Diagnosis Of Thyroid Carcinoma Research Articles

Fine needle aspiration cytology diagnoses of follicular thyroid carcinoma: results from a multicenter study in Asia.

This study was designed to compare diagnostic categories of thyroid fine needle aspiration cytology (FNAC) and incidence of thyroid tumors in the multi-institutional Asian series with a special focus on diagnostic category IV (suspicious for a follicular neoplasm) and follicular thyroid carcinomas (FTCs). Distribution of FNAC categories, incidence of thyroid tumors in resection specimens and cytologic diagnoses of surgically confirmed follicular adenomas (FAs) and FTCs were collected from 10 institutes from five Asian countries and were compared among countries and between FAs and FTCs. The frequency of category IV diagnoses (3.0%) in preoperative FNAC were significantly lower compared to those in Western countries (10.1%). When comparing diagnostic categories among Asian countries, category IV was more frequent in Japan (4.6%) and India (7.9%) than in Taiwan (1.4%), Korea (1.4%), and China (3.6%). Similarly, incidence of FAs and FTCs in surgical resection specimens was significantly higher in Japan (10.9%) and India (10.1%) than in Taiwan (5.5%), Korea (3.0%), and China (2.5%). FTCs were more commonly diagnosed as category IV in Japan (77.5%) than in Korea (33.3%) and China (35.0%). Nuclear pleomorphism, nuclear crowding, microfollicular pattern, and dyshesive cell pattern were more common in FTCs compared with FAs. Our study highlighted the difference in FNAC diagnostic categories of FTCs among Asian countries, which is likely related to different reporting systems and thyroid cancer incidence. Cytologic features such as nuclear pleomorphism, nuclear crowding, microfollicular pattern, and dyshesive cell pattern were found to be useful in diagnosing FTCs more effectively.

Use of the immunohistochemical marker HBME-1 to optimize the diagnosis of follicular carcinomas

Background. In clinical practice, there are often patients with a diagnosis of benign follicular adenoma (FA) and follicular tumor with an uncertain malignant potential, whose diagnoses must be changed to malignant processes due to relapse or metastasis observed over time. The purpose of the study was to optimize the differential diagnosis of FA and follicular thyroid carcinoma (FTC) using the immunohistochemical (IHC) marker HBME-1 on the histological material of patients who were operated for nodular goiter with a cytological conclusion corresponding to the Bethesda categories III–V. Materials and methods. One hundred and twenty-four patients underwent surgery for follicular nodular neoplasms with a cytological conclusion according to Bethesda Gray zone and had a histological diagnosis of FTC in 23 ca­ses (18.55 %) and FA in 101 cases (81.45 %). IHC analysis was performed using mouse monoclonal antibodies against human HBME-1 (Bio SB, USA). Evaluation criteria corresponded to the strength of staining (from 0 to 3). Results. According to the intensity of IHC staining, there was an increase in the diagnosis of FTC (p < 0.05): 0 — 0 %, 1 — 12.7 %, 2 — 25 %, 3 — 36.4 %. Histopathological findings were reexamined for FA that had the strongest staining reaction: in 3 (2.97 %) cases, the diagnosis was changed to FTC. Accor­dingly, the total number of detected FTC increased to 26 (20.96 %). These cases showed a good positive result regarding IHC study with HMBE-1 on FA preparations for a differential diagnosis between FA and FTC. Conclusions. HBME-1 can serve as an IHC marker for the differential diagnosis of FA and FTC in cases considered as FA, as after the study, the diagnosis was changed to FTC in 2.97 % of patients.

