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Bastien AJ, Ng J, Cong I, Garcia J, Walgama ES, Luu M, Jang JK, Mita AC, Scher KS, Moyers JT, Clair JMS, Maghami E, Chen MM, Zumsteg ZS, Ho AS. Patient perceptions underlying ctDNA molecular surveillance for HPV(+) oropharyngeal squamous cell carcinoma. Oral Oncol 2024; 156:106894. [PMID: 38909394 DOI: 10.1016/j.oraloncology.2024.106894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/12/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE Circulating tumor DNA assays have robust potential as molecular surveillance tools. They may also exacerbate patient distress without improving outcomes. We investigate patient acceptability of a validated ctHPVDNA assay (NavDx) during cancer surveillance for HPV(+) oropharyngeal cancer (OPC). METHODS Consented HPV(+) OPC participants completed the NCCN Distress Thermometer, the Hospital Anxiety Depression Scale (HADS), and the Functional Assessment of Cancer Therapy-General (FACT-G) scale both (1) before NavDx blood draw, and (2) after results were provided. Patients then completed a series of focused questions related to their perceptions of the assay. RESULTS Overall, 55 patients completed the study, with 98.2 % showing no recurrence. For the NCCN Distress Thermometer, median patient distress decreased (2.0 (IQR 1-5) vs. 1.0 (IQR 0-3)) (p < 0.001) in association with NavDx. Using scores ≥ 4 as a cutoff point to define clinically elevated distress, scores also improved (36.4 % vs. 18.2 %, p = 0.031). For HADS, anxiety significantly improved (5.0 (IQR 2.0-7.0) vs. 3.0 (IQR 1.0-6.5)) (p = 0.037), but not depression (3.0 (IQR 1.0-7.0) vs. 3.0 (IQR 1.0-6.5)) (p = 0.870). FACT-G scores showed no substantial differences. On survey questionnaires, 95.5 % of patients believed the test to be helpful, and 100 % felt "somewhat" or "extremely" confident in the assay as a monitoring tool. While 59.1 % felt that it reduced anxiety, 88.4 % concordantly felt that it did not introduce anxiety. CONCLUSION ctHPVDNA as a molecular surveillance tool reduced distress levels in HPV(+) OPC patients, with notably high patient confidence in the approach. Further investigation is warranted to judiciously incorporate this emerging modality in surveillance guidelines.
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Affiliation(s)
- Amanda J Bastien
- Division of Otolaryngology-Head and Neck Surgery, Dept. of Surgery, Cedars-Sinai Medical Center, 8631 West Third St., Suite 915E, Los Angeles, CA 90048, United States
| | - Jewel Ng
- Division of Otolaryngology-Head and Neck Surgery, Dept. of Surgery, Cedars-Sinai Medical Center, 8631 West Third St., Suite 915E, Los Angeles, CA 90048, United States
| | - Iris Cong
- Division of Otolaryngology-Head and Neck Surgery, Dept. of Surgery, Cedars-Sinai Medical Center, 8631 West Third St., Suite 915E, Los Angeles, CA 90048, United States
| | - Jonathan Garcia
- Division of Otolaryngology-Head and Neck Surgery, Dept. of Surgery, Cedars-Sinai Medical Center, 8631 West Third St., Suite 915E, Los Angeles, CA 90048, United States
| | - Evan S Walgama
- Division of Otolaryngology-Head and Neck Surgery, Dept. of Surgery, Cedars-Sinai Medical Center, 8631 West Third St., Suite 915E, Los Angeles, CA 90048, United States; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States
| | - Michael Luu
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States; Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States
| | - Julie K Jang
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States; Department of Radiation Oncology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States
| | - Alain C Mita
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States; Division of Medical Oncology, Dept. of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States
| | - Kevin S Scher
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States; Division of Medical Oncology, Dept. of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States
| | - Justin T Moyers
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States; Division of Medical Oncology, Dept. of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States; The Angeles Clinic and Research Institute, Cedars-Sinai Medical Center, 1919 Santa Monica Boulevard, Fourth Floor, Los Angeles, CA 90048, United States
| | - Jon Mallen-St Clair
- Division of Otolaryngology-Head and Neck Surgery, Dept. of Surgery, Cedars-Sinai Medical Center, 8631 West Third St., Suite 915E, Los Angeles, CA 90048, United States; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States
| | - Ellie Maghami
- Dept. of Surgery, City of Hope National Medical Center, 1500 E Duarte Rd, Duarte, CA 91010, United States
| | - Michelle M Chen
- Dept. of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, Stanford, CA 94305, United States
| | - Zachary S Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States; Department of Radiation Oncology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States
| | - Allen S Ho
- Division of Otolaryngology-Head and Neck Surgery, Dept. of Surgery, Cedars-Sinai Medical Center, 8631 West Third St., Suite 915E, Los Angeles, CA 90048, United States; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States.
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Morikawa H, Oba T, Kitazawa A, Iji R, Kiyosawa N, Amitani M, Shimizu T, Kanai T, Uehara T, Ito KI. CA19-9 producing locally advanced papillary thyroid carcinoma: a case report. Surg Case Rep 2024; 10:83. [PMID: 38598167 PMCID: PMC11006640 DOI: 10.1186/s40792-024-01887-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/04/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND CA19-9 is a tumor marker for gastrointestinal and biliary-pancreatic adenocarcinomas; however, its association with thyroid cancer is unknown. Here, we report a case of CA19-9 producing locally advanced papillary thyroid carcinoma (PTC). CASE PRESENTATION A 66-year-old woman who was identified with a thyroid tumor after a close examination of an elevated serum CA19-9 level, which was detected at health screening, was referred to our hospital. Ultrasonography revealed a 34 × 31 mm hypoechoic lesion in the lower pole of the left thyroid lobe. Computed tomography revealed a solid thyroid tumor with tracheal invasion without any distant metastases. Bronchoscopy revealed tumor exposure into the tracheal lumen on the left side of the trachea. Fine-needle aspiration cytology led to a diagnosis of papillary thyroid carcinoma (PTC). The patient underwent a total thyroidectomy, tracheal sleeve resection with end-to-end anastomosis, and lymph node dissection in the left cervical and superior mediastinal regions (D3c) with a reversed T-shaped upper sternotomy down to the third intercostal level. Histopathological analysis confirmed the diagnosis of PTC with tracheal invasion and no lymph node metastases (pT4a Ex2 N0). Immunohistochemical staining showed the expression of CA19-9 in cancer cells. Postoperatively, the serum CA19-9 level of the patient decreased to within the normal range. CONCLUSIONS Some PTCs produce CA19-9, although less frequently. When elevated serum CA19-9 levels are observed, PTC should be included in the differential diagnosis for further investigation.
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Affiliation(s)
- Hiroki Morikawa
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Takaaki Oba
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan.
| | - Ayaka Kitazawa
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Ryoko Iji
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Nami Kiyosawa
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Masatsugu Amitani
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Tadafumi Shimizu
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Toshiharu Kanai
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Takeshi Uehara
- Division of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Ken-Ichi Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
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Yamaguchi Y, Okajima F, Sugihara H, Iwabu M, Emoto N. Atypical Clinical Courses of Graves' Disease Confound Differential Diagnosis of Hyperthyroidism. J NIPPON MED SCH 2024; 91:48-58. [PMID: 38072422 DOI: 10.1272/jnms.jnms.2024_91-104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND This study examined the appropriateness of the current paradigm for differential diagnosis of painless thyroiditis and Graves' disease (GD) in patients with thyrotoxicosis. METHODS We retrospectively evaluated the clinical course of 343 consecutive patients with hyperthyroidism diagnosed by Tc-99m pertechnetate thyroid uptake (TcTU) testing at our hospital from January 2011 to December 2017. RESULTS Of the 263 patients with normal or high TcTU levels (≥1.0%), 255 (97%) had unequivocal GD and 5 had spontaneous remission GD or atypical GD. Of the 10 patients with low TcTU levels (<1.0% and ≥0.5%), 7 had GD, while others had subclinical GD, spontaneous remission GD with later relapse, and painless thyroiditis. Of those with very low TcTU levels (<0.5%), most had thyroiditis (painless thyroiditis, 33/67 [49%]; subacute thyroiditis, 29/67 [43%]), and some were positive for anti-TSH receptor antibodies. CONCLUSION Given that atypical GD may confound the diagnosis of thyrotoxicosis, it is essential to follow the patient as a tentative diagnosis, whatever the diagnosis. This is the first report clearly demonstrating that so far there is no gold standard for the diagnosis of GD. It is therefore urgent to establish a consensus on the definition of GD so that the specificity and sensitivity of future diagnostic tests can be determined.
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Affiliation(s)
- Yuji Yamaguchi
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School
- Department of Diabetes, Endocrinology and Metabolism, Nippon Medical School Chiba Hokusoh Hospital
| | - Fumitaka Okajima
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School
- Department of Diabetes, Endocrinology and Metabolism, Nippon Medical School Chiba Hokusoh Hospital
| | - Hitoshi Sugihara
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School
- IVY Clinic
| | - Masato Iwabu
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School
| | - Naoya Emoto
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School
- Department of Diabetes, Endocrinology and Metabolism, Nippon Medical School Chiba Hokusoh Hospital
- Diabetes & Endocrine Clinic, Sakura Chuo Hospital
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Han N, Lu C, Li J, Wang C, Zhao Z, Zhang Y, Liu X, Si Z, Wang G, Wang Z, Li F, Wang X. Stimulated thyroglobulin and pre-ablation antithyroglobulin antibody products can predict the response to radioiodine therapy of TgAb-positive differentiated thyroid cancer patients: a retrospective study. Front Endocrinol (Lausanne) 2023; 14:1222470. [PMID: 37810895 PMCID: PMC10556735 DOI: 10.3389/fendo.2023.1222470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Objective We aimed to explore the predictive value of stimulated thyroglobulin (sTg) and pre-ablation antithyroglobulin (pa-TgAb) products for the effect of radioiodine therapy (RAIT) on TgAb-positive differentiated thyroid cancer (DTC) patients. Methods In this study, we enrolled 265 patients with TgAb-positive DTC who underwent RAIT after total thyroidectomy (TT). Based on the last follow-up result, the patients were divided into two groups: the excellent response (ER) group and the non-excellent response (NER) group. We analyzed the factors related to the effect of RAIT. Results The ER group consisted of 197 patients. The NER group consisted of 68 patients. For the univariate analysis, we found that the maximal tumor diameter, whether with extrathyroidal extension (ETE), bilateral or unilateral primary lesion, multifocality, preoperative TgAb (preop-TgAb), pa-TgAb, sTg × pa-TgAb, initial RAIT dose, N stage, and surgical extent (modified radical neck dissection or not), showed significant differences between the ER group and NER group (all p-values <0.05). The receiver operating characteristic (ROC) curves showed that the cutoff value was 724.25 IU/ml, 424.00 IU/ml, and 59.73 for preop-TgAb, pa-TgAb, and sTg × pa-TgAb, respectively. The multivariate logistic regression analysis results indicated that pa-TgAb, sTg × pa-TgAb, initial RAIT dose, and N stage were independent risk factors for NER (all p-values <0.05). For the Kaplan-Meier analysis of disease-free survival (DFS), the median DFS of the patients with sTg × pa-TgAb < 59.73 and initial RAIT dose ≤ 100 mCi was significantly longer than that of the patients with sTg × pa-TgAb ≥ 59.73 (50.27 months vs. 48.59 months, p = 0.041) and initial RAIT dose >100 mCi (50.50 months vs. 38.00 months, p = 0.030). Conclusion We found the sTg and pa-TgAb conducts is a good predictor of the efficacy of RAIT in TgAb-positive DTC patients. It can play a very positive and important role in optimizing treatment, improving prognosis, and reducing the burden of patients.
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Affiliation(s)
- Na Han
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chenghui Lu
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jiao Li
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Congcong Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zilong Zhao
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- Department of Nuclear Medicine, Ordos Central Hospital, Ordos, Inner Mongolia, China
| | - Yingying Zhang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xinfeng Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zengmei Si
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guoqiang Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zenghua Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Fengqi Li
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xufu Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Kitamura Y, Narita S, Yagi S, Aoyagi K. Thyroglobulin immunoassay with a fully automated pretreatment process provides accurate thyroglobulin values in anti-thyroglobulin antibody positive specimens. Clin Biochem 2023:110598. [PMID: 37330000 DOI: 10.1016/j.clinbiochem.2023.110598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Human thyroglobulin (Tg) is widely used as a tumor marker for recurrence and metastasis of differentiated thyroid cancer (DTC). Currently, serum Tg values are measured using second-generation sandwich immunoassays (2nd-IMA). However, interference by endogenous autoantibodies to thyroglobulin (TgAbs) can lead to false-negative results or falsely low Tg values. Here, we describe a new Tg assay using the immunoassay for total antigen including complex via pretreatment (iTACT) method to prevent TgAb interference and compare it with 2nd-IMA. METHODS Tg values were evaluated by three assays: iTACT Tg, Elecsys Tg-II, which is a 2nd-IMA, and LC-MS/MS (Liquid chromatography tandem-mass spectrometry). The ratio of Tg values between each assay was then compared to the Tg value by LC-MS/MS and TgAb titer. Tg immunoreactivity was analyzed by size-exclusion chromatography. RESULTS Correlation between iTACT Tg and LC-MS/MS using TgAb-positive specimens was good: Passing-Bablok regression with iTACT Tg = 1.084 x LC-MS/MS + 0.831. Correlation between 2nd-IMA and LC-MS/MS showed a relatively lower slope: 2nd-IMA = 0.747 x LC-MS/MS - 0.518. Thus, Tg values determined by iTACT Tg are equivalent to those of LC-MS/MS regardless of TgAb titer, whereas 2nd-IMA gave lower Tg values due to TgAb interference. Tg-TgAb complexes of various molecular weights were verified by size-exclusion chromatography. Tg values measured by 2nd-IMA fluctuated depending on the molecular weight of the Tg-TgAb complexes, whereas iTACT Tg accurately quantified Tg values regardless of the size of the Tg-TgAb complexes. CONCLUSION Tg values in TgAb-positive specimens were accurately determined by iTACT Tg. TgAb-positive specimens contain Tg-TgAb complexes of various molecular weights that interfere with Tg value determination by 2nd-IMA, whereas iTACT Tg is unaffected by the presence of Tg-TgAb complexes.
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Affiliation(s)
| | - Sho Narita
- Development Division, FUJIREBIO INC., Tokyo, Japan
| | - Shintaro Yagi
- Development Division, Advanced Life Science Institute, Inc., Tokyo, Japan
| | - Katsumi Aoyagi
- Development Division, FUJIREBIO INC., Tokyo, Japan; Development Division, Advanced Life Science Institute, Inc., Tokyo, Japan.
