What is ENT - What molecular testing may be performed on thyroid nodules right now?
1. Mutation panel testing: Tests for DNA mutations most commonly seen in thyroid cancer, including BRAF V000E, RAS, RET/PTC, and PAX8/PPARG rearrangements. The test's positive predictive value for cancer is 83% when these mutations are found. 2. Gene sequencing classifier testing: checks for RNA expression of several distinct genes for benign and malignant nodules. Has a greater than 95% negative predictive value and virtually “rules out” cancer.
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What is ENT -How important is molecular testing in thyroid cancer?
Genetic molecular testing is utilised for Bethesda III and IV thyroid nodules to either “rule in” a cancer or “rule out” a benign nodule. These tests should help to further risk stratify patients to improve diagnostic accuracy preoperatively, prevent unnecessary surgery, and help determine the degree of surgery when warranted. What is ENT - When it comes to thyroid cytopathology, what is the Bethesda Classification and how does it relate to cancer risk?
• Bethesda I: nondiagnostic or unsatisfactory (n/a) • Bethesda II: benign (<5%) • Bethesda III: atypia of undetermined significance (AUS) or follicular lesion of unknown significance (FLUS) (5%–15%) • Bethesda IV: follicular neoplasm (15%–30%) • Bethesda V: suspicious for malignancy (60%–75%) • Bethesda VI: malignancy (97%–99%) What is ENT - How reliable is FNA cytology as a diagnostic tool?
Results: 95% accurate, 2.3 % false-negative, 1.1 % false-positive. What is ENT - What ultrasound characteristics raise red flags for cancer?
Calcification on a microscopic scale Enlarged cervical lymph nodes, especially on the same side of the neck, are accompanied by: • Irregular edges • Solid rather than cystic nodules • Internal vascularity • Multiple nodules • Hypoechoic or isoechoic What is ENT - What characteristics of thyroid nodules are associated with an increased likelihood of cancer?
Male gender, age less than 30, age greater than 60, positive family history, radiation exposure, Hashimoto's thyroiditis, and rapid growth are risk factors for developing Hashimoto's thyroiditis. • Discomfort • Dysphonia • Cervical lymphadenopathy • Nodules that are firm and fixed What is ENT - What kind of tests are performed on a patient who has a thyroid nodule?
• Thyroid function assay • Ultrasound evaluation of nodule • Possible fine-needle aspiration (FNA) if concern for malignancy • Comprehensive history and physical exam, including a visualisation of the vocal cords (laryngoscopy) to evaluate recurrent laryngealnerve function • Laryngoscopy to evaluate recurrent laryngealnerve function • What is ENT - How often is the development of a nodule in the thyroid?
However, the proportion of incidental nodule founds on ultrasonography is higher (20%–67% of patients), with more than half of thyroids including more than one nodule. Clinically palpable nodules occur in 4% to 7% of the population. The female gender is four times more likely to be affected by nodules than the male. Thyroid cancer develops in 5% to 10% of palpable nodules. What is ENT - When it comes to benign tumours, is extracapsular dissection a viable option to superficial parotidectomy?
Extracapsular dissection requires meticulous dissection around a movable benign tumour capsule that is less than four centimetres in diameter. This is done without locating the facial nerve. When compared to superficial parotidectomy, retrospective studies have demonstrated comparable recurrence rates as well as a decrease in the incidence of facial nerve paresis/paralysis and Frey's syndrome. Both the appropriate selection of patients and the experience of the surgeon are crucial variables. What is ENT - When performing parotid surgery, how should one handle a facial nerve that is either fully functional or partially functional?
If the facial nerve is not substantially infiltrated or entrenched in the tumour, it should be preserved, and only the section of the nerve that is infiltrated should be removed during surgery. In the event that the facial nerve is damaged, an immediate nerve grafting procedure needs to be carried out. The great auricular nerve is a reliable donor nerve that can be used in grafting procedures. |
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