15251
|
Pigal A, Draganova-Tacheva R, Solomides CC, Bibbo M. Thyroglobulin wash testing in the surveillance of patients with thyroid carcinoma: proposal for a reflex test. Acta Cytol 2013; 57:545-9. [PMID: 24107415 DOI: 10.1159/000354379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 07/10/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Fine needle aspiration (FNA) cytology with thyroglobulin wash (TG-W) testing is recommended for follow-up of patients with differentiated thyroid carcinoma (DTC). The goal of this retrospective study was to determine if TG-W results contributed to the management of cases with positive FNA cytology. STUDY DESIGN We reviewed data on patients with positive and suspicious cytology results, undergoing lymph node or thyroid bed FNA with TG-W testing as part of the preoperative or follow-up investigation of histologically proven DTC in our institution and from the literature. RESULTS Of 30 positive/suspicious lymph node and thyroid bed FNAs in our institution, 22 (73%) had an elevated (>1 ng/ml) TG-W level. Seven of 8 TG-W-negative cases had DTC on follow-up. Of 577 cytology-positive/suspicious FNAs in the literature, 557 (97%) showed TG-W-positive results. Fourteen of 20 TG-W-negative cases had DTC on follow-up. All patients in retrospective and literature review groups with positive and suspicious FNA cytology and available follow-up were treated for recurrent or metastatic disease regardless of TG-W results. CONCLUSION Observations of both our and other institutions support a recommendation of reflex FNA TG-W testing only for cases with negative or indeterminate cytology results.
Collapse
|
15252
|
Malandrino P, Scollo C, Marturano I, Russo M, Tavarelli M, Attard M, Richiusa P, Violi MA, Dardanoni G, Vigneri R, Pellegriti G. Descriptive epidemiology of human thyroid cancer: experience from a regional registry and the "volcanic factor". Front Endocrinol (Lausanne) 2013; 4:65. [PMID: 23761783 PMCID: PMC3671345 DOI: 10.3389/fendo.2013.00065] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 05/19/2013] [Indexed: 01/11/2023] Open
Abstract
Thyroid cancer (TC), the most common endocrine tumor, has steadily increased worldwide due to the increase of the papillary histotype. The reasons for this spread have not been established. In addition to more sensitive thyroid nodule screening, the effect of environmental factors cannot be excluded. Because high incidences of TC were found in volcanic areas (Hawaii and Iceland), a volcanic environment may play a role in the pathogenesis of TC. In January 2002, the Regional Register for TC was instituted in Sicily. With a population of approximately five million inhabitants with similar genetic and lifestyle features, the coexistence in Sicily of rural, urban, industrial, moderate-to-low iodine intake, and volcanic areas provides a conducive setting for assessing the environmental influences on the etiology of TC. In Sicily, between 2002 and 2004, 1,950 new cases of TC were identified, with an age-standardized rate (world) ASR(w) = 17.8/10(5) in females and 3.7/10(5) in males and a high female/male ratio (4.3:1.0). The incidence of TC was heterogeneous within Sicily. There were 2.3 times more cases in the Catania province (where most of the inhabitants live in the volcanic area of Mt. Etna): ASR(w) = 31.7/10(5) in females and 6.4/10(5) in males vs. 14.1 in females and 3.0 in males in the rest of Sicily. Multivariate analysis documented that residents in the volcanic area of Mt. Etna had a higher risk of TC, compared to the residents in urban, industrial, and iodine deficient areas of Sicily. An abnormally high concentration of several chemicals was found in the drinking water of the Mt. Etna aquifer, which provides water to most of the residents in the Catania province. Our data suggest that environmental carcinogen(s) of volcanic origin may promote papillary TC. Additional analyses, including cancer biological and molecular features, will allow a better understanding of risk factors and etiopathogenetic mechanisms.
Collapse
Affiliation(s)
- Pasqualino Malandrino
- Endocrinology, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Claudia Scollo
- Endocrinology, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Ilenia Marturano
- Endocrinology, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Marco Russo
- Endocrinology, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Martina Tavarelli
- Endocrinology, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Marco Attard
- Endocrinology, “Ospedali Riuniti Villa Sofia – Cervello” Hospital, Palermo, Italy
| | - Pierina Richiusa
- Endocrinology, Diabetology and Metabolism, Department of Internal and Specialistic Biomedicine, University of Palermo, Palermo, Italy
| | - Maria Antonia Violi
- Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Riccardo Vigneri
- Endocrinology, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Gabriella Pellegriti
- Endocrinology, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
- *Correspondence: Gabriella Pellegriti, Endocrinology Unit, Department of Clinical and Molecular Biomedicine, University of Catania, Garibaldi-Nesima Medical Center, Via Palermo 636, Catania 95122, Italy e-mail:
| |
Collapse
|
15253
|
Giovanella L, Bongiovanni M, Trimboli P. Diagnostic value of thyroglobulin assay in cervical lymph node fine-needle aspirations for metastatic differentiated thyroid cancer. Curr Opin Oncol 2013; 25:6-13. [DOI: 10.1097/cco.0b013e32835a9ab1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
15254
|
|
15255
|
Li LC, Jayarama S, Pilli T, Qian L, Pacini F, Prabhakar BS. Down-modulation of expression, or dephosphorylation, of IG20/MADD in tumor necrosis factor-related apoptosis-inducing ligand-resistant thyroid cancer cells makes them susceptible to treatment with this ligand. Thyroid 2013; 23:70-8. [PMID: 22998497 PMCID: PMC3539253 DOI: 10.1089/thy.2012.0155] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The IG20/MADD gene is overexpressed in thyroid cancer tissues and cell lines, and can contribute to tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) resistance. The ability of the MADD protein to resist TRAIL-induced apoptosis is dependent upon its phosphorylation by Akt. Interestingly, while TRAIL induces a significant reduction in the levels of phospho-Akt (pAkt) and phospho-MADD (pMADD) in TRAIL-sensitive cells, it fails to do so in TRAIL-resistant cells. In this study, we investigated if MADD phosphorylation by Akt was contributing to TRAIL resistance in thyroid cancer cells. METHODS We determined the susceptibility of different thyroid cancer cell lines to TRAIL-induced apoptosis by fluorescence-activated cell sorting (FACS) analysis. We tested for various TRAIL resistance factors by FACS analyses or for IG20/MADD expression by quantitative reverse transcription-polymerase chain reaction. We determined the levels of pAkt and pMADD upon TRAIL treatment in thyroid cancer cells by Western blotting. We tested if down-modulation of IG20/MADD gene expression using shRNA or phosphorylation using a dominant negative Akt (DN-Akt) or pretreatment with LY294002, a PI3 kinase inhibitor, could help overcome TRAIL resistance. RESULT BCPAP and TPC1 cells were susceptible, while KTC1 and FTC133 cells were resistant, to TRAIL-induced apoptosis. The differential susceptibility to TRAIL was not related to the levels of expression of death receptors, decoy receptors, or TRAIL. KTC1 and FTC133 cells showed higher levels of IG20/MADD expression relative to BCPAP and TPC1, and were rendered susceptible to TRAIL treatment upon IG20/MADD knockdown. Interestingly, upon TRAIL treatment, the pAkt and pMADD levels were reduced in TRAIL-sensitive BCPAP and TPC1 cells, while they remained unchanged in the resistant KTC1 and FTC133 cells. While expression of a constitutively active Akt in BCPAP and TPC1 cells rendered them resistant to TRAIL, pretreating KTC1 and FTC133 cells with LY294002 rendered them TRAIL-sensitive. Moreover, expression of a DN-Akt in KTC1 and FTC133 cells reduced the levels of pAkt and pMADD and sensitized them to TRAIL-induced apoptosis. CONCLUSION Our results show that pMADD is an important TRAIL resistance factor in certain thyroid cancer cells and suggest that down-modulation of either IG20/MADD expression or phosphorylation can render TRAIL-resistant thyroid cancer cells sensitive to TRAIL.
Collapse
Affiliation(s)
- Liang-Cheng Li
- Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Shankara Jayarama
- Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Tania Pilli
- Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
- Section of Endocrinology & Metabolism, Department of Internal Medicine, Endocrinology & Metabolism and Biochemistry, University of Siena, Siena, Italy
| | - Lixia Qian
- Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Furio Pacini
- Section of Endocrinology & Metabolism, Department of Internal Medicine, Endocrinology & Metabolism and Biochemistry, University of Siena, Siena, Italy
| | - Bellur S. Prabhakar
- Department of Microbiology and Immunology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
15256
|
Profilo MA, Sisti E, Marcocci C, Vitti P, Pinchera A, Nardi M, Rocchi R, Latrofa F, Menconi F, Altea MA, Leo M, Rago T, Marinò M. Thyroid volume and severity of Graves' orbitopathy. Thyroid 2013; 23:97-102. [PMID: 23088654 DOI: 10.1089/thy.2012.0379] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Graves' orbitopathy (GO) is thought to be related to one or more autoantigens present in the thyroid and in orbital tissues. Although this may not imply a quantitative relation between thyroid antigens and degree of GO, which in turn is a risk factor for a more pronounced GO, we postulated that the severity of GO may parallel the amount of thyroid tissue, namely, the size of the thyroid gland. This hypothesis is also based on the observation that patients with Graves' disease presenting with large goiters tend to have more severe hyperthyroidism. Thus, we evaluated retrospectively whether there is a correlation between the degree of GO at its first observation and, among other parameters, the thyroid volume. METHODS Eighty-six consecutive patients with untreated GO lasting for no longer than 24 months underwent an endocrinological and an ophthalmological evaluation, the latter including: exophthalmometry, eyelid width, clinical activity score (CAS), diplopia, and visual acuity. The overall degree of GO was ranked using the NOSPECS score as well as a modification of the NOSPECS score. The following parameters were considered for correlations: time since GO appearance, time since detection of hyperthyroidism, FT3, anti-thyrotropin receptor antibodies, thyroid volume, and cigarette-years. RESULTS Thyroid volume, but not the other parameters, correlated significantly by simple regression with exophthalmometry (p=0.02) and CAS (p=0.02). The standard NOSPECS score correlated with FT3 (p=0.05), thyroid volume (p=0.02), and cigarette-years (p=0.03), by simple, but not by multiple regression analysis. The modified NOSPECS score correlated with thyroid volume (p=0.007) and cigarette-years (p=0.04) by simple regression, and with thyroid volume also by multiple regression analysis (p=0.05). CONCLUSIONS Thyroid volume correlates with the severity of GO at its first observation, especially with exophthalmometry and CAS. The finding is in line with a possible pathogenetic role of antigens shared by the thyroid and orbital tissues. Nevertheless, other mechanisms may explain this observation, including an overall more reactive immune system in patients with a large goiter, resulting in more severe thyroid and eye disease, regardless of the nature of the autoantigen, or whether it is shared by the thyroid and the orbit.
