Ultrasound of thyroid cancer

Preoperative identification of low-risk medullary thyroid carcinoma: potential application to reduce total thyroidectomy

Current guidelines recommend total thyroidectomy with central lymph node dissection (CND) for patients with medullary thyroid carcinoma (MTC). This study aimed to identify low-risk MTC patients who may be candidates for lobectomy. We retrospectively reviewed MTC patients who underwent primary surgery at a tertiary referral center from 1998 to 2019. Eighty-five MTC patients were enrolled, excluding patients with primary tumor size > 2.0 cm. Among them, one (1.2%) patient had bilateral tumors. During a median follow-up of 84 months, 12 of the 85 patients experienced structural recurrence. 13 patients had occult lymph node metastasis, and structural recurrence occurred in 2 patients. Factors that significantly affected disease-free survival were clinical N stage (cN0 vs. cN1, log-rank P < 0.001), pathological N stage (pN0 vs. pN1, P < 0.001), and preoperative calcitonin levels (≤ 250 vs. > 250 pg/mL, P = 0.017). After categorizing patients into four groups, patients with preoperative calcitonin levels > 250 pg/mL and cN1 or pN1 had a significantly worse prognosis. Patients with a primary tumor size of 2 cm or less, cN0, and preoperative calcitonin of 250 pg/mL or less can be classified as low-risk MTC patients. We used preoperative clinical information to identify low-risk MTC patients. Lobectomy with prophylactic CND may be a potential therapeutic approach.

A UPLC Q-Exactive Orbitrap Mass Spectrometry-Based Metabolomic Study of Serum and Tumor Tissue in Patients with Papillary Thyroid Cancer

OBJECTIVE

To find the metabolomic characteristics of tumor or para-tumor tissues, and the differences in serums from papillary thyroid cancer (PTC) patients with or without lymph node metastasis.

METHODS

We collected serums of PTC patients with/without lymph node metastasis (SN1/SN0), tumor and adjacent tumor tissues of PTC patients with lymph node metastasis (TN1 and PN1), and without lymph node metastasis (TN0 and PN0). Metabolite detection was performed by ultra-high performance liquid chromatography combined with Q-Exactive orbitrap mass spectrometry (UPLC Q-Exactive).

RESULTS

There were 31, 15, differential metabolites in the comparisons of TN1 and PN1, TN0 and PN0, respectively. Seven uniquely increased metabolites and fourteen uniquely decreased metabolites appeared in the lymph node metastasis (TN1 and PN1) group. Meanwhile, the results indicated that four pathways were co-owned pathways in two comparisons (TN1 and PN1, TN0 and PN0), and four unique pathways presented in the lymph node metastasis (TN1 and PN1) group.

CONCLUSIONS

Common or differential metabolites and metabolic pathways were detected in the lymph node metastasis and non-metastatic group, which might provide novel ways for the diagnosis and treatment of PTC.

Interobserver variability in ultrasound assessment of thyroid nodules

The first diagnostic tool for thyroid disease management is ultrasound. Despite its importance, ultrasound is an extremely subjective procedure that requires a high level of performance skill. Few studies have assessed thyroid ultrasound performance and its effectiveness, particularly the variability between observers in the assessment of ultrasound images. This study evaluated the variability in ultrasound assessments and diagnoses of thyroid nodules between 2 radiologists. In this retrospective study, 75 thyroid nodules in 39 patients were reviewed by 2 experienced radiologists. The nodule composition, margin, shape, calcification, and vasculitis were determined using echogenicity. The study evaluation included these 5 assessments and the final diagnosis. Interobserver variation was determined using Cohen kappa statistics. The interobserver agreements in the interpretation of echogenicity, shape, and margin were fair (κ = 0.21-0.40), whereas there were substantial agreements for vascularity and calcification (κ = 0.62-0.78). The agreements between the observers for individual ultrasound features in this study were the highest for vascularity and the presence/absence of calcification. The interobserver reproducibility for thyroid nodule ultrasound reporting was adequate, but the diagnostic evaluation ability of the observers was inconsistent. The variability in the interpretation of sonographic features could influence the level of suspicion of thyroid malignancy. This study emphasizes the need for consistency in the training of sonographic interpretation of thyroid nodules, particularly for echogenicity, shape, and margin.

Radiologist versus Non-Radiologist Detection of Lymph Node Metastasis in Papillary Thyroid Carcinoma by Ultrasound: A Meta-Analysis

Papillary thyroid carcinoma (PTC) is the most common thyroid cancer worldwide and is known to spread to adjacent neck lymphatics. Lymph node metastasis (LNM) is a known predictor of disease recurrence and is an indicator for aggressive resection. Our study aims to determine if ultrasound sonographers’ degree of training influences overall LNM detection. PubMed, Embase, and Scopus articles were searched and screened for relevant articles. Two investigators independently screened and extracted the data. Diagnostic test parameters were determined for all studies, studies reported by radiologists, and studies reported by non-radiologists. The total sample size amounted to 5768 patients and 10,030 lymph nodes. Radiologists performed ultrasounds in 18 studies, while non-radiologists performed ultrasounds in seven studies, corresponding to 4442 and 1326 patients, respectively. The overall sensitivity of LNM detection by US was 59% (95%CI = 58–60%), and the overall specificity was 85% (95%CI = 84–86%). The sensitivity and specificity of US performed by radiologists were 58% and 86%, respectively. The sensitivity and specificity of US performed by non-radiologists were 62% and 78%, respectively. Summary receiver operating curve (sROC) found radiologists and non-radiologists to detect LNM on US with similar accuracy (p = 0.517). Our work suggests that both radiologists and non-radiologists alike detect overall LNM with high accuracy on US.

Using Deep Convolutional Neural Networks for Enhanced Ultrasonographic Image Diagnosis of Differentiated Thyroid Cancer

Differentiated thyroid cancer (DTC) from follicular epithelial cells is the most common form of thyroid cancer. Beyond the common papillary thyroid carcinoma (PTC), there are a number of rare but difficult-to-diagnose pathological classifications, such as follicular thyroid carcinoma (FTC). We employed deep convolutional neural networks (CNNs) to facilitate the clinical diagnosis of differentiated thyroid cancers. An image dataset with thyroid ultrasound images of 421 DTCs and 391 benign patients was collected. Three CNNs (InceptionV3, ResNet101, and VGG19) were retrained and tested after undergoing transfer learning to classify malignant and benign thyroid tumors. The enrolled cases were classified as PTC, FTC, follicular variant of PTC (FVPTC), Hürthle cell carcinoma (HCC), or benign. The accuracy of the CNNs was as follows: InceptionV3 (76.5%), ResNet101 (77.6%), and VGG19 (76.1%). The sensitivity was as follows: InceptionV3 (83.7%), ResNet101 (72.5%), and VGG19 (66.2%). The specificity was as follows: InceptionV3 (83.7%), ResNet101 (81.4%), and VGG19 (76.9%). The area under the curve was as follows: Incep-tionV3 (0.82), ResNet101 (0.83), and VGG19 (0.83). A comparison between performance of physicians and CNNs was assessed and showed significantly better outcomes in the latter. Our results demonstrate that retrained deep CNNs can enhance diagnostic accuracy in most DTCs, including follicular cancers.

