Recurrent Differentiated Thyroid Cancer Research Articles

18F]FAA-guided re-operative surgery for recurrent differentiated thyroid cancer.

18F]FAA-guided re-operative surgery for recurrent differentiated thyroid cancer.

Learning from Imbalanced Data: Integration of Advanced Resampling Techniques and Machine Learning Models for Enhanced Cancer Diagnosis and Prognosis

Background/Objectives: This study aims to evaluate the performance of various classification algorithms and resampling methods across multiple diagnostic and prognostic cancer datasets, addressing the challenges of class imbalance. Methods: A total of five datasets were analyzed, including three diagnostic datasets (Wisconsin Breast Cancer Database, Cancer Prediction Dataset, Lung Cancer Detection Dataset) and two prognostic datasets (Seer Breast Cancer Dataset, Differentiated Thyroid Cancer Recurrence Dataset). Nineteen resampling methods from three categories were employed, and ten classifiers from four distinct categories were utilized for comparison. Results: The results demonstrated that hybrid sampling methods, particularly SMOTEENN, achieved the highest mean performance at 98.19%, followed by IHT (97.20%) and RENN (96.48%). In terms of classifiers, Random Forest showed the best performance with a mean value of 94.69%, with Balanced Random Forest and XGBoost following closely. The baseline method (no resampling) yielded a significantly lower performance of 91.33%, highlighting the effectiveness of resampling techniques in improving model outcomes. Conclusions: This research underscores the importance of resampling methods in enhancing classification performance on imbalanced datasets, providing valuable insights for researchers and healthcare professionals. The findings serve as a foundation for future studies aimed at integrating machine learning techniques in cancer diagnosis and prognosis, with recommendations for further research on hybrid models and clinical applications.

8426 Recurrence of Papillary Thyroid Carcinoma Despite Undetectable Levels of Thyroglobulin Measured by Both Immunoassay and LCMS

Abstract Disclosure: M.G. Hamilton: None. G. Patel: None. S. Teja Sathi: None. K. Win: None. P. Lekprasert: None. Serum thyroglobulin (Tg) levels are affected by the presence of anti-thyroglobulin antibodies (anti-Tg Abs) during surveillance of differentiated thyroid cancer (DTC). About 20% of patients have positive anti-Tg Abs post-thyroidectomy and laboratory investigations for DTC surveillance may lead to false negative results. Liquid chromatography-tandem mass spectrometry (LCMS) is superior to immunoassay in measuring Tg levels in patients with the presence of anti-Tg Abs. Mass spectrometry is the only currently available method that could eliminate the interference of anti-Tg Abs in the quantification of Tg but is not readily available. We present the case of a patient who had a recurrence of DTC despite persistently undetectable Tg levels using both immunoassay and LCMS methods. The patient is a 49-year-old female with a history of papillary thyroid cancer who underwent total thyroidectomy followed by adjuvant radio-ablation. She presented to our endocrinology office for routine follow up for her DTC. She reported subjective unknown weight loss over four months. Her physical exam was unremarkable with no palpable neck swelling or mass. Vital signs were within normal limits. She continued to have undetectable levels of Tg as measured by immunoassay, stable levels of anti-Tg Abs ranging from 19 IU/mL to 33 IU/mL, and negative findings on her thyroid ultrasound for the first four years post-op. When she presented to the office five years post-thyroidectomy her anti-Tg Ab level had increased to 114 IU/mL and subsequently to 137 IU/mL a few months later despite undetectable Tg levels on both immunoassay and LCMS. A thyroid ultrasound was completed due to rising anti-Tg Abs levels which showed a suspicious one cm mass at the right thyroid bed and suspicious bilateral cervical lymph nodes. Repeated FNA biopsy of the bilateral cervical lymph nodes confirmed follicular epithelium with nuclear inclusions and grooves, compatible with recurrent papillary thyroid carcinoma. This patient had a recurrence of her DTC despite undetectable Tg levels on both immunoassay and LCMS. Tg is an important aspect of surveillance post-treatment for all patients with DTC because its presence is a surrogate for the presence of thyroid tissue and therefore the recurrence of thyroid malignancy. Clinicians must have a high index of suspicion when monitoring a patient with a history of DTC and the presence of anti-Tg Abs because it interferes with the accurate measurement of Tg levels. A study conducted by Azmat et al. demonstrated that measuring Tg levels via LCMS has been found to eliminate the confounding effect of anti-Tg Abs with a sensitivity and specificity of 44.4% and 94.1% respectively. However, our case illustrates that even LCMS is not always reliable in such situations, and increasing levels of anti-Tg Abs should be an individual risk factor for suspecting recurrence of DTC. Presentation: 6/3/2024