Collapse
|
15257
|
Emmanouilidis N, Schrem H, Winkler M, Klempnauer J, Scheumann GFW. Long-term results after treatment of very low-, low-, and high-risk thyroid cancers in a combined setting of thyroidectomy and radio ablation therapy in euthyroidism. Int J Endocrinol 2013; 2013:769473. [PMID: 23935620 PMCID: PMC3723358 DOI: 10.1155/2013/769473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 06/17/2013] [Accepted: 06/17/2013] [Indexed: 11/07/2022] Open
Abstract
Introduction. Differentiated thyroid cancer treatment usually consists of thyroidectomy and radio ablation in hypothyroidism 4-6 weeks after surgery. Replacing hypothyroidism by recombinant human thyroid stimulating hormone can facilitate radio ablation in euthyroidism within one week after surgery. The outcome of this approach was investigated. Methods. This is a prospective randomized trial to compare thyroidectomy and radio ablation within a few days after preconditioning with recombinant human thyroid stimulating hormone versus thyroidectomy and radio ablation separated by four weeks of L-T4 withdrawal. Tumors were graded into very low-, low- , or high-risk tumors. Recurrence-free survival was confirmed at follow-up controls by neck ultrasound and serum thyroglobulin. Suspected tumor recurrence was treated by additional radio ablation or surgery. Quality-of-life questionnaires with additional evaluation of job performance and sick-leave time were used in all patients. Results. Radio ablation in euthyroidism in quick succession after thyroidectomy did not lead to higher tumor recurrence rates of differentiated thyroid cancers in any risk category and was significantly advantageous with respect to quality-of-life (P < 0.001), sick-leave time (P < 0.001), and job performance (P = 0.002). Conclusion. Recombinant human thyroid stimulating hormone can be used safely and with good efficacy to allow radio ablation under sustained euthyroidism within one week after thyroidectomy.
Collapse
Affiliation(s)
- Nikos Emmanouilidis
- Allgemein-, Viszeral- und Transplantationschirurgie, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
- *Nikos Emmanouilidis:
| | - Harald Schrem
- Allgemein-, Viszeral- und Transplantationschirurgie, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Michael Winkler
- Allgemein-, Viszeral- und Transplantationschirurgie, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Jürgen Klempnauer
- Allgemein-, Viszeral- und Transplantationschirurgie, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Georg F. W. Scheumann
- Allgemein-, Viszeral- und Transplantationschirurgie, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| |
Collapse
|
15258
|
Tsushima Y, Miyauchi A, Ito Y, Kudo T, Masuoka H, Yabuta T, Fukushima M, Kihara M, Higashiyama T, Takamura Y, Kobayashi K, Miya A, Kikumori T, Imai T, Kiuchi T. Prognostic significance of changes in serum thyroglobulin antibody levels of pre- and post-total thyroidectomy in thyroglobulin antibody-positive papillary thyroid carcinoma patients. Endocr J 2013; 60:871-6. [PMID: 23585494 DOI: 10.1507/endocrj.ej12-0410] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although postoperative serum thyroglobulin (Tg) is a prognostic indicator for papillary thyroid carcinoma (PTC), it is unreliable when Tg antibody (TgAb) is positive. We evaluated the prognostic significance of changes in serum TgAb levels of pre- and post-total thyroidectomy in TgAb-positive PTC patients. We reviewed our medical charts of 225 TgAb-positive PTC patients in whom TgAb levels were measured before and 1-2 years after total thyroidectomy, performed between April 2002 and March 2007. We divided them into 3 groups based on changes in TgAb levels. Postoperative serum TgAb levels decreased by ≥ 50% in 181 patients (80.4%) (Group 1), by <50% in 22 patients (9.8%) (Group 2), and increased in 22 patients (9.8%) (Group 3). During the follow-up, 3 patients died of the disease and 14 patients had recurrences. All 3 patients who died of PTC were seen only in Groups 2 and 3. Groups 2 and 3 showed similar prognostic outcomes, thus were analyzed together as Group 2+3. Group 1 had significantly better lymph node recurrence-free survival and distant recurrence-free survival than Group 2+3 (96.9% vs. 90.5%, p <0.001, and 98.9% vs. 90.1%, p = 0.004, respectively at 5 years). Multivariate analyses on prognostic factors revealed that classification to Group 2+3 was the strongest indicator for poor prognosis. The present results suggest that changes in TgAb levels following total thyroidectomy can be an important dynamic prognostic factor of PTC patients. Prospective periodical measurements of TgAb are necessary to confirm these findings.
Collapse
Affiliation(s)
- Yukiko Tsushima
- Department of Breast and Endocrine Surgery, Nagoya University, Nagoya 466-8550, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15259
|
Solymosi T, Lukacs Toth G, Nagy D, Gal I. Twenty years of experience with the preoperative diagnosis of medullary cancer in a moderately iodine-deficient region. Int J Endocrinol 2013; 2013:571606. [PMID: 23533405 PMCID: PMC3606730 DOI: 10.1155/2013/571606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 01/20/2013] [Accepted: 01/30/2013] [Indexed: 11/17/2022] Open
Abstract
Background. There is a current debate in the medical literature about plasma calcitonin screening in patients with nodular goiter (NG). We decided on analyzing our 20-year experience with patients in an iodine-deficient region (ID). Patients and Methods. 22,857 consecutive patients with NG underwent ultrasonography and aspiration cytology (FNAC). If FNAC raised suspicion of medullary cancer (MTC), the serum calcitonin was measured. Results. 4,601 patients underwent surgery; there were 23 patients among them who had MTC (0.1% prevalence). Significantly more MTC cases were diagnosed cytologically in the second decade than in the first: 11/12 and 6/11, respectively. The frozen section was of help in 2 cases out of 3. Two patients suffered from a 3-year delay in proper therapy, and reoperation was necessary in 1 case. FNAC raised the suspicion of MTC in 20 cases that were later histologically verified and did not present MTC. The diagnostic accuracy of FNAC in diagnosing MTC was 99.2%. Two false-positive serum calcitonin tests (one of them in a hemodialyzed patient) and one false-negative serum calcitonin test occurred in 40 cases. Conclusion. Regarding the low prevalence of MTC in ID regions, calcitonin screening of all NG patients does not only appear superfluously but may have more disadvantages than advantages.
Collapse
Affiliation(s)
- Tamas Solymosi
- Thyroid Outpatient Department, Bugat Hospital, 6 Fenyves Street, Matrafured, Gyongyos 3232, Hungary
- *Tamas Solymosi:
| | - Gyula Lukacs Toth
- Department of Pathology, Bugat Hospital, Dozsa Gyorgy Street, Gyongyos 3200, Hungary
| | - Dezso Nagy
- Department of Nuclear Medicine, Honved Hospital, 44 Robert Karoly Avenue, Budapest 1134, Hungary
| | - Istvan Gal
- Department of Surgery, Telki Hospital, Telki 2089, Hungary
| |
Collapse
|
15260
|
Gigoux V, Fourmy D. Acting on Hormone Receptors with Minimal Side Effect on Cell Proliferation: A Timely Challenge Illustrated with GLP-1R and GPER. Front Endocrinol (Lausanne) 2013; 4:50. [PMID: 23641235 PMCID: PMC3638125 DOI: 10.3389/fendo.2013.00050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 04/10/2013] [Indexed: 12/18/2022] Open
Abstract
G protein-coupled receptors (GPCRs) constitute a large family of receptors that sense molecules outside the cell and activate inside signal transduction pathways and cellular responses. GPCR are involved in a wide variety of physiological processes, including in the neuroendocrine system. GPCR are also involved in many diseases and are the target of 30% of marketed medicinal drugs. Whereas the majority of the GPCR-targeting drugs have proved their therapeutic benefit, some of them were associated with undesired effects. We develop two examples of used drugs whose therapeutic benefits are tarnished by carcinogenesis risks. The chronic administration of glucagon-like peptide-1 (GLP-1) analogs widely used to treat type-2 diabetes was associated with an increased risk of pancreatic or thyroid cancers. The long-term treatment with the estrogen antagonist tamoxifen, developed to target breast cancer overexpressing estrogen receptors ER, presents agonist activity on the G protein-coupled estrogen receptor which is associated with an increased incidence of endometrial cancer and breast cancer resistance to hormonotherapy. We point out and discuss the need of pharmacological studies to understand and overcome the undesired effects associated with the chronic administration of GPCR ligands. In fact, biological effects triggered by GPCR often result from the activation of multiple intracellular signaling pathways. Deciphering which signaling networks are engaged following GPCR activation appears to be primordial to unveil their contribution in the physiological and physiopathological processes. The development of biased agonists to elucidate the role of the different signaling mechanisms mediated by GPCR activation will allow the generation of new therapeutic agents with improved efficacy and reduced side effects. In this regard, the identification of GLP-1R biased ligands promoting insulin secretion without inducing pro-tumoral effects would offer therapeutic benefit.
