Diagnostic performance of MRI to detect metastatic cervical lymph nodes in patients with thyroid cancer: a systematic review and meta-analysis

Management of medullary thyroid cancer based on variation of carcinoembryonic antigen and calcitonin

Carcinoembryonic antigen (CEA) and calcitonin (Ctn) are pivotal biomarkers in the diagnosis and management of medullary thyroid carcinoma (MTC). However, their diagnostic reliability in perioperative period remains a topic of ongoing debate. This review synthesizes researches on perioperative fluctuations in CEA and Ctn levels, and evaluates the impact of their different combinations on MTC diagnosis, treatment decisions, and prognosis. Our findings highlight it is crucial to understand and interpret the various combinations of CEA and Ctn fluctuations within a clinical context. Furthermore, to reduce diagnostic errors and improve patient outcomes, we recommend follow-up diagnostic and treatment protocols designed to address the potential pitfalls associated with the use of these biomarkers.

Three-year follow-up results of radiofrequency ablation for low-risk papillary thyroid microcarcinomas: Systematic review and meta-analysis

OBJECTIVES

Confidence in long-term treatment results of radiofrequency ablation (RFA) for papillary thyroid microcarcinoma (PTMC) is required in comparison with surgery and active surveillance (AS). The objective of this meta-analysis is to report more than three years of follow-up results of radiofrequency ablation for PTMCs.

METHODS

Ovid PUBMED, COCHRANE, and EMBASE databases were searched through Nov 19, 2023, for studies reporting outcomes in patients with PTMC treated with radiofrequency ablation and followed up for more than 3 years. The standard mean difference of the tumor volume before and after therapy, tumor recurrence, lymph node (LN) metastasis, distant metastasis, complications, and the pooled volume reduction rates (VRRs) at 1, 3, 6, 12, 24, 36, and 48 months after radiofrequency ablation were assessed. Data were extracted and methodological quality was assessed independently by two radiologists according to the PRISMA guidelines.

RESULTS

Eight studies, involving 2131 patients, met the inclusion criteria through database searches. The overall VRR was 99.81 % (95 % CI: 99.68, 99.95) in the last follow-up. During a mean pooled follow-up of 46.59 months, 69 patients experienced local PTMC recurrence, with 8 cases within the ablation area. Additionally, 44 patients were diagnosed with newly discovered PTMC, and 17 patients exhibited lymph node metastases. Among the patients with PTMC recurrence, 3 were under active surveillance while 59 underwent additional RFA. The pooled mean complication rate was 2.80 %, with no instances of life-threatening or delayed complications.

CONCLUSIONS

Radiofrequency ablation proves to be an effective local tumor control method for low-risk PTMC patients, resulting in clinically significant and enduring volume reduction. The rate of regrowth and retreatment requirement post-RFA was notably lower, positioning RFA as a compelling alternative to existing treatment options.

The value of synthetic MRI for quantitative analysis in the diagnosis of cervical lymph node metastasis in thyroid cancer

BACKGROUND

Preoperative effective assessment of cervical lymph node metastasis in thyroid cancer plays an important role in formulating the surgical plan.

PURPOSE

To investigate the significance of synthetic magnetic resonance imaging (MRI) for quantitatively analyzing cervical lymph node metastasis in thyroid cancer.

MATERIAL AND METHODS

A retrospective analysis was conducted on 30 patients with thyroid cancer, consisting of 19 thyroid cancer nodules, 45 metastatic lymph nodes, and 47 non-metastatic lymph nodes. Regions of interest (ROIs) for each type of nodule were manually delineated using a workstation. Quantitative parameters, such as T1, T2, and proton density (PD) values, were automatically extracted from synthetic MRI scans. Statistical tests and regression analysis were performed to assess differences and correlations among the quantitative parameters.

RESULTS

There were no significant differences in the quantitative parameter values between the primary tumor and metastatic lymph node tissues (P > 0.05). However, significant differences were observed in the quantitative parameters between the primary tumor and non-metastatic lymph node tissues and between the metastatic and non-metastatic lymph node tissues (P < 0.05). The diagnostic accuracy for cervical lymph node metastasis in thyroid cancer was 94.4% for the T1 and T2 combined index, 91.9% for T2, 86.8% for T1, and 71.7% for PD values.

CONCLUSION

The application of quantitative parameters from synthetic MRI can assist clinicians in accurately planning surgical interventions for thyroid cancer patients before surgery.

