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.

Bone metastasis from noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP); a case report.

BACKGROUND: The term non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was recently proposed as a non-malignant thyroid lesion with indolent behavior that does not require post-operative radio-iodine treatment. We are reporting a case of NIFTP with bone metastasis that is the second case reported so far. CASE PRESENTATION: We describe a 38-year-old woman who presented with an indeterminate thyroid nodule and underwent total thyroidectomy with the finding of NIFTP on careful pathologic examination. However, her initial follow-up evaluation revealed a serum thyroglobulin level of > 300 ng/ml and a diagnostic whole body 131I scan demonstrated a focus of increased uptake in the left hemipelvis, confirmed on CT scan to be a lytic lesion in the left iliac bone. She was treated with 7.4GBq (200 mCi) of 131I and her follow-up 1 year later revealed an undetectable serum thyroglobulin and a negative whole body 131I scan with no visible uptake in the iliac bone indicating an excellent response. CONCLUSION: This case presentation reminds us to be alert to the rare occurrence of distant metastasis in NIFTP and the need for a case by case analysis and continuing post-operative follow-up for detection of residual or recurrent disease.

The burden and predisposing factors of non-communicable diseases in Mashhad University of Medical Sciences personnel: a prospective 15-year organizational cohort study protocol and baseline assessment.

BACKGROUND: The rising burden of premature mortality for Non-Communicable Diseases (NCDs) in developing countries necessitates the institutionalization of a comprehensive surveillance framework to track trends and provide evidence to design, implement, and evaluate preventive strategies. This study aims to conduct an organization-based prospective cohort study on the NCDs and NCD-related secondary outcomes in adult personnel of the Mashhad University of Medical Sciences (MUMS) as main target population. METHODS: This study was designed to recruit 12,000 adults aged between 30 and 70 years for 15 years. Baseline assessment includes a wide range of established NCD risk factors obtaining by face-to-face interview or examination. The questionnaires consist of demographic and socioeconomic characteristics, lifestyle pattern, fuel consumption and pesticide exposures, occupational history and hazards, personal and familial medical history, medication profile, oral hygiene, reproduction history, dietary intake, and psychological conditions. Examinations include body size and composition test, abdominopelvic and thyroid ultrasonography, orthopedic evaluation, pulse wave velocity test, electrocardiography, blood pressure measurement, smell-taste evaluation, spirometry, mammography, and preferred tea temperature assessment. Routine biochemical, cell count, and fecal occult blood tests are also performed, and the biological samples (i.e., blood, urine, hair, and nail) are stored in preserving temperature. Annual telephone interviews and repeated examinations at 5-year intervals are planned to update information on health status and its determinants. RESULTS: A total of 5287 individuals (mean age of 43.9 ± 7.6 and 45.9% male) were included in the study thus far. About 18.5% were nurses and midwives and 44.2% had at least bachelor's degree. Fatty liver (15.4%), thyroid disorders (11.2%), hypertension (8.8%), and diabetes (4.9%) were the most prevalent NCDs. A large proportion of the population had some degree of anxiety (64.2%). Low physical activity (13 ± 22.4 min per day), high calorie intake (3079 ± 1252), and poor pulse-wave velocity (7.2 ± 1.6 m/s) highlight the need for strategies to improve lifestyle behaviors. CONCLUSION: The PERSIAN Organizational Cohort study in Mashhad University of Medical Sciences is the first organizational cohort study in a metropolitan city of Iran aiming to provide a large data repository on the prevalence and risk factors of the NCDs in a developing country for future national and international research cooperation.

Investigating the prevalence of risk factors of papillary thyroid carcinoma recurrence and disease-free survival after thyroidectomy and central neck dissection in Iranian patients.

Background: Papillary thyroid carcinoma (PTC) is considered the most frequent thyroid malignancy (85-90%) with a good prognosis. However, its frequent recurrence increases mortality and morbidity. In this inquiry we investigated the prevalence of risk factors of PTC recurrence and disease free survival after thyroidectomy and central neck dissection. Method: In this retrospective study, all patients with confirmed PTC who underwent total thyroidectomy and central neck dissection in Imam Reza and Omid hospitals of Mashhad University of Medical Sciences from 2004 to 2011 were included. Total locoregional and distant recurrence rate, 5-year disease free survival rate (DFS) and contributing factors of recurrence were investigated after at least 5 years. Results: In this study 289 patients were included with a mean follow-up of 72.90 ± 11.02 months. 70.6% were female and 29.4% were male. Recurrence occurred in 58 cases from which 10 were distant and 48 were loco-regional. 5-year DFS was 80% and total-survival-rate was 99%. Our analysis showed that primary tumor size, vascular-invasion, extra-thyroid extension, and lymph node ratio (LNR) were significantly related to DFS.