Collapse
Affiliation(s)
- Véronique Gigoux
- Université de Toulouse, Université Paul SabatierToulouse, France
- *Correspondence: Véronique Gigoux, CHU Rangueil – INSERM, Université de Toulouse, Université Paul Sabatier, EA4552, 1 Avenue Jean Poulhès, BP 84225, 31432 Toulouse Cedex 4, France. e-mail:
| | - Daniel Fourmy
- Université de Toulouse, Université Paul SabatierToulouse, France
| |
Collapse
|
15261
|
Huguet I, Lamas C, Vera R, Lomas A, Quilez RP, Grossman A, Botella F. Medullary thyroid carcinoma and duodenal calcitonin-secreting neuroendocrine tumour: more than coincidence? Endocrinol Diabetes Metab Case Rep 2013; 2013:130021. [PMID: 24616764 PMCID: PMC3922115 DOI: 10.1530/edm-13-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 06/20/2013] [Indexed: 11/25/2022] Open
Abstract
Neuroendocrine tumours (NETs) are a heterogeneous group of neoplasms whose management can be problematic. In many cases, multiple tumours may occur in the same patient or his or her family, and some of these have now been defined genetically, although in other cases the underlying gene or genes involved remain unclear. We describe a patient, a 63-year-old female, who was diagnosed with a medullary thyroid carcinoma (MTC), which was confirmed pathologically after thyroidectomy, but whose circulating calcitonin levels remained elevated after thyroidectomy with no evidence of metastatic disease. Subsequently, an entirely separate and discrete duodenal NET was identified; this was 2.8 cm in diameter and was removed at partial duodenectomy. The tumour stained immunohistochemically for calcitonin, and its removal led to persistent normalisation of the circulating calcitonin levels. There was no germline mutation of the RET oncogene. This is the first identification of a duodenal NET secreting calcitonin and also the first demonstration of a second tumour secreting calcitonin in a patient with MTC. We suggest that where calcitonin levels remain high after removal of a MTC a search for other NETs should be conducted.
Collapse
Affiliation(s)
- I Huguet
- Departments of Endocrinology University Hospital Complex Albacete Spain
| | - C Lamas
- Departments of Endocrinology University Hospital Complex Albacete Spain
| | - R Vera
- Pathology University Hospital Complex Albacete Spain
| | - A Lomas
- Departments of Endocrinology University Hospital Complex Albacete Spain
| | - R P Quilez
- Departments of Endocrinology University Hospital Complex Albacete Spain
| | | | - F Botella
- Departments of Endocrinology University Hospital Complex Albacete Spain
| |
Collapse
|
15262
|
Lupoli GA, Poggiano MR, Panico A, Granieri L, Lupoli R, Cacciapuoti M, Lupoli G. An easy schedule for postsurgical radioiodine administration in newly diagnosed differentiated thyroid carcinoma patients. Clin Endocrinol (Oxf) 2013; 78:145-51. [PMID: 22882239 DOI: 10.1111/cen.12004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 07/11/2012] [Accepted: 07/30/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To validate the simplest approach to preparing patients with differentiated thyroid carcinoma (DTC) for (131) I-administration ((131) I-A), minimizing the impact of hypothyroidism. DESIGN Panel study. PATIENTS Ninety patients with DTC were enrolled in the study. Sixty (Group A) underwent total thyroidectomy (TT); L-T4 was not administered in preparation for (131) I-A planned for 3 weeks later. Thirty patients (Group B) with previous TT and (131) I-A stopped L-T4 in preparation for clinical evaluation, including whole-body scanning (WBS)/radioiodine therapy during thyrotrophin (TSH) stimulation planned for 3 weeks (or more) later. MEASUREMENTS Thyrotrophin was measured the day before TT for group A, during L-T4 for group B (baseline-time 1) and then every week until it reached ≥ 30 mIU/l (time 2). Quality of life (QoL) was evaluated by Billewicz index. RESULTS At week 3, 100% of patients in group A and 56.6% of group B exceeded TSH > 30 mIU/l. In group B, the cut-off was achieved in four patients at the fourth week (TSH 38.6 ± 8.7 mIU/l), in 3 at the fifth (53.2 ± 3) and in 6 at the sixth (42.3 ± 6.1). From time 1 to time 2, total QoL scores were less affected in group A (percentage decrease: 105%) than in group B (218%). At time 2, the total score was >+19 in group A in 46 patients and in 30 in group B. In group A, TSH levels in the higher tertile of QoL (61 ± 6 mIU/l) were not different from those in the lower tertile (62.3 ± 11.1)(P > 0.1); similar results were seen in group B (69.3 ± 13.3 vs 62.9 ± 13.1)(P > 0.1). There was a positive correlation between the time to obtain TSH ≥ 30 mIU/l and total QoL scores. CONCLUSIONS Quality of life scores were not affected by thyrotrophin was measured the day before TT levels as absolute values. A longer time to obtain TSH ≥ 30 mIU/l was positively correlated with worse scores of QoL. We suggest 3 weeks without therapy can be used as an easy schedule in patients who undergo TT for DTC.
Collapse
Affiliation(s)
- Gelsy A Lupoli
- Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinica, Università degli Studi di Napoli Federico II, Naples, Italy
| | | | | | | | | | | | | |
Collapse
|
15263
|
Kandil E, Krishnan B, Noureldine SI, Yao L, Tufano RP. Hemithyroidectomy: A Meta-Analysis of Postoperative Need for Hormone Replacement and Complications. ACTA ACUST UNITED AC 2013; 75:6-17. [DOI: 10.1159/000345498] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 09/27/2012] [Indexed: 12/30/2022]
|
15264
|
Choi YS, Kwon HJ, Kim BK, Kwon SK, Park YH, Kim JH, Jung SB, Lee CH, Lee SK, Uchino S. A Case of medullary thyroid carcinoma with de novo V804M RET germline mutation. J Korean Med Sci 2013; 28:156-9. [PMID: 23341727 PMCID: PMC3546095 DOI: 10.3346/jkms.2013.28.1.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 08/27/2012] [Indexed: 11/20/2022] Open
Abstract
Many cases of RET proto-oncogene mutations of hereditary medullary thyroid carcinoma (MTC) have been reported in Korea. However, MTC with V804M RET proto-oncogene germline mutations have not been reported in Korea. A 33-yr-old man was diagnosed with a 0.7-cm sized thyroid nodule. Laboratory testing revealed serum calcitonin was elevated. The patient underwent total thyroidectomy with central compartment neck dissection for the thyroid tumor. RET gene analysis was performed in both the index patient and his family. There were no V804M RET mutation and abnormal laboratory findings within his family except the index patient. Therefore, this patient was a de novo V804M RET germline mutation.
Collapse
Affiliation(s)
- Young Sik Choi
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15265
|
Askitis D, Efremidou EI, Karanikas M, Mitrakas A, Tripsianis G, Polychronidis A, Liratzopoulos N. Incidental thyroid carcinoma diagnosed after total thyroidectomy for benign thyroid diseases: incidence and association with thyroid disease type and laboratory markers. Int J Endocrinol 2013; 2013:451959. [PMID: 24348554 PMCID: PMC3853072 DOI: 10.1155/2013/451959] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/16/2013] [Accepted: 10/17/2013] [Indexed: 11/21/2022] Open
Abstract
Objective. Currently, total thyroidectomy (TT) is widely used to treat benign thyroid diseases and thyroid carcinoma. The differential diagnosis between benign and malignant thyroid disorders and the potential identification of thyroid microcarcinomas with biochemical markers remain controversial. This retrospective study aimed to estimate the prognostic validity of thyroid autoantibodies, thyroglobulin (Tg), and the thyroid disease type in diagnostic approaches regarding the co-existence of incidental thyroid carcinoma (ITC) with benign thyroid diseases. Methods. A cohort of 228 patients was treated with TT for benign thyroid disorders between 2005 and 2010. Thyroid autoantibodies and Tg were preoperatively estimated. Patients were classified according to the preoperative and histologically established diagnoses, and the median values of the biochemical markers were compared between the groups. Results. ITC was detected in 33/228 patients and almost exclusively in the presence of nontoxic thyroid disorders (P = 0.014). There were no statistically significant differences in the median values of the biochemical markers between the benign and malignant groups. There was also no significant association between ITC and chronic lymphocytic thyroiditis. Conclusions. The co-existence of ITC with benign and especially nontoxic thyroid diseases is significant, and treatment of these disorders with TT when indicated can lead to the identification and definitive cure of microcarcinomas. Further studies are required to establish precise markers with prognostic validity for TC diagnosis.
Collapse
Affiliation(s)
- D. Askitis
- First Surgical Department, Medical School, University General Hospital of Alexandroupolis, Democritus University of Thrace, University Campus Dragana 1, 68100 Alexandroupolis, Greece
- *D. Askitis:
| | - E. I. Efremidou
- First Surgical Department, Medical School, University General Hospital of Alexandroupolis, Democritus University of Thrace, University Campus Dragana 1, 68100 Alexandroupolis, Greece
| | - M. Karanikas
- First Surgical Department, Medical School, University General Hospital of Alexandroupolis, Democritus University of Thrace, University Campus Dragana 1, 68100 Alexandroupolis, Greece
| | - A. Mitrakas
- First Surgical Department, Medical School, University General Hospital of Alexandroupolis, Democritus University of Thrace, University Campus Dragana 1, 68100 Alexandroupolis, Greece
| | - G. Tripsianis
- First Surgical Department, Medical School, University General Hospital of Alexandroupolis, Democritus University of Thrace, University Campus Dragana 1, 68100 Alexandroupolis, Greece
| | - A. Polychronidis
- First Surgical Department, Medical School, University General Hospital of Alexandroupolis, Democritus University of Thrace, University Campus Dragana 1, 68100 Alexandroupolis, Greece
| | - N. Liratzopoulos
- First Surgical Department, Medical School, University General Hospital of Alexandroupolis, Democritus University of Thrace, University Campus Dragana 1, 68100 Alexandroupolis, Greece
| |
Collapse
|
15266
|
Goyal N, Setabutr D, Abdulghani J, Goldenberg D. Molecular and Genetic Markers of Follicular-Cell Thyroid Cancer: Etiology and Diagnostic and Therapeutic Opportunities. Advances in Experimental Medicine and Biology 2013. [DOI: 10.1007/978-1-4614-6176-0_14] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
15267
|
|
15268
|
Elisei R, Alevizaki M, Conte-Devolx B, Frank-Raue K, Leite V, Williams G. 2012 European thyroid association guidelines for genetic testing and its clinical consequences in medullary thyroid cancer. Eur Thyroid J 2013; 1:216-31. [PMID: 24783025 PMCID: PMC3821492 DOI: 10.1159/000346174] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 11/30/2012] [Indexed: 01/09/2023] Open
Abstract
Twenty-five percent of medullary thyroid cancers (MTC) are familial and inherited as an autosomal dominant trait. Three different phenotypes can be distinguished: multiple endocrine neoplasia (MEN) types 2A and 2B, in which the MTC is associated with other endocrine neoplasias, and familial MTC (FMTC), which occurs in isolation. The discovery that germline RET oncogene activating mutations are associated with 95-98% of MEN 2/FMTC syndromes and the availability of genotyping to identify mutations in affected patients and their relatives has revolutionized the diagnostic and therapeutic strategies available for the management of these patients. All patients with MTC, both those with a positive familial history and those apparently sporadic, should be submitted to RET genetic screening. Once an RET mutation has been confirmed in an index patient, first-degree relatives should be screened rapidly to identify the 50% who inherited the mutation and are therefore at risk for development of MTC. Relatives in whom no RET mutation is identified can be reassured and discharged from further follow-up, whereas RET-positive subjects (i.e. gene carriers) must be investigated and a therapeutic strategy initiated. These guideline recommendations are derived from the most recent studies identifying phenotype-genotype correlations following the discovery of causative RET gene mutations in MEN 2 eighteen years ago. Three major points will be discussed: (a) identification of patients and relatives who should have genetic screening for RET mutations, (b) management of asymptomatic gene carriers, and (c) ethics.