Preoperative clinical and paraclinical features and neck lymph metastasis in patients with follicular thyroid cancer undergoing surgery in National Hospital of Endocrinology

Background: Follicular thyroid cancer has a low rate of lymph node metastasis compared to other types. However, cervical lymph node metastasis is a risk factor for recurrence and distant metastasis, affecting the patient's prognosis. The study aims to evaluate the clinicopathologic features and metastasis states of follicular thyroid carcinoma at National hospital of Endocrinology. Methods: We conducted a retrospective cohort study of 64 follicular thyroid carcinoma patients treated by surgery at National hospital of Endocrinology from June 2017 to March 2019. Results: The mean age was 45,5 ± 13,1 and the female/male ratio was 15/1. Most patients presented with an asymptomatic and had a unilateral tumor with mean diameter was 15, 09 ± 8,42 mm. 73,4% of tumors were classifled as TIRADS 4 on ultrasound. FNA was not of great significance for diagnosis of follicular thyroid carcinoma with undetermined significance result in 40,6%. The overall rate of nodal metastasis was 29,7%, higher with cancer surgery in both lobes of the thyroid gland. Conclusions: Follicular thyroid cancer has a higher rate of cervical lymph node metastasis in patients aged 55 years and older, with tumors in both lobes and larger than 2 cm. However, cervical lymph node metastasis in follicular thyroid cancer is lower than in other thyroid cancers and cytology is not of high value in preoperative diagnosis.

Anaplastic transformation of papillary thyroid carcinoma in the cervical lymph nodes showing a variety of rhabdoid, epithelioid and spindle cell phenotype

Abstract Introduction/Objective Anaplastic thyroid carcinoma (ATC) is a rare undifferentiated tumor of thyroid follicular cells with a dismal prognosis. Most ATCs derive from pre-existing, well-differentiated thyroid carcinomas, most commonly papillary thyroid carcinoma (PTC). In nearly all instances, ATC arises within the thyroid gland. Completely divergent morphologies of this tumor between the bilateral cervical nodes as well as the almost exclusive presence of ATC in the metastatic and nodal locations are very unusual and are reported here. Methods/Case Report A 67-year-old man presented with a rapidly enlarging left cervical mass, hoarseness, dry cough, and drooping left eye. MRI demonstrated bilateral enlarged cervical lymph nodes spanning levels II to V, and nodules in thyroid lobes. Subsequent total thyroidectomy with bilateral radical neck dissection was performed. Histologically, the left lateral cervical masses revealed undifferentiated tumor cells with rhabdoid, epithelioid and spindle cells features. Conversely, the tumor within the thyroid lobes and the right cervical lymph nodes exhibited PTC with tall cell features. All undifferentiated tumor components stained positive with AE1-3, CK7, PAX8, and negative with thyroglobulin, EMA, CD34, S100, Melan-A, Sox 10, desmin, myogenin, and P40. INI-1 staining is retained. Only the spindle cell component stained positive with TTF1. Based on the morphology and immunoprofile, a diagnosis of anaplastic thyroid carcinoma was rendred. Results (if a Case Study enter NA) NA Conclusion Diagnosing anaplastic thyroid carcinoma outside the thyroid lesion can be challenging. In our case, only extensive sampling of the surgical specimen identified a small focus of well-differentiated PTC, staining positive for thyroglobulin, in the left cervical anaplastic carcinoma component, identifying its origin. This case adds to the scarce literature documenting unilateral anaplastic transformation in the left cervical metastatic lymph nodes, while the right cervical lymph nodes contained pure well differentiated PTC. This represents a significant potential pitfall in presurgical fine needle aspiration (FNA) evaluation of patients with ATC.

Improving thyroid cancer diagnosis with advanced deep learning techniques

The accurate diagnosis of thyroid carcinoma is a complex and critical challenge in medical practice due to the clinical and pathological diversity of thyroid tumors. This study explores the application of advanced deep learning models, specifically EfficientNet B4 and MobileNetV3, to enhance the classification of thyroid histopathological images. By leveraging transfer learning, these models were fine-tuned on a dataset of 7,272 images encompassing three types of carcinoma: Medullary, Papillary, and Vesicular. The performance of these models was evaluated using metrics such as accuracy, precision, recall, and F1-score. The results indicate that both models are effective, with EfficientNet B4 demonstrating slightly superior accuracy, particularly in more challenging diagnostic scenarios. Despite these promising results, the study acknowledges limitations related to dataset size and variability, which could affect the generalizability of the models. To address these issues, future research should focus on expanding the dataset and incorporating additional diagnostic data, such as genetic and molecular markers, to improve model performance and clinical applicability. This study highlights the potential of deep learning models to significantly enhance the diagnostic accuracy of thyroid carcinomas, paving the way for more reliable and precise clinical decision-making.