12382 A Prospective Analysis of De Novo Thyroglobulin Antibodies in Patients with Differentiated Thyroid Cancer Using the Italian Thyroid Cancer Observatory Repository

Abstract Disclosure: B.S. Neutel: None. G. Grani: None. S. D'elia: None. C. Durante: None. A.G. Gianoukakis: None. The prevalence and significance of newly developed (de novo) thyroglobulin antibodies (dnTgAb) in patients with differentiated thyroid cancer (DTC) who were initially thyroglobulin antibody (TgAb) negative, is not well established. We sought to examine the phenomenon of dnTgAb using the Italian Thyroid Cancer Observatory (ITCO) database. Beginning in 2013, the ITCO repository prospectively collected clinical data on DTC management in a consecutive series of newly diagnosed patients treated in large academic centers distributed across Italy. Patients were managed by treating physicians based on perceived best practice. Pre-specified parameters were collected. Clinical status, investigations, and treatments were updated periodically. We formulated inclusion and exclusion criteria to mirror previously published literature studying dnTgAb. Patients included in the analysis were initially TgAb negative at their first postoperative check and had no evidence of persistent disease at their 1 year follow up visit. The dnTgAb group included patients who were initially TgAb negative and then developed TgAb on at least one measurement from the second postoperative check or later. All patients included in the study had at least 3 years of follow up and 3 TgAb measurements. At the time of analysis, 5360 patients were without persistent disease at 1 year. 2107 of these patients had a least 3 years of follow up and 3 TgAb measurements. 334 patients with positive TgAb at their first lab check and an additional 124 patient with incomplete data were excluded. 1649 patients met criteria for inclusion. Median follow up time was 1.85 years. DnTgAb occurred in 4.3% of patients (n=71). We found no statically significant difference in gender, tumor size, tumor focality, extrathyroidal extension, AJCC stage and ATA risk level between the persistently negative TgAb group and the dnTgAb group. Only primary tumor vascular invasion occurred at a higher rate in patients within the dnTgAb group when compared to the persistently negative group (p=0.012). Structural DTC recurrences occurred in 1.4% (n=22) of persistently TgAb negative patients and 5.6% (n=4) of patients with dnTgAb (p=0.02).This is the largest and first prospective cohort used to evaluate the prevalence and clinical significance of dnTgAb. DnTgAb occurred at a clinically relevant rate and there was a statistically significant relationship between detection of dnTgAb and structural DTC recurrence. The study is limited by the small overall recurrence rates and the exclusion of patients with less than 3 years of follow up. Presentation: 6/3/2024

Tumor size and molecular risk group are associated with differentiated thyroid cancer recurrence

