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Mao Y, Lin R, Wang Y, Yu J. Correlation analysis between the quantitative parameters of iodine-131 single-photon emission computed tomography-computed tomography thyroid bed uptake and the efficacy of radioactive iodine adjuvant therapy for papillary thyroid cancer. Quant Imaging Med Surg 2024; 14:3665-3675. [PMID: 38720856 PMCID: PMC11074731 DOI: 10.21037/qims-23-1723] [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: 12/02/2023] [Accepted: 03/22/2024] [Indexed: 05/12/2024]
Abstract
Background Single-photon emission computed tomography-computed tomography (SPECT/CT) quantification has emerged as a valuable tool for assessing disease prognosis by accurately identifying and characterizing abnormal lesions with accumulated radionuclides. Papillary thyroid carcinoma (PTC) is the most prevalent type of thyroid cancer, and radioactive iodine (RAI) therapy is a standard treatment following total thyroidectomy. This study aimed to explore the potential utility the quantitative parameters of the thyroid bed under iodine-131 (I-131) SPECT/CT in the efficacy of RAI adjuvant therapy for patients with PTC. Methods The retrospective cohort study enrolled 107 patients with PTC who underwent RAI adjuvant therapy from June 2020 to January 2023. Three days after the RAI adjuvant therapy, all patients underwent I-131 whole-body scans and SPECT/CT imaging. The quantitative parameters, including maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), and percent injected dose (%ID), were measured using image analysis software based on I-131 SPECT/CT thyroid bed uptake. Successful therapy was defined as inhibitory thyroglobulin (Tg) <0.2 ng/mL with negative thyroglobulin antibody (TgAb) and negative imaging examination 6 months after RAI adjuvant therapy. The relationship between the quantitative parameters and the treatment efficacy, in addition to the potential influencing factors, were analyzed. Results The quantitative parameters from the successful group [SUVmax: median 6.15 g/mL, interquartile range (IQR) 2.34-13.80 g/mL; SUVmean: median 2.02 g/mL, IQR 0.89-4.93 g/mL; %ID: median 2.00%, IQR 1.00-4.00%] were significantly lower than those from the unsuccessful group (SUVmax: median 19.03 g/mL, IQR 5.31-45.10 g/mL, SUVmean 4.64 g/mL, IQR 2.07-19.05 g/mL; %ID: median 8.00%, IQR 3.00-18.00%) (SUVmax: Z=-3.755; SUVmean; Z=-3.671; %ID: Z=-4.070; all P values <0.001). SUVmax, SUVmean and %ID were positively correlated with the stimulated thyroglobulin (sTg) and inhibitory Tg at 6 months after RAI adjuvant therapy, respectively (all P values <0.001). SUVmax [odds ratio (OR) =1.045], SUVmean (OR =1.130), and %ID (OR =1.092) were predictive factors for the failure of RAI adjuvant therapy (all P values <0.001). Conclusions Our study suggested that quantitative parameters (SUVmax, SUVmean, and %ID) derived from I-131 SPECT/CT imaging of the thyroid bed can serve as useful tools for predicting therapy outcomes following RAI adjuvant therapy.
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Affiliation(s)
- Yangting Mao
- Department of Nuclear Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Runlong Lin
- Department of Nuclear Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yizhen Wang
- Department of Nuclear Medicine, The Second Hospital of Dalian Medical University, Dalian, China
- Department of Nuclear Medicine, The First Affiliated Hospital of Henan University of CM, Zhengzhou, China
| | - Jing Yu
- Department of Nuclear Medicine, The Second Hospital of Dalian Medical University, Dalian, China
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Giovanella L, D’Aurizio F, Petranović Ovčariček P, Görges R. Diagnostic, Theranostic and Prognostic Value of Thyroglobulin in Thyroid Cancer. J Clin Med 2024; 13:2463. [PMID: 38730992 PMCID: PMC11084486 DOI: 10.3390/jcm13092463] [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: 03/10/2024] [Revised: 04/12/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
Thyroglobulin (Tg) is an iodinated glycoprotein, which is normally stored in the follicular colloid of the thyroid, being a substrate for thyroid hormone production. Since it is produced by well-differentiated thyroid cells, it is considered a reliable tumor marker for patients with differentiated thyroid carcinoma (DTC) during their follow-up after total thyroidectomy and radioiodine ablation. It is used to monitor residual disease and to detect recurrent disease. After total thyroid ablation, unstimulated highly sensitive Tg measurements are sufficiently accurate to avoid exogenous or endogenous thyrotropin (TSH) stimulation and provide accurate diagnostic and prognostic information in the great majority of DTC patients. Adopting sophisticated statistical analysis, i.e., decision tree models, the use of Tg before radioiodine theranostic administration was demonstrated to be useful in refining conventional, pathology-based risk stratification and providing personalized adjuvant or therapeutic radioiodine administrations. The follow-up of DTC patients aims to promptly identify patients with residual or recurrent disease following primary treatment. Our review paper covers the diagnostic, theranostic and prognostic value of thyroglobulin in DTC patients.
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Affiliation(s)
- Luca Giovanella
- Department of Nuclear Medicine, Gruppo Ospedaliero Moncucco SA, Clinica Moncucco, 6900 Lugano, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, 8006 Zurich, Switzerland
| | - Federica D’Aurizio
- Institute of Clinical Pathology, Department of Laboratory Medicine, University Hospital of Udine, 33100 Udine, Italy;
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Rainer Görges
- Clinic for Nuclear Medicine, University Hospital of Essen, 45147 Essen, Germany;
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Chandekar KR, Satapathy S, Bal C. Impact of radioiodine therapy on recurrence and survival outcomes in intermediate-risk papillary thyroid carcinoma -A systematic review and meta-analysis. Clin Endocrinol (Oxf) 2024; 100:181-191. [PMID: 38050454 DOI: 10.1111/cen.15001] [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: 08/02/2023] [Revised: 10/19/2023] [Accepted: 11/25/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE The utility of radioiodine (RAI) therapy in intermediate-risk papillary thyroid carcinoma (PTC) remains a topic of ongoing discussion. This systematic review and meta-analysis aimed to consolidate existing evidence on the impact of postoperative RAI therapy on recurrence and survival outcomes in intermediate-risk PTC. METHODS A literature search was performed using relevant keywords in PubMed, Scopus, and EMBASE. Articles from January 2008 to March 2023 were included. Odds ratios (ORs) and hazard ratios (HRs) were extracted from the individual articles, and pooled estimates were generated using meta-analysis. RESULTS Eleven articles comprising 56,266 intermediate-risk PTC patients were included. 41,530 (73.8%) patients underwent postoperative RAI therapy, while 14,736 (26.2%) patients were kept on no-RAI (NOI) follow-up. No significant reduction in rates of structural disease recurrence was noted with RAI therapy in comparison to NOI follow-up (pooled univariate OR, 0.73, 95% confidence interval [CI], 0.29-1.87, I2 = 75%). RAI therapy was not a significant predictor of better recurrence-free survival (pooled multivariate HR, 0.21; 95% CI, 0.01-3.74, I2 = 94%). Interestingly, RAI therapy was associated with an overall survival benefit compared to NOI follow-up (pooled multivariate HR, 0.63; 95% CI, 0.48-0.82, I2 = 79%). CONCLUSIONS This meta-analysis did not establish a conclusive benefit of RAI therapy in preventing structural disease recurrence or improving recurrence-free survival in intermediate-risk PTC. However, these results need to be interpreted with caution owing to significant heterogeneity in the existing literature. A prospective, randomised clinical trial is the need of the hour to better understand the effect of RAI therapy on long-term outcomes.
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Affiliation(s)
- Kunal Ramesh Chandekar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Swayamjeet Satapathy
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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Lee H, Kim TS, Gu JY, Yu MR, Lee SE, Kim ES, Kim HK. Value of circulating neutrophil elastase for detecting recurrence of differentiated thyroid cancer. Endocr Connect 2023; 12:e230400. [PMID: 37909732 PMCID: PMC10692691 DOI: 10.1530/ec-23-0400] [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: 09/25/2023] [Accepted: 10/31/2023] [Indexed: 11/03/2023]
Abstract
Objective The inflammatory microenvironment has been implicated in differentiated thyroid cancer (DTC). Inflammatory stimuli induce the release of components of neutrophils into extracellular space, leading to formation of neutrophil extracellular trap (NET), which can stimulate growth and progression of cancer. Generation of activated factor XII and thrombin is also involved in cancer progression. This study attempted to determine whether the level of circulating markers of NET, activated factor XII, and endogenous thrombin potential may be useful for detecting the recurrence of DTC. Methods A total of 122 patients with DTC were recruited during the postoperative follow-up period. Measurement of the levels of circulating markers of NET (neutrophil elastase, histone-DNA complex, cell-free dsDNA), activated factor XII, and endogenous thrombin potential was performed. Results A significantly elevated level of neutrophil elastase was detected in patients with recurrence (n = 12) compared to those without recurrence (n = 110), while significant elevation of the levels of other markers was not observed. The value for area under the curve (0.717, P = 0.018) of neutrophil elastase for detecting recurrence of DTC was superior to that (0.661, P = 0.051) of serum thyroglobulin. An elevated level of neutrophil elastase was significantly associated with recurrence of DTC independent of serum thyroglobulin. Conclusions Because an elevated level of neutrophil elastase was detected in patients with recurrence of DTC and showed a significant association with recurrence of DTC, it can be proposed as a novel biomarker for use in detecting recurrence of DTC along with other tests.
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Affiliation(s)
- Hyunjae Lee
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae-Shin Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ja-Yoon Gu
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Mi Ran Yu
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Seung-Eun Lee
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Eun Sook Kim
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyun Kyung Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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Satapathy S, Tupalli A, Chandekar KR, Ballal S, Bal C. Radioiodine versus no radioiodine outcomes in low-risk differentiated thyroid cancers: A propensity-score matched analysis. Clin Endocrinol (Oxf) 2023; 99:483-491. [PMID: 37491776 DOI: 10.1111/cen.14950] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/03/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE The 2015 American Thyroid Association guidelines recommend against radioiodine (RAI) ablation for patients with low-risk papillary microcarcinoma. However, its role in other low-risk differentiated thyroid cancer (DTC) patients remains controversial. Here, we compare long-term outcomes with RAI versus no-RAI in a large cohort comprising all low-risk DTCs. METHODS Patients with low-risk, histologically-proven DTC post-thyroidectomy, treated with RAI or kept on follow-up without RAI, between 1990 and 2019 were included. The main outcomes included recurrence rate and recurrence-free survival (RFS), and were validated by propensity-score matching analysis. RESULTS Of the 2074 low-risk DTC patients (median age: 35 years), 1686 patients underwent RAI-ablation (RAI group), while 388 patients underwent no-RAI follow-up (NOI group). Over a median follow-up of 8 years (range: 3-29), the recurrence rates were similar between the RAI and NOI groups (2.0% vs. 3.3%, p = .161). The 5- and 10-year RFS probabilities were 99.2% and 97.4%, respectively in RAI group versus 98.4% and 96.2%, respectively, in NOI group (p = .055). Subgroup regression analyses showed that patients with age <55 years (p = .044), male sex (p = .015), papillary histology (p = .043), pT3a tumours (p = .049) and postoperative thyroglobulin ≥5 ng/mL (p = .002) had significantly better RFS with RAI compared to NOI follow-up. Propensity-score matching generated 776 matched pairs with no significantly different outcomes between the two groups. CONCLUSIONS In low-risk DTC patients post-thyroidectomy, RAI ablation does not confer significant survival advantage over no-RAI follow-up. Further studies are required to demonstrate any long-term benefit with RAI, specifically in patients with tumour size >4 cm and elevated postoperative thyroglobulin.
