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1.
Ther Umsch ; 77(9): 427-431, 2020 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-33146095

RESUMEN

The ablative radioiodine therapy of differentiated thyroid carcinoma Abstract. In the treatment of differentiated thyroid carcinoma, ablative radioiodine therapy holds a key role in curative intended therapy after total thyroidectomy and consideration of the appropriate indication. The benefit of ablation therapy extends from the completion of initial staging via post-therapeutic whole body scintigraphy via optimization of the value of thyreoglobuline measurement and implementation of dynamic risk stratification in follow-up care to decreasing the rate of tumor recurrence and mortality of thyroid cancer. Within this article, we discuss aims, indication, side reactions and specifics in preparation and execution of ablative radioiodine therapy.


Asunto(s)
Radioisótopos de Yodo , Neoplasias de la Tiroides , Humanos , Radioisótopos de Yodo/uso terapéutico , Recurrencia Local de Neoplasia , Cintigrafía , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/radioterapia , Neoplasias de la Tiroides/cirugía , Tiroidectomía
2.
Medicine (Baltimore) ; 99(40): e22350, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019411

RESUMEN

BACKGROUND: Ultrasonography is the first choice for clinical diagnosis and differentiation of thyroid cancer Currently. However, due to the complexity and overlapping nature of the thyroid nodule sonograms, it remains difficult to accurately identify nodules with atypical ultrasound characteristics. Previous studies showed that superb microvascular imaging (SMI) can detect tumor neovascularization to differentiate benign from malignant thyroid nodules. However, the results of these studies have been contradictory with low sample sizes. This meta-analysis tested the hypothesis that SMI is accurate in distinguishing benign and malignant thyroid nodules. METHODS: We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the August 20, 2020, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software ((Stata Corp, College Station, TX) will be used for data analysis. RESULTS: This systematic review will determine the accuracy of SMI in distinguishing thyroid nodules. CONCLUSION: Its findings will provide helpful evidence for the accuracy of SMI in in distinguishing thyroid nodules.Systematic review registration: INPLASY202080084.


Asunto(s)
Procesamiento de Imagen Asistido por Computador/métodos , Nódulo Tiroideo/diagnóstico , Nódulo Tiroideo/patología , Ultrasonografía/métodos , Diagnóstico Diferencial , Neovascularización Patológica/patología , Proyectos de Investigación , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/diagnóstico por imagen
3.
Radiol Clin North Am ; 58(6): 1009-1018, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33040844

RESUMEN

Thyroid nodules are a common clinical problem encountered in an endocrine practice. More and more thyroid nodules are now being detected on unrelated imaging studies, leading to an increased diagnosis of low-risk thyroid cancers. There is therefore a greater emphasis on risk assessment based on clinical and sonographic features to avoid morbidity secondary to unnecessary therapy. Molecular diagnostics are also being widely used to further characterize indeterminate nodules. The American Thyroid Association and American College of Radiology-Thyroid Imaging Reporting and Data System guidelines are the most commonly used in clinical practice for risk assessment.


Asunto(s)
Guías de Práctica Clínica como Asunto , Neoplasias de la Tiroides/diagnóstico , Nódulo Tiroideo/diagnóstico , Ultrasonografía Doppler/métodos , Biopsia con Aguja , Femenino , Humanos , Incidencia , Masculino , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Medición de Riesgo , Sociedades Médicas , Análisis de Supervivencia , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/epidemiología , Nódulo Tiroideo/patología , Estados Unidos
4.
Radiol Clin North Am ; 58(6): 1019-1031, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33040845

RESUMEN

Radiologists very frequently encounter incidental findings related to the thyroid gland. Given increases in imaging use over the past several decades, thyroid incidentalomas are increasingly encountered in clinical practice, and it is important for radiologists to be aware of recent developments with respect to workup and diagnosis of incidental thyroid abnormalities. Recent reporting and management guidelines, such as those from the American College of Radiology and American Thyroid Association, are reviewed along with applicable evidence in the literature. Trending topics, such as artificial intelligence approaches to guide thyroid incidentaloma workup, are also discussed.