Diagnostic value of FNA, ultrasound elastography and CEUS in thyroid carcinoma

Background: To investigate the role of fine needle aspiration cytology (FNA), sonoelastography and contrast-enhanced ultrasound (CEUS) in the diagnosis of thyroid carcinoma. Methodology: A total of 150 patients with suspected thyroid cancer admitted to our hospital from January 2019 to December 2021 were selected and divided into group A, group B and group C according to random number table, with 50 cases in each group. FNA was used in group A, ultrasound elastography was used in group B, and CEUS was used in group C. Pathological diagnosis was performed in all patients, and the diagnostic sensitivity, specificity, and accuracy were compared among the three groups. Results: The diagnostic sensitivity, specificity and accuracy of FNA in group A were 90.91%, 70.59% and 84.00%, respectively; the diagnostic sensitivity, specificity and accuracy of ultrasound elastography in group B were 94.12%, 81.25% and 90.00%, respectively; the diagnostic sensitivity, specificity and accuracy of CEUS in group C were 88.57%, 73.33% and 84.00%, respectively; the three groups were compared (P > 0.05). Conclusion: All three diagnostic techniques had a relatively high sensitivity and accuracy in the diagnosis of thyroid carcinoma. Ultrasound elastography had the highest sensitivity and specificity among the three techniques, while FNA and CEUS had similar diagnostic performance. Keywords: Fine needle aspiration cytology; ultrasound elastography; contrast-enhanced ultrasound; thyroid cancer; diagnostic efficacy.

Diagnostic challenges in calcitonin negative medullary thyroid carcinoma: a systematic review of 101 cases.

Calcitonin-negative medullary thyroid carcinoma (CNMTC), a rare form of MTC characterized by classic histopathology with normal serum calcitonin levels, presents a diagnostic challenge. This systematic review aims to summarize the clinical and pathological features of CNMTC and evaluate the utility of alternative biochemical markers. Eligibility criteria for this systematic review included patients with a confirmed histopathological diagnosis of medullary thyroid carcinoma (MTC), normal preoperative serum calcitonin levels, or negative immunohistochemical (IHC) stain for calcitonin. A comprehensive electronic search strategy was employed on PubMed, Scopus, and Embase databases from January 1st, 1950, to March 9th, 2023. This systematic review consists of 32 studies with 101 patients (66% females, 33% males) with a mean age of 52.2 years. All patients had a preoperative serum calcitonin level below the upper reference limit. Out of 101 patients, only seven underwent the Pentagastrin Stimulation Test (PST), only two patients had elevated calcitonin levels after stimulation. A total of 59 patients were tested for carcinoembryonic antigen (CEA) levels, and the majority tested normal (n=51, 86.4%). A total of 57 patients (61.2%) were found to have positive IHC staining on operative specimens for calcitonin. No recurrence was reported in the majority of cases, only 10 patients (9.9%) experienced recurrence. Despite the rarity of CNMTC, it is crucial to maintain a high level of suspicion when evaluating thyroid nodules. Total thyroidectomy with central neck dissection remains as the primary treatment. A multimarker approach may improve the sensitivity and specificity of CNMTC diagnosis and surveillance, particularly when calcitonin and CEA levels are inconclusive.

The alternative value of thyroid stimulating hormone instead of thyroglobulin in differentiation of follicular thyroid neoplasm in Hashimoto's thyroiditis.