Collapse
Affiliation(s)
- R. Elisei
- Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
- *Dr. Rossella Elisei, Department of Endocrinology, University of Pisa, Via Paradisa 2, IT–56124 Pisa (Italy), E-Mail
| | - M. Alevizaki
- Endocrine Unit, Department of Medical Therapeutics, Athens University School of Medicine, Athens, Greece
| | - B. Conte-Devolx
- Department of Endocrinology, La Timone Hospital, Aix Marseille University, Marseille, France
| | - K. Frank-Raue
- Endocrine Practice, Molecular Laboratory, Heidelberg, Germany
| | - V. Leite
- Department of Endocrinology, Portuguese Institute of Oncology and CEDOC, Faculty of Medical Sciences, Lisbon, Portugal
| | - G.R. Williams
- Molecular Endocrinology Group, Department of Medicine, Hammersmith Hospital, Imperial College London, London, UK
| |
Collapse
|
15269
|
Boonyaarunnate T, Olson MT, Ali SZ. 'Suspicious for a follicular neoplasm' before and after the Bethesda System for Reporting Thyroid Cytopathology: impact of standardized terminology. Acta Cytol 2013; 57:455-63. [PMID: 24021843 DOI: 10.1159/000351664] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 04/25/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) standardized the terminology for indeterminate diagnoses, but the performance of the indeterminate categories before and after TBSRTC has not been compared. This study evaluates the 'suspicious for a follicular or Hürthle cell neoplasm' (SFN/HCN) category before and after the introduction of TBSRTC at a single institution and in a meta-analysis of the literature. METHODS A meta-analysis compiled findings from publications on SFN/HCN or similar diagnoses before and after the introduction of TBSRTC. The pathology database at our institution identified all SFN/HCN or similar diagnoses in the 8 years surrounding the introduction of TBSRTC, and those cases were correlated with the surgical follow-up. RESULTS In the meta-analysis, the fraction of cases called SFN/HCN or the equivalent increased from 6.1 to 7.4% (p = 0.0002); the surgical follow-up rate increased from 55 to 61% (p < 0.00001), and the histological malignancy rate among the cases that were resected increased from 22 to 28% (p = 0.03) after TBSRTC. In our institutional experience, the introduction of TBSRTC did not coincide with any significant changes. CONCLUSION Standardized terminology clearly coincided with increases in follow-up and the malignancy rate of SFN/HCN. A change in the same statistics was not seen in our institutional experience.
Collapse
|
15270
|
Abstract
BACKGROUND An autoimmune etiology has been suggested in up to one-third of cases of chronic idiopathic urticaria (CIU), in which it has been proposed that a subset of cases are associated with thyroid autoimmunity. The objective of our present study was to verify the prevalence of thyroid antibodies in the patients with CIU. METHODS Sixty patients aged 12-51 years, who met criteria for CIU, and 40 aged-matched healthy controls (18 males and 22 females) were participated in this study. Serum anti-thyroid antibodies (ATAs), thyroid hormones, total immunoglobulin E (IgE), and food allergen-specific IgE antibodies were measured. The CIU group was treated with anti-H1 and anti-H2 histamines for 3 weeks. RESULTS The total ATA positive rate was 27.3% (33% males and 25% females) in the CIU group. The prevalence of anti-thyroglobulin antibodies, anti-TSH-receptor antibodies, and anti-thyroid peroxidase antibodies were 16.6%, 83.3%, and 8.3%, respectively. The thyroid hormones, T3, and T4, and the TSH were within the normal limits. The radioallergosorbent test was negative for food allergens, and only 18% of the patients had a total IgE concentration >200 IU/mL. CONCLUSION ATAs were found in 27% of the patients with CIU, but these antibodies did not dysregulate thyroid hormone secretion nor did they mediate any clinical manifestations.
Collapse
Affiliation(s)
- Kong-Sang Wan
- Department of Pediatrics, Taipei City Hospital-Renai Branch, Taipei, Taiwan.
| | | |
Collapse
|
15271
|
Stamatakos M, Paraskeva P, Katsaronis P, Tasiopoulou G, Kontzoglou K. Surgical Approach to the Management of Medullary Thyroid Cancer: When Is Lymph Node Dissection Needed? Oncology 2013; 84:350-5. [DOI: 10.1159/000351148] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 04/03/2013] [Indexed: 11/19/2022]
|
15272
|
Abstract
BACKGROUND External beam radiotherapy (XRT) has an established role in the management of recurrent or advanced well-differentiated thyroid carcinoma (WDTC). The goal of this study was to investigate the impact of this additional intervention on the quality of life (QOL) compared with total thyroidectomy (TT), with or without adjuvant radioactive iodine (RAI). METHODS A cross-sectional analysis using validated QOL instruments was performed. Patients receiving XRT between 1992 and 2008 for WDTC were identified and offered study participation. The Quality of Life Radiation Therapy Instrument and the Head and Neck Companion Module were administered retrospectively (N=13). For a comparison, patients previously treated with TT (N=11) alone as well as TT with postoperative RAI (N=11) for WDTC were also evaluated. RESULTS Thirty-four patients were included in the analysis. The XRT group reported significant decreases in chewing, swallowing, and appetite, and significant increase in pain, compared with both the RAI group and the TT group. Significant differences were reported for questions with regard to peace of mind, feeling discouraged, saliva, taste, ability to eat regular food, and concerns for the appearance of the neck in both RAI and XRT groups compared with TT patients. Subscale analysis of head and neck specific questions demonstrated significant overall differences for both RAI and XRT groups compared with thyroidectomy alone, with no differences observed between RAI and XRT groups in a direct comparison. CONCLUSIONS RAI therapy results in a measurable decrease in head and neck specific QOL measures compared with TT alone. The addition of XRT results in additional measurable morbidity secondary to pain and dysphagia.
Collapse
Affiliation(s)
- Thomas J Gal
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky 40536, USA.
| | | | | | | | | | | |
Collapse
|
15273
|
Affiliation(s)
- Furio Pacini
- *Furio Pacini, MD, Sezione di Endocrinologia, University of Siena, Via Bracci, IT–53100 Siena (Italy), E-Mail
| |
Collapse
|
15274
|
Pach D, Sowa-Staszczak A, Jabrocka-Hybel A, Stefańska A, Tomaszuk M, Mikołajczak R, Janota B, Trofimiuk-Müldner M, Przybylik-Mazurek E, Hubalewska-Dydejczyk A. Glucagon-Like Peptide-1 Receptor Imaging with [Lys (40) (Ahx-HYNIC- (99 m) Tc/EDDA)NH 2 ]-Exendin-4 for the Diagnosis of Recurrence or Dissemination of Medullary Thyroid Cancer: A Preliminary Report. Int J Endocrinol 2013; 2013:384508. [PMID: 23606839 PMCID: PMC3626320 DOI: 10.1155/2013/384508] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/14/2013] [Accepted: 03/13/2013] [Indexed: 12/21/2022] Open
Abstract
Introduction. Epidemiological studies on medullary thyroid cancer (MTC) have shown that neither a change in stage at diagnosis nor improvement in survival has occurred during the past 30 years. In patients with detectable serum calcitonin and no clinically apparent disease, a careful search for local recurrence, and nodal or distant metastases, should be performed. Conventional imaging modalities will not show any disease until basal serum calcitonin is at least 150 pg/mL. The objective of the study was to present the first experience with labelled glucagon-like peptide-1 (GLP-1) analogue [Lys(40)(Ahx-HYNIC-(99m)Tc/EDDA)NH2]-exendin-4 in the visualisation of MTC in humans. Material and Method. Four patients aged 22-74 years (two with sporadic and two with MEN2 syndrome-related disseminated MTC) were enrolled in the study. In all patients, GLP-1 receptor imaging was performed. Results. High-quality images were obtained in all patients. All previously known MTC lesions have been confirmed in GLP-1 scintigraphy. Moreover, one additional liver lesion was detected in sporadic MTC male patient. Conclusions. GLP-1 receptor imaging with [Lys(40)(Ahx-HYNIC-(99m)Tc/EDDA)NH2]-exendin-4 is able to detect MTC lesions. GLP-1 scintigraphy can serve as a confirmatory test in MTC patients, in whom other imaging procedures are inconsistent.
Collapse
Affiliation(s)
- D. Pach
- Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17, 31-501 Krakow, Poland
| | - A. Sowa-Staszczak
- Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17, 31-501 Krakow, Poland
| | - A. Jabrocka-Hybel
- Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17, 31-501 Krakow, Poland
| | - A. Stefańska
- Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17, 31-501 Krakow, Poland
| | - M. Tomaszuk
- Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17, 31-501 Krakow, Poland
| | - R. Mikołajczak
- Radioisotope Center POLATOM, National Centre for Nuclear Research, 05-400 Otwock, Poland
| | - B. Janota
- Radioisotope Center POLATOM, National Centre for Nuclear Research, 05-400 Otwock, Poland
| | - M. Trofimiuk-Müldner
- Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17, 31-501 Krakow, Poland
| | - E. Przybylik-Mazurek
- Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17, 31-501 Krakow, Poland
| | - A. Hubalewska-Dydejczyk
- Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17, 31-501 Krakow, Poland
- *A. Hubalewska-Dydejczyk:
| |
Collapse
|
15275
|
Abstract
Hakaru Hashimoto described 4 patients with a hitherto unknown cause for goitre, struma lymphomatosa, a century ago. He was careful to distinguish this from Riedel thyroiditis but it has become clear that fibrosis and atrophy of the thyroid are indeed components of Hashimoto thyroiditis, and in rare cases IgG4-related sclerosing disease may be an outcome. Although the cause of the lymphocytic infiltration was unknown to Hashimoto, we now know through the pioneering studies of N.R. Rose and E. Witebsky [J Immunol 1956;76:417-427] that this condition is the archetype for autoimmune destruction as a disease mechanism. In the last two decades in particular, there has been huge interest in unravelling the genetic basis for this and related autoimmune disorders. The list of polymorphisms associated with autoimmune thyroid disease grows each year, and in the case of vitiligo, which is frequently found in association with thyroid autoimmunity, we know that 27 separate susceptibility loci account for less than 20% of the heritability of this condition. Environmental and existential factors may turn out to be just as complex in number and in interactions. We can thus imagine a 'Swiss cheese' model for the causation of autoimmune thyroid disease, in which the effects of cumulative weaknesses line up - like the holes in slices of cheese - to allow the catastrophic event of autoimmune destruction to occur.
