Comparison of Core-Needle Biopsy and Fine-Needle Aspiration for Evaluating Thyroid Incidentalomas Detected by 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: A Propensity Score Analysis

Targeting Diagnosis of High-Risk Papillary Thyroid Carcinoma Using Ultrasound Contrast Agent With the BRAFV600E Mutation: An Experimental Study

OBJECTIVE

High-risk papillary thyroid carcinoma (PTC) patients with BRAF mutation have lymph node and distant metastases and poor prognosis. Therefore, this study aims to develop a targeted ultrasound contrast agent for the BRAF^V600E mutation to screen high-risk PTC at early stage.

METHODS

The targeted lipid nanobubbles carrying BRAF^V600E antibody were prepared using thin film hydration-sonication and avidin-biotin binding methods. The physicochemical properties and stability of the targeted nanobubbles were detected by transmission electron microscopy, atomic force microscopy, and confocal laser scanning microscopy. The target binding abilities of the targeted nanobubbles in the PTC cells (B-CPAP) overexpressed mutant BRAF^V600E were evaluated by immunofluorescence staining, quantitative real-time polymerase chain reaction, western blot, and fluorescence microscopy. After PTC tumor models overexpressed mutant BRAF^V600E were established, the enhanced images of targeted lipid nanobubbles and untargeted lipid nanobubbles on PTC tumors in nude mice were observed using contrast-enhanced ultrasound imaging.

RESULTS

The targeted lipid nanobubbles revealed uniform, round morphology, and good stability with a nanoscale size. Besides, BRAF^V600E monoclonal antibody was observed to be combined on the surface of lipid nanobubbles. Furthermore, the targeted nanobubbles had a good targeting diagnosis ability in PTC cells with BRAF^V600E overexpression. Moreover, the targeted nanobubbles had better ultrasound enhancement and peak intensity of the time-intensity curve (P < .001) in PTC tumors with BRAF^V600E overexpression as compared to the untargeted lipid nanobubbles.

CONCLUSION

The targeted lipid nanobubbles carrying BRAF^V600E antibody could be regarded as a potential targeted ultrasound contrast agent for the diagnosis of high-risk PTC.

The dilemma of 18F-FDG PET/CT thyroid incidentaloma: what we should expect from FNA. A systematic review and meta-analysis

PURPOSE

¹⁸F-FDG thyroid incidentaloma (TI) occurs in ~2% of PET/CT examinations with a cancer prevalence of up to 35-40%. Guidelines recommend fine-needle aspiration cytology (FNA) if a focal ¹⁸F-FDG TI corresponds to a sonographic nodule >1 cm. The aim of this systematic review and meta-analysis was to provide evidence-based data on the diagnostic distribution of ¹⁸F-FDG TIs in the six Bethesda systems for reporting thyroid cytopathology (BETHESDA) subcategories.

METHODS

Original studies reporting ¹⁸F-FDG TIs and cytologically classified according to BETHESDA were included. Six separate meta-analyses were performed to obtain the pooled prevalence (95% confidence interval, 95% CI) of ¹⁸F-FDG TIs in the six BETHESDA subcategories.

RESULTS

Fifteen studies were finally included. Nine studies were from Asian/Eastern and six from Western countries. FNA data according to BETHESDA was available in 2304 cases. The pooled prevalence of ¹⁸F-FDG TIs according to BETHESDA was BETHESDA I 10% (6-14), BETHESDA II 45% (37-53), BETHESDA III 8% (3-13), BETHESDA IV 8% (5-12), BETHESDA V 6% (4-9), BETHESDA VI 19% (13-25). A significantly different prevalence was found in the BETHESDA IV between Asian/Eastern (2%) and Western (19%) studies.

CONCLUSION

Two-thirds of focal ¹⁸F-FDG TIs undergoing FNA have either malignant (BETHESDA VI) or benign (BETHESDA II) cytology while a minority will have indeterminate (BETHESDA III or IV) FNA results. Significant differences between Asian/Eastern and Western studies are also present in the prevalence of indeterminate FNA results.

Prediction of Cervical Lymph Node Metastasis Using MRI Radiomics Approach in Papillary Thyroid Carcinoma: A Feasibility Study

BACKGROUND

Cervical lymph node (LN) metastasis of papillary thyroid carcinoma (PTC) is critical for treatment and prognosis. To examine the feasibility of MRI radiomics to preoperatively predict cervical LN metastasis in patients with PTC.

METHODS

Between January 2015 and March 2018, a total of 61 patients with pathologically confirmed PTC were analyzed retrospectively. The patients were divided into cervical LN metastasis group (n = 37) and no cervical LN metastasis (n = 24). T2WI and T2WI-fat-suppression (T2WI-FS) images were collected. A number of radiomic features were automatically extracted from the largest section of tumor. Three types of classifier (the random forests, the support vector machine classifier and the generalized linear model) based on T2WI and T2WI-FS images of cervical LN metastasis and no cervical LN metastasis were constructed and evaluated with a nested cross-validation scheme.

RESULTS

Radiomic features extracted from T2WI images were more discriminative than T2WI-FS images. The random forests model showed the best discriminate performance with the highest area under the curve (0.85, CI:0.76 -1), accuracy (0.87), sensitivity (0.83), specificity (1.00), positive predictive value (PPV = 1.00) and negative predictive value (NPV = 0.88).

CONCLUSION

MRI radiomics analysis based on conventional T2WI and T2WI-FS can predict cervical LN metastasis in patients with PTC, and the radiomics is shown to be an assistant diagnosis tool for radiologists.