BackgroundThe threshold at which active surveillance can be considered is variable, with some algorithms proposing nonoperative treatment for differentiated thyroid carcinomas ≤2 cm and lobectomy alone for lesions 2.1–4 cm. To inform both decision for and extent of initial surgery, we aim to evaluate whether molecular results can complement tumor size to identify differentiated thyroid carcinomas associated with disease recurrence. MethodsPatients from 2007–2013 and 2017–2021 who had initial thyroidectomy (differentiated thyroid carcinoma size 1–4 cm, clinical N0M0) were included. When available, molecular testing results were categorized into 3 previously described molecular risk groups (low, intermediate, and high). Primary outcome was structural recurrence. ResultsRecurrence was diagnosed in 3.8% of 1,739 patients with differentiated thyroid carcinomas. Preoperative variables including size (1–2 cm vs 2.1–4 cm, P = .43), age >55 years (P = .92), and male sex (P = .31) were not associated with recurrence. Molecular testing results were available for 1,020, and after excluding molecular risk group high-risk differentiated thyroid carcinoma, structural recurrences were associated with molecular risk group intermediate risk (7.2% vs molecular risk group low, 0.7%, P < .001), and most likely in differentiated thyroid carcinoma, which were both 2.1–4 cm and molecular risk group intermediate risk (11.3% vs size 1–2 cm 5.8%, P = .04). ConclusionOverall, structural recurrences for differentiated thyroid carcinomas ≤4 cm were low (<5%) and molecuar testing was the only preoperative variable associated with recurrence. However, when molecular risk group intermediate risk was present, larger tumor size (2.1–4 cm) had a 2-fold greater risk of recurrence compared with tumors 1–2 cm, and size may still be helpful to guide management. When considering de-escalated treatment for the proposed guidelines with a cutoff of 2 cm, initial decision-making may be further optimized with identification of preoperative molecular risk groups.

The Comparison of Extreme Machine Learning and Hidden Markov Model Algorithm in Predicting The Recurrence Of Differentiated Thyroid Cancer Using SMOTE

Differentiated thyroid cancer is the most common type of thyroid cancer; the types in this category are papillary, follicular, and hurthel cell carcinoma. Up to 20% of DTCs will experience recurrence, although this figure reduces to 5% in low-risk patients. There is still little research on thyroid cancer prediction using a machine learning approach, especially the prediction recurrence of DTCs. This research aims to compare the performance of the Extreme Learning Machine and the Hidden Markov Model using SMOTE in predicting the recurrence of DTCs. The dataset used in this research is differentiated thyroid cancer recurrence from Kaggle. This research methodology comprises preprocessing, data sharing, SMOTE, ELM and HMM modeling algorithms, and evaluation. ELM with SMOTE gets the best results at a ratio of 90:10 with 35 hidden neurons that get an accuracy value of 1.00, precision 1.00, recall 1.00, and AUC 1.00. ELM modeling gets the best results at a ratio of 90:10 with 45 hidden neurons that get an accuracy value of 1.00, precision 1.00, recall 1.00, and AUC 1.00. HMM modeling gets the best value at a ratio of 70:30 with two hidden states and two iterations, which get an accuracy value of 0.8696, precision 0.8696, recall 0.7944, and AUC 0.9575. Last, HMM modeling with SMOTE gets the best results at a ratio of 60:40 with two hidden states and two iterations, with an accuracy value of 0.8696, precision of 0.8832, recall of 0.7848, and AUC of 0.9174. Based on the results of this study, it can be concluded that ELM with SMOTE gets the best performance, followed by ELM without SMOTE, HMM without SMOTE, and finally, HMM with SMOTE. The implication is that ELM with SMOTE can produce high accuracy in predicting the recurrence of DTCs.

Diagnostic performance of 2-[18F]FDG PET/CT in recurrent differentiated thyroid cancer and elevated antithyroglobulin antibodies: an updated systematic review and bivariate meta-analysis.

This updated systematic review and bivariate meta-analysis aimed to investigate the diagnostic performance of 2-[18F]FDG PET/CT for the detection of recurrent disease in patients with differentiated thyroid cancer (DTC) who have negative 131I whole body scintigraphy and increased antithyroglobulin antibodies (TgAb) levels. The current systematic review was carried out following a preset protocol, and the "Preferred Reporting Items for a Systematic Review and Meta-Analysis" served as a guideline for its development and reporting. A comprehensive research of the PubMed/MEDLINE, Embase and Cochrane library databases was conducted until June 2024. Between 2002 and 2023, 13 studies (608 patients) published on this topic were selected. The pooled sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 2-[18F]FDG PET or PET/CT were 84% (95%CI: 78-87%), 82% (95%CI: 78-86%), 72% (95%CI: 67-76%), 90% (95%CI: 87-93%) and 83% (95%CI: 79%-86%) respectively. The pooled positive and negative likelihood ratios (LR+ and LR - ) and the diagnostic odds ratio (DOR) were 0.180 (95%CI: 0.128-0.253), 3.214 (95%CI: 2.357-4.383), and 17.863 (95%CI: 10.475-30.462), respectively. No statistically significant heterogeneity among the studies was found for all the metrics evaluated (I2 < 50%). 2-[18F]FDG PET/CT demonstrated a good diagnostic performance in patients with DTC and increased TgAb. Although more studies are warranted, the provided evidence-based data should support the integration of 2-[18F]FDG PET/CT in clinical and diagnostic guidelines on DTC patients with increased TgAb.

