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Gong Y, Tang S, Tan W, Liao L, Li X, Niu C. Papillary thyroid microcarcinoma with contralateral large humerus metastasis and cervical lymph node metastasis: A case report. Front Oncol 2022; 12:924465. [PMID: 36033467 PMCID: PMC9400018 DOI: 10.3389/fonc.2022.924465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Papillary thyroid microcarcinoma (PTMC) that metastasizes to bone, especially metastasizes to contralateral humerus with so large mass, is rarely reported before. Case report We presented a 50-year-old female patient with a large painful mass in the right humerus for 5 years, presenting with swelling of the right shoulder with limited mobility. Positron emission tomography–computed tomography (PET/CT) showed a large mass in the right humerus, bilateral lung lesions, and enlarged lymph nodes in the right supraclavicular fossa. Right humerus lesion biopsy and immunohistochemical evaluations confirmed that the lesion originated from the thyroid tissue. Then, the thyroid ultrasonography showed a hypo-echoic solid nodule with an irregular taller-than-wide shape in the upper of left thyroid lobe and enlarged lymph nodes with the absence of fatty hilum in the contralateral right IV compartment. The total thyroidectomy and cervical lymph node dissection were undertaken; the histopathology confirmed the diagnosis of PTMC with contralateral cervical lymph node metastasis. Conclusion We reported a case of PTMC with contralateral large humerus and cervical lymph node metastasis and demonstrated the PET/CT images of the metastatic large humerus and thyroid ultrasonographic appearances of the PTMC and enlarged cervical lymph node.
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Affiliation(s)
- Yi Gong
- Department of Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shixiong Tang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wanlin Tan
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Ultrasonography, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Liyan Liao
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaodu Li
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Ultrasonography, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chengcheng Niu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Ultrasonography, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Chengcheng Niu,
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Seo JW, Hwang SH, Cho A, Lee HS, Kim EK, Moon HJ, Yoon JH, Kwak JY. Prognostic Impact of Ultrasonography Features and (18)F-Fluorodeoxyglucose Uptake in Patients With Papillary Thyroid Microcarcinoma. Clin Exp Otorhinolaryngol 2016; 9:62-9. [PMID: 26976029 PMCID: PMC4792236 DOI: 10.21053/ceo.2016.9.1.62] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/15/2014] [Accepted: 01/31/2015] [Indexed: 01/30/2023] Open
Abstract
Objectives To evaluate the prognostic impact of ultrasonography (US) features and 18F-fluorodeoxyglucose (18F-FDG) uptake in patients with papillary thyroid microcarcinoma (PTMC). Methods This study included 74 patients with a single PTMC diagnosed pathologically. Patients underwent total thyroidectomy, or near-total thyroidectomy and staging thyroid US and positron emission tomography (PET) were performed prior to surgery. US features of thyroid nodules were reviewed retrospectively and the maximum standard uptake value (SUV) of nodules was semiquantitatively analyzed on 18F-FDG PET/computed tomography (CT). Patients were followed-up for recurrence, which was defined as PTC on cytology results, elevated serum thyroglobulin (Tg) or anti-Tg antibody levels, or uptake on whole-body scintigraphy. We used univariate and multivariate analyses to evaluate whether poor prognostic outcomes were associated with US features or SUV values derived from PET/CT of nodules. In addition, subjects were divided into 2 groups for subgroup analyses: one with nodules equal to or larger than 5 mm and one with nodules smaller than 5 mm. Results Among the 74 patients, there was no recurrence. Thus we evaluated the correlation between SUV value and US features with poor prognostic factors of PTMC which included extrathyroid extension, central and lateral lymph node (LN) metastasis. However no clinicopathologic factors were associated with extrathyroid extension, central LN metastasis, or lateral LN metastasis. Conclusion In patients with PTMC, US features and SUV values on FDG-PET were not related to extrathyroid extension or LN metastasis. However, future studies with a larger sample size and longer follow-up should be performed to verify the results of this study.
