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Continuing Controversies in the Management of Thyroid Nodules

M. Regina Castro, MD; and Hossein Gharib, MD
[+] Article and Author Information

From the Mayo Clinic College of Medicine, Rochester, Minnesota.


Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: M. Regina Castro, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55902; e-mail, castro.regina@mayo.edu.

Current Author Addresses: Drs. Castro and Gharib: Mayo Clinic, 200 First Street SW, Rochester, MN 55902.


Ann Intern Med. 2005;142(11):926-931. doi:10.7326/0003-4819-142-11-200506070-00011
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Although thyroid nodules are common, few are malignant and require surgical treatment. A systematic approach to their evaluation is important to avoid unnecessary surgery. Fine-needle aspiration biopsy has resulted in substantial improvements in diagnostic accuracy, cost reductions, and higher malignancy yield at time of surgery. The preferred approach when repeated fine-needle aspiration biopsy fails to yield an adequate specimen remains a challenge. Management of patients with nodules “suspicious for follicular neoplasm” is difficult, since only 15% to 20% of such lesions have been shown to be malignant. Immunohistochemical markers, such as galectin-3 and human bone marrow endothelial cell (HBME-1), have shown promise in preliminary studies. Routine calcitonin measurement in patients with thyroid nodules has been advocated for early detection of medullary thyroid cancer. However, the low frequency of this cancer, coupled with the high cost associated with case detection, has resulted in a lack of general acceptance of this recommendation.

Figures

Grahic Jump Location
Figure 1.
Ultrasonography-guided fine-needle aspiration with needle tip accurately placed in the nodule.
Grahic Jump Location
Grahic Jump Location
Figure 2.
Cystic lesion.

The lesion was nondiagnostic on direct fine-needle aspiration and benign by ultrasonography-guided fine-needle aspiration.

Grahic Jump Location

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HBME-1 in the context of thyroid
Posted on August 9, 2005
Sanjay Mukhopadhyay
State University of New York Upstate Medical University
Conflict of Interest: None Declared

Dear Sir,

I read the article by Castro et al. (Continuing controversies in the management of thyroid nodules, June 2005 issue) with interest, since I am currently involved in a study using one of the immunohistochemical markers described as having diagnostic potential. The authors refer to this antibody, HBME-1, as "Human Bone Marrow Endothelial Cell".

I would like to point out that HBME-1, in the context of thyroid immunohistochemistry, stands for "Hector Battifora Mesothelial Epitope" (Mase et al, 2003), named after the pathologist who developed the antibody using a mesothelioma cell line at the City of Hope National Medical Center in Duarte, CA (Sheibani et al, 1992).

Confusingly, HBME-1 is also an endothelial cell-line used in tumor studies which stands for "Human Bone Marrow Endothelial Cell". Prostate carcinoma cells selectively adhere to this cell line, and this observation has been used to explain the propensity for bone metastases in prostate cancer. However, this cell line is in no way related to the antibody used in thyroid immunohistochemistry.

Sincerely, Sanjay Mukhopadhyay, MD Dept of Pathology SUNY Upstate Medical Univ Syracuse, NY

References: 1.Castro MR, Gharib H. Continuing controversies in the management of thyroid nodules. Ann Intern Med. 2005 Jun 7;142(11):926-31. 2. Mase T, Funahashi H, Koshikawa T, Imai T, Nara Y, Tanaka Y, Nakao A. HBME-1 immunostaining in thyroid tumors especially in follicular neoplasm. Endocr J. 2003 Apr;50(2):173-7. 3. Sheibani K, Esteban JM, Bailey A, Battifora H, Weiss LM. Hum Pathol. 1992 Feb;23(2):107-16.

Conflict of Interest:

None declared

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