To provide novel aspects for the preoperative diagnosis and appropriate differentiation strategies for follicular thyroid carcinoma (FTC) and follicular thyroid adenoma (FTA). Among 25,765 cases, a total of 326 patients with follicular thyroid neoplasms between 2013 and 2019 were enrolled. Patient demographics, perioperative parameters, surgical profiles and oncologic outcomes were collected and analyzed. There were no significant differences in preoperative ultrasound findings between FTA and FTC patients. The true positive rate (sensitivity) and true negative rate (specificity) of fine needle aspiration (FNA) for FTA patients were 0.6956 and 0.5000, respectively, and those for FTC patients were 0.0714 and 0.9348, respectively. Patients with FTC presented significantly higher serum thyroglobulin (TG) levels than patients with FTA. Preoperative TG level was positively related to tumor invasiveness and recurrence or distant metastases in FTC patients. There were 55 patients with Hashimoto's thyroiditis (HT), accounting for 16.87% of enrolled patients. HT patients had significantly lower serum TG concentrations than antibody-negative patients. Among HT patients, no significant differences were observed in TG levels between the FTA and FTC groups. Instead, FTA patients had significantly higher serum thyroid stimulating hormone (TSH) levels and lower serum T3 (Triiodothyronine) levels compared to FTC patients. Serum TSH level >1.736U/L was associated with benign follicular neoplasms in HT patients according to the receiver operating characteristic (ROC) curve. Distinguishing FTC from FTA remains a challenge for ultrasonography and FNA. Serum TG should be measured as a risk factor of FTC. However, in HT patients, serum TSH levels can serve as a more reliable indicator for differentiating FTC from FTA preoperatively.

Decoding the NCCN Guidelines With AI: A Comparative Evaluation of ChatGPT-4.0 and Llama 2 in the Management of Thyroid Carcinoma.

Artificial Intelligence (AI) has emerged as a promising tool in the delivery of health care. ChatGPT-4.0 (OpenAI, San Francisco, California) and Llama 2 (Meta, Menlo Park, CA) have each gained attention for their use in various medical applications. This study aims to evaluate and compare the effectiveness of ChatGPT-4.0 and Llama 2 in assisting with complex clinical decision making in the diagnosis and treatment of thyroid carcinoma. We reviewed the National Comprehensive Cancer Network® (NCCN) Clinical Practice Guidelines for the management of thyroid carcinoma and formulated up to 3 complex clinical questions for each decision-making page. ChatGPT-4.0 and Llama 2 were queried in a reproducible manner. The answers were scored on a Likert scale: 5) Correct; 4) correct, with missing information requiring clarification; 3) correct, but unable to complete answer; 2) partially incorrect; 1) absolutely incorrect. Score frequencies were compared, and subgroup analysis was conducted on Correctness (defined as scores 1-2 vs 3-5) and Accuracy (scores 1-3 vs 4-5). In total, 58 pages of the NCCN Guidelines® were analyzed, generating 167 unique questions. There was no statistically significant difference between ChatGPT-4.0 and Llama 2 in terms of overall score (Mann-Whitney U-test; Mean Rank = 160.53 vs 174.47, P = 0.123), Correctness (P = 0.177), or Accuracy (P = 0.891).[Formula: see text]. ChatGPT-4.0 and Llama 2 demonstrate a limited but substantial capacity to assist with complex clinical decision making relating to the management of thyroid carcinoma, with no significant difference in their effectiveness.

Advances in the Diagnosis and Treatment of Follicular Thyroid Carcinoma: A Comprehensive Review.

Follicular thyroid carcinoma (FTC) is the second most common type of thyroid cancer, presenting unique diagnostic and therapeutic challenges. This review provides a comprehensive analysis of the recent advancements in the diagnosis and treatment of FTC, emphasizing the significance of these developments in improving patient outcomes. We discuss the evolution of diagnostic techniques, including advancements in imaging modalities, fine needle aspiration biopsy, and molecular diagnostics, which have enhanced the accuracy of FTC detection and differentiation from benign conditions. The review also evaluates current treatment strategies, including surgical interventions, radioactive iodine therapy, and targeted therapies, examining their effectiveness and impact on patient prognosis. Additionally, we address ongoing challenges in FTC management, such as variability in treatment guidelines and disparities in care. Finally, the review explores emerging therapies and future research directions, highlighting innovations that may further optimize FTC management. By synthesizing current knowledge and identifying future research opportunities, this review aims to contribute to refining diagnostic and therapeutic approaches for FTC.

Gender and tumor size-specific calcitonin cutoff value for diagnosing MTC in 10,618 patients with thyroid nodule surgery.

