DTC Patients Research Articles

The Prognostic Impact of Tumor Size and BRAF Mutational Status in Middle Eastern Differentiated Thyroid Cancer.

Tumor size at diagnosis has been widely used as a major mortality risk factor in risk stratification of DTC. The current study was designed to analyze whether tumor size at diagnosis is a major prognostic factor in Middle Eastern DTC. We conducted a comparative study of the relationship between tumor size at diagnosis and event free survival (EFS) with respect to BRAF status in 1709 consecutive patients treated surgically for DTC. Patients were divided into four groups according to the size of tumor and BRAF mutation status: Group 1 (≤4 cm without BRAF mutation), Group 2 (≤4 cm with BRAF mutation), Group 3 (>4 cm without BRAF mutation) and Group 4 (>4 cm with BRAF mutation). Predictors of EFS were compared using the Log-rank test and Cox proportional hazards models. Tumor size >4cm was associated with adverse clinico-pathologic characteristics, such as older age, male gender, bilateral tumors, extrathyroidal extension, lymphovascular invasion, advanced tumor stage and persistent/recurrent disease. Tumor size was also inversely associated with BRAF mutation. Both tumor size (> 4cm) and BRAF mutation were associated with EFS on univariate analysis. On subgroup analysis, larger tumor size was an independent predictor of EFS (Group 3 vs. Group 1), irrespective of BRAF mutation status. Also, within the BRAF mutant tumors, larger tumor size was still an independent predictor of EFS (Group 4 vs. Group 2). Tumor size is an independent predictor of EFS in Middle Eastern DTC patients, regardless of BRAF mutational status.

Reproductive life and differentiated thyroid carcinoma in women: reciprocal influences on their respective outcome.

To analyze the reciprocal influences between female reproductive life and DTC management. Data on pregnancy outcome in DTC patients indicate that after conceiving, these women may need an increased L-T4 dose to maintain suppressed serum TSH levels. Nevertheless, this does not determine major harm in terms of pregnancy outcome. Analogously, the most recent findings obtained with the propensity score matching approach have confirmed that pregnancy does not significantly affect DTC clinical course and eventually tumor prognosis. A recent metanalysis and a large case-control study excluded a significant effect of radioactive iodine treatment (RAIT) on several reproductive variables in DTC patients, providing reassuring evidence that the current recommendations on RAIT for women of childbearing age are sufficiently well tolerated and do not affect fertility nor pregnancy rate. Overall, the most recent studies have provided sufficiently reassuring evidence that the occurrence of pregnancy and DTC management are of no reciprocal harm for adverse outcome in affected women of childbearing age. Thus, female DTC patients should be managed according to the individual response to treatment before pregnancy. When DTC diagnosis is made after conception, delaying surgery does not represent a harm in most patients.