Asunto(s)
Inteligencia Artificial/estadística & datos numéricos , Toma de Decisiones Clínicas , Diagnóstico por Imagen/métodos , Hallazgos Incidentales , Neoplasias de la Tiroides/diagnóstico por imagen , Nódulo Tiroideo/diagnóstico por imagen , Biopsia con Aguja , Femenino , Humanos , Inmunohistoquímica , Incidencia , Imagen por Resonancia Magnética/métodos , Masculino , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Guías de Práctica Clínica como Asunto , Radiólogos/estadística & datos numéricos , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/epidemiología , Nódulo Tiroideo/patología , Ultrasonografía Doppler/métodos , Estados Unidos/epidemiología
5.
Radiol Clin North Am ; 58(6): 1041-1057, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33040847

RESUMEN

Thyroid ultrasound with gray-scale and color Doppler is the most helpful imaging modality to differentiate normal thyroid parenchyma from diffuse or nodular thyroid disease by evaluating glandular size, echogenicity, echotexture, margins, and vascularity. The various causes of diffuse thyroid disease often have overlapping sonographic imaging features. Thyroid nodules may be hyperplastic or neoplastic, with most due to benign hyperplastic changes in architecture and benign follicular adenomas; only a small percentage are malignant. A systematic approach to nodule morphology that includes evaluation of composition, echogenicity, margin, shape, and any echogenic foci can guide decision to biopsy or follow nodules.


Asunto(s)
Glándula Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/diagnóstico por imagen , Nódulo Tiroideo/diagnóstico por imagen , Ultrasonografía Doppler/métodos , Biopsia con Aguja Fina/métodos , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Medición de Riesgo , Enfermedades de la Tiroides/diagnóstico por imagen , Enfermedades de la Tiroides/patología , Glándula Tiroides/patología , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/patología , Ultrasonografía Doppler en Color/métodos
6.
Radiol Clin North Am ; 58(6): 1059-1070, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33040848

RESUMEN

Over the past several years, there has been an increase in the discovery of thyroid cancers, likely because of the marked increased utilization of computed tomography (CT) and MR imaging. Despite the increase in number of thyroid cancers, the overall mortality remains unchanged because most of these cancers are the differentiated type and have a more indolent behavior. CT and MR imaging are important in the preoperative evaluation of thyroid goiters and thyroid cancer. This article discusses the imaging characteristics of benign and malignant thyroid diseases, and the important information that needs to be relayed to the surgeon.


Asunto(s)
Imagen por Resonancia Magnética/métodos , Neoplasias de la Tiroides/diagnóstico por imagen , Nódulo Tiroideo/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Biopsia con Aguja , Diagnóstico Diferencial , Femenino , Humanos , Inmunohistoquímica , Incidencia , Masculino , Medición de Riesgo , Enfermedades de la Tiroides/diagnóstico por imagen , Enfermedades de la Tiroides/patología , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/epidemiología , Nódulo Tiroideo/patología , Nódulo Tiroideo/cirugía , Tiroidectomía/métodos , Resultado del Tratamiento
7.
Radiol Clin North Am ; 58(6): 1085-1098, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33040850

RESUMEN

Fine-needle aspiration (FNA) and core biopsy of masses in the neck predominantly include samples from thyroid nodules, parathyroids and lymph nodes. The diagnostic rate of a thyroid nodule FNA improves up to 6 passes and then does not significantly change. Thyroid FNA can be performed on patients who are anticoagulated. Appropriate transducer selection is essential for visualization of the needle. Lymph node biopsies can be additionally sampled for thyroglobulin assay to improve sensitivity for detection of recurrent carcinoma. Parathyroid FNA usually involves additional estimation of parathyroid hormone concentration in needle washouts. Biopsies of the neck are simple procedures with minimal complications.


