Interobserver Agreement of Planar and SPECT Tc99m-MIBI Scintigraphy for the Assessment of Hypofunctioning Thyroid Nodules

Nuklearmedizin â—½  
10.1055/a-0894-4843 â—½  
2019 â—½  
Vol 58 (03) â—½  
pp. 258-264
Author(s):  
Simone Schenke â—½  
Rigobert Klett â—½  
Peter Acker â—½  
Thomas Rink â—½  
Michael C Kreissl â—½  
...  
Keyword(s):  
Thyroid Carcinoma â—½  
Interobserver Agreement â—½  
Thyroid Nodules â—½  
Study Cohort â—½  
Papillary Thyroid â—½  
Planar Images â—½  
Benign Nodules â—½  
Different Levels â—½  
Mibi Scintigraphy â—½  
Spect Images

Abstract Introduction Thyroid scintigraphy with 99mTc-methoxyisobutylisonitrile (MIBI) is a helpful tool for the risk stratification of thyroid nodules (TN). Whereas a nodule with low or hypointense MIBI uptake has a low risk for malignancy, a hyperintense uptake may indicate a malignant nodule, which requires surgical resection. The appropriate diagnostic or therapeutic regimen of an isointense nodule with an uptake similar to the paranodular tissue is discussed controversially. Aim of this study was to assess the interobserver agreement (IA) for the assignment of TN to the three categories: hypo-, iso-or hyperintense. Methods Retrospective analysis of planar and SPECT images of MIBI scintigraphy was performed in 36 randomly selected patients with hypofunctioning TN and histological diagnosis. Four observers with different levels of experience in MIBI-scintigraphy analyzed MIBI uptake and assigned the nodules to the appropriate category. To assess the IA, Fleiss‘ Kappa was calculated. Results The study cohort included 11 patients with papillary thyroid carcinoma (diameter 20.3 mm) and 25 patients with benign nodules (diameter 24.8 mm). The IA for all nodules using planar images was 0.76 compared to 0.80 for SPECT images. The IA was better in the subgroup of malignant nodules for planar images as well as SPECT images (Kappa 0.91 and 0.90, respectively) compared to benign nodules (0.65 and 0.76, respectively). Using SPECT images, only one thyroid carcinoma presented with hypointense uptake, the remainder with hyper- or isointense uptake. In contrast, benign nodules were found in all categories. Conclusion MIBI scintigraphy shows a good IA for the interpretation of thyroid carcinoma. The IA is further improved if MIBI scintigraphy is performed in SPECT technique.

scholarly journals High Thyroglobulin Antibody Levels Increase the Risk of Differentiated Thyroid Carcinoma

Disease Markers â—½  
10.1155/2015/648670 â—½  
2015 â—½  
Vol 2015 â—½  
pp. 1-7 â—½  
Author(s):  
Jing Qin â—½  
Zhenqian Yu â—½  
Haixia Guan â—½  
Liangfeng Shi â—½  
Yongping Liu â—½  
...  
Keyword(s):  
Thyroid Carcinoma â—½  
Thyroid Surgery â—½  
Thyroid Nodules â—½  
Thyroid Autoimmunity â—½  
Differentiated Thyroid Carcinoma â—½  
Thyroid Peroxidase â—½  
Study Cohort â—½  
Thyroid Autoantibodies â—½  
Extrathyroidal Invasion â—½  
Benign Nodules

Background. Despite the many studies examining thyroid cancers, the effect of thyroid autoantibodies on differentiated thyroid carcinoma (DTC) remains unclear.Objective. To investigate the association between serologic thyroid autoantibodies (ATAs) and DTC, we retrospectively evaluated data of thyroid nodules obtained from patients who underwent thyroid surgery.Methods. Data of thyroid nodules obtained from 1,638 patients who underwent thyroid surgery were evaluated. Thyroid autoimmunity was assessed by the presence of thyroglobulin (TgAb) or thyroid peroxidase antibodies (TPOAb).Results. Among our study cohort, the prevalence of elevated TgAb (≥40 IU/mL) and TPOAb (≥50 IU/mL) was higher in patients with DTC than those with benign nodules. Patients with DTC and elevated TgAb had a higher prevalence of extrathyroidal invasion. In the multivariate analysis, TgAb ≥ 40 IU/mL was significantly associated with DTC (odds ratio [OR] = 2.10, 95% confidence interval [CI] 1.40–3.15) compared with TgAb < 40 IU/mL group, independent of other confounding factors such as decreased age, single nodule, and elevated TSH level. In conclusion, elevated TgAb was associated with DTC.Conclusions. This study revealed that high levels of TgAb may act as an independent prediction factor for DTC, and suggests that patients with high TgAb concentrations may be predisposed to DTC.