7742 Clinical Outcomes of Thyroid Cancer Patients Enrolled in a Comprehensive Thyroid Cancer Survivorship Program

Abstract Disclosure: M.A. Ruiz Santillan: None. J.L. Rollins: None. S. Lee-Kim: None. M.I. Hu: None. S.I. Sherman: None. J. Varghese: None. N.L. Busaidy: None. M. Cabanillas: None. R. Dadu: None. P.C. Iyer: None. A.K. Ying: None. S.G. Waguespack: None. J.K. Devin: None. C. Jimenez: None. R. Vassilopoulou-Sellin: None. R.F. Gagel: None. M. Zafereo: None. P.H. Graham: None. N.D. Perrier: None. E. Grubbs: None. S.B. Fisher: None. M.A. Habra: None. Background Thyroid cancer, being the most common endocrine malignancy with excellent prognosis, is an ideal model for cancer survivorship. The Thyroid Cancer Survivorship clinic (TCSC) was established to provide oncologic, functional, behavioral follow-up, and age-appropriate cancer screening. Entry criteria into TCSC were developed using expert opinion as formalized consensus guidelines for thyroid cancer survivorship care do not exist. Patients may transition at 1, 3, or 5 years after initial diagnosis depending on original histology and stage, lack of definitive biochemical (thyroglobulin or Calcitonin/CEA), and/or structural evidence of disease. It is run by nurse practitioners with physician supervision. The impact of the transition criteria from acute care to survivorship has not been evaluated. To fill this knowledge gap, we analyzed data from TCSC to assess important clinical outcomes including return to active care, disease recurrence, and overall survival. Methods A single-institution, retrospective review was conducted to identify patients with differentiated (DTC) and medullary (MTC) thyroid cancer enrolled in our TCSC. We particularly assessed patients who were referred from TCSC back to active care because of suspected recurrence, which was defined as either biochemical and/or structural and based on abnormal biochemical markers and/or imaging. Results Between 2009-2023, 2887 patients were transitioned from active care to the TCSC out of whom 246 (8%) patients returned to active care for: the evaluation of endocrine disorders in 84 pts (2.9%), scheduling factors 74 pts (2.6%), and suspected recurrence in 88 pts (3%) (83 with DTC and 5 with MTC). Recurrence was suspected based on abnormal biochemical markers in 40/88, imaging in 34/88, or both in 14/88. Of the patients with suspected recurrence there were 66 females and 22 males with a median age at the time of initial diagnosis of 44 (range: 18-76) years. The median follow-up time from diagnosis to the last visit to our institution was 14 (range: 5-55) years and the median follow-up from transition to the TCSC to the last visit was 8 (range: 1-14) years. At the time of entering TCSC, 21/88 (24%) had biochemical indeterminate disease, while 38 (43%) had indeterminate imaging findings on neck ultrasound. DTC patients returned to active care after a median of 5 (range: 0.26-13) years and MTC patients returned after a median of 2 years (range: 0.81-11). At the last follow-up visit, 42/88 (48%) patients were alive with no evidence of disease, 41/88 (47%) were alive with residual disease and 5/88 (5%) died (3 of thyroid cancer, 1 of breast and 1 of genitourinary malignancy complications). Conclusions The retention rate is high in TCSC, with a small percentage transitioning back to active care. Only 3% of patients transitioned back to active care for suspected recurrences, with half occurring more than 5 years after entering survivorship. Presentation: 6/3/2024

Application Progress in the Surgical Treatment of Differentiated Thyroid Cancer

Differentiated thyroid cancer accounts for more than 90% of thyroid cancer, including follicular and papillary carcinoma, and surgery is the main way to treat the disease. With the increasing incidence of thyroid cancer in recent years, the progress of its main treatment methods has attracted people's attention. In order to achieve good treatment results and promote the prognosis of patients, they should accurately evaluate their actual condition before surgery, and then choose the appropriate surgical method. This article mainly reviews the technology and application effect of DTC surgical treatment, in order to provide more basis and reference for the formulation of surgical treatment plans for DTC patients.

Do Different TSH Suppression Levels Effect Heart Rate Variability and QT Dispersions in Patients with Differentiated Thyroid Cancer?

ABSTRACT Objective The aim of this study was to investigate changes in heart rate variability (HRV) and QT dispersion (QTd) in patients with differentiated thyroid cancer at different TSH suppression levels. Methods The study included 125 DTC patients, who had been on TSH suppression treatment (TSHST) for at least 1 year. The patients were categorized into three groups: patients with TSH < 0.1 mIU/L (n:30), those with TSH 0.1 to 0.5 mIU/L (n:56), and those with TSH 0.5 to 2 mIU/L (n:39). The first two groups were classified as suppression groups, and the last as replacement (control) group. All patients underwent 12-lead electrocardiogram (ECG) recording and 24-hour rhythm holter echocardiography analysis. Results The HRV results derived from a 24-hour rhythm holter did not exhibit any significant difference (p < 0.05). In dispersion evaluations, the QTd was significantly longer in the suppression groups (groups 1 and 2), than in the replacement group (group 3) (p < 0.001 and p:0.002, respectively). The same was found for corrected QT dispersion (QTcd) (p < 0.001 and p: 0.008, respectively). In multivariate linear regression analysis, TSH was found to affect QTd (β = -0.299; p = 0.002) and QTcd (β = -0.300; p = 0.002) values independently. Conclusion In this study, it was shown that in patients with DTC receiving TSHST, QT dispersion prolonged as the TSH suppression level increased. Especially in high-risk DTC patients, evaluation of QTd may be useful in terms of evaluating cardiovascular risk and regulating TSHST level.