Collapse
Affiliation(s)
- Anthony P Weetman
- *Anthony P. Weetman, Department of Human Metabolism, Faculty of Medicine, Dentistry and Health, University of Sheffield, Barber House, 387 Glossop Road, Sheffield S10 2HQ (UK), E-Mail
| |
Collapse
|
15276
|
Chikani V, Lambie D, Russell A. Pituitary metastases from papillary carcinoma of thyroid: a case report and literature review. Endocrinol Diabetes Metab Case Rep 2013; 2013:130024. [PMID: 24616765 PMCID: PMC3922192 DOI: 10.1530/edm-13-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 07/22/2013] [Indexed: 11/12/2022] Open
Abstract
Metastases to the pituitary gland are an uncommon complication of thyroid cancer. They resemble pituitary neoplasms posing a diagnostic challenge. We present a case of an aggressive non-radioiodine avid papillary thyroid cancer with recurrent pituitary metastases and a review of the literature. A 70-year-old woman with a history of papillary thyroid cancer and bony metastases presented with symptoms of hypoadrenalism and peripheral vision loss. Magnetic resonance imaging showed a large pituitary mass impinging on the optic chiasm. She underwent transsphenoidal resection followed by 131I ablation. Post-therapy scintigraphy showed no iodine uptake in the sellar region or bony metastases. Histology of the pituitary mass confirmed metastatic papillary thyroid cancer. Fifteen months later, she had a recurrence of pituitary metastases affecting her vision. This was resected and followed with external beam radiotherapy. Over 2 years, the pituitary metastases increased in size and required two further operations. Radioactive iodine was not considered due to poor response in the past. Progressively, she developed a left-sided III and IV cranial nerve palsy and permanent bitemporal hemianopia. There was a rapid decline in the patient's health with further imaging revealing new lung and bony metastases, and she eventually died 8 months later. To our knowledge, this is the first case of pituitary metastases from a radioiodine-resistant papillary thyroid cancer. Radioiodine-resistant metastatic thyroid cancer may exhibit rapid aggressive growth and remain poorly responsive to the currently available treatment.
Collapse
Affiliation(s)
- Viral Chikani
- Department of Diabetes and Endocrinology The Princess Alexandra Hospital 199 Ipswich Road, Woolloongabba, Queensland, 4102 Australia
| | - Duncan Lambie
- Department of Anatomical Pathology The Princess Alexandra Hospital 199 Ipswich Road, Woolloongabba, Queensland, 4102 Australia
| | - Anthony Russell
- Department of Diabetes and Endocrinology The Princess Alexandra Hospital 199 Ipswich Road, Woolloongabba, Queensland, 4102 Australia
| |
Collapse
|
15277
|
Affiliation(s)
- Won Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Min Jung Bae
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Yang Seon Yi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Yun Kyung Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sang Soo Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Bo Hyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - In Joo Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| |
Collapse
|
15278
|
Jang HY, Kim BH, Kim WJ, Jeon YK, Kim SS, Kim YK, Kim IJ. False-positive radioiodine uptake in a functional ovarian cyst in a patient treated with total thyroidectomy for papillary cancer. Intern Med 2013; 52:2321-3. [PMID: 24126393 DOI: 10.2169/internalmedicine.52.0786] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
False positive radioiodine uptake following thyroidectomy for differentiated thyroid cancer has been reported in some cases. A 42-year-old woman was referred for ablative radioiodine treatment six weeks after undergoing total thyroidectomy for papillary thyroid carcinoma. Posttherapeutic I-131 scintigraphy showed an intense hot spot in the left pelvis. Pelvic computed tomography (CT) revealed a benign left ovarian mass such as a functional cyst. After menstruation, ultrasonographic imaging demonstrated a shrunken ovarian mass. Therefore, we diagnosed the patient with a functional cyst that was influenced by hormonal fluctuation. It is believed that this is the first case of false-positive radioiodine uptake in a functional ovarian cyst.
Collapse
Affiliation(s)
- Hye Yoon Jang
- Department of Internal Medicine, Pusan National University School of Medicine, Korea
| | | | | | | | | | | | | |
Collapse
|
15279
|
Abstract
BACKGROUND Fine-needle aspiration (FNA) is a useful diagnostic tool for preoperative evaluation of thyroid nodules. However, cytomorphology alone has poor accuracy for the diagnosis of lymphoproliferative disorders involving the thyroid. This study reviews our experience with flow cytometry on thyroid FNA and correlation with surgical follow-up at The Johns Hopkins Hospital. METHODS The 11,118 thyroid FNAs performed over a 20-year period were reviewed for clinical flow cytometry data (n = 62) or a subsequent diagnosis of lymphoma in the thyroid without flow cytometry data (n = 2). RESULT Sixty-four cases (0.6%) were included out of 11,118 thyroid FNAs collected over a 20-year period. Lymphoma was diagnosed 13 times. In 8 cases, both cytomorphology and flow cytometry arrived at the correct diagnosis. Cytomorphology alone made the correct diagnosis twice in the absence of flow cytometric results; flow cytometry made the diagnosis once in the absence of suspicious morphology. Neither flow cytometry nor cytomorphology made the correct diagnosis in 2 sparsely cellular cases. CONCLUSION The combination of cytomorphology and flow cytometry is a useful diagnostic modality for the work-up of lymphocyte-rich thyroid nodules that show atypical lymphocyte populations.
Collapse
|
15280
|
Sim Y, Yap F, Soo KC, Low Y. Medullary thyroid carcinoma in ethnic Chinese with MEN2A: a case report and literature review. J Pediatr Surg 2013; 48:e43-6. [PMID: 23331839 DOI: 10.1016/j.jpedsurg.2012.10.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/29/2012] [Accepted: 10/31/2012] [Indexed: 11/18/2022]
Abstract
Medullary Thyroid Carcinoma (MTC) is the most common cause of death in MEN patients. It is curative by prophylactic total thyroidectomy, but controversies remain as to the optimal timing for prophylactic thyroidectomy. The current recommendation is for prophylactic total thyroidectomy before age 5, but a recent study suggested that in the ethnic Chinese, even "high risk" mutations did not result in early malignant change, and it was suggested that prophylactic thyroidectomy may be performed at a later age. We report a case of an ethnic Chinese girl with MEN2A codon 634 (C634R) mutation, whose operative specimen at prophylactic thyroidectomy at 4 years 8 months showed MTC. We advocate that management of MEN2A patients should be codon-directed, regardless of ethnicity.
Collapse
Affiliation(s)
- Yirong Sim
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore S229899, Singapore
| | | | | | | |
Collapse
|
15281
|
Hiéronimus S, Ferrari P, Gal J, Berthier F, Azoulay S, Bongain A, Fénichel P, Brucker-Davis F. Relative impact of iodine supplementation and maternal smoking on cord blood thyroglobulin in pregnant women with normal thyroid function. Eur Thyroid J 2013; 1:264-73. [PMID: 24783029 PMCID: PMC3821487 DOI: 10.1159/000342915] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 08/23/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the impact on cord blood (CB) thyroglobulin (Tg) of early iodine supplementation during pregnancy. METHODS A total of 111 healthy pregnant women with normal thyroid function were included in a prospective randomized study and divided into two groups with (150 μg/day) or without iodine supplementation started during the first trimester. Maternal smoking was assessed qualitatively by self-reported statements and quantitatively by cotininuria. Exhaustive thyroid tests were performed at delivery in the mother and in CB. RESULTS Third-trimester ioduria documented compliance with iodine supplementation (160 vs. 76 μg/l in controls). CB Tg was not different between the iodine and control groups (median 77 vs. 79.5 ng/ml, respectively) and did not correlate with maternal ioduria. CB Tg was higher in newborns from smoking mothers (114 vs. 64.7 ng/ml) and correlated with self-reported smoking status more than with maternal cotininuria. Nonsmokers had no difference in CB Tg whether they took iodine supplementation or not, as opposed to smokers, who tended to benefit from supplementation. CONCLUSIONS Iodine supplementation does not significantly impact CB Tg in healthy nonsmoker pregnant women selected for normal thyroid function, as opposed to maternal smoking. CB Tg appears to be a marker of in utero tobacco exposure. In areas of mild iodine deficiency, iodine supplementation could especially benefit the fetuses of smokers.