Calcitonin is a sensitive marker for medullary thyroid carcinoma (MTC) diagnosis and postsurgical follow-up. This study aimed to define the gender and tumor size-specific calcitonin cutoff values for diagnosing MTC. This retrospective study recruited 95 MTC patients and 10,523 non-MTC patients who underwent thyroid nodule surgery at Zhongshan Hospital between January 2015 and June 2023. Receiver operating characteristic (ROC) curves were used to assess calcitonin cutoff values for diagnosing MTC. Calcitonin levels in non-MTC patients were influenced by gender, CKD stage and age, with gender being the highest ranked predictor. In MTC patients, calcitonin levels were associated with tumor diameter, lymph node metastasis, and TNM stage. In the entire study population, calcitonin cutoff values to diagnose MTC were 17.75 pg/mL for males (sensitivity: 97.60%, specificity: 99.40%) and 7.15 pg/mL for females (sensitivity: 94.34%, specificity: 99.22%). In patients with a thyroid nodule diameter ≤10 mm, the calcitonin cutoff values to diagnose MTC were 17.50 pg/mL for males (sensitivity: 95.00%, specificity: 99.27%) and 7.15 pg/mL for females (sensitivity: 90.91%, specificity: 99.04%). In patients with a thyroid nodule diameter >10 mm, the calcitonin cutoff values to diagnose MTC were 104.80 pg/mL for males (sensitivity: 100.00%, specificity: 100.00%) and 32.60 pg/mL for females (sensitivity: 96.77%, specificity: 100.00%). We have identified the gender and tumor size-specific cutoff values for the diagnosis of MTC. Cutoff values based on gender and tumor diameter may help to improve the accuracy of preoperative diagnosis of MTC, which is worth to be verified by future studies.

The impact of V-flow on preoperative diagnosis of thyroid tumors: individually and as part of multimodal sonographic imaging.

V-flow is a dynamic ultrasound technique that visualizes perfusion patterns by displaying dynamic arrows that change in response to the flow of erythrocytes. Furthermore, it provides quantitative values for the maximum and mean velocity of blood flow as well as a percentage value for turbulence. The aim was to enhance the preoperative diagnostic accuracy of thyroid lesions by combining V-flow with established ultrasound modes.B-mode, CCDS, elastography, CEUS, and V-flow were performed on 101 patients. After the ultrasound examination, every nodule was confirmed as benign or malignant via histopathology. The Kruskal-Wallis test, ROC curve, and binary logistic regression were used for the statistical analysis.93 benign regressive thyroid nodules and 8 carcinomas were included in this study. The average mean velocity value for benign lesions was measured at 19.5 cm/s and at 10.7 cm/s for malignant lesions (p = 0.039). The average turbulence percentage was 26.1% for benign nodules and 46.7% for carcinomas (p = 0.016). Carcinomas exhibited a slower and more turbulent perfusion pattern compared to benign tumors. A V-flow-centered system achieves a sensitivity of 100.0% and a specificity of 84.9% in predicting malignancy. This system could have reduced the number of unnecessary thyroid surgeries for benign lesions in our patient group by 70%.The capillary perfusion of thyroid nodules represents a significant indicator of its status. By analyzing the velocity and turbulence level of microvascular blood flow, V-flow offers promising prospects for accurately distinguishing between benign and malignant thyroid lesions. When integrated into a comprehensive multimodal sonographic imaging approach, V-flow further enhances diagnostic accuracy. · V-flow allows for qualitative and quantitative analysis of microvascular perfusion. · Malignant tumors are associated with slower and more turbulent microvascular hemodynamics. · Combining V-flow with other ultrasound modes eases the diagnosis of thyroid carcinomas. · Brandenstein MK, Zhang L, Scharf G et al. The impact of V-flow on preoperative diagnosis of thyroid tumors: individually and as part of multimodal sonographic imaging. Fortschr Röntgenstr 2024; DOI 10.1055/a-2350-0107.