Explainable Machine Learning Models for Predicting Recurrence in Differentiated Thyroid Cancer

Aim: Differentiated thyroid cancer (DTC) is a common type of cancer that originates in the thyroid gland. This study aimed to predict the recurrence of differentiated thyroid carcinoma, in patient with well-DTC, using explainable machine learning (XAI) models. Material and Methods: The study utilized a dataset from the UCI Machine Learning Repository, which included 383 patients and 13 candidate predictors. After a variable selection process using distance correlation, only four predictors (Response, Risk, T, and N) were retained for model building. Two XAI models, Fast Interpretable Greedy-Tree Sums (FIGS) and Explainable Boosting Machines (EBM), were employed. Results: The EBM model slightly outperformed the FIGS model in terms of accuracy. The study found that the most influential predictors of Well-DTC recurrence were the response to DTC treatment, risk status according to the American Thyroid Association classification, tumor size (T), and lymph node metastasis (N). Conclusion: In conclusion, this study successfully identified key risk factors for DTC recurrence using XAI models, providing interpretable insights for clinical decision-making and potential for personalized treatment strategies.

Genotoxic effects of ablative treatment with I-131 determined through the analysis of dicentric chromosomes in peripheral blood lymphocytes. Can it influence the clinical management of patients with differentiated thyroid carcinoma?

Study including 61 differentiated thyroid cancer (DTC) patients who received ablative doses of I-131 after total thyroidectomy. Biodosimetry was performed by dicentric chromosomes analysis before and after treatment, determining dicentric yield and blood absorbed dose. An increased yield of dicentrics after treatment was demonstrated. With an average administered activity of 4.32 ± 0.879 GBq, the absorbed dose in bone marrow was 0.28 Gy (0.25–0.30 95% CI). These data were compared with the administered I-131 activity and body mass index. Increased genotoxic effects were observed, with a slightly higher dicentric yield rising along I-131 activity. No correlation was found between administered activity and BMI. No significant risk of myelotoxicity due to dose regimens of I-131 intended for ablative purposes in “de novo” treated patients was found among the ranges of activities used in clinical practice. Biodosimetric data was included in patients’ Clinical History, which translates into a more detailed dosimetric report. With this information, physicians can take a more patient-specific approach. Personalized administration would be of special consideration in the event of re-treatments, be it due to recurrent disease or I-131 refractory DTC patients.

Pregnancy and the disease recurrence of patients previously treated for differentiated thyroid cancer: A systematic review and meta analysis.