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Affiliation(s)
- Swayamjeet Satapathy
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Avinash Tupalli
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kunal Ramesh Chandekar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjana Ballal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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Giovanella L, D'Aurizio F, Algeciras-Schimnich A, Görges R, Petranovic Ovcaricek P, Tuttle RM, Visser WE, Verburg FA. Thyroglobulin and thyroglobulin antibody: an updated clinical and laboratory expert consensus. Eur J Endocrinol 2023; 189:R11-R27. [PMID: 37625447 DOI: 10.1093/ejendo/lvad109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/12/2023] [Accepted: 05/31/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Thyroglobulin measurement is the cornerstone of modern management of differentiated thyroid cancer, with clinical decisions on treatment and follow-up based on the results of such measurements. However, numerous factors need to be considered regarding measurement with and interpretation of thyroglobulin assay results. DESIGN The present document provides an integrated update to the 2013 and 2014 separate clinical position papers of our group on these issues. METHODS Issues concerning analytical and clinical aspects of highly-sensitive thyroglobulin measurement will be reviewed and discussed based on an extensive analysis of the available literature. RESULTS Thyroglobulin measurement remains a highly complex process with many pitfalls and major sources of interference, especially anti-thyroglobulin antibodies, need to be assessed, considered and, when necessary, dealt with appropriately. CONCLUSIONS Our expert consensus group formulated 53 practical, graded recommendations for guidance on highly-sensitive thyroglobulin and TgAb in laboratory and clinical practice, especially valuable where current guidelines do not offer sufficient guidance.
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Affiliation(s)
- Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Federica D'Aurizio
- Institute of Clinical Pathology, Department of Laboratory Medicine, University Hospital of Udine, Udine, Italy
| | | | - Rainer Görges
- Department of Nuclear Medicine, University Hospital of Essen, Essen, Germany
| | - Petra Petranovic Ovcaricek
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - R Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - W Edward Visser
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frederik A Verburg
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Sipos JA, Aloi J, Gianoukakis A, Lee SL, Klopper JP, Kung JT, Lupo MA, Morgenstern D, Prat-Knoll C, Schuetzenmeister A, Goldner WS. Thyroglobulin Cutoff Values for Detecting Excellent Response to Therapy in Patients With Differentiated Thyroid Cancer. J Endocr Soc 2023; 7:bvad102. [PMID: 37564885 PMCID: PMC10410295 DOI: 10.1210/jendso/bvad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Indexed: 08/12/2023] Open
Abstract
Context Serum thyroglobulin (Tg) is a biochemical marker for detecting persistent or recurrent differentiated thyroid carcinoma (DTC) post-thyroidectomy. Tg can indicate DTC before structural disease (SD) is visible with imaging procedures. Objective This work aimed to evaluate the clinical performance of the Elecsys® Tg II assay at a Tg cutoff of 0.2 ng/mL for ruling out SD in adults with DTC after total/near-total thyroidectomy, with or without radioiodine ablation (RAI). Methods Patients were enrolled into 2 cohorts: longitudinal (Tg assessed every 6 months over 2 years under thyroid-stimulating hormone [TSH] suppression therapy following thyroidectomy with or without RAI) and cross-sectional with confirmed SD (Tg assessed once >12 weeks after thyroidectomy). Analyses were performed for both cohorts combined and in the longitudinal cohort. Results The study included 530 clinically evaluable samples, the majority (n = 424 samples) from patients who had not received RAI treatment. Following correction for SD prevalence (4.97% in the longitudinal cohort), an Elecsys Tg II cutoff of 0.2 ng/mL ruled out SD with a negative predictive value of 99.9% (95% CI, 99.5%-100%). The assay had excellent sensitivity (98.5%-100%) and acceptable specificity (53.4%-53.5%) for detecting SD (Tg ≥ 0.2 ng/mL) for both cohorts combined and in the longitudinal cohort, with similar findings in RAI-treated and non-RAI-treated subgroups. Conclusion In this cohort of DTC patients post-thyroidectomy, a Tg cutoff of 0.2 ng/mL was highly effective for ruling out the presence of SD under TSH-suppressed conditions, including in patients who had not received RAI treatment.
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Affiliation(s)
- Jennifer A Sipos
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University, Columbus, OH 43210, USA
| | - Joseph Aloi
- Division of Endocrinology, Diabetes and Metabolism, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27101, USA
| | - Andrew Gianoukakis
- Division of Endocrinology, The Lundquist Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
- David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, CA 90095, USA
| | - Stephanie L Lee
- Department of Medicine, Boston Medical Center, Boston, MA 02118, USA
| | - Joshua P Klopper
- Department of Endocrinology, Kaiser Permanente of Colorado, Denver, CO 80920, USA
| | - Jacqueline T Kung
- Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center, Boston, MA 02111, USA
| | - Mark A Lupo
- The Thyroid & Endocrine Center of Florida, Sarasota, FL 34231, USA
| | - David Morgenstern
- Clinical Development and Medical Affairs, Roche Molecular Systems, Pleasanton, CA 94588, USA
| | - Cristina Prat-Knoll
- Clinical Development and Medical Affairs, Roche Diagnostics GmbH, 68305 Mannheim, Germany
| | | | - Whitney S Goldner
- Division of Endocrinology, Diabetes and Metabolism, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Bögershausen LR, Giovanella L, Stief T, Luster M, Verburg FA. Long-term predictive value of highly sensitive thyroglobulin measurement. Clin Endocrinol (Oxf) 2023; 98:622-628. [PMID: 36263618 DOI: 10.1111/cen.14837] [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: 06/29/2022] [Revised: 10/08/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the predictive value of unremarkable nonstimulated highly sensitive thyroglobulin (hsTg) measurement with regard to the results of stimulated thyroglobulin (Tg) measurement, diagnostic whole-body scintigraphy, recurrence and differentiated thyroid cancer (DTC)-related death. DESIGN, PATIENTS AND MEASUREMENTS We retrospectively analysed the data of all 461 (410 without anti-Tg-antibodies [TgAbs], 51 with) DTC patients who were referred to our department for treatment and follow-up care of differentiated thyroid cancer from 2004 onwards, and in whom at least one posttreatment Tg value was measured in our hospital at least 3 months after I-131 ablation. RESULTS In the group of TgAb-negative patients, 2.0% of patients with an unstimulated Tg < 0.1 ng/ml showed a stimulated Tg ≥ 1.0 ng/ml, whereas this happened in 77.6% with an unstimulated Tg ≥ 0.1 but <1.0 ng/ml. An unstimulated hsTg ≥ 0.1 ng/ml had a sensitivity specificity positive and negative predictive value of 90.0%, 94.1%, 77.6% and 97.6%, respectively, for a stimulated Tg ≥ 1.0 ng/ml. In TgAb-positive patients, this was 75%, 97%, 75% and 97%, respectively. An unstimulated Tg ≥ 0.1 ng/ml did not significantly discriminate with regard to the risk of DTC-related death (p = .06), but ≥1.0 ng/ml did (p = .012), as did a stimulated Tg ≥ 1.0 ng/ml (p = .029). Excluding patients with distant metastases at diagnosis nullifies this significance. CONCLUSION Except for patients with distant metastases, both TgAb negative and TgAb positive patients with an undetectable nonstimulated hsTg measurement have a very good prognosis. The high net present value of unstimulated hsTg testing means that further diagnostic procedures can be omitted in such patients.
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Affiliation(s)
| | - Luca Giovanella
- Department of Nuclear Medicine and PET-Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Thomas Stief
- Department of Laboratory Medicine, University Hospital Marburg, Marburg, Germany
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Frederik A Verburg
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Garo ML, Campennì A, Petranovic-Ovcaricek P, D’Aurizio F, Giovanella L. Evolution of thyroid cancer biomarkers: from laboratory test to patients’ clinical management. Clin Chem Lab Med 2022; 61:935-945. [PMID: 36370420 DOI: 10.1515/cclm-2022-1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Over the past three decades, laboratory medicine has significantly evolved thanks to technological advances made possible by new materials and evidence. Clinicians’ ongoing requests for powerful, rapid, and minimally invasive tests has led manufacturers to develop rapid, accurate, and sensitive tests that can increase diagnostic accuracy and improve follow-up, bringing laboratory medicine ever closer to personalized medicine. The aim of this study was to critically review the main problems of the current Tg and CT biomarkers for the diagnosis/monitoring of DTC and MTC, respectively, and to identify the advantages and challenges of using the new laboratory biomarkers in the clinical management of patients with differentiated and medullary thyroid cancer. Insufficient harmonization of Tg and CT assays and lack of interchangeability of laboratory results and cutoff values pose challenges for comparability and standardization of procedures and methods. New diagnostic and monitoring approaches such as PCT or the Tg doubling time have proven to be effective. Close collaboration between clinicians and laboratory specialists remains essential to translate the advantages and limitations of current assays into appropriate clinical interpretation criteria. Over the years, the journal Clinical Chemistry and Laboratory Medicine (CCLM) has taken many steps to develop advanced research and technology in the diagnosis and monitoring of tumor cancer and to help clinicians translate it into clinical practice.
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Affiliation(s)
| | - Alfredo Campennì
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging , University of Messina , Messina , Italy
| | - Petra Petranovic-Ovcaricek
- Department of Oncology and Nuclear Medicine , University Hospital Center Sestre Milosrdnice , Zagreb , Croatia
| | - Federica D’Aurizio
- Department of Laboratory Medicine , Institute of Clinical Pathology, Santa Maria della Misericordia University Hospital , Udine , Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale , Bellinzona , Switzerland
- Clinic for Nuclear Medicine, University Hospital of Zürich , Zürich , Switzerland
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Leitão C, Pereira SO, Marques C, Cennamo N, Zeni L, Shaimerdenova M, Ayupova T, Tosi D. Cost-Effective Fiber Optic Solutions for Biosensing. BIOSENSORS 2022; 12:575. [PMID: 36004971 PMCID: PMC9405647 DOI: 10.3390/bios12080575] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 05/13/2023]
Abstract
In the last years, optical fiber sensors have proven to be a reliable and versatile biosensing tool. Optical fiber biosensors (OFBs) are analytical devices that use optical fibers as transducers, with the advantages of being easily coated and biofunctionalized, allowing the monitorization of all functionalization and detection in real-time, as well as being small in size and geometrically flexible, thus allowing device miniaturization and portability for point-of-care (POC) testing. Knowing the potential of such biosensing tools, this paper reviews the reported OFBs which are, at the moment, the most cost-effective. Different fiber configurations are highlighted, namely, end-face reflected, unclad, D- and U-shaped, tips, ball resonators, tapered, light-diffusing, and specialty fibers. Packaging techniques to enhance OFBs' application in the medical field, namely for implementing in subcutaneous, percutaneous, and endoscopic operations as well as in wearable structures, are presented and discussed. Interrogation approaches of OFBs using smartphones' hardware are a great way to obtain cost-effective sensing approaches. In this review paper, different architectures of such interrogation methods and their respective applications are presented. Finally, the application of OFBs in monitoring three crucial fields of human life and wellbeing are reported: detection of cancer biomarkers, detection of cardiovascular biomarkers, and environmental monitoring.
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Affiliation(s)
- Cátia Leitão
- i3N, Department of Physics, University of Aveiro, 3810-193 Aveiro, Portugal; (S.O.P.); (C.M.)
| | - Sónia O. Pereira
- i3N, Department of Physics, University of Aveiro, 3810-193 Aveiro, Portugal; (S.O.P.); (C.M.)
| | - Carlos Marques
- i3N, Department of Physics, University of Aveiro, 3810-193 Aveiro, Portugal; (S.O.P.); (C.M.)
| | - Nunzio Cennamo
- Department of Engineering, University of Campania Luigi Vanvitelli, Via Roma 29, 81031 Aversa, Italy; (N.C.); (L.Z.)
| | - Luigi Zeni
- Department of Engineering, University of Campania Luigi Vanvitelli, Via Roma 29, 81031 Aversa, Italy; (N.C.); (L.Z.)
| | - Madina Shaimerdenova
- School of Engineering and Digital Sciences, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.S.); (T.A.)
| | - Takhmina Ayupova
- School of Engineering and Digital Sciences, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.S.); (T.A.)
| | - Daniele Tosi
- School of Engineering and Digital Sciences, Nazarbayev University, Nur-Sultan 010000, Kazakhstan; (M.S.); (T.A.)