Capsular extension at ultrasound is associated with lateral lymph node metastasis in patients with papillary thyroid carcinoma: a retrospective study

BACKGROUND

In patients with papillary thyroid cancer (PTC), cervical lymph node metastasis (LNM) must be carefully assessed to determine the extent of lymph node dissection required and patient prognosis. Few studies attempted to determine whether the ultrasound (US) appearance of the primary thyroid tumor could be used to predict cervical lymph node involvement. This study aimed to identify the US features of the tumor that could predict cervical LNM in patients with PTC.

METHODS

This was a retrospective study of patients with pathologically confirmed PTC. We evaluated the following US characteristics: lobe, isthmus, and tumor size; tumor position; parenchymal echogenicity; the number of lesions (i.e., tumor multifocality); parenchymal and lesional vascularity; tumor margins and shape; calcifications; capsular extension; tumor consistency; and the lymph nodes along the carotid vessels. The patients were grouped as no LNM (NLNM), central LNM (CLNM) alone, and lateral LNM (LLNM) with/without CLNM, according to the postoperative pathological examination.

RESULTS

Totally, 247 patients, there were 67 men and 180 women. Tumor size of > 10 mm was significantly more common in the CLNM (70.2%) and LLNM groups (89.6%) than in the NLNM group (45.4%). At US, capsular extension > 50% was most common in the LLNM group (35.4%). The multivariable analysis revealed that age (OR = 0.203, 95%CI: 0.095-0.431, P < 0.001) and tumor size (OR = 2.657, 95%CI: 1.144-6.168, P = 0.023) were independently associated with CLNM compared with NLNM. In addition, age (OR = 0.277, 95%CI: 0.127-0.603, P = 0.001), tumor size (OR = 6.069, 95%CI: 2.075-17.75, P = 0.001), and capsular extension (OR = 2.09, 95%CI: 1.326-3.294, P = 0.001) were independently associated with LLNM compared with NLNM.

CONCLUSION

Percentage of capsular extension at ultrasound is associated with LLNM. US-guided puncture cytology and eluent thyroglobulin examination could be performed as appropriate to minimize the missed diagnosis of LNM.

Thyroid hemiagenesis associated with Hurthle cell carcinoma: A case report

Introduction and importance

Thyroid hemiagenesis (TH) is a rare congenital anomaly where one lobe fails to develop, especially more frequently occurs on the left lobe. The exact mechanisms for thyroid morphogenesis remain unclear. In this paper, we report a rare case of right lobe TH associated with Hurthle cell carcinoma.

Case presentation

A 59 years old woman was admitted with a neck lump increasing in size in the last 20 years. There were no symptoms of hyperthyroidism and hypothyroidism. There was a palpable, painless 5 cm mass in the middle of the neck. Initial thyroid ultrasonography (USG) revealed an enlarged left lobe, with hypoechoic lesion with cystic component and calcification (TIRADS 4). However, the right lobe was non-visualized. Fine needle aspiration biopsy result tendency was a malignancy. Hence, isthmolobectomy was conducted. Pathology result was Hurthle cell carcinoma. On the ninth month, USG revealed fibrotic tissue in the right thyroid bed and bilateral lymphadenopathy. Due to discrepancy, the patient was planned for a neck exploration surgery and a right lobe incision. Intraoperatively, the right thyroid was absent. Intraoperative USG also confirmed no right thyroid lobe.

Discussion

Thyroid hemiagenesis can be visualized by using USG due to its practicality and cost effectiveness reasons. Follow up evaluations consisted of systematic monitoring of thyroid morphology and hormonal functions should follow the diagnosis of TH. Neck exploration surgery might need to be performed to clarify any discrepancy and confirm the diagnosis.

Conclusion

TH can be recognized through supporting examination; however, discrepancy may occur.

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History taking and physical examination is mandatory yet might not adequate to diagnose hemiagenesis accompanying thyroid diseases.

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Ultrasonography is easily performed, cost effective, and without any radiation exposure to identify thyroid hemiagenesis

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If discrepancy occur in ultrasonography examination, neck exploration surgery can clarify and confirm the diagnosis.

Multi-Reader Multi-Case Study for Performance Evaluation of High-Risk Thyroid Ultrasound with Computer-Aided Detection

Physicians use sonographic characteristics as a reference for the possible diagnosis of thyroid cancers. The purpose of this study was to investigate whether physicians were more effective in their tentative diagnosis based on the information provided by a computer-aided detection (CAD) system. A computer compared software-defined and physician-adjusted tumor loci. A multicenter, multireader, and multicase (MRMC) study was designed to compare clinician performance without and with the use of CAD. Interobserver variability was also analyzed. Excellent, satisfactory, and poor segmentations were observed in 25.3%, 58.9%, and 15.8% of nodules, respectively. There were 200 patients with 265 nodules in the study set. Nineteen physicians scored the malignancy potential of the nodules. The average area under the curve (AUC) of all readers was 0.728 without CAD and significantly increased to 0.792 with CAD. The average standard deviation of the malignant potential score significantly decreased from 18.97 to 16.29. The mean malignant potential score significantly decreased from 35.01 to 31.24 for benign cases. With the CAD system, an additional 7.6% of malignant nodules would be suggested for further evaluation, and biopsy would not be recommended for an additional 10.8% of benign nodules. The results demonstrated that applying a CAD system would improve clinicians’ interpretations and lessen the variability in diagnosis. However, more studies are needed to explore the use of the CAD system in an actual ultrasound diagnostic situation where much more benign thyroid nodules would be seen.

A Comparison of the Diagnostic Efficiency of Guided Fine Needle Aspiration Cytology Versus Conventional Fine Needle Aspiration Cytology of the Thyroid

Fine needle aspiration cytology (FNAC) is possibly the most useful investigation for the thyroid. However, conventional FNAC (C-FNAC) is limited by a high rate of inadequate samples. Ultrasound guided FNAC (US-FNAC) has been proposed as an alternative. This study aims to estimate the measures of diagnostic accuracy of FNAC as well as to compare US-FNAC against C-FNAC. Patients who underwent FNAC at our for a period of 5 years were selected. This comprised of 237 C-FNAC cases and 173 US-FNAC cases. Out of these 410 cases, 129 cases had cyto-histological correlation. The proportion of inadequate samples, malignant cases as well as indeterminate cases were compared between US-FNAC and C-FNAC. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios for positive and negative results and odds ratio were estimated for overall FNAC as well as US-FNAC and C-FNAC patients. US-FNAC has a significantly lower proportion of inadequate samples (0.58 vs. 15.19%), as well as a lower proportion of indeterminate samples (1.7 vs. 7.6%) and a higher proportion of malignant cases (6.4 vs. 2.1%). When the inadequate samples were excluded, the results for tests of diagnostic effectiveness for overall FNAC, US-FNAC and C-FNAC respectively ranged between 66.67 and 80% for sensitivity, between 86.05 and 100% for specificity, between 45.45 and 100% for PPV and between 97.37 and 98.7% for NPV. FNAC is a useful test for differentiating malignant from benign lesions. When inadequate samples are excluded, both US-FNAC and C-FNAC are accurate diagnostic tests. However, US-FNAC is a more useful test since it results in a lower number of inadequate samples. Also, US-FNAC results in a greater yield of malignancy and a lower percentage of indeterminates, possibly due to additional information received from ultrasound examination.