Differentiated thyroid cancer (DTC) is commonly diagnosed in women of child-bearing age, but whether pregnancy influences the prognosis of DTC remains controversial. This study aimed to summarize existing evidence regarding the association of pregnancy with recurrence risk in patients previously treated for DTC. We searched PubMed, Embase, Web of Science, Cochrane, and Scopus based on the prespecified protocol registered at PROSPERO (CRD42022367896). After study selection, two researchers independently extracted data from the included studies. For quantitative data synthesis, we used random-effects meta-analysis models to pool the proportion of recurrence (for pregnant women only) and odds ratio (OR; comparing the risk of recurrence between the pregnancy group and the nonpregnancy group), respectively. Then we conducted subgroup analyses to explore whether risk of recurrence differed by response to therapy status or duration of follow-up time. We also assessed quality of the included studies. A total of ten studies were included. The sample size ranged from 8 to 235, with participants' age at pregnancy or delivery ranging from 28 to 35 years. The follow-up time varied from 0.1 to 36.0 years. The pooled proportion of recurrence in all pregnant patients was 0.13 (95% confidence intervals [CI]: 0.06-0.25; I2 : 0.58). Among six included studies reporting response to therapy status before pregnancy, we observed a trend for increasingly higher risk of recurrence from excellent, indeterminate, and biochemically incomplete to structurally incomplete response to therapy ( Ptrend <0.05). The pooled risk of recurrence in the pregnancy group showed no evidence of a significant difference from that in the nonpregnancy group (OR: 0.75; 95% CI: 0.45-1.23; I2 : 0). The difference in follow-up time (below/above five years) was not associated with either the proportion of recurrence in all pregnant patients ( P >0.05) or the OR of recurrence in studies with a comparison group ( P >0.05). Two included studies that focused on patients with distant metastasis also did not show a significant difference in disease recurrence between pregnancy and nonpregnancy groups (OR: 0.51 [95% CI: 0.14-1.87; I2 : 59%]). In general, pregnancy appears to have a minimal association with the disease recurrence of DTC with initial treatment. Clinicians should pay more attention to progression of DTC among pregnant women with biochemical and/or structural persistence. PROSPERO, https://www.crd.york.ac.uk/PROSPERO/ ; No. CRD42022367896.

A hybrid machine learning model combining association rule mining and classification algorithms to predict differentiated thyroid cancer recurrence.

Differentiated thyroid cancer (DTC) is the most prevalent endocrine malignancy with a recurrence rate of about 20%, necessitating better predictive methods for patient management. This study aims to create a relational classification model to predict DTC recurrence by integrating clinical, pathological, and follow-up data. The balanced dataset comprises 550 DTC samples collected over 15 years, featuring 13 clinicopathological variables. To address the class imbalance in recurrence status, the Synthetic Minority Over-sampling Technique for Nominal and Continuous (SMOTE-NC) was utilized. A hybrid model combining classification algorithms with association rule mining was developed. Two relational classification approaches, regularized class association rules (RCAR) and classification based on association rules (CBAR), were implemented. Binomial logistic regression analyzed independent predictors of recurrence. Model performance was assessed through accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and F1 score. The RCAR model demonstrated superior performance over the CBAR model, achieving accuracy, sensitivity, and F1 score of 96.7%, 93.1%, and 96.7%, respectively. Association rules highlighted that papillary pathology with an incomplete response strongly predicted recurrence. The combination of incomplete response and lymphadenopathy was also a significant predictor. Conversely, the absence of adenopathy and complete response to treatment were linked to freedom from recurrence. Incomplete structural response was identified as a critical predictor of recurrence risk, even with other low-recurrence conditions. This study introduces a robust and interpretable predictive model that enhances personalized medicine in thyroid cancer care. The model effectively identifies high-risk individuals, allowing for tailored follow-up strategies that could improve patient outcomes and optimize resource allocation in DTC management.

Diagnostic Performance of [18F]TFB PET/CT Compared with Therapeutic Activity [131I]Iodine SPECT/CT and [18F]FDG PET/CT in Recurrent Differentiated Thyroid Carcinoma.