- Laboratory of Biosensors and Bioinstruments, National Laboratory Astana, Nur-Sultan 010000, Kazakhstan
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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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12
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Chou R, Dana T, Brent GA, Goldner W, Haymart M, Leung AM, Ringel MD, Sosa JA. Serum Thyroglobulin Measurement Following Surgery Without Radioactive Iodine for Differentiated Thyroid Cancer: A Systematic Review. Thyroid 2022; 32:613-639. [PMID: 35412871 PMCID: PMC11265617 DOI: 10.1089/thy.2021.0666] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: The utility of serum thyroglobulin (Tg) measurement following partial thyroidectomy or total/near-total thyroidectomy without radioactive iodine (RAI) for differentiated thyroid cancer is unclear. This systematic review examines the diagnostic accuracy of serum Tg measurement for persistent, recurrent, and/or metastatic cancer in these situations. Methods: Ovid MEDLINE, Embase, and Cochrane Central were searched in October 2021 for studies on Tg measurement following partial thyroidectomy or total/near-total thyroidectomy without or before RAI. Quality assessment was performed, and evidence was synthesized qualitatively. Results: Thirty-seven studies met inclusion criteria. Four studies (N = 561) evaluated serum Tg measurement following partial thyroidectomy, five studies (N = 751) evaluated Tg measurement following total/near-total thyroidectomy without RAI, and 28 studies (N = 7618) evaluated Tg measurement following total or near-total thyroidectomy before RAI administration. Following partial thyroidectomy, Tg measurement was not accurate for diagnosing recurrence or metastasis, or estimates were imprecise. Following total/near-total thyroidectomy without RAI, evidence was limited due to few studies with very low rates of recurrence or metastasis, but indicated that Tg levels were usually stable and low. For Tg measurements before RAI administration, diagnostic accuracy for metastatic disease or persistence varied, although sensitivity appeared high (but specificity low) at a cutoff of >1 to 2.5 ng/mL. However, applicability to patients who do not undergo RAI is uncertain because patients selected for RAI are likely to represent a higher risk group. The evidence was very low quality for all scenarios. All studies had methodological limitations, and there was variability in the Tg thresholds evaluated, patient populations, outcomes assessed, and other factors. Conclusions: Very limited evidence suggests low utility of Tg measurement for identifying recurrent or metastatic disease following partial thyroidectomy. Following total/near-total thyroidectomy, Tg levels using a cutoff of 1-2.5 ng/mL might identify patients at low risk for persistent or metastatic disease. Additional research is needed to clarify the role of Tg measurement in these settings, determine optimal Tg thresholds, and determine appropriate measurement intervals.
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Affiliation(s)
- Roger Chou
- The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Tracy Dana
- The Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Gregory A. Brent
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Whitney Goldner
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Megan Haymart
- Division of Metabolism, Endocrinology, and Diabetes and Hematology/Oncology; University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Angela M. Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Matthew D. Ringel
- Divison of Endocrinology, Diabetes, and Metabolism and Cancer Biology Program, The Ohio State University College of Medicine and Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California, USA
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13
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Giovanella L, Ceriani L, Garo ML. Is thyroglobulin a reliable biomarker of differentiated thyroid cancer in patients treated by lobectomy? A systematic review and meta-analysis. Clin Chem Lab Med 2022; 60:1091-1100. [PMID: 35475431 DOI: 10.1515/cclm-2022-0154] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/19/2022] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The prognostic role of thyroglobulin in predicting recurrence in differentiated thyroid cancer (DTC) patients treated by lobectomy is controversial. This systematic review with meta-analysis aimed to update the current evidence deepening the reliability of circulating thyroglobulin in assessing the early response and in predictive recurrence. METHODS The methodology was registered in the PROSPERO database under the protocol number CRD42021288189. A systematic search was carried out on PubMed, Embase, Web of Science, and Scopus from September to November 2021 without time and language restrictions. The literature search strategy was based on the following keywords: Thyroglobulin AND (Lobectomy OR Hemithyroidectomy). RESULTS After screening 273 articles, seven studies were included in the systematic review, and only six of them were included in the meta-analysis for a total of 2,455 patients. Circulating thyroglobulin was found non-reliable in assessing early response and predicting recurrence in patients with hemithyroidectomy, especially those with a low initial ATA classification. CONCLUSIONS Our study does not support serum thyroglobulin levels for monitoring patients with low-risk DTC treated with lobectomy, and weak evidence supports its role for intermediate- or high-risk patients. Studies with longer follow-up, different study designs, and stringent inclusion/exclusion criteria are needed to evaluate the role of thyroglobulin in recurrence prediction.
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Affiliation(s)
- Luca Giovanella
- Clinic for Nuclear Medicine and Thyroid Centre, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Clinic for Nuclear Medicine and Thyroid Centre, University Hospital of Zürich, Zürich, Switzerland
| | - Luca Ceriani
- Clinic for Nuclear Medicine and Thyroid Centre, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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14
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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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15
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Sun YQ, Sun D, Zhang X, Zhang YQ, Lin YS. Radioiodine adjuvant therapy in differentiated thyroid cancer: An update and reconsideration. Front Endocrinol (Lausanne) 2022; 13:994288. [PMID: 36531486 PMCID: PMC9747769 DOI: 10.3389/fendo.2022.994288] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/07/2022] [Indexed: 12/02/2022] Open
Abstract
Radioiodine (131I) therapy (RAI) has been utilized for treating differentiated thyroid cancer (DTC) for decades, and its uses can be characterized as remnant ablation, adjuvant therapy (RAT) or treatment for known diseases. Compared with the definite 131I treatment targets for remnant ablation and known disease, 131I adjuvant therapy (RAT) aims to reduce the risk of recurrence by destroying potential subclinical disease. Since it is merely given as a risk with no imaging confirmation of persistence/recurrence/metastases, the evidence is uncertain. With limited knowledge and substance, the indication for RAT remains poorly defined for everyday clinical practice, and the benefits of RAT remain controversial. This ambiguity results in a puzzle for clinicians seeking clarity on whether patients should receive RAT, and whether patients are at risk of recurrence/death from undertreatment or adverse events from overtreatment. Herein, we clarified the RAT indications in terms of clinicopathological features, postoperative disease status and response to therapy evaluation, and retrospectively examined the clinical outcomes of RAT as reported in current studies and guidelines. Furthermore, given the evolution of nuclear medicine imaging techniques, it can be expected that the future of RAT may be advanced by nuclear medicine theranostics (i.e., 131I whole-body scan, PET/CT) by accurately revealing the biological behaviors, as well as the underlying molecular background.
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16
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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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17
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Zahra HO, Omran GA, Gewely AG, Eldehn AF, Abdo W, Elmahallawy EK, Okda TM. Prognostic Value of Serum Thyroglobulin and Anti-Thyroglobulin Antibody in Thyroid Carcinoma Patients following Thyroidectomy. Diagnostics (Basel) 2021; 11:diagnostics11112080. [PMID: 34829426 PMCID: PMC8622548 DOI: 10.3390/diagnostics11112080] [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: 08/30/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022] Open
Abstract
Well-differentiated thyroid cancer (WDTC) is a malignant head and neck tumor with a very high incidence. Thyroidectomized WDTC patients have been referred to nuclear medicine for radioactive iodine (RAI) ablation therapy and/or annual follow-up with diagnostic whole-body imaging. Serum thyroglobulin (TG) and thyroglobulin antibodies (TGAb) are biochemical tumor markers used to monitor WDTC. A global rise in the prevalence of WDTC is increasing the number of thyroidectomized patients requiring lifelong monitoring for persistent or recurrent diseases. The present study aimed to identify the most successful prognostic factors in well-defined thyroid carcinoma patients following total thyroidectomy and RAI therapy, followed by an estimation of the cutoff value of TG and TGAb. In this context, a total of 100 subjects were recruited and classified as follows: 60 thyroid carcinoma patients underwent total thyroidectomy and successful RAI therapy, while 40 normal healthy individuals matched for age, sex, and socioeconomic status constituted the control group. Interestingly, the levels of TG did not differ significantly between the relapsed and non-relapsed cases, but the levels of TGAb differed significantly between the relapsed and non-relapsed cases. Collectively, TG and TGAb are considered the most successful prognostic factors in well-defined thyroid carcinoma patients after total thyroidectomy and RAI therapy. The present study also concluded that the TGAb determination was better than that of the TG level, with a cutoff value of 10 ng/mL. These findings provide baseline information for follow-up and lifelong monitoring of thyroidectomized WDTC patients. Further research is warranted to explore more about serum TG and TGAb in thyroid carcinoma patients on a larger scale.
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Affiliation(s)
- Hashem O. Zahra
- Department of Biochemistry, Faculty of Pharmacy, Damanhour University, Damanhour 22511, Egypt; (H.O.Z.); (G.A.O.); (T.M.O.)
| | - Gamal A. Omran
- Department of Biochemistry, Faculty of Pharmacy, Damanhour University, Damanhour 22511, Egypt; (H.O.Z.); (G.A.O.); (T.M.O.)
| | - Ahmed G. Gewely
- Department of Oncology Medicine, Faculty of Medicine, Alexandria University, Alexandria 21111, Egypt;
| | - Ahmed Fathy Eldehn
- Department of Otorhinolaryngology, Kasr Al-Ainy Medical School, Cairo University, Cairo 12613, Egypt;
| | - Walied Abdo
- Department of Pathology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh 35516, Egypt;
| | - Ehab Kotb Elmahallawy
- Department of Zoonoses, Faculty of Veterinary Medicine, Sohag University, Sohag 82524, Egypt
- Correspondence:
| | - Tarek M. Okda
- Department of Biochemistry, Faculty of Pharmacy, Damanhour University, Damanhour 22511, Egypt; (H.O.Z.); (G.A.O.); (T.M.O.)
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18
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Knappe L, Giovanella L. Life after thyroid cancer: the role of thyroglobulin and thyroglobulin antibodies for postoperative follow-up. Expert Rev Endocrinol Metab 2021; 16:273-279. [PMID: 34693849 DOI: 10.1080/17446651.2021.1993060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/11/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Differentiated thyroid carcinomas (DTCs) are treated with (near-)total thyroidectomy and radioiodine therapy. Recently, the use of highly sensitive thyroglobulin (hsTg) assays has simplified DTC follow-up and improved patients' quality of life. More limited approaches are currently applied in low-risk patients requiring interpretations of Tg results in different clinical scenarios. Finally, Tg assays are hampered by interference from thyroglobulin autoantibodies (TgAb). AREAS COVERED The role of Tg measurement in DTC patients treated with complete thyroid ablation, thyroidectomy alone, or lobectomy is summarized. The management of patients carrying positive TgAb is also addressed. EXPERT OPINION Patients with undetectable hsTg after total thyroid ablation are safely managed by periodic hsTg measurement, combined with selective use of imaging procedures in few cases. Serum hsTg trend remains informative in patients treated without radioiodine ablation. However, reliable reference values are urgently needed in this setting. The role of hsTg is debated in patients who have undergone lobectomy due to the amount of Tg released by a functioning thyroid lobe. The evaluation of TgAb trend over time (i.e. surrogate tumor marker) is recommended in patients with positive TgAb and potentially interfering Tg results.