Prediction of Follicular Thyroid Neoplasm and Malignancy of Follicular Thyroid Neoplasm Using Multiparametric MRI

The study aims to evaluate multiparametric magnetic resonance imaging (MRI) for differentiating Follicular thyroid neoplasm (FTN) from non-FTN and malignant FTN (MFTN) from benign FTN (BFTN). We retrospectively analyzed 702 postoperatively confirmed thyroid nodules, and divided them into training (n = 482) and validation (n = 220) cohorts. The 133 FTNs were further split into BFTN (n = 116) and MFTN (n = 17) groups. Employing univariate and multivariate logistic regression, we identified independent predictors of FTN and MFTN, and subsequently develop a nomogram for FTN and a risk score system (RSS) for MFTN prediction. We assessed performance of nomogram through its discrimination, calibration, and clinical utility. The diagnostic performance of the RSS for MFTN was further compared with the performance of the Thyroid Imaging Reporting and Data System (TIRADS). The nomogram, integrating independent predictors, demonstrated robust discrimination and calibration in differentiating FTN from non-FTN in both training cohort (AUC = 0.947, Hosmer-Lemeshow P = 0.698) and validation cohort (AUC = 0.927, Hosmer-Lemeshow P = 0.088). Key risk factors for differentiating MFTN from BFTN included tumor size, restricted diffusion, and cystic degeneration. The AUC of the RSS for MFTN prediction was 0.902 (95% CI 0.798-0.971), outperforming five TIRADS with a sensitivity of 73.3%, specificity of 95.1%, accuracy of 92.4%, and positive and negative predictive values of 68.8% and 96.1%, respectively, at the optimal cutoff. MRI-based models demonstrate excellent diagnostic performance for preoperative predicting of FTN and MFTN, potentially guiding clinicians in optimizing therapeutic decision-making.

The efficacy and assessment value of the level of thyroglobulin wash-out after fine-needle aspiration cytodiagnosis in the evaluation of lymph node metastasis in papillary thyroid carcinoma

OBJECTIVE

The purpose of this study was to evaluate the efficacy and clinical value of US, FNAC,FNA-Tg and FNAC + FNA-Tg, as well as the cutoff values of FNA-Tg to evaluate LN metastasis.

METHODS

We analyzed the diagnostic value of different US signs, the efficiency of US, FNAC, FNA-Tg and FNAC + FNA-Tg among the LN- and LN + groups, and the cutoff value of FNA-Tg to evaluate LN metastasis. We punctured LNs multiple times and measured the levels of FNA-Tg. Furthermore, the LNs were marked with immunohistochemical Tg and LCA to distinguish the presence of Tg in the para-cancerous tissue of the LNs.

RESULTS

The s-Tg and FNA-Tg of the LN + group were higher than those of the LN- group (P = 0.018, ≤ 0.001). The LN + group had more abnormal US signs than the LN- group. The cutoff value of FNA-Tg was 3.2 ng/mL. US had a high sensitivity (92.42), but the specificity was not satisfactory (55.1). FNA-Tg had a higher sensitivity (92.42 vs. 89.39), specificity (100 vs. 93.88), and accuracy (92.42 vs. 83.27) than FNAC. However, the sensitivity of FNAC + FNA-Tg increased further, while the specificity and accuracy decreased slightly. The presence of Tg in the normal lymphocytes adjacent to the cancer was confirmed.

CONCLUSION

Ultrasonography provides a noninvasive, dynamic, multidimensional assessment of LNs. With a cutoff value of 3.2 ng/mL, FNA-Tg has higher accuracy and a lower false-negative rate than various single diagnoses. However, FNAC combined with FNA-Tg does not cause additional pain to patients and offers a higher diagnostic efficacy and clinical value.

Comprehensive Review of the Imaging Recommendations for Diagnosis, Staging, and Management of Thyroid Carcinoma

Thyroid cancer is the most common head and neck cancer (HNC) in the world. In this article, we comprehensively cover baseline, posttreatment, and follow-up imaging recommendations for thyroid carcinomas along with the eighth edition of the tumor, node, metastasis (TNM) staging system proposed by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC). We include characterization and risk stratification of thyroid nodules on ultrasound (US) proposed by various international bodies. Management guidelines (depending upon the type of thyroid carcinoma) based on the international consensus recommendations (mainly by the American Thyroid Association) are also extensively covered in this article, including the role of a radioiodine scan. The management of recurrent disease is also briefly elucidated in this article. In addition, we cover the risk factors and etiopathogenesis of thyroid carcinoma along with the non-imaging diagnostic workup essential for thyroid carcinoma management, including the significance of genetic mutations. US is the diagnostic imaging modality of choice, with US-guided fine needle aspiration (FNA) being the procedure of choice for tissue diagnosis. The roles of computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) in thyroid carcinoma staging are also specified. Through this article, we aim to provide a comprehensive reference guide for the radiologists and the clinicians in the pursuit of optimal care for patients with thyroid carcinoma.

2020 Imaging Guidelines for Thyroid Nodules and Differentiated Thyroid Cancer: Korean Society of Thyroid Radiology

Imaging plays a key role in the diagnosis and characterization of thyroid diseases, and the information provided by imaging studies is essential for management planning. A referral guideline for imaging studies may help physicians make reasonable decisions and minimize the number of unnecessary examinations. The Korean Society of Thyroid Radiology (KSThR) developed imaging guidelines for thyroid nodules and differentiated thyroid cancer using an adaptation process through a collaboration between the National Evidence-based Healthcare Collaborating Agency and the working group of KSThR, which is composed of radiologists specializing in thyroid imaging. When evidence is either insufficient or equivocal, expert opinion may supplement the available evidence for recommending imaging. Therefore, we suggest rating the appropriateness of imaging for specific clinical situations in this guideline.