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Buczyńska A, Sidorkiewicz I, Kościuszko M, Adamska A, Siewko K, Dzięcioł J, Szumowski P, Myśliwiec J, Popławska-Kita A, Krętowski AJ. The Relationship between Oxidative Status and Radioiodine Treatment Qualification among Papillary Thyroid Cancer Patients. Cancers (Basel) 2023; 15:cancers15092436. [PMID: 37173902 PMCID: PMC10177082 DOI: 10.3390/cancers15092436] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/13/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Total oxidative status (TOS), total antioxidant capacity (TAC), tumor protein 53 (p53), nuclear factor kappa B (NF-κB), forkhead box protein O1 (FOXO), and sirtuin 1 (SIRT1) play crucial roles in oxidative homeostasis and the progression of papillary thyroid cancer (PTC), as previously demonstrated in the literature. Therefore, profiling these markers among PTC patients may be useful in determining their eligibility for radioiodine (RAI) treatment. Since treatment indications are based on multiple and dynamic recommendations, additional criteria for adjuvant RAI therapy are still needed. In our study, we evaluated the TOS, TAC, and serum concentrations of p53, NF-κB, FOXO, and SIRT1 to analyze the relationship between oxidative status and qualification for RAI treatment. For the purpose of this study, we enrolled 60 patients with PTC allocated for RAI treatment as the study group and 25 very low-risk PTC patients not allocated for RAI treatment as a reference group. The serum TOS and SIRT1 concentrations were significantly higher in the study group compared to the reference group (both p < 0.001), whereas the TAC and p53, NK-κB, and FOXO concentrations were significantly lower (all p < 0.05). We also demonstrated the diagnostic utility of TAC (AUC = 0.987), FOXO (AUC = 0.648), TOS (AUC = 0.664), SIRT1 (AUC = 0.709), p53 (AUC = 0.664), and NF-κB (AUC = 0.651) measurements as indications for RAI treatment based on American Thyroid Association recommendations. Our study revealed that oxidative status-related markers may become additional criteria for RAI treatment in PTC patients.
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Affiliation(s)
- Angelika Buczyńska
- Clinical Research Centre, Medical University of Bialystok, M. Skłodowskiej 24a, 15-276 Bialystok, Poland
| | - Iwona Sidorkiewicz
- Clinical Research Centre, Medical University of Bialystok, M. Skłodowskiej 24a, 15-276 Bialystok, Poland
| | - Maria Kościuszko
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, M. Skłodowskiej 24a, 15-276 Bialystok, Poland
| | - Agnieszka Adamska
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, M. Skłodowskiej 24a, 15-276 Bialystok, Poland
| | - Katarzyna Siewko
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, M. Skłodowskiej 24a, 15-276 Bialystok, Poland
| | - Janusz Dzięcioł
- Department of Human Anatomy, Medical University of Bialystok, ul. Mickiewicza 2A, 15-230 Bialystok, Poland
| | - Piotr Szumowski
- Nuclear Medicine, Medical University of Bialystok, M. Skłodowskiej 24a, 15-276 Bialystok, Poland
| | - Janusz Myśliwiec
- Nuclear Medicine, Medical University of Bialystok, M. Skłodowskiej 24a, 15-276 Bialystok, Poland
| | - Anna Popławska-Kita
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, M. Skłodowskiej 24a, 15-276 Bialystok, Poland
| | - Adam Jacek Krętowski
- Clinical Research Centre, Medical University of Bialystok, M. Skłodowskiej 24a, 15-276 Bialystok, Poland
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, M. Skłodowskiej 24a, 15-276 Bialystok, Poland
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Spencer CA. Laboratory Thyroid Tests: A Historical Perspective. Thyroid 2023; 33:407-419. [PMID: 37037032 DOI: 10.1089/thy.2022.0397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Background: This review presents a timeline showing how technical advances made over the last seven decades have impacted the development of laboratory thyroid tests. Summary: Thyroid tests have evolved from time-consuming manual procedures using isotopically labeled iodine as signals (131I and later 125I) performed in nuclear medicine laboratories, to automated nonisotopic tests performed on multianalyte instruments in routine clinical chemistry laboratories. The development of isotopic radioimmunoassay techniques around 1960, followed by the advent of monoclonal antibody technology in the mid-1970s, led to the development of a nonisotopic immunometric assay methodology that forms the backbone of present-day thyroid testing. This review discusses the development of methods for measuring total thyroxine and triiodothyronine, direct and indirect free thyroid hormone measurements and estimates (free thyroxine and free triiodothyronine), thyrotropin (TSH), thyroid autoantibodies (thyroperoxidase, thyroglobulin [Tg] and TSH receptor autoantibodies), and Tg protein. Despite progressive improvements made in sensitivity and specificity, current thyroid tests remain limited by between-method differences in the numeric values they report, as well as nonspecific interferences with test reagents and interferences from analyte autoantibodies. Conclusions: Thyroid disease affects ∼10% of the U.S. population and is mostly managed on an outpatient basis, generating 60% of endocrine laboratory tests. In future, it is hoped that interferences will be eliminated, and the standardization/harmonization of tests will facilitate the establishment of universal test reference ranges.
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Affiliation(s)
- Carole Ann Spencer
- Department of Endocrinology, University of Southern California, Los Angeles, California, USA
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Resveratrol thyro-protective role in fluorosis rat model (histo-morphometric, biochemical and ultrastructural study). Tissue Cell 2023; 80:101986. [PMID: 36470120 DOI: 10.1016/j.tice.2022.101986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Thyroid gland affection by Fluorosis is documented in a number of previous studies. Resveratrol is a natural compound of plant origin. Its protective role was demonstrated previously in mice and rats against fluoride-induced hepatotoxicity and neurotoxicity. AIM to detect the thyro-protective role of Resveratrol in sodium fluoride rat model. MATERIAL AND METHODS Forty adult male albino rats were distributed equally into: Group I (control): given 5 ml distilled water; Group II (Resveratrol): received 30 mg/kg Resveratrol; Group III (Sodium fluoride): given 10 mg/kg of Sodium Fluoride dissolved in 2.5 ml distilled water; Group IV (Sodium fluoride + Resveratrol): received 10 mg/kg of Sodium Fluoride and 30 mg/kg of Resveratrol. All doses were administered once daily by intra-gastric intubation. By the end of the experiment, rats were sedated by intra-peritoneal injection of Sodium thiopental; blood samples were collected, and thyroid lobes were dissected then processed for examination. RESULTS In the control and Resveratrol groups, there were multiple variable follicles filled with homogenous eosinophilic colloid and lined with flat to cuboidal thyrocytes. Large pale-staining Para follicular cells. In the Sodium fluoride - treated group there were multiple dark stained nuclei of shrunken and exfoliated cells, areas of exudate and multiple layered follicular cells with high activity of Para follicular cells immuno-histochemically. Sodium fluoride+ Resveratrol - treated group appeared with almost preserved control appearance. Findings were confirmed using morphometric and electron microscopic studies. CONCLUSION Resveratrol supplementation with sodium fluoride restored almost all damaged appearance and functions of the thyroid cells to normal values. Further studies are necessary to examine the extended effect of Resveratrol with increased dosage or time of treatment.
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Zhao H, Liu CH, Cao Y, Zhang LY, Zhao Y, Liu YW, Liu HF, Lin YS, Li XY. Survival prognostic factors for differentiated thyroid cancer patients with pulmonary metastases: A systematic review and meta-analysis. Front Oncol 2022; 12:990154. [PMID: 36591452 PMCID: PMC9798085 DOI: 10.3389/fonc.2022.990154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Background The prognostic factors for differentiated thyroid cancer (DTC) patients with pulmonary metastases (PM) remain scantly identified and analyzed. Therefore, this systematic review and meta-analysis were performed to identify and summarize the prognostic factors in adult DTC patients with PM to help distinguish patients with different prognoses and inform the rational treatment regimens. Method We performed a comprehensive search of the relevant studies published in the Cochrane Library, PubMed, Scopus, Embase, Wanfang database, VIP database, China National Knowledge Infrastructure, and Google Scholar from their inception until February 2021. The pooled hazard ratios (HR) for overall survival and/or progression-free survival (PFS) with 95% confidence intervals were applied to evaluate and identify the potential prognostic factors. Pooled OS at different time points were also calculated for the available data. A random-effects model was used in the meta-analysis. Results The review and meta-analysis included 21 studies comprising 2722 DTC patients with PM. The prognostic factors for poor OS were: age over 40 years (HR=7.21, 95% confidence interval [CI] 1.52-34.10, P=0.01, N=788), age over 45 years (HR=2.18, 95% CI 1.26-3.77, P<0.01, N=601), male gender (HR=1.01, 95% CI 1.01-1.19, P=0.03, N=1396), follicular subtype of thyroid cancer (HR=1.63, 95% CI 1.36-1.96, P<0.01, N=2110), iodine non-avidity (HR=3.10, 95% CI 1.79-5.37, P<0.01, N=646), and metastases to other organs (HR=3.18, 95% CI 2.43-4.16, P<0.01, N=1713). Factors associated with poor PFS included age over 45 years (HR=3.85, 95% CI 1.29-11.47, P<0.01, N=306), male gender (HR=1.36, 95% CI 1.06-1.75, P=0.02, N=546), iodine non-avidity (HR=2.93, 95% CI 2.18-3.95, P<0.01, N=395), pulmonary metastatic nodule size over 10mm (HR=2.56, 95% CI 2.02-3.24, P<0.01, N=513), and extra-thyroidal invasion (HR=2.05, 95% CI 1.15-3.67, P=0.02, N=271). The pooled 1, 3, 5, 10, 15, and 20-years OS were 95.24%, 88.46%, 78.36%, 64.86%, 56.57%, and 51.03%, respectively. Conclusions This review and meta-analysis identified the prognostic factors of DTC patients with PM. Notably, FTC, metastases to other organs, and iodine non-avidity were particularly associated with poor prognosis. The identified prognostic factors will help guide the clinical management of DTC patients with PM. Systematic review registration https://inplasy.com/inplasy-2022-2-0026/, identifier (INPLASY202220026).
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Affiliation(s)
- Hao Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chun-Hao Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yue Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Li-Yang Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ya Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yue-Wu Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hong-Feng Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan-Song Lin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiao-Yi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,*Correspondence: Xiao-Yi Li,
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10
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Dekker BL, van der Horst-Schrivers ANA, Brouwers AH, Shuford CM, Kema IP, Muller Kobold AC, Links TP. Clinical irrelevance of lower titer thyroglobulin autoantibodies in patients with differentiated thyroid carcinoma. Eur Thyroid J 2022; 11:e220137. [PMID: 36169927 PMCID: PMC9641791 DOI: 10.1530/etj-22-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/28/2022] [Indexed: 11/08/2022] Open
Abstract
Objective Thyroglobulin (Tg) is an established tumor marker for differentiated thyroid carcinoma (DTC) patients. However, Tg immunoassays can be subject to Tg autoantibody (TgAb) interference resulting in incorrect Tg values. Therefore, Tg measurement with liquid chromatography-tandem mass spectrometry (LC-MS/MS) could be promising in patients with TgAbs. In this study, we compared Tg IRMA and Tg-LC-MS/MS analytically in the presence of TgAbs. Furthermore, we compared the clinical interpretation of results obtained by both Tg assays in DTC patients with lower TgAbs titers (<10 U/mL) during 131I ablation therapy. Methods Totally 118 DTC patients diagnosed between 2006 and 2014 in a University Medical Center were followed with the Tg-IRMA (Thermo Fischer Scientific) and ARCHITECT anti-Tg (Abbott Laboratories) assays. We re-analyzed their samples with a sensitive Tg-LC-MS/MS method (Labcorp, limit of quantification of 0.02 ng/mL). Passing-Bablok regression analysis was performed on samples obtained during 131I ablation therapy and follow-up. Results In 304 samples with lower TgAb titers, a good analytical agreement was found between both Tg assays (slope of 1.09 (95% CI: 1.05-1.16)). Fifty-five samples with potentially interfering TgAbs showed higher Tg-LC-MS/MS values than Tg-IRMA (slope of 1.45 (95% CI: 1.12->>100)). In patients(n = 91) with lower TgAb titers at the time of 131I ablation therapy, the Tg assays showed a clinical concordance of 91.2, 87.9, and 98.9%, respectively, using a Tg cut-off value of 1.0, 2.0, and 5.0 ng/mL. Conclusions In DTC patients with lower titer TgAbs, Tg-IRMA is still a reliable and useful tumor marker. In DTC patients with potentially interfering TgAbs, Tg-IRMA values decreased due to TgAb interference.
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Affiliation(s)
- Bernadette L Dekker
- Internal Medicine, Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anouk N A van der Horst-Schrivers
- Internal Medicine, Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Emergency Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Christopher M Shuford
- Laboratory Corporation of America Holdings, Center for Esoteric Testing, Burlington, North California, USA
| | - Ido P Kema
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anneke C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Thera P Links
- Internal Medicine, Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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11
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Barbesino G, Algeciras-Schimnich A, Bornhorst J. Thyroglobulin Assay Interferences: Clinical Usefulness of Mass-Spectrometry Methods. J Endocr Soc 2022; 7:bvac169. [PMCID: PMC9683495 DOI: 10.1210/jendso/bvac169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Indexed: 11/27/2022] Open
Abstract
Context Thyroglobulin autoantibodies (TgAbs) affect thyroglobulin immunometric assays (TgIMAs), causing falsely low results. Conversely, heterophilic antibodies (HAs) may cause falsely elevated results. Thyroglobulin (Tg) measurements by mass spectrometry (MS) resist antibody interference. The most effective use of TgIMA/TgMS in the evaluation of Tg remains unclear. Objective The objective of this work was to study the usefulness of TgMS vs TgIMA in the presence of Tg measurement interference by HA and TgAb. Methods In 163 thyroid cancer patients, Tg was postoperatively measured by TgIMA and TgMS. When TgIMA was elevated and TgMS undetectable, HA was assessed by serial dilution and pretreatment with HA blocking reagent. TgIMA and TgMS were compared in TgAb-positive patients with well-characterized clinical status. Results 6 out of 45 cases with TgIMA >1 ng/mL had undetectable TgMS. HA interference was confirmed by serial dilution and HA blocking reagent addition. In TgAb-positive cases, TgIMA and TgMS were highly correlated (R2 = 0.86). In patients with structural disease and TgAb, TgIMA and TgMS were detectable in 6/19 patients, and 9/19 cases, respectively. The TgMS concentration range in the 3 discrepant cases ranged from 0.5 to 2.0 ng/mL. Hence, the presence of TgAb was associated with inappropriately reduced Tg concentrations with both TgIMA and TgMS. Conclusion HA cause falsely elevated TgIMA with undetectable TgMS with significant frequency. TgMS can be used to rule out HA interference. Albeit resistant to TgAb in vitro, TgMS detects little Tg in patients with TgAb and structural disease. Hence, TgAb may reduce Tg concentrations in vivo. The implication is that no assay design may be able to overcome this problem. TgMS may not detect structural disease in TgAb-positive patients.