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Affiliation(s)
- Luisa Knappe
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital of Bern, Bern, Switzerland
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital of Zürich, Zürich, Switzerland
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19
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Sol B, Bravenboer B, Velkeniers B, Raeymaeckers S, Keyaerts M, Andreescu CE. Undetectable thyroglobulin makes 123I whole-body scan and stimulated thyroglobulin obsolete in follow-up care of differentiated thyroid cancer: a retrospective study. Thyroid Res 2021; 14:23. [PMID: 34666793 PMCID: PMC8524885 DOI: 10.1186/s13044-021-00114-0] [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: 05/31/2021] [Accepted: 09/30/2021] [Indexed: 11/15/2022] Open
Abstract
Background Differentiated thyroid cancer (DTC) is a common malignancy with increasing incidence. Follow-up care for DTC includes thyroglobulin (Tg) measurement and ultrasound (US) of the neck, combined with 131I remnant ablation when indicated. Diagnostic precision has evolved with the introduction of the new high-sensitive Tg-assays (sensitivity ≤0.1 ng/mL). The aim of the study was to determine the prognostic utility of high-sensitive Tg and the need for other diagnostic tests in DTC. Methods This was a retrospective, observational study. Patients with pathologically confirmed DTC, treated with total thyroidectomy and 131I remnant ablation, who had their complete follow-up care in our institution were selected (October 2013–December 2018). Subjects with possible thyroglobulin autoantibody interference were excluded. Statistical analysis was performed using the IBM SPSS® Statistics 24 software package. Results Forty patients were eligible for analysis. A total of 24 out of the 40 patients (60%) had an undetectable high-sensitive Tg 6 months after total thyroidectomy. None of these patients had a stimulated Tg above 1 ng/mL, or remnant on the 123I Whole-Body Scan (WBS) after 1 year of follow-up. Ultrasound of the neck, performed between 6 and 12 months postoperative, was negative in 21 out of the 24 patients. Conclusions This study shows that an undetectable high-sensitive Tg can change the management of patients with DTC and decrease the use and need of stimulated Tg and 123I WBS.
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Affiliation(s)
- Bastiaan Sol
- Department of Endocrinology, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Bert Bravenboer
- Department of Endocrinology, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Brigitte Velkeniers
- Department of Endocrinology, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Steven Raeymaeckers
- Department of Radiology, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Marleen Keyaerts
- Department of Nuclear Medicine, UZ Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
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20
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Fröhlich E, Wahl R. Nanoparticles: Promising Auxiliary Agents for Diagnosis and Therapy of Thyroid Cancers. Cancers (Basel) 2021; 13:cancers13164063. [PMID: 34439219 PMCID: PMC8393380 DOI: 10.3390/cancers13164063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Thyroid cancer (TC) is rare relative to cancers of many other organs (breast, prostate, lung, and colon). The majority of TCs are differentiated tumors that are relatively easy to treat and have a good prognosis. However, for anaplastic TC, a rapidly growing and aggressive tumor, treatment is suboptimal because the effective drugs cause severe adverse effects. Drug delivery by nanocarriers can improve treatment by reducing side effects. This can either be mediated through better retention in the tumor tissue due to size (passive targeting) or through the attachment of specific molecules that zero in on the cancer cells (active targeting). Nanoparticles are already used for diagnosis and imaging of TC. For unresectable anaplastic TC, nanoparticle-based treatments, less suitable for deeply located cancers, could be useful, based on low-intensity focused ultrasound and near-infrared irradiation. All potential applications of nanoparticles in TC are still in the preclinical phase. Abstract Cancers of the endocrine system are rare. The majority are not highly malignant tumors. Thyroid cancer (TC) is the most common endocrine cancer, with differentiated papillary and follicular tumors occurring more frequently than the more aggressive poorly differentiated and anaplastic TC. Nanoparticles (NP) (mainly mesoporous silica, gold, carbon, or liposomes) have been developed to improve the detection of biomarkers and routine laboratory parameters (e.g., thyroid stimulating hormone, thyroglobulin, and calcitonin), tumor imaging, and drug delivery in TC. The majority of drug-loaded nanocarriers to be used for treatment was developed for anaplastic tumors because current treatments are suboptimal. Further, doxorubicin, sorafenib, and gemcitabine treatment can be improved by nanotherapy due to decreased adverse effects. Selective delivery of retinoic acid to TC cells might improve the re-differentiation of de-differentiated TC. The use of carbon NPs for the prevention of parathyroid damage during TC surgery does not show a clear benefit. Certain technologies less suitable for the treatment of deeply located cancers may have some potential for unresectable anaplastic carcinomas, namely those based on low-intensity focused ultrasound and near-infrared irradiation. Although some of these approaches yielded promising results in animal studies, results from clinical trials are currently lacking.
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Affiliation(s)
- Eleonore Fröhlich
- Center for Medical Research, Medical University Graz, 8036 Graz, Austria;
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Richard Wahl
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tuebingen, 72076 Tuebingen, Germany
- Correspondence: ; Tel.: +49-7071-2983136
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21
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Design and validation of fiber optic localized surface plasmon resonance sensor for thyroglobulin immunoassay with high sensitivity and rapid detection. Sci Rep 2021; 11:15985. [PMID: 34362953 PMCID: PMC8346482 DOI: 10.1038/s41598-021-95375-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022] Open
Abstract
A simple optical fiber sensor based on localized surface plasmon resonance was constructed for direct and rapid measurement of thyroglobulin (Tg). Specific tests for Tg in patients that have undergone thyroidectomy are limited because of insufficient sensitivity, complicated procedures, and in some cases, a long time to yield a result. A sensitive, fast, and simple method is necessary to relieve the psychological and physical burden of the patient. Various concentrations of Tg were measured in a microfluidic channel using an optical fiber sensor with gold nanoparticles. The sensor chip has a detection limit of 93.11 fg/mL with no specificity for other antigens. The potential applicability of the Tg sensing system was evaluated using arbitrary samples containing specific concentrations of Tg. Finally, the sensor can be employed to detect Tg in the patient’s serum, with a good correlation when compared with the commercial kit.
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22
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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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Szujo S, Bajnok L, Bodis B, Nagy Z, Nemes O, Rucz K, Mezosi E. The Prognostic Role of Postablative Non-Stimulated Thyroglobulin in Differentiated Thyroid Cancer. Cancers (Basel) 2021; 13:cancers13020310. [PMID: 33467717 PMCID: PMC7830405 DOI: 10.3390/cancers13020310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/03/2022] Open
Abstract
Simple Summary In the management of patients with differentiated thyroid cancer, thyroglobulin (Tg) is used as a tumor marker to predict residual disease. After surgery, the presence or absence of persistent disease and the risk for recurrent disease should be assessed. Risk categories may be changed during the course of disease; the reclassification of patients influences the management of the disease and the intensity of follow-up. The diagnostic and prognostic roles of postoperative stimulated and one-year postablative non-stimulated Tg was evaluated. The individual lowest and highest non-stimulated Tg values during the entire follow-up were also assessed. Non-stimulated Tg values had excellent diagnostic accuracy in predicting structural disease, and the risk classification based on these was significantly more accurate regarding outcome than that based on the postoperative stimulated Tg. Analysis of the lowest and highest Tg values highlighted that a patient’s risk category can be revised based on a single Tg measurement. Abstract Thyroglobulin (Tg) is the most important tumor marker in differentiated thyroid cancer (DTC). The aim of this study was to assess the diagnostic and prognostic roles of postoperative stimulated and postablative lowest, highest, and one-year non-stimulated Tg values obtained during the follow-up of patients with DTC. In this retrospective study, 222 radioiodine-treated, anti-thyroglobulin antibody (TgAb)-negative DTC patients having at least 9 months’ follow-up time were included (172 papillary and 50 follicular cancers; median age: 48 (from 15 to 91) years; female–male ratio: 158/64; median (quartiles) follow-up time: 54 (22–97) months). The 2015 American Thyroid Association guidelines were applied as criteria of the therapeutic response. Postoperative stimulated Tg values had significantly lower diagnostic accuracy than any of the non-stimulated postablative Tg values. One-year non-stimulated Tg had excellent prognostic value for structural disease: a cut-off value of 0.85 ng/mL had an 88.1% diagnostic accuracy. If the Tg value did not decrease below 0.75 ng/mL at any time during follow-up, the risk of residual disease was 25 times higher. The highest non-stimulated Tg during follow-up was the best predictor of residual disease (e.g., a Tg value exceeding 7.7 ng/mL indicated a 30-fold increase in risk). Non-stimulated Tg values measured during follow-up have excellent diagnostic accuracy to predict structural disease in DTC patients. The risk classification of a patient can safely be modified based on even a single Tg measurement.
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Affiliation(s)
- Szabina Szujo
- Ist Department of Medicine, Medical School, University of Pecs, 13 Ifjusag, H-7624 Pecs, Hungary; (S.S.); (L.B.); (B.B.); (O.N.); (K.R.)
| | - Laszlo Bajnok
- Ist Department of Medicine, Medical School, University of Pecs, 13 Ifjusag, H-7624 Pecs, Hungary; (S.S.); (L.B.); (B.B.); (O.N.); (K.R.)
| | - Beata Bodis
- Ist Department of Medicine, Medical School, University of Pecs, 13 Ifjusag, H-7624 Pecs, Hungary; (S.S.); (L.B.); (B.B.); (O.N.); (K.R.)
| | - Zsuzsanna Nagy
- IInd Department of Medicine and Nephrological Center, Medical School, University of Pecs, 1 Pacsirta, H-7624 Pecs, Hungary;
| | - Orsolya Nemes
- Ist Department of Medicine, Medical School, University of Pecs, 13 Ifjusag, H-7624 Pecs, Hungary; (S.S.); (L.B.); (B.B.); (O.N.); (K.R.)
| | - Karoly Rucz
- Ist Department of Medicine, Medical School, University of Pecs, 13 Ifjusag, H-7624 Pecs, Hungary; (S.S.); (L.B.); (B.B.); (O.N.); (K.R.)
| | - Emese Mezosi
- Ist Department of Medicine, Medical School, University of Pecs, 13 Ifjusag, H-7624 Pecs, Hungary; (S.S.); (L.B.); (B.B.); (O.N.); (K.R.)
- Szentagothai Research Centre, University of Pecs, 20 Ifjusag, H-7624 Pecs, Hungary
- Correspondence: ; Tel.: +36-30-565-4155; Fax: +36-72-536-148
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Donohoe KJ, Aloff J, Avram AM, Bennet KG, Giovanella L, Greenspan B, Gulec S, Hassan A, Kloos RT, Solórzano CC, Stack BC, Tulchinsky M, Tuttle RM, Van Nostrand D, Wexler JA. Appropriate Use Criteria for Nuclear Medicine in the Evaluation and Treatment of Differentiated Thyroid Cancer. J Nucl Med 2020; 61:375-396. [PMID: 32123131 DOI: 10.2967/jnumed.119.240945] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- Kevin J Donohoe
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | | | - Anca M Avram
- American College of Nuclear Medicine, Reston, Virginia
| | - K G Bennet
- American College of Nuclear Medicine, Reston, Virginia
| | | | | | - Seza Gulec
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Aamna Hassan
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | | | | | | | - Mark Tulchinsky
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
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25
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Souza SS, Alameer ES, Kandil E, Lee GS. METASTATIC THYROID CANCER IN A MAN WITH TUMOR-FREE THYROID. AACE Clin Case Rep 2020; 6:e225-e229. [PMID: 32984526 DOI: 10.4158/accr-2019-0464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 04/20/2020] [Indexed: 12/18/2022] Open
Abstract
Objective The objective of this report is to emphasize the importance of considering thyroid cancer in the differential diagnosis, when the origin of a metastatic boney lesion is indeterminate. Methods Diagnostic studies performed included a thyroid function test, an ultrasound, and a computed tomography (CT) scan of the neck, biopsies of the bone, and thyroid lesions. Results A 61-year-old man was found to have incidental sclerotic bone lesions in the lumbar region on CT scan performed in the setting of a prostate abscess induced sepsis. The bone biopsy suggested metastatic follicular thyroid carcinoma. Imaging studies of the neck showed markedly enlarged left greater than right thyroid nodules. A surgical specimen from the staged total thyroidectomy showed no evidence of thyroid malignancy, despite a thorough review of microscopic tissue sections at 5 μm. A whole body scan 2-months after radioactive iodine therapy demonstrated persistent uptake in the metastatic lesion at L4 and interval progression of widely metastatic disease. Conclusion Metastatic thyroid cancer may be present without a histopathologic evidence of thyroid malignancy, albeit rarely. When the origin of a metastatic boney lesion is unclear, thyroid cancer should be included in the differential diagnosis.
