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Summary: Background: Several ultrasound (US) risk stratification systems have been proposed for the assessment of thyroid nodules, and their performance was shown as good. However, the rate of nodules assessed at intermediate risk is not negligible and whether they should be submitted or not to further examination is still under debate. The present study aimed to evaluate the reliability of 18F‐FDG PET/CT in stratifying the risk of malignancy in these lesions. Methods: Two institutions participated to this retrospective study in which a dedicated 18F‐FDG PET/CT was proposed to patients having a thyroid nodule with US assessment of EU‐TIRADS 4 or 5. 18F‐FDG PET/CT did not influence the diagnostic and therapeutic decision. Histology was the gold standard for all patients. Results: Ninety‐three patients were included for the study with 48 EU‐TIRADS 4 and 45 EU‐TIRADS 5 nodules. Of these, 26 underwent thyroidectomy following FNAC suspicious for or consistent with malignancy, 38 for inconclusive cytology, 27 because of large goitre and 2 for high‐risk lesion at US. At histology, 35 carcinomas and 58 benign lesions were found. Cancer prevalence was 16.7% in EU‐TIRADS 4 and 60% in EU‐TIRADS 5. Overall, 18F‐FDG PET/CT was positive in 33/35 cancers (94.5% sensitivity) and negative in 31/58 benign lesions (53.4% specificity). When considering only EU‐TIRADS 4, 18F‐FDG PET/CT was positive in 7/8 cancers and negative in 20/40 benign lesions; among these, there were 36 cases with FNAC indication according to dimensional cut‐off (ie >1.5 cm), and 18F‐FDG PET/CT showed 85.7% sensitivity and 41.4% specificity. Conclusions: 18F‐FDG PET/CT may have a role in stratifying the cancer risk of thyroid nodules with an intermediate ultrasound assessment. More specifically, thyroid lesions classified as EU‐TIRADS 4 and with no 18F‐FDG uptake could be ruled out from further examination, similar to other anamnestic and clinical suspicious factors of patients. Further prospective and cost‐effectiveness studies are needed. [ABSTRACT FROM AUTHOR]

Pancreatic inflammation and tumors can induce various systemic lesions of steatonecrosis. We report here the case of a 73-year-old woman presenting a painful left leg. Roentgenograms and tomograms of the left tibia were normal. Radionuclide bone scan showed diffuse increased uptake in the whole tibia and a CT scan of the same region demonstrated an unusual pattern of bone tumor. Tibial biopsy revealed intra medullary steatonecrosis and led to the discovery of a pancreatic carcinoma. [ABSTRACT FROM AUTHOR]

Objective: The ultrasound evaluation of thyroid nodules (TNs) in patient selection for fine needle aspiration (FNA) requires both uniformly accepted definitions of each nodule characteristic and extensive experience from the examiner. We hypothesized that nodule echogenicity alone may provide comparable performance to more complex approaches in patient selection for FNA., Patients and Methods: Seven highly experienced investigators from four countries evaluated, online, the ultrasound (US) video recordings of 123 histologically verified TN by answering 17 nodule characteristics-related questions. The diagnostic performances of five TN image reporting and data systems (TIRADS) were compared to making decisions based solely on the echogenicity of the nodule for indicating FNA in 110 nodules ≥10 mm., Results: In the 10-20 mm size range, the sensitivities and specificities of the five TIRADS systems in identifying malignant nodules were 80.5-91.0% and 31.4-50.9%, respectively. Had FNA been recommended for all hypoechoic nodules, disregarding other US characteristics, comparable sensitivity and specificity (87.5% and 43.4%, respectively) were obtained. Compared to nodules >20 mm, a higher proportion of cancers were hypoechoic in the 10-20 mm size range (87.2% vs 77.8%, P = 0.05). In the 10-20 mm size range, compared to hypoechoic nodules, a significantly lower proportion of isoechoic nodules demonstrated suspicious findings (70.7% vs 30.0%, P < 0.05)., Conclusion: In contrast to >20 mm diameter nodules, the recommendation of FNA may rely on a single US feature, echogenicity, in the 10-20 mm size range. If independently confirmed in larger cohorts, this may simplify nodule evaluation in this size range.

Objectives: The aim was to evaluate the clinical, ultrasound (US) and, when indicated, the cytological and histological characteristics of autonomously functioning thyroid nodules (AFTN) in consecutive patients., Methods: A prospective, single-centre study was conducted between March 2018 and September 2021. In total, 901 consecutive patients were referred for thyroid workup and of 67 AFTN were evaluated. All enrolled patients underwent 99mTcO4 - scintigraphy, additional 123I scintigraphy only in case of normal serum TSH, evaluation of thyroid function, US examination using European Thyroid Imaging and Reporting Data System (EU-TIRADS), and US-guided fine needle aspiration (FNA) cytology when indicated. All indeterminate FNA samples were subjected to DNA sequencing analysis., Results: More than half of the evaluated patients with AFTN were euthyroid; median serum TSH was 0.41 (IQR: 0.03-0.97) mU/L. The median AFTN size measured by US was 27.0 (IQR: 21.1-35.0) mm. 28.4% of AFTN were classified as EU-TIRADS score 3 and 71.6% as EU-TIRADS score 4, indicating that the majority of AFTN had intermediate risk for malignancy according to US. Out of the 47 AFTN subjected to cytological evaluation, 24 (51%) yielded indeterminate FNA results. DNA sequencing revealed pathogenic TSHR and GNAS mutations in 60% of cases. No malignancy was detected at final histology in surgically excised AFTN (n = 12)., Conclusions: Of the 67 AFTN evaluated in this study, 50% presented with normal serum TSH, 70% displayed ultrasound features suggesting an intermediate malignancy risk and 50% of the AFTN submitted to cytology yielded indeterminate results. No malignant AFTN was detected.

Management of thyroid nodules. Thyroid nodules are frequent and most of them are benign incidentalomas. Physical examination will search for risk factors of thyroid cancer and should evaluate the presence of local or cosmetic symptoms. Whatever the way they are discovered, TSH assessment and ultrasound (US) examination should be systematic. Scintigraphy should be reserved to low TSH patients. US allows to assert the nodule's existence, to measure it and to assess the context (goiter, auto-immune disease). US also allows quantitative risk stratification of malignancy using the EU-TIRADS score, which goes from 1 to 5 and defines the indications for fine-needle aspiration : all nodules above 20 mm (except non compressive EU-TIRADS 2 cysts), EUTIRADS 4 nodules above 15mm and EU-TIRADS 5 nodules above 10 mm. Surgery is indicated for compressive benign nodules and for suspect and malignant nodules above 10 mm. For those below 10 mm in diameter, the patient may be offered active surveillance and surgery in case of progression, provided that there is no lymph node involvement and no extra-capsular extension. Other nodules will be monitored after one year, three years and every five years if needed. Laser and radiofrequency thermoablation will probably partially replace over time surgery for solitary benign nodules., Competing Interests: G. Russ déclare n’avoir aucun lien d’intérêts.