Axillary concordance between superficial and deep sentinel node mapping material injections in breast cancer patients: systematic review and meta-analysis of the literature.

It is still unclear whether the deep and superficial lymphatics of the breast always drain into the same nodes and which route best simulates the spread of breast cancer. In the current study, we systematically searched the available literature to find the studies evaluated the sentinel node locations of deep and superficial injections in the same patients simultaneously or serially. We searched SCOPUS, and PUBMED for relevant studies. Patient basis concordance rate was defined as the ratio of patients with at least one identified axillary sentinel node by both deep and superficial injections to all patients with identified axillary sentinel nodes using either methods. Sentinel node basis concordance was defined as the ratio of the number of axillary sentinel nodes identified by both deep and superficial injections to the sum of all identified axillary sentinel nodes using either methods. Pooled sentinel node detection rates were 94 % [92.1-95.5], 91.2 % [87.1-94.1], and 97.2 % [96-98] for superficial, deep, and combined (superficial and deep) injections. Pooled patient basis and sentinel node basis concordance rates were 90 % [86.7-92.4] and 73 % [63.3-80.9]. Pooled false negative rates were 9.1 % [5.9-14], 8.6 % [3.7-18.8], and 6.5 % [3.4-11.9] for superficial, deep, and combined (superficial and deep) injections, respectively. Axillary lymphatic drainage concordance between superficial and deep sentinel node mapping material in breast cancer patients is fairly high and clinically acceptable. However, both injection techniques can complement each other and the combined superficial/deep injection technique seems to be more successful clinically and can decrease the overall false negative rate.

The role of BRAF V600E mutation as a potential marker for prognostic stratification of papillary thyroid carcinoma: a long-term follow-up study.

Abstract Papillary carcinoma is the most prevalent malignancy of thyroid gland, and its incidence has been recently increased. The BRAF(V600E) mutation is the most frequent genetic alteration in papillary thyroid carcinoma (PTC). The role of BRAF(V600E) mutation as a potential prognostic factor has been controversially reported in different studies, with short-term follow-up. In this study, we evaluated the role of BRAF(V600E) mutation as a potential marker for prognostic stratification of patients with PTC in long-term follow-up. We studied 69 PTC patients with a mean follow-up period of 63.9 months (median: 60 m). The BRAF(V600E) mutation was analyzed by PCR-single-strand conformational polymorphism and sequencing. The correlation between the presence or absence of the BRAF(V600E) mutation, clinicopathological features and prognosis of PTC patients were studied. The BRAF(V600E) mutation was found in 28 of 69 (40.6%) PTC patients, and it was significantly more frequent in older patients (p < 0.001), in advanced tumor stages (p = 0.006) and in patients with history of radiation exposure (p = 0.037). Incomplete response to treatment in PTC patients was significantly correlated with certain clinicopathological characteristics (follow-up time, distant metastases, advanced stage, first thyroglobulin (fTg) level, history of reoperation and external radiotherapy and delay in iodine therapy) but it was not related to the presence of BRAF(V600E) mutation. Prevalence of BRAF(V600E) mutation was 40.6% in patients with papillary thyroid cancer in northeast of Iran. The BRAF(V600E) mutation was associated with older age and advanced tumor stage but was not correlated with incomplete response during follow-up.

Comparison of 8th and 7th editions of TNM staging in terms of mortality, persistent disease, and response to treatment in patients with differentiated thyroid cancer.

OBJECTIVE: To compare the eighth and seventh editions of TNM staging (TNM-8 and TNM-7) on disease-related mortality, persistent disease, and response to treatment in patients with differentiated thyroid cancer (DTC). METHODS AND MATERIALS: We studied 400 patients (79% female) with DTC with a mean age of 40.93±14.11 years. TNM staging was recorded according to the 7th and 8th editions and patients were followed for at least 1 year and response to therapy was recorded according to ATA response categorization. RESULTS: The mean follow up time was 42.5±15.24 months. Overall, 108 patients (27%) were down-staged using the TNM-8, mainly due to the changes in the age cut-off (14.5%), N (9.25%), and T categorization (3.25%). All patients in stage III and 82.8% in stage IV were down-staged. The mean Tg levels were significantly higher in stages III and IV in TNM-8 compared to TNM-7. Four disease-related death were recorded during follow up, all in stage IV according to TNM-7, while one was in stage II according to TNM-8. One year after treatment, persistent disease was detected in 12% and 77% of patients in stage III according to the 7th and 8th editions, respectively (P= 0.04). Similarly, biochemical incomplete response one year after treatment was seen in 7.3% and 87% in stage III disease using 7th and 8th editions (P = 0.006) that fell to 2.4% and 22% in the last visit respectively (P = 0.04). CONCLUSION: Persistent disease and incomplete response to therapy were more common in stages III and IV in TNM-8 compared to TNM-7. The eighth edition was a better predictor of persistent disease in stages III and IV disease.