Patients with radioiodine-refractory differentiated thyroid cancer (RAI-R DTC) with BRAF V600E and/or K601E mutation status: A real-world view of effectiveness of lenvatinib monotherapy.

6098 Background: Lenvatinib was approved for the treatment of patients RAI-R DTC in the United States (US) in 2015, and the treatment landscape has evolved with agents targeting specific driver mutations. We assessed real-world clinical effectiveness of first line therapy with lenvatinib in patients with BRAF-mutated tumors, wild-type (WT) tumors, and patients who have not been tested for BRAF mutations (BRAF untested tumors). Methods: A retrospective chart review of RAI-R DTC patients in the US who initiated first-line lenvatinib monotherapy between February 13, 2015, and September 30, 2020. Data, including a boosted cohort of patients with BRAF-mutated tumors collected in late 2023, were abstracted from patients’ electronic health records and were de-identified. Descriptive analyses were conducted in patient cohorts with BRAF V600E and/or K601E mutated tumors, wild-type (WT) tumors, and BRAF untested tumors. Best response in first-line therapy was captured, real-world progression-free survival (rwPFS) and real-world overall survival (rwOS) were assessed using Kaplan-Meier methods. Results: Of the 361 patients reviewed, 185 had records showing BRAF mutational status testing. 89 had BRAF V600E and/or K601E mutated tumors, 96 had WT tumors. 176 patients did not have BRAF mutational assessment. Of all subjects, 73.7% were White/Caucasian, 15.2% were African American, and 16.8% were Hispanic/Latino; 27.1% had ECOG performance status ≥2. The median follow-up times for each cohort were 30.0, 18.7 and 18.0 months, showing the longer follow up period for the BRAF-mutated cohort boost. Kaplan-Meier estimation for lenvatinib treatment discontinuation for the three cohorts at 24-months were as shown in the table below. Provider-reported overall response rate (complete or partial response) was 76.4%, 75.0% and 69.3% respectively. The estimated 24-month rwPFS rates (95% CI) were 74.1% (62.2%-82.8%), 61.7% (49.6%-71.8%), and 69.8% (60.9%-77.0%) respectively. Median rwOS was not reached for patients with BRAF-mutated and WT tumors, median OS was 54.2 months for BRAF untested tumors. Estimated rwOS rates at 12- and 48-months were 93.2% (85.4%-96.9%) and 83.9% (73.3%-90.3%) in BRAF-mutated patients, 90.6% (82.8%-95.0%) and 68.5% (53.4%-79.6%) in WT patients, and 90.2% (84.7%-93.8%) and 72.5% (61.6%-80.7%) in BRAF untested patients respectively. Conclusions: In this US real-world experience, the effectiveness of lenvatinib is consistent across a diverse cohort of RAI-R DTC patients with BRAF-mutated, WT, and BRAF untested tumors. This has implications for the first-line use of lenvatinib in BRAF mutated patients. [Table: see text]

Metabolomics reveals the implication of acetoacetate and ketogenic diet therapy in radioiodine-refractory differentiated thyroid carcinoma.