A Case of Milk Alkali Syndrome: The Forgotten Diagnosis of Generalized Weakness and Altered Consciousness

This case reports outlines a 76-year-old male’s progression from papillary thyroid carcinoma diagnosis to the development of Calcium-Alkali Syndrome (CAS) following thyroidectomy. Initially presenting with thyroid mass, surgery was followed by generalized weakness and altered sensorium, investigations that revealed elevated calcium levels ,metabolic alkalosis and renal impairment . Diagnosis pointed to CAS, likely triggered by prescribed calcium and calcitriol post-surgery. Cessation of supplements and hydration resulted in resolution. While post-thyroidectomy hypocalcemia is anticipated, CAS poses challenges, especially with increasing calcium supplement use. This emphasizes the need for vigilant monitoring of electrolyte imbalances, particularly in regions with limited follow-up practices. Clinicians should balance preventing hypocalcemia without risking hypercalcemia, stressing the importance of timely identification and tailored interventions to prevent CAS complications. This case underscores the significance of recognizing CAS as a potential postoperative complication, urging vigilant monitoring and tailored management in similar clinical settings. J MEDICINE 2024; 25: 184-186

Advanced medullary thyroid carcinoma uncovered by persistently elevated procalcitonin in a patient with COVID-19.

We report the case of an 88-year-old man hospitalized for COVID-19 with persistently very high procalcitonin (proCt) levels despite infection resolution. Since proCt is an adjunct tumor marker in the diagnosis of medullary thyroid carcinoma (MTC), serum calcitonin (Ct) was also measured showing very high levels. Computed tomography (CT) scan showed the presence of a thyroid mass and neck ultrasound revealed a solid isoechoic, inhomogeneous, 50 mm nodule in the right thyroid lobe, extended into the mediastinum. Fine needle aspiration (FNA) of the thyroid nodule confirmed the diagnosis of MTC. An 18F-fluorodopa positron emission tomography/computed tomography (PET/CT) scan revealed the presence of distant metastases in ribs, vertebrae, in the right iliac wing and the liver. Since surgery was not feasible, the patient was started on cabozantinib 40 mg/dL. After 16 months the patient is still on cabozantinib at the same dose, he reports complete autonomy in daily life activities, and serum Ct is still elevated; however, the imaging evaluation does not show signs of disease progression. High procalcitonin serum values despite the absence of infection are suggestive of MTC. Advanced MTC with multiple metastases can have an indolent course and can go unrecognized for years. Cabozantinib is a valuable option for the treatment of advanced MTC.

3D Virtual Histopathology by Phase-Contrast X-Ray Micro-CT for Follicular Thyroid Neoplasms.

Histological analysis is the core of follicular thyroid carcinoma (FTC) classification. The histopathological criteria of capsular and vascular invasion define malignancy and aggressiveness of FTC. Analysis of multiple sections is cumbersome and as only a minute tissue fraction is analyzed during histopathology, under-sampling remains a problem. Application of an efficient tool for complete tissue imaging in 3D would speed-up diagnosis and increase accuracy. We show that X-ray propagation-based imaging (XPBI) of paraffin-embedded tissue blocks is a valuable complementary method for follicular thyroid carcinoma diagnosis and assessment. It enables a fast, non-destructive and accurate 3D virtual histology of the FTC resection specimen. We demonstrate that XPBI virtual slices can reliably evaluate capsular invasions. Then we discuss the accessible morphological information from XPBI and their significance for vascular invasion diagnosis. We show 3D morphological information that allow to discern vascular invasions. The results are validated by comparing XPBI images with clinically accepted histology slides revised by and under supervision of two experienced endocrine pathologists.

The Impact of Race and the Affordable Care Act on Thyroid Carcinoma Outcomes: A National Cancer Database Study.

To assess the impact of race and the Affordable Care Act (ACA) of 2010 on disease presentation and overall survival for patients with well-differentiated thyroid carcinoma. Cross-sectional study of patients (n = 51,078) who underwent partial or total thyroidectomy with or without postoperative radioactive iodine (RAI) for well-differentiated thyroid carcinoma between 2004 and 2018 in the National Cancer Database (NCDB). Cumulative survival (CS) was assessed with Cox proportional hazard regression analyses. There were significant disparities in disease presentation at the time of diagnosis, with Black, Asian/Pacific Islander (API), and Hispanic patients were more likely to have metastatic disease (p < 0.001) and higher TNM stage (p < 0.001) at the time of diagnosis compared to White patients. Black patients had significantly increased risk of death (HR 1.147, 95%CI 1.021-1.289) but API patients had improved CS (HR 0.730, 95% CI 0.608-0.877) compared to White patients. Passage of the ACA was associated with lower risk of mortality, regardless of whether patients lived in states that did not expand Medicaid (HR 0.866, 95% CI 0.823-0.910) or whether they lived in expansion states (HR 0.818, 95% CI 0.758-0.884). Racial disparities significantly impact thyroid carcinoma diagnosis and treatment in the United States but have improved over time. Both expansion and non-expansion states had improved survival outcomes over time, and suggesting analysis of the ACA's long-term impact and ability to address health inequities is still warranted. 3 Laryngoscope, 134:4421-4430, 2024.

