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Dai Z, Wei R, Wang H, Hu W, Sun X, Zhu J, Li H, Ge Y, Song B. Multimodality MRI-based radiomics for aggressiveness prediction in papillary thyroid cancer. BMC Med Imaging 2022; 22:54. [PMID: 35331162 PMCID: PMC8952254 DOI: 10.1186/s12880-022-00779-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the ability of a multimodality MRI-based radiomics model in predicting the aggressiveness of papillary thyroid carcinoma (PTC). Methods This study included consecutive patients who underwent neck magnetic resonance (MR) scans and subsequent thyroidectomy during the study period. The pathological diagnosis of thyroidectomy specimens was the gold standard to determine the aggressiveness. Thyroid nodules were manually segmented on three modal MR images, and then radiomics features were extracted. A machine learning model was established to evaluate the prediction of PTC aggressiveness. Results The study cohort included 107 patients with PTC confirmed by pathology (cross-validation cohort: n = 71; test cohort: n = 36). A total of 1584 features were extracted from contrast-enhanced T1-weighted (CE-T1 WI), T2-weighted (T2 WI) and diffusion weighted (DWI) images of each patient. Sparse representation method is used for radiation feature selection and classification model establishment. The accuracy of the independent test set that using only one modality, like CE-T1WI, T2WI or DWI was not particularly satisfactory. In contrast, the result of these three modalities combined achieved 0.917. Conclusion Our study shows that multimodality MR image based on radiomics model can accurately distinguish aggressiveness in PTC from non-aggressiveness PTC before operation. This method may be helpful to inform the treatment strategy and prognosis of patients with aggressiveness PTC.
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Affiliation(s)
- Zedong Dai
- Department of Radiology, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai, 201199, People's Republic of China
| | - Ran Wei
- Department of Radiology, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai, 201199, People's Republic of China
| | - Hao Wang
- Department of Radiology, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai, 201199, People's Republic of China
| | - Wenjuan Hu
- Department of Radiology, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai, 201199, People's Republic of China
| | - Xilin Sun
- Department of Radiology, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai, 201199, People's Republic of China
| | - Jie Zhu
- Department of Radiology, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai, 201199, People's Republic of China
| | - Hong Li
- Department of Radiology, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai, 201199, People's Republic of China
| | - Yaqiong Ge
- GE Healthcare, Shanghai, People's Republic of China
| | - Bin Song
- Department of Radiology, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai, 201199, People's Republic of China.
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Dionigi G, Fama' F, Pignata SA, Pino A, Pontin A, Caruso E, Fu Y, Li S, Mazzeo C, Sun H, Baldari S. Usefulness of PET-CT scan in recurrent thyroid cancer. World J Otorhinolaryngol Head Neck Surg 2020; 6:182-187. [PMID: 33073214 PMCID: PMC7548382 DOI: 10.1016/j.wjorl.2020.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/16/2020] [Indexed: 11/28/2022] Open
Abstract
The aim of this paper is to discuss the risk of recurrence in patients with differentiated thyroid cancer and emphasize the importance of risk-group stratification, early recurrence identification and application of new imaging modalities, what is the PET-CT. Moreover, follow-up of patients with thyroid carcinoma should be carried out by specialized teams throughout life. Therefore, interdisciplinary case discussions in tumor conferences may improve the use of multimodal therapy especially in patients with poorly differentiated thyroid carcinomas. After baseline follow-up, if there is a suspicion of thyroid carcinoma, early PET-CT should be used for early detection and appropriate planning. Fortunately, due to the good localization possibility, the PET-CT enables a focused surgical procedure with avoidance of an unnecessary tumor search and thereby a reduction of the risk of injury of neighboring structures which is a concern with reoperative neck surgery.