Patients with radioiodine-refractory (RAIR) differentiated thyroid carcinoma (DTC; RAIR-DTC) have a poor prognosis. The aim of this study was to provide new insights and possibilities for the diagnosis and treatment of RAIR-DTC. The metabolomics of 24 RAIR-DTC and 18 non-radioiodine-refractory (NonRAIR) DTC patients samples were analyzed by liquid chromatograph-mass spectrometry. Cellular radioiodine uptake was detected with γ counter. Sodium iodide symporter (NIS) expression and thyroid stimulating hormone receptor (TSHR) were measured by Western blot analysis. CCK8 and colony formation assays were used to measure cellular proliferation. Scratch and transwell assays were performed to assess cell migration and invasion. Annexin V/PI staining was used to detect cell apoptosis. Cell growth in vivo was evaluated by a tumor xenograft model. The acetoacetate (AcAc) level was measured by ELISA. Pathological changes, Ki67, NIS, and TSHR expression were investigated by immunohistochemistry. The metabolite profiles of RAIR could be distinguished from those of NonRAIR, with AcAc significantly lower in RAIR. The significantly different metabolic pathway was ketone body metabolism. AcAc increased NIS and TSHR expression and improved radioiodine uptake. AcAc inhibited cell proliferation, migration, and invasion, and as well promoted cell apoptosis. Ketogenic diet (KD) elevated AcAc levels and significantly suppressed tumor growth, as well as improved NIS and TSHR expression. Significant metabolic differences were observed between RAIR and NonRAIR, and ketone body metabolism might play an important role in RAIR-DTC. AcAc improved cellular iodine uptake and had antitumor effects for thyroid carcinoma. KD might be a new therapeutic strategy for RAIR-DTC.

Pre-Treatment and Post-Treatment I-131 Imaging in Differentiated Thyroid Carcinoma.

Radioiodine imaging in initial perioperative settings, after the total thyroidectomy, includes pre-treatment and post-treatment radioiodine imaging. While the benefit of post-treatment whole-body imaging (PT-WBI) is well established, the role of diagnostic whole-body imaging (dx WBI), prior to radioiodine (I-131) ablative or therapeutic doses, is controversial. Dx WBI has been abandoned in most nuclear medicine centers long ago. Planar low-dose dxWBI provides the volume of postoperative thyroid remnants, but it cannot detect occult metastatic foci in the neck. The modern integrated multimodality, i.e., SPECT/CT imaging, provides three dimensional images and accurate anatomic/metabolic data. This hybrid technology offers better spatial resolution but not better sensitivity. Dx WBI has low theranostic power because of the radioiodine indifference and low detection sensitivity for small-volume nodal disease in the neck. Since dx WBI cannot clarify the paratracheal cervical uptake, thyroid remnants may be easily misinterpreted as nodal disease, leading to a false N upstaging (from N0 stage to N1 stage) in DTC patients. Post-ablation I-131 imaging has a significant role in the initial staging of radioiodine-avid DTC and in the identification of non-radioiodine avid tumors. Additionally, SPECT/CT in the post-treatment setting provides more accurate initial TNM staging and better risk stratification of DTC patients. Post-treatment I-131 imaging is obligatory and must be performed in all DTC patients who receive radioiodine treatment.

External beam radiation therapy for recurrent or residual thyroid cancer: What is the best treatment time and the best candidate for long-term local disease control?