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Affiliation(s)
- Giuseppe Barbesino
- Correspondence: Giuseppe Barbesino, MD, Thyroid Unit, Massachusetts General Hospital-Harvard Medical School, WACC 730S, 55 Fruit St., Boston MA 02114, USA.
| | | | - Joshua Bornhorst
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55092, USA
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12
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Iglesias ML, Calabretta JM, Coggiola O, Califano I. Thyroglobulin antibodies: Trend over time and clinical impact in differentiated thyroid carcinoma with and without radioiodine ablation. ENDOCRINOL DIAB NUTR 2022; 69:702-708. [PMID: 36470645 DOI: 10.1016/j.endien.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/04/2021] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Thyroglobulin antibodies (TgAb) trend may be considered a surrogate marker for thyroglobulin in differentiated thyroid carcinoma. The aim of this study is to analyse, in cases with positive TgAb, trend over time and its relationship with response to treatment. MATERIAL AND METHODS Retrospective and descriptive study of 100 patients with differentiated thyroid carcinoma and positive TgAb (measured by electrochemoluminiscense) after thyroidectomy. Assessment of response to initial treatment was performed 6-24 months after surgery. Status at last follow-up was evaluated. RESULTS After the first year nearly half of the patients showed a reduction in TgAb levels ≥50%, in 91% of these patients, status at last follow up was excellent response (65%) or indeterminate response due to decreasing TgAb levels (26%). At first assessment, indeterminate responses were found in 49% of cases, without significant differences among initial risk of recurrence category or whether radioiodine ablation was performed. At last evaluation (median 53.5 months), 15% of ablated low-risk patients had an indeterminate response (due to declining TgAb), vs 62% in the non-ablated low-risk group (p 0.03). Median time to negativization for post-surgical TgAb levels<100UI/ml was 11 months [3-94] vs 31 months [8-119] for patients with TgAb≥100UI/ml (p 0.0003). CONCLUSION A reduction of ≥50% in TgAb levels during the first year correlated with favourable outcomes. Non-ablated patients and patients with higher levels of post-surgical TgAb may need a longer time to achieve negative conversion.
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Affiliation(s)
- María Laura Iglesias
- Endocrinology Department, Instituto de oncología Angel H. Roffo, Avenida. San Martín 5481, C1417DTB Buenos Aires, Argentina.
| | - Juan Matías Calabretta
- Endocrinology Department, Instituto de oncología Angel H. Roffo, Avenida. San Martín 5481, C1417DTB Buenos Aires, Argentina
| | - Osvaldo Coggiola
- Biochemistry Department, Instituto de oncología Angel H. Roffo, Avenida. San Martín 5481, C1417DTB Buenos Aires, Argentina
| | - Inés Califano
- Endocrinology Department, Instituto de oncología Angel H. Roffo, Avenida. San Martín 5481, C1417DTB Buenos Aires, Argentina
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13
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Uslu-Beşli L. Circulating Biomarkers in Thyroid Cancer. Biomark Med 2022. [DOI: 10.2174/9789815040463122010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Thyroid cancer is the most important endocrine cancer with increasing
incidence. While thyroid cancers, especially papillary thyroid cancers, are known to
exhibit generally a favorable outcome with excellent survival rates, some thyroid
cancers are more aggressive with a poor prognosis. Several different biomarkers have
been introduced for the diagnosis of disease, identification of tumor load, assessment of
therapy response, and the detection of recurrence during follow-up of the thyroid
cancer patients. This chapter gives a brief overview of the circulating biomarkers used
in thyroid cancer patients.
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Affiliation(s)
- Lebriz Uslu-Beşli
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa,
Istanbul, Turkey
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14
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Toraih EA, Fawzy MS, Ning B, Zerfaoui M, Errami Y, Ruiz EM, Hussein MH, Haidari M, Bratton M, Tortelote GG, Hilliard S, Nilubol N, Russell JO, Shama MA, El-Dahr SS, Moroz K, Hu T, Kandil E. A miRNA-Based Prognostic Model to Trace Thyroid Cancer Recurrence. Cancers (Basel) 2022; 14:cancers14174128. [PMID: 36077665 PMCID: PMC9454675 DOI: 10.3390/cancers14174128] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/12/2022] [Accepted: 08/21/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Some thyroid tumors elected for surveillance remain indolent, while others progress. The mechanism responsible for this difference is poorly understood, making it challenging to devise patient surveillance plans. Early prediction is important for tailoring treatment and follow-up in high-risk patients. The aim of our study was to identify predictive markers for progression. We leveraged a highly sensitive test that accurately predicts which thyroid nodules are more likely to develop lymph node metastasis, thereby improving care and outcomes for cancer patients. Abstract Papillary thyroid carcinomas (PTCs) account for most endocrine tumors; however, screening and diagnosing the recurrence of PTC remains a clinical challenge. Using microRNA sequencing (miR-seq) to explore miRNA expression profiles in PTC tissues and adjacent normal tissues, we aimed to determine which miRNAs may be associated with PTC recurrence and metastasis. Public databases such as TCGA and GEO were utilized for data sourcing and external validation, respectively, and miR-seq results were validated using quantitative real-time PCR (qRT-PCR). We found miR-145 to be significantly downregulated in tumor tissues and blood. Deregulation was significantly related to clinicopathological features of PTC patients including tumor size, lymph node metastasis, TNM stage, and recurrence. In silico data analysis showed that miR-145 can negatively regulate multiple genes in the TC signaling pathway and was associated with cell apoptosis, proliferation, stem cell differentiation, angiogenesis, and metastasis. Taken together, the current study suggests that miR-145 may be a biomarker for PTC recurrence. Further mechanistic studies are required to uncover its cellular roles in this regard.
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Affiliation(s)
- Eman A. Toraih
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
- Correspondence: ; Tel.: +1-346-907-4237
| | - Manal S. Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
- Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar P.O. Box 1321, Saudi Arabia
| | - Bo Ning
- Department of Biochemistry and Molecular Biology, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Mourad Zerfaoui
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Youssef Errami
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Emmanuelle M. Ruiz
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Mohammad H. Hussein
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Muhib Haidari
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Melyssa Bratton
- Biospecimen Core Laboratory, Louisiana Cancer Research Center, New Orleans, LA 70112, USA
| | - Giovane G. Tortelote
- Section of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Sylvia Hilliard
- Section of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Naris Nilubol
- Endocrine Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, MD 20814, USA
| | - Jonathon O. Russell
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, MD 21287, USA
| | - Mohamed A. Shama
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Samir S. El-Dahr
- Section of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Krzysztof Moroz
- Department of Pathology and Laboratory Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Tony Hu
- Department of Biochemistry and Molecular Biology, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
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15
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Evans C, Lotz J, Bhandari M, Hellier RT, Wang XY, Lott R, Lackner KJ, Müller R, Kulasingam V. Multi-center evaluation of the highly sensitive Abbott ARCHITECT and Alinity thyroglobulin chemiluminescent microparticle immunoassay. J Clin Lab Anal 2022; 36:e24595. [PMID: 35837992 PMCID: PMC9459248 DOI: 10.1002/jcla.24595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/13/2022] [Accepted: 05/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Thyroglobulin (Tg) is an essential part for the management of patients with differentiated thyroid carcinoma (DTC) after thyroidectomy. Highly sensitive Tg assays are now established in clinical practice as they facilitate follow‐up of DTC patients. In this study, we evaluated the recently launched highly sensitive Abbott Tg assay for Alinity and ARCHITECT. Methods In this three‐center study, Tg values of 447 routine patient samples, characterized for the presence of anti‐Tg, were measured with the ARCHITECT Tg assay and compared with the Roche Elecsys TgII assay. In addition, a subset of 154 samples was compared also with the Beckman Tg Access assay and another subset (n = 122) with Abbott Tg on the Alinity i analyzer. Results LoQ was verified to be less than or equal to 0.1 ng/ml confirming that the Tg assay on ARCHITECT and Alinity is highly sensitive. Correlation of ARCHITECT, Alinity, and Roche was excellent with a slope between 0.9 and 1.1 and a correlation coefficient >0.98. Correlation to Beckmann Tg was also very good, but the differences in absolute values were significant (slope: 1.477). Conclusions The Abbott Thyroglobulin assay, which is standardized to CRM‐457, demonstrated a high correlation to the Roche and Beckman Tg assays, though good agreement of absolute values was only observed between Abbott and Roche. Strength of correlation and slope were not affected by the presence of anti‐Tg indicating that all assays included in the study have a similar susceptibility to anti‐Tg.
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Affiliation(s)
- Carol Evans
- Department of Medical Biochemistry & Immunology, University Hospital of Wales (UHW), Cardiff, UK
| | - Johannes Lotz
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center (UMC), Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Rowan T Hellier
- Department of Medical Biochemistry & Immunology, University Hospital of Wales (UHW), Cardiff, UK
| | - Xiao Yan Wang
- Department of Clinical Biochemistry, Laboratory Medicine Program, University Health Network (UHN), Toronto, Ontario, Canada
| | - Rosemarie Lott
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center (UMC), Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center (UMC), Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Vathany Kulasingam
- Department of Clinical Biochemistry, Laboratory Medicine Program, University Health Network (UHN), Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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16
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Takamori T, Izawa S, Fukuhara T, Sato A, Ichikawa H, Motokura T, Yamamoto K, Fukuda T. Clinical Characteristics and Predictors Related to the Progression of Multinodular Goiter Causing Tracheal Compression and Deviation: A Report of Two Cases and Review of the Literature. Intern Med 2022; 61:1375-1381. [PMID: 34670889 PMCID: PMC9152857 DOI: 10.2169/internalmedicine.7989-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe the clinical course of two patients who developed tracheal compression and deviation by multinodular goiter (MNG). Case 1: A 66-year-old woman presented with thyroid swelling. Five years after the initial admission, she was diagnosed with hyperthyroidism by Graves' disease and increased bilateral thyroid lobes compressing the trachea. Thyroglobulin was elevated from 210 to 472 ng/mL. Case 2: A 52-year-old woman presented with thyroid swelling. Five years after the initial admission, the increased right lobe deviated the trachea and compressed the right recurrent laryngeal nerve. Thyroglobulin was elevated from 122 to 392 ng/mL. Two cases and literature review indicated that MNG with >50 mm, solid components, and extension to the mediastinum or paralarynx were risk factors of tracheal compression and deviation. Monitoring thyroglobulin elevation can help predict the clinical course.
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Affiliation(s)
| | - Shoichiro Izawa
- Division of Endocrinology and Metabolism, Tottori University Faculty of Medicine, Japan
| | - Takahiro Fukuhara
- Department of Otolaryngology, Head and Neck Surgery, Tottori University Faculty of Medicine, Japan
| | - Akemi Sato
- Division of Clinical Laboratory, Tottori University Hospital, Japan
| | - Hitomi Ichikawa
- Division of Clinical Laboratory, Tottori University Hospital, Japan
| | - Toru Motokura
- Division of Clinical Laboratory Medicine, Tottori University Faculty of Medicine, Japan
| | - Kazuhiro Yamamoto
- Division of Endocrinology and Metabolism, Tottori University Faculty of Medicine, Japan
| | - Tetsuya Fukuda
- Division of Clinical Laboratory, Tottori University Hospital, Japan
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17
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van Kinschot CMJ, Peeters RP, van den Berg SAA, Verburg FA, van Noord C, van Ginhoven TM, Visser WE. Thyroglobulin and thyroglobulin antibodies: assay-dependent management consequences in patients with differentiated thyroid carcinoma. Clin Chem Lab Med 2022; 60:756-765. [PMID: 35108464 DOI: 10.1515/cclm-2021-1046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/14/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES International guidelines recommend fixed cut-off values for thyroglobulin (Tg). These cut-offs do not take potential assay differences into account. This study aimed to evaluate if different assays for Tg and Tg antibodies (TgAb) affect management guidance for differentiated thyroid cancer (DTC) patients. METHODS In 793 samples derived from 413 patients with DTC, Tg and TgAb were simultaneously measured with two immunometric assays: Immulite 2000XPi and Kryptor compact plus. In addition, a qualitative measurement for TgAb interference (recovery test) was performed on the Kryptor compact plus platform. The extent to which different assays lead to different classifications of response to therapy was evaluated when applying the current cut-offs for Tg. RESULTS Mean Tg concentrations were 37.4% lower with Kryptor as compared with Immulite. Applying guideline based cut-off values for Tg, 33 (4.7%) samples had a Tg-on concentration ≥1.0 μg/L with Immulite and <1.0 μg/L with Kryptor. Of the samples tested as TgAb+ with at least one assay (n=125), 68 (54.4%) samples showed discrepancy in TgAb status. Differences between Immulite and Kryptor measurements resulted in a change in the response to therapy classification in 94 (12.0%) measurements derived from 67 (16.2%) individual patients. CONCLUSIONS A substantial portion of DTC patients were classified differently dependent on which Tg and TgAb assays are used, when applying the cut-off values as defined in clinical guidelines. Such differences can significantly affect clinical management. In the context of large between-method variation, the recommended Tg cut-offs in guidelines should be used with wisdom rather than as fixed cut-offs.