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Affiliation(s)
- Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi'', University Hospital G. Martino, University of Messina, Messina, Italy
| | - Fausto Fama'
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi'', University Hospital G. Martino, University of Messina, Messina, Italy
| | - Salvatore Antonio Pignata
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University Hospital G. Martino, University of Messina, Messina, Italy
| | - Antonella Pino
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi'', University Hospital G. Martino, University of Messina, Messina, Italy
| | - Alessandro Pontin
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi'', University Hospital G. Martino, University of Messina, Messina, Italy
| | - Ettore Caruso
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi'', University Hospital G. Martino, University of Messina, Messina, Italy
| | - Yantao Fu
- Jilin Provincial Key Laboratory of Surgical Translational Medicine, Division of Thyroid Surgery, China- Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Shijie Li
- Jilin Provincial Key Laboratory of Surgical Translational Medicine, Division of Thyroid Surgery, China- Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Carmelo Mazzeo
- Division for Emergency Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi'', University Hospital G. Martino, University of Messina, Messina, Italy
| | - Hui Sun
- Jilin Provincial Key Laboratory of Surgical Translational Medicine, Division of Thyroid Surgery, China- Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Sergio Baldari
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University Hospital G. Martino, University of Messina, Messina, Italy
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Diagnostic performance of CT in detection of metastatic cervical lymph nodes in patients with thyroid cancer: a systematic review and meta-analysis. Eur Radiol 2019; 29:4635-4647. [DOI: 10.1007/s00330-019-06036-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/26/2018] [Accepted: 01/22/2019] [Indexed: 12/21/2022]
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Hong EK, Kim JH, Lee J, Yoo RE, Kim SC, Kim MJ, Park YJ, Chung EJ, Ryu YJ, Lee E, Kang KM, Yun TJ, Choi SH, Sohn CH. Diagnostic value of computed tomography combined with ultrasonography in detecting cervical recurrence in patients with thyroid cancer. Head Neck 2018; 41:1206-1212. [PMID: 30552732 DOI: 10.1002/hed.25538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/06/2018] [Accepted: 10/06/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To determine the diagnostic role of CT added to ultrasound for the diagnosis of recurrent differentiated thyroid cancer (DTC) and to evaluate potential benefits for patients. METHODS A total of 193 patients with recurrent DTC were retrospectively included. The diagnostic performances of ultrasound and combination of ultrasound and CT (ultrasound/CT) in detecting recurrence were compared. Benefits of CT were assessed based on the presence of any recurrence detected only with additional CT. RESULTS In detecting cervical recurrence, ultrasound/CT showed higher sensitivity (P = .001) and lower specificity (P < .001) than ultrasound alone, overall resulting in higher area under the curve (P < .001). Seventy-nine patients (40.9%) benefited from additional CT in detecting recurrence. CONCLUSION For reoperation of cervical recurrence in patients with DTC, addition of CT to ultrasound offers better surgical planning by enhancing detection of recurrent cancers that were overlooked with ultrasound alone.
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Affiliation(s)
- Eun Kyoung Hong
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joongyub Lee
- Division of Clinical Epidemiology, Medical Research Collaborating Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soo Chin Kim
- Department of Radiology, Gangnam Center, Seoul National University Hospital Healthcare System, Seoul, Republic of Korea
| | - Min Joo Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Jin Ryu
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eunjung Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Jin Yun
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Kang JH, Jung DW, Pak KJ, Kim IJ, Kim HJ, Cho JK, Shin SC, Wang SG, Lee BJ. Prognostic implication of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in patients with recurrent papillary thyroid cancer. Head Neck 2017; 40:94-102. [PMID: 29130586 DOI: 10.1002/hed.24967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/03/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Fluorine-18 fluorodeoxyglucose positron emission tomography/CT (18 F-FDG PET/CT) has been widely accepted as an effective method for detecting recurrent papillary thyroid cancer (PTC) in patients with increased serum thyroglobulin (Tg) or Tg antibody (TgAb) levels and negative whole-body scintigraphy (WBS) results. The role of WBS as a diagnostic tool in detecting recurrence has relatively decreased recently. However, only a few studies have examined the usefulness of 18 F-FDG PET/CT for evaluating patients with recurrent PTC, regardless of the WBS results. The purpose of this analysis was to evaluate the diagnostic value and prognostic role of 18 F-FDG PET/CT for patients with recurrent PTC, irrespective of their WBS results. METHODS Sixty-six patients with locoregional recurrent PTC who underwent 18 F-FDG PET/CT and neck CT within 6 months before surgical treatment were included in this retrospective analysis. Imaging findings were compared with postoperative histopathologic results. The diagnostic values of 18 F-FDG PET/CT and neck CT were compared according to the serum Tg and TgAb levels and cervical levels. Each patient's status at the last follow-up was also reviewed, and survival probabilities were estimated using the Kaplan-Meier plot. RESULTS The sensitivity, specificity, and diagnostic accuracy of 18 F-FDG PET/CT for the entire patient group were 38.5%, 90.2%, and 58.3%, respectively. The corresponding neck CT values were 55.0%, 85.7%, and 66.7%, respectively. According to the serum Tg and TgAb levels, except for the specificity, most diagnostic values of 18 F-FDG PET/CT were worse than those of the neck CTs, with or without statistical significance. For the high maximum standardized uptake value (SUVmax) group (SUVmax >10) and the low SUVmax group, the median locoregional disease-free survival times were 33.3 months and 81.8 months, respectively (P < .001). CONCLUSION The diagnostic value of 18 F-FDG PET/CT for localizing recurrent lesions was worse than that of the neck CT, irrespective of the WBS results. However, patients with a higher SUVmax showed a significantly worse prognosis than did those with a lower SUVmax. Therefore, we suggest that, in patients with recurrent PTC, 18 F-FDG PET/CT should be considered for prognostication rather than diagnosis.