Cervical disease control might be challenging in advanced thyroid cancer (DTC). Indications for cervical external beam radiation therapy (EBRT) are controversial. To identify clinical and molecular factors associated with control of cervical disease with EBRT. Retrospective evaluation and molecular analysis of the primary tumor DTC patients who underwent cervical EBRT between 1995 and 2022 was performed. Eighty adults, median age of 61 years, were included. T4 disease was present in 43.7%, lymph node involvement in 42.5%, and distant metastasis in 47.5%. Those with cervical progression were older (62.5 vs. 57.3, p = 0.04) with more nodes affected (12.1 vs. 2.8, p = 0.04) and had EBRT performed later following surgery (76.6 vs. 64 months, p = 0.05). EBRT associated with multikinase inhibitors showed longer overall survival than EBRT alone (64.3 vs. 37.9, p = 0.018) and better local disease control. Performing EBRT before radioiodine (RAI) was associated with longer cervical progression-free survival (CPFS) than was RAI before (67.5 vs. 34.5, p < 0.01). EBRT ≥2 years after surgery was associated with worse CPFS (4.9 vs. 34, p = 0.04). The most common molecular alterations were ERBB2, BRAF, FAT1, RET and ROS1 and TERT mutation was predictive of worse disease control after EBRT (p = 0.04). Younger patients, with fewer affected nodes and treated earlier after surgery had better cervical disease control. Combination of EBRT with MKI improved OS. TERT mutation might indicate worse responders to EBRT; however, further studies are necessary to clarify the role of molecular testing in selecting candidates for cervical EBRT.

Survival Trends in Pediatric Differentiated Thyroid Cancer: A Middle Eastern Perspective.

Pediatric Differentiated Thyroid Cancer (pedDTC) is a rare pediatric malignancy with an increasing incidence over time. To date, there is a paucity of literature specifically addressing pedDTC within the context of Middle Eastern ethnicity. This retrospective study aimed to assess the risk-stratifying factors for overall survival (OS) and event-free survival (EFS) in pediatric DTC patients from Iraq and Jordan. The medical records of 81 patients from two tertiary cancer institutes were retrieved. Kaplan-Meier analysis was employed to investigate OS and EFS, and the Cox proportional hazards model was employed to estimate hazard ratios. All patients underwent surgery and radioactive iodine therapy, with a median age of 14 and an interquartile range of 12-15. Lymph node involvement was observed in 55% of cases, while distant metastases were present in 13.5%. After a median follow-up period of 68 months, the 10-year survival rate was determined to be 94%, while the 10-year EFS rate was 58%. EFS was negatively impacted by cervical lymph node metastases and early age of diagnosis (p ≤ 0.01, each). Therefore, pediatrics with initial cervical lymph node metastases and those diagnosed before puberty tend to experience poorer EFS, which may justify the need for more aggressive management plans.

Short-Term Postoperative Depression and Anxiety in Patients with Differentiated Thyroid Carcinoma: Assessment of Potential Oncologic-Psycho Relevance.

Objective: To understand whether TSH suppressive therapy affect short-term postoperative cancer-related depression and anxiety among DTC patients. To evaluate short-term postoperative psychological problems and its relationship with baseline parameters, fatigue, sleep quality, illness perception, and patients' quality of life. Study Design and Methods: This was a prospective, observational, single center study. This study involved 831 TC patients who consecutively admitted to the inpatient department of hospital between 1st June 2020 and 31th February 2021. Results: Mean scores of the self-rated anxiety scale (SAS) (49.04 vs. 40.69) and self-rated depression scale (SDS) (44.61 vs. 39.86), as well as the incidence of anxiety (41.5% vs. 22.1%) and depression (22.5% vs. 2.4%) significantly decreased 3 months after surgery. For personal and clinical characteristics, low educational background (SAS, β = 1.392; SDS, β = 1.622; and p < 0.05), without children (SAS, β = 4.068; SDS, β = 1.873, and p < 0.01), FNAC (SAS, β = -0.981; SDS, β = -2.583; and p < 0.05), and multifocal tumor (SAS, β = -1.287; SDS, β = -2.681; and p < 0.05) were the main effects for both short-term postoperative anxiety and depression. Multiple linear regression analysis identified the serum TSH level as a significant variable associated with worse SAS (Beta = -0.695 and p=0.043) and SDS (Beta = -3.133 and p < 0.001) scores 3 months after surgery. FT4 was independently associated with SAS scores (Beta = -0.202 and p < 0.001). Patients with middle ATA risk had a significantly higher level of SDS scores (p=0.033). Conclusion: We confirmed that cancer-related anxiety and depression among DTC patients significantly alleviated 3 months after surgery. TSH suppression therapy has profound effects on cancer-related anxiety and depression, and the degree of anxiety and depression significantly deteriorated with the decrease of TSH level.

