Browsing by Author "Madrid, Arturo"
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Item Estudio y manejo de nódulos tiroideos por médicos no especialistas. Consenso SOCHED(Sociedad Medica de Santiago, 2017) Tala, Hernán; Díaz, René; Domínguez, José; Sapunar, Jorge; Pineda, Pedro; Arroyo, Patricia; Barberán, Marcela; Cabané, Patricio; Cruz, Francisco; Gac, Patricio; Glasinovic, Andrea; González, Hernán; Grob, Francisca; Hidalgo, Maria; Jaimovich, Rodrigo; Lanas, Alejandra; Liberman, Claudio; Lobo, Maite; Madrid, Arturo; Moreno, Marcela; Mosso, Lorena; Munizaga, Fernando; Ortiz, Eugenia; Osorio, Fernando; Slater, Jeannie; Solar, Antonieta; Stehr, Carlos; Vásquez, Félix; Véliz, Jesús; Villaseca, Roberto; Wohllk, NelsonThe thyroid nodule is a frequent cause of primary care consultation. The prevalence of a palpable thyroid nodule is approximately 4-7%, increasing up to 67% by the incidental detection of nodules on ultrasound. The vast majority are benign and asymptomatic, staying stable over time. The clinical importance of studying a thyroid nodule is to exclude thyroid cancer, which occurs in 5 to 10% of the nodules. The Board of SOCHED (Chilean Society of Endocrinology and Diabetes) asked the Thyroid Study Group to develop a consensus regarding the diagnostic management of the thyroid nodule in Chile, aimed at non-specialist physicians and adapted to the national reality. To this end, a multidisciplinary group of 31 experts was established among university academics, active researchers with publications on the subject and prominent members of scientific societies of endocrinology, head and neck surgery, pathology and radiology. A total of 14 questions were developed with key aspects for the diagnosis and subsequent referral of patients with thyroid nodules, which were addressed by the participants. In those areas where the evidence was insufficient or the national reality had to be considered, the consensus opinion of the experts was used through the Delphi methodology. The consensus was approved by the SOCHED board for publication.Item Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules(Springer, 2017) Horvath, Eleonora; Silva, Claudio; Majlis, Sergio; Rodriguez, Ignacio; Skoknic, Velimir; Castro, Alex; Rojas, Hugo; Niedmann, Juan Pablo; Madrid, Arturo; Capdeville, Felipe; Whittle, Carolina; Rossi, Ricardo; Dominguez, Miguel; Tala, HernánOBJECTIVE: To assess performance of TIRADS classification on a prospective surgical cohort, demonstrating its clinical usefulness. METHODS: Between June 2009 and October 2012, patients assessed with pre-operative ultrasound (US) were included in this IRB-approved study. Nodules were categorised according to our previously described TIRADS classification. Final pathological diagnosis was obtained from the thyroidectomy specimen. Sensitivity, specificity, positive/negative predictive values and likelihood ratios were calculated. RESULTS: The study included 210 patients with 502 nodules (average: 2.39 (±1.64) nodules/patient). Median size was 7 mm (3-60 mm). Malignancy was 0 % (0/116) in TIRADS 2, 1.79 % (1/56) in TIRADS 3, 76.13 % (185/243) in TIRADS 4 [subgroups: TIRADS 4A 5.88 % (1/17), TIRADS 4B 62.82 % (49/78), TIRADS 4C 91.22 % (135/148)], and 98.85 % (86/87) in TIRADS 5. With a cut-off point at TIRADS 4-5 to perform FNAB, we obtained: sensitivity 99.6 % (95 % CI: 98.9-100.0), specificity 74.35 % (95 % CI: 68.7-80.0), PPV 82.1 % (95 % CI: 78.0-86.3), NPV 99.4 % (95 % CI: 98.3-100.0), PLR 3.9 (95 % CI: 3.6-4.2) and an NLR 0.005 (95 % CI: 0.003-0.04) for malignancy. CONCLUSION: US-based TIRADS classification allows selection of nodules requiring FNAB and recognition of those with a low malignancy risk. KEY POINTS: • TIRADS classification allows accurate selection of thyroid nodules requiring biopsy (TIRADS 4-5). • The recognition of benign/possibly benign patterns can avoid unnecessary procedures. • This classification and its sonographic patterns are validated using surgical specimens.