Color Doppler ultrasonography diagnostic value in detection of malignant nodules in cysts with pathologically proven thyroid malignancy: a systematic review and meta-analysis

AIMS

Today, the color Doppler ultrasonography is used to further evaluate suspected malignant tumors. This study investigates the malignant thyroid nodules using color Doppler.

METHODS

After extracting true positive, false positive, false negative, and true negative among included studies, a quality was evaluated by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (with 95% confidence interval) were found using a random effect model. Summary receiver operating characteristic curves (SROC) were used to assess relationship between sensitivity and specificity. The area under the curve of the SROC was calculated to estimate the performance of color Doppler ultrasound to distinguish malignant thyroid nodules. Our registration code in PROSPERO is CRD42018111198.

RESULTS

Of 1125 articles, 288 articles were selected for the further investigation. After excluding irrelevant and poor articles, 20 studies were included for the meta-analysis. According to a random effect model, the pooled sensitivity and specificity of color Doppler ultrasound to distinguish malignant thyroid nodules were estimated as 0.74 (95% CI 0.62-0.83; [Formula: see text]) and 0.70 (95% CI 0.56-0.81; [Formula: see text]), respectively. The SROC curve consists of representing the paired results for sensitivity and specificity. According to SROC, AUC = 0.78 (95% CI 0.74-0.81) is between 0.75 and 0.92, so that color Doppler ultrasound has a good accuracy.

CONCLUSION

Color Doppler is a valuable non-invasive method for evaluating thyroid nodules, and it is a high-sensitivity diagnostic tool for assessing thyroid nodules. Resistive index > 0.75 and a pattern III or more in color Doppler predicts malignant with the confidence. Due to its precision, cost-efficiency, easy access, and non-invasive nature, color Doppler should be included in the standard clinical protocol for the decision-making period and the treatment evaluation.

Re-Evaluation of 162 Malignant Thyroid Nodules that were Interpreted as Benign Based on Ultrasound Findings

Purpose

The goal of this study was to estimate the risk of malignant thyroid nodules being interpreted as benign based on ultrasound findings and to clarify the pathological features of these malignant nodules.

Materials and Methods

We retrospectively re-evaluated ultrasound and pathological findings for 162 malignant thyroid nodules that were initially interpreted as benign based on ultrasound findings at Kuma Hospital between April 2012 and June 2015.

Results

The incidences of malignancy among “benign” thyroid nodules were 0.5% overall and 6.2% among resected nodules. In addition, 82.7% of thyroid nodules that were originally judged to have low or very low suspicion patterns were subsequently re-categorized as having high or intermediate suspicion patterns. The incidences of irregular margins (63.6%) and low echogenicity (36.4%) were higher than those of punctate microcalcification (17.9%) and the taller-than-wide shape (20.4%). Among microcarcinomas, the incidences were 65.7% for irregular margins and 51.4% for low echogenicity. Rim calcification with small extrusive soft tissue components and extrathyroidal extensions were not observed. After re-evaluation, 40.0% of papillary thyroid carcinomas remained benign based on their variants, such as the encapsulated, follicular, macrofollicular, and oxyphilic cell variants.

Conclusion

We conclude that more careful observation, especially for lesions with irregular margins and low echogenicity, can help improve the diagnostic accuracy of thyroid ultrasonography. Furthermore, greater care may decrease the incidence of malignancy among thyroid nodules with low or very low suspicion patterns. Some variants of papillary thyroid carcinoma can have benign ultrasound findings.

Medullary Thyroid Carcinoma: Do Ultrasonography and F-DOPA-PET-CT Influence the Initial Surgical Strategy?

Background

At the time of diagnosis, one-third of medullary thyroid carcinoma (MTC) patients show lymph node (LN) or distant metastasis. A metastasized MTC requires different surgical strategies.

Objective

This study aimed to determine the value of ultrasound and [18F]fluoro-dihydroxyphenylalanine positron emission tomography with computed tomography (F-DOPA-PET-CT) in localizing MTC, as well as LN and distant metastasis.

Methods

The study included 50 patients (24 males/26 females) with preoperative ultrasound, F-DOPA-PET-CT, and histologically proven MTC. Imaging results were correlated with both preoperative basal calcitonin (bCt) levels and final histology.

Results

Tumors were classified as pT1a:17 (diameter, mean ± standard deviation: 5.8 ± 3.0 mm), pT1b:15 (15.0 ± 3.2 mm), pT2:9 (27.3 ± 7.0 mm), and pT3:9 (38.3 ± 24.2 mm). The median bCt level was 202 pg/mL (lower/upper quartile: 82/1074 pg/mL). Ultrasound was positive for tumor in 45/50 (92%) patients (20.0 ± 16.0 mm) and negative in 5 patients (3.2 ± 2.2 mm). Overall, 43/50 (86%) patients had positive F-DOPA local scans (20.0 ± 16.4 mm), while 7 (14%) patients were negative (7.7 ± 8.1 mm). Lastly, 21/50 (42%) patients had LN metastasis; 8/21 (38%) patients had positive LNs suspected with ultrasound, and 12/21 (57%) patients had positive LNs suspected with F-DOPA. Tumor and LN sensitivity of ultrasound was 92% and 43%, respectively, and 86% and 57% of F-DOPA-PET-CT, respectively. In 3/50 (6%) patients and 3/50 (6%) patients, mediastinal LN metastasis and distant metastasis, respectively, were diagnosed only by F-DOPA-PET-CT.

Conclusion

Ultrasound and F-DOPA-PET-CT are sensitive for the localization of MTC but not for the presence and location of LN metastasis (limitations: size/number). Only F-DOPA ensures the diagnosis of distant metastasis and influences the extent of LN surgery. Surgical strategy cannot be predicted based on neither ultrasound nor F-DOPA-PET-CT.

LncRNA HCP5 promotes follicular thyroid carcinoma progression via miRNAs sponge

Long non-coding RNAs (lncRNAs), which are important functional regulators in cancer, have received increased attention in recent years. In this study, next-generation sequencing technology was used to identify aberrantly expressed lncRNAs in follicular thyroid carcinoma (FTC). The long non-coding RNA–HLA complex P5 (HCP5) was found to be overexpressed in FTC. The results of the qPCR analysis were consistent with the sequencing results. In addition, functional experiments showed that overexpression of HCP5 can promote the proliferation, migration, invasiveness and angiogenic ability of FTC cells. Furthermore, according to the sequencing results, HCP5 and alpha-2, 6-sialyltransferase 2 (ST6GAL2) were co-expressed in FTC. We hypothesised that ST6GAL2 may be regulated by HCP5, which would in turn mediate the activity of FTC cells. Through qPCR, immunostaining analyses and functional experiments, we determined that the expression of HCP5 was elevated and was correlated with the levels of ST6GAL2 in FTC tissues and cells. Mechanistic experiments showed that HCP5 functions as a competing endogenous RNA (ceRNA) and acts as a sponge for miR-22-3p, miR-186-5p and miR-216a-5p, which activates ST6GAL2. In summary, our study revealed that HCP5 is a tumour regulator in the development of FTC and that it may contribute to improvement of FTC diagnosis and therapy.