Real-world treatment patterns and clinical outcomes in patients with radioiodine-refractory differentiated thyroid cancer (RAI-R DTC) treated with first line lenvatinib monotherapy in the United States

PurposeLenvatinib was approved for the treatment of patients with radioiodine-refractory differentiated thyroid cancer (RAI-R DTC) in the United States (US) in 2015. The main objective of the current study was to assess real-world clinical effectiveness in RAI-R DTC patients treated with first line lenvatinib monotherapy in the US.MethodsA retrospective chart review was conducted in RAI-R DTC patients who initiated lenvatinib monotherapy as first line treatment between February 2015 and September 2020. Anonymized data were abstracted by prescribing physicians from individual patient’s electronic health records. Clinical outcomes included provider-reported real-world best overall response (rwBOR), real-world progression-free survival (rwPFS), and overall survival (OS). Time-to-event endpoints were assessed using Kaplan–Meier methods.ResultsOur study included 308 RAI-R DTC patients treated with first line lenvatinib. At lenvatinib initiation, patients’ median age was 60 years, 51.6% were female, and 26.0% of patients had an ECOG performance score of ≥2. Over the follow-up period, 32.5% of patients discontinued first line lenvatinib permanently, with others remaining on treatment. The median duration of lenvatinib therapy was 17.5 months overall. Provider-reported rwBOR (complete or partial response) to lenvatinib was 72.4%. Median rwPFS was 49.0 months. Estimated rwPFS rates at 24 and 48 months were 68.5% and 55.0%, respectively. Estimated OS rates at 24 and 72 months were 78.4% and 57.0%, respectively; median OS was not reached.ConclusionThe current study reinforces the clinical effectiveness of first line lenvatinib as standard of care in patients with RAI-R DTC in real-world clinical practice in the US.

Prognostic Factors Improving ATA Risk System and Dynamic Risk Stratification in Low- and Intermediate-Risk DTC Patients.

American Thyroid Association (ATA) guidelines do not consider age at diagnosis as a prognostic factor on the estimation of the risk of persistent/recurrent disease in differentiated thyroid carcinoma (DTC) patients. While age at diagnosis has already been assessed in high-risk patients, it remains to be established in low- and intermediate-risk patients. The aim of our study was to investigate the role of age as a prognostic factor in the short- and long-term outcome of DTC patients classified at low and intermediate risk according to the ATA stratification risk system. We retrospectively evaluated 863 DTC patients (mean follow-up: 10 ± 6.2 years) 52% classified as low (449/863) and 48% as intermediate risk (414/863). For each ATA-risk class patients were divided into subgroups based on age at diagnosis (<55 or ≥55 years). In the intermediate-risk group, patients aged 55 years or older had a higher rate of structural disease (11.6% vs 8.9%), recurrent disease (4.1% vs 0.7%), and death (4.1% vs 1%) when compared with younger patients (<55 years) (P = .007). Multivariate analysis confirmed that older age at diagnosis (odds ratio [OR] = 3.9; 95% CI, 1.9-8.6; P < .001) was an independent risk factor for worse long-term outcome together with response to initial therapy (OR = 13.0; 95% CI, 6.3-27.9; P < .001), and T (OR = 32; 95% CI, 1.4-7.1; P = .005) and N category (OR = 2.3; 95% CI, 1.1-5.0; P = .03). Nevertheless, a negative effect of older age was documented only in the subgroup of intermediate DTC patients with persistent structural disease after initial therapy. Indeed, the rate of worse long-term outcome rose from 13.3% in the whole population of intermediate DTC patients to 47.8% in patients with persistent structural disease after initial therapy (P < .001) and to 80% in patients older than 55 years and persistent structural disease after initial therapy (P = .02). Our results suggest that age at diagnosis further predict individual outcomes in Intermediate-Risk DTC allowing ongoing management to be tailored accordingly.