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Affiliation(s)
- Ji Won Seo
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyun Hwang
- Division of Nuclear Medicine, Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Arthur Cho
- Division of Nuclear Medicine, Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Yoon S, An YS, Lee SJ, So EY, Kim JH, Chung YS, Yoon JK. Relation Between F-18 FDG Uptake of PET/CT and BRAFV600E Mutation in Papillary Thyroid Cancer. Medicine (Baltimore) 2015; 94:e2063. [PMID: 26632889 PMCID: PMC4674192 DOI: 10.1097/md.0000000000002063] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BRAFV600E mutation and F-18 fluorodeoxyglucose (FDG) uptake are potential prognostic factors of papillary thyroid cancer (PTC). This study was performed to investigate the relationship between the BRAFV600E mutation and F-18 FDG uptake in PTC.We retrospectively included 169 PTC patients who underwent F-18 FDG positron emission tomography/computed tomography (PET/CT) before thyroidectomy from May 2009 to August 2012. Subjects were classified into overt PTC (>1 cm, n = 76) and papillary thyroid microcarcinoma (PTMC, n = 93) groups. Univariate and multivariate analyses were performed to assess the relationship between maximum standardized uptake value (SUVmax) of the primary tumors and clinicopathologic variables.The BRAFV600E mutation was detected in 82.2% (139/169). In all subjects, the BRAFV600E mutation and tumor size were independently related to SUVmax by multivariate analysis (P = 0.048 and P < 0.001, respectively). SUVmax was significantly higher in tumors with the BRAFV600E mutation than in those with wild-type BRAF (9.4 ± 10.9 vs 5.0 ± 4.1, P < 0.001). Similarly, in overt PTC group, the BRAFV600E mutation and tumor size were independently correlated with SUVmax (P = 0.032 and P = 0.001, respectively). By contrast, in PTMC group, only tumor size was significantly associated with SUVmax (P = 0.010). The presence of the BRAFV600E mutation is independently associated with high F-18 FDG uptake on preoperative PET/CT in patients with overt PTC, but this relationship was not evident in PTMC. This study provides a better understanding of the relationship between F-18 FDG uptake and BRAFV600E mutation in patients with PTC.
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Affiliation(s)
- Seokho Yoon
- From the Department of Nuclear Medicine and Molecular Imaging (SY, Y-SA, SJL, J-KY); Department of Surgery (EYS); Department of Pathology (J-HK); and Department of Endocrinology and Metabolism (Y-SC), Ajou University School of Medicine, Suwon, Republic of Korea
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Jun S, Kim H, Nam HY. A new method for segmentation of FDG PET metabolic tumour volume using the peritumoural halo layer and a 10-step colour scale. A study in patients with papillary thyroid carcinoma. Nuklearmedizin 2015; 54:272-85. [PMID: 26429587 DOI: 10.3413/nukmed-0749-15-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/22/2015] [Indexed: 12/15/2022]
Abstract
AIM We observed a layer between tumour activity and background on FDG PET/CT with the 10-step colour scale and the window level set properly. We named the layer peritumoral halo layer (PHL). We performed this study to establish the reliability of metabolic tumor volume (MTV) segmentation using PHL (MTV(PHL)) in patients with papillary thyroid carcinoma. PATIENTS, METHODS Of a total of 140 papillary thyroid carcinoma (PTC) patients, 70 (50.0%) had FDG-avid PTC. In these patients, MTV(PHL), MTV segmented according to fixed 50% SUVmax (MTV(50%)), and fixed SUV with 2.5 to 4.0 (MTV(2.5) to MTV(4.0)) were compared with pathologic tumour volume (PTV). The absolute percentage difference between MTV(PHL) and PTV was compared in micropapillary carcinoma (MPTC) and non-micropapillary carcinoma (non-MPTC) subgroups. The % SUVmax and SUV thresholds of MTV(PHL) were compared with tumour SUVmax. RESULTS Among the MTVs, MTV(50%) was not correlated with PTV (r = -0.16, p = 0.182) and was not reliable according to the Bland-Altman plot. Although MTV(2.5), MTV(3.0), MTV(3.5), and MTV(4.0) correlated with PTV (r = 0.85, 0.86, 0.87, and 0.87, respectively; p < 0.001), these MTVs were not reliable on Bland-Altman analyses. MTV(PHL) was significantly correlated with PTV (r = 0.80, p < 0.001), and the Bland-Altman plot did not show systemic error. The MTV(PHL) was more accurate in non-MPTC than in MPTC (p < 0.001), and the absolute % difference was smaller as PTV became larger (σ = -0.65, p < 0.001). The MTV(PHL) thresholds had correlations with SUVmax (% SUVmax threshold: σ = -0.87, p < 0.001; SUV threshold: r = 0.88, p < 0.001). CONCLUSIONS MTV(PHL) was more reliable than MTV(%SUVmax) or MTV(SUV). The reliability of MTV(PHL) improved with larger PTVs. The threshold of the MTV(PHL) was naturally altered by PHL according to SUVmax.
