The Prognostic Power of Preablation Stimulated Thyroglobulin in Children With Differentiated Thyroid Cancer.

OBJECTIVE: To analyze prognostic factors in children with differentiated thyroid carcinoma (DTC) who have been treated in a single center in the last 27 years. METHODS: We studied 126 children (≤18 years old) who have been treated with near-total thyroidectomy followed by radioiodine therapy and thyroid hormone replacement. Follow-up of the patients was done 2, 6, and 12 months after treatment and then by yearly evaluation. Response to treatment was defined according to the American Thyroid Association guidelines. RESULTS: Papillary thyroid cancer was the main pathology (93.7%), and 52.4% of the patients had lymph node metastasis at presentation, which was extensive (>5) in 30% of the patients. Distant metastasis was seen in 8.8%. The mean initial dose of I-131 was 74 ± 42.2 MBq/kg. The median follow-up was 59 months and the median time to achieve an excellent response was 29 months. The preablation stimulated thyroglobulin (psTg) level was 202.4 ± 301.8 ng/mL in patients with first-year incomplete response compared with 11.2 ± 17.5 ng/mL in others (P =.001). Furthermore, using logistic regression, the psTg level was found to be the only significant predictor of distant metastasis, and psTg ≥ 13.75 ng/mL was the most powerful predictor of first-year incomplete response. Moreover, distant metastasis was more common in boys than in girls, and it took longer time for boys to achieve an excellent response. CONCLUSION: The psTg level was the only significant predictor of distant metastases in children with DTC, and psTg ≥ 13.75 ng/mL was the most powerful predictor of first-year incomplete response.

Body mass index, lipid profile, and hypertension contribute to prolonged QRS complex.

BACKGROUND AND AIMS: QRS prolongation is one of the most common findings in patients with underlying cardiac diseases. Recent studies have shown that QRS prolongation can be accompanied by obesity, hypertension, and hyperlipidemia, which are known risk factors for cardiovascular events. This study aimed to evaluate how obesity, hypertension, and hyperlipidemia could affect QRS duration. METHODS: A total of 4033 eligible subjects aged between 35 and 70 years were included from the Persian Cohort Study in Mashhad. ECG intervals, blood pressures, lipid profile, and BMI measures were obtained at the time of enrolment. Multiple regression analysis was performed to assess the relationship between QRS duration and BMI, hypertension, and lipid profile. RESULTS: This study population consisted of 2047 females and 1986 males with a mean age of 46.05 ± 9.50 years. Higher BMI values and heart rate were observed in women (27.12 ± 4 and 74.66 ± 8.54; P < 0.001), while height, weight, and QRS duration showed a significant increase in men (172.60 ± 7.18, 79.44 ± 12.55, and 97 ± 11.05; P < 0.001). Except for total cholesterol (P = 0.317), blood pressures and lipid profile differed significantly among women and men (P < 0.001). Furthermore, univariate analyses indicated that QRS duration was associated with age, sex, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), systolic blood pressure, diastolic blood pressure, categorical blood pressure, categorical BMI, and continuous BMI. On the backward multivariate model, TG, LDL, HDL, DBP, SBP, categorical blood pressure, categorical BMI, and continuous BMI were independently correlated with QRS duration. CONCLUSIONS: Hypertension, increased BMI, and high levels of LDL, TG, and lower HDL, as well-known risk factors of cardiovascular disease, were associated with prolonged QRS duration. These findings could be beneficial in future investigations regarding establishing the underlying heart problems.

Thyroid Ultrasound-Image Dataset.

Thyroid Computer-Aided Diagnosis (CAD) systems have been developed to assist radiologists in improving efficiency, reliability, and diagnosis performance. Often the performance of these CAD systems is evaluated with different datasets that make it incomparable. A valuable thyroid ultrasound (US) dataset is presented in this work. This dataset consists of 2450 thyroid US images from 2018 to 2020 in Prospective Epidemiological Research Studies in Mashhad, Iran (PERSIAN), a large national cohort study. These US images have the ROI of thyroid nodules and the associated American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TIRADS) features by expert physicians provided in XML format. Dataset's images are categorized into five groups based on the ACR-TIRADS (Tirads1-Tirads5). The presented dataset is expected to be a valuable resource to develop and assess thyroid CAD systems to help radiologists better diagnose.

Observation Variation in Ultrasonography Assessment of Thyroid Nodules.

