The treatment and preoperative diagnosis of differentiated thyroid carcinoma presenting as a clinically solitary nodule

Background: Thyroid carcinoma generally has a good prognosis. The main focus of current research on thyroid carcinoma is to increase the accuracy of preoperative diagnosis of thyroid nodules. When the result of fine needle aspiration biopsy (FNAB) is indeterminate, clinicians often have doubts in determining the surgical management. Objective: Protein BRAF expression analysis can help improve the accuracy of FNAB and optimize the management of differentiated thyroid carcinoma. Methods: This study is a diagnostic test performed from October 2016 at Sanglah General Hospital with 38 patients as subjects who fulfilled the inclusion criteria. Data is being presented in descriptive form before diagnostic test is done to determine sensitivity, specificity, positive predictive value, negative predictive value and the accuracy of immunocytochemistry test for BRAF on indeterminate thyroid nodule. Results: Thirty-eight samples met the inclusion criteria during the study period. Three samples were male (7.9%) and 35 samples (92.1%) were female. The mean age of the sample was 45.21 years (SD ±10.910 years) with ages ranging from 23 to 66 years. Of the 12 samples undergoing isthmolobectomy, 7 samples (58.4%) were determined to be malignant from histopathological results. The sensitivity value of BRAF immunocytochemistry test is 45.45% with a specificity value of 81.25%, a positive predictive value of 76.92%, a negative predictive value of 52% and an accuracy of 60.50%. Analysis of the receiver operator (ROC) curve shows the area under the curve (AUC) of 63.4% with a confidence interval of 45.5–81.2%. Conclusion: Immunocytochemistry BRAF test have a reliable diagnostic value and can be taken into consideration in the preoperative diagnosis of thyroid malignancies.

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Risk stratification of 282 differentiated thyroid cancers found incidentally in 1369 total thyroidectomies according to the 2015 ATA guidelines; implications for management and treatment

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0017 ◽

2018 ◽

Vol 100 (5) ◽

pp. 357-365 ◽

Cited By ~ 1

Author(s):

I Christakis ◽

S Dimas ◽

ID Kafetzis ◽

N Roukounakis

Keyword(s):

Thyroid Carcinoma ◽

Preoperative Diagnosis ◽

Radioactive Iodine ◽

Risk Group ◽

Differentiated Thyroid Carcinoma ◽

Stage I ◽

American Thyroid Association ◽

Intermediate Risk ◽

Incidental Group ◽

Iodine Treatment

Introduction The purpose of this study was to evaluate the incidence of incidental differentiated thyroid carcinoma in thyroid operations for a benign preoperative diagnosis, to identify the risk factors involved and to risk stratify the cancer patients according to the 2015 American Thyroid Association (ATA) guidelines. Materials and methods The study was a retrospective review of all thyroidectomy operations performed in a single institution (January 2004 to January 2009). We excluded patients with a preoperative diagnosis of thyroid malignancy. Results Incidental differentiated thyroid carcinoma was diagnosed in 282/1369 patients (21%). The incidental group had a significantly higher number of males (19% vs 14%, P = 0.033) and a higher number of patients with histopathological evidence of thyroiditis (35% vs 25%, P = 0.004). There was a higher number of lymph nodes present in the incidental group but numbers did not reach statistical significance (17% vs 13%, P = 0.079). There were 270 cases in the ATA low-risk group (96%) and 12 cases in the ATA intermediate-risk group (4%). Patients with an ATA intermediate risk had a statistically higher number of capsule invasion, extrathyroidal extension and angioinvasion (P < 0.001, P < 0.001 and P < 0.001, respectively). Overall, 22% of patients with an incidental differentiated thyroid carcinoma should be considered for radioactive iodine 131I treatment. 29 of the 191 patients in American Joint Committee on Cancer stage I should be considered for radioactive iodine treatment (15%). Conclusions Males and patients with thyroiditis are at a higher risk for an incidental differentiated thyroid carcinoma. One of every five of patients diagnosed with cancer will need radioactive iodine treatment, even some patients with stage I disease.

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Changes in TNM stage, reoperation and 131-I ablation rate during the use of newer methods for the preoperative diagnosis of differentiated thyroid carcinoma

Clinical Endocrinology ◽

10.1111/j.1365-2265.2011.04199.x ◽

2012 ◽

Vol 76 (2) ◽

pp. 289-296 ◽

Cited By ~ 1

Author(s):

H. Karga ◽

K. Mavroudis ◽

I. Giagourta ◽

M. Triantaphyllopoulou ◽

V. Ktena ◽

...

Keyword(s):

Thyroid Carcinoma ◽

Preoperative Diagnosis ◽

Ablation Rate ◽

Differentiated Thyroid Carcinoma ◽

Tnm Stage

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Cytopathology of Solid Variant of Papillary Thyroid Carcinoma: Differential Diagnoses with other Thyroid Tumors

Acta Cytologica ◽

10.1159/000493081 ◽

2018 ◽

Vol 62 (5-6) ◽

pp. 371-379 ◽

Cited By ~ 4

Author(s):

Prerna Guleria ◽

Ravi Phulware ◽

Shipra Agarwal ◽

Deepali Jain ◽

Sandeep R. Mathur ◽

...

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Preoperative Diagnosis ◽

Differentiated Thyroid Carcinoma ◽

Follicular Neoplasm ◽

Thyroid Tumors ◽

Papillary Thyroid ◽

Follicular Variant ◽

Poorly Differentiated ◽

Nuclear Features

Objectives: Solid variant of papillary thyroid carcinoma (SVPTC) is rare, differing from classical PTC (cPTC) in architecture and outcome. We evaluated the cytomorphology of SVPTC cases to assess the feasibility of a preoperative diagnosis. Study Design: SVPTC cases were evaluated for architecture, nuclear features, and Bethesda category and were compared with noninvasive follicular thyroid neoplasm with papillary-like nuclear features/follicular variant of PTC (NIFTP/FVPTC), cPTC, and poorly differentiated thyroid carcinoma (PDTC). Results: Nine SVPTCs, 29 NIFTP/FVPTCs, 12 cPTCs, and 4 PDTCs were included. The predominant architecture in most SVPTCs was solid fragment, which is helpful in differentiating them from NIFTP/FVPTC (p < 0.001) and cPTC (p = 0.006) but not from PDTC. The presence of microfollicles led to misinterpretation as NIFTP/FVPTC/follicular neoplasm in 4 patients. All but 1 SVPTC showed diffuse nuclear features. Intranuclear pseudoinclusions (INIs) were seen in 67% of SVPTCs as compared to 83% of cPTCs, 14% of NIFTP/FVPTCs (p = 0.005), and none of PDTCs. SVPTC cases were commonly (78%) categorized as intermediate/suspicious. Conclusions: The presence of solid fragments and lack of true papillae are helpful in differentiating SVPTC from cPTC. Solid fragments, trabeculae, the extent of nuclear features, and INIs should be looked for in cases with prominent microfollicles for distinguishing SVPTC from NIFTP/FVPTC. None of the features were helpful in differentiating SVPTC from PDTC.

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A Single Recombinant Human Thyrotropin-Stimulated Serum Thyroglobulin Measurement Predicts Differentiated Thyroid Carcinoma Metastases Three to Five Years Later

Yearbook of Surgery ◽

10.1016/s0090-3671(08)70416-6 ◽

2006 ◽

Vol 2006 ◽

pp. 152-153

Author(s):

T.J. Fahey

Keyword(s):

Thyroid Carcinoma ◽

Differentiated Thyroid Carcinoma ◽

Serum Thyroglobulin ◽

Recombinant Human Thyrotropin

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Clinical evaluation of a new thyroglobulin immunoradiometric assay in the follow-up of differentiated thyroid carcinoma

Nuklearmedizin ◽

10.1055/s-0038-1625299 ◽

2003 ◽

Vol 42 (02) ◽

pp. 71-77 ◽

Cited By ~ 4

Author(s):

I. Schreivogel ◽

C. Angerstein ◽

U. Siefker ◽

K. Lehmann ◽

G. Altenvoerde ◽

...

Keyword(s):

Thyroid Carcinoma ◽

Residual Disease ◽

False Negative ◽

Differentiated Thyroid Carcinoma ◽

Threshold Concentration ◽

High Rate ◽

Functional Assay ◽

Hypothyroid Patient ◽

Assay Sensitivity ◽

Significant Difference

SummaryAim: Formal and clinical comparison of a new 3rd-gene-ration-Tg-IRMA (3-G-IRMA; Dynotest®Tg-plus) with a conventional Tg-IRMA (3-G-IRMA; SELco®Tg-assay) for patients with differentiated thyroid carcinoma. In addition we evaluated, if thyroglobulin (Tg) levels above a specific threshold concentration indicate the need for further investigations for residual disease. Patients, methods: Tg concentration of 105 sera of 93 consecutive patients with a differentiated thyroid cancer was determined with both assays and compared at different cut-off values (Dynotest®Tg-plus: 0.2, 1, 2 ng/ml; SELco®Tg-assay: 0.5, 1, 2 ng/ml) with the clinical results in respect to the corresponding TSH concentration. Results: Tg concentration did not show any significant difference (SELco®Tg-assay 0.5 ng/ml, Dynotest® Tg-plus 0.2 ng/ml). The Tg-values of both assays correlated with 97%. However, correlation of recovery in both assays was small (40%). The sensitivities and specificities of both assays at different cut-offs and TSH values did not reveal significant differences. In patients with TSH concentration >30 µU/ml the functional assay sensitivity was superior to arbitrary cut-offs in the decision to start further evaluations. Conclusions: In our study neither formal nor clinical significant differences between two Tg-assays were found. In a hypothyroid patient (TSH >30 µU/ml, Tg concentration exceeding the functional assay sensitivity) further investigations for residual disease are warranted. Higher thresholds are of limited value, due to a inacceptable high rate of false negative results.

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131J-speichernde pulmonale und ossäre Metastasen differenzierter Schilddrüsenkarzinome bei niedrigem Serum-Thyreoglobulinspiegel – Ausnahme in der Tumornachsorge?

Nuklearmedizin ◽

10.1055/s-0038-1628878 ◽

1987 ◽

Vol 26 (03) ◽

pp. 139-142 ◽

Cited By ~ 4

Author(s):

G. Arning ◽

O. Schober ◽

H. Hundeshagen ◽

Ch. Ehrenheim

Keyword(s):

Serum Level ◽

Thyroid Carcinoma ◽

Bone Metastases ◽

Differentiated Thyroid Carcinoma ◽

Serum Thyroglobulin ◽

Thyroglobulin Level ◽

Low Serum

In the follow-up of differentiated thyroid carcinoma it is discussed whether the tumormarker thyroglobulin can replace the1311 scan, especially when the thyroglobulin serum level is normal. A positive1311 scan of metastases in the follow-up of patients with differentiated thyroid carcinoma combined with a low serum thyroglobulin level is extremely rare. The literature shows a frequency of about 4%. Recently we found 3 cases with a positive1311 scan demonstrating pulmonary and bone metastases whereas the serum thyroglobulin level was low.

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