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Affiliation(s)
- Spenser S Souza
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
| | - Ehab S Alameer
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
| | - Emad Kandil
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
| | - Grace S Lee
- Tulane University School of Medicine, Department of Surgery, New Orleans, Louisiana
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26
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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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27
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Circulating biomarkers for the detection of tumor recurrence in the postsurgical follow-up of differentiated thyroid carcinoma. Curr Opin Oncol 2020; 32:7-12. [PMID: 31599768 DOI: 10.1097/cco.0000000000000588] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW To discuss advances and challenges in thyroglobulin and Tg-antibody (TgAb) measurement and their impact on clinical management of differentiated thyroid carcinoma (DTC). RECENT FINDINGS Basal high-sensitive Tg (hsTg) measurement avoids the need for stimulation and greatly simplifies DTC patients' management. In addition, patients with undetectable hsTg after thyroid ablation are at a very low risk of recurrence and can be safely managed by periodic hsTg measurement alone. When TgAb is present, its trend over time serves as primary (surrogate) tumor marker. However, an undetectable hsTg measurement appears to indicate a complete remission of DTC even in the presence of TgAb. Finally, reliable reference values are not yet available for low-risk DTC who are treated with less than total thyroid ablation, and caution is needed before well-designed studies addressing these issues have been published. SUMMARY The use of hsTg assays has changed paradigms for DTC monitoring even in the presence of TgAb, and greatly reduced patients' discomfort and overall case-management costs. Reliable Tg interpretation criteria are urgently needed for patients treated with less than total thyroid ablation.
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28
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Scappaticcio L, Trimboli P, Verburg FA, Giovanella L. Significance of "de novo" appearance of thyroglobulin antibodies in patients with differentiated thyroid cancer. Int J Biol Markers 2020; 35:41-49. [PMID: 33073682 DOI: 10.1177/1724600820931517] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Clinical and laboratory guidelines recommend thyroglobulin antibodies (TgAbs) measurement with every thyroglobulin (Tg) measurement for the follow-up of differentiated thyroid cancer (DTC) patients. However, no evidence exists on the need for perpetual TgAbs testing in patients who are TgAb-negative at baseline. Our study was carried out to evaluate the prevalence, the dynamic changes, and the clinical significance of TgAbs that appeared de novo during the follow-up of DTC patients who were TgAb-negative at baseline. METHODS The data of DTC patients with negative pre-ablation TgAbs were reviewed retrospectively. The main characteristics of patients with both transient and sustained de novo TgAbs appearance were analyzed. DTC patients with persistently negative TgAbs served as controls. RESULTS Among 119 patients with pre-ablation negative TgAbs, 14 cases (11.7%) with de novo TgAbs appearance (10 and 4 patients with a transient and sustained de novo TgAbs appearance, respectively) were detected. No differences in disease-free survival were observed in patients with de novo TgAbs appearance compared to controls. The TgAbs peak value was higher in patients with sustained de novo appearance compared to patients with transient de novo. Two of 14 patients with de novo TgAbs developed structural disease with concurrently detectable Tg in both cases. CONCLUSIONS Transient de novo TgAbs appearance is not infrequent during DTC patients' follow-up, and it has no apparent clinical impact. Sustained de novo TgAbs appearance is rare and may predict structural recurrences; however, similar disease-free survival was observed in patients with sustained de novo TgAbs and TgAb-negative DTC patients.
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Affiliation(s)
- Lorenzo Scappaticcio
- Unit of Endocrinology and Metabolic Diseases, University of Campania "L. Vanvitelli," Naples, Italy.,Clinic for Nuclear Medicine and Competence Centre for Thyroid Disease, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Disease, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano (Switzerland)
| | - Frederik A Verburg
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Disease, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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29
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Giovanella L, Castellana M, Trimboli P. Unstimulated high-sensitive thyroglobulin is a powerful prognostic predictor in patients with thyroid cancer. Clin Chem Lab Med 2020; 58:130-137. [PMID: 31444962 DOI: 10.1515/cclm-2019-0654] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/30/2019] [Indexed: 02/01/2023]
Abstract
Background Differentiated thyroid carcinoma (DTC) has an excellent prognosis and the role of high-sensitive thyroglobulin measured during levothyroxine (ON-T4 hs-Tg) testing to discriminate patients with structural from not-evidence of disease (SED and NED, respectively) has been investigated. We conducted a systematic review and meta-analysis evaluating the performance of ON-T4 hs-Tg in two clinical scenarios considering its negative predictive value (NPV) as primary outcome: (1) diagnostic performance of Tg when undetectable value and NED status are simultaneously demonstrated; (2) prognostic performance of undetectable Tg in predicting NED in the subsequent follow-up. Methods This systematic review and meta-analysis were registered on PROSPERO (CRD42019125092). PubMed, Scopus, CENTRAL and Web of Science were searched until February 12, 2019. Original articles reporting data on SED/NED in patients with detectable/undetectable ON-T4 hs-Tg were selected. Summary operating points were estimated using a random-effects model. Results Out of 1413 retrieved papers, 10 studies evaluating 1796 patients were included. Participants were outpatients diagnosed with DTC, treated with near-total (NTx) or total thyroidectomy (TTx) with or without radioactive iodine (RAI). The NPV of ON-T4 hs-Tg for diagnostic and prognostic performance was 99.4% (95% CI 98.9-99.9; I2 = 13%) and 99.4% (95% CI 98.8-100; I2 = 0%), respectively. Conclusions Our findings show that ON-T4 hs-Tg is an excellent diagnostic tool and prognostic factor to rule-out SED. A high level of evidence is provided to decrease the intensity and frequency of follow-up in those DTC patients having undetectable high-sensitive Tg.
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Affiliation(s)
- Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Laboratory for Endocrinology and Tumour Markers, Department of Laboratory Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Clinic for Nuclear Medicine, University Hospital and University of Zürich, Zürich, Switzerland, Phone: +41-91-811 86 72, Fax: +41-91-811 85 20
| | - Marco Castellana
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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30
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Comparison of Thyroglobulin Concentrations Measured by Two Immunoradiometric Assay. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020. [DOI: 10.2478/sjecr-2018-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Circulating thyroglobulin measurements is a highly specific test in the management of patients affected by differentiated thyroid cancer after total thyroidectomy, followed by radioiodine ablation. The aim of our study was to compare two thyroglobulinimmunoradiometric assays (INEP, Serbia and Cisbio Bioassays, France). Study included 42 patients of both genders with DTC. The subjects were on suppres¬sive doses of levothyroxine and followed up. Results showed concordance between the two assay methods for determining serum thyroglobulin for 39 (92.85%) patients. Statistical analysis showed that there was a direct correlation between two IRMA tests, with a positive correlation coefficient r=0.613 (p 0.05). We concluded that there is good agreement between the two thyroglobulin assays compared in this study.
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31
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Matrone A, Faranda A, Latrofa F, Gambale C, Stefani Donati D, Molinaro E, Agate L, Viola D, Piaggi P, Torregrossa L, Basolo F, Elisei R. Thyroglobulin Changes are Highly Dependent on TSH in Low-risk DTC Patients not Treated with Radioiodine. J Clin Endocrinol Metab 2020; 105:5845992. [PMID: 32453405 DOI: 10.1210/clinem/dgaa297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/22/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Low-risk differentiated thyroid cancer (DTC) is currently rarely treated with radioiodine (131I) to ablate the postoperative remnant. Therefore, the interpretation of the serum thyroglobulin (Tg) values should be reconsidered. The aim of our study was to evaluate the changes in Tg values during follow-up with regard to the changing values in thyroid stimulating hormone (TSH). MATERIALS AND METHODS We evaluated 271 low-risk DTC patients, treated with total thyroidectomy but not 131I. To be included, patients had to be negative for Tg antibodies and have at least 3 evaluations in our department. All patients were on levothyroxine (L-T4) therapy. RESULTS After a median follow-up of 73 months, the overall Tg values were stable, while TSH values slightly increased. Therefore, we pooled data of Tg and TSH from all evaluations and a significant positive correlation was demonstrated (R = 0.2; P < 0.01), and was also demonstrated when we performed the analysis using time-weighted values (R = 0.14; P = 0.02). Moreover, when dividing patients into 3 groups according to first postoperative Tg (Group A [Tg < 0.2 ng/ml], Group B [Tg 0.2-1 ng/ml], and Group C [Tg > 1 ng/ml]) most patients showed stable values of Tg at the end of follow-up but TSH variations had a clear impact on the changes in Tg among the groups. CONCLUSION We demonstrated that in low-risk DTC not treated with 131I, serum Tg remains substantially stable over time, and the variations observed were correlated with the concomitant variations of TSH levels, mainly due to the modification of LT-4 therapy performed according to the ongoing risk stratification.
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Affiliation(s)
- Antonio Matrone
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Alessio Faranda
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Francesco Latrofa
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Carla Gambale
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Delio Stefani Donati
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Eleonora Molinaro
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Laura Agate
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - David Viola
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Paolo Piaggi
- Phoenix Epidemiology and Clinical Research Branch National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Phoenix, Arizona
| | - Liborio Torregrossa
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Anatomic Pathology Section, University Hospital of Pisa, Pisa, Italy
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Anatomic Pathology Section, University Hospital of Pisa, Pisa, Italy
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
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Blažeković I, Romić M, Bosak Butković M, Šiško Markoš I, Gladić Nenadić V, Vidranski V, Petranović Ovčariček P, Krilić D, Varjačić T, Staničić J, Granić R, Punda M, Mihaljević I, Jukić T, Franceschi M. Thyroglobulin Measurement in Needle Aspiration for Detection of Recurrences and Neck Metastases in Patients with Differentiated Thyroid Carcinoma: Significance of Anti-Tg Antibodies. Acta Clin Croat 2020; 59:9-17. [PMID: 34219879 PMCID: PMC8212602 DOI: 10.20471/acc.2020.59.s1.01] [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] [Indexed: 11/24/2022] Open
Abstract
The worldwide incidence of differentiated thyroid cancer (DTC) has increased in recent decades, likely due to frequent use of cervical ultrasonography (US) and US-guided fine needle aspiration biopsy (FNA)., US is performed during follow-up after thyroidectomy, and US-guided FNA with cytology is used if suspicious cervical lymph nodes (LN) or thyroid bed masses are detected. Knowing that serum anti-Tg antibodies (sTgAb) affect the use of serum Tg (sTg) as a tumor marker, the aim of our study was to assess the usefulness of Tg determination in needle aspirates (FNA-Tg) in presence of sTgAb. This retrospective study included 149 patients with DTC and 159 aspirations of suspicious LN and thyroid bed masses. As expected, there was a negative correlation between sTg and sTgAb levels (p<0.05), while FNA-Tg levels had a positive correlation with FNA-TgAb levels (p<0.05). Furthermore, we found a positive correlation between sTg and FNA-Tg levels (p<0.05), but not between sTgAb and FNA-TgAb or sTgAb and FNA-Tg. In conclusion, these results show that FNA-Tg values were not affected by sTgAb and that FNA-Tg measurement were highly effective in detecting cervical DTC metastases. However, combined use with cytology is suggested for neck evaluation because cytology could reveal metastases from other tumor sites.