OBJECTIVES: Accurate detection and competent management of thyroid nodules, as a common disease, basically depends on the reliability of the ultrasonography (US) report. In this research, we evaluated inter and intra-observer variation among ultrasonography reporters, based on ACR-TIRADS. METHODS: In this retrospective study, 345 thyroid US images of 150 patients were reviewed. Three clinicians with at least 6-year experience in thyroid US reviewed the images twice at 6-8 weeks' intervals. Composition, echogenicity, shape, margin, and echogenic foci based on ACR-TIRADS were reported, independently. Inter and intra-observer variations were calculated based on Cohen's Kappa statistics. RESULTS: 345 ultrasonography images of 150 patients with thyroid nodules (83 women and 67 men) with a mean age of 65 years were reviewed. Moderate to the substantial intra-observer agreement was achieved with the highest Kapa value in the category of shape (k=0.61-0.77). For TIRADS level, the moderate intra-observer agreement was observed (k=0.42-0.46). Inter-observer agreement for the US category of thyroid nodules was obtained slightly to moderate. Composition (k=0.42 and 0.51) and echogenicity (k=0.45 and 0.46) showed the highest overall agreement and margin showed the lowest overall agreement (k=0.18 and 0.19). In assessing TIRADS level of nodules, a fair agreement was obtained (k=0.23 and 0.29). CONCLUSION: Moderate to substantial intra-observer agreement and slight to moderate inter-observer variation for evaluation of thyroid nodules; shows the need for a computer-aided diagnosis system based on artificial intelligence to assist our physicians in differentiating thyroid nodule characteristics based on explicit image features. An additional training course based on ACR-TIRADS for physicians can be another useful recommendation.

Longer Time to Reach Excellent Response to Treatment in Familial Versus Sporadic Non-medullary Thyroid Cancer (NMTC): A Matched Case-Control Study.

BACKGROUND: Familial non-medullary thyroid cancer (NMTC) are supposed to be more aggressive and require more frequent treatment compared to non-familial thyroid cancer. OBJECTIVES: This matched case-control study aimed to compare the response to treatment between the matched case-control groups of familial and sporadic NMTC. METHODS: This is a retrospective study in patients with familial NMTC (at least one other first-degree relative involved) who were treated with surgery, followed by radio-iodine therapy (RIT) without consideration of its familial origin. Response to treatment was compared between familial NMTC and age, sex, and TNM stage-matched non-familial NMTC (control group). Response to treatment was assessed one and two years after RIT, and time to excellent response was identified. RESULTS: Out of 2,944 NMTC patients, 81 (2.75%) patients had familial NMTC. We compared 66 patients with familial NMTC and 66 sporadic NMTC patients. There was no significant difference in first thyroglobulin, initial and accumulative iodine dose, and additional treatments (additional surgery and radiotherapy) between patients and controls. Although no significant difference was noted in one and two years' responses to treatment between the case and control groups, familial NMTC patients required more time to achieve excellent response (26.7 ± 24.9 versus 15.9 ± 9.0 months, P = 0.01). No significant difference was noted between familial NMTC patients with two or more than two involved relatives. CONCLUSIONS: Our study showed that if patients with familial NMTCs were treated in the same way as non-familial patients, the time to excellent response would be significantly longer, even when they have only one other involved relative.

Prognostic value and optimal threshold of first thyroglobulin in low/intermediate risk DTC.

BACKGROUND: The aim of this study was to define prognostic value and optimal threshold of first thyroglobulin (fTg) measured after thyroidectomy and just before radio-iodine therapy (RIT), in low/intermediate risk patients with differentiated thyroid cancer (DTC). METHODS: This is a retrospective study in 383 patients with DTC who were treated with surgery followed by RIT. Response to treatment was assessed 1 and 2 years after RIT. Odds ratio of different risk factors like age, sex, TNM stage, fTg and Anti-Tg Ab were compared between patients with and without incomplete response 1 and 2 years after treatment. Receiver operating curve analysis was used for definition of optimal fTg cut off for detection of incomplete response. RESULTS: 218 female and 55 male with DTC had negative anti-Tg antibody (mean age: 37.5±14.5 years) and analyzed separately. fTg≥33.5 ng/mL and fTg/TSH ratio of ≥0.36 had the optimal sensitivity and specificity for detection of incomplete response 1 and 2 years after treatment. fTg<33.5 ng/mL had NPV of 98.5% for exclusion of distant metastases. Patients with fTg≥33.5 ng/mL had longer "time to excellent response" (3.6±2.3 vs. 2.0±1.8 yrs) and needed more additional treatments compared to patients with fTg<33.5 ng/mL. Multivariate analysis showed that fTg was the most potent risk factor for prediction of treatment failure 1 and 2 years after RIT. CONCLUSIONS: fTg of ≥33.5 ng/mL was the most important risk factor for prediction of treatment failure after RIT and could be included in decision algorithms regarding intensity of treatments in low/intermediate risk patients with DTC.