Asunto(s)
Biopsia con Aguja Fina/métodos , Biopsia con Aguja Gruesa/métodos , Biopsia Guiada por Imagen/métodos , Neoplasias de las Paratiroides/patología , Neoplasias de la Tiroides/patología , Femenino , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Neoplasias de las Paratiroides/diagnóstico por imagen , Mejoramiento de la Calidad , Sensibilidad y Especificidad , Neoplasias de la Tiroides/diagnóstico por imagen , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/patología , Ultrasonografía Doppler/métodos
8.
Medicine (Baltimore) ; 99(33): e21712, 2020 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-32872050

RESUMEN

BACKGROUND: This study aims to explore the accuracy of thyroid ultrasonography (TUS) combined ultrasound-guided fine-needle aspiration biopsy (UGFNAB) for detection of thyroid microcarcinoma (TMC). METHODS: A comprehensive search in PUBMED, EMBASE, Cochrane Library, Web of Science, Scopus, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from the beginning to the June 1, 2020 without language and publication status limitations. Two authors will independently perform articles identification, data extraction and assessment of study quality. Any disagreements will be resolved by discussion with a third author. We will carry out study quality evaluation using Quality Assessment of Diagnostic Accuracy Studies tool, and will employ statistical analysis using RevMan V.5.3 and Stata V.12.0 softwares. RESULTS: We will summarize current evidence to investigate the accuracy of TUS combined UGFNAB in detection of TMC. CONCLUSION: The findings of this study may provide helpful evidence of TUS combined UGFNAB in detection of TMC. STUDY REGISTRATION: INPLASY202070048.


Asunto(s)
Carcinoma/diagnóstico por imagen , Glándula Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/diagnóstico por imagen , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Humanos , Revisiones Sistemáticas como Asunto
9.
Medicine (Baltimore) ; 99(30): e21346, 2020 Jul 24.
Artículo en Inglés | MEDLINE | ID: mdl-32791734

RESUMEN

RATIONALE: Papillary thyroid carcinoma (PTC) is the most common type of primary thyroid cancer with a low incidence of distant metastases. PTC represents more than 70% to -90% of thyroid malignancies. Distant metastases have only been observed in only 1% to 15% of patients with PTC. In this article, we reported the case of a patient with PTC and hyperthyroidism as well as simultaneous multiple metastases. PATIENT CONCERNS: A 47-year-old man was admitted to our hospital on February 22, 2019, with several neck masses that had been present for 12 months, low back pain for 9 months, and lower limb paraplegia for 3 months. DIAGNOSES: According to the patient physical examination, adjuvant examination (e.g., ultrasound, computed tomography, magnetic resonance imaging, blood test, and biopsy) and medical history, the clinical diagnosis was as follows: thyroid papillary carcinoma; cervical lymph node metastasis; multisite bone metastasis (6th and 7th cervical vertebrae, left clavicle proximal, right scapula bone, thoracic vertebrae, lumbar vertebrae, sacral vertebrae, bilateral ilium, and left pubic bone); muscular metastasis (the right medial femoral muscle, the vastus lateralis muscle, left thigh muscle, and the flexor superficialis of the left forearm); possible mediastinal lymph node metastasis; and paraplegia due to the soft-tissue metastasis around the 9th thoracic vertebral spine; and hyperthyroidism (free thyroxine: 36.59 pmol/L, free triiodothyronine: 9.58 pmol/L, thyroid-stimulating hormone: 0.005 µIU/mL, thyroid autoantibody: 2.53 IU/L). INTERVENTIONS AND OUTCOMES: The patient refused to undergo further intervention or follow-up. LESSONS: In summary, this is the 1st case of in which a patient with PTC and hyperthyroidism, as well as simultaneous multiple skeletal muscles and bone metastases, lymph node metastasis, and paraplegia was observed. In practice, in cases where patients have PTC and hyperthyroidism, practitioners should perform further examinations to rule out the presence of distant metastases. We believe that the use of ultrasound has a unique advantage in the diagnosis of PTC and skeletal muscle metastasis.


Asunto(s)
Carcinoma Papilar/patología , Hipertiroidismo/diagnóstico , Paraplejía/etiología , Cáncer Papilar Tiroideo/patología , Neoplasias de la Tiroides/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Metástasis Linfática/diagnóstico por imagen , Metástasis Linfática/patología , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Paraplejía/diagnóstico , Neoplasias de la Tiroides/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Negativa del Paciente al Tratamiento , Ultrasonografía/métodos
10.
Praxis (Bern 1994) ; 109(10): 763-770, 2020 Aug.
Artículo en Alemán | MEDLINE | ID: mdl-32752966

RESUMEN

CME Sonography 92: Nodes on the Neck Abstract. Nodules on the neck can be discovered accidentally when looking in the mirror, or due to pain that may be acute or gradual. The clinical examination is helpful to estimate the localization or to assign the nodule to a specific organ and assess its consistency and mobility. A sonography is very helpful in most cases as there are typical findings related to the thyroid gland, findings based on lymph nodes, changes in the tonsils, vessels and salivary glands. In some cases, the ultrasound must be supplemented by fine needle puncture.


