Thyroid & Salivary glands.

Transcription

1 Thyroid & Salivary glands. Rhodri M Evans

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3 Incidence of nodules. 3 7% have palpable nodule 30 70% have nodules detected on Ultrasound x 10 Increase in incidence of nodules with Ultrasound.

4 Incidence 70 Thyroid Nodules 30 Palpation 50 Age 100

5 Incidence 70 Thyroid Nodules US/Autopsy 30 Palpation 50 Age 100

6 Incidence of malignancy? 1000 new cases per annum in England and Wales ( 0.002%) 1 new case per 50,000, per year. 250,000 population = 5 new cases/year 500,000 population=10 new cases/year.

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9 Signs? 426 resected nodules,surgical correlation Benign nodules :iso/hyper-echoic and contain cystic degenerative change with a perinodular hypoechoic rim Brkljacic et al,j Clin US;22:

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17 Incidence of Papillary carcinoma? 6,499 patients:us and FNAC 164 cases( incidence : 2.52%) of malignancy : 116 Papillary Ca 23 Follicular Ca 6 Medullary Ca 7 Anaplastic Ca 8 Hurthle Cell Ca 4 Lymphomas Lin et al,acta Cytol,1997;41:

18 Occult Incidence. Autopsy series. Small (less than 1cm) papillary tumours : micro-carcinomas. Reported incidence : 10-30%.

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23 Signs:papillary carcinoma? Combination of absent halo,microcalcification and type III(marked intranodular flow) most specific Specificity:97.2% Sensitivity:16.6% Rago et al,eur J Endocrinol.,1998;138,41-46

24 Follicular carcinoma.

25 Follicular lesions. Spectrum from adenoma to carcinoma. 80% will be benign Follicular carcinoma 10-15% of all thyroid Ca. Cytology of no use. Histology of no use in differentiation. Surgical specimen : vascular and capsular invasion follicular carcinoma.

26 Ultrasound :follicular lesion.

27 CBX:follicular lesion.

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30 Follicular lesions. Adenomas : solid,homogenous,iso/hyperechoic. Well defined halo. Carcinoma : solid,hypo-echoic areas within.

31 Medullary carcinoma.

32 Medullary Carcinoma Thyroid Typically hypo-echoic. Contains calcification. Calcification more globular. Calcification may be amyloid.

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34 Signs?

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47 Predictors of Cancer. Sensitivity Specificity Micro-calcifications 40% 90% Absence of halo 66% 46% Irregular margins 64% 84% Hypo-echoic 83% 49% Intra-nodular flow 70% 65% MicroCa. & irreg m. 30% 95% MicroCa. & hypoechoic 28% 95% Solid & hypoechoic 73% 69% RSNA 2005

48 Predictors of Cancer. Sensitivity Specificity Micro-calcifications 40% 90% Absence of halo 66% 46% Irregular margins 64% 84% Hypo-echoic 83% 49% Intra-nodular flow 70% 65% MicroCa. & irreg m. 30% 95% MicroCa. & hypoechoic 28% 95% Solid & hypoechoic 73% 69% RSNA 2005

49 Predictors of Cancer. Sensitivity Specificity Micro-calcifications 40% 90% Absence of halo 66% 46% Irregular margins 64% 84% Hypo-echoic 83% 49% Intra-nodular flow 70% 65% MicroCa. & irreg m. 30% 95% MicroCa. & hypoechoic 28% 95% Solid & hypoechoic 73% 69% RSNA 2005

50 Predictors of Cancer. Sensitivity Specificity Micro-calcifications 40% 90% Absence of halo 66% 46% Irregular margins 64% 84% Hypo-echoic 83% 49% Intra-nodular flow 70% 65% MicroCa. & irreg m. 30% 95% MicroCa. & hypoechoic 28% 95% Solid & hypoechoic 73% 69% RSNA 2005

51 Predictors of Cancer. Sensitivity Specificity Micro-calcifications 40% 90% Absence of halo 66% 46% Irregular margins 64% 84% Hypo-echoic 83% 49% Intra-nodular flow 70% 65% MicroCa. & irreg m. 30% 95% MicroCa. & hypoechoic 28% 95% Solid & hypoechoic 73% 69% RSNA 2005

52 Predictors of Cancer. Sensitivity Specificity Micro-calcifications 40% 90% Absence of halo 66% 46% Irregular margins 64% 84% Hypo-echoic 83% 49% Intra-nodular flow 70% 65% MicroCa. & irreg m. 30% 95% MicroCa. & hypoechoic 28% 95% Solid & hypoechoic 73% 69% RSNA 2005

53 Predictors of Cancer. Sensitivity Specificity Micro-calcifications 40% 90% Absence of halo 66% 46% Irregular margins 64% 84% Hypo-echoic 83% 49% Intra-nodular flow 70% 65% MicroCa. & irreg m. 30% 95% MicroCa. & hypoechoic 28% 95% Solid & hypoechoic 73% 69% RSNA 2005

54 Predictors of Cancer. Sensitivity Specificity Micro-calcifications 40% 90% Absence of halo 66% 46% Irregular margins 64% 84% Hypo-echoic 83% 49% Intra-nodular flow 70% 65% MicroCa. & irreg m. 30% 95% MicroCa. & hypoechoic 28% 95% Solid & hypoechoic 73% 69% RSNA 2005

55 Thyroid nodules. Sorting out nodules. Learn from others Breast Radiologists. R Classification. Cytological classification(1-5) Clinical scenario. Correctly manage patient.

56 Breast nodules R classification.. R 1 : Normal. 2 : Probably benign. 3 : Indeterminate. 4 : Suspicious. 5 : Malignant

57 Nodules R classification thyroid? R 1 : Normal. 2 : Probably benign. 3 : Indeterminate. 4 : Suspicious. 5 : Malignant

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59 R 1

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61 R 2

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63 R 2

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67 R 3

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69 R?

70 R?

71 R 3

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73 R 4

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75 R 4/5

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79 R 5

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81 R 5 Lymphoma

82 R 5 Metastases

83 Thyroid nodules. R Classification. Cytological classification(1-5) Clinical scenario. Correctly manage patient.

84 Case 1.

85 R2

86 Case 2.

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90 R 2 or 3?

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92 Case 3.

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95 R 4

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98 FNA(x2) :non-diagnostic.

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101 CBX:No features of malignancy,probable colloid nodule.

102 Case 4.

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104 R2

105 Case 5.

106 R1

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110 Salivary glands. Stones. Salivary tumours. Extra salivary tumours.

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117 Sublingual glands.

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120 Sublingual Gland

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126 mylohyoid Posterior belly digastric hyoglossus

127 mylohyoid Posterior belly digastric hyoglossus

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148 Parotid.

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157 Parotid tumours. 80% parotid in origin (20% extra-parotid) 80% superficial 80% benign 80% :pleomorphic adenoma

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168 Extra parotid masses.

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185 Salivary glands. Anatomy. Stones. Salivary tumours. Extra salivary tumours.

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