Sentinel ode apping in on-small ell ung ancer sing an ntraoperative adiotracer echnique.

OBJECTIVES: Lymph node metastases are the most significant prognostic factor in localized non-small cell lung cancer (NSCLC). Identification of the first nodal drainage site (sentinel node) may improve detection of metastatic nodes. Extended surgeries, such as lobectomy or pneumonectomy with lymph node dissection, are among the therapeutic options of higher acceptability. Sentinel node biopsy can be an alternative approach to less invasive surgeries. The current study was conducted to evaluate the accuracy of sentinel node mapping in patients with NSCLC using an intraoperative radiotracer techniques. METHODS: This prospective study was conducted on 21 patients with biopsy-proven NSCLC who were candidates for sentinel node mapping during 2012-2014. All patients underwent thoracoabdominal computed tomography, based on which they had no lymph node involvement. Immediately after thoracotomy and before mobilizing the tumor, peritumoral injection of 2mCi/0.4 mL Tc-99m- phytate was performed in 4 corners of tumor. After mobilization of the tumoral tissues, the sentinel nodes were searched for in the hillar and mediastinal areas using hand-held gamma probe . Any lymph node with in vivo count twice the background was considered as sentinel node and removed and sent for frozen section evaluation. All dissected nodes were evaluated by step sectioning and hematoxylin and eosin staining (H&E).The recorded data included age, gender, kind of pathology, site of lesion, number of dissected sentinel nodes, number of sentinel nodes, and site of sentinel nodes. Data analysis was performed in SPSS software (version 22). RESULTS: The mean age of the patients was 58.52±11.46 years with a male to female ratio of 15/6. The left lower lobe was the most commonly affected site (30.09%). Squamous cell carcinoma and adenocarcinoma were detected in 11 and 10 subjects, respectively. A total of 120 lymph nodes were harvested with the mean number of 5.71±2.9 lymph nodes per patient. At least one sentinel node was identified in each patient, resulting in a detection rate of 95.2%. The mean number of sentinel nodes per patient was 3.61±2. Frozen section results showed 100% concordance with the results of hematoxylin and eosin staining. CONCLUSION: Based on the findings, sentinel node mapping can be considered feasible and accurate for lymph node staging and NSCLC treatment.

Whole-Body Blood Pool Metastatic Superscan (Bone Hunger Pattern).

We presented a 61-year-old man's surprising Tc-MDP whole-body blood pool superscan pattern with early unexpected generalized bone uptake. He complained of weakness and undesired weight loss with anemia and elevated erythrocyte sedimentation rate. As a malignancy workup in a patient without obvious suspicious origin, a whole-body Tc-MDP bone scan was requested. This unusual tracer distribution on blood pool imaging was very similar to the whole-body delayed scan except for visible kidneys.

Comparison of treatment efficacy 1 and 2 years after thyroid remnant ablation with 1110 versus 5550 MBq of iodine-131 in patients with intermediate-risk differentiated thyroid cancer.

BACKGROUND: Radioiodine ablation may be associated with improved survival in patients with intermediate-risk follicular cell differentiated thyroid cancer (FCDTC). The aim of this study was to compare ablation efficacy of 1110 versus 5500 MBq of iodine-131 (I) in FCDTC patients with intermediate risk. METHODS: Thirty-nine patients with intermediate-risk FCDTC (T3N0, T1-2N1b and T1-3N1a) were treated with 1110 MBq of I and compared with 43 age-matched and sex-matched patients who received 5550 MBq of I. Patients with invasive histology, extensive lymph node involvement, and preablation thyroglobulin (Tg) of more than 100 ng/ml were excluded from the study. All patients underwent total or near total thyroidectomy with or without lymph node dissection. Response to treatment was evaluated 1 and 2 years after I treatment. RESULTS: We studied four male and 78 female patients, age range 21-69 years. Preablation Tg level was 12.7±17.8 and 15.8±22.6 ng/ml in patients in the low-dose and high-dose groups, respectively (P=0.48). Anti-Tg antibody level as well as T and N staging were not significantly different in the two groups (P>0.2). One and 2 years after treatment, an excellent response was noted in 19 and 22 patients in the low-dose group and in 16 and 23 patients in the high-dose group, respectively (P>0.3). Using logistic regression analysis, preablation Tg was the only significant factor in the prediction of an incomplete response 2 years after therapy. CONCLUSION: 1110 MBq of I was as effective as 5550 MBq of I in the treatment of FCDTC patients with intermediate risk 1 and 2 years after therapy.