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Affiliation(s)
- Caroline M J van Kinschot
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Robin P Peeters
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sjoerd A A van den Berg
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frederik A Verburg
- Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Charlotte van Noord
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Tessa M van Ginhoven
- Academic Center for Thyroid Diseases, Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - W Edward Visser
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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18
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Kihara M, Miyauchi A, Hirokawa M, Fujishima M, Masuoka H, Higashiyama T, Onoda N, Ito Y, Miya A. Metastatic papillary thyroid carcinoma presenting with elevated serum levels of carbohydrate antigen 19-9 (CA19-9): a case report. Surg Case Rep 2022; 8:45. [PMID: 35292876 PMCID: PMC8924338 DOI: 10.1186/s40792-022-01397-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The major sites of distant metastases of papillary thyroid carcinoma (PTC) are the lung and bone; metastasis to the liver is rare. Although the postoperative serum thyroglobulin (Tg) level after total thyroidectomy is a good prognostic indicator for PTC when anti-thyroglobulin antibody (TgAb) is negative, the presence of TgAb interferes with the Tg assay, making serum Tg levels unreliable. Here we report a case of liver metastasis of PTC that presented with elevated serum levels of carbohydrate antigen 19-9 (CA19-9), which is usually a serum marker of pancreatic and gastrointestinal neoplasias. CASE PRESENTATION A 69-year-old man was diagnosed with PTC and underwent total thyroidectomy 16 years ago. The patient's serum Tg levels increased progressively during follow-up and his serum TgAb was negative. Positron emission tomography (PET) and computed tomography (CT) revealed metastases of the lung, cervical spine, mediastinum and liver. The liver lesion was a solitary tumor measuring 4.0 cm in the greatest dimension. His serum CA19-9 level was very high (326 U/mL), and intrahepatic cholangiocarcinoma was suspected from the results of various examinations including gastrointestinal endoscopic imaging and CT. Laparoscopic partial liver resection for segment 4 was performed. The histopathological diagnosis was a metastatic liver tumor from PTC. The immunohistological examination revealed that the liver tumor was positive for CA19-9 and Tg. The primary PTC, recovered from paraffin-embedded specimen, was also positive for CA19-9. After the surgery, his serum CA19-9 level as well as serum Tg level markedly decreased. CONCLUSIONS We presented the first reported case of liver metastasis of a PTC presenting with elevated serum levels of CA19-9 after total thyroidectomy. This case suggests that the serum CA19-9 levels may serve as a surrogate marker for PTC in place of the serum Tg level in patients with positive serum TgAb if the PTC and/or the metastatic lesions are positive for CA19-9 staining.
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Affiliation(s)
- Minoru Kihara
- Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan.
| | - Akira Miyauchi
- Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan
| | - Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan
| | - Makoto Fujishima
- Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan
| | - Hiroo Masuoka
- Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan
| | - Takuya Higashiyama
- Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan
| | - Naoyoshi Onoda
- Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan
| | - Yasuhiro Ito
- Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan
| | - Akihiro Miya
- Departments of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, Hyogo, 650-0011, Japan
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Iglesias ML, Calabretta JM, Coggiola O, Califano I. Thyroglobulin antibodies: Trend over time and clinical impact in differentiated thyroid carcinoma with and without radioiodine ablation. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Nishihara E, Hobo Y, Miyauchi A, Ito Y, Higuchi M, Hirokawa M, Ito M, Fukata S, Nishikawa M, Akamizu T. Serum thyroglobulin evaluation on LC-MS/MS and immunoassay in TgAb-positive patients with papillary thyroid carcinoma. Eur Thyroid J 2022; 11:e210041. [PMID: 34981756 PMCID: PMC9142804 DOI: 10.1530/etj-21-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/07/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE This study aimed to elucidate disproportionately low serum thyroglobulin (Tg) values in Tg antibody (TgAb)-positive patients with structural recurrence of papillary thyroid carcinoma (PTC) using liquid chromatography-tandem mass spectrometry (LC-MS/MS). DESIGN A retrospective study was performed on 176 patients in whom Tg and TgAb levels were measured between 2016 and 2021. Several comprehensive analyses of Tg-LC-MS/MS with an electrochemiluminescence immunoassay for Tg (Tg-ECLIA) were conducted using serum samples. METHODS TgAb-positive patients who underwent total thyroidectomy with multiple lung metastases due to PTC were evaluated using Tg-LC-MS/MS and Tg-ECLIA. Tg expression in lymph node metastases and metastatic lesions was evaluated by immunohistochemistry and Tg levels of aspiration washouts were also evaluated. Two in vitro assays were performed to elucidate TgAb interference. RESULTS Tg concentrations of negative TgAb in both assays were similar (R2 = 0.99; n = 52). Patients with structural recurrence showed higher Tg values with Tg-LC-MS/MS than with Tg-ECLIA. The undetectable proportion was significantly lower with Tg-LC-MS/MS (31.6%, 6/19) than with Tg-ECLIA (68.4%, 13/19; P = 0.023). The spike-recovery rate and Tg concentrations determined by the serum mixture text (n = 29) were significantly reduced to 75.0% (118.3-88.7%) and 81.3% (107.0-87.0%), respectively, with TgAb using Tg-ECLIA (both P > 0.001) confirming assay interference but not using Tg-LC-MS/MS (91.8-92.3%, P = 0.77 and 98.4-100.8%, P = 0.18, respectively). CONCLUSIONS TgAb had no effect on the Tg-LC-MS/MS assay but yielded 19-25% lower values in Tg-ECLIA. Tg-LC-MS/MS is preferable for monitoring serum Tg levels in TgAb-positive patients, although those with structural recurrence often had disproportionally low Tg values.
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Affiliation(s)
- Eijun Nishihara
- Kuma Hospital, Center for Excellence in Thyroid Care, Kobe, Japan
- Correspondence should be addressed to E Nishihara:
| | | | - Akira Miyauchi
- Kuma Hospital, Center for Excellence in Thyroid Care, Kobe, Japan
| | - Yasuhiro Ito
- Kuma Hospital, Center for Excellence in Thyroid Care, Kobe, Japan
| | - Miyoko Higuchi
- Kuma Hospital, Center for Excellence in Thyroid Care, Kobe, Japan
| | | | - Mitsuru Ito
- Kuma Hospital, Center for Excellence in Thyroid Care, Kobe, Japan
| | - Shuji Fukata
- Kuma Hospital, Center for Excellence in Thyroid Care, Kobe, Japan
| | | | - Takashi Akamizu
- Kuma Hospital, Center for Excellence in Thyroid Care, Kobe, Japan
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21
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Schoonen L, Neele M, van Toor H, van Kinschot CMJ, van Noord C, Visser WE, Groen J, Boesten LSM, Lentjes EGWM, van den Berg SAA, Kos S. Impact of Thyroglobulin and Thyroglobulin Antibody Assay Performance on the Differential Classification of DTC Patients. J Endocr Soc 2022; 6:bvab166. [PMID: 35024538 PMCID: PMC8739647 DOI: 10.1210/jendso/bvab166] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Indexed: 01/14/2023] Open
Abstract
CONTEXT Measurements of thyroglobulin (Tg) and Tg antibodies are crucial in the follow-up of treated differentiated thyroid cancer (DTC) patients. Interassay differences may significantly impact follow-up. OBJECTIVE The aim of this multicenter study was to explore the impact of Tg and Tg antibody assay performance on the differential classification of DTC patients, as described in national and international guidelines. DESIGN Four commonly used Tg and Tg antibody assays were technically compared to reflect possible effects on patients with DTC follow-up. Storage stability at different storage temperatures was also investigated for LIAISON® and Kryptor assays, as this is an underexposed topic in current literature. RESULTS B.R.A.H.M.S. assays yield approximately 50% lower Tg values over the whole range compared to the DiaSorin and Roche assays investigated. These differences between assays may result in potential misclassification in up to 7% of patients if fixed cutoffs (eg, 1 ng/mL) are applied. Poor correlation was also observed between the Tg antibody assays when the method-specific upper limits of normal are used as cutoffs. Storage of Tg and Tg antibodies was possible for 3 to 4 weeks at -20°C and -80°C. Calibration of the assays, however, was found to be crucial for stable results over time. CONCLUSIONS Technical aspects of Tg and Tg antibody assays, including interassay differences, calibration and standardization, and cutoff values, may have a significant clinical impact on the follow-up of DTC patients.
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Affiliation(s)
- Lise Schoonen
- Department of Clinical Chemistry, Maasstad Hospital, Rotterdam, the Netherlands
| | - Marjolein Neele
- Department of Clinical Chemistry, Maasstad Hospital, Rotterdam, the Netherlands
| | - Hans van Toor
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Caroline M J van Kinschot
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Charlotte van Noord
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | - W Edward Visser
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joost Groen
- Department of Clinical Chemistry, IJsselland Hospital, Capelle aan de IJssel, the Netherlands
| | - Lianne S M Boesten
- Department of Clinical Chemistry, IJsselland Hospital, Capelle aan de IJssel, the Netherlands
| | - Eef G W M Lentjes
- Department of Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sjoerd A A van den Berg
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Snjezana Kos
- Department of Clinical Chemistry, Maasstad Hospital, Rotterdam, the Netherlands
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22
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Thyroglobulin and thyroid cancer. Cancer Biomark 2022. [DOI: 10.1016/b978-0-12-824302-2.00006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Kitamura Y, Narita S, Kuroda Y, Yagi S, Aoyagi K. A Novel Thyroglobulin Immunoassay Using the Specimen-Pretreatment Process Improves the Accuracy of Thyroglobulin Measurements in Anti-Thyroglobulin Positive Specimens. J Appl Lab Med 2021; 6:1463-1475. [PMID: 34580727 DOI: 10.1093/jalm/jfab083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/22/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Recently, second-generation thyroglobulin (Tg) sandwich immunoassays have been used in clinical laboratories to measure the serum Tg levels, which is a tumor marker used to monitor postoperative patients with differentiated thyroid cancers. However, these immunoassays are often subject to Tg autoantibody (TgAb) interference. TgAb interference is inevitable for almost all Tg immunoassays, resulting in unreliable Tg measurement values of TgAb-positive samples. METHODS To address TgAb interference, we have developed a novel immunoassay based on a fully automated chemiluminescent enzyme immunoassay system using the effective specimen-pretreatment process to inactivate TgAb in blood and evaluated its assay performance. RESULTS The developed assay was traceable to BCR457 IRMM reference material with a limit of quantification of 0.03 ng/mL. The pretreatment process inactivated almost all TgAb in specimens and allowed accurate Tg measurements in TgAb-positive samples in which TgAb interference was observed using the immunoassays. Size-exclusion chromatography analysis of immunoreactive Tg molecule in a TgAb-positive serum verified disruption of the Tg-TgAb immune complex by the pretreatment process. Good correlation of Tg values in TgAb-negative specimens was observed between the new Tg immunoassay and the second-generation sandwich immunoassays. However, there were numerous discrepant samples on bias plots between the new Tg immunoassay and the second-generation sandwich immunoassays for TgAb-positive specimens. CONCLUSIONS This study indicates the new Tg immunoassay with the specimen-pretreatment process is both robust and free from interference by TgAb. Thus, this novel assay is superior to second-generation sandwich immunoassays and gives accurate Tg concentrations even for TgAb-positive cases.
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Affiliation(s)
| | - Sho Narita
- Research and Development Division, FUJIREBIO INC., Tokyo, Japan
| | - Yu Kuroda
- Research and Development Division, FUJIREBIO INC., Tokyo, Japan
| | - Shintaro Yagi
- Research and Development Division, Advanced Life Science Institute, Inc., Tokyo, Japan
| | - Katsumi Aoyagi
- Research and Development Division, FUJIREBIO INC., Tokyo, Japan.,Research and Development Division, Advanced Life Science Institute, Inc., Tokyo, Japan
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24
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Yang SP, Koh LCW, Kong KW, Parameswaran R, Loke KSH, Ngiam KY, Tan WB, Loh T, Ng DCE, Goh BC, Ngeow J, Tai ES. A Multiplex Thyroid-Specific Assay for Quantification of Circulating Thyroid Cell-Free RNA in Plasma of Thyroid Cancer Patients. Front Genet 2021; 12:721832. [PMID: 34512731 PMCID: PMC8425593 DOI: 10.3389/fgene.2021.721832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/04/2021] [Indexed: 01/21/2023] Open
Abstract
Background The standard of care for thyroid cancer management is thyroidectomy and adjuvant radioactive iodine (RAI). There is a paucity of clinical tool that quantifies residual thyroid volume reliably for precise adjuvant RAI dosing. Serum thyroglobulin (TG), tumour marker for thyroid cancer, takes 4 weeks for complete clearance due to its long half-life, and might be undetectable in 12% of structural disease patients. It detects recurrence with a sensitivity of 19-40%, mainly attributed to issue of TG antibody interference with TG immunometric assay. We hypothesise that the quantity of thyroid-specific cell-free RNA (cfRNA) is indicative of amount of thyroid tissues, and that during thyroid surgery, cfRNA levels decrease accordingly. Methods We identified 11 biologically significant and highly expressed thyroid-specific targets from Human Protein Atlas and literature. To assess for a fall in thyroid-specific cfRNA level, we recruited 16 patients undergoing thyroid surgery or RAI for malignant or benign thyroid disease, and tracked longitudinal trend of cfRNA. To assess the utility of cfRNA in detecting metastatic thyroid cancer, cfRNA of 11 patients at intermediate to high risk of recurrence was measured during surveillance and at time of clinical recurrence. Results The multiplex assay was capable of amplifying and quantifying multiple thyroid-specific genes in a single reaction. The selected targets were amplified successfully from RNA extracted directly from the thyroid (positive control), indicating that they were highly expressed within thyroid tissue. These cfRNAs were present in plasma, in amounts quantifiable using qRT-PCR. Four cfRNA transcripts (TPO, GFRA2, IVD, TG) fell post-treatment in more than 50% of cohort. The thyroid peroxidase (TPO) cfRNA fell post-therapy in 63% of cohort by 80%, as early as 1 day post-treatment, supporting the potential role as early indicator of remnant thyroid tissue volume. We demonstrated the clinical relevance of circulating TPO cfRNA by tracking temporal changes in setting of peri-treatment, recurrence, and TG Ab positive state. Conclusion Using a multiplex pre-amplification approach, the TPO cfRNA was a potential biomarker that can track residual thyroid mass. It can be further optimised for quantification of thyroid volume to guide RAI doses and for detection of thyroid cancer recurrence.