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Affiliation(s)
- Ivan Blažeković
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Matija Romić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Marija Bosak Butković
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Ines Šiško Markoš
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Vedrana Gladić Nenadić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Valentina Vidranski
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Petra Petranović Ovčariček
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Dražena Krilić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Tea Varjačić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Josip Staničić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Roko Granić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Marija Punda
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Ivan Mihaljević
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Tomislav Jukić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Maja Franceschi
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
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Piccardo A, Trimboli P, Bottoni G, Giovanella L. Radioiodine Ablation of Remaining Thyroid Lobe in Patients with Differentiated Thyroid Cancer Treated by Lobectomy: A Systematic Review and Metaanalysis. J Nucl Med 2020; 61:1730-1735. [PMID: 32332146 DOI: 10.2967/jnumed.120.244384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 03/28/2020] [Indexed: 11/16/2022] Open
Abstract
We aimed to conduct a systematic review and metaanalysis of studies reporting the performance of radioactive iodine (131I) therapy in differentiated thyroid cancer (DTC) patients requiring a completion treatment after lobectomy. We also evaluated the response to 131I therapy according to 2015 American Thyroid Association guidelines and the adverse events. Methods: A specific search strategy was designed to find articles evaluating the use of 131I in patients with evidence of DTC after lobectomy. PubMed, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science were searched. The search was updated until January 2020, without language restriction. Data were cross-checked and any discrepancy discussed. A proportion metaanalysis (with 95% confidence interval) was performed using the random-effects model. Metaregressions on 131I success were attempted. Results: The pooled success ablation rate was 69%, with better results in patients receiving a single administration of about 3.7 GBq; high heterogeneity was found (I2 test, 85%), and publication bias was absent (Egger test, P = 0.57). Incomplete structural responses were recorded in only 14 of 695 (2%) patients enrolled in our analysis. Incomplete biochemical responses were observed in 8%-24% of patients, with higher rates (24%) in patients receiving low radioiodine activities (∼1.1 GBq) and lower rates (8%-18%) in patients receiving higher activities of radioiodine (∼3.7 GBq). Neck pain due to thyroiditis was reported in up to 18% of patients, but in most cases, symptoms resolved after oral paracetamol or a short course of prednisone. Conclusion: Lobar ablation with 131I is effective, especially when high 131I activities are used. However, the rate of incomplete biochemical response to initial treatment appears to be slightly higher than in the classic scheme of initial treatment of DTC. Radioisotopic lobectomy should be considered for patients with low- to intermediate-risk DTC requiring completion treatment after lobectomy due to specific individual risk factors or patient preferences.
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Affiliation(s)
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Thyroid Centre, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; and
| | | | - Luca Giovanella
- Clinic for Nuclear Medicine and Thyroid Centre, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
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Hirokawa T, Arimasu Y, Nakazato Y, Chiba T, Fujiwara M, Kamma H. Effect of single-nucleotide polymorphism in TERT promoter on follicular thyroid tumor development. Pathol Int 2020; 70:210-216. [PMID: 31943533 DOI: 10.1111/pin.12893] [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: 10/03/2019] [Accepted: 12/10/2019] [Indexed: 01/21/2023]
Abstract
Follicular thyroid neoplasm is a common tumor, and consists of follicular thyroid adenoma (FTA) and carcinoma (FTC). The mechanisms of tumor development of FTA and FTC are not well-understood. Single-nucleotide polymorphisms (SNPs) and point mutations in the telomerase reverse transcriptase (TERT) promoter have been associated with tumor development of many cancers. In order to clarify the significance of TERT promoter SNPs and mutations, including rs2853669 (-245T>C), C228T, and C250T, we analyzed 59 FTA patients and 19 FTC patients. Rs2853669 was found in 67.8% (40/59) and 57.9% (11/19) of FTAs and FTCs, respectively, and homozygous rs2853669 (CC) was more frequently found in FTC than in FTA. Furthermore, in FTA, rs2853669 was significantly associated with tumor size greater than 2.0 cm (P < 0.05). C228T was found in 5.1% and 36.8% of FTAs and FTCs, respectively. Frequencies of rs2853669 or/and C228T mutation were 71.2% in FTAs and 73.7%, in FTCs, and were significantly associated with larger tumor sizes in FTAs (P < 0.05). Rs2853669 is considered to be associated with tumor development in FTA and FTC.
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Affiliation(s)
- Tatsuya Hirokawa
- Department of Pathology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Yuu Arimasu
- Department of Pathology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Yoko Nakazato
- Department of Respiratory and Thyroid Surgery, School of Medicine, Kyorin University, Tokyo, Japan
| | - Tomohiro Chiba
- Department of Pathology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Masachika Fujiwara
- Department of Pathology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Hiroshi Kamma
- Department of Pathology, School of Medicine, Kyorin University, Tokyo, Japan
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35
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Huang TY, Wang CY, Chen KY, Huang LT. Urinary Exosomal Thyroglobulin in Thyroid Cancer Patients With Post-ablative Therapy: A New Biomarker in Thyroid Cancer. Front Endocrinol (Lausanne) 2020; 11:382. [PMID: 32612576 PMCID: PMC7308545 DOI: 10.3389/fendo.2020.00382] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Most patients with thyroid cancer typically receive thyroidectomy with ablative radioactive iodine therapy. Such patients were followed with thyroid ultrasonography and serial serum thyroglobulin evaluation. Exosomes are nanovesicles secreted into extracellular environments, including plasma, saliva, urine, and other body fluids of patients with cancer. We try to find the early prognostic and exosomal biological markers of urine. Methods: We analyzed urinary exosomal proteins, including thyroglobulin and galectin-3, to identify early prognostic biological markers in urine for patients receiving operation and radioactive iodine ablative therapy. We enrolled sixteen newly diagnosed patients with papillary thyroid carcinoma and follicular thyroid carcinoma. We collect all patient's urine samples before operation, immediately after operation, post-operatively at three and six months (4 collections per patient). The levels of pre-operative and post-ablative of U-Ex Tg and galectin-3 in patients with thyroid cancer were measured. Results: Trends in urinary thyroglobulin concentrations in patients with post-ablative thyroid cancer were detected in the first sixteen patients. Importantly, serum thyroglobulin was not detected in five patients after operation and radioactive I-131 ablation, while U-Ex Tg still showed an increasing trend, which implicating the probable recurrence of thyroid cancer. This is the first study to evaluate whether U-Ex Tg is a future biological marker as a substitute for serum thyroglobulin. Conclusion: Our study have developed a brand-new evaluation for tracking thyroid cancer. The most useful scenario in using a test that is potentially more sensitive than existing serological testing is to eliminate the suspicion of recurrence and remove subjects from long term follow up. Trial Registration: ClinicalTrials.gov: NCT02862470; 5, August 2016. https://clinicaltrials.gov/ct2/show/NCT02862470?term=NCT02862470&rank=1. ClinicalTrials.gov: NCT03488134; 3, August 2018. https://clinicaltrials.gov/ct2/show/NCT03488134?term=NCT03488134&draw=2&rank=1.
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Affiliation(s)
- Tse-Ying Huang
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin/Hsin-Chu Branch, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Yuan Wang
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin/Hsin-Chu Branch, College of Medicine, National Taiwan University, Taipei, Taiwan
- *Correspondence: Chih-Yuan Wang ;
| | - Kuen-Yuan Chen
- Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Li-Ting Huang
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin/Hsin-Chu Branch, College of Medicine, National Taiwan University, Taipei, Taiwan
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Filetti S, Durante C, Hartl D, Leboulleux S, Locati LD, Newbold K, Papotti MG, Berruti A. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol 2019; 30:1856-1883. [PMID: 31549998 DOI: 10.1093/annonc/mdz400] [Citation(s) in RCA: 532] [Impact Index Per Article: 106.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
MESH Headings
- Humans
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/epidemiology
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/therapy
- Carcinoma, Neuroendocrine/diagnosis
- Carcinoma, Neuroendocrine/epidemiology
- Carcinoma, Neuroendocrine/pathology
- Carcinoma, Neuroendocrine/therapy
- Follow-Up Studies
- Thyroid Cancer, Papillary/diagnosis
- Thyroid Cancer, Papillary/epidemiology
- Thyroid Cancer, Papillary/pathology
- Thyroid Cancer, Papillary/therapy
- Thyroid Carcinoma, Anaplastic/diagnosis
- Thyroid Carcinoma, Anaplastic/epidemiology
- Thyroid Carcinoma, Anaplastic/pathology
- Thyroid Carcinoma, Anaplastic/therapy
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/therapy
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Affiliation(s)
- S Filetti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - C Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - D Hartl
- Department of Head and Neck Oncology, Gustave Roussy, Villejuif; Université Paris Saclay, Villejuif
| | - S Leboulleux
- Université Paris Saclay, Villejuif; Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, Villejuif, France
| | - L D Locati
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - K Newbold
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - M G Papotti
- Department of Pathology, University of Turin, Turin
| | - A Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology Unit, University of Brescia, ASST Spedali Civili, Brescia, Italy
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37
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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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38
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Role of thyroglobulin in the management of patients with differentiated thyroid cancer. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00325-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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39
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Santhanam P, Ladenson PW. Surveillance for Differentiated Thyroid Cancer Recurrence. Endocrinol Metab Clin North Am 2019; 48:239-252. [PMID: 30717906 DOI: 10.1016/j.ecl.2018.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Serum thyroglobulin monitoring along with anatomic and functional imaging play key roles in the surveillance of patients with differentiated thyroid cancer after initial treatment. Among patients with a disease stage justifying thyroid remnant ablation or with suspected metastatic disease, radioiodine whole-body scans are essential in the months after surgery. For patients with low to moderate-risk cancers, ultrasonography of the neck (with measurement of serum thyroglobulin on thyroid hormone replacement) are the best initial diagnostic modalities, and are often the only tests required. In individuals suspected of having distant metastases, CT, MRI, and 18F-FDG PET can make important contributions in localizing residual disease and monitoring its progression and responses to therapy, provided they are used in the appropriate setting.
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Affiliation(s)
- Prasanna Santhanam
- Division of Endocrinology, Metabolism and Diabetes, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Suite 3 B 73, Baltimore, MD 21224, USA.
| | - Paul W Ladenson
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA
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40
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Flores-Rebollar A, Pérez-Díaz I, Lagunas-Bárcenas S, García-Martínez B, Rivera-Moscoso R, Fagundo-Sierra R. Clinical utility of an ultrasensitive thyroglobulin assay in the follow-up of patients with differentiated thyroid cancer: can the stimulation test be avoided in patients with an intermediate recurrence risk? ACTA ACUST UNITED AC 2019; 38:188-193. [PMID: 29984794 DOI: 10.14639/0392-100x-1494] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 09/19/2017] [Indexed: 12/30/2022]
Abstract
SUMMARY Serum thyroglobulin (Tg) measurement during suppression with levothyroxine (LT4) using an ultrasensitive assay (OnT4-Tg) has been proposed as a replacement of TSH-stimulated Tg measurement (OffT4-Tg) in management of patients with differentiated thyroid cancer (DTC). The aim of this study is to evaluate the capacity of an ultrasensitive Tg assay in predicting an OffT4-Tg > 2.0 ng/mL based on the OnT4-Tg in patients with DTC and an intermediate recurrence risk. We analysed 101 patients with DTC and an intermediate (n = 92) or high risk of recurrence (n = 9) who were treated with total thyroidectomy and ablation with 131I, and followed for an average of 6 years. OnT4-Tg was undetectable in 64 of 101 patients; OffT4-Tg was #x003C; 2.0 ng/mL in 61 of these 64 patients, all with negative imaging results. Furthermore, 37 of 101 patients had detectable OnT4-Tg; 32 of these 37 patients also presented OffT4-Tg > 2.0 ng/mL, and only 3 of these 32 patients had metastases detected by neck ultrasound. Considering a cutoff point of 0.1 ng/mL for OnT4-Tg, the assay had a sensitivity of 91%, specificity of 92%, positive predictive value (PPV) of 86% and the negative predictive value (NPV) of 95% when predicting an OffT4-Tg > 2.0 ng/mL (biochemical disease). The use of an ultrasensitive Tg assay allows prediction of which patients will remain disease-free even if they are at an intermediate risk of recurrence, and to decrease the need for stimulated Tg assays in two-thirds of these patients.