scholarly journals Break–apart interphase fluorescence in situ hybridization assay in papillary thyroid carcinoma: on the road to optimizing the cut-off level for RET/PTC rearrangements

10.1530/eje-14-0930 â—½  
2015 â—½  
Vol 172 (5) â—½  
pp. 571-582 â—½  
Author(s):  
Chiara Colato â—½  
Caterina Vicentini â—½  
Silvia Cantara â—½  
Serena Pedron â—½  
Paolo Brazzarola â—½  
...  
Keyword(s):  
Papillary Thyroid Carcinoma â—½  
Thyroid Carcinoma â—½  
Chromosomal Rearrangements â—½  
Study Cohort â—½  
Fish Analysis â—½  
Papillary Thyroid â—½  
Qrt Pcr â—½  
Molecular Events â—½  
On The Road

ObjectiveChromosomal rearrangements of theRETproto-oncogene is one of the most common molecular events in papillary thyroid carcinoma (PTC). However, their pathogenic role and clinical significance are still debated. This study aimed to investigate the prevalence of RET/PTC rearrangement in a cohort ofBRAFWT PTCs by fluorescencein situhybridization (FISH) and to search a reliable cut-off level in order to distinguish clonal or non-clonal RET changes.DesignFortyBRAFWT PTCs were analyzed by FISH for RET rearrangements. As controls, sixBRAFV600E mutated PTCs, 13 follicular adenomas (FA), and ten normal thyroid parenchyma were also analyzed.MethodsWe performed FISH analysis on formalin-fixed, paraffin-embedded tissue using a commercially available RET break–apart probe. A cut-off level equivalent to 10.2% of aberrant cells was accepted as significant. To validate FISH results, we analyzed the study cohort by qRT-PCR.ResultsSplit RET signals above the cut-off level were observed in 25% (10/40) of PTCs, harboring a percentage of positive cells ranging from 12 to 50%, and in one spontaneous FA (1/13, 7.7%). Overall, the data obtained by FISH matched well with qRT-PCR results. Challenging findings were observed in five cases showing a frequency of rearrangement very close to the cut-off.ConclusionsFISH approach represents a powerful tool to estimate the ratio between broken and non-broken RET tumor cells. Establishing a precise FISH cut-off may be useful in the interpretation of the presence of RET rearrangement, primarily when this strategy is used for cytological evaluation or for targeted therapy.

scholarly journals Prevalence and pattern of thyroid malignancy in thyroid nodule in Aseer Central Hospital in KSA

2017 â—½  
Vol 3 (4) â—½  
pp. 908 â—½  
Author(s):  
Jibril Yahya Hudise â—½  
Khalid Ali Alshehri â—½  
Saad Nasser Alqarni â—½  
Yara Assiri â—½  
Ashwaq Asiri â—½  
...  
Keyword(s):  
Papillary Thyroid Carcinoma â—½  
Thyroid Carcinoma â—½  
Thyroid Nodule â—½  
Cell Carcinoma â—½  
Thyroid Nodules â—½  
Follicular Thyroid Carcinoma â—½  
Papillary Thyroid â—½  
Thyroid Malignancy â—½  
Central Hospital â—½  
Medullary Thyroid