Collapse
Affiliation(s)
- Sylvie Hiéronimus
- Department of Endocrinology, Diabetology and Reproductive Medicine, University Hospital of Nice, Nice, France
- *Dr. Sylvie Hiéronimus, Department of Endocrinology, Hôpital l'Archet 2, CHU Nice, 151 route de Saint-Antoine, FR–06200 Nice (France), E-Mail
| | - Patricia Ferrari
- Department of Biochemistry, University Hospital of Nice, Nice, France
| | - Jocelyn Gal
- Department of Biostatistics, University of Nice, Nice, France
| | | | - Stéphane Azoulay
- Institute of Chemistry, UMR 6001, University of Nice-Sophia-Antipolis, Nice, France
| | - André Bongain
- Department of Gynaecology and Obstetrics, University Hospital of Nice, Nice, France
| | - Patrick Fénichel
- Department of Endocrinology, Diabetology and Reproductive Medicine, University Hospital of Nice, Nice, France
- Institut National de la Recherche Médicale, UMR U895, University Nice-Sophia-Antipolis, Nice, France
| | - Françoise Brucker-Davis
- Department of Endocrinology, Diabetology and Reproductive Medicine, University Hospital of Nice, Nice, France
- Institut National de la Recherche Médicale, UMR U895, University Nice-Sophia-Antipolis, Nice, France
| |
Collapse
|
15282
|
Piccardo A, Arecco F, Puntoni M, Foppiani L, Cabria M, Corvisieri S, Arlandini A, Altrinetti V, Bandelloni R, Orlandi F. Focus on High-Risk DTC Patients: High Postoperative Serum Thyroglobulin Level Is a Strong Predictor of Disease Persistence and Is Associated to Progression-Free Survival and Overall Survival. Clin Nucl Med 2013; 38:18-24. [DOI: 10.1097/rlu.0b013e318266d4d8] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
15283
|
Ahn BC, Lee WK, Jeong SY, Lee SW, Lee J. Estimation of true serum thyroglobulin concentration using simultaneous measurement of serum antithyroglobulin antibody. Int J Endocrinol 2013; 2013:210639. [PMID: 23606837 PMCID: PMC3626228 DOI: 10.1155/2013/210639] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 02/07/2013] [Accepted: 03/05/2013] [Indexed: 11/17/2022] Open
Abstract
We investigated the analytical interference of antithyroglobulin antibody (TgAb) to thyroglobulin (Tg) measurement and tried to convert measured Tg concentration to true Tg concentration using a mathematical equation which includes a concentration of TgAb. Methods. Tg was measured by immunoradiometric assay and TgAb by radioimmunoassy. Experimental samples were produced by mixing Tg and TgAb standard solutions or mixing patients' serum with high Tg or high TgAb. Mathematical equations for prediction of expected Tg concentration with measured Tg and TgAb concentrations were deduced. The Tg concentration calculated using the equations was compared with the expected Tg concentration. Results. Measured Tg concentrations of samples having high TgAb were significantly lower than their expected Tg concentration. Magnitude of TgAb interference with the Tg assay showed a positive correlation with concentration of TgAb. Mathematical equations for estimation of expected Tg concentration using measured Tg and TgAb concentrations were successfully deduced and the calculated Tg concentration showed excellent correlation with expected Tg concentration. Conclusions. A mathematic equation for estimation of true Tg concentration using measured Tg and TgAb concentration was deduced. Tg concentration calculated by use of the equation might be more valuable than measured Tg concentration in patients with differentiated thyroid cancer.
Collapse
Affiliation(s)
- Byeong-Cheol Ahn
- Department of Nuclear Medicine, Kyungpook National University School of Medicine/Hospital, 50 Samduk-dong 2-ga, Chung Gu, Daegu 700-721, Republic of Korea
- *Byeong-Cheol Ahn:
| | - Won Kee Lee
- Department of Preventive Medicine, Kyungpook National University School of Medicine/Hospital, 50 Samduk-dong 2-ga, Chung Gu, Daegu 700-721, Republic of Korea
| | - Shin Young Jeong
- Department of Nuclear Medicine, Kyungpook National University School of Medicine/Hospital, 50 Samduk-dong 2-ga, Chung Gu, Daegu 700-721, Republic of Korea
| | - Sang-Woo Lee
- Department of Nuclear Medicine, Kyungpook National University School of Medicine/Hospital, 50 Samduk-dong 2-ga, Chung Gu, Daegu 700-721, Republic of Korea
| | - Jaetae Lee
- Department of Nuclear Medicine, Kyungpook National University School of Medicine/Hospital, 50 Samduk-dong 2-ga, Chung Gu, Daegu 700-721, Republic of Korea
| |
Collapse
|
15284
|
Napolitano G, Romeo A, Bianco A, Gasperi M, Zeppa P, Brunese L. B-flow twinkling sign in preoperative evaluation of cervical lymph nodes in patients with papillary thyroid carcinoma. Int J Endocrinol 2013; 2013:203610. [PMID: 23878537 PMCID: PMC3710605 DOI: 10.1155/2013/203610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/26/2013] [Indexed: 12/13/2022] Open
Abstract
Papillary thyroid cancer (PTC) is the most common histologic type of differentiated thyroid cancer. The first site of metastasis is the cervical lymph nodes (LNs). The ultrasonography (US) is the best diagnostic method for the detection of cervical metastatic LNs. We use a new technique, B-flow imaging (BFI), recently used for evaluation of thyroid nodules, to estimate the presence of BFI twinkling signs (BFI-TS), within metastatic LNs in patients with PTC. Two hundred and fifty-two patients with known PTC were examined for preoperative evaluation with conventional US and BFI. Only 83 with at least one metastatic LN were included. All patients included underwent surgery; the final diagnosis was based on the results of histology. The following LN characteristics were evaluated: shape, abnormal echogenicity, absent hilum, calcifications, cystic appearance, peripheral vascularization, and BFI-TS. A total of 604 LNs were analyzed. Of these, 298 were metastatic, according to histopathology. The BFI-TS showed high values of specificity (99.7%) and sensitivity (80.9%). The combination of each conventional US sign with the BF-TS increases the specificity. Our findings suggest that BFI can be helpful in the selection of suspicious neck LNs that should be examined at cytologic examination for accurate preoperative staging and individual therapy selection.
Collapse
Affiliation(s)
- Giuseppina Napolitano
- Department of Health Science, Chair of Radiology, University of Molise, Contrada Tappino, 86100 Campobasso, Italy
| | - Antonio Romeo
- Department of Health Science, Chair of Radiology, University of Molise, Contrada Tappino, 86100 Campobasso, Italy
| | - Andrea Bianco
- Department of Health Science, Chair of Radiology, University of Molise, Contrada Tappino, 86100 Campobasso, Italy
| | - Maurizio Gasperi
- Department of Health Science, Chair of Radiology, University of Molise, Contrada Tappino, 86100 Campobasso, Italy
| | - Pio Zeppa
- Department of Medicine and Surgery, the University of Salerno (IT), Italy
| | - Luca Brunese
- Department of Health Science, Chair of Radiology, University of Molise, Contrada Tappino, 86100 Campobasso, Italy
- *Luca Brunese:
| |
Collapse
|
15285
|
Figlioli G, Landi S, Romei C, Elisei R, Gemignani F. Medullary thyroid carcinoma (MTC) and RET proto-oncogene: Mutation spectrum in the familial cases and a meta-analysis of studies on the sporadic form. Mutation Research/Reviews in Mutation Research 2013; 752:36-44. [DOI: 10.1016/j.mrrev.2012.09.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 09/28/2012] [Accepted: 09/29/2012] [Indexed: 12/16/2022]
|
15286
|
Bartsch DK, Albers M, Knoop R, Kann PH, Fendrich V, Waldmann J. Enucleation and limited pancreatic resection provide long-term cure for insulinoma in multiple endocrine neoplasia type 1. Neuroendocrinology 2013; 98:290-8. [PMID: 24356648 DOI: 10.1159/000357779] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 12/06/2013] [Indexed: 12/25/2022]
Abstract
AIM To assess the characteristics and long-term outcome after surgery in patients with multiple endocrine neoplasia type 1 (MEN1)-associated insulinoma. METHODS Retrospective analysis of prospectively collected data of MEN1 patients with organic hyperinsulinism at a tertiary referral center. RESULTS Thirteen (17%) of 74 patients with MEN1 had organic hyperinsulinism. The median age at diagnosis was 27 (range 9-48) years. In 7 patients insulinoma was the first manifestation of the syndrome. All patients had at least one pancreatic neuroendocrine neoplasm (pNEN) upon imaging, including CT, MRI or endoscopic ultrasonography. Seven patients had solitary lesions upon imaging, 4 patients had one dominant tumor with coexisting multiple small pNENs, and 2 patients had multiple lesions without dominance. Eight patients had limited resections (1 segmental resection, 7 enucleations), 4 subtotal distal pancreatectomies, and 1 patient a partial duodenopancreatectomy. There was no postoperative mortality. Six patients experienced complications, including pancreatic fistula in 5 patients. Pathological examination revealed median three (range 1-14) macro-pNENs sized between 6 and 40 mm, and a total of 14 potentially benign insulinomas were detected in the 13 patients. After median follow-up of 156 months, only 1 patient developed recurrent hyperinsulinism after initial enucleation. Twelve patients developed new pNENs in the pancreatic remnant and 4 patients underwent reoperations (3 for metastatic ZES, 1 for recurrent hyperinsulinism). One of 5 patients with an initial extended pancreatic resection developed insulin-dependent diabetes mellitus. CONCLUSION Enucleation and limited resection provide long-term cure for MEN1 insulinoma in patients with solitary or dominant tumors. Subtotal distal pancreatectomy should thus be preserved for patients with multiple pNENs without dominance given the risk of exocrine and endocrine pancreas insufficiency in the mostly young patients.
Collapse
Affiliation(s)
- Detlef K Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany
| | | | | | | | | | | |
Collapse
|
15287
|
Ahmadieh H, Azar ST. Controversies in the management and followup of differentiated thyroid cancer: beyond the guidelines. J Thyroid Res 2012; 2012:512401. [PMID: 23326756 DOI: 10.1155/2012/512401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 12/12/2012] [Indexed: 01/21/2023] Open
Abstract
Thyroid cancer is among the most common endocrine malignancies. Genetic and environmental factors play an important role in the pathogenesis of differentiated thyroid cancer. Both have good prognosis but with frequent recurrences. Cancer staging is an essential prognostic part of cancer management. There are multiple controversies in the management and followup of differentiated thyroid cancer. Debate still exists with regard to the optimal surgical approach but trends toward a more conservative approach, such as lobectomy, are being more favored, especially in papillary thyroid cancer, of tumor sizes less than 4 cm, in the absence of other high-risk suggestive features. Survival of patients with well-differentiated thyroid cancer was adversely affected by lymph node metastases. Prophylactic central LN dissection did improve accuracy in staging and decrease postop TG level, but it had no effect on small-sized tumors. Conservative approach was more applied with regard to the need and dose of radioiodine given postoperatively. There have been several advancements in the management of radioiodine resistant advanced differentiated thyroid cancers. Appropriate followup is required based on risk stratification of patients postoperatively. Many studies are still ongoing in order to reach the optimal management and followup of differentiated thyroid cancer.