Optimized multi-level elongated quinary patterns for the assessment of thyroid nodules in ultrasound images

Ultrasound imaging is one of the most common visualizing tools used by radiologists to identify the location of thyroid nodules. However, visual assessment of nodules is difficult and often affected by inter- and intra-observer variabilities. Thus, a computer-aided diagnosis (CAD) system can be helpful to cross-verify the severity of nodules. This paper proposes a new CAD system to characterize thyroid nodules using optimized multi-level elongated quinary patterns. In this study, higher order spectral (HOS) entropy features extracted from these patterns appropriately distinguished benign and malignant nodules under particle swarm optimization (PSO) and support vector machine (SVM) frameworks. Our CAD algorithm achieved a maximum accuracy of 97.71% and 97.01% in private and public datasets respectively. The evaluation of this CAD system on both private and public datasets confirmed its effectiveness as a secondary tool in assisting radiological findings.

Breast cancer metastasis to thyroid: a retrospective analysis

Background

Breast cancers metastasizing to thyroid gland are relatively uncommon in clinical practice.

Objective

Retrospective analysis of data from breast cancer patients with thyroid metastasis (TM).

Methods

The US suspected, fine-needle aspiration cytology (FNAC) confirmed TM in breast cancer patients, treated between 2005 and 2015 at our hospital, was retrospectively analyzed. The data were re-evaluated by the pathologist and radiologist who were blinded to the patients' data.

Results

FNAC and immunohistochemistry confirmed the ultrasonography (US) suspected TM in eight breast cancer patients. Clinically both unilateral and bilateral TM was seen, which were symptomless and metachronously (6–121 months) metastasized. Six of eight cases exhibited recurrence/distant metastasis and were treated with chemotherapy/thyroidectomy of which two cases passed away. The remaining two patients had no recurrences/distant metastases and were treated with partial/total thyroidectomy. Post-chemotherapy US showed more homogenous thyroid parenchyma with gathering of calcification that reduced in size, revealing the sensitiveness of TM to chemotherapy.

Conclusion

US was useful in screening TM in breast cancer patients. Both partial and total thyroidectomy was effective in disease free survival of isolated TM cases, with controlled primary condition. TM responded well to chemotherapy in most of the recurrent breast cancer cases with or without distant metastasis.

Computer-aided assessment of regional vascularity of thyroid nodules for prediction of malignancy

Color Doppler vascular index (VI) was assessed alone and in combination with grey-scale ultrasound (GSU) in regionally subdivided thyroid nodules in diagnosing thyroid cancer. Color Doppler sonograms of 111 thyroid nodules were evaluated by a home-developed algorithm that performed “offsetting” (algorithm for changing the area of a region of interest, ROI, without distorting the ROI’s contour) and assessed peripheral, central and overall VI of thyroid nodules. Results showed that the optimum offset for dividing peripheral and central regions of nodule was 22%. At the optimum offset, the mean VI of peripheral, central, and overall regions of malignant nodules were significantly higher than those of benign nodules (26.5 ± 16.2%, 21.7 ± 19.6%, 23.8 ± 4.6% v/s 18.2 ± 16.7%, 11.9 ± 15.1% and 16.6 ± 1.8% respectively, P < 0.05). The optimum cut-off of peripheral, central, and overall VI was 19.7%, 9.1% and 20.2% respectively. When compared to GSU alone, combination of VI assessment with GSU evaluation of thyroid nodules increased the diagnostic accuracy from 58.6% to 79.3% (P < 0.05). In conclusion, a novel algorithm for regional subdivision and quantification of thyroid nodular VI in ultrasound images was established, and the optimum offset and cut-off were derived. Assessment of intranodular VI in conjunction with GSU can increase the accuracy in ultrasound diagnosis of thyroid cancer.

Thyroid Cancer: Ultrasound Imaging and Fine-Needle Aspiration Biopsy

Ultrasound is critical in detection, diagnosis, and management of thyroid nodules. Ultrasound detection of regional nodal metastatic disease is based on abnormal nodal morphology rather than size and is critical to initial surgical and long-term management of thyroid cancer. Fine-needle aspiration biopsy is the gold standard for malignancy diagnosis in thyroid cancer. Thyroglobulin assay of nodal aspirates improves accuracy in diagnosis of metastases. Reporting lexicons assign risk levels to thyroid nodules with the goal of improving and standardizing patient management. Surveillance ultrasound in papillary microcarcinomas is being evaluated and compared with surgical management.

Primary and isolated thyroid Hodgkin's lymphoma: A case report

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Hodgkin’s lymphoma rarely involves the thyroid gland.

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We report a case of primary and isolated Hodgkin’s thyroid lymphoma.

Introduction

Hodgkin’s lymphoma rarely involves the thyroid gland. It is typically presented as a fast growing neck mass that is sometimes accompanied by respiratory compression symptoms.

Case report

We report one of the few (the seventeenth) case of primary and isolated Hodgkin’s thyroid lymphoma presented by a 65 years old man, consulting for a fast growing neck mass with Hodgkin’s symptoms. The patient had total thyroidectomy and short courses of chemotherapy, then total resolution of symptomatology.

Conclusion

Most thyroid Hodgkin’s lymphoma are presented by women, rarely man, isolated and primary. Since 1962, we only found sixteen cases described in the literature. Hodgkin’s lymphoma should be considered in the differential diagnosis of patients with a thyroid mass for rapid management.

The diagnostic performances of conventional strain elastography (SE), acoustic radiation force impulse (ARFI) imaging and point shear-wave speed (pSWS) measurement for non-calcified thyroid nodules

BACKGROUND

Non-calcified thyroid nodules are relatively difficult to diagnose only relying on features of at conventional US images.

OBJECTIVE

To investigate the diagnostic performances of conventional strain elastography (SE), acoustic radiation force impulse (ARFI) SE and point shear-wave speed (pSWS) measurement for non-calcified thyroid nodules.

METHODS

A total of 201 non-calcified thyroid nodules in 195 patients were studied. They were examined with conventional ultrasound (US), conventional SE, ARFI SE and pSWS measurement. Their diagnostic performances and multivariable models were assessed with receiver operating characteristic (ROC) curve and logistic regression analyses respectively.

RESULTS

There were 156 benign and 45 malignant non-calcified nodules proven by histopathology or cystology. The mean diameters of the nodules were 21.2±10.8 mm. Areas under receiver operating characteristic curve (AUCs) of elastography features (ranged, 0.488-0.745) were all greater than that of US (ranged, 0.111-0.332). At multivariate analysis, there were three predictors of malignancy for non-calcified nodules, including pSWS of nodule (odds ratio [OR], 34.960; 95% CI, 11.582-105.529), marked hypoechogenicity (OR, 16.223; 95% CI, 1.761-149.454) and ARFI SE grade (OR, 10.900; 95% CI, 3.567-33.310). US+SE+pSWS owned the largest AUC (0.936; 95% CI, 0.887-0.985; P < 0.05), followed by US+pSWS (0.889; 95% CI, 0.823-0.955), and the poorest was US (0.727; 95% CI, 0.635-0.819).