[18F]tetrafluoroborate ([18F]TFB) is an emerging PET tracer with excellent properties for human sodium iodide symporter (NIS)-based imaging in patients with differentiated thyroid cancer (DTC). The aim of this study was to compare [18F]TFB PET with high-activity posttherapeutic [131I]iodine whole-body scintigraphy and SPECT/CT in recurrent DTC and with [18F]FDG PET/CT in suspected dedifferentiation. Methods: Twenty-six patients treated with high-activity radioactive [131I]iodine therapy (range, 5.00-10.23 GBq) between May 2020 and November 2022 were retrospectively included. Thyroid-stimulating hormone was stimulated by 2 injections of recombinant thyroid-stimulating hormone (0.9 mg) 48 and 24 h before therapy. Before treatment, all patients underwent [18F]TFB PET/CT 40 min after injection of a median of 321 MBq of [18F]TFB. To study tracer kinetics in DTC lesions, 23 patients received an additional scan at 90 min. [131I]iodine therapeutic whole-body scintigraphy and SPECT/CT were performed at a median of 3.8 d after treatment. Twenty-five patients underwent additional [18F]FDG PET. Two experienced nuclear medicine physicians evaluated all imaging modalities in consensus. Results: A total of 62 suspected lesions were identified; of these, 30 lesions were [131I]iodine positive, 32 lesions were [18F]TFB positive, and 52 were [18F]FDG positive. Three of the 30 [131I]iodine-positive lesions were retrospectively rated as false-positive iodide uptake. Tumor-to-background ratio measurements at the 40- and 90-min time points were closely correlated (e.g., for the tumor-to-background ratio for muscle, the Pearson correlation coefficient was 0.91; P < 0.001; n = 49). We found a significant negative correlation between [18F]TFB uptake and [18F]FDG uptake as a potential marker for dedifferentiation (Pearson correlation coefficient, -0.26; P = 0.041; n = 62). Conclusion: Pretherapeutic [18F]TFB PET/CT may help to predict the positivity of recurrent DTC lesions on [131I]iodine scans. Therefore, it may help in the selection of patients for [131I]iodine therapy. Future prospective trials for iodine therapy guidance are warranted. Lesion [18F]TFB uptake seems to be inversely correlated with [18F]FDG uptake and therefore might serve as a dedifferentiation marker in DTC.

Value of circulating neutrophil elastase for detecting recurrence of differentiated thyroid cancer.

The inflammatory microenvironment has been implicated in differentiated thyroid cancer (DTC). Inflammatory stimuli induce the release of components of neutrophils into extracellular space, leading to formation of neutrophil extracellular trap (NET), which can stimulate growth and progression of cancer. Generation of activated factor XII and thrombin is also involved in cancer progression. This study attempted to determine whether the level of circulating markers of NET, activated factor XII, and endogenous thrombin potential may be useful for detecting the recurrence of DTC. A total of 122 patients with DTC were recruited during the postoperative follow-up period. Measurement of the levels of circulating markers of NET (neutrophil elastase, histone-DNA complex, cell-free dsDNA), activated factor XII, and endogenous thrombin potential was performed. A significantly elevated level of neutrophil elastase was detected in patients with recurrence (n = 12) compared to those without recurrence (n = 110), while significant elevation of the levels of other markers was not observed. The value for area under the curve (0.717, P = 0.018) of neutrophil elastase for detecting recurrence of DTC was superior to that (0.661, P = 0.051) of serum thyroglobulin. An elevated level of neutrophil elastase was significantly associated with recurrence of DTC independent of serum thyroglobulin. Because an elevated level of neutrophil elastase was detected in patients with recurrence of DTC and showed a significant association with recurrence of DTC, it can be proposed as a novel biomarker for use in detecting recurrence of DTC along with other tests.

The Frequency of Differentiated Thyroid Cancer Recurrence in 2302 Patients With Excellent Response to Primary Therapy.

Discrepant data on the recurrence rate of differentiated thyroid cancer (DTC) are reported. To evaluate the frequency and risk factors of true recurrence in DTC patients with excellent responses (ExR) to initial therapy. A retrospective analysis of the 2302 consecutive DTC patients with ExR to primary therapy, treated during 24 years at single center. The percentage of recurrence and cumulative recurrence rate (CRR) were analyzed. Risk factors for recurrence for patients with papillary thyroid cancer (PTC) were investigated and methods for establishing a diagnosis of recurrence were evaluated. Of DTC patients, 32 (1.4%) experienced recurrence. PTC patients with recurrence were more likely to have younger age (P = .0182), larger tumor size (P = .0013), lymph node metastases (P = .0013), incomplete resection (P = .0446), higher ATA risk (P = .0002), and had more frequently been treated with 131I (P = .0203). CRRs at 5, 10, 15, 20, and 24 years after surgery were 1.2%, 1.9%, 2.5%, 2.9%, and 2.9%, respectively. The CRRs according to histological type were highest for poorly differentiated thyroid cancer (PDTC), lower for oncocytic (OTC) and follicular thyroid cancer (FTC), and lowest for PTC. Most recurrences occurred within the first 5 years of observation. The most effective method for detecting local recurrence was ultrasonography with fine needle aspiration cytology, and for distant metastases, 18F-FDG PET. True recurrence is rare in DTC patients. PTC patients with ExR to primary therapy and N0/Nx can be dismissed from oncological follow-up. Despite ExR to primary therapy, DTC patients with N1, and PDTC, OTC, FTC should remain under oncological follow-up.