Tailored mortality risk in stage I-II DTC patients by integrating ata stratification and response to initial therapy

Tailored mortality risk in stage I-II DTC patients by integrating ata stratification and response to initial therapy

Predictive Factors of Lymph Nodes Recurrence in Patients with Differentiated Thyroid Carcinoma Post Thyroidectomy in Clinically Node Negative Patients: A Systematic Review and Meta-Analysis Study

Abstract Background Differentiated thyroid cancer (DTC), a term used to describe papillary thyroid cancer (PTC), follicular thyroid cancer (FTC), and Hürthle cell thyroid cancer (HTC), accounts for approximately 95% of all thyroid malignancies. The expression clinically lymph node-negative (cN0)‘ was used to describe the patients that did not show the clinical evidence of CLNM on US or other imaging modalities preoperatively. Objective To assess the incidence of recurrence after surgery for DTC and to identify predictive factors of recurrence. Patients and Methods The search was conducted through PubMed, Web of science, Scopes, and the Cochrane Library for data from inception to November 1, 2021 with a combination of the following terms: "clinically node negative", "Risk Factors" and "Thyroid Neoplasms". All the studies were reviewed according to the eligible criteria. Abstract-based eligibility studies were obtained, and the manuscripts were fully reviewed. Results There was no evidence of publication bias. The funnel plot analysis demonstrated a symmetrical appearance, and the P values were greater than 0.05 for all comparisons according to the Begg-Mazumdar test and eggers test. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment meas ures. Conclusion Young age (&amp;lt;45 years), male gender, Bilaterality, multifocality, capsular invasion, lymphovascular invasion and ETE were significantly associated with LNM in clinically N0 DTC patients and Prophylactic central neck dissection would be expected to have higher yield in patients with these factors.

Predicting 18F-FDG SUVs of metastatic pulmonary nodes from CT images in patients with differentiated thyroid cancer by using a convolutional neural network.

The aim of this study was to predict standard uptake values (SUVs) from computed tomography (CT) images of patients with lung metastases from differentiated thyroid cancer (DTC-LM). We proposed a novel SUVs prediction model using 18-layer Residual Network for generating SUVmax, SUVmean, SUVmin of metastatic pulmonary nodes from CT images of patients with DTC-LM. Nuclear medicine specialists outlined the metastatic pulmonary as primary set. The best model parameters were obtained after five-fold cross-validation on the training and validation set, further evaluated in independent test set. Mean absolute error (MAE), mean squared error (MSE), and mean relative error (MRE) were used to assess the performance of regression task. Specificity, sensitivity, F1 score, positive predictive value, negative predictive value and accuracy were used for classification task. The correlation between predicted and actual SUVs was analyzed. A total of 3407 nodes from 74 patients with DTC-LM were collected in this study. On the independent test set, the average MAE, MSE and MRE was 0.3843, 1.0133, 0.3491 respectively, and the accuracy was 88.26%. Our proposed model achieved high metric scores (MAE=0.3843, MSE=1.0113, MRE=34.91%) compared with other backbones. The predicted SUVmax (R2 = 0.8987), SUVmean (R2 = 0.8346), SUVmin (R2 = 0.7373) were all significantly correlated with actual SUVs. The novel approach proposed in this study provides new ideas for the application of predicting SUVs for metastatic pulmonary nodes in DTC patients.