CONCLUSIONS

ARFI SE and pSWS measurement had better diagnostic performances than conventional SE and US. When US combined with SE and pSWS measurement, it could achieve an excellent diagnostic performance and might contribute a better decision-making of FNA for non-calcified thyroid nodules.

Korean Thyroid Imaging Reporting and Data System features of follicular thyroid adenoma and carcinoma: a single-center study

PURPOSE

This study aimed to assess the diagnostic efficacy of Korean Thyroid Imaging Reporting and Data System (K-TIRADS) features for distinguishing follicular thyroid adenoma (FTA) from follicular thyroid carcinoma (FTC).

METHODS

From January 2013 to July 2016, 46 follicular neoplasms in 45 patients who underwent preoperative thyroid ultrasonography (US) and thyroid surgery were included. The US features of each thyroid nodule were retrospectively evaluated by a single radiologist using a picture archiving and communication system. The diagnostic indices of K-TIRADS for follicular neoplasms were calculated according to whether K-TIRADS category 4 lesions were excluded or classified as benign or malignant.

RESULTS

Of the 46 follicular neoplasms (mean size, 3.1±1.6 cm), 37 were FTAs (mean size, 3.1±1.7 cm) and nine were FTCs (mean size, 3.0±1.5 cm). A statistically significant difference was found between FTAs and FTCs regarding the margin (P=0.035), while no significant differences were observed in the composition, echogenicity, shape, orientation, calcification, or vascularity of the lesions (P<0.05). The FTAs belonged to K-TIRADS categories 3 (n=22) and 4 (n=15), while the FTCs belonged to K-TIRADS categories 3 (n=4), 4 (n=4), and 5 (n=1). However, there was no statistically significant difference in the distribution of K-TIRADS categories between FTAs and FTCs (P=0.184).

CONCLUSION

K-TIRADS features were not helpful for distinguishing FTA from FTC, although follicular neoplasms showed a high prevalence of K-TIRADS categories 3 and 4.

The T4/T3 quotient as a risk factor for differentiated thyroid cancer: a case control study

Background

The incidence of thyroid nodules is increasing among patients in North America. Few of these nodules harbour malignancy, thus further research is required to identify predictive markers of malignant thyroid disease. This study set out to understand the relationship between the levels of fT4 and fT3 and differentiated thyroid cancer.

Methods

A case-control study was conducted with 142 cases and 86 controls from the McGill University Teaching Hospitals. All patients underwent thyroid surgery. Cases were defined as patients with malignant nodules confirmed on final pathology and controls were defined as patients with benign nodules. The serological levels of TSH, fT4 and fT3 were measured preoperatively. Odds ratios were determined for each parameter and logistic regressions were calculated between markers and probability of malignancy. Additionally, fT4 values were divided by fT3 values (fT4/fT3 quotient) for each patient and an odds ratio was calculated.

Results

Amongst cases, the mean TSH was 2.25 ± 0.360U/mL, fT4 was 14.8 ± 0.689pmol/L, and fT3 was 4.65 ± 0.463pmol/L. Amongst controls, the mean TSH was 2.36 ± 1.68U/mL, fT4 was 14.3 ± 1.71pmol/L, and fT3 was 5.27 ± 0.957pmol/L. Patients in the control group were more likely to have low TSH, while patients in the case group would have high fT4 and patients in the control group were more likely to have a low fT4. The OR for patients with TSH >4.4U/mL was 2.13 (0.97, 4.65), and for patients with TSH <0.4U/mL was 0.46 (0.22, 0.95). The OR for patients with fT4 > 16pmol/L was 2.10 (1.09, 4.06), and for patients with fT4 < 10pmol/L was 0.45 (0.20, 0.98). The OR for patients with fT3 > 5.5pmol/L was 0.39 (0.14, 1.28). The OR for patients with fT3 < 3pmol/L was 1.83 (0.25, 13.69). The average fT4/fT3 was 3.39 ± 0.206 for cases and 2.93 ± 0.467 for controls. The fT4/fT3 quotient was considered high if it was >3.3 (OR =6.00 (2.94, 12.25)).

Conclusion

In this study, a direct relationship between high levels of fT4 and malignancy was uncovered. Furthermore, low levels of TSH and fT4 increased the likelihood that a nodule was benign. In this study a fT4/fT3 ratio >3.3 increased the risk of malignancy by 3.6 times (p-value =0.0013).

"Nodule in Nodule" on Thyroid Ultrasonography: Possibility of Follicular Carcinoma Transformed from Benign Thyroid Tumor

BACKGROUND

It is generally considered impossible to differentiate follicular carcinomas from follicular adenomas by means of ultrasonography or cytology before surgery. Therefore, follicular carcinoma is histopathologically diagnosed by verifying capsular and/or vascular invasion after surgery. However, ultrasonography may play an important role in diagnosing follicular carcinoma preoperatively in a small number of cases.

CASE DESCRIPTION

Four cases of follicular carcinoma or follicular neoplasm that transformed from a benign thyroid tumor and demonstrated a "nodule in nodule" appearance on ultrasonography are presented in this report. Characteristic ultrasound features of such patients are: (1) a "nodule in nodule" appearance, (2) a well-defined boundary line between the nodules, and (3) separate distribution of blood signals within each nodule.

CONCLUSION

A small number of patients with follicular carcinomas or follicular neoplasms may present with a "nodule in nodule" appearance on ultrasonography. It was suggested a long time ago that follicular carcinomas may develop from benign thyroid tumors. The fact that follicular carcinomas appear within benign tumors may be evidence of thyroid tumorigenesis.

Diffusion-Weighted Imaging Using a Readout-Segmented, Multishot EPI Sequence at 3 T Distinguishes between Morphologically Differentiated and Undifferentiated Subtypes of Thyroid Carcinoma-A Preliminary Study

BACKGROUND

Thyroid carcinomas represent the most frequent endocrine malignancies. Recent studies were able to distinguish malignant from benign nodules of the thyroid gland with diffusion-weighted imaging (DWI). Although this differentiation is undoubtedly helpful, presurgical discrimination between well-differentiated and undifferentiated carcinomas would be crucial to define the optimal treatment algorithm. Therefore, the aim of this study was to investigate if readout-segmented multishot echo planar DWI is able to differentiate between differentiated and undifferentiated subtypes of thyroid carcinomas.

PATIENTS AND METHODS

Fourteen patients with different types of thyroid carcinomas who received preoperative DWI were included in our study. In all lesions, apparent diffusion coefficient (ADC)min, ADCmean, ADCmax, and D were estimated on the basis of region of interest measurements after coregistration with T1-weighted, postcontrast images. All tumors were resected and analyzed histopathologically. Ki-67 index, p53 synthesis, cellularity, and total and average nucleic areas were estimated using ImageJ version 1.48.