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Thyroid nodules are common in the general population, especially in women. Non palpable nodules are often found when patients undergo diagnostic imaging such as ultrasonogra­phy and computed tomography of the chest and neck. This retrospective study to assess the Prevalence of thyroid malignancy in thyroid nodule related to gender, age, and pathology, in Aseer Central Hospital KSA. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">During a 5-year period (2011–2016), the medical records of 319 patients with thyroid nodules were collected from the department of pathology at Aseer Central Hospital KSA. The cases were reviewed for data on gender, age, and the pathological result. All patients underwent hemi or total thyroidectomy. Comparisons between genders, age groups, and tissue origins were performed. All statistical tests were performed with SPSS software.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Over a period of 5 years, a total of 319 patients: male 17.2% and female 82.8% Underwent for hemi or total thyroidectomy. The age of presentation was ranging from 14 to 80 years. Among the 319 cases of thyroid nodules 73.7% were benign nodules and 26.3% malignant nodules. Papillary thyroid carcinoma in 72.6%, follicular thyroid carcinoma 10.6%, Hurthle cell carcinoma 4.8%, anaplastic carcinoma 4.8%, thyroid lymphoma 4.8% and medullary thyroid carcinoma in 2.4%. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Thyroid nodule is a common clinical problem and the proportion of such nodules that prove to be malignant is not small, investigations are of immense help to corroborate with the clinical and morphological finding. Papillary thyroid carcinoma most common malignant thyroid carcinoma followed by follicular thyroid carcinoma, hurthel cell carcinoma, anaplastic thyroid carcinoma, lymphoma and finally medullary thyroid Carcinoma. No significant different between male and female as risk factors for malignancy.</span></p>

scholarly journals INCIDENTAL PULMONARY METASTASES REVEALING SUBCENTIMETER PAPILLARY THYROID CARCINOMA

2020 â—½  
Vol 6 (5) â—½  
pp. e273-e278
Author(s):  
Ruey Hu â—½  
George Xu â—½  
Thomas Stricker â—½  
Bingshan Li â—½  
Vivian L. Weiss â—½  
...  
Keyword(s):  
Computed Tomography â—½  
Papillary Thyroid Carcinoma â—½  
Thyroid Carcinoma â—½  
Active Surveillance â—½  
Thyroid Nodules â—½  
Lung Metastases â—½  
Molecular Testing â—½  
American Thyroid Association â—½  
Cancer Genes â—½  
Papillary Thyroid

Objective: Here we present 2 cases of papillary thyroid microcarcinomas (PMCs) that had metastasized at presentation. The 2015 American Thyroid Association and the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) criteria do not recommend biopsy of the majority of subcentimeter thyroid nodules, as PMCs are mostly indolent with excellent prognosis. However, the paradigm of active surveillance presents a conundrum on how to identify the rare patient with distant metastatic disease while avoiding unnecessary intervention in the majority. Methods: After initial discovery of incidental lesions on chest computed tomography, core or wedge biopsies of the lung lesion were performed. Thyroid nodules on ultrasound were classified by TI-RADS. Tumor DNA was sequenced, annotated, filtered on 119 known cancer genes, and filtered for variants with an exome allele frequency of <0.001. Results: A 70-year-old woman and a 29-year-old woman presented with incidental pulmonary lesions on computed tomography scan. Lung biopsy revealed lung metastases from papillary thyroid carcinoma. The thyroid nodules in both patients were TI-RADS 3 and American Thyroid Association low-suspicion. Molecular testing showed a c.1721C>G mutation (p.Thr574Ser) in the TSHR gene in patient 1 and a codon 61 mutation in the NRAS gene in patient 2. Both patients were iodine-avid, with complete structural remission in one patient and ongoing treatment with evidence of structural response in the other. Conclusion: The 2 presentations demonstrate unexpected and concerning behavior of PMCs. Both thyroid tumors were subcentimeter in diameter, meaning they would have escaped detection using traditional risk-stratification algorithms in active surveillance. Further knowledge of tumor genetics and microenvironment may assist in predicting tumor behavior in PMCs.

scholarly journals Papillary Thyroid Carcinoma With Cystic Changes in a Patient With Prior History of Toxic Nodule

2020 â—½  
Vol 8 â—½  
pp. 232470962094267
Author(s):  
Gliceida Maria Galarza Fortuna â—½  
Paola Rios â—½  
Ailyn Rivero â—½  
Gabriela Zuniga â—½  
Kathrin Dvir â—½  
...  
Keyword(s):  
Thyroid Cancer â—½  
Papillary Thyroid Carcinoma â—½  
Thyroid Carcinoma â—½  
Thyroid Nodule â—½  
Thyroid Nodules â—½  
Molecular Testing â—½  
Papillary Thyroid â—½  
Thyroid Lobectomy â—½  
Cystic Changes â—½  
History Of