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Affiliation(s)
- Ji-Hun Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University, Busan, South Korea
| | - Da-Woon Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University, Busan, South Korea
| | - Kyoung-June Pak
- Department of Nuclear Medicine, Pusan National University School of Medicine, Pusan National University, Busan, South Korea
| | - In-Ju Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University, Busan, South Korea
| | - Hak-Jin Kim
- Department of Radiology, Pusan National University School of Medicine, Pusan National University, Busan, South Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Inje University Ilsan Paik Hospital, Ilsan, South Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University, Busan, South Korea
| | - Soo-Geun Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University, Busan, South Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University, Busan, South Korea
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Thyroid computed tomography imaging: pictorial review of variable pathologies. Insights Imaging 2016; 7:601-17. [PMID: 27271508 PMCID: PMC4956631 DOI: 10.1007/s13244-016-0506-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 05/03/2016] [Accepted: 05/24/2016] [Indexed: 12/25/2022] Open
Abstract
Abstract Focal and diffuse thyroid abnormalities are commonly encountered during the interpretation of computed tomography (CT) exams performed for various clinical purposes. These findings can often lead to a diagnostic dilemma, as the CT reflects the nonspecific appearances. Ultrasound (US) examination has a superior spatial resolution and is considered the modality of choice for thyroid evaluation. Nevertheless, CT detects incidental thyroid nodules (ITNs) and plays an important role in the evaluation of thyroid cancer. In this pictorial review, we cover a wide spectrum of common and uncommon, incidental and non-incidental thyroid findings from CT scans. We also discuss the most common incidental thyroid findings, best practices for their evaluation, and recommendations for their management. In addition, we explore the role of imaging in the assessment of thyroid carcinoma (before and after treatment) and preoperative thyroid goiter, as well as localization of ectopic and congenital thyroid tissue. Teaching Points • Thyroid disorders tend to have non-specific CT appearances. • ITNs are common on neck CT. • ITN management depends on nodule size, age, health status, lymphadenopathy, and invasion. • CT is used in assessment of cancer extension, mass effect, invasion, and recurrence. • CT plays a role in preoperative planning in patients with symptomatic goiter.
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Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, Na DG, Nam KH, Park SY, Park JW, Bae SK, Baek SK, Baek JH, Lee BJ, Chung KW, Jung YS, Cheon GJ, Kim WB, Chung JH, Rho YS. 2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.11106/ijt.2016.9.2.59] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Yunwoo Koh
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - In Joo Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Korea
| | - Kee-Hyun Nam
- Department of Surgery, College of Medicine, Yonsei University, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, College of Medicine, Chungbuk National University, Korea
| | - Sang Kyun Bae
- Department of Nuclear Medicine, Inje University College of Medicine, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, College of Medicine, Korea University, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Korea
| | - Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology, Hallym University College of Medicine, Korea
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 8533] [Impact Index Per Article: 1066.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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Mulla M, Schulte KM. Terminology inaccuracies in the interpretation of imaging results in detection of cervical lymph node metastases in papillary thyroid cancer. Endocr Connect 2012; 1:78-86. [PMID: 23781308 PMCID: PMC3681322 DOI: 10.1530/ec-12-0050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 09/04/2012] [Indexed: 11/26/2022]
Abstract
UNLABELLED Cervical lymph nodes (CLNs) are the most common site of metastases in papillary thyroid cancer (PTC). Ultrasound scan (US) is the most commonly used imaging modality in the evaluation of CLNs in PTC. Computerised tomography (CT) and (18)fluorodeoxyglucose positron emission tomography ((18)FDG PET-CT) are used less commonly. It is widely believed that the above imaging techniques should guide the surgical approach to the patient with PTC. METHODS We performed a systematic review of imaging studies from the literature assessing the usefulness for the detection of metastatic CLNs in PTC. We evaluated the author's interpretation of their numeric findings specifically with regard to 'sensitivity' and 'negative predictive value' (NPV) by comparing their use against standard definitions of these terms in probabilistic statistics. RESULTS A total of 16 studies used probabilistic terms to describe the value of US for the detection of LN metastases. Only 6 (37.5%) calculated sensitivity and NPV correctly. For CT, out of the eight studies, only 1 (12.5%) used correct terms to describe analytical results. One study looked at magnetic resonance imaging, while three assessed (18)FDG PET-CT, none of which provided correct calculations for sensitivity and NPV. CONCLUSION Imaging provides high specificity for the detection of cervical metastases of PTC. However, sensitivity and NPV are low. The majority of studies reporting on a high sensitivity have not used key terms according to standard definitions of probabilistic statistics. Against common opinion, there is no current evidence that failure to find LN metastases on ultrasound or cross-sectional imaging can be used to guide surgical decision making.
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Affiliation(s)
- Mubashir Mulla
- Department of Endocrine SurgeryKing's College HospitalDenmark Hill, London, SE5 9RSUK
- King's College LondonLondonUK
| | - Klaus-Martin Schulte
- Department of Endocrine SurgeryKing's College HospitalDenmark Hill, London, SE5 9RSUK
- King's College LondonLondonUK
- King's Health PartnersLondonUK
- Correspondence should be addressed to M Mulla Email
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10
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Wu LM, Gu HY, Qu XH, Zheng J, Zhang W, Yin Y, Xu JR. The accuracy of ultrasonography in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma: A meta-analysis. Eur J Radiol 2012; 81:1798-805. [DOI: 10.1016/j.ejrad.2011.04.028] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 04/06/2011] [Indexed: 11/29/2022]
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11
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Seo YL, Yoon DY, Baek S, Ku YJ, Rho YS, Chung EJ, Koh SH. Detection of neck recurrence in patients with differentiated thyroid cancer: comparison of ultrasound, contrast-enhanced CT and 18F-FDG PET/CT using surgical pathology as a reference standard: (ultrasound vs. CT vs. 18F-FDG PET/CT in recurrent thyroid cancer). Eur Radiol 2012; 22:2246-54. [DOI: 10.1007/s00330-012-2470-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 02/27/2012] [Accepted: 03/23/2012] [Indexed: 01/08/2023]
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12
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Lal G, Fairchild T, Howe JR, Weigel RJ, Sugg SL, Menda Y. PET-CT scans in recurrent or persistent differentiated thyroid cancer: is there added utility beyond conventional imaging? Surgery 2011; 148:1082-9; discussion 1089-90. [PMID: 21134537 DOI: 10.1016/j.surg.2010.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 09/16/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Integrated positron emission tomography (PET)-computed tomography (CT) may have advantages over conventional imaging in localizing recurrent or persistent differentiated thyroid cancer. METHODS A retrospective review of patients who underwent PET-CT scans was performed. Results were compared with contrast CT, magnetic resonance imaging, ultrasonography, and radioactive iodine (RAI) scans. RESULTS Thirty patients (mean age, 49.9 ± 17 years) underwent 36 PET-CT scans, mostly for elevated thyroglobulin levels and negative RAI scans (30 scans). Fifty percent (18/36) of PET-CT scans showed increased uptake in the neck, 11 of 36 (31%) in the chest, 3 of 36 (8.3%) in bone, and 6 of 36 (16.6%) in other areas. PET-CT had overall sensitivity, specificity, and positive predictive values of 73.9%, 61.5%, and 77.3% respectively. To assess the added value of PET-CT, we focused on the 21 scans performed after conventional imaging in 20 patients. PET-CT provided additional information in 2 (10%) patients, both of whom were spared interventions. However, PET-CT underestimated extent of disease in 3 (15%) patients and led to unnecessary interventions in 3 (15%) additional patients. CONCLUSION PET-CT has reasonable sensitivity in the detection of recurrent thyroid cancer. However, the added value of PET-CT may be seen only in a limited number of patients after good quality, conventional imaging. Further studies are needed to determine the most cost-effective approach to managing these patients.
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Affiliation(s)
- Geeta Lal
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
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