Collapse
|
15288
|
Kwak JY, Jung I, Baek JH, Baek SM, Choi N, Choi YJ, Jung SL, Kim EK, Kim JA, Kim JH, Kim KS, Lee JH, Lee JH, Moon HJ, Moon WJ, Park JS, Ryu JH, Shin JH, Son EJ, Sung JY, Na DG. Image reporting and characterization system for ultrasound features of thyroid nodules: multicentric Korean retrospective study. Korean J Radiol 2012; 14:110-7. [PMID: 23323040 PMCID: PMC3542293 DOI: 10.3348/kjr.2013.14.1.110] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 07/18/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The objective of this retrospective study was to develop and validate a simple diagnostic prediction model by using ultrasound (US) features of thyroid nodules obtained from multicenter retrospective data. MATERIALS AND METHODS Patient data were collected from 20 different institutions and the data included 2000 thyroid nodules from 1796 patients. For developing a diagnostic prediction model to estimate the malignant risk of thyroid nodules using suspicious malignant US features, we developed a training model in a subset of 1402 nodules from 1260 patients. Several suspicious malignant US features were evaluated to create the prediction model using a scoring tool. The scores for such US features were estimated by calculating odds ratios, and the risk score of malignancy for each thyroid nodule was defined as the sum of these individual scores. Later, we verified the usefulness of developed scoring system by applying into the remaining 598 nodules from 536 patients. RESULTS Among 2000 tumors, 1268 were benign and 732 were malignant. In our multiple regression analysis models, the following US features were statistically significant for malignant nodules when using the training data set: hypoechogenicity, marked hypoechogenicity, non-parallel orientation, microlobulated or spiculated margin, ill-defined margins, and microcalcifications. The malignancy rate was 7.3% in thyroid nodules that did not have suspicious-malignant features on US. Area under the receiver operating characteristic (ROC) curve was 0.867, which shows that the US risk score help predict thyroid malignancy well. In the test data set, the malignancy rates were 6.2% in thyroid nodules without malignant features on US. Area under the ROC curve of the test set was 0.872 when using the prediction model. CONCLUSION The predictor model using suspicious malignant US features may be helpful in risk stratification of thyroid nodules.
Collapse
Affiliation(s)
- Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15289
|
Yu WB, Song YT, Zhang NS. Completion lobectomy and central compartment dissection in low-risk patients who had undergone less extensive surgery than hemithyroidectomy. Oncol Lett 2012; 5:743-748. [PMID: 23426389 PMCID: PMC3576203 DOI: 10.3892/ol.2012.1100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 12/13/2012] [Indexed: 01/06/2023] Open
Abstract
Many low-risk patients with solitary papillary thyroid cancer located in one lobe had undergone surgery that was less extensive than hemithyroidectomy in China. An acceptable completion surgery regimen was suggested for these patients based on our experience. A total of 117 enrolled patients underwent completion surgery. Thirty-two patients had prior tumor resection, 46 patients had prior partial thyroidectomy and 39 patients had prior subtotal thyroidectomy. No neck dissection was performed. Reoperation was scheduled a median of 1.2 months (range, 3 days–6.5 months) after primary surgery for papillary thyroid cancer (PTC). Among the 117 patients, residual tumor was pathologically confirmed in 60 patients, with a residual rate of 51.28%. Among these 60 patients, residual tumor was identified in the thyroid bed alone in 18 patients and in compartment VI alone in 28 patients, while 14 patients exhibited residual tumor in both of these regions. Lymph node metastasis was observed in compartment VI in 42 patients (35.90%), and an average of 6.5 nodes were removed (range, 2–14 nodes for each patient). Additionally, 3.14 positive lymph nodes were removed on average from each of the 42 patients. We conclude that the completion regimen, including the ipsilateral residual lobe, the isthmus and ipsilateral compartment VI (prelaryngeal, pretracheal and paratracheal lymph nodes), is reasonable and acceptable for low-risk patients undergoing surgery that is less extensive than hemithyroidectomy.
Collapse
Affiliation(s)
- Wen-Bin Yu
- Department of Head and Neck, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Haidian, Beijing 100142, P.R. China
| | | | | |
Collapse
|
15290
|
Abstract
Recent findings in the past two decades have brought many insights into the biology of thyroid benign and malignant lesions, in particular the papillary and follicular thyroid cancers. Although, much progress have been made, thyroid cancers still pose diagnostic problems regarding differentiation of follicular lesions in relation to their aggressiveness and the treatment of advanced and undifferentiated thyroid cancers. Metallothioneins (MTs) were shown to induce cancer cells proliferation, mediate resistance to apoptosis, certain chemotherapeutics and radiotherapy. Therefore, MTs may be of utility in diagnosis and management of patients with benign and malignant lesions of the thyroid.
Collapse
Affiliation(s)
- Bartosz Pula
- Department of Histology and Embryology, Medical University in Wroclaw, Wroclaw, Poland.
| | | | | | | |
Collapse
|
15291
|
Safavi A, Vijayasekaran A, Guerrero MA. New insight into the treatment of advanced differentiated thyroid cancer. J Thyroid Res 2012; 2012:437569. [PMID: 23326755 DOI: 10.1155/2012/437569] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 12/12/2012] [Indexed: 01/16/2023] Open
Abstract
The vast majority of patients with differentiated thyroid cancer (DTC) are treated successfully with surgery and radioactive iodine ablation, yet the treatment of advanced cases is frustrating and largely ineffective. Systemic treatment with conventional cytotoxic chemotherapy is basically ineffective in most patients with advanced DTC. However, a better understanding of the genetics and biologic basis of thyroid cancers has generated opportunities for innovative therapeutic modalities, resulting in several clinical trials. We aim to delineate the latest knowledge regarding the biologic characteristics of DTC and to describe the available data related to novel targeted therapies that have demonstrated clinical effectiveness.
Collapse
|
15292
|
Lantieri F, Caroli F, Ceccherini I, Griseri P. The involvement of the RET variant G691S in medullary thyroid carcinoma enlightened by a meta-analysis study. Int J Cancer 2012. [PMID: 23180660 DOI: 10.1002/ijc.27967] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Medullary thyroid carcinoma (MTC) is a rare tumor, partially explained by mutations in the rearranged during transfection (RET) proto-oncogene. The nonsynonymous RET polymorphism G691S has been reported as associated with MTC, but findings are discordant. We sought to clarify the role of G691S in MTCs through in silico analysis, genetic association in our patients and a meta-analysis with extensive literature revision. Ninety-three Italian patients were compared to 85 healthy individuals. Results were included in a meta-analysis together with 11 case-control association studies identified through PubMed, EMBASE and Web of Science, with a combined sample of 968 cases and 2,115 controls. No association of G691S with MTC was found in our sample; however, we observed an excess of homozygotes for the variant, significantly higher among females. The overall allelic association in the meta-analysis was significant under the fixed-effect model (odds ratio [OR] = 1.22 [95% confidence intervals: 1.06-1.39], p = 0.0049), but borderline under the random effect model (OR = 1.21 [0.99-1.46], p = 0.0575), with a moderate/high heterogeneity (I(2) = 44.6%, p = 0.047). Under the recessive model of transmission, applied to the eight studies with available genotype frequencies, results were significant under both effect models (OR = 2.016 and OR = 2.022, p = 0.0004). No heterogeneity was anymore detectable. In silico analyses on G691S confirmed a change of the phosphorylation pattern that might account for the enhanced signaling transduction previously reported for G691S in several cancers, thus also explaining its overrepresentation in MTCs. The G691S variant allele does increase the risk for MTC, with a recessive mechanism of action, apparently more evident among females.
Collapse
Affiliation(s)
- Francesca Lantieri
- Health Science Department, Biostatistics Unit, University of Genoa, via Pastore 1, 16132 Genova, Italy
| | | | | | | |
Collapse
|
15293
|
Kang KH. Osteopontin expression in papillary thyroid carcinoma and its relationship with the BRAF mutation and tumor characteristics. J Korean Surg Soc 2012; 84:9-17. [PMID: 23323230 PMCID: PMC3539115 DOI: 10.4174/jkss.2013.84.1.9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 11/11/2012] [Accepted: 11/12/2012] [Indexed: 11/30/2022]
Abstract
Purpose We evaluated the relationship between the degree of osteopontin (OPN) expression in papillary thyroid carcinoma (PTC) specimens and the presence of the BRAF mutation and clinicopathologic variables. Methods Fifty-six snap-frozen thyroid tumor samples, including those of 49 PTCs, four follicular adenomas, two follicular carcinomas, and one Hürthle cell adenoma, were studied. We performed reverse transcription-polymerase chain reaction (RT-PCR) to assess the OPN expression levels. We also tested the BRAF codon 599 mutations using RT-PCR with the direct sequencing method. All of the tumors were microscopically reexamined by a pathologist with a special interest in thyroid neoplasia. Results OPN mRNA was significantly overexpressed in the PTC samples compared with other thyroid tumors (P = 0.011). In PTCs, the OPN expression level was higher in the BRAF mutation group than in the wild-type group (P = 0.041). Among the clinicopathologic variables, nonfollicular variant histologic subtypes (P = 0.002) and the presence of lymph node metastases (P = 0.042) were correlated with elevated level of OPN expression. Conclusion OPN might play a crucial role in tumorigenesis and the progression of PTC.
Collapse
Affiliation(s)
- Kyung Ho Kang
- Department of Surgery, Chung-Ang University Hospital, Seoul, Korea
| |
Collapse
|
15294
|
Abele JS. Putting aspiration back into thyroid fine-needle biopsy-the re-emerging role of vacuum assistance. Cancer Cytopathol 2012; 120:366-72. [PMID: 23161796 DOI: 10.1002/cncy.21256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 10/08/2012] [Accepted: 10/11/2012] [Indexed: 11/09/2022]
Affiliation(s)
- John S Abele
- Outpatient Pathology Associates, Sacramento, CA 95826, USA.
| |
Collapse
|
15295
|
Kim GR, Kim MH, Moon HJ, Chung WY, Kwak JY, Kim EK. Sonographic Characteristics Suggesting Papillary Thyroid Carcinoma According to Nodule Size. Ann Surg Oncol 2012; 20:906-13. [PMID: 23266584 DOI: 10.1245/s10434-012-2830-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Ga Ram Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
15296
|
Wong KP, Lang BH. New molecular targeted therapy and redifferentiation therapy for radioiodine-refractory advanced papillary thyroid carcinoma: literature review. J Thyroid Res 2012; 2012:818204. [PMID: 23320248 DOI: 10.1155/2012/818204] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/03/2012] [Indexed: 01/26/2023] Open
Abstract
Although the majority of papillary thyroid carcinoma could be successfully managed by complete surgical resection alone or resection followed by radioiodine ablation, a small proportion of patients may develop radioiodine-refractory progressive disease which is not amenable to surgery, local ablative treatment or other treatment modalities. The use of FDG-PET/CT scan for persistent/recurrent disease has improved the accuracy of restaging as well as cancer prognostication. Given that patients with RAI-refractory disease tend to do significantly worse than those with radioiodine-avid or non-progressive disease, an increasing number of phase I and II studies have been conducted to evaluate the efficacy of new molecular targeted drugs such as the tyrosine kinase inhibitors and redifferentiation drugs. The overall response rate of these drugs ranged between 0–53%, depending on whether the patients had been previously treated with these drugs, performance status and extent of disease. However, drug toxicity remains a major concern in administration of target therapies. Nevertheless, there are also ongoing phase III studies evaluating the efficacy of these new drugs. The aim of the review was to summarize and discuss the results of these targeted drugs and redifferentiation agents for patients with progressive, radioiodine-refractory papillary thyroid carcinoma.
Collapse
|
15297
|
Kleiman DA, Sporn MJ, Beninato T, Crowley MJ, Nguyen A, Uccelli A, Scognamiglio T, Zarnegar R, Fahey TJ. Preoperative BRAF(V600E) mutation screening is unlikely to alter initial surgical treatment of patients with indeterminate thyroid nodules: a prospective case series of 960 patients. Cancer 2012; 119:1495-502. [PMID: 23280049 DOI: 10.1002/cncr.27888] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 10/10/2012] [Accepted: 10/15/2012] [Indexed: 01/21/2023]
Abstract
BACKGROUND Preoperative B-type Raf kinase Val600Glu mutation, or BRAF(V600E), analysis has been proposed as a tool to guide initial surgery for indeterminate thyroid nodules. This study sought to determine if cytologic markers of malignancy are associated with the BRAF(V600E) mutation and if preoperative BRAF(V600E) testing would alter the initial management of patients with indeterminate nodules. METHODS Patients who underwent surgery for a thyroid nodule between 2003 and 2012 at a tertiary care center were prospectively enrolled. Stored nodule samples were retrospectively genotyped for the BRAF(V600E) mutation. BRAF(V600E) status, demographics, cytologic and histopathologic findings, and choice of initial surgery were examined. RESULTS A total of 960 patients were enrolled, of which 310 (32%) had an indeterminate nodule. The BRAF(V600E) mutation was identified in 13 patients (4%), 12 of whom had either cytologic atypia or were Bethesda category V. Three percent of Bethesda category III or IV nodules that were malignant harbored the mutation compared with 42% of Bethesda category V malignancies. Nuclear grooves (P = .030), pseudoinclusions (P < .001), and oval nuclei (P = .022) were all more common among BRAF(V600E) mutants. The sensitivities of using BRAF testing alone, cytologic atypia/Bethesda category V classification, or both, were 15%, 73%, and 76%, respectively. Twelve of the 13 BRAF(V600E) mutants had total thyroidectomies initially due to worrisome cytologic features, and therefore the initial management of only one patient would have been altered if BRAF(V600E) testing had been performed preoperatively. CONCLUSIONS Preoperative mutation screening for BRAF(V600E) does not meaningfully improve risk stratification and is unlikely to alter the initial management of patients with indeterminate nodules.
Collapse
Affiliation(s)
- David A Kleiman
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
15298
|
Słowińska-Klencka D, Popowicz B, Woźniak E, Sporny S, Klencki M. The influence of fine-needle aspiration biopsy of the thyroid gland on the size of the examined nodule and its ultrasound image. Arch Med Sci 2012; 8:1059-64. [PMID: 23319982 PMCID: PMC3542497 DOI: 10.5114/aoms.2012.32415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 01/15/2011] [Accepted: 01/31/2011] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The aim of the study was to assess the influence of thyroid fine-needle aspiration biopsy (FNAB) on the size and ultrasound (US) features of the lesions and to examine whether the possible effects are persistent. MATERIAL AND METHODS One hundred and fifty biopsied and 50 control thyroid nodules underwent two US examinations, 10-20 days and 8-10 weeks after the biopsy. The study took into account lesion volume alterations, both absolute and relative (with reference to its initial value), and the presence of US features of malignancy: hypoechogenicity, microcalcifications, internal blood flow, irregular or blurred margins and suspicious shape of the lesions. The analysis covered only those nodules which immediately after FNAB did not change their appearance owing to cyst fluid evacuation or intranodular hemorrhage. RESULTS The increase of the lesion volume was more frequent in the group of biopsied lesions than the control one (58.0% vs. 24.0%, p < 0.0001) with the highest increase of 61.5%. The mean change percentage, however, was determined below 5% and a tendency of the lesions to resume their initial volume was noticeable. Neither a persistent increase in nodule volume of above 50% nor significant changes in the presence of malignancy suggestive US features were observed after FNAB. None of the biopsied nodules developed any microcalcifications, irregular or blurred margins, internal blood flow, or suspicious shape. CONCLUSIONS Fine-needle aspiration biopsy does not cause permanent changes in the US image of biopsied lesions, provided that the sampling technique is appropriate and there are no significant changes observed during the biopsy.
Collapse
Affiliation(s)
- Dorota Słowińska-Klencka
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Poland
| | - Bożena Popowicz
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Poland
| | - Ewa Woźniak
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Poland
| | - Stanisław Sporny
- Department of Dental Pathomorphology, Chair of Pathomorphology, Medical University of Lodz, Poland
| | - Mariusz Klencki
- Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Poland
| |
Collapse
|
15299
|
Shim MJ, Roh JL, Gong G, Choi KJ, Lee JH, Cho SH, Nam SY, Kim SY. Preoperative detection and predictors of level V lymph node metastasis in patients with papillary thyroid carcinoma. Br J Surg 2012; 100:497-503. [DOI: 10.1002/bjs.9024] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2012] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Papillary thyroid carcinoma (PTC) frequently metastasizes to regional lymph nodes. Metastasis to the posterior neck, level V, is uncommon, and level V lymphadenectomy may lead to spinal accessory nerve injury and associated postoperative morbidities. The aim of this study was to assess the diagnostic efficiency of preoperative ultrasonography and to identify predictors of level V metastasis in patients with PTC.
Methods
This study involved patients with previously untreated PTC that had metastasized to the lateral neck, and who underwent total thyroidectomy with central and lateral neck dissection. Histopathological findings were compared with ultrasound results for various neck levels. Clinical and histopathological factors that predicted level V metastasis were identified.
Results
Of 143 patients, 26 (18·2 per cent) had lymph node metastasis at level V. The sensitivity and positive predictive value of ultrasonography for level V metastasis were 46·2 and 30·0 per cent respectively. Univariable analysis showed that male sex, extranodal disease extension, a metastatic lymph node ratio in the ipsilateral lateral neck of more than 0·2, and simultaneous involvement of ipsilateral levels II–IV or level III were associated with ipsilateral level V metastasis. Multivariable analysis revealed an independent association between macroscopic extranodal disease extension and level V metastasis (odds ratio 26·05, 95 per cent confidence interval 5·63 to 120·56; P < 0·001).
Conclusion
Preoperative ultrasonography frequently failed to detect level V metastasis in patients with metastatic PTC. Level V lymphadenectomy may be considered in patients with lymph node metastasis in the ipsilateral lateral neck with macroscopic extranodal extension.
Collapse
Affiliation(s)
- M J Shim
- Department of Otolaryngology, University of Ulsan College of Medicine, Seoul, Korea
| | - J-L Roh
- Department of Otolaryngology, University of Ulsan College of Medicine, Seoul, Korea
| | - G Gong
- Department of Pathology, University of Ulsan College of Medicine, Seoul, Korea
| | - K-J Choi
- Department of Pathology, University of Ulsan College of Medicine, Seoul, Korea
| | - J H Lee
- Department of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - S-H Cho
- Department of Otolaryngology, University of Ulsan College of Medicine, Seoul, Korea
| | - S Y Nam
- Department of Otolaryngology, University of Ulsan College of Medicine, Seoul, Korea
| | - S Y Kim
- Department of Otolaryngology, University of Ulsan College of Medicine, Seoul, Korea
- Department of Biomedical Research Institute, Korea Institute of Science and Technology, Seoul, Korea
| |
Collapse
|
15300
|
Xue YL, Qiu ZL, Song HJ, Luo QY. Value of ¹³¹I SPECT/CT for the evaluation of differentiated thyroid cancer: a systematic review of the literature. Eur J Nucl Med Mol Imaging 2012; 40:768-78. [PMID: 23242250 DOI: 10.1007/s00259-012-2310-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 11/19/2012] [Indexed: 12/12/2022]
Abstract
PURPOSE In the present study, we performed a systematic review of the current literature to assess the incremental value of (131)I single photon emission computed tomography (SPECT)/CT for the management of patients with differentiated thyroid cancer (DTC). METHODS The search of PubMed/MEDLINE and EMBASE databases to identify studies and reference lists for articles was conducted using the terms "SPECT or SPECT/CT or SPECT-CT or single photon emission computed tomography/computed tomography and thyroid carcinoma or thyroid cancer." Studies reporting the clinical value of (131)I SPECT/CT were selected. All studies included were assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2). Two independent reviewers selected the studies, summarized and tabulated the data, and pooled estimates were obtained. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS A total of 14 studies involving 1,066 patients met the inclusion criteria. Data obtained included the impact of (131)I SPECT/CT on staging or risk classification (three studies), diagnostic accuracy (six studies), and follow-up (five studies). CONCLUSION Integrated SPECT/CT is a useful tool for the diagnosis, staging, risk stratification, and follow-up of DTC. The impact of (131)I SPECT/CT on the management of patients with thyroid cancer was evaluated.
Collapse
Affiliation(s)
- Yan-Li Xue
- Department of Nuclear Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Rd., Shanghai 200233, China
| | | | | | | |
Collapse
|