Thyroid nodules are palpable on up to 7% of asymptomatic patients. Cancer is present in 8% to 16% of those patients with previously identified thyroid nodules. Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, accounting for approximately 85% of thyroid cancers. Although most appear as solid nodules on ultrasound imaging, a subset of 2.5% to 6% has cystic components. The presence of cystic changes within thyroid nodules decreases the accuracy of fine needle aspiration (FNA) in the diagnosis of thyroid cancer, given the difficulty of obtaining appropriate cellular content. This becomes a diagnostic and therapeutic challenge. We present a case of a 31-year-old female with a 1-month history of palpitations, fatigue, and night sweats, who underwent evaluation, and was diagnosed with subclinical hyperthyroidism. She presented 4 years later with compressive symptoms leading to repeat FNA, showing Bethesda III-atypia of undetermined significance and negative molecular testing. Thyroid lobectomy revealed PTC with cystic changes. This case is a reminder that patients with hyperfunctioning thyroid nodule should have closer follow-up. It poses the diagnostic dilemma of how much is good enough in the evaluation and management of a thyroid nodule. Early detection and action should be the standard of care.

scholarly journals Diffuse Follicular Variant of Papillary Thyroid Carcinoma: A Case Report with a Revision of Literature

Rare Tumors â—½  
2016 â—½  
Vol 8 (4) â—½  
pp. 159-161 â—½  
Author(s):  
Gian Luca Rampioni Vinciguerra â—½  
Niccolò Noccioli â—½  
Armando Bartolazzi
Keyword(s):  
Papillary Thyroid Carcinoma â—½  
Thyroid Carcinoma â—½  
Young Women â—½  
Unusual Case â—½  
Thyroid Nodules â—½  
Papillary Thyroid â—½  
Follicular Variant â—½  
Few Data â—½  
Thyroid Parenchyma â—½  
Nuclear Features

The diffuse follicular variant of papillary thyroid carcinoma (DFV-PTC) is a rare malignant thyroid condition. It represents an uncommon variant of papillary carcinoma characterized by a diffuse involvement of thyroid parenchyma, follicular architecture and nuclear features of PTC in absence of a surrounding capsule. Up to date few data have been collected about this entity and, at the best of our knowledge, only 24 cases have been reported in the literature. According to these reports DFV-PTC seems to occur preferentially in young women and shows more aggressive behavior than other papillary thyroid tumors. Herein we present an unusual case of DFV-PTC occurring in an 83 years old woman, involving the entire thyroid gland, without distinct or prevalent thyroid nodules. The tumor was clinically misdiagnosed as obstructive goiter.

scholarly journals Preoperative RAS Mutational Analysis Is of Great Value in Predicting Follicular Variant of Papillary Thyroid Carcinoma

10.1155/2015/697068 â—½  
2015 â—½  
Vol 2015 â—½  
pp. 1-8 â—½  
Author(s):  
Tae Sook Hwang â—½  
Wook Youn Kim â—½  
Hye Seung Han â—½  
So Dug Lim â—½  
Wan-Seop Kim â—½  
...  
Keyword(s):  
Papillary Thyroid Carcinoma â—½  
Thyroid Carcinoma â—½  
Thyroid Nodules â—½  
Mutational Analysis â—½  
Braf V600e â—½  
Papillary Thyroid â—½  
Follicular Variant â—½  
Ras Mutation â—½  
Ras Mutations â—½  
Codon 61

Follicular variant of papillary thyroid carcinoma (FVPTC), particularly the encapsulated subtype, often causes a diagnostic dilemma. We reconfirmed the molecular profiles in a large number of FVPTCs and investigated the efficacy of the preoperative mutational analysis in indeterminate thyroid nodules. BRAF V600E/K601E and RAS mutational analysis was performed on 187 FVPTCs. Of these, 132 (70.6%) had a point mutation in one of the BRAF V600E (n=57), BRAF K601E (n=11), or RAS (n=64) genes. All mutations were mutually exclusive. The most common RAS mutations were at NRAS codon 61. FNA aspirates from 564 indeterminate nodules were prospectively tested for BRAF and RAS mutation and the surgical outcome was correlated with the mutational status. Fifty-seven and 47 cases were positive for BRAF and RAS mutation, respectively. Twenty-seven RAS-positive patients underwent surgery and all except one patient had FVPTC. The PPV and accuracy of RAS mutational analysis for predicting FVPTC were 96% and 84%, respectively. BRAF or RAS mutations were present in more than two-thirds of FVPTCs and these were mutually exclusive. BRAF mutational analysis followed by N, H, and KRAS codon 61 mutational analysis in indeterminate thyroid nodules would streamline the management of patients with malignancies, mostly FVPTC.