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Affiliation(s)
- Samantha Peiling Yang
- Endocrinology Division, Department of Medicine, National University Hospital, Singapore, Singapore.,Endocrinology Division, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lian Chye Winston Koh
- Molecular Engineering Lab, Institute of Molecular and Cell Biology (IMCB), A∗STAR, Singapore, Singapore
| | - Kiat Whye Kong
- Molecular Engineering Lab, Institute of Molecular and Cell Biology (IMCB), A∗STAR, Singapore, Singapore
| | - Rajeev Parameswaran
- Department of Endocrine Surgery, National University Hospital, Singapore, Singapore
| | - Kelvin Siu Hoong Loke
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
| | - Kee Yuan Ngiam
- Department of Endocrine Surgery, National University Hospital, Singapore, Singapore
| | - Wee Boon Tan
- Department of Endocrine Surgery, National University Hospital, Singapore, Singapore
| | - Thomas Loh
- Department of Otolaryngology Surgery, National University Hospital, Singapore, Singapore
| | - David Chee Eng Ng
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
| | - Boon Cher Goh
- Department of Medical Oncology, National University Hospital, Singapore, Singapore
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - E Shyong Tai
- Endocrinology Division, Department of Medicine, National University Hospital, Singapore, Singapore.,Endocrinology Division, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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25
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Broecker-Preuss M, Mehnert I, Gilman E, Herrmann K, Weber M, Görges R. Evaluation of a new automated assay for high-sensitivity thyroglobulin measurement and comparison with two established high-sensitivity thyroglobulin assays. Pract Lab Med 2021; 26:e00250. [PMID: 34386567 PMCID: PMC8342782 DOI: 10.1016/j.plabm.2021.e00250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Thyroglobulin (Tg) is an important tumor marker for therapy control and follow-up of differentiated thyroid carcinoma (DTC). Over the past decade, assays for highly sensitive Tg measurement have become increasingly established. We evaluated a newly developed high-sensitive Tg assay running on an automated platform (LIAISON® Tg II Gen assay, DiaSorin), with a limit of quantification of 0.10 ng/ml. Design and Methods Tg values of 166 sera from subjects without thyroid diseases and of more than 500 sera of well-defined DTC patients were determined with the new LIAISON® Tg II Gen assay and compared with two established assays (Elecsys® Tg II/Roche, and Medizym® Tg REM/Medipan). Results Tg reference values from healthy subjects were up to 37.93 ng/ml (women) resp. 24.59 ng/ml (men) with the LIAISON® Tg II Gen assay. Tg values showed good correlations in healthy subjects and patients with active tumorous disease. In contrast, Tg values in the very low range from cured thyroidectomized patients were poorly comparable between the three assays, while clinical differences between the cohorts were correctly reflected by all assays. Conclusions With the new LIAISON® Tg II Gen assay, another automated assay standardized against the first International Reference Preparation CRM-457 for highly sensitive measurement of Tg values is available.
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Affiliation(s)
- Martina Broecker-Preuss
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital of Essen, Germany
| | - Irina Mehnert
- Department of Nuclear Medicine, University Hospital of Essen, Germany
| | - Elena Gilman
- Gilman Biometrics, Consultant for Data Processing and Statistics, Köln, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital of Essen, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital of Essen, Germany
| | - Rainer Görges
- Department of Nuclear Medicine, University Hospital of Essen, Germany
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26
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Guastapaglia L, Kasamatsu TS, Nakabashi CCD, Camacho CP, Maciel RMB, Vieira JGH, Biscolla RPM. The role of a new polyclonal competitive thyroglobulin assay in the follow-up of patients with differentiated thyroid cancer with structural disease but low levels of serum thyroglobulin by immunometric and LC-MS/MS methods. Endocrine 2021; 72:784-790. [PMID: 33222120 DOI: 10.1007/s12020-020-02526-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/13/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aims of this study were to assess the role of an in-house competitive thyroglobulin assay (Tg-c) in the follow-up of metastatic differentiated thyroid carcinoma (DTC) patients who presented underestimated Tg measurements by immunometric assays (Tg-IMA) and to compare the results with IMA and LC-MS/MS Tg methods. METHODS This prospective study included 40 patients. Twenty-one with metastatic disease: 14 had Tg-IMA levels inappropriately low or undetectable (eight patients with positive and six with borderline TgAb) and seven had high Tg-IMA levels. Nineteen had an excellent response to therapy. The competitive assay employs a polyclonal antibody produced in rabbits immunized with human Tg, Tg labeled with biotin, and for the solid phase separation, a monoclonal anti-rabbit IgG antibody adsorbed to microtiter plates. RESULTS All 14 patients with structural disease and underestimated levels of Tg-IMA presented detectable Tg-c levels. The median Tg-c level in the group with positive TgAb was 183 µg/L (range: 22-710 µg/L), and 58 µg/L (range 23-148 µg/L) in the borderline TgAb group. The levels of Tg-LC-MS/MS were detectable in some patients (range < 0.5-18 µg/L). All seven patients with high Tg-IMA presented also high levels of Tg-c. Only 2/19 patients with excellent response had Tg-c levels above the functional sensitivity. CONCLUSIONS The competitive assay was able to detect Tg in all patients, even in the presence of serum TgAb, and may be an option in patients with underestimated Tg-IMA and relevant structural disease.
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Affiliation(s)
- Leila Guastapaglia
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Teresa S Kasamatsu
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Claudia Cristina D Nakabashi
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Fleury Medicina e Saúde, São Paulo, Brazil
| | - Cléber P Camacho
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Molecular Innovation and Biotechnology Laboratory, Medical Postgraduation Division, Universidade Nove de Julho (Uninove), São Paulo, Brazil
| | - Rui M B Maciel
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Fleury Medicina e Saúde, São Paulo, Brazil
| | - José Gilberto H Vieira
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Fleury Medicina e Saúde, São Paulo, Brazil
| | - Rosa Paula M Biscolla
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
- Fleury Medicina e Saúde, São Paulo, Brazil.
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Barbesino G, Algeciras-Schimnich A, Bornhorst JA. False Positives in Thyroglobulin Determinations Due to the Presence of Heterophile Antibodies: An Underrecognized and Consequential Clinical Problem. Endocr Pract 2021; 27:396-400. [PMID: 33581326 DOI: 10.1016/j.eprac.2020.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/16/2020] [Accepted: 10/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report a case series of thyroid cancer patients in whom false positive results in immunometric assays for thyroglobulin (TgIMA) were caused by heterophilic antibody interference, describe the clinical scenario in which this interference should be suspected, and recommend methods to demonstrate the interference. METHODS Three patients with unexpectedly elevated thyroglobulin results (range, 1.6-75 ng/mL) were studied. In the first patient, thyroglobulin was elevated despite the presence of Tg antibody. In the second patient, suppressed thyroglobulin was higher than a recent stimulated thyroglobulin. In the third patient, thyroglobulin became detectable years after treatment and did not change after thyroid-stimulating hormone stimulation. TgIMA concentration determination was compared to determination by a mass spectrometry method (TgMS). Thyroglobulin was also remeasured after preabsorption with heterophile antibody blocking reagents and after serial dilutions. RESULTS In all cases, thyroglobulin was undetectable by TgMS. In 2 of 3 patients, dilutions provided nonlinear thyroglobulin results. After blocking agent preabsorption, thyroglobulin dropped by 35%, 45%, and 91% in the 3 samples. CONCLUSION False positive thyroglobulin concentrations from heterophilic antibody interference have significant impact on the management of thyroid cancer. Here we show that TgMS assays can be used to rule out heterophilic antibody interference. This interference should be suspected when a detectable thyroglobulin by TgIMA does not respond to thyroid-stimulating hormone or is discordant from the clinical assessment.
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Affiliation(s)
- Giuseppe Barbesino
- Thyroid Unit, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts.
| | | | - Joshua A Bornhorst
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Scrutinizing the therapeutic and diagnostic potential of nanotechnology in thyroid cancer: Edifying drug targeting by nano-oncotherapeutics. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2020.102221] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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29
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Determination of thyroglobulin levels by radioimmunoassay method in anti thyroglobulin positive differentiated thyroid patients: One center clinical experience. Appl Radiat Isot 2020; 166:109400. [PMID: 32956923 DOI: 10.1016/j.apradiso.2020.109400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/20/2022]
Abstract
It is very crucial to determine Tg accurately and precisely in thyroid cancer cases. Although there are many studies on the detection of Tg in thyroid cases in the literature, there are no sufficient clinical studies examining many cases with different features by using RIA methodology. Here, a radiometric and chromatographic method has been studied for the first time to eliminate the interference from anti-Tg positive patients. In this paper, radioimmunoassay (RIA) and immunoradiometric (IRMA) techniques were used for the analysis of 302 sera collected from patients for Tg and TgAb quantification. By the RIA technique, a reliable result was obtained by calculating the real Tg value quantitatively in 41 patients showing TgAb positivity out of 208 patients. Our findings show that the RIA assay is the most suitable approach for detection of changeable (low or undetectable) Tg value and metastases detected by post-therapeutic imaging in early-stage DTC cases showing preoperative and postoperative TgAb positivity. The new immunoradiometric method allows the real (%) Tg value to be reached in a part of TgAb-positive DTC. Even if TgAb positive in the metastatic and nonmetastatic DTC patient group. This allows the accurate clinical follow-up of patients.
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Cennamo M, La Civita E, Curci A, Liotti A, Braschi U, Terracciano D. Comparison between a new thyroglobulin assay with the well-established Beckman Access immunoassay: A preliminary report. J Clin Lab Anal 2020; 35:e23589. [PMID: 32951246 PMCID: PMC7891525 DOI: 10.1002/jcla.23589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Measurement of serum thyroglobulin (Tg) plays a key role in the post-thyroidectomy management of differentiated thyroid carcinoma (DTC). In this context, the performance of new-generation thyroglobulin assay has clinical implications in the follow-up of DTC patients. Aim of this study was to compare the new highly sensitive Liaison Tg II (Tg-L) with the well-established Tg Access assay (Tg-A). MATERIALS AND METHODS A total of 91 residual serum samples (23 positive and 68 negatives for Tg auto-antibodies) were tested by the Beckman Access and Diasorin Liaison assays. Study samples were from 21 patients with pathologically proven DTC and control samples from 70 (16 patients with benign thyroid disease and 54 apparently healthy subjects). RESULTS Our results showed that Tg-L was highly correlated with Tg-A for both values ranging between 0.2 and 50 ng/mL (Pearson's r = 0.933 [95%CI 0.894-0.958], P < .001) and higher than 50 ng/mL (Pearson's r = 0.849 [95%CI 0.609-0.946], P < .001). For Tg values lower than 0.2 ng/mL, the overall concordance rate was 92%. Moreover, we tested 7 fine-needle aspiration washout fluids (FNA), showing an overall concordance rate in discriminating negative and positive of 100%. Finally, we found no interference by Tg auto-antibodies (TgAbs) for both Tg-L and Tg-A. Conversely, rheumatoid factor (RF) interferes with Tg-A, but not with Tg-L in one patient with no relapsing thyroid carcinoma. CONCLUSIONS Liaison Tg II demonstrated a good correlation with Access Tg assay both for sera and FNAs. Further studies on larger population are needed to evaluate Tg-L clinical impact on DTC patient's follow-up.
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Affiliation(s)
- Michele Cennamo
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Evelina La Civita
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Anna Curci
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Antonietta Liotti
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Umberto Braschi
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
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Yéléhé-Okouma M, Malaplate C, Petitpain N, Metallo M, Ziegler F, Klein M, Guerci B, Feigerlová E. Immunoglobulin Preparations Can Mislead Clinical Decision-Making in Follow-Up of Differentiated Thyroid Cancer. Endocr Pract 2020; 26:1031-1038. [PMID: 33471692 DOI: 10.4158/ep-2020-0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/26/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Intravenous and subcutaneous immunoglobulins are commonly used for immune substitution or as immune modulators in a variety of inflammatory and autoimmune disorders. Exogenous thyroid-specific thyroglobulin (Tg) antibodies present in the donor plasma may interfere with the interpretation of measurements of Tg autoantibodies (Tg-Abs) in the recipient's plasma and potentially trigger an immune response in the recipient's immune cells. Levels of antibodies causing bioassay interferences or those leading to clinically relevant changes in patient outcomes are not known. Tg is used as a biomarker in the long-term surveillance of patients with differentiated thyroid cancer (DTC) following total thyroidectomy and radioactive iodine ablation. However, the presence of Tg-Abs in the circulation interferes with Tg measurements. Assessment of levels of Tg-Abs is thus recommended as a part of standard follow-up of DTC together with Tg testing. METHODS To understand the potential mechanisms and pathophysiologic significance of possible interferences associated with administration immunoglobulin preparations and Tg measurement, we overview the current knowledge on interactions between Tg autoimmunity and immunoglobulin preparations and illustrate diagnostic challenges and perspectives for follow-up of patients with DTC treated with exogenous immunoglobulins. RESULTS In patients with DTC treated with immunoglobulin preparations, monitoring of thyroid cancer using Tg and Tg-Abs is challenging due to possible analytical interferences through passive transfer of exogenous antibodies from immunoglobulin preparations. CONCLUSION Analytical interferences must be suspected when a discrepancy exists between clinical examination and diagnostic tests. Collaboration between endocrinologists, biologists, and pharmacologists is fundamental to avoid misdiagnosis and unnecessary medical or radiologic procedures. ABBREVIATIONS CT = computed tomography; DTC = differentiated thyroid cancer; FNAB = fine-needle aspiration biopsy; HAb = heterophile antibody; IMA = immunometric assay; IVIg = intravenous immunoglobulin; RAI = radioactive iodine; RIA = radioimmunoassay; SCIg = subcutaneous immunoglobulin; Tg = thyroglobulin; Tg-Ab = thyroglobulin autoantibody; Tg-MS = thyroglobulin mass spectrometry; TPO-Ab = thyroid peroxidase autoantibody; TSHR-Ab = thyrotropin receptor autoantibody.
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Affiliation(s)
- Mélissa Yéléhé-Okouma
- From the CHRU-Nancy, Department of Clinical Pharmacology and Toxicology - Centre Régional de Pharmacovigilance de Lorraine, Nancy, France
| | - Catherine Malaplate
- Université de Lorraine, CHRU-Nancy, Department of Biochemistry, Nancy, France
| | - Nadine Petitpain
- From the CHRU-Nancy, Department of Clinical Pharmacology and Toxicology - Centre Régional de Pharmacovigilance de Lorraine, Nancy, France
| | - Mélanie Metallo
- Université de Lorraine, CHRU-Nancy, Department of Endocrinology, Diabetology and Nutrition, Nancy, France
| | - François Ziegler
- Department of Neurology, Site de Vesoul, Groupe Hospitalier de la Haute Saône, Vesoul, France
| | - Marc Klein
- Université de Lorraine, CHRU-Nancy, Department of Endocrinology, Diabetology and Nutrition, Nancy, France
| | - Bruno Guerci
- Université de Lorraine, CHRU-Nancy, Department of Endocrinology, Diabetology and Nutrition, Nancy, France
| | - Eva Feigerlová
- Université de Lorraine, CHRU-Nancy, Department of Endocrinology, Diabetology and Nutrition, Nancy, France; Université de Lorraine, Inserm UMR_S 1116 - DCAC, Nancy, France..