Diagnostic performance of fluorine-18-fluorodeoxyglucose positron emission tomography imaging in uterine sarcomas: systematic review and meta-analysis of the literature.

OBJECTIVE: We reviewed the medical literature on the application of fluorine-18-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) imaging in the management of uterine sarcomas and presented the results in systematic review and meta-analysis format. METHODS: Medline, SCOPUS, and ISI Web of Knowledge were searched electronically with "PET AND (Uterine OR Uterus)" as key words. All studies evaluating the accuracy of (18)F-FDG imaging in the staging or restaging of uterine sarcomas were included if enough data could be extracted for calculation of sensitivity and/or specificity. RESULTS: Eight studies were included in the systematic review. Only 2 studies reported the accuracy of (18)F-FDG PET imaging in the primary staging of uterine sarcoma with low sensitivity for lymph node staging. For restaging (detection of recurrence), all 8 included studies had quantitative data, and the patient-based pooled sensitivity and specificity were 92.1% (95% confidence interval [95% CI], 82.4-97.4) and 96.2% (95% CI, 87-99.5), respectively. On a lesion-based analysis, sensitivity was 86.3% (95% CI, 76.7-92.9), and specificity was 94.4% (95% CI, 72.7-99.9). Device used (PET vs PET/CT), spectrum of studied patients, and histology of the sarcoma seem to be factors influencing the overall accuracy of (18)F-FDG PET imaging. CONCLUSIONS: (8)Fluorine-18-fluorodeoxyglucose PET and PET/CT seem to be accurate methods for detection and localization of recurrence in patients with uterine sarcoma. Further large multicenter studies are needed to validate our results and to correlate both sarcoma type and spectrum of patients to the diagnostic performance of (18)F-FDG PET imaging in recurrence detection. The studies evaluating the accuracy of (18)F-FDG PET imaging for the primary staging of uterine sarcoma are very limited, and no definite conclusion can be made in this regard.

Diagnostic performance of fluorine 18 fluorodeoxyglucose positron emission tomography imaging for detection of primary lesion and staging of endometrial cancer patients: systematic review and meta-analysis of the literature.

OBJECTIVES: Fluorine 18 fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) imaging has been used for staging of endometrial cancer. In the current study, we systematically searched the available literature on the accuracy of (18)F-FDG PET imaging for staging of endometrial cancer. METHODS: PubMed, SCOPUS, ISI Web of Knowledge, Science Direct, and Springer were searched using "endometr* AND PET" as the search terms. All studies evaluating the accuracy of (18)F-FDG PET in the staging of endometrial carcinoma were included. Statistical pooling of diagnostic accuracy indices was done using random-effects model. Cochrane Q test and I(2) index were used for heterogeneity evaluation. RESULTS: Sixteen studies (807 patients in total) were included in the meta-analysis. Sensitivity and specificity for detection of the primary lesions were 81.8% (77.9%-85.3%) and 89.8% (79.2%-96.2%); for lymph node staging were 72.3% (63.8%-79.8%) and 92.9% (90.6%-94.8%); and for distant metastasis detection were 95.7% (85.5%-99.5%) and 95.4% (92.7%-97.3%). CONCLUSIONS: Because of low sensitivity, diagnostic utility of (18)F-FDG PET imaging is limited in primary tumor detection and lymph node staging of endometrial cancer patients. However, high specificities ensure high positive predictive values in these 2 indications. Diagnostic performance of (18)F-FDG PET imaging is much better in detection of distant metastases. Larger studies with better design are needed to draw any more definite conclusion.

AOJNMB enters the Second Decade of Publication.

No Abstract is available.

Unilateral Chronic Parotitis With 68 Ga-DOTA-FAPI-04 PET/CT and 18 F-FDG PET/CT Imaging in a Case of a Patient With Papillary Thyroid Carcinoma.

