Browsing by Subject "Nodule"
Now showing 1 - 2 of 2
- Results Per Page
- Sort Options
Item Open Access High Suspicion Sub-Centimeter Thyroid Nodules: Cost-Effectiveness of Active Surveillance versus Fine Needle Aspiration.(Journal of vascular and interventional radiology : JVIR, 2022-11) Woon, Tian Kai; Zhou, Ke; Tan, Bien Soo; Matchar, David BPurpose
To compare the cost-benefit of active surveillance (AS) against immediate fine needle aspiration (FNA) of sonographically suspicious sub-centimeter thyroid nodules.Methods
A Markov model was constructed to compare the cost-benefit of three strategies from point of discovery till death: 1) Surveillance of All Nodules; 2) Surveillance of Nodules with Positive Cytology; and 3) Surgery of Nodules with Positive Cytology. The reference case was a 40 year-old female with a sonographically suspicious sub-centimeter thyroid nodule. Transition probabilities, costs, and health utilities were derived from the literature. Sensitivity analyses were performed to evaluate model uncertainty. Willingness-to-pay threshold was set at $100,000/quality-adjusted life year (QALY).Results
Surveillance of Nodules with Positive Cytology dominated in the reference scenario, and was cost-beneficial over Surveillance of All Nodules independent of the utility of AS. Surveillance of All Nodules was cost-beneficial only at life expectancy <2.6 years or surveillance duration <4 years.Conclusion
While current guidelines recommend AS of sonographically suspicious sub-centimeter nodules, this study's results suggest immediate FNA (Surveillance of Nodules with Positive Cytology) is more cost-beneficial compared to AS (Surveillance of All Nodules). Patients with positive cytology on FNA may subsequently opt for AS (Surveillance of Nodules with Positive Cytology) or surgery (Surgery of Nodules with Positive Cytology) according to their level of comfort (i.e. utility) with AS.Item Open Access Pulmonary Talaromycosis: A Window into the Immunopathogenesis of an Endemic Mycosis.(Mycopathologia, 2021-07-06) Narayanasamy, Shanti; Dougherty, John; van Doorn, H Rogier; Le, ThuyTalaromycosis is an invasive mycosis caused by the thermally dimorphic saprophytic fungus Talaromyces marneffei (Tm) endemic in Asia. Like other endemic mycoses, talaromycosis occurs predominantly in immunocompromised and, to a lesser extent, immunocompetent hosts. The lungs are the primary portal of entry, and pulmonary manifestations provide a window into the immunopathogenesis of talaromycosis. Failure of alveolar macrophages to destroy Tm results in reticuloendothelial system dissemination and multi-organ disease. Primary or secondary immune defects that reduce CD4+ T cells, INF-γ, IL-12, and IL-17 functions, such as HIV infection, anti-interferon-γ autoantibodies, STAT-1 and STAT-3 mutations, and CD40 ligand deficiency, highlight the central roles of Th1 and Th17 effector cells in the control of Tm infection. Both upper and lower respiratory infections can manifest as localised or disseminated disease. Upper respiratory disease appears unique to talaromycosis, presenting with oropharyngeal lesions and obstructive tracheobronchial masses. Lower respiratory disease is protean, including alveolar consolidation, solitary or multiple nodules, mediastinal lymphadenopathy, cavitary disease, and pleural effusion. Structural lung disease such as chronic obstructive pulmonary disease is an emerging risk factor in immunocompetent hosts. Mortality, up to 55%, is driven by delayed or missed diagnosis. Rapid, non-culture-based diagnostics including antigen and PCR assays are shown to be superior to blood culture for diagnosis, but still require rigorous clinical validation and commercialisation. Our current understanding of acute pulmonary infections is limited by the lack of an antibody test. Such a tool is expected to unveil a larger disease burden and wider clinical spectrum of talaromycosis.