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Affiliation(s)
| | | | - H-Y Nam
- Hyun-Yeol Nam, M.D., Samsung Changwon Hospital, 158, Paryong-ro, Masan Hoewon-gu, Changwon-si, Korea, 630-723, Tel. +82/55/290-65 93; Fax -55 98,
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Kim H, Na KJ, Choi JH, Ahn BC, Ahn D, Sohn JH. Feasibility of FDG-PET/CT for the initial diagnosis of papillary thyroid cancer. Eur Arch Otorhinolaryngol 2015; 273:1569-76. [PMID: 25971994 DOI: 10.1007/s00405-015-3640-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/26/2015] [Indexed: 12/26/2022]
Abstract
To assess the role of [18F]-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) as a preoperative diagnostic tool in papillary thyroid carcinoma (PTC). From 2011 to 2014, 197 patients with PTC (246 tumor foci in all) underwent FDG-PET. Among these patients, 46 underwent neck dissection for lateral neck metastasis. According to the FDG avidity of the tumor foci or lateral neck metastasis, factors associated with the prognostic value were evaluated by univariate and multivariate logistic regression analyses. Among the 197 patients, 7 (3.6 %) were incidentally found to have non-thyroid origin malignancy. Additionally, 63.0 % (155/246) of PTC foci showed FDG uptake on PET/CT. Univariate analysis showed that the tumor size, the presence of extrathyroidal extension, BRAF mutation, and Hashimoto thyroiditis were associated with FDG avidity. However, except for pathological extrathyroidal extension, the other factors showed statistically significant correlations with FDG avidity (p < 0.001, p = 0.008, and p = 0.009, respectively). FDG uptake in lateral neck node metastasis showed high specificity and negative predictive value (NPV). In four cases of nonspecific findings on ultrasonography (USG)/CT, FDG avidity was helpful to diagnose the presence of lateral neck metastasis. The maximum standardized uptake value (SUVmax) of PET/CT was correlated with the maximum diameter of the involved lateral node. FDG avidity did not show any significance in the recurrence-free survival of both the thyroid tumor and lateral neck metastasis. The FDG avidity of PTC did not show prognostic predictive meaning. However, in the case of lateral neck metastasis, FDG avidity showed high sensitivity and NPV, and could provide better information in cases of nonspecific findings on USG and CT.
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Affiliation(s)
- Heejin Kim
- Department of Otorhinolaryngology, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea
| | - Kyung Jin Na
- Department of Otorhinolaryngology, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea
| | - Jae Hyuk Choi
- Department of Otorhinolaryngology, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea
| | - Byeong-Cheol Ahn
- Department of Nuclear Medicine, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea
| | - Dongbin Ahn
- Department of Otorhinolaryngology, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea
| | - Jin Ho Sohn
- Department of Otorhinolaryngology, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea.
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