Asunto(s)
Ganglios Linfáticos , Cuello , Neoplasias de la Tiroides , Ganglios Linfáticos/diagnóstico por imagen , Glándula Tiroides , Neoplasias de la Tiroides/diagnóstico por imagen , Ultrasonografía
11.
PLoS One ; 15(8): e0238207, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32841270

RESUMEN

BACKGROUND: Although infrequent, distant metastasis from differentiated thyroid cancer is the main cause of mortality in patients and mostly involves the lung, bone, and brain. Distant metastases to other sites in differentiated thyroid cancer patients are rare, thus, the clinical course of unusual metastases has not been adequately researched. In the present study, the clinico-pathological findings and treatment outcomes of unusual metastases in differentiated thyroid cancer patients in Korea were evaluated. PATIENTS AND METHODS: We retrospectively reviewed the medical records of differentiated thyroid cancer patients with unusual metastases in four Korean tertiary hospitals (Chonnam National University Hwasun Hospital, Asan Medical Center, Busan National University Hospital, Severance Hospital). Unusual metastases were diagnosed using (1) cytology or histology and/or (2) imaging studies including fluorodeoxyglucose F 18 positron emission tomography/computed tomography and/or iodine 131 whole body scans with simultaneously elevated serum levels of thyroglobulin. The pathological findings of primary thyroid cancer, diagnostic method for unusual metastases, and treatment responses of unusual metastases were examined. RESULTS: In all, 25 unusual metastatic foci of 19 patients were analyzed; 13 patients (68.4%) had papillary thyroid carcinoma including 4 follicular variant papillary thyroid carcinomas. The median time interval between the first diagnosis of primary thyroid cancer and unusual metastases diagnosis was 110 months (11.0-138.0 months). Only 4 patients (21.1%) had synchronous unusual metastases and 6 patients (31.6%) were symptomatic. Unusual metastases included 19 metastases to solid organs (6 to kidney, 5 to liver, 4 to pancreas, 3 to adrenal gland, and 1 to ovary) and 6 to the skin and muscles. Unusual metastases were pathologically proven in 10 patients (52.6%) and 11 of 16 patients (68.8%) who received iodine 131 whole body scans had radioiodine-refractory differentiated thyroid cancer. Among 5 patients treated with tyrosine kinase inhibitors, 4 treated with lenvatinib showed stable disease or a partial response at the first treatment response. Six patients (31.6%) died due to disease progression during the median 20.0-month follow-up period (11.0-55.0 months). CONCLUSION: Unusual metastases from differentiated thyroid cancer are thought to be underestimated due to disease rarity and their metachronous nature with other distant metastases. The most of unusual metastases in differentiated thyroid cancer patients are existed with usual distant metastasis and clinical outcomes of those could not be significantly different from the prognosis of usual distant metastasis.


Asunto(s)
Neoplasias de la Tiroides/patología , Adulto , Anciano , Antineoplásicos/uso terapéutico , Carcinoma Papilar/diagnóstico por imagen , Carcinoma Papilar/patología , Carcinoma Papilar/secundario , Terapia Combinada , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia/diagnóstico por imagen , Metástasis de la Neoplasia/patología , Metástasis de la Neoplasia/terapia , Especificidad de Órganos , Compuestos de Fenilurea/uso terapéutico , Tomografía Computarizada por Tomografía de Emisión de Positrones , Pronóstico , Inhibidores de Proteínas Quinasas/uso terapéutico , Quinolinas/uso terapéutico , República de Corea , Estudios Retrospectivos , Cáncer Papilar Tiroideo/diagnóstico por imagen , Cáncer Papilar Tiroideo/patología , Cáncer Papilar Tiroideo/terapia , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/terapia , Factores de Tiempo , Imagen de Cuerpo Entero
12.
Eur J Endocrinol ; 183(5): 521-528, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32841935