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Bueno F, Falcone MGG, Peñaloza MA, Abelleira E, Pitoia F. Dynamics of serum antithyroglobulin antibodies in patients with differentiated thyroid cancer. Endocrine 2020; 67:387-396. [PMID: 31650394 DOI: 10.1007/s12020-019-02112-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/02/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE Serum antithyroglobulin antibodies (sTgAb) affect the reliability of Tg measurement in patients with thyroid cancer. We compared the outcome of patients with detectable and undetectable sTgAb, stratified according to the initial risk of recurrence (RR); also the response to treatment in patients with detectable sTgAb treated with total thyroidectomy (TT) with and without radioiodine remnant ablation (RA) and the sTgAb trend in the long-term follow-up according to the initial response. METHODS We included 432 patients submitted to TT, with or without RA; 106 patients had detectable sTgAb levels. Median follow-up was 53 months. RESULTS There were no statistically significant differences considering presentation between negative or positive sTgAb subjects. The frequency of structural incomplete response (SIR) in low, intermediate, and high RR was similar. Undetectable sTgAb in patients was achieved in a median of 16 months in ablated patients compared with 11 months in those without RA (p = 0.0232). Patients without RA had a higher rate of undetectable sTgAb during the first 12 months. A SIR was observed in 3% of patients with declining sTgAb, in 19% of those with stable levels, and in 43% with increasing sTgAb (p = 0.004). The status of no evidence of disease was achieved more frequently in patients with initial sTgAb levels < 200 mUI/l, independently of the initial RR. CONCLUSIONS There was no impact of sTgAb on the initial clinical presentation and the response to therapy in low-risk patients treated with or without RA. sTgAb trend is more useful than an absolute value to predict a SIR.
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Affiliation(s)
- Fernanda Bueno
- Division of Endocrinology, Hospital de Clínicas-University of Buenos Aires, Buenos Aires, Argentina
| | | | - Mirna Angela Peñaloza
- Division of Endocrinology, Hospital de Clínicas-University of Buenos Aires, Buenos Aires, Argentina
| | - Erika Abelleira
- Division of Endocrinology, Hospital de Clínicas-University of Buenos Aires, Buenos Aires, Argentina
| | - Fabián Pitoia
- Division of Endocrinology, Hospital de Clínicas-University of Buenos Aires, Buenos Aires, Argentina.
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Tuttle RM, Alzahrani AS. Risk Stratification in Differentiated Thyroid Cancer: From Detection to Final Follow-Up. J Clin Endocrinol Metab 2019; 104:4087-4100. [PMID: 30874735 PMCID: PMC6684308 DOI: 10.1210/jc.2019-00177] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/04/2019] [Indexed: 02/07/2023]
Abstract
CONTEXT Modern management of differentiated thyroid cancer requires individualized care plans that tailor the intensity of therapy and follow-up to the estimated risks of recurrence and disease-specific mortality. DESIGN This summary is based on the authors' knowledge and extensive clinical experience, supplemented by review of published review articles, thyroid cancer management guidelines, published staging systems, and original articles identified through a PubMed search, which included terms such as risk stratification, staging, clinical outcomes, and differentiated thyroid cancer. MAIN OUTCOME MEASURES In the past, risk stratification in differentiated thyroid cancer usually referred to a static estimate of disease-specific mortality that was based on a small set of clinicopathological features available within a few weeks of completing initial therapy (thyroidectomy, with or without radioactive iodine). Today, risk stratification is a dynamic, active process used to predict the appropriateness for minimalistic initial therapy, disease-specific mortality, risk of recurrence, and the most likely response to initial therapy. Rather than being a static prediction available only after initial therapy, modern risk stratification is a dynamic, iterative process that begins as soon as a suspicious nodule is detected and continues through final follow-up. CONCLUSIONS Dynamic risk assessment should be used to guide all aspects of thyroid cancer management, beginning before a definitive diagnosis is made and continuing through the final follow-up visit.
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Affiliation(s)
- R Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ali S Alzahrani
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Giovanella L, Verburg FA, Trimboli P, Imperiali M, Keller F, Ceriani L. Measuring thyroglobulin in patients with thyroglobulin autoantibodies: evaluation of the clinical impact of BRAHMS Kryptor® Tg-minirecovery test in a large series of patients with differentiated thyroid carcinoma. ACTA ACUST UNITED AC 2019; 57:1185-1191. [DOI: 10.1515/cclm-2018-1390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 01/21/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background
The present study was undertaken to evaluate the clinical impact of a thyroglobulin (Tg) minirecovery test (Tg-mRec) in a large series of differentiated thyroid carcinoma (DTC) patients treated and monitored homogeneously in a tertiary referral center.
Methods
Included were 1120 serum samples from 798 DTC patients. Tg, Tg autoantibodies (TgAb) and Tg-mrec measurements were performed on the automated Kryptor® platform and results compared to the corresponding clinical status.
Results
Among included samples 228 (20%) were TgAb-positive (TgAb+) and 892 (80%) TgAb-negative (TgAb−), respectively. Tg cutoff points were settled at 0.31 μg/L and 0.15 μg/L for TgAb− and TgAb+ patients, respectively, by ROC curve analysis. The diagnostic performance of serum Tg was reduced in TgAb+ compared to TgAb− patients, however, 87% of TgAb+ patients with recurrent disease and, particularly, all patients with distant metastases were correctly detected by adopting an optimized Tg cutoff for TgAb+ patients. A disturbed recovery was found in only 1% of TgAb− patients and in these cases no clinically relevant information was added by the Tg-mRec. Among TgAb+ patients with undetectable Tg and undisturbed Tg-mRec, no one had recurrent disease. However, a falsely undetectable Tg was demonstrated in two patients with recurrent disease who next to increased TgAb also had a disturbed Tg-mRec test.
Conclusions
There is no additional clinical benefit from performing Tg-mRec in most patients. It can however be considered in TgAb+ patients with undetectable Tg levels as it may help differentiate between patients with true negative and false negative Tg levels in the presence of such antibodies.
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35
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Zavala LF, Barra MI, Olmos R, Tuttle M, González H, Droppelmann N, Mosso L, Domínguez JM. In properly selected patients with differentiated thyroid cancer, antithyroglobulin antibodies decline after thyroidectomy and their sole presence should not be an indication for radioiodine ablation. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:293-299. [PMID: 31038590 PMCID: PMC10522203 DOI: 10.20945/2359-3997000000123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/17/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Our objective was to evaluate the trend of antithyroglobulin antibodies (TgAb) during follow-up of patients with differentiated thyroid cancer (DTC) treated without RAI, as well as their role in the risk of recurrence. SUBJECTS AND METHODS This was a prospective, descriptive study. A total of 152 consecutive patients with DTC treated in a single institution undergoing total thyroidectomy without RAI and followed for a median of 2.3 years (0.5-10.3) were divided in two groups: TgAb(-) (n = 111) and TgAb(+) (n = 41). Patients were classified according to AJCC 7th and 8th editions, as well as to their risk of recurrence and response to treatment categories. RESULTS Both groups, TgAb(-) and TgAb(+), were similar regarding patient and tumor characteristics. At the end of follow-up, 90 (59.2%), 57 (37.5%), 3 (2%) and 2 (1.3%) patients achieved excellent, indeterminate, biochemically incomplete and structurally incomplete response, respectively. The risk of structural recurrence was similar in both groups (TgAb[-] 0.9% vs. TgAb[+] 2.4%, p = 0.46). In the TgAb(+) group, TgAb became negative in 10 (24.4%), decreased ≥ 50% without negativization in 25 (60.9%), decreased < 50% in 4 (9.8%) and remained stable or increased in 2 (4.9%) cases. The only incomplete structural response had increasing TgAb during follow-up. CONCLUSIONS In properly selected patients with DTC, TgAb concentration immediately after total thyroidectomy should not mandate RAI ablation, and their trend during follow-up may impact the risk of recurrence.
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Affiliation(s)
- Luis Felipe Zavala
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Inés Barra
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roberto Olmos
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Michael Tuttle
- Department of Endocrinology Service, Memorial Sloan-Kettering Cancer Center, New York, New YorkUnited States
| | - Hernán González
- Head and Neck Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Droppelmann
- Head and Neck Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lorena Mosso
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José M Domínguez
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Song E, Ahn J, Oh HS, Jeon MJ, Kim WG, Kim WB, Shong YK, Baek JH, Lee JH, Ryu JS, Chung KW, Hong SJ, Kim TY. Time trends of thyroglobulin antibody in ablated papillary thyroid carcinoma patients: Can we predict the rate of negative conversion? Oral Oncol 2019; 91:29-34. [PMID: 30926059 DOI: 10.1016/j.oraloncology.2019.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/22/2019] [Accepted: 02/21/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Persistence of thyroglobulin antibody (TgAb) in patients with papillary thyroid carcinoma (PTC) years after total thyroidectomy (TT) followed by ablation occurs even without any evidence of structural disease. Few studies have studied the natural course of TgAb positivity and factors that may influence this course. The present study evaluated the time trends of TgAb in ablated PTC patients and aimed to identify the predictive factors for the rate of negative conversion of TgAb. MATERIALS AND METHODS Overall, 1279 patients who underwent TT and subsequent ablation for PTC, with available data on thyroid peroxidase Ab (TPOAb) and TgAb prior to surgery (preop-) and ablation (abl-) were enrolled. Patients with initial distant metastasis or recurrence during follow-up were excluded. RESULTS AND CONCLUSION Preop-TgAb was positive in 24.9% of patients (n = 319), whereas abl-TgAb positivity decreased to 12.8% (n = 164). In 164 patients positive for abl-TgAb, TgAb in patients with higher abl-TgAb levels decreased more gradually than those observed in patients with lower abl-TgAb levels (p < 0.001). Furthermore, in patients within the same range of abl-TgAb levels, patients positive for abl-TPOAb had a higher rate of negative conversion of TgAb compared with negative patients for abl-TPOAb (log rank p < 0.001). TPOAb significantly increased the rate of negative conversion in multivariate analysis adjusted for abl-TgAb (odds ratio 1.59, 95% confidence interval 1.11-2.28, p = 0.011). This study clearly showed that abl-TgAb titers and abl-TPOAb status can predict the rate of negative conversion. These findings can guide the optimal timing for additional examination in patients positive for TgAb during follow-up.
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Affiliation(s)
- Eyun Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Jonghwa Ahn
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Hye-Seon Oh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Jung Hwan Baek
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Jeong Hyun Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Jin Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Ki Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Suck Joon Hong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
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Dekker BL, van der Horst-Schrivers ANA, Sluiter WJ, Brouwers AH, Lentjes EGWM, Heijboer AC, Muller Kobold AC, Links TP. Clinical Applicability of Low Levels of Thyroglobulin Autoantibodies as Cutoff Point for Thyroglobulin Autoantibody Positivity. Thyroid 2019; 29:71-78. [PMID: 30351209 DOI: 10.1089/thy.2018.0195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Thyroglobulin (Tg) is an established tumor marker in differentiated thyroid carcinoma (DTC). However, Tg assays can be subject to interference by autoantibodies against Tg (TgAbs). No clinical consensus exists on the cutoff value of TgAb positivity and its relationship to Tg assay interference. The aims of this study were to investigate the most applicable cutoff value for TgAb positivity in clinical practice and to evaluate whether tumor characteristics differ between TgAb+ and TgAb- patients during ablation therapy using the manufacturer's cutoff (MCO) and institutional cutoff (ICO). METHODS This single-center cohort study included 230 DTC patients diagnosed between January 2006 and December 2014. Serum Tg and TgAbs were measured with the Tg-IRMA (Thermo Fisher Scientific) and ARCHITECT Anti-Tg (Abbott Laboratories) assays. Patients were divided into TgAb- and TgAb+ based on the limit of detection (LoD; ≥0.07 IU/mL), functional sensitivity (FS; ≥0.31 IU/mL), MCO (≥4.11 IU/mL), and ICO (≥10 IU/mL). RESULTS All patients were TgAb+ based on the LoD; one patient was negative on FS. Fifty-five (23.9%) and 34 (14.8%) patients had TgAbs above the MCO and ICO, respectively. Histology, presence of multifocality, tumor-node-metastasis, and American Thyroid Assocation risk stratification did not differ between TgAb- and TgAb+ patients using MCO and ICO during ablation. CONCLUSIONS This study supports the use of a higher cutoff value than that of the FS for TgAb positivity in clinical settings. The LoD and FS are too sensitive to discriminate TgAb positivity and negativity in DTC patients during ablation therapy. The presence of TgAbs during ablation is not related to tumor characteristics and risk profile. This implies that TgAb positivity should not be considered a separate risk factor.
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Affiliation(s)
- Bernadette L Dekker
- 1 Department of Endocrinology and University of Groningen, Groningen, The Netherlands
| | | | - Wim J Sluiter
- 1 Department of Endocrinology and University of Groningen, Groningen, The Netherlands
| | - Adrienne H Brouwers
- 2 Department of Nuclear Medicine and Molecular Imaging; University of Groningen, Groningen, The Netherlands
| | - Eef G W M Lentjes
- 3 Department of Clinical Chemistry and Hematology, Laboratory of Endocrinology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Annemieke C Heijboer
- 4 Department of Clinical Chemistry, Endocrine Laboratory, VU University Medical Center, VU University, Amsterdam, The Netherlands
| | - Anneke C Muller Kobold
- 5 Department of Laboratory Medicine; University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thera P Links
- 1 Department of Endocrinology and University of Groningen, Groningen, The Netherlands
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Gray JL, Singh G, Uttley L, Balasubramanian SP. Routine thyroglobulin, neck ultrasound and physical examination in the routine follow up of patients with differentiated thyroid cancer-Where is the evidence? Endocrine 2018; 62:26-33. [PMID: 30128957 PMCID: PMC6153587 DOI: 10.1007/s12020-018-1720-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/10/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Patients with differentiated thyroid cancer (DTC) typically have a favourable prognosis and recurrence as late as 45 years after diagnosis has been reported. International clinical guidelines for monitoring recommend routine thyroglobulin, ultrasound and physical examination for the detection of recurrence. The aim of this review was to systematically review whether routine monitoring using thyroglobulin (Tg), neck ultrasound and physical examination for recurrence in differentiated thyroid cancer patients is effective in improving patient survival and/or quality of life. METHODS Primary studies were retrieved via a comprehensive search of three electronic bibliographic databases (PubMed, Web of Science Core Collection and Cochrane Library) without time restriction. Eligible studies must have reported on disease-free patients with DTC subject to long-term routine surveillance. The primary and secondary outcomes of interest were overall survival (or other survival parameters) and quality of life, respectively. RESULTS Literature searches yielded 5529 citations, which were screened by two reviewers. 241 full texts were retrieved. No randomised controlled trials or two-arm cohort studies on the effectiveness of any of the three specified interventions were identified. However, three 'single-arm' studies reporting long-term follow-up outcomes in patients undergoing regular surveillance were identified and appraised. CONCLUSIONS This review highlights a lack of empirical evidence to support current use of routine surveillance in DTC. Although early detection is possible, routine surveillance may lead to unnecessary intervention.