RESULTS

Analysis of variance revealed a statistically significant difference in ADCmean values between differentiated and undifferentiated thyroid carcinomas (P=.022). Spearman Rho calculation identified significant correlations between ADCmax and cell count (r=0.541, P=.046) as well as between ADCmax and total nuclei area (r=0.605, P=.022).

CONCLUSION

DWI can distinguish between differentiated and undifferentiated thyroid carcinomas.

Hyper-Echoic Rim in Thyroid Nodules: A New Ultrasonographic Feature for Malignancy Prediction

The goal of this study was to verify the ultrasound features of hyper-echoic rims in thyroid nodules and to evaluate their diagnostic value in predicting thyroid malignancies. We retrospectively analyzed 228 pathologically proven thyroid nodules (137 malignant and 91 benign nodules). Forty-eight thyroid nodules had a hyper echogenic rim. All malignant nodules (137) were papillary carcinomas, which were studied to identify the correlation between the hyper-echoic rim (detected by ultrasound) and other histologic features. Presence of a hyper-echoic rim had high specificity (94.51%), but low sensitivity (31.39%) in predicting malignancy (p < 0.05). Thirty-seven of 43 malignant nodules had boundary zones of mixed structure (apparent fibrous stroma bands or dense collagenous border with a mixed population of cancerous cells) under microscopic examination. In conclusion, the hyper-echogenic rim could be one additional ultrasound parameter in the diagnosis of thyroid lesions.

Role of Gray Scale, Color Doppler and Spectral Doppler in Differentiation Between Malignant and Benign Thyroid Nodules

INTRODUCTION

High resolution ultrasound is the most sensitive imaging test available for the examination of the thyroid gland and due to increase in use of ultrasound more incidental thyroid nodules are diagnosed. In this study we try to establish the specific grayscale, color and spectral Doppler characteristics of malignant and benign thyroid nodules.

AIM

To determine the specific gray scale characteristics, angioarchitecture and cut-off values of Doppler indices of malignant and benign thyroid nodules. To assess the efficacy of grayscale, Doppler and combined conventional and Doppler using defined criteria in differentiating malignant from benign nodules.

MATERIALS AND METHODS

We prospectively examined 194 thyroid nodules which were confirmed on FNAC. Each nodule was described according to size, number, contents, echogenicity, margins, halo, shape, calcification, local infiltration and lymphnode enlargement. Vascularity, RI and PI values of each nodule were assessed on Doppler. Each nodule was characterized as benign, indeterminate or malignant based on grayscale and Doppler characteristics. Cut-off RI and PI values for malignant thyroid nodules were obtained by ROC.

RESULTS

Out of 194 nodules, 151 nodules were benign and 43 nodules were malignant. Significant relationship was observed between malignancy and hypoechogenicity, irregular margins, taller than wide, thick incomplete halo, micro calcifications, lymphnode enlargement and local infiltration. Intranodular vascularity was a significant criterion to suggest malignancy in thyroid nodules on color Doppler. Malignant nodules had a mean RI of 0.73 and mean PI of 1.3 which were significantly higher than the benign nodules. Accuracy of detecting malignant thyroid nodules by combining gray scale and Doppler is higher than either of them alone.

CONCLUSION

Using specific morphological pattern recognition features like microcalcifications, hypoechogenicity, taller than wide, irregular thick halo, lymphadenopathy and local extra thyroidal invasion has helped in differentiating malignant from benign features. Intranodular vascularity and high RI indices were the specific Doppler signs for malignant thyroid nodules. Since, Gray scale and Doppler have their own strengths and weaknesses, they were complementary rather than competitive modalities in diagnosing benign from malignant thyroid nodules.

Photoacoustic Imaging in Oncology: Translational Preclinical and Early Clinical Experience

Photoacoustic imaging has evolved into a clinically translatable platform with the potential to complement existing imaging techniques for the management of cancer, including detection, characterization, prognosis, and treatment monitoring. In photoacoustic imaging, tissue is optically excited to produce ultrasonographic images that represent a spatial map of optical absorption of endogenous constituents such as hemoglobin, fat, melanin, and water or exogenous contrast agents such as dyes and nanoparticles. It can therefore provide functional and molecular information that allows noninvasive soft-tissue characterization. Photoacoustic imaging has matured over the years and is currently being translated into the clinic with various clinical studies underway. In this review, the current state of photoacoustic imaging is presented, including techniques and instrumentation, followed by a discussion of potential clinical applications of this technique for the detection and management of cancer. (©) RSNA, 2016.

Clinical Presentation and Diagnostic Challenges of Thyroid Lymphoma: A Cohort Study

BACKGROUND

Thyroid lymphoma is a relatively rare disease often posing a diagnostic challenge. Reaching the final diagnosis can be delayed if insufficient biopsy material is obtained for immunohistochemistry analysis. The aim of this study was to evaluate the clinical, biochemical, and radiological features of thyroid lymphoma.

METHODS

A retrospective analysis was conducted of all Mayo Clinic patients evaluated between 2000 and 2014 who had a tissue biopsy positive for thyroid lymphoma.

RESULTS

Seventy-five subjects had biopsy-proven thyroid lymphoma, and 62.7% were primary thyroid lymphomas. The median age at diagnosis was 67 years (range 20-90 years). A total of 50.7% were male, and 54.7% had a history of Hashimoto's thyroiditis. Presenting symptoms included neck mass (88%), dysphagia (45.3%), and hoarseness (37.3%). The typical ultrasound appearance consisted of a solid, hypoechoic mass with increased vascularity and variable edge characteristics. Fine-needle aspiration (FNA) biopsies were abnormal in 70.7% of cases, and 42% indicated a specific lymphoma subtype. The diagnosis was confirmed in 53.3% by core biopsy, in 21.3% by thyroidectomy (partial or total), in 12% through incisional biopsy, and in 12% by lymph node biopsy. Core biopsy had a higher sensitivity compared with FNA (93% vs. 71%, p = 0.006).

CONCLUSION

A rapidly enlarging neck mass in the setting of Hashimoto's thyroiditis should raise suspicion for thyroid lymphoma. Radiologically, this usually presents as a large, unilateral, thyroid-centered mass, hypoechoic by ultrasound, and expanding into adjacent soft tissues. Core-needle biopsy should be the first diagnostic test to expedite reaching the final diagnosis and decrease patient burden of additional tests and interventions.

Ultrasonographic Findings in Patients with Benign and Malignant Thyroid Nodules who underwent Ultrasound Guided Fine Needle Aspiration Cytology

BACKGROUND

Patients with thyroid nodules represent common problem in daily routine of thyroidologists as well as other medical specialties. Fortunately only small number of thyroid nodules turns out to be malignant. Ultrasound is most frequently used imaging modality in the evaluation of thyroid nodules and certain ultrasonographic features are associated with greater risk for malignancy.

AIM

The aim of our study was to evaluate the diagnostic performance of various ultrasonographic findings regarding thyroid malignancy.