RESUMEN

Objective: The ultrasonographic scores EU TI-RADS and ACR TI-RADS were introduced to give the clinicians indications for fine needle aspiration cytology (FNAC). The predictive role of these scores was never evaluated and compared in a surgical series of patients. The aim of this study was to evaluate the ex post diagnostic accuracy of EU TI-RADS and ACR TI-RADS in a real-life series of thyroidectomized patients and to evaluate the 'missing' thyroid cancer following the operational indications of these scores. Design: Retrospective monocentric cohort study. Methods: In total, 255 patients (harboring 304 nodules) undergoing thyroidectomy for benign and malignant thyroid conditions were enrolled. The prevalence of thyroid malignancy for each class of ACR TI-RADS and EU TI-RADS, their diagnostic accuracy, the number of 'unnecessary' FNAC and the number of 'missed' cancers were evaluated. Results: ACR TI-RADS and EU TI-RADS score had similar and satisfactory accuracy values for predicting thyroid malignancy (AUC: 0.835 for ACR TI-RADS vs 0.827 for EU TI-RADS). The ACR TI-RADS and EU TI-RADS categories (suspicious vs non-suspicious), age, sex and presence of a single nodule significantly and independently predicted the presence of malignancy in a logistic regression model. An ex post analysis according to the indications for FNAC for each score indicated that 31 and 16 cases of cancer would have been missed by ACR TI-RADS and EU TI-RADS scores, respectively. Conclusions: ACR TI-RADS and EU TI-RADS display a good performance in predicting thyroid cancer when histology is taken as reference standard, but additional clinical judgement is required to decide the indication for FNAC.


Asunto(s)
Glándula Tiroides/patología , Neoplasias de la Tiroides/diagnóstico , Nódulo Tiroideo/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Glándula Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/patología , Tiroidectomía , Ultrasonografía , Adulto Joven
13.
Am Surg ; 86(5): 450-457, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32684022

RESUMEN

This study analyzed the characteristics of BRAFV600E mutation in papillary thyroid carcinoma (PTC) in Chinese coastal areas. We intended to identify noninvasive methods to determine BRAFV600E status in thyroid nodules prior to surgery. BRAFV600E mutation and the sonographic characteristics of thyroid nodules were investigated in 670 PTC patients in our hospital. We aimed to determine the relationship between BRAFV600E mutation and the clinicopathological and sonographic imaging characteristics of PTC. The mutation rate of the BRAFV600E was 78.2%. BRAFV600E mutation was significantly associated with central node (univariate analyses, P = .005; multivariate analyses, P < .001, odds ratio [OR] = 10.255) and lateral node metastases (univariate analyses, P = .001; multivariate analyses, P < .001, OR = 22). It was less frequent in PTC coexisting with Hashimoto's thyroiditis (univariate analyses, P = .016; multivariate analyses, P < .001, OR = .034). Nodules without blood flow had a significantly higher mutation rate of BRAFV600E in PTC patients (univariate analyses, P = .026). BRAFV600E mutation was significantly associated with high suspicion in the Thyroid Imaging Reporting and Data System 5 (univariate analyses, P = .004; multivariate analyses, P = .014, OR = 6.456). Our results strongly suggest that BRAFV600E mutation plays a potential role in lymph node metastasis (central node metastasis, OR = 10.225; lateral node metastasis, OR = 22). Some sonographic imaging features might be helpful in estimating the status of BRAFV600E preoperatively.


Asunto(s)
Mutación , Proteínas Proto-Oncogénicas B-raf/genética , Cáncer Papilar Tiroideo/diagnóstico por imagen , Cáncer Papilar Tiroideo/genética , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/genética , Nódulo Tiroideo/genética , Adulto , China , Correlación de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ultrasonografía
14.
Medicine (Baltimore) ; 99(27): e20440, 2020 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-32629628