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Affiliation(s)
- Jessica L Gray
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Gautam Singh
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Lesley Uttley
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Saba P Balasubramanian
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK.
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MacFarland SP, Bauer AJ, Adzick NS, Surrey LF, Noyes J, Kazahaya K, Mostoufi-Moab S. Disease Burden and Outcome in Children and Young Adults With Concurrent Graves Disease and Differentiated Thyroid Carcinoma. J Clin Endocrinol Metab 2018; 103:2918-2925. [PMID: 29788090 PMCID: PMC6692710 DOI: 10.1210/jc.2018-00026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/15/2018] [Indexed: 01/21/2023]
Abstract
CONTEXT Adults with differentiated thyroid cancer (DTC) and Graves disease (GD) demonstrate a greater reported disease burden and aggressive DTC behavior. To date, no studies have examined the impact and long-term outcome of concurrent GD and DTC (GD-DTC) in children and young adults. DESIGN Single institution, retrospective longitudinal cohort study between 1997 and 2016. PARTICIPANTS One hundred thirty-nine children and young adults with DTC, diagnosed at median age 15 (range, 5 to 23) years, compared with 12 patients with GD-DTC, median age 18 (range, 12 to 20) years. MAJOR OUTCOME MEASURES Patient demographics, preoperative imaging, fine needle aspiration (FNA) cytology, operative and pathological reports, laboratory studies, treatment, and subsequent 2-year outcomes. RESULTS Compared with DTC, patients with GD-DTC were significantly older at the time of DTC diagnosis (P < 0.01). Patients with GD-DTC were more likely to exhibit microcarcinoma (P < 0.01), and 2 of 12 (17%) demonstrated tall cell variant papillary thyroid cancer (PTC) vs 2 of 139 (2%) in patients who had DTC alone (P = 0.03). Although patients with DTC showed greater lymphovascular invasion (60% vs 25%; P = 0.03), no group differences were noted in extrathyroidal extension, regional lymph node, and distant or lung metastasis. There were no group differences in the 2-year outcome for remission, persistent disease, or recurrence. CONCLUSIONS Concurrent DTC in pediatric patients with GD is not associated with a greater disease burden at presentation and shows no significant difference in 2-year outcomes compared with DTC alone. Similar to adults, microcarcinoma and tall cell variant PTC is prevalent in pediatric patients with GD-DTC. For patients who have GD-DTC with an identified nodule on ultrasound imaging prior to definitive therapy, FNA biopsy is recommended to guide definitive treatment.
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Affiliation(s)
- Suzanne P MacFarland
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Andrew J Bauer
- Division of Endocrinology and Diabetes, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - N Scott Adzick
- Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lea F Surrey
- Division of Anatomic Pathology, Department of Pathology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jessica Noyes
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ken Kazahaya
- Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sogol Mostoufi-Moab
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Endocrinology and Diabetes, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Correspondence and Reprint Requests: Sogol Mostoufi-Moab, MD, Department of Pediatrics, Children’s Hospital of Philadelphia, 2716 South Street, Roberts Building, Philadelphia, Pennsylvania 19146. E-mail:
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Matrone A, Latrofa F, Torregrossa L, Piaggi P, Gambale C, Faranda A, Ricci D, Agate L, Molinaro E, Basolo F, Vitti P, Elisei R. Changing Trend of Thyroglobulin Antibodies in Patients With Differentiated Thyroid Cancer Treated With Total Thyroidectomy Without 131I Ablation. Thyroid 2018; 28:871-879. [PMID: 29860933 DOI: 10.1089/thy.2018.0080] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Thyroglobulin (Tg) antibodies (TgAb) can interfere with Tg measurement and can be used as "Tg surrogate" in patients with differentiated thyroid cancer (DTC) treated with total thyroidectomy (TTx) and radioiodine remnant ablation (RRA). In contrast, few data, and in patients usually followed for a short-term follow-up, have been reported about the changes of TgAb levels in patients treated with TTx but without RRA. The aims of this study were to evaluate the changes of TgAb levels in DTC patients treated with TTx but not RRA and to identify the factors that influence these changes. METHODS The change in TgAb levels in 107 DTC (<1 cm) patients submitted to TTx but not RRA was evaluated. Patients were followed for a median of 6.3 years, and all had at least three determinations of TgAb and neck ultrasound (nUS). RESULTS TgAb levels showed a progressive decrease during follow-up. Initial TgAb levels and degree of lymphocytic infiltration influenced the time but not the rate of TgAb disappearance. No influence on time and rate of the decrease in TgAb was observed when the association with thyroperoxidase antibodies (TPOAb) levels were considered. A TgAb cutoff value of 61.9 IU/mL at first postoperative evaluation was a good indicator for disappearance of the TgAb within six years. No tumor recurrence was observed in the series. In one case, the progressive increase in TgAb anticipated the reappearance of benign thyroid tissue with lymphocytic infiltration. CONCLUSIONS TgAb levels decline in the majority of DTC patients treated with TTx but not ablated with radioiodine. The levels decrease rapidly after the surgical treatment and continue to decrease over time. The time of disappearance is influenced by the initial TgAb levels and the degree of lymphocytic infiltration. No influence of the actual TPOAb levels has been observed. An increase in TgAb levels should not be overlooked, since it can indicate the presence or reappearance of either normal thyroid tissue or tumor recurrence.
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Affiliation(s)
- Antonio Matrone
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
| | - Francesco Latrofa
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
| | - Liborio Torregrossa
- 2 Department of Surgical, Medical, Molecular Pathology and Critical Area, Anatomic Pathology Section, University of Pisa , Pisa, Italy
| | - Paolo Piaggi
- 3 Phoenix Epidemiology and Clinical Research Branch National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health , Phoenix, Arizona
| | - Carla Gambale
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
| | - Alessio Faranda
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
| | - Debora Ricci
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
| | - Laura Agate
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
| | - Eleonora Molinaro
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
| | - Fulvio Basolo
- 2 Department of Surgical, Medical, Molecular Pathology and Critical Area, Anatomic Pathology Section, University of Pisa , Pisa, Italy
| | - Paolo Vitti
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
| | - Rossella Elisei
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
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Algeciras-Schimnich A. Thyroglobulin measurement in the management of patients with differentiated thyroid cancer. Crit Rev Clin Lab Sci 2018; 55:205-218. [DOI: 10.1080/10408363.2018.1450830] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Latrofa F, Ricci D, Bottai S, Brozzi F, Chiovato L, Piaggi P, Marinò M, Vitti P. Effect of Thyroglobulin Autoantibodies on the Metabolic Clearance of Serum Thyroglobulin. Thyroid 2018; 28:288-294. [PMID: 29439614 DOI: 10.1089/thy.2017.0052] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND In order to establish whether thyroglobulin autoantibodies (TgAb) influence the metabolic clearance of thyroglobulin (Tg) in humans, serum Tg and TgAb were correlated shortly after radioiodine (131I) treatment. METHODS Samples were collected from 30 consecutive patients undergoing 131I activity for Graves' hyperthyroidism at the time of treatment and every 15 days thereafter, up to 90 days. Tg and TgAb were measured by immunometric assays (functional sensitivities: 0.1 ng/mL and 8 IU/mL). RESULTS Tg was detectable in all patients at day 0. Tg concentrations rose from a mean of 33.2 ng/mL [confidence interval (CI) 17.8-61.0 ng/mL] at day 0 to a mean of 214.6 ng/mL [CI 116.9-393.4 ng/mL] at day 30 and then steadily decreased, reaching the lowest concentration at day 90 (M = 10.9 ng/mL [CI 5.5-20.9 ng/mL]). Compared to their levels at day 0 (M = 23.6 IU/mL [CI 10.5-52.9 IU/mL]), TgAb remained stable through day 15 and then gradually increased up to a mean of 116.6 IU/mL [CI 51.9-262.2 IU/mL] at day 90. Patients were then split into two groups according to their TgAb status at day 0: undetectable (<8 IU/mL; 9 patients) or detectable (≥8 IU/mL; 21 patients) TgAb. Compared to the other cohort, patients with detectable TgAb showed significantly lower Tg concentrations at day 0 (M = 20.3 ng/mL [CI 10.1-40.2 ng/mL] vs. M = 101.8 ng/mL [CI 36.6-279.8 ng/mL]), similar at day 15, lower levels at day 30 (M = 146.5 ng/mL [CI 74.3-287.8 ng/mL] vs. M = 514.8 ng/mL [CI 187.8-1407.9 ng/mL]), at day 45 (M = 87.5 ng/mL [CI 43.1-176.6 ng/mL] vs. M = 337.9 ng/mL [CI 120.1-947.0 ng/mL]), at day 60 (M = 61.6 ng/mL [CI 31.0-121.4 ng/mL] vs. M = 255.8 ng/mL [CI 79.0-823.8 ng/mL]), and at day 75 (M = 24.5 ng/mL [CI 11.9-49.2 ng/mL] vs. M = 249.5 ng/mL [CI 63.5-971.1 ng/mL]), and similar levels at day 90. Patients with detectable TgAb showed a lower (M = 182.5 ng/mL [CI 92.0-361.0 ng/mL] vs. M = 514.8 ng/mL [CI 187.8-1407.9 ng/mL]) and an earlier (day 15 vs. day 30) peak of Tg. The mean Tg concentration was lower in patients with detectable TgAb than in those with undetectable TgAb (area under the curve: 17,340 ± 16,481 ng/mL vs. 36,883 ± 44,625 ng/mL; p = 0.02). CONCLUSIONS TgAb influence the changes in Tg concentrations observed immediately after 131I treatment, inducing lower levels and an earlier peak of Tg. These observations indicate that TgAb significantly influence the metabolic clearance of Tg, supporting the concept that their interference in the measurement of Tg is mainly due to an in vivo effect.
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Affiliation(s)
- Francesco Latrofa
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Italy
| | - Debora Ricci
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Italy
| | - Sara Bottai
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Italy
| | - Federica Brozzi
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Italy
| | - Luca Chiovato
- 2 Unit of Internal Medicine and Endocrinology, Fondazione Salvatore Maugeri, University of Pavia , Pavia, Italy
| | - Paolo Piaggi
- 3 Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Phoenix, Arizona
| | - Michele Marinò
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Italy
| | - Paolo Vitti
- 1 Endocrinology Unit I, Department of Clinical and Experimental Medicine, University Hospital of Pisa , Italy
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Wheeler SE, Liu L, Blair HC, Sivak R, Longo N, Tischler J, Mulvey K, Palmer OMP. Clinical laboratory verification of thyroglobulin concentrations in the presence of autoantibodies to thyroglobulin: comparison of EIA, radioimmunoassay and LC MS/MS measurements in an Urban Hospital. BMC Res Notes 2017; 10:725. [PMID: 29221487 PMCID: PMC5723050 DOI: 10.1186/s13104-017-3050-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/30/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Thyroglobulin (Tg) measurements assess recurrence in post-thyroidectomy thyroid cancer patients. Tg measurements by enzyme immunoassays (EIA) can be falsely elevated by interference from Tg autoantibodies (TgAb). Radioimmunoassay (RIA) is less susceptible to TgAb interference and has been the standard-of-care test for TgAb positive patients. Recently developed liquid chromatography tandem mass spectrometry (LC-MS/MS) methods may eliminate TgAb interference. We assessed the performance of Tg measurements by EIA, RIA and LC-MS/MS to evaluate TgAb interference differences. RESULTS We measured TgAb and Tg in 50 plasma samples from 40 patients in whom Tg measurement was part of their routine follow-up and 10 healthy volunteers. Discrepancy between EIA and both LC-MS/MS and RIA was observed at low Tg concentrations (≤ 7.55 ng/mL) in TgAb positive specimens (LC-MS/MS = 1.9 * EIA - 0.03, r = 0.68). RIA and LC-MS/MS Tg measurements in TgAb positive specimens with low Tg concentrations had improved correlation but demonstrated bias (LC MS/MS = 0.6 * RIA - 1.4, r = 0.90). Disagreement between methods may be attributed to LC-MS/MS reported Tg concentrations as undetectable compared to RIA. It seems likely that most discrepant cases are falsely elevated in RIA due to TgAb interference, however, some cases appear below the detection limit of LC-MS/MS; implementation of LC-MS/MS by clinicians will require lower detection limits.
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Affiliation(s)
- Sarah E Wheeler
- Department of Pathology, University of Pittsburgh School of Medicine, S723 Scaife Hall, 3550 Terrace St, Pittsburgh, PA, 15261, USA
| | - Li Liu
- Department of Pathology, University of Pittsburgh School of Medicine, S723 Scaife Hall, 3550 Terrace St, Pittsburgh, PA, 15261, USA
| | - Harry C Blair
- Department of Pathology, University of Pittsburgh School of Medicine, S723 Scaife Hall, 3550 Terrace St, Pittsburgh, PA, 15261, USA.,University of Pittsburgh Medical Center (UPMC), Clinical Laboratory Building, 3477 Euler Way, Room 3014, Pittsburgh, PA, 15213, USA
| | - Richard Sivak
- University of Pittsburgh Medical Center (UPMC), Clinical Laboratory Building, 3477 Euler Way, Room 3014, Pittsburgh, PA, 15213, USA
| | - Nancy Longo
- University of Pittsburgh Medical Center (UPMC), Clinical Laboratory Building, 3477 Euler Way, Room 3014, Pittsburgh, PA, 15213, USA
| | - Jeffery Tischler
- University of Pittsburgh Medical Center (UPMC), Clinical Laboratory Building, 3477 Euler Way, Room 3014, Pittsburgh, PA, 15213, USA
| | - Kathryn Mulvey
- University of Pittsburgh Medical Center (UPMC), Clinical Laboratory Building, 3477 Euler Way, Room 3014, Pittsburgh, PA, 15213, USA
| | - Octavia M Peck Palmer
- Department of Pathology, University of Pittsburgh School of Medicine, S723 Scaife Hall, 3550 Terrace St, Pittsburgh, PA, 15261, USA. .,University of Pittsburgh Medical Center (UPMC), Clinical Laboratory Building, 3477 Euler Way, Room 3014, Pittsburgh, PA, 15213, USA. .,Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA. .,Department of Clinical and Translational Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.