METHODS

Between September 2012 and August 2013 a total of 592 patients with 694 nodules were included in the present study. They were evaluated for thyroid nodules as a part of routine work up at outpatient's unit of Institute of Pathophysiology and Nuclear Medicine, Medical Faculty, UKIM Skopje. In all patients thyroid ultrasound and fine needle aspiration cytology (FNAC) were performed. Surgically were removed 84 nodules and ultrasonography and cytology data were compared to histology results.

RESULTS

From all examined ultrasonographic features, significant association with malignancy has been found for hypoechogenecity, marked central vascularisation, ultrasound suspicious nodules (including at least two suspicious features) and marginal for presence of microcalcifications. Highest sensitivity was obtained for hypoechogenecity, and highest specificity for microcalcifications and marked central vascularisation.

CONCLUSION

Awareness of the suspicious ultrasound features is mandatory in order to optimize diagnostic and therapeutic approach to the vast number of patients with thyroid nodules.

Comb-push ultrasound shear elastography (CUSE) for evaluation of thyroid nodules: preliminary in vivo results

In clinical practice, an overwhelming majority of biopsied thyroid nodules are benign. Therefore, there is a need for a complementary and noninvasive imaging tool to provide clinically relevant diagnostic information about thyroid nodules to reduce the rate of unnecessary biopsies. The goal of this study was to evaluate the feasibility of utilizing comb-push ultrasound shear elastography (CUSE) to measure the mechanical properties (i.e., stiffness) of thyroid nodules and use this information to help classify nodules as benign or malignant. CUSE is a fast and robust 2-D shear elastography technique in which multiple laterally distributed acoustic radiation force beams are utilized simultaneously to produce shear waves. Unlike other shear elasticity imaging modalities, CUSE does not suffer from limited field of view (FOV) due to shear wave attenuation and can provide a large FOV at high frame rates. To evaluate the utility of CUSE in thyroid imaging, a preliminary study was performed on a group of five healthy volunteers and 10 patients with ultrasound-detected thyroid nodules prior to fine needle aspiration biopsy. The measured shear wave speeds in normal thyroid tissue and thyroid nodules were converted to Young's modulus (E), indicating a measure of tissue stiffness. Our results indicate an increase in E for thyroid nodules compared to normal thyroid tissue. This increase was significantly higher in malignant nodules compared to benign. The Young's modulus in normal thyroid tissue, benign and malignant nodules were found to be 23.2 ±8.29 kPa, 91.2±34.8 kPa, and 173.0±17.1 kPa, respectively. Results of this study suggest the utility of CUSE in differentiating between benign and malignant thyroid nodules.

PET/CT in the management of thyroid cancers

OBJECTIVE

Thyroid cancer is the most common endocrine cancer. This review evaluates the established use of (18)F-FDG PET/CT in papillary, follicular, Hürthle cell, anaplastic, and medullary thyroid cancers. The significance of incidental diffuse and focal thyroid FDG uptake is discussed. The evolving value of non-FDG radiotracers, including (124)I, (18)F-dihydroxyphenylalanine, and (68)Ga somatostatin analogs, is summarized.

CONCLUSION

PET/CT is a valuable imaging test, in the appropriate clinical context, for the management of thyroid cancers.

Medullary thyroid carcinoma: surgical treatment advances

Since medullary thyroid cancer (MTC) was first recognized as a distinct tumor in 1959, it became clear that MTC is more difficult to cure than papillary thyroid cancer and has higher rates of recurrence and mortality. MTC represents 5-8% of thyroid cancers. It derives from parafollicular cells of the ultimobranchial body derived from the neural crest. MTC secretes calcitonin and other hormonal peptides and is considered part of the amine precursor uptake and decarboxilation system. MTC may occur either as a hereditary or nonhereditary entity. Hereditary MTC can occur either alone as the familial MTC or as the thyroid manifestation of multiple endocrine neoplasia (MEN) type 2 syndromes (MEN 2A MEN 2B). Activating point mutations of the RET proto-oncogene have demonstrated to be causative of the familial form of medullary thyroid cancer, both isolated familial MTC and associated with MEN 2A and 2B. In the last 10 years, major improvements and new technologies have been proposed and applied in thyroid surgery; among these are molecular diagnosis with genetic screening and mini-invasive video-assisted thyroidectomy. The history of thyroid surgery starts with Billroth, Kocher and Halsted, who developed the technique for thyroidectomy between 1873 and 1910. Prophylactic surgery for patients carrying a positive RET proto-oncogene has proven to be highly effective in curing those likely to experience the development of MTC. Video-assisted procedures with central compartment dissection have proved feasible for patients carrying a positive RET proto-oncogene. This paper reviews relevant medical literature published in the English language on surgery of MTC in well-controlled trials. We discuss the particular ethical and legal issues that thyroid prophylactic surgery raises. Searches were last updated in February 2007.

Surgery of lymph nodes in papillary thyroid cancer

Optimal treatment for differentiated thyroid carcinoma is controversial with respect to the extent of thyroid resection, the extent and technique of nodal dissection and use of prophylactic radioiodine treatment. Postoperative complications, such as recurrent laryngeal nerve injury and definitive hypoparathyroidism, have carried great weight in the discussion regarding how radical the surgical treatment should be. The discussion of whether total thyroidectomy or lesser procedures should be the treatment for thyroid carcinomas has been protracted. Now, reasonable agreement exists that total thyroidectomy is the best treatment and the focus of the discussion has moved to the treatment of lymph nodes. At the time of diagnosis, node metastases are a common finding in patients with differentiated thyroid cancer, in particular papillary carcinoma. The argument supporting a radical approach to lymph node excision is that the presence of node metastases increases the recurrence rate. Advocates for the conservative approach believe that little association exists between node metastases and death from thyroid carcinoma. This paper reviews relevant medical literature published in the English language on surgery of lymph nodes in differentiated thyroid cancer with well-controlled trials. Searches were last updated in June 2006.

Sonographic findings in three cases of carcinoma showing thymus-like differentiation

Carcinoma showing thymus-like differentiation (CASTLE) is a rare tumor of the thyroid gland or soft tissues of the head and neck. To our knowledge, there have been only a few reports concerning imaging findings of CASTLE. We report herein the sonographic appearances of three cases of CASTLE. Two tumors were located at the lower part of the thyroid and one had spread throughout the thyroid. Sonograms showed heterogeneously solid tumors without cystic components or calcification. The central part of the tumor was slightly hyperechoic compared with the peripheral part of the tumor. Histologically, the tumors were composed of a mixture of fibrous stroma and epithelial nests.

Evaluation and development of a real-time predictive model for ultrasound investigation of malignant thyroid nodules

Ultrasound investigations and correct identification of malignant thyroid nodules depend on the experience and qualifications of the investigators; thus, a model that provides better evaluation before needle aspiration is desired. Data from 687 patients with 726 thyroid nodules comprising 65 malignant nodules (61 papillary and 4 follicular carcinoma) and 661 benign nodules were used to construct a predictive model. Presence of micro-calcification, taller-than-wide shape, predominant solid echostructure, and irregular margins were shown to be good independent predictive parameters. A thyroid nodule was predicted as malignant with a score ≥3.3. Internal validation of this predictive tool by the bootstrapping method showed excellent overall model performance.

Diagnosis of thyroid cancer: state of art

INTRODUCTION

Thyroid cancer is the most common endocrine cancer in the USA and its incidence is increasing worldwide. Thyroid fine-needle aspiration biopsy (FNA) and cytologic analysis is the most cost-effective approach to distinguish between malignant and benign thyroid nodules. However, up to 30% of thyroid FNA biopsy results are inconclusive.

AREAS COVERED

In this article, the authors provide an update on the current status and emerging approaches for improving thyroid cancer diagnosis. This review covers imaging, genetic and genomic approaches being used or in development to help distinguish between malignant and benign thyroid nodules.

EXPERT OPINION

There has been considerable progress in improving thyroid cancer diagnosis. The molecular markers analysis to avoid diagnostic surgeries seems to be promising. However, the clinical utility and accuracy of some markers reported in this review are not conclusive and need to be validated as clinical diagnostic tool.

The role of nuclear medicine in differentiated thyroid cancer

In differentiated thyroid cancer (DTC) nuclear medicine is able to cover the spectrum from diagnosis and treatment to follow up keeping patient's management in one institution. Nowadays, DTC is often diagnosed per chance, presenting as small indolent nodule diagnosed on routinely performed ultrasound. Ultrasound and ultrasonography-guided fine-needle aspiration biopsy together with scintigraphy are probably the most adequate tools for diagnosis. After thyroidectomy, treatment with iodine-131 is routinely performed in a nuclear medicine therapy institution as a standard procedure in most of the cases with regard to histology. In case of iodine positive metastases, repeated therapies can be performed in order to reduce tumour burden. In the follow up of DTC thyroglobulin (tumour marker), ultrasound and diagnostic whole body scan are established procedures. With the development of SPECT/CT and PET/CT ((18)F-FDG, (68)Ga-somatostatin receptor) combining functional and anatomic imaging the nuclear medicine spectrum has further increased.

Non-invasive automated 3D thyroid lesion classification in ultrasound: a class of ThyroScan™ systems

Ultrasound-based thyroid nodule characterization into benign and malignant types is limited by subjective interpretations. This paper presents a Computer Aided Diagnostic (CAD) technique that would present more objective and accurate classification and further would offer the physician a valuable second opinion. In this paradigm, we first extracted the features that quantify the local changes in the texture characteristics of the ultrasound off-line training images from both benign and malignant nodules. These features include: Fractal Dimension (FD), Local Binary Pattern (LBP), Fourier Spectrum Descriptor (FS), and Laws Texture Energy (LTE). The resulting feature vectors were used to build seven different classifiers: Support Vector Machine (SVM), Decision Tree (DT), Sugeno Fuzzy, Gaussian Mixture Model (GMM), K-Nearest Neighbor (KNN), Radial Basis Probabilistic Neural Network (RBPNN), and Naive Bayes Classifier (NBC). Subsequently, the feature vector-classifier combination that results in the maximum classification accuracy was used to predict the class of a new on-line test thyroid ultrasound image. Two data sets with 3D Contrast-Enhanced Ultrasound (CEUS) and 3D High Resolution Ultrasound (HRUS) images of 20 nodules (10 benign and 10 malignant) were used. Fine needle aspiration biopsy and histology results were used to confirm malignancy. Our results show that a combination of texture features coupled with SVM or Fuzzy classifiers resulted in 100% accuracy for the HRUS dataset, while GMM classifier resulted in 98.1% accuracy for the CEUS dataset. Finally, for each dataset, we have proposed a novel integrated index called Thyroid Malignancy Index (TMI) using the combination of FD, LBP, LTE texture features, to diagnose benign or malignant nodules. This index can help clinicians to make a more objective differentiation of benign/malignant thyroid lesions. We have compared and benchmarked the system with existing methods.

High-frequency ultrasound in the evaluation of cerebral intraventricular haemorrhage in preterm rabbit pups

Cerebral intraventricular haemorrhage (IVH) is the most common cause of severe neurologic impairment following preterm birth in human infants. Ideally, an animal model for cerebral IVH should allow for reliable noninvasive evaluation of haemorrhagic extension and of subsequent development of posthaemorrhagic ventricular dilatation (PHVD). The aim of this study was to evaluate the use of high-frequency ultrasound (HFU) in premature rabbit pups with cerebral IVH induced by IP glycerol injection. Serial examinations using HFU enabled an accurate description of haemorrhagic extension and measurement of progressive PHVD over 72 h. The coefficient of variation for inter- and intraobserver variability in two measurements of ventricular size was less than 8.8% and 9.3%, respectively. Repeated ultrasound-guided intraventricular injection and sampling could be performed in vivo excluding requirement of stereotactic procedures and sedation. Application of HFU is a powerful tool for the evaluation of mechanisms involved in cerebral IVH and PHVD in the preterm rabbit pup model.

Evaluation of a new method for the diagnosis of alterations of Lens culinaris agglutinin binding of thyroglobulin molecules in thyroid carcinoma

BACKGROUND

The measurement of serum thyroglobulin (Tg) is widely used as a marker for recurrence of thyroid carcinoma following total thyroidectomy. However, this method cannot differentiate between benign and malignant disease. We focused on the sugar chain in the Tg molecule and investigated the usefulness of Lens culinaris agglutinin (LCA)-reactive Tg ratios in sera and wash fluids obtained during fine-needle aspiration (FNA) for the detection of thyroid carcinoma.

METHODS

The study was performed using 203 serum samples (115 from patients with benign thyroid disease and 88 from patients with thyroid carcinomas) and 176 wash fluid samples (143 benign, 21 malignant, and 12 inconclusive). LCA-reactive Tg ratios were determined using an enzyme-linked immunosorbent assay, and a comparison was made between malignant and benign lesions.

RESULTS

In serum, the ratio in patients with malignancy was 79.5+/-6.0 [mean+/-standard deviation (SD)], significantly lower than in patients with benign lesions (84.9+/-3.5). The ratios in wash fluid from malignant lesions (75.8+/-18.9) were also significantly lower than those from benign lesions (85.6+/-3.9).

CONCLUSIONS

These results suggest that this method could distinguish between benign and malignant lesions and may be useful for screening serum and wash samples.

Medical management of persistent or recurrent differentiated thyroid carcinoma

This article presents an overview of medical management of persistent or recurrent differentiated thyroid cancer, in particular focusing on monitoring strategy and treatment plans. Most patients with differentiated thyroid carcinoma can be successfully rendered to be free of disease with initial treatments, and those with persistent or recurrent disease can still expect long-term survival when they are monitored properly and treated accordingly. Along with serum thyroglobulin, neck ultrasonography, and radioactive iodine whole-body scans, the use of cross-sectional imaging studies and (18F) fluoro-2-deoxy-D-glucose-positron emission tomography have facilitated the effort in localizing lesions and traditional treatments can be implemented effectively. For disease resistant to conventional therapies, there are new treatment modalities emerging and being tested, including several agents targeting specific signaling pathways, each of which may offer the potential remedy.