RESUMEN

Since Fukushima nuclear accident in 2011, thyroid ultrasound examinations have been conducted. The first full-scale examination detected 71 thyroid-cancer cases. This study examined whether radiation exposure was associated with thyroid-cancer incidence.Subjects were participants in the baseline screening and newborns during the 2011 fiscal year. Under nested matched case-control study design, 10 controls per each case were selected by matching the age, sex, baseline screening results, and interval between examinations. With 3 dose levels of external radiation: 1.3 + mSv (upper), 0.8 to 1.3 (middle), and 0.0 to 0.8 (reference), we applied 2 logistic models adjusting for 3 participation-proportions (primary, secondary, and fine-needle aspiratory cytology), overweight, and the B-result of baseline screening (Model 1), and past medical history, family history of thyroid cancer, and frequencies of eating seafood and seaweed in addition to the parameters in Model 1 (Model 2). We examined each model in 3 ways: (a) excluding subjects with a missing radiation exposure dose; and substituting (b1) median or (b2) mean dose of the municipality with missing dose.Odds ratios (ORs) of middle-dose exposure were (a) 1.35 (0.46-3.94), (b1) 1.55 (0.61-3.96), and (b2) 1.23 (0.50-3.03) for Model 1, and (a) 1.18 (0.39-3.57), (b1) 1.31 (0.49-3.49), and (b2) 1.02 (0.40-2.59) for Model 2. For upper-dose exposure, similar results were obtained. Past medical history was significantly associated (odds ratio  = 2.04-2.08) with both (b1) and (b2) in Model 2.No significant associations were obtained between the external radiation exposure and thyroid-cancer incidence.


Asunto(s)
Accidente Nuclear de Fukushima , Glándula Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/epidemiología , Adolescente , Estudios de Casos y Controles , Femenino , Humanos , Incidencia , Japón/epidemiología , Masculino , Neoplasias de la Tiroides/diagnóstico por imagen , Ultrasonografía
15.
PLoS One ; 15(7): e0236257, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32692768

RESUMEN

BACKGROUND: It is estimated that one of the potential cause of the increasing prevalence of thyroid cancer (TC) is the easier and widespread access to diagnostic tools. If an individual evaluates the thyroid gland due to a mentioned mechanism without considering TC risk factors or symptoms, we can describe this phenomenon as cancer screening activity (CSA). AIM OF THE STUDY: We 1) estimated what types of TC were diagnosed due to CSA, 2) analyzed what clinicopathological features were characteristic of TCs diagnosed by CSA, 3) determined if these features were characteristic of indolent cases, and finally we 4) assessed whether CSA could have resulted in the increasing incidence of potentially indolent papillary thyroid cancer (PTC). MATERIALS AND METHODS: A retrospective review of 4,701 medical records of patients admitted and surgically treated at one surgical center between 2008 and 2017 was performed. Among the enrolled patients, 569 (12.1%) had thyroid malignancy, and 514 (10.9%) were diagnosed with PTC. We divided these patients into two groups: 1) patients in whom TC diagnostics were performed without considering any TC risk factors or symptoms (CSA-yes) and 2) those in whom TC was diagnosed due to TC risk factors or symptoms (CSA-no). We then compared the clinicopathological features of these two groups. RESULTS: The most common type of TC diagnosed in the CSA-group was PTC (p = 0.024). CSA-yes patients showed a significantly lower degree of Tumor-Node-Metastasis (TNM) staging and demonstrated a significantly lower rate of multifocality, but not of bilaterality (p<0.0001 and p = 0.198, respectively). In the CSA-yes group, the number of TC foci was significantly lower than that in the CSA-no group (p<0.0001). All clinicopathological features characteristic of aggressive cases of TC were absent in CSA-yes patients (p<0.0001), while all features observed in CSA-yes patients were characteristic of indolent cases (p<0.0001). CONCLUSIONS: The use of CSA results in the diagnosis of indolent cases of PTC and may be one of the potential causes of overdiagnosis and overtreatment of this malignancy.


Asunto(s)
Detección Precoz del Cáncer , Uso Excesivo de los Servicios de Salud , Cáncer Papilar Tiroideo/diagnóstico , Cáncer Papilar Tiroideo/terapia , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cáncer Papilar Tiroideo/diagnóstico por imagen , Cáncer Papilar Tiroideo/patología , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología
16.
J Laryngol Otol ; 134(8): 680-683, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32613916