Predictive value and dynamic risk stratification of high sensitive basal or stimulated thyroglobulin assay in a long-term thyroid carcinoma cohort

PurposeTo evaluate the predictive value of the rhTSH thyroglobulin stimulation test (rhTSH-Tg) compared to basal high-sensitive thyroglobulin (hs-Tg) under TSH suppressive therapy at 12 months after the completion of initial treatment to predict the long-term response and Dynamic Risk Stratification (DRS) at the last follow-up visit in a long-term DTC cohort.MethodsProspective study in 114 DTC patients (77.2% women, mean age 46.4 ± 14.1 years old, median/IQR evolution 6.7[3.1–8.0] years) from 2013 to 2020 undergoing total thyroidectomy and radioiodine ablation in whom hs-Tg and rhTSH-Tg was performed 12 months after completing initial treatment. Pearson correlation, receiving operating characteristics (ROC) and DRS at initial and last follow-up visit were analyzed.Resultshs-Tg and rhTSH-Tg show a strong positive linear correlation (r = 0.864, p < 0.001). The diagnostic performance of initial hs-Tg and rhTSH-Tg levels were evaluated via ROC-AUC as a predictor of excellent response (ER) in the last follow-up visit. Hs-Tg showed a better AUC (0.969, 95%CI = 0.941–0.997) than rhTSH-Tg (0.944, 95%IC = 0.905–0.984; p < 0.001). The hs-Tg and rhTSH-Tg cutoff point of highest sensitivity (S) and specificity (E) was 0.110 and 0.815 ng/dl, respectively. Hs-Tg showed a higher diagnostic accuracy than rhTSH-Tg (S = 100% vs 96.8%, E = 84.3% vs 84.3%, NPV = 100% vs 98.6%, PPV = 70.5% vs 69.7%; p < 0.05). The DRS based on initial hs-Tg showed better ability to predict ER (93.3% vs 86.7%) and biochemical incomplete response (53.3%vs13.3%) in the last follow-up visit compared to rhTSH-Tg.ConclusionsBoth initial hs-Th and rhTSH-Tg were good predictors of long-term ER. In patients with hs-Tg, the rhTSH-test did not provide relevant prognosis information. An ER after initial treatment was associated with a very high NPV at subsequent follow-up.

A user-friendly nomogram for predicting radioiodine refractory differentiated thyroid cancer.

The diagnosis of radioiodine refractory differentiated thyroid cancer (RAIR-DTC) is primarily based on clinical evolution and iodine uptake over the lesions, which is still time-consuming, thus urging a predictive model for timely RAIR-DTC informing. The aim of this study was to develop a nomogram model for RAIR prediction among DTC patients with distant metastases (DM). Data were extracted from the treatment and follow-up databases of Peking Union Medical College Hospital between 2010 and 2021. A total of 124 patients were included and divided into RAIR (n=71) and non-RAIR (n=53) according to 2015 ATA guidelines. All patients underwent total thyroidectomy followed by at least two courses of RAI treatment. Serological markers and various clinical, pathological, genetic status, and imaging factors were integrated into this study. The pre-treatment stimulated Tg and pre- and post-treatment suppressed Tg at the first and second course RAI treatment were defined as s-Tg1, s-Tg2, sup-Tg1, and sup-Tg2, respectively. Δs-Tg denoted s-Tg1/s-Tg2, and Δs-TSH denoted s-TSH1/s-TSH2. Multivariate logistic regression and correlation analysis were utilized to determine the independent predictors of RAIR. The performance of the nomogram was assessed by internal validation and receiver operating characteristic (ROC) curve, and benefit in clinical decision-making was assessed using decision curve. In univariate logistic regression, nine possible risk factors were related to RAIR. Correlation analysis showed four of the above factors associated with RAIR. Through multivariate logistic regression, Δs-Tg/Δs-TSH<1.50 and age upon diagnosis were obtained to develop a convenient nomogram model for predicting RAIR. The model was internally validated and had good predictive efficacy with an AUC of 0.830, specificity of 0.830, and sensitivity of 0.755. The decision curve also showed that if the model is used for clinical decision-making when the probability threshold is between 0.23 and 0.97, the net benefit of patients is markedly higher than that of the TreatAll and TreatNone control groups.By using 1.50 as a cut-off ofΔs-Tg/Δs-TSH, differing biochemical progression among the generally so-called RAