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Fernández-Velasco P, Díaz-Soto G, Pérez López P, Torres Torres B, de Luis D. Predictive value and dynamic risk stratification of high sensitive basal or stimulated thyroglobulin assay in a long-term thyroid carcinoma cohort. Endocrine 2023:10.1007/s12020-023-03320-y. [PMID: 36820996 PMCID: PMC10239375 DOI: 10.1007/s12020-023-03320-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To evaluate the predictive value of the rhTSH thyroglobulin stimulation test (rhTSH-Tg) compared to basal high-sensitive thyroglobulin (hs-Tg) under TSH suppressive therapy at 12 months after the completion of initial treatment to predict the long-term response and Dynamic Risk Stratification (DRS) at the last follow-up visit in a long-term DTC cohort. METHODS Prospective study in 114 DTC patients (77.2% women, mean age 46.4 ± 14.1 years old, median/IQR evolution 6.7[3.1-8.0] years) from 2013 to 2020 undergoing total thyroidectomy and radioiodine ablation in whom hs-Tg and rhTSH-Tg was performed 12 months after completing initial treatment. Pearson correlation, receiving operating characteristics (ROC) and DRS at initial and last follow-up visit were analyzed. RESULTS hs-Tg and rhTSH-Tg show a strong positive linear correlation (r = 0.864, p < 0.001). The diagnostic performance of initial hs-Tg and rhTSH-Tg levels were evaluated via ROC-AUC as a predictor of excellent response (ER) in the last follow-up visit. Hs-Tg showed a better AUC (0.969, 95%CI = 0.941-0.997) than rhTSH-Tg (0.944, 95%IC = 0.905-0.984; p < 0.001). The hs-Tg and rhTSH-Tg cutoff point of highest sensitivity (S) and specificity (E) was 0.110 and 0.815 ng/dl, respectively. Hs-Tg showed a higher diagnostic accuracy than rhTSH-Tg (S = 100% vs 96.8%, E = 84.3% vs 84.3%, NPV = 100% vs 98.6%, PPV = 70.5% vs 69.7%; p < 0.05). The DRS based on initial hs-Tg showed better ability to predict ER (93.3% vs 86.7%) and biochemical incomplete response (53.3%vs13.3%) in the last follow-up visit compared to rhTSH-Tg. CONCLUSIONS Both initial hs-Th and rhTSH-Tg were good predictors of long-term ER. In patients with hs-Tg, the rhTSH-test did not provide relevant prognosis information. An ER after initial treatment was associated with a very high NPV at subsequent follow-up.
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Affiliation(s)
- Pablo Fernández-Velasco
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación de Endocrinología y Nutrición Clinica (CIENC), Facultad de Medicina. Universidad de Valladolid, Valladolid, Spain
| | - Gonzalo Díaz-Soto
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
- Centro de Investigación de Endocrinología y Nutrición Clinica (CIENC), Facultad de Medicina. Universidad de Valladolid, Valladolid, Spain.
| | - Paloma Pérez López
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación de Endocrinología y Nutrición Clinica (CIENC), Facultad de Medicina. Universidad de Valladolid, Valladolid, Spain
| | - Beatriz Torres Torres
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación de Endocrinología y Nutrición Clinica (CIENC), Facultad de Medicina. Universidad de Valladolid, Valladolid, Spain
| | - Daniel de Luis
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación de Endocrinología y Nutrición Clinica (CIENC), Facultad de Medicina. Universidad de Valladolid, Valladolid, Spain
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Frich PS, Sigstad E, Berstad AE, Fagerlid KH, Paulsen TH, Bjøro T, Flinder LI. Long-Term Efficacy of Ethanol Ablation as Treatment of Metastatic Lymph Nodes From Papillary Thyroid Carcinoma. J Clin Endocrinol Metab 2022; 107:e2141-e2147. [PMID: 34922379 PMCID: PMC9016442 DOI: 10.1210/clinem/dgab907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Indexed: 11/25/2022]
Abstract
CONTEXT Ethanol ablation (EA) is considered an alternative to surgery for metastatic lymph nodes from papillary thyroid carcinoma (PTC) in selected patients. OBJECTIVE The aim of this study was to evaluate the long-term efficacy and safety of this treatment. DESIGN AND SETTING Adult patients with PTC who had received EA in lymph node metastasis at a tertiary referral center, and were included in a published study from 2011, were invited to participate in this follow-up study. METHODS Radiologic and medical history were reviewed. Ultrasound examination of the neck was performed by radiologists, and clinical examination was performed by an endocrine surgeon. Response was reported according to predefined criteria for satisfactory EA treatment. Adverse events associated with EA were evaluated. Cause of death was reported for deceased patients. RESULTS From the 2011 study, 51 of 63 patients were included. Forty-four patients were reexamined (67/109 lesions) and 7 patients were deceased. Median follow-up time from primary surgery was 14.5 years. Median follow-up from the latest performed EA in the 2011 study was 11.3 years. Local control was permanently achieved in most patients (80%). Recurrence within an ablated node was registered in 13 metastases in 10 patients. Seven of these patients also had recurrent disease elsewhere in the neck. No major side effects were reported. CONCLUSION EA is a minimally invasive procedure with a low risk of complications. Our data suggest that EA is a safe and efficient treatment, providing excellent results for a large group of patients in the long term.
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Affiliation(s)
- Pål Stefan Frich
- Division of Radiology and Nuclear Medicine, Department of Radiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Correspondence: Pål Stefan Frich, MD, Department of Radiology, The Norwegian Radium Hospital, Oslo University Hospital, P.O. Box 4953, Nydalen N-0424 Oslo, Norway. E-mail:
| | - Eva Sigstad
- Division of Laboratory Medicine, Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Audun Elnæs Berstad
- Division of Radiology and Nuclear Medicine, Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Kristin Holgersen Fagerlid
- Division of Radiology and Nuclear Medicine, Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Trond Harder Paulsen
- Division of Cancer Medicine, Department of Breast and Endocrine Surgery, Oslo University Hospital, Oslo, Norway
| | - Trine Bjøro
- Division of Laboratory Medicine, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Liv Ingrid Flinder
- Division of Radiology and Nuclear Medicine, Department of Radiology, Oslo University Hospital, Oslo, Norway
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Ylli D, Soldin SJ, Stolze B, Wei B, Nigussie G, Nguyen H, Mendu DR, Mete M, Wu D, Gomes-Lima CJ, Klubo-Gwiezdzinska J, Burman KD, Wartofsky L. Biotin Interference in Assays for Thyroid Hormones, Thyrotropin and Thyroglobulin. Thyroid 2021; 31:1160-1170. [PMID: 34042535 PMCID: PMC8420951 DOI: 10.1089/thy.2020.0866] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: Biotin has been reported to interfere with several commonly used laboratory assays resulting in misleading values and possible erroneous diagnosis and treatment. This report describes a prospective study of possible biotin interference in thyroid-related laboratory assays, with a comparison of different commonly used assay platforms. Materials and Methods: Thirteen adult subjects (mean age 45 ± 13 years old) were administered biotin 10 mg/day for eight days. Blood specimens were collected at three time points on day 1 and on day 8 (baseline, two, and five hours after biotin ingestion). Thyrotropin (TSH), free triiodothyronine (fT3), free thyroxine (fT4), total triiodothyronine (TT3), total thyroxine (TT4), thyroxine binding globulin (TBG), and thyroglobulin (Tg) levels were analyzed with four different platforms: Abbott Architect, Roche Cobas 6000, Siemens IMMULITE 2000, and liquid chromatography with tandem mass spectrometry (LC-MS/MS). TSH, fT3, fT4, TT3, and TT4 were measured with Abbott Architect and Roche Cobas 6000. fT3, fT4, TT3, and TT4 were also measured by LC-MS/MS. Tg was measured by Siemens IMMULITE 2000. TBG was assessed with Siemens IMMULITE 2000. Results: Significant changes in TSH, fT4, and TT3 measurements were observed after biotin exposure when the Roche Cobas 6000 platform was used. Biotin intake resulted in a falsely lower Tg level when measurements were performed with Siemens IMMULITE 2000. At the time points examined, maximal biotin interference was observed two hours after biotin exposure both on day 1 and day 8. Conclusions: A daily dose of 10 mg was shown to interfere with specific assays for TSH, fT4, TT3, and Tg. Physicians must be aware of the potential risk of erroneous test results in subjects taking biotin supplements. Altered test results for TSH and Tg can be particularly problematic in patients requiring careful titration of levothyroxine therapy such as those with thyroid cancer.
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Affiliation(s)
- Dorina Ylli
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Steven J. Soldin
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, Maryland, USA
| | - Brian Stolze
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, Maryland, USA
| | - Bin Wei
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, Maryland, USA
| | - Girum Nigussie
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, Maryland, USA
| | - Hung Nguyen
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, Maryland, USA
| | - Damodara Rao Mendu
- Department of Laboratory Medicine, Mount Sinai Hospital NY, New York, New York, USA
| | - Mihriye Mete
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Di Wu
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Cristiane J. Gomes-Lima
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Joanna Klubo-Gwiezdzinska
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Kenneth D. Burman
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Leonard Wartofsky
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Address correspondence to: Leonard Wartofsky, MD, Endocrinology Division, MedStar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA
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de Moraes MOS, de Moraes Segundo JDDP, Paula MMDS, Sales MGF, Brito WR. Highly sensitive electrochemical immunosensor using a protein-polyvinylidene fluoride nanocomposite for human thyroglobulin. Bioelectrochemistry 2021; 142:107888. [PMID: 34325091 DOI: 10.1016/j.bioelechem.2021.107888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/16/2023]
Abstract
The highly sensitive detection of serum thyroglobulin (Tg) is essential in the post-treatment follow-up of patients with differentiated thyroid cancer undergoing total or partial thyroidectomy and radioactive iodine ablation and requires sensitive, accurate and stable methods. This work proposes an electrochemical immunosensor for the detection of serum Tg antigen, making use of innovative nanocomposites including polyvinylidene fluoride (PVDF) microparticles coated with streptavidin (MP) and gold nanoparticles (AuNPs). The functionalized polymer matrices were characterized by UV-Vis, FTIR, XPS, SEM, dynamic light scattering, and free surface energy. Immobilization of biotin-labeled anti-thyroglobulin monoclonal antibodies was achieved by binding these to the polymer nanocomposite via streptavidin proteins. The analytical response was measured in quintuplicate and had a linear profile from 2.0 to 10.0 ng/mL Tg, with r2 of 0.985. The limits of detection and quantification were excellent, equal to 0.015 and 0.047 ng/mL, respectively. In addition, the recovery factor was equal to 95.4% (1.0 ng/mL Tg). Overall, the innovative polymer-based nanocomposite used herein enabled the production of an electrochemical-based immunosensor with excellent sensitivity, selectivity, and reproducibility. It evidenced the remarkable potential of determining low levels of Tg in in vitro assays, thereby suggesting that it may be considered for the analyzes of serum patients.
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Affiliation(s)
- Maria Oneide Silva de Moraes
- LABEL, Department of Chemistry, Federal University of Amazonas, Manaus, Amazonas 69067-005, Brazil; Thematic Laboratory of Microscopy and Nanotechnology, National Institute of Amazonian Research Manaus, Amazonas 69067-001, Brazil.
| | | | | | - Maria Goreti Ferreira Sales
- BioMark@UC, Department of Chemical Engineering, Faculty of Sciences and Technology, University of Coimbra, Coimbra 3030-790, Portugal
| | - Walter Ricardo Brito
- LABEL, Department of Chemistry, Federal University of Amazonas, Manaus, Amazonas 69067-005, Brazil.
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Levernæs MCS, Moe AU, Bøe SL, Paus E, Reubsaet L, Halvorsen TG. Liquid chromatography mass spectrometry based characterization of epitope configurations. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2020; 12:5476-5484. [PMID: 33141131 DOI: 10.1039/d0ay01283a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Here we evaluate a quick and easy tool for determination of epitope configuration using immunocapture and liquid chromatography mass spectrometry (LC-MS) subsequent to pre-treatment of the target protein to disrupt its three-dimensional structure. The approach can be a valuable screening tool to identify antibodies that can be used in peptide capture by anti-protein antibodies. The experimental set-up was established using seven monoclonal antibodies (mAbs) with known linear or conformational epitope recognition. The mAbs were developed to target either of the two biomarkers, progastrin releasing peptide (ProGRP) or human chorionic gonadotropin (hCG). Best coherence with established epitope configuration was seen when using both denaturation, reduction and alkylation as pre-treatment method of the proteins (≥70% reduction in MS signal intensity compared to control) prior to immunocapture and LC-MS determination. The final method was used to determine the epitope configuration of four anti-thyroglobulin mAbs with unknown epitope configuration; all four mAbs showed configurational epitope recognition. These results were also supported by western blots of native, and reduced and alkylated protein using three of the evaluated mAbs, and by analysis native, and reduced and alkylated protein in a routine immunofluorometric assay employing the four evaluated antibodies.
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Cennamo M, La Civita E, Curci A, Liotti A, Braschi U, Terracciano D. Comparison between a new thyroglobulin assay with the well-established Beckman Access immunoassay: A preliminary report. J Clin Lab Anal 2020; 35:e23589. [PMID: 32951246 PMCID: PMC7891525 DOI: 10.1002/jcla.23589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Measurement of serum thyroglobulin (Tg) plays a key role in the post-thyroidectomy management of differentiated thyroid carcinoma (DTC). In this context, the performance of new-generation thyroglobulin assay has clinical implications in the follow-up of DTC patients. Aim of this study was to compare the new highly sensitive Liaison Tg II (Tg-L) with the well-established Tg Access assay (Tg-A). MATERIALS AND METHODS A total of 91 residual serum samples (23 positive and 68 negatives for Tg auto-antibodies) were tested by the Beckman Access and Diasorin Liaison assays. Study samples were from 21 patients with pathologically proven DTC and control samples from 70 (16 patients with benign thyroid disease and 54 apparently healthy subjects). RESULTS Our results showed that Tg-L was highly correlated with Tg-A for both values ranging between 0.2 and 50 ng/mL (Pearson's r = 0.933 [95%CI 0.894-0.958], P < .001) and higher than 50 ng/mL (Pearson's r = 0.849 [95%CI 0.609-0.946], P < .001). For Tg values lower than 0.2 ng/mL, the overall concordance rate was 92%. Moreover, we tested 7 fine-needle aspiration washout fluids (FNA), showing an overall concordance rate in discriminating negative and positive of 100%. Finally, we found no interference by Tg auto-antibodies (TgAbs) for both Tg-L and Tg-A. Conversely, rheumatoid factor (RF) interferes with Tg-A, but not with Tg-L in one patient with no relapsing thyroid carcinoma. CONCLUSIONS Liaison Tg II demonstrated a good correlation with Access Tg assay both for sera and FNAs. Further studies on larger population are needed to evaluate Tg-L clinical impact on DTC patient's follow-up.
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Affiliation(s)
- Michele Cennamo
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Evelina La Civita
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Anna Curci
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Antonietta Liotti
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Umberto Braschi
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
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Broughton MN, Westgaard A, Paus E, Øijordsbakken M, Henanger KJ, Naume B, Bjøro T. Specific antibodies and sensitive immunoassays for the human epidermal growth factor receptors (HER2, HER3, and HER4). Tumour Biol 2017; 39:1010428317707436. [PMID: 28653892 DOI: 10.1177/1010428317707436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The use of trastuzumab in patients with breast cancer that overexpresses human epidermal growth factor receptor 2 has significantly improved treatment outcomes. However, a substantial proportion of this patient group still experiences progression of the disease after receiving the drug. Evaluation of the changes in expression of the human epidermal growth factor receptors could be of interest. Monoclonal antibodies against the extracellular domain of the human growth factor receptors, 2, 3, and 4, have been raised, and specific and sensitive immunoassays have been established. Sera from healthy individuals (Nordic Reference Interval Project and Database) were analyzed in the human epidermal growth factor receptor 2 assay (N = 805) and the human epidermal growth factor receptor 3 and 4 assays (N = 114), and reference limits were calculated. In addition, sera from 208 individual patients with breast cancer were tested in all three assays. Finally, the human epidermal growth factor receptor 2 assay was compared with a chemiluminescent immunoassay for serum human epidermal growth factor receptor 2/neu. Reference values were as follows: human epidermal growth factor receptor 2, <2.5 µg/L; human epidermal growth factor receptor 3, <2.8 µg/L; and human epidermal growth factor receptor 4, <1.8 µg/L. There were significant differences in human epidermal growth factor receptor 2 and human epidermal growth factor receptor 3 serum levels between the patients with tissue human epidermal growth factor receptor 2-positive and tissue human epidermal growth factor receptor 2-negative ( p = 0.0026, p = 0.000011) tumors, but not in the serum levels of human epidermal growth factor receptor 4 ( p = 0.054). There was good agreement between the in-house human epidermal growth factor receptor 2 assay and the chemiluminescent immunoassay. Our new specific antibodies for all the three human epidermal growth factor receptors may prove valuable in the development of novel anti-human epidermal growth factor receptor targeted therapies with sensitive immunoassays for measuring serum levels of the respective targets and in monitoring established treatment.
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Affiliation(s)
| | - Arne Westgaard
- 2 Department of Oncology, Radiumhospitalet, Oslo University Hospital, Oslo, Norway
| | - Elisabeth Paus
- 1 Department of Medical Biochemistry, Radiumhospitalet, Oslo University Hospital, Oslo, Norway
| | - Miriam Øijordsbakken
- 1 Department of Medical Biochemistry, Radiumhospitalet, Oslo University Hospital, Oslo, Norway
| | - Karoline J Henanger
- 1 Department of Medical Biochemistry, Radiumhospitalet, Oslo University Hospital, Oslo, Norway
| | - Bjørn Naume
- 2 Department of Oncology, Radiumhospitalet, Oslo University Hospital, Oslo, Norway.,3 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Trine Bjøro
- 1 Department of Medical Biochemistry, Radiumhospitalet, Oslo University Hospital, Oslo, Norway.,3 Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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