The role of 18 F-FDG-PET/CT in the management of differentiated thyroid cancer.

In previous literature, 18 F-FDG-PET/ CT imaging significantly impacted differentiated thyroid cancer (DTC) therapy. Low thyroglobulin (Tg) levels and negative Iodine-131 (131I) whole-body scan (WBS), along with negative 18 F-FDG-PET/ CT, suggested a lesser likelihood of active illness. Positive 18 F-FDG-PET/CT findings, however, were associated with a variety of signs of local recurrence and regional or distant metastases in patients with suspected WBS. We aim to evaluate the utility of 18 F-FDG-PET/CT in managing DTC patients with negative 131I post-therapy WBS and elevated Tg. We retrospectively reviewed 55 patients with DTC (76% papillary and 24% follicular). Patients underwent total thyroidectomy or several radioactive iodine (RAI) treatments or both. WBS was performed 5-7 days after RAI treatment. Inclusion criteria were elevated serum Tg, negative anti-Tg auto-antibodies (AbTg) during long-term follow-up, presence of 18F-FDG-PET/CT images, and negative or suspicious WBS. 54% of 18 F-FDG-PET/CTs detected at least one lesion, mainly, cervical lymph nodes (49.9%), mediastinal lymph nodes (40.4%), local recurrence (34%), and bone or tissue metastasis (36.2%). The three major sites of metastasis were lung, bone, and liver. 18 F-FDG-PET/CT identified recurrence or metastasis in 45% of patients with high serum Tg and negative WBS, modifying therapeutic management in half the patients for suitable treatment modality (surgery vs. tyrosine kinase inhibitor). The findings redemonstrate that elevated Tg with negative or suspicious WBS necessitates 18 F-FDG-PET/CT for localization of recurrence. 18 F-FDG-PET/CT is useful in managing locally recurrent or metastatic DTC with high Tg levels. It influences treatment and accurately assesses disease severity.

Characteristics, staging and outcomes of differentiated thyroid cancer in patients with and without Graves’ disease

BackgroundThe incidence of thyroid cancer has increased over the last three decades with studies showing incidence of thyroid cancer is higher among patients with Graves’ Disease (GD) when compared to Toxic multinodular goiter.1 We conducted a retrospective study to further investigate characteristics and outcomes in patients with thyroid cancer and GD. MethodsWe retrospectively reviewed 62 patients with a diagnosis of Differentiated Thyroid Cancer (DTC). We compared age at diagnosis, type, size of tumor, radioactive iodine (RAI) use, and DTC recurrence amongst patients with GD, non-GD patients. We used Chi-square to test for independence among categorical variables at a nominal level of 0.05; comparison was based on t-test. ResultsOut of 62 patients, 29 patients had GD and DTC (47%). 94% had papillary thyroid cancer. Patients with GD were diagnosed with DTC at a younger age (mean 46 years) in comparison to patients without GD (mean 53 years). There was no difference in the type of DTC. Patients with GD had significantly smaller tumor size (mean size 1.035 cm; p value = 0.002), more Stage 1 and 2 compared to patients without GD (p-value = 0.009). Both groups of patients had similar rates of recurrence on follow up and RAI use. ConclusionWe found patients with GD had smaller tumor size, early-stage DTC when compared to patients without GD and potentially favorable prognosis. More data is needed to understand whether this is due to pathogenesis like Graves antibodies promoting tumor formation or merely earlier detection of DTC in GD.