RESUMEN

BACKGROUND: The coronavirus disease 2019 pandemic requires urgent modification to existing head and neck cancer diagnosis and management practices. A protocol was established that utilises risk stratification, early investigation prior to clinical review and a reduction in aerosol generating procedures to lessen the risk of coronavirus disease 2019 spread. METHODS: Two-week wait referrals were stratified into low, intermediate and high risk. Low risk patients were referred back to primary care with advice; intermediate and high risk patients underwent investigation. Clinical encounters and aerosol generating procedures were minimised. A combined diagnostic and therapeutic surgical approach was undertaken where possible. RESULTS: Forty-one patients were used to assess feasibility. Thirty-one per cent were low risk, 35 per cent were intermediate and 33 per cent were high risk. Thirty-three per cent were discharged with no imaging. CONCLUSION: Implementing this protocol reduces the future burden on tertiary services, by empowering primary care physicians to re-refer low risk patients. The protocol is applicable across the UK and avoids diagnostic delay.


Asunto(s)
Infecciones por Coronavirus/transmisión , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/patología , Procedimientos Quirúrgicos Otorrinolaringológicos/estadística & datos numéricos , Neumonía Viral/transmisión , Aerosoles , Betacoronavirus/aislamiento & purificación , Biopsia con Aguja Fina/instrumentación , Protocolos Clínicos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Diagnóstico Tardío/prevención & control , Estudios de Factibilidad , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Londres/epidemiología , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/virología , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Derivación y Consulta , Medición de Riesgo , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Ultrasonografía Intervencional/métodos
17.
Rev Med Chil ; 148(1): 10-16, 2020 Jan.
Artículo en Español | MEDLINE | ID: mdl-32730431

RESUMEN

BACKGROUND: Thyroid incidentalomas detected by 18F-Fludeoxyglucose (FDG) PET/CT are defined as an incidental and unexpected thyroid focus present in a patient studied for a non-thyroid disease. AIM: To assess the frequency of malignancy of nodular thyroid incidentalomas, and their association with 18F-FDG avidity (standard uptake value (SUV) max). MATERIAL AND METHODS: Whole body PET/CT performed from December 2008 to December 2017 were reviewed selecting those that showed nodular thyroid foci. Glands with diffuse increased uptake were excluded. Thyroid ultrasonography and fine-needle aspiration cytology (FNAC) performed after PET/CT were reviewed. Bethesda score and SUVmax were correlated. RESULTS: Of 5,100 whole body 18F-FDG PET/CT, 119 showed a thyroid nodular uptake (2.3%). Forty eight percent of these patients were studied with FNAC or surgery, 50% of which (29/58) were confirmed as malignant. Benign nodules showed significantly lower 18F-FDG uptake (n = 20, SUVmax: 3.5 ± 1.7) than Bethesda V-VI (n=24, SUVmax: 8.2 ± 5.2) and thyroid metastases (n=5, SUVmax: 6.3 ± 2.1). The best cut-off value to distinguish between benign and malignant nodules was a SUVmax of 5.0, with a sensitivity of 76% (95% confidence intervals (CI) 56-90%), a specificity of 85% (95% CI 62 - 97%), and positive likelihood ratio of 5 (95% CI 1.8 - 14.6). The size of the thyroid nodule was not predictive of malignancy. CONCLUSIONS: Half of nodular thyroid incidentalomas detected by 18F-FDG PETC/CT are malignant. A nodule with a SUVmax ≥ 5,0 is highly suggestive of malignancy, regardless of its size.


Asunto(s)
Neoplasias de la Tiroides , Nódulo Tiroideo , Fluorodesoxiglucosa F18 , Humanos , Hallazgos Incidentales , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Estudios Retrospectivos , Neoplasias de la Tiroides/diagnóstico por imagen
18.
Magy Onkol ; 64(2): 112-117, 2020 Jun 10.
Artículo en Húngaro | MEDLINE | ID: mdl-32520004

RESUMEN

The first classic theranostic agent, radioactive iodine was used in the treatment of differentitated thyroid cancer (DTC) and it has an important role in the good prognosis of DTC even nowadays. I-131 provides a specific, molecular targeted therapy through the active uptake of iodide by sodium iodide symporter. The development of other theranostics also aimed the personalized therapy with minimal side effects and optimal therapeutic efficacy. The incidence of DTC which basically has good prognosis is increasing rapidly worldwide. This required the modification of guidelines to avoid the overtreatment of the disease, in the direction of less radical therapy. Currently, new pathological classification and staging systems were reported. The present work summarizes the new recommendations in the management of DTC, focusing on the indications of radioiodine therapy and reviewing the proposal of the Hungarian consensus conference.