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Affiliation(s)
- A Flores-Rebollar
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México City, México
| | - I Pérez-Díaz
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México City, México
| | - S Lagunas-Bárcenas
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México City, México
| | - B García-Martínez
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México City, México
| | - R Rivera-Moscoso
- Planning and Quality Improvement Division, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México City, México
| | - R Fagundo-Sierra
- Central Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México City, México
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41
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Moussallieh FM, Ranaivosoa MK, Romain S, Reix N. Analytical validation of two second generation thyroglobulin immunoassays (Roche and Thermo Fisher). ACTA ACUST UNITED AC 2018; 56:e302-e305. [DOI: 10.1515/cclm-2018-0413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/01/2018] [Indexed: 11/15/2022]
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Prpić M, Franceschi M, Romić M, Jukić T, Kusić Z. THYROGLOBULIN AS A TUMOR MARKER IN DIFFERENTIATED THYROID CANCER - CLINICAL CONSIDERATIONS. Acta Clin Croat 2018; 57:518-527. [PMID: 31168186 PMCID: PMC6536288 DOI: 10.20471/acc.2018.57.03.16] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
SUMMARY – Initial treatment of the majority of patients with differentiated thyroid cancer (DTC) includes total thyroidectomy. Postoperative ablation therapy with radioactive iodine (I-131) is indicated in all high-risk patients, however, there is disagreement regarding its use in low- and intermediate-risk patients. Over the last few decades, thyroglobulin (Tg) has been established as the primary biochemical tumor marker for patients with DTC. Thyroglobulin can be measured during thyroid hormone therapy or after thyroid-stimulating hormone (TSH) stimulation, through thyroid hormone withdrawal or the use of human recombinant TSH. In many studies, the cut-off value for adequate Tg stimulation is a TSH value ≥30 mIU/L. However, there is an emerging body of evidence suggesting that this long-established standard should be re-evaluated, bringing this threshold into question. Recently, a risk stratification system of response to initial therapy (with four categories) has been introduced and Tg measurement is one of the main components. The relationship between the Tg/TSH ratio and the outcome of radioiodine ablation has also been studied, as well as clinical significance of serum thyroglobulin doubling-time. The postoperative serum Tg value is an important prognostic factor that is used to guide clinical management, and it is the most valuable tool in long term follow-up of patients with DTC.
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Affiliation(s)
| | - Maja Franceschi
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Croatian Academy of Sciences and Arts, Zagreb, Croatia; 5Aviva Polyclinic, Zagreb, Croatia
| | - Matija Romić
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Croatian Academy of Sciences and Arts, Zagreb, Croatia; 5Aviva Polyclinic, Zagreb, Croatia
| | - Tomislav Jukić
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Croatian Academy of Sciences and Arts, Zagreb, Croatia; 5Aviva Polyclinic, Zagreb, Croatia
| | - Zvonko Kusić
- 1Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4Croatian Academy of Sciences and Arts, Zagreb, Croatia; 5Aviva Polyclinic, Zagreb, Croatia
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Postoperative serum thyroglobulin and neck ultrasound to drive decisions about iodine-131 therapy in patients with differentiated thyroid carcinoma: an evidence-based strategy? Eur J Nucl Med Mol Imaging 2018; 45:2155-2158. [DOI: 10.1007/s00259-018-4110-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/25/2018] [Indexed: 01/13/2023]
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Jin XZ, Lu WW, Zhang HF, Yan YY, Gu XL. Comparative study on the diagnostic values of different ultrasound technologies for malignant thyroid nodules. Oncol Lett 2018; 16:910-914. [PMID: 29963163 PMCID: PMC6019883 DOI: 10.3892/ol.2018.8706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 01/25/2018] [Indexed: 12/11/2022] Open
Abstract
The present study compared and analyzed the diagnostic values of B-mode ultrasound and elasticity imaging technology for the identification of benign and malignant thyroid nodules. Ninety-four patients who were diagnosed with thyroid nodules by ultrasound were chosen. All patients were checked with B-mode ultrasound and ultrasound elasticity imaging technology before surgeries. Further, the post-operative outcomes were compared with operation pathology. The pathological examination results were taken as the gold standard. The accuracy, sensitivity, specificity, positive predictive value and negative predictive values of combined ultrasound diagnosis were all obviously higher than those by the B-mode ultrasound and the ultrasound elastography method (P<0.05). In conclusion, as a new technology, ultrasound elasticity imaging technology has relatively high diagnositic value in identifying benign and malignant thyroid nodules. With its own advantages and limitations, the ultrasound elasticity imaging technology could effectively complement B-mode ultrasound, and improve the sensitivity, specificity and accuracy of ultrasound diagnosis for thyroid nodules.
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Affiliation(s)
- Xiao-Zhu Jin
- Department of Ultrasonography, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Wei-Wei Lu
- Department of Ultrasonography, The First People's Hospital of Shangqiu, Shangqiu, Henan 476000, P.R. China
| | - Hai-Feng Zhang
- Department of Radiology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Yuan-Yuan Yan
- Department of Ultrasonography, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Xiao-Le Gu
- Department of Ultrasonography, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
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45
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Verburg FA, Mäder U, Giovanella L, Luster M, Reiners C. Low or Undetectable Basal Thyroglobulin Levels Obviate the Need for Neck Ultrasound in Differentiated Thyroid Cancer Patients After Total Thyroidectomy and 131I Ablation. Thyroid 2018; 28:722-728. [PMID: 29665748 DOI: 10.1089/thy.2017.0352] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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 Neck ultrasound (NUS) is currently seen as a main component of follow-up of differentiated thyroid cancer (DTC) and is usually performed regardless of non-stimulated thyroglobulin (Tg) levels. The aim of this study was to determine whether there is a clinical benefit from such a routine NUS in DTC patients. METHODS A retrospective database study was conducted of 3176 cervical ultrasound exams performed in 773 patients between June 15, 1996, and July 1, 2012. The accuracy of ultrasound results was assessed based on the results of further diagnostic and/or therapeutic procedures within six months of a particular ultrasound. RESULTS A total of 2199 NUS exams were classified as true negative, 216 as true positive, 692 as false positive in 339 (43.9%) individual patients, 170 of whom were low risk, and 69 as false negative. Thus, overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy [confidence interval] were 75.8% [70.1-81.5%], 76.1% [74.3-77.8%], 23.8% [18.1-29.5%], 97.0 [96.2-97.7%], and 76.0% [74.3-77.7%], respectively. No significant differences were found between low- and high-risk patients. There were no significant differences between patients with an undetectable and a low detectable (<1 μg/L) Tg level. However, these two groups both showed significantly lower positive predictive value and higher negative predictive value than patients with a Tg ≥1 μg/L. From January 2007 onwards, true-positive and false-negative neck ultrasounds were no longer observed in patients with Tg <1 μg/L. CONCLUSION After total thyroidectomy and 131I ablation, neck ultrasound should be reserved only for anti-Tg antibody negative patients with a Tg level of ≥1 μg/L.
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Affiliation(s)
- Frederik A Verburg
- 1 Department of Nuclear Medicine, University of Würzburg , Würzburg, Germany
- 2 Department of Nuclear Medicine, University Hospital Marburg , Marburg, Germany
| | - Uwe Mäder
- 3 Comprehensive Cancer Center Mainfranken, University of Würzburg , Würzburg, Germany
| | - Luca Giovanella
- 4 Department of Nuclear Medicine, Oncology Institute of Southern Switzerland , Bellinzona, Switzerland
| | - Markus Luster
- 2 Department of Nuclear Medicine, University Hospital Marburg , Marburg, Germany
| | - Christoph Reiners
- 1 Department of Nuclear Medicine, University of Würzburg , Würzburg, Germany
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Sager S, Hatipoglu E, Gunes B, Asa S, Uslu L, Sönmezoğlu K. Comparison of day 3 and day 5 thyroglobulin results after thyrogen injection in differentiated thyroid cancer patients. Ther Adv Endocrinol Metab 2018; 9:177-183. [PMID: 29854387 PMCID: PMC5956637 DOI: 10.1177/2042018818770108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/16/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND It is necessary to stimulate serum thyroid-stimulating hormone (TSH) levels either endogenously by thyroid hormone withdrawal (THW) or exogenously by administration of recombinant human TSH (rhTSH) for radioactive iodine (RAI) therapy. Thyrotropin alfa (Thyrogen) has many advantages over THW. Radiation dose to laboratory staff while drawing blood for tests on the day 5 is one of the disadvantages of preferring Thyrogen. Our aim was to compare day 3 and day 5 blood test results after Thyrogen injections. MATERIAL AND METHOD In our study, Thyrogen was preferred in 32 differentiated thyroid cancer patients with a mean age of 50.5 ± 12.3 years. Thyrogen was injected on day 1 and day 2 intramuscularly in all patients before I-131 was given on day 3. A total of 22 patients received 5 mCi RAI for ablation control scintigraphy and 10 patients received 100-250 mCi RAI for ablation or therapy (high-dose group). Blood tests were performed on day 3 and day 5 after Thyrogen injections. RESULTS Mean TSH level was 98.1 mg/dl for day 3 and 29.5 mg/dl for day 5. In the diagnostic group, thyroglobulin (Tg) and anti-Tg levels were nearly the same on day 3 and day 5. In the therapy group, day 5 Tg levels were higher than day 3. CONCLUSION After Thyrogen injection of two consecutive days, blood sampling might be enough on day 3. Day 5 blood sampling may not be necessary routinely for radiation protection of laboratory staff. For the diagnostic group, if Tg and anti-Tg is normal then 5 mCi imaging may not be necessary.
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Affiliation(s)
| | - Esra Hatipoglu
- Department of Endocrinology, Istanbul University, Istanbul, Turkey
| | - Burcak Gunes
- Department of Nuclear Medicine, Istanbul University, Istanbul, Turkey
| | - Sertac Asa
- Department of Nuclear Medicine, Istanbul University, Istanbul, Turkey
| | - Lebriz Uslu
- Department of Nuclear Medicine, Istanbul University, Istanbul, Turkey
| | - Kerim Sönmezoğlu
- Department of Nuclear Medicine, Istanbul University, Istanbul, Turkey
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47
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Côrtes MCS, Rosario PW, Oliveira LFF, Calsolari MR. Clinical Impact of Detectable Antithyroglobulin Antibodies Below the Reference Limit (Borderline) in Patients with Papillary Thyroid Carcinoma with Undetectable Serum Thyroglobulin and Normal Neck Ultrasonography After Ablation: A Prospective Study. Thyroid 2018; 28:229-235. [PMID: 29325506 DOI: 10.1089/thy.2017.0350] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Interference of antithyroglobulin antibodies (TgAb) with serum thyroglobulin (Tg) can occur even at detectable TgAb concentrations below the reference limit (borderline TgAb). Thus, borderline TgAb is considered as TgAb positivity in patients with thyroid cancer. This prospective study evaluated patients with papillary thyroid carcinoma with undetectable Tg and normal neck ultrasonography (US) after total thyroidectomy and ablation with 131I, and compared tumor persistence/recurrence and long-term Tg and TgAb behavior in those with borderline versus undetectable TgAb. METHODS A total of 576 patients were evaluated, divided into two groups: group A with undetectable TgAb (n = 420), and group B with borderline TgAb (n = 156). RESULTS Groups A and B were similar in terms of patient and tumor characteristics. The time of follow-up ranged from 24 to 120 months. During follow-up, 11 (2.6%) patients in group A and 5 (3.2%) in group B developed a recurrence (p = 0.77). In group A, recurrences occurred in 9/390 patients who continued to have undetectable TgAb and in 1/9 patients who progressed to borderline TgAb. In group B, recurrences were detected in 1/84 patients who progressed to have undetectable TgAb, in 1/45 who still had borderline TgAb, and in 3/12 who developed elevated TgAb. In the presence of Tg levels <0.2 ng/mL, recurrences were detected in 2/486 patients with undetectable TgAb, in 0/67 with borderline TgAb, and in 3/12 with elevated TgAb. The results of post-therapy whole-body scanning (RxWBS) of 216 patients with Tg ≤0.2 ng/mL and normal US at the time of ablation were also analyzed. In low-risk patients, none of the 40 patients with borderline TgAb and none of the 94 with undetectable TgAb exhibited ectopic uptake on RxWBS. In intermediate-risk patients, lymph node metastases were detected by RxWBS in 1/25 (4%) with borderline TgAb and in 2/57 (3.5%) with undetectable TgAb. CONCLUSIONS The results suggest that among low- or intermediate-risk patients with undetectable Tg and normal US after thyroidectomy, those with borderline TgAb are at no greater risk of tumor persistence or recurrence than those with undetectable TgAb. When undetectable Tg levels persist, recurrence should be suspected in the case of a TgAb elevation above the reference limit.