Comparative analysis through propensity score matching in thyroid cancer: unveiling the impact of multiple malignancies.

The incidence of thyroid cancer is on the rise worldwide, with childhood exposure to radiation being the sole acknowledged catalyst for its emergence. Nonetheless, numerous other factors that may pose risks are awaiting thorough examination and validation. This retrospective study aims to explore the malignancies linked to thyroid cancer and contrast the survival rates of those afflicted with a solitary tumor versus those with multiple primary neoplasms (MPN). This retrospective study examined data from King Hussein Cancer Center (KHCC), Jordan. Among 563 patients diagnosed with thyroid cancer, 30 patients had thyroid malignancy as part of MPN. For a 1:3 propensity score-matched analysis, 90 patients with only a primary thyroid malignancy were also enrolled. Hematologic and breast malignancies were among the most frequent observed cancers alongside thyroid neoplasm. Patients who had MPN were diagnosed at older age, had higher body mass index and presented with higher thyroglobulin antibody levels (p < 0.05 for each). Additionally, MPN patient displayed a stronger family history for cancers (p= 0.002). A median follow-up duration of 135 months unveiled that MPN patients faced a worse 5-year survival compared to their counterparts with a singular neoplasm (87% vs 100% respectively; p < 0.01). However, no distinction emerged in the 5-year event-free survival between these two groups. MPN correlates with a significantly altered survival outcome of thyroid cancer patients. The diagnosis of thyroid carcinoma at an older age, accompanied by elevated initial thyroglobulin antibody levels and a notable familial predisposition, may raise concerns about the potential occurrence of synchronous or metachronous tumors.

Comprehensive Review of the Imaging Recommendations for Diagnosis, Staging, and Management of Thyroid Carcinoma.

Thyroid cancer is the most common head and neck cancer (HNC) in the world. In this article, we comprehensively cover baseline, posttreatment, and follow-up imaging recommendations for thyroid carcinomas along with the eighth edition of the tumor, node, metastasis (TNM) staging system proposed by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC). We include characterization and risk stratification of thyroid nodules on ultrasound (US) proposed by various international bodies. Management guidelines (depending upon the type of thyroid carcinoma) based on the international consensus recommendations (mainly by the American Thyroid Association) are also extensively covered in this article, including the role of a radioiodine scan. The management of recurrent disease is also briefly elucidated in this article. In addition, we cover the risk factors and etiopathogenesis of thyroid carcinoma along with the non-imaging diagnostic workup essential for thyroid carcinoma management, including the significance of genetic mutations. US is the diagnostic imaging modality of choice, with US-guided fine needle aspiration (FNA) being the procedure of choice for tissue diagnosis. The roles of computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) in thyroid carcinoma staging are also specified. Through this article, we aim to provide a comprehensive reference guide for the radiologists and the clinicians in the pursuit of optimal care for patients with thyroid carcinoma.

Abstract 6273: GGCT expression is a useful marker for the diagnosis of follicular thyroid carcinoma