Asunto(s)
Adenocarcinoma , Nanomedicina Teranóstica , Neoplasias de la Tiroides , Humanos , Radioisótopos de Yodo , Neoplasias de la Tiroides/diagnóstico por imagen
19.
Clin Nucl Med ; 45(8): 604-610, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32520503

RESUMEN

PURPOSE: As patients with progressive medullary thyroid cancer (MTC) and radioiodine-refractory metastatic differentiated nonmedullary thyroid cancer (DTC) have poor prognoses and present therapeutic challenges, peptide receptor radionuclide therapy (PRRT) targeting the somatostatin receptor provides a promising option. This meta-analysis evaluated the therapeutic effects and outcomes of PRRT in differentiated thyroid cancer. PATIENTS AND METHODS: PUBMED, EMBASE, CINAHL, SCOPUS, and COCHRANE were systematically searched using appropriate key words. The primary therapeutic effect was the radiological response after PRRT, and the objective response rate (ORR) and disease control rate (DCR) were identified in MTC and DTC, respectively. The outcome of serious adverse events (grade 3 or 4), additional therapeutic effects of F-FDG PET/CT and biochemical (calcitonin and thyroglobulin) responses, and radionuclides for PRRT were assessed as subgroup analyses. The parameters were generated as pooled proportions. RESULTS: Eleven articles with 165 patients were included (98 patients with MTC and 67 patients with DTC). PRRT achieved pooled proportions of ORR in 8.53% to 15.61%, DCR in 53.95% to 59.99%, and serious adverse events in 2.79% to 2.82% in MTC and DTC patients. F-FDG PET/CT and biochemical responses revealed similar results as the radiological response. Lu-based PRRT (ORR, 11.48%-24.52%; DCR, 61.47%-67.26%) showed better therapeutic effects than Y-based PRRT (ORR, 6.98%-13.82%; DCR, 50.86%-57.29%). CONCLUSIONS: This meta-analysis suggests that PRRT could be a potential and safe strategy for MTC and DTC. In particular, PRRT with Lu exhibited improved therapeutic effects relative to PRRT with Y.


Asunto(s)
Carcinoma Neuroendocrino/radioterapia , Octreótido/análogos & derivados , Radiofármacos/uso terapéutico , Neoplasias de la Tiroides/radioterapia , Anciano , Carcinoma Neuroendocrino/diagnóstico por imagen , Femenino , Humanos , Masculino , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias de la Tiroides/diagnóstico por imagen
20.
Medicine (Baltimore) ; 99(26): e20644, 2020 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-32590739

RESUMEN

The present study aimed to investigate the correlation between ultrasonographic features, basic fibroblast growth factor (bFGF), and the local invasiveness of papillary thyroid carcinoma (PTC).A total of 350 samples of thyroid nodules were collected. Routine ultrasonography was performed before the operation and routine pathological diagnosis and bFGF detection were performed after the operation.'These 350 samples of thyroid nodules included 90 samples of nodular goiter, 36 samples of focal thyroiditis, and 224 samples of PTC. A total of 326 thyroid nodules were examined for bFGF. The results revealed that the difference in the expression of bFGF between the benign and malignant groups was statistically significant (P < .05) and the difference in the positive expression of bFGF between the invasive and non-invasive PTC groups was statistically significant (P < .05).Whether the shape of PTC is regular or not and whether there is micro-calcification in PTC and other ultrasonographic features, the size and location of the lesions and the age of the patient help make a preliminary prediction of local invasiveness before the operation. Postoperative detection of bFGF is helpful for further risk assessments of PTC.


Asunto(s)
Factor 2 de Crecimiento de Fibroblastos/metabolismo , Cáncer Papilar Tiroideo/diagnóstico por imagen , Cáncer Papilar Tiroideo/metabolismo , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/metabolismo , Adulto , Factores de Edad , Anciano , Biomarcadores de Tumor/metabolismo , Femenino , Bocio/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estudios Prospectivos , Cáncer Papilar Tiroideo/patología , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/metabolismo , Tiroiditis/metabolismo , Ultrasonografía , Adulto Joven
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