and two small-cell carcinomas. Adenocarcinoma was the most frequent amongst the NSCLCs (11/14). We retrieved the clinical information of these cases and reviewed the pathological characteristics to provide practical tools for pathologists to aid in their identification. Even in the absence of a clinical history of lung cancer, metastatic pulmonary adenocarcinoma to the breast should be considered in at least one of the following scenarios: (1) single or multiple well-circumscribed lesions of the breast that lack an in situ component and that are accompanied by distant metastases but negative axillary lymph nodes, (2) breast tumors that are triple negative yet not high-grade, or (3) breast tumors presenting as stage 4 disease and/or having an unusually aggressive clinical course on standard breast therapy. Accurate and timely diagnosis of these tumors is mandatory because of treatment and prognostic implications.

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Negative selection, epitope mimicry and autoimmunity

Noel R Rose

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Extreme Violence and the Invisibility of Women Who Murder: The Intersectionality of Gender, Race, Ethnicity, Sexual Orientation, and Gender Identity Equals Silence

Violence and Gender , Vol. 0, No. 0.


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Debates in allergy, regarding the symposium on: “Position Statements and Therapeutic Guidelines”

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): P. Rodríguez del Río, A. Cisteró-Bahima, R. van Ree




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Predictive biomarkers in allergen specific immunotherapy

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): D. Barber, M.M. Escribese




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Biologics in the treatment of severe asthma

Publication date: Available online 3 November 2017
Source:Allergologia et Immunopathologia
Author(s): S. Quirce, E. Phillips-Angles, J. Domínguez-Ortega, P. Barranco
Severe asthma is defined as asthma which requires treatment with high dose inhaled corticosteroids and with a second controller drug to prevent it from becoming uncontrolled or which remains uncontrolled despite this therapy. Patients with uncontrolled severe asthma require additional treatment options as add-on therapy, including biologics. Biologic therapies in asthma are designed to block key immune regulators, such as IgE, or certain pro-inflammatory cytokines, e.g. interleukin (IL)-5, IL-4, IL-13 or IL-17. Patients with severe asthma and eosinophilic phenotype may benefit from biologic therapies aimed at reducing blood and tissue eosinophils, such as mepolizumab, reslizumab and benralizumab. Patients with Th2-high phenotype may also benefit from therapy with anti-IL-4/anti-IL-13 monoclonal antibodies (dupilumab). The main limitations of asthma treatment with biologic agents are the crossover and overlap of the different pathways in the pathogenesis of asthma which may cause lack of complete success of these therapies, in addition of high costs, which make pharmacoeconomic studies necessary to identify the ideal target patient population to receive these biologic drugs.



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