Abstract Background: Follicular thyroid carcinoma (FTC) and follicular adenoma (FA) have similar histological findings. FTC is distinct from FA based on the presence of capsular or vascular invasion in the tissues, but it is difficult to confirm the diagnosis in some cases. In this study, we aimed to establish useful molecular maker for differential diagnosis between FTC and FA. Methods: This study included FTC (n = 32), FA (n = 64), and follicular tumors of uncertain malignant potential (FT-UMP, n = 5). Invasive front tissue and tumor center tissue from 3 cases of FTC were collected using a laser microdissection system; RNA was extracted, followed by microarray analysis to examine molecules that were commonly highly expressed in the invasive front. Subsequently, immunohistochemical staining of gamma-glutamyl cyclotransferase (GGCT) was performed. For assessment of GGCT expression, the intensity of the nuclear staining was stratified using a four-tiered scale (0 to 3) and percentage of positive cells (0-100%) in the hotspot. Multiplying intensity score and percent of positive cells, an expression score ranging from 0 to 300 was calculated. The Ki-67 labeling index was examined in 20 cases of FTC, 25 cases of FA, and 4 cases of FT-UMP from the same cohort. We counted at least 2,000 tumor cells in the hot spot for the assessment of Ki-67 labeling index. Results: Microarray analysis revealed GGCT exhibited high expression levels at the invasive front of FTC. In immunohistochemical assessment, GGCT expression scores were significantly higher in FTC than in FA (118.5 ± 51.4 vs. 57.3 ± 34.7, p &amp;lt; 0.0001). The median Ki-67 labeling index were 3.9% (range 0.2 - 16.1) for FTC and 2.4% (range 0.3 - 7.0) for FA. FTC showed a higher Ki-67 index than FA (Wilcoxon rank sum test, p = 0.0444). With GGCT expression score, applying a cutoff value of 101.1, the distinction between FTC and FA resulted in a sensitivity of 68.8% and a specificity of 87.5% (AUC: 0.832). With Ki-67 labeling index, applying a cutoff value of 4.0%, the distinction between FTC and FA resulted in a sensitivity of 50.0% and a specificity of 80.0% (AUC: 0.677). The GGCT expression score was positively related with the Ki-67 labeling index in the FTC cases. (Spearman's ρ = 0.5293, p = 0.0164). There were no significant associations between GGCT expression scores and clinicopathological parameters, including age, gender, tumor diameter, pT stage, pN stage, pattern of capsular invasion, number of foci of vascular invasion, and the presence of distant metastasis. Conclusions: GGCT is a potential marker for differentiating FTC from FA. The GGCT expression of FTC may contribute to estimating the invasive activity and proliferative activity. Citation Format: Toshiyuki Mitsuhashi, Sachiko Ogasawara, Masamichi Nakayama, Reiichiro Kondo, Jun Akiba, Kenta Murotani, Takeharu Ono, Fumihiko Sato, Hirohito Umeno, Hirohisa Yano. GGCT expression is a useful marker for the diagnosis of follicular thyroid carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6273.

Sodium iodide symporter immunolabelling as a predictor of clinical iodide uptake in canine thyroid carcinoma: A preliminary study.

Thyroid follicular tumours may take up iodide via the sodium-iodide symporter. Knowledge of iodide uptake could then allow treatment with I-131 in dogs with high-risk tumours. The objective of this study was to determine the relationship between clinically detectable iodide uptake (as determined by scintigraphy and/or thyroxine concentrations) and sodium iodide symporter immunohistochemical labelling on histologically fixed thyroid tumours. Nineteen dogs were identified who were diagnosed with thyroid carcinoma and underwent surgery from November 2017 to July 2021. All had recorded thyroid hormone concentrations and were hyperthyroid and/or underwent preoperative nuclear imaging using planar scintigraphy (technetium-99m or I-123), or I-124 PET-CT. All dogs subsequently underwent surgery to remove the thyroid mass. Twenty-two tumours were submitted for histopathologic analysis immediately following surgery, which confirmed a diagnosis of thyroid carcinoma for each tumour. Images and/or thyroid hormone concentrations were reviewed for the included cases, and tumours were sorted into an avid/functional group (group 1) and a non-avid/functional group (group 2). The tumour tissues were re-examined histologically using sodium iodide symporter (NIS) immunohistochemistry (IHC). Group 1 contained 15 avid/functional tumours. Twelve of these tumours had membranous NIS IHC labelling. Group 2 contained 7 non-avid tumours. One of these tumours had membranous NIS IHC labelling. This resulted in an overall sensitivity and specificity for identification of avid/functional tumours with membranous NIS of 80.0% and 85.7%, respectively. NIS IHC may predict ion trapping in canine follicular thyroid tumours. Further studies using iodide-based imaging are warranted to better determine the clinical utility of this diagnostic modality.