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BACKGROUND Optical coherence tomography (OCT) is a noninvasive imaging modality that may reproduce the microarchitecture of tissues in real-time. This study examines whether OCT can render distinct images of thyroid, parathyroid glands, adipose tissue, and lymph nodes in both healthy and pathological states. METHODS Twenty-seven patients undergoing thyroidectomy, parathyroidectomy, and/or neck dissection for thyroid cancer were recruited prospectively for imaging prior to histopathological analysis. RESULTS Based on 122 imaged specimens, qualitative OCT descriptions were derived for healthy thyroid, parathyroid gland, adipose tissue, and lymph node. The frequencies at which distinguishing features were present for each tissue type were 88%, 83%, 100%, and 82%. OCT appearance of pathological specimens were also described. CONCLUSIONS Healthy neck tissues have distinct OCT appearances, which could facilitate parathyroid identification during thyroidectomies. However, images of parathyroid adenomas could be confused with those of lymph nodes, and benign and malignant thyroid nodules could not be differentiated.

There are presently a great number of publications pertaining to the clinical risk factors associated with thyroid cancer. These studies deal mostly with a single feature from either patient demographics, physical examination, laboratory values, imaging, or cytology. We sought to create a novel scoring system that integrates the diagnostic indices of each of these clinical features for carcinoma.A retrospective analysis of 1047 consecutive thyroidectomy patients was performed. Each patient was assigned a cancer risk score according to a newly devised 22-variable scoring scheme termed the McGill Thyroid Nodule Score (MTNS). The MTNS was developed by a multidisciplinary team of endocrinologists, thyroid surgeons, and pathologists using already established evidence-based risk factors for thyroid cancer.The exact incidence of malignancy was calculated for each MTNS score based on final pathology. The incidence for scores of 1 to 3 was 27%, of 4 to 7 was 32%, of 8 was 39%, of 9 to 11 was 63%, of 12 to 13 was 88%, and of 14 to 18 was 93%. All (130 of 130) patients with a score ≥ 19 had carcinoma. A score ≤ 8 correlated with a 32% (115 of 357) risk of thyroid cancer, whereas a score8 implied an 86% (417 of 487) risk.Our data suggest that a combined scoring system, the MTNS, can serve as an accurate predictor of the risk for thyroid cancer in a specific thyroid nodule. This will help physicians better formulate management decisions accordingly.

To assess the efficacy of ultrasound-guided thyroid fine-needle aspiration biopsies (USFNABs) performed in the office setting by an otolaryngologist and to evaluate the specimen adequacy of USFNABs performed in patients whose initial palpation-guided fine-needle aspiration biopsies (PGFNABs) were nondiagnostic.Retrospective chart review.Royal Victoria Hospital-McGill University Health Centre, Montreal.This is a retrospective analysis of 76 USFNABs performed by an otolaryngologist on consecutive patients over a 6-month period. Each patient had a previous nondiagnostic PGFNAB. Biopsies were performed using a 20-gauge fine needle with a Mylab25 Biosound Esoate ultrasound machine. Samples were then classified according to the adequacy of sample and pathologic findings.Specimen adequacy rate.Sixty-six patients underwent 76 USFNABs. The sample included 57 females and 9 males (mean age 51.1 and 55.4 years, respectively). The specimen adequacy rate was 90.8% (69 of 76). Among the adequate specimens, 2 (2.6%) were malignant, 6 (7.9%) were suspicious for malignancy, 43 (56.6%) were benign, and 18 (23.7%) were follicular or Hürthle cell lesions (indeterminate).Our experience demonstrates that USFNAB performed in the clinic by an otolaryngologist is a promising tool for improving specimen adequacy for nodules initially classified as nondiagnostic. USFNAB also avoids the need for radiologic consultation, thus improving efficacy in the workup of nodules.

To determine whether sentinel lymph node (SLN) biopsy can accurately predict central compartment metastasis in patients with differentiated thyroid carcinoma.Prospective clinical study.Academic tertiary care center.Ninety-eight patients (82 women and 16 men; mean age, 48.3 years) underwent a total thyroidectomy and central compartment dissection.Peritumoral injection of methylene blue dye, 1%, followed by SLN biopsy.The final pathology report established the presence of metastasis among SLNs and lymph nodes that did not stain blue (non-SLNs [NSLNs]).Differentiated thyroid carcinoma was found in 75 of 98 patients (77%). Seventy of 75 patients with differentiated thyroid carcinoma presented with SLNs and/or NSLNs within the central compartment. Fifteen of 70 patients had metastasis-positive SLNs, while 55 had metastasis-negative SLNs. Six of 15 patients with positive SLNs also had positive NSLNs. No patients with negative SLNs were found to have positive NSLNs. Sentinal lymph node status was a highly significant predictor of NSLN result (Fisher exact test, P.001). The accuracy, sensitivity, specificity, and positive and negative predictive values of SLN biopsy were 87%, 100%, 86%, 40%, and 100%, respectively.To our knowledge, this is the largest series of SLN biopsy in patients with differentiated thyroid carcinoma. Our experience suggests that this is an accurate and noninvasive means to identify subclinical lymph node metastasis. Because negative SLNs correlate strongly with a negative central compartment (100% in this study, P.001), this technique can be used as an intraoperative guide when determining the extent of surgery necessary in cervical level VI.