ABSTRACT: The 68 Ga-FAPI (fibroblast activation protein inhibitor) radiotracer is a novel and versatile tool in nuclear medicine, exhibiting potential for use in various conditions due to its significant upregulation in cancerous and inflammatory conditions, particularly those involving fibrotic and infectious processes. In this report, we present the case of a patient with papillary thyroid carcinoma who underwent total thyroidectomy and iodine therapy. He was referred because of high thyroglobulin despite negative diagnostic radioiodine imaging (TENIS syndrome). The patient underwent 18 F-FDG and 68 Ga-DOTA-FAPI-46 PET/CT imaging for metastatic workup and treatment planning. FAPI uptake was observed in the right parotid gland (with no FDG uptake), prompting a 99m TcO 4- salivary scintigraphy. Subsequently, a diagnosis of chronic sialadenitis was made.

Impact of [18F]FDG PET/CT in the Assessment of Immunotherapy-Induced Arterial Wall Inflammation in Melanoma Patients Receiving Immune Checkpoint Inhibitors.

We aimed to investigate the role of [18F]FDG positron emission tomography/computed tomography (PET/CT) in the early detection of arterial wall inflammation (AWI) in melanoma patients receiving immune checkpoint inhibitors (ICIs). Our retrospective study enrolled 95 melanoma patients who had received ICIs. Inclusion criteria were ICI therapy for at least six months and at least three [18F]FDG PET/CTs, including one pretreatment session plus two scans three and six months after treatment initiation. AWI was assessed using quantitative and qualitative methods in the subclavian artery, thoracic aorta, and abdominal aorta. We found three patients with AWI visual suspicion in the baseline scan, which increased to five in the second and twelve in the third session. Most of these patients' treatments were terminated due to either immune-related adverse events (irAEs) or disease progression. In the overall population, the ratio of arterial-wall maximum standardized uptake value (SUVmax)/liver-SUVmax was significantly higher three months after treatment than the pretreatment scan in the thoracic aorta (0.83 ± 0.12 vs. 0.79 ± 0.10; p-value = 0.01) and subclavian artery (0.67 ± 0.13 vs. 0.63 ± 0.12; p-value = 0.01), and it remained steady in the six-month follow-up. None of our patients were diagnosed with definite clinical vasculitis on the dermatology follow-up reports. To conclude, our study showed [18F]FDG PET/CT's potential to visualise immunotherapy-induced subclinical inflammation in large vessels. This may lead to more accurate prediction of irAEs and better patient management.

Accuracy of sentinel lymph node biopsy for inguinal lymph node staging of penile squamous cell carcinoma: systematic review and meta-analysis of the literature.

PURPOSE: Sentinel lymph node biopsy is emerging as a promising method for inguinal lymph node staging of penile squamous cell carcinoma. In the current systematic review we evaluated the accuracy of sentinel lymph node biopsy for inguinal lymph node staging of penile squamous cell carcinoma and studied possible influential factors. MATERIALS AND METHODS: MEDLINE®, Scopus®, ISI®, Ovid SP®, Springer, ScienceDirect® and Google™ Scholar were searched by the key words "(penile OR penis) AND sentinel". No date or language limitation was imposed on the search and meeting abstracts were not excluded from analysis. A random effects model was used for statistical pooling. RESULTS: A total of 17 studies suitable for meta-analysis were detected. Three articles had 2 different subgroups of patients and each subgroup was considered as a separate study. Overall 18 studies (including the subgroups) were used for detection rate meta-analysis and 19 for sensitivity meta-analysis. The pooled detection rate was 88.3% (95% CI 81.9-92.6). Pooled detection rate of 90.1% (95% CI 83.6-94.1) was calculated for the studies using blue dye and radiotracer. The pooled sensitivity was 88% (95% CI 83-92). The highest pooled sensitivity (92% [95% CI 86-96]) was in the studies using radiotracer and blue dye, and recruiting only cN0 cases. CONCLUSIONS: Sentinel lymph node mapping in penile squamous cell carcinoma is a method with a high detection rate and sensitivity. Using radiotracer and blue dye for sentinel lymph node mapping and including only cN0 disease ensures the highest detection rate and sensitivity.

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.

Bone scan with technetium 99m-methyl diphosphonate, the missing link in the initial staging of muscle-invasive bladder carcinoma.