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Affiliation(s)
| | - Pedro Weslley Rosario
- 1 Postgraduation Program, Santa Casa de Belo Horizonte , Minas Gerais, Brazil
- 2 Endocrinology Service, Santa Casa de Belo Horizonte , Minas Gerais, Brazil
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48
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Trimboli P, Imperiali M, Piccardo A, CampennÌ A, Giordani I, Ruggeri RM, Baldari S, Orlandi F, Giovanella L. Multicentre clinical evaluation of the new highly sensitive Elecsys® thyroglobulin II assay in patients with differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2018; 88:295-302. [PMID: 28960391 DOI: 10.1111/cen.13487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/21/2017] [Accepted: 09/12/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A highly sensitive thyroglobulin assay (Elecsys® Tg II, Roche Diagnostics, Penzberg, Germany) has become available for monitoring patients with differentiated thyroid cancer (DTC). Here, we evaluated the clinical performance of Elecsys® Tg II assay in a multicentre patients series and compare it with the established Access® Tg assay (Beckman Coulter, Brea, CA, USA). DESIGN Retrospective analysis on prospectively selected patients in four thyroid cancer referral centres with uniform DTC management. PARTICIPANTS All DTC cases diagnosed, treated and followed up in four tertiary referral centres for thyroid cancer since January 2005 (n = 1456) were retrieved, and predefined selection criteria were applied to prevent relevant enrolment biases. A series of 204 patients was finally selected for this study. MEASUREMENTS Samples had been stored at -80°C. Tg was measured by fully automated immunometric Elecsys® Tg II and Access® Tg assays in a centralized laboratory. RESULTS Two hundred and four DTC were finally included. Of these, 10.8% had structural recurrence (sREC), and 81.4% showed no evidence of disease (NED) at the end of follow-up. There was a significant analytical bias between methods that cannot be used interchangeably. Using ROC curve analysis, the best basal and rhTSH-stimulated Tg cut-offs to detect sREC were 0.41 μg/L and 1.82 μg/L for Elecsys® and 0.36 μg/L and 1.62 μg/L for Access® assay, respectively. Using Cox proportional hazard regression, Tg was the only independent predictor of cancer relapse. CONCLUSIONS Using appropriate assay-specific cut-offs, the clinical performance of the Elecsys® Tg II assay was comparable to that provided by the well-established Access® Tg assay.
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Affiliation(s)
- P Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - M Imperiali
- Department of Clinical Chemistry and Laboratory Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - A Piccardo
- Department of Nuclear Medicine, Ente Ospedaliero "Ospedali Galliera", Genova, Italy
| | - A CampennÌ
- Department of Biomedical and Dental Science and Morpho-Functional Images, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - I Giordani
- Department of Internal Medicine and Endocrinology, University of Torino, Torino, Italy
| | - R M Ruggeri
- Department of Clinical and Experimental Medicine, Endocrinology Unit, University of Messina, Messina, Italy
| | - S Baldari
- Department of Biomedical and Dental Science and Morpho-Functional Images, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - F Orlandi
- Department of Internal Medicine and Endocrinology, University of Torino, Torino, Italy
| | - L Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Clinical Chemistry and Laboratory Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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49
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Gao M, Ge M, Ji Q, Cheng R, Lu H, Guan H, Cui W, Gao L, Gao Z, Guo L, Guo Z, Huang T, Huang X, Lin Y, Liu Q, Ni X, Qin J, Ren L, Shan Z, Sun H, Wang X, Xu Z, Yu Y, Zhang B, Zhao D, Zheng Y, Zhu J, Zheng X, Chinese Association Of Thyroid Oncology Cato China Anti-Cancer Association. 2017 Chinese expert consensus on the clinical application of serum marker for thyroid cancer. Cancer Biol Med 2018; 15:468-477. [PMID: 30766757 PMCID: PMC6372917 DOI: 10.20892/j.issn.2095-3941.2018.0084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Ming Gao
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Minghua Ge
- Department of Head and Neck, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Qinghai Ji
- Department of Head and Neck Tumor, Fudan University Shanghai Cancer Center, Shanghai 200433, China
| | - Ruochuan Cheng
- Department of General Surgery, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Hankui Lu
- Department of Nuclear Medicine, The Sixth Affiliated Hospital of Shanghai Jiao Tong University, Shanghai 200025, China
| | - Haixia Guan
- Department of Endocrinology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Wei Cui
- Department of Clinical Laboratory, Cancer Hospital Chinese Academy of Medical Science, Beijing 100021, China
| | - Li Gao
- Department of Head and Neck, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, China
| | - Zairong Gao
- Department of Nuclear Medicine, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, China
| | - Lin Guo
- Department of Clinical Laboratory, Fudan University Shanghai Cancer Center, Shanghai 200433, China
| | - Zhuming Guo
- Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Tao Huang
- Department of Thyroid and Breast, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiaoming Huang
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yansong Lin
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Beijing 100730, China
| | - Qinjiang Liu
- Department of Head and Neck, Gansu Provincial Cancer Hospital, Lanzhou 730050, China
| | - Xin Ni
- Department of Head and Neck, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Jianwu Qin
- Department of Thyroid, Head and Neck, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Li Ren
- Department of Clinical Laboratory, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Zhongyan Shan
- Department of Endocrinology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Hui Sun
- Department of Thyroid, Sino Japanese Union Hospital of Jilin University, Changchun 130033, China
| | - Xudong Wang
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Zhengang Xu
- Department of Head and Neck, Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Yang Yu
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Bin Zhang
- Department of Head and Neck, Peking Union Medical College Hospital, Beijing 100730, China
| | - Daiwei Zhao
- Department of General Surgery, The Second Affiliated Hospital of Guizhou Medical University, Kaili 556099, China
| | - Ying Zheng
- Department of Head and Neck, Jilin Tumor Hospital, Changchun 130012, China
| | - Jingqiang Zhu
- Department of Thyroid and Breast, West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610047, China
| | - Xiangqian Zheng
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Chinese Association Of Thyroid Oncology Cato China Anti-Cancer Association
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.,Department of Head and Neck, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Department of Head and Neck Tumor, Fudan University Shanghai Cancer Center, Shanghai 200433, China.,Department of General Surgery, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China.,Department of Nuclear Medicine, The Sixth Affiliated Hospital of Shanghai Jiao Tong University, Shanghai 200025, China.,Department of Endocrinology, The First Hospital of China Medical University, Shenyang 110001, China.,Department of Clinical Laboratory, Cancer Hospital Chinese Academy of Medical Science, Beijing 100021, China.,Department of Head and Neck, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, China.,Department of Nuclear Medicine, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Clinical Laboratory, Fudan University Shanghai Cancer Center, Shanghai 200433, China.,Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Thyroid and Breast, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Nuclear Medicine, Peking Union Medical College Hospital, Beijing 100730, China.,Department of Head and Neck, Gansu Provincial Cancer Hospital, Lanzhou 730050, China.,Department of Head and Neck, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.,Department of Thyroid, Head and Neck, Henan Cancer Hospital, Zhengzhou 450008, China.,Department of Clinical Laboratory, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.,Department of Thyroid, Sino Japanese Union Hospital of Jilin University, Changchun 130033, China.,Department of Head and Neck, Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China.,Department of Head and Neck, Peking Union Medical College Hospital, Beijing 100730, China.,Department of General Surgery, The Second Affiliated Hospital of Guizhou Medical University, Kaili 556099, China.,Department of Head and Neck, Jilin Tumor Hospital, Changchun 130012, China.,Department of Thyroid and Breast, West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610047, China
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50
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Winter M, Winter J, Heinzel A, Behrendt FF, Krohn T, Mottaghy FM, Verburg FA. Timing of post 131I ablation diagnostic whole body scan in differentiated thyroid cancer patients. Nuklearmedizin 2017; 54:151-7. [DOI: 10.3413/nukmed-0733-15-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/15/2015] [Indexed: 01/08/2023]
Abstract
ZusammenfassungZiel: Beantwortung der Frage, ob drei Monate nach 131I-Ablation als zu früh für eine diagnostische Radioiod-Ganzkörperszintigraphie (dxWBS) bei Patienten mit einem differenzierten Schilddrüsenkarzinom (DTC) anzusehen sind. Patienten, Material, Methode: Daten von 462 DTC-Patienten, die in unserem Klinikum behandelt worden waren, wurden analysiert. Alle Patienten wurden thyreoid ektomiert. Von 129 Patienten waren folgende Daten verfügbar a) eine dxWBS mit gleichzeitiger TSH-stimulierter Thyreoglobulin-Messung, die innerhalb von vier Monaten (max. 120 Tage) nach 131I-Ablation durchgeführt wurde ohne weitere therapeutische Maßnahmen zwischen Ablation und dxWBS, b) eine zweite dxWBS oder 131I-Therapie (rxWBS), die innerhalb von 1,5 Jahren nach Ablation durchgeführt wurde. Ergebnisse: Bei 25/129 Patienten stimmten die Ergebnisse der initialen und weiteren Scans nicht überein: Bei 15 von 54 Patienten (27%) mit einem positiven initialen dxWBS widersprachen diese Ergebnisse dem zweiten dxWBS oder rxWBS. Neue Läsionen wurden bei 10/74 (14%) Patienten mit einem initial negativen dxWBS entdeckt. Eine Diskordanz zwischen dem ersten und weiteren in der Nachsorge gemessenen stimulierten Tg-Werten wurde in 5/129 (4%) der Patienten gefunden: Bei 2/90 (2%) Patienten mit einer negativen ersten stimulierten Tg-Bestimmung wurde nachfolgend ein positives Ergebnis gefunden. Bei 3/29 (10%) Patienten mit einer positiven ersten Bestimmung wurde bei der zweiten Untersuchung ein negatives Ergebnis festgestellt. Schlussfolgerung: Weniger als vier Monate nach 131I-Ablation ist zu früh für eine diagnostische Radioiod-Ganzkörperszintigraphie mit zeitgleich TSH-stimulierter Tg-Messung. Die Ermittlung des richtigen späteren Zeitpunkts erfordert weitere Untersuchungen.Das Zeitintervall zwischen 131I Ablation und diagnostischer Ganzkörperszintigraphie bei Patienten mit differenziertem Schilddrüsenkarzinom Weniger als vier Monate nach Ablation dürfte zu früh sein
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