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Bandeira L, Padovani RDP, Ticly AL, Cury AN, Scalissi NM, Marone MMS, Ferraz C. Thyroglobulin levels before radioactive iodine therapy and dynamic risk stratification after 1 year in patients with differentiated thyroid cancer. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:590-599. [PMID: 29412384 PMCID: PMC10522064 DOI: 10.1590/2359-3997000000308] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 08/23/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We sought to assess the relationship between stimulated thyroglobulin (sTg) before radioactive iodine therapy (RIT), and the dynamic risk stratification 1 year after treatment, and to establish the utility of the sTg as a predictor of response to therapy in these patients. A retrospective chart review of patients with differentiated thyroid cancer (DTC) who underwent RIT after surgery and were followed for at least 1 year, was carried out. SUBJECTS AND METHODS Patients were classified according to the dynamic risk stratification 1 year after initial treatment. The sTg values before RIT were compared among the groups. ROC curve analysis was performed. RESULTS Fifty-six patients were enrolled (mean age 44.7 ± 14.4 years, 80.7% had papillary carcinoma). Patients with excellent response had sTg = 2.1 ± 3.3 ng/mL, those with indeterminate response had sTg = 8.2 ± 9.2 ng/mL and those with incomplete response had sTg = 22.4 ± 28.3 ng/mL before RIT (p = 0.01). There was a difference in sTg between excellent and incomplete response groups (p = 0.009) while no difference was found between indeterminate and either excellent or incomplete groups. The ROC curve showed an area under the curve of 0.779 assuming a sTg value of 3.75 ng/mL. CONCLUSION Our study results suggest that the higher the sTg before RIT, the greater the likelihood of an incomplete response to initial treatment. A sTg cut-off of 3.75 ng/mL was found to be a good predictor of response to initial treatment in patients with DTC.
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Affiliation(s)
- Leonardo Bandeira
- Irmandade da Santa Casa de Misericórdia de São PauloDepartamento de MedicinaServiço de EndocrinologíaSão PauloSPBrasilServiço de Endocrinología, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, SP Brasil
| | - Rosália do Prado Padovani
- Irmandade da Santa Casa de Misericórdia de São PauloDepartamento de MedicinaServiço de EndocrinologíaSão PauloSPBrasilServiço de Endocrinología, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, SP Brasil
- Irmandade da Santa Casa de Misericórdia de São PauloServiços de Medicina NuclearSão PauloSPBrasilServiços de Medicina Nuclear, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, SP Brasil
| | - Ana Luiza Ticly
- Irmandade da Santa Casa de Misericórdia de São PauloDepartamento de MedicinaServiço de EndocrinologíaSão PauloSPBrasilServiço de Endocrinología, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, SP Brasil
| | - Adriano Namo Cury
- Irmandade da Santa Casa de Misericórdia de São PauloDepartamento de MedicinaServiço de EndocrinologíaSão PauloSPBrasilServiço de Endocrinología, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, SP Brasil
| | - Nilza Maria Scalissi
- Irmandade da Santa Casa de Misericórdia de São PauloDepartamento de MedicinaServiço de EndocrinologíaSão PauloSPBrasilServiço de Endocrinología, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, SP Brasil
| | - Marília Martins Silveira Marone
- Irmandade da Santa Casa de Misericórdia de São PauloServiços de Medicina NuclearSão PauloSPBrasilServiços de Medicina Nuclear, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, SP Brasil
| | - Carolina Ferraz
- Irmandade da Santa Casa de Misericórdia de São PauloDepartamento de MedicinaServiço de EndocrinologíaSão PauloSPBrasilServiço de Endocrinología, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, SP Brasil
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Cheng X, Yu S, Jin C, Han S, Hu Y, Zhang K, Liu H, Qiu L. Comparison of three different assays for measuring thyroglobulin and thyroglobulin antibodies in patients with chronic lymphocytic thyroiditis. Clin Biochem 2017; 50:1183-1187. [DOI: 10.1016/j.clinbiochem.2017.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/27/2017] [Accepted: 08/08/2017] [Indexed: 11/30/2022]
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Ernaga-Lorea A, Hernández-Morhain MC, Anda-Apiñániz E, Pineda-Arribas JJ, Migueliz-Bermejo I, Eguílaz-Esparza N, Irigaray-Echarri A. Prognostic value of change in anti-thyroglobulin antibodies after thyroidectomy in patients with papillary thyroid carcinoma. Clin Transl Oncol 2017; 20:740-744. [PMID: 29071517 DOI: 10.1007/s12094-017-1782-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Anti-thyroglobulin antibodies (TgAb) can be used as a surrogate tumor marker in the follow-up of papillary thyroid carcinoma (PTC). We try to determine if the change in TgAb levels in the first post-operative year is a good predictor of persistence/recurrence risk in TgAb-positive PTC patients. METHODS/PATIENTS 105 patients with PTC who underwent thyroidectomy between 1988 and 2014 were enrolled. We calculated the percentage of change in TgAb levels with the first measurement at 1-2 months after surgery and the second one at 12-14 months. RESULTS TgAb negativization was observed in 29 patients (27.6%), a decrease of more than 50% was observed in 57 patients (54.3%), less than 50% in 12 patients (11.4%) and in 7 patients (6.7%) the TgAb level had increased. The percentage of persistence/recurrence was 0, 8.8, 16.7 and 71.4% in each group, respectively (p < 0.001). In the multivariate analysis, only the percentage of change in TgAb showed a significant association with the risk of persistence/recurrence, regardless of other factors such as age, size and TNM stages. CONCLUSIONS Changes in TgAb levels in the first year after surgery can predict the risk of persistence/recurrence of TgAb-positive PTC patients. Patients who achieved negativization of TgAb presented an excellent prognosis.
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Affiliation(s)
- A Ernaga-Lorea
- Department of Endocrinology, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Navarra, Spain.
| | - M C Hernández-Morhain
- Department of Endocrinology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - E Anda-Apiñániz
- Department of Endocrinology, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - J J Pineda-Arribas
- Department of Endocrinology, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - I Migueliz-Bermejo
- Department of Endocrinology, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - N Eguílaz-Esparza
- Department of Endocrinology, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - A Irigaray-Echarri
- Department of Endocrinology, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008, Pamplona, Navarra, Spain
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Nixon AM, Provatopoulou X, Kalogera E, Zografos GN, Gounaris A. Circulating thyroid cancer biomarkers: Current limitations and future prospects. Clin Endocrinol (Oxf) 2017; 87:117-126. [PMID: 28493290 DOI: 10.1111/cen.13369] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/20/2017] [Accepted: 05/05/2017] [Indexed: 01/04/2023]
Abstract
Differentiated thyroid cancer (DTC) is the most common malignancy of the endocrine system. There has been a significant increase in its incidence over the past two decades attributable mainly to the use of more sensitive diagnostic modalities. Ultrasound-guided fine needle aspiration cytology is the mainstay of diagnosis of benign disorders and malignancy. However, approximately 20% of lesions cannot be adequately categorized as benign or malignant. In the postoperative setting, monitoring of thyroglobulin (Tg) levels has been employed for the detection of disease recurrence. Unfortunately, Tg antibodies are common and interfere with Tg measurement in this subset of patients. Despite this limitation, Tg remains the sole widely used thyroid cancer biomarker in the clinical setting. In an attempt to bypass antibody interference, research has focused mainly on mRNA targets thought to be exclusively expressed in thyroid cells. Tg and thyroid stimulating hormone receptor (TSHR) mRNA have been extensively studied both for discerning between benign disease and malignancy and in postoperative disease surveillance. However, results among reports have been inconsistent probably reflecting considerable differences in methodology. Recently, microRNA (miRNA) targets are being investigated as potential biomarkers in DTC. MiRNAs are more stable molecules and theoretically are not as vulnerable as mRNA during manipulation. Initial results have been encouraging but large-scale studies are warranted to verify and elucidate their potential application in diagnosis and postoperative surveillance of thyroid cancer. Several other novel targets, primarily mutations and circulating cells, are currently emerging as promising thyroid cancer circulating biomarkers. Although interesting and intriguing, data are limited and derive from small-scale studies in specific patient cohorts. Further research findings demonstrating their value are awaited with anticipation.
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Affiliation(s)
- Alexander M Nixon
- Third Department of Surgery, Athens General Hospital "Georgios Gennimatas", Athens, Greece
| | | | - Eleni Kalogera
- Research Center, Hellenic Anticancer Institute, Athens, Greece
| | - George N Zografos
- Third Department of Surgery, Athens General Hospital "Georgios Gennimatas", Athens, Greece
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Trimboli P, D'Aurizio F, Tozzoli R, Giovanella L. Measurement of thyroglobulin, calcitonin, and PTH in FNA washout fluids. Clin Chem Lab Med 2017; 55:914-925. [PMID: 27802177 DOI: 10.1515/cclm-2016-0543] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/20/2016] [Indexed: 12/20/2022]
Abstract
Different imaging tools, circulating endocrine markers, and fine-needle aspiration (FNA) cytology are of great importance in the diagnosis and follow-up of different thyroid and parathyroid diseases. Sometimes, however, they are conflicting or inconclusive: interestingly, measuring endocrine markers (i.e. thyroglobulin, calcitonin, parathyroid hormone) in fluids from FNA proved to be a very useful complementary diagnostic tool in such cases. The determination of endocrine markers in fluids other than serum/plasma has been developed in the last years. Although studies have reported overall satisfactory results, a good standardization of procedures has not yet been reached, and further efforts should be made in order to better define pre-analytical, analytical, and post-analytical aspects. Here we reviewed critically the literature on the measurement of FNA endocrine markers, focusing on laboratory issues, such as preparation of the sample, choice of solution, and technical features of determination of these markers. Indeed, information for use of FNA-Tg, FNA-CT, and FNA-PTH in clinical practice was also provided.
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D'Aurizio F, Metus P, Ferrari A, Caruso B, Castello R, Villalta D, Steffan A, Gaspardo K, Pesente F, Bizzaro N, Tonutti E, Valverde S, Cosma C, Plebani M, Tozzoli R. Definition of the upper reference limit for thyroglobulin antibodies according to the National Academy of Clinical Biochemistry guidelines: comparison of eleven different automated methods. AUTOIMMUNITY HIGHLIGHTS 2017. [PMID: 28631225 PMCID: PMC5476530 DOI: 10.1007/s13317-017-0096-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose In the last two decades, thyroglobulin autoantibodies (TgAb) measurement has progressively switched from marker of thyroid autoimmunity to test associated with thyroglobulin (Tg) to verify the presence or absence of TgAb interference in the follow-up of patients with differentiated thyroid cancer. Of note, TgAb measurement is cumbersome: despite standardization against the International Reference Preparation MRC 65/93, several studies demonstrated high inter-method variability and wide variation in limits of detection and in reference intervals. Taking into account the above considerations, the main aim of the present study was the determination of TgAb upper reference limit (URL), according to the National Academy of Clinical Biochemistry guidelines, through the comparison of eleven commercial automated immunoassay platforms. Methods The sera of 120 healthy males, selected from a population survey in the province of Verona, Italy, were tested for TgAb concentration using eleven IMA applied on as many automated analyzers: AIA-2000 (AIA) and AIA-CL2400 (CL2), Tosoh Bioscience; Architect (ARC), Abbott Diagnostics; Advia Centaur XP (CEN) and Immulite 2000 XPi (IMM), Siemens Healthineers; Cobas 6000 (COB), Roche Diagnostics; Kryptor (KRY), Thermo Fisher Scientific BRAHMS, Liaison XL (LIA), Diasorin; Lumipulse G (LUM), Fujirebio; Maglumi 2000 Plus (MAG), Snibe and Phadia 250 (PHA), Phadia AB, Thermo Fisher Scientific. All assays were performed according to manufacturers’ instructions in six different laboratories in Friuli-Venezia Giulia and Veneto regions of Italy [Lab 1 (AIA), Lab 2 (CL2), Lab 3 (ARC, COB and LUM), Lab 4 (CEN, IMM, KRY and MAG), Lab 5 (LIA) and Lab 6 (PHA)]. Since TgAb values were not normally distributed, the experimental URL (e-URL) was established at 97.5 percentile according to the non-parametric method. Results TgAb e-URLs showed a significant inter-method variability. Considering the same method, e-URL was much lower than that suggested by manufacturers (m-URL), except for ARC and MAG. Correlation and linear regression were unsatisfactory. Consequently, the agreement between methods was poor, with significant bias in Bland–Altman plot. Conclusions Despite the efforts for harmonization, TgAb methods cannot be used interchangeably. Therefore, additional effort is required to improve analytical performance taking into consideration approved protocols and guidelines. Moreover, TgAb URL should be used with caution in the management of differentiated thyroid carcinoma patients since the presence and/or the degree of TgAb interference in Tg measurement has not yet been well defined.
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Affiliation(s)
- F D'Aurizio
- Clinical Pathology Institute, University Hospital, P.le S. Maria della Misericordia, 33100, Udine, Italy.
| | - P Metus
- Clinical Pathology Laboratory, 'S. Maria degli Angeli' Hospital, Pordenone, Italy
| | - A Ferrari
- Clinical Pathology Laboratory, University Hospital, Verona, Italy
| | - B Caruso
- Clinical Pathology Laboratory, University Hospital, Verona, Italy
| | - R Castello
- General Medicine and Endocrinology, University Hospital, Verona, Italy
| | - D Villalta
- Allergology and Immunology, 'S. Maria degli Angeli' Hospital, Pordenone, Italy
| | - A Steffan
- Oncological Clinical Pathology Laboratory, CRO, IRCCS, Aviano, Italy
| | - K Gaspardo
- Oncological Clinical Pathology Laboratory, CRO, IRCCS, Aviano, Italy
| | - F Pesente
- Clinical Pathology Laboratory, 'S. Antonio Hospital', Tolmezzo, Italy
| | - N Bizzaro
- Clinical Pathology Laboratory, 'S. Antonio Hospital', Tolmezzo, Italy
| | - E Tonutti
- Laboratory of Immunopathology and Allergology, University Hospital, Udine, Italy
| | - S Valverde
- Laboratory Medicine, 'Madonna della Navicella' Hospital, Chioggia (Ve), Italy
| | - C Cosma
- Department of Laboratory Medicine, University Hospital, Padua, Italy
| | - M Plebani
- Department of Laboratory Medicine, University Hospital, Padua, Italy
| | - R Tozzoli
- Clinical Pathology Laboratory, 'S. Maria degli Angeli' Hospital, Pordenone, Italy
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Vaisman F. Serum positive thyroglobulin antibodies: an old problem with new questions. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:103-104. [PMID: 28489154 PMCID: PMC10118857 DOI: 10.1590/2359-3997000000263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 11/22/2022]
Affiliation(s)
- Fernanda Vaisman
- Instituto Nacional de Câncer (Inca). Programa de Pós-Graduação Stricto-Sensu em Endocrinologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
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