BACKGROUND: Accurate staging is crucial to determine the type of treatment for patients with bladder cancer (BCa), especially in high-risk cases. We aimed to assess the role of bone scan in the initial staging of muscle-invasive bladder carcinoma (MIBC). MATERIAL AND METHODS: Forty-five patients with MIBC were referred to our tertiary clinic to perform a technetium 99m-methyl diphosphonate (Tc99m-MDP) bone scan from January 2019 to March 2020. The patients underwent bone scintigraphy with pelvic SPECT/CT before radical cystectomy. Whole-body scanning was performed 4 hours after Tc99m-MDP injection in both anterior and posterior views. Since the most common bone involvement site in these patients is the pelvic bones and the spine, pelvic SPECT/CT was performed in all patients. RESULTS: Frequency of skeletal metastasis was 26.7%. Only 19% of the metastases were detected by previous pelvic CT/MRI images performed for routine staging. All the reported skeletal metastases by previous anatomical imaging methods were detected in the bone scan. There was no statistically significant correlation between bone metastasis and the patient's age, lymph nodes metastasis (LNM), hydronephrosis, and muscle-invasive type. The mean serum calcium level was 8.7 ± 0.57 in patients with bone metastasis and 8.87 ± 0.99 in patients without bone metastasis, which was not statistically significant. CONCLUSION: Bone scan has higher diagnostic performance than conventional imaging methods for detecting bone metastases. It changed the management plan in 8.8% of our patients, so we conclude that performing a whole-body bone scan in the initial staging of MIBC would be helpful.

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.

Value of polyclonal human immunoglobulin tagged with 99mTc for detecting acute appendicitis in patients with intermediate probability of appendicitis.

BACKGROUND: The aim of this study was to assess the value of a technetium ((99m)Tc)-polyclonal antibody to detect acute appendicitis in patients with intermediate probability of appendicitis. METHODS: A total of 40 patients with mean age of 24.6 ± 6.9 years with intermediate probability of appendicitis according to the Alvarado scoring system (score 5 or 6) were studied. After intravenous injection of 740 MBq of (99m)Tc-immunoglobulin G (IgG), a flow and blood pool image was obtained followed by two planar images and single photon emission tomography (SPECT) scan from the lower abdominal and pelvic regions. The images were subjected to visual and quantitative analysis. Patients were followed clinically, and the surgeon decided to operate on or observe the patient depending on the clinical findings. The pathology results were considered the gold standard if patients underwent an operation. If patients improved without surgery, it was considered negative for appendicitis. RESULTS: Altogether, 31 patients were operated on, and 21 patients had acute appendicitis. Nine patients were discharged from hospital and had no symptoms during follow-up. The sensitivity of the planar images for diagnosing appendicitis was 19-24% and specificity was 100%. The sensitivity of SPECT for diagnosis of appendicitis was 62%, the specificity was 68%, and the negative predictive value (NPV) was 62%. Quantitative analysis showed that using a cutoff of >1.2 for the mean right-to-left count per voxel ratio, the sensitivity of the test for detection of appendicitis was 54%, and the specificity was 86%. CONCLUSIONS: (99m)Tc-polyclonal IgG scanning has low sensitivity and moderate NPV for detecting appendicitis. Therefore, it is not a suitable tracer for excluding appendicitis.

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.

Incidental finding of a dermoid cyst in a whole-body iodine scan: importance of using [131I]SPECT/CT in the differentiated thyroid carcinoma.

A 33-year-old female with a history of total thyroidectomy for papillary thyroid carcinoma was referred to the nuclear medicine department for ablative radioiodine therapy. Post ablation scan showed an area of intense iodine uptake on the left side of the pelvic region, corresponding to the large well-defined heterogeneous mass in the left ovary in the SPECT/CT images. The radiologic features of this lesion were compatible with a dermoid cyst, previously unrecognized. Eventually, the lesion was laparoscopically removed, and a typical dermoid cyst was confirmed through histopathologic assessment.

Systemic absorption of Tc-99m-pertechnetate during dacryoscintigraphy: a note of caution.

We report a 37-year-old patient with the history of bilateral epiphora, who was referred to our department for dacryoscintigraphy imaging. The patient had bilateral obstruction of the lacrimal apparatus at the sac-duct level on the scintigraphy images. Delayed imaging showed Tc-99m pertechnetate uptake in the thyroid due to systemic absorption of the tracer from the conjunctiva. We recommend using tracers with large particle size and lower possibility of mucosal absorption for dacryoscintigraphy in order to decrease unnecessary thyroid radiation.