Estimated Risk of Differentiated Thyroid Cancer Recurrence Is Similar Between Preoperative Molecular Testing and the 2015 ATA Risk Stratification System in a Retrospective Analysis

Clinical ThyroidologyVol. 35, No. 6 Thyroid CancerEstimated Risk of Differentiated Thyroid Cancer Recurrence Is Similar Between Preoperative Molecular Testing and the 2015 ATA Risk Stratification System in a Retrospective AnalysisLindsay A. BischoffLindsay A. BischoffDivision of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.Search for more papers by this authorPublished Online:13 Jun 2023https://doi.org/10.1089/ct.2023;35.246-248AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 35Issue 6Jun 2023 Information© Copyright 2023, Mary Ann Liebert, Inc.To cite this article:Lindsay A. Bischoff.Estimated Risk of Differentiated Thyroid Cancer Recurrence Is Similar Between Preoperative Molecular Testing and the 2015 ATA Risk Stratification System in a Retrospective Analysis.Clinical Thyroidology.Jun 2023.246-248.http://doi.org/10.1089/ct.2023;35.246-248Published in Volume: 35 Issue 6: June 13, 2023PDF download

Recurrent Differentiated Thyroid Cancer: The Current Treatment Options.

Differentiated thyroid carcinomas (DTC) have an excellent prognosis, but this is sometimes overshadowed by tumor recurrences following initial treatment (approximately 15% of cases during follow-up), due to unrecognized disease extent at initial diagnosis or a more aggressive tumor biology, which are the usual risk factors. The possible sites of recurrence are local, regional, or distant. Local and regional recurrences can usually be successfully managed with surgery and radioiodine therapy, as are some isolated distant recurrences, such as bone metastases. If these treatments are not possible, other therapeutic options such as external beam radiation therapy or systemic treatments should be considered. Major advances in systemic treatments have led to improved progression-free survival in patients previously considered for palliative treatments; among these treatments, the most promising results have been achieved with tyrosine kinase inhibitors (TKI). This review attempts to give a comprehensive overview of the current treatment options suited for recurrences and the new treatments that are available in cases where salvage surgery is not possible or in cases resistant to radioiodine.

PO-1207 Intensity-modulated radiotherapy for inoperable/unresectable recurrent differentiated thyroid cancer

PO-1207 Intensity-modulated radiotherapy for inoperable/unresectable recurrent differentiated thyroid cancer

Diagnostic significance of MRI versus CT using identical PET data in patients with recurrent differentiated thyroid cancer: A PET/MRI study.

In this retrospective study we compared magnet resonance imaging (MRI) and computed tomography (CT) each combined with identical 2-deoxy-2-[18F] fluoro-D-glucose or 2-[18F] F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) data in patients with recurrent differentiated thyroid cancer (DTC). In total 42 patients with DTC were examined. All patients underwent FDG PET/MRI and CT, the latter originating from one of the following examinations: I-131 single photon emission computed tomography/CT (32/42), low dose FDG PET/CT (5/42) or diagnostic FDG PET/CT (5/42). Two readers assessed FDG PET/MRI as well as FDG PET/CT, with the latter CT coming from one of the above examinations performed at a maximum temporal interval of 5 days from PET/MRI. Local recurrence, cervical lymph node - and pulmonary metastases were assessed in a consensus read. Lesions rated with a high malignancy score (score 4 or 5) were further analyzed. Every malignant lesion was verified if it was identified by one of both or by both modalities. In 20 of 42 patients altogether 100 malignant lesions were present. In 11/20 patients in total 15 local recurrences (15 in MRI/ 9 in CT: 9 CT/MRI, 6 MRI only, 0 CT only; P = .04) were found with a statistically significant better performance of MRI. Regarding lymph node metastases, in total 13 lesions (12 in MRI/ 8 in CT: 7 CT/MRI, 5 MRI only, 1 CT only; P = .22) in 8/20 patients were found with no significant difference between both modalities. Furthermore, in 9/20 patients in total 72 lung lesions (40 in MRI/ 63 in CT: 31 CT/MRI, 9 MRI only, 32 CT only; P = .001) were found with a statistically significant better performance of CT. In 33/42 patients follow up was available and supported the observations. In patients with recurrent DTC, PET/MRI showed superiority compared to PET/CT in evaluation of the neck region. PET/MRI was inferior to PET/CT in evaluation of the lung. PET/MRI in combination with a low dose CT of the lung may thus represent the ideal staging tool in patients with recurrent DTC.