T2* mapping at 3.0T MRI for differentiation of papillary thyroid carcinoma from benign thyroid nodules

10.1002/jmri.25041 â—½  
2015 â—½  
Vol 43 (4) â—½  
pp. 956-961 â—½  
Author(s):  
Ruoyang Shi â—½  
Qiuying Yao â—½  
Lianming Wu â—½  
Qinyi Zhou â—½  
Qing Lu â—½  
...  
Keyword(s):  
Papillary Thyroid Carcinoma â—½  
Thyroid Carcinoma â—½  
Thyroid Nodules â—½  
T2 Mapping â—½  
Papillary Thyroid â—½  
3.0T Mri â—½  
Benign Thyroid Nodules â—½  
Benign Thyroid

Immunohistochemical Study of Papillary Thyroid Carcinoma and Possible Papillary Thyroid Carcinoma-related Benign Thyroid Nodules

2000 â—½  
Vol 196 (8) â—½  
pp. 533-540 â—½  
Author(s):  
Kien T. Mai â—½  
Jason C. Ford â—½  
Hossein M. Yazdi â—½  
D. Garth Perkins â—½  
A. Susan Commons
Keyword(s):  
Papillary Thyroid Carcinoma â—½  
Thyroid Carcinoma â—½  
Thyroid Nodules â—½  
Immunohistochemical Study â—½  
Papillary Thyroid â—½  
Benign Thyroid Nodules â—½  
Benign Thyroid

scholarly journals Hashimoto Thyroiditis and Thyroid Ultrasound: A Prospective Study

2021 â—½  
Author(s):  
Anabela Zunino â—½  
Claudia Vazquez â—½  
Laura Delfino â—½  
Adriana Reyes â—½  
Alicia Lowenstein
Keyword(s):  
Prospective Study â—½  
Thyroid Nodules â—½  
Thyroid Volume â—½  
Hashimoto Thyroiditis â—½  
Needle Aspiration â—½  
Thyroid Peroxidase â—½  
Papillary Thyroid â—½  
Immunological Activity â—½  
Benign Nodules â—½  
A Prospective Study

Abstract Purpose We performed a prospective study in patients with positive thyroid peroxidase antibodies (TPOAb), to describe their ultrasound (US) patterns and the prevalence of thyroid nodules. Methods In 195 consecutive patients, with positive TPOAb, thyroid US was performed by the same physician and equipment and categorized into four echographic patterns (EP). We determined the prevalence of thyroid nodules and their etiology confirmed by cytology or histology. Results The median TPOAb was 526 IUI/ml. EP1 or normal US was present in 9,7%; EP2 or early/indeterminate stage in 29,4%; EP3 or established thyroiditis in 45,4% and EP4 or advanced/late stage in 15,5% of the patients. TPOAb (median = 857 UI / ml) (p = 0.001), TSH and thyroid volume ​​were higher in EP3. A higher degree of fibrosis was associated with TPOAb > 1000 IU/ml(p = 0,003). Thyroid nodules were reported on US at 47,2% of HT. Fine needle aspiration(FNA) was performed in 49/60 nodules. Cytology: BII: 41 patients (83,7%), B V: 1 patient (2%): suspicious for lymphoma; B VI: 3 patients(6,1%) : Papillary thyroid carcinoma. Benign cytology was present in 56% of EP3 (p = 0,048). Conclusions Higher TPOAb, TSH levels, and thyroid volume were associated with EP3. Fibrosis correlated with TPOAb > 1000 IU/ml. In our population, benign nodules were associated with established thyroiditis patterns. The increased inflammation and immunological activity of Hashimoto thyroiditis (HT) could be a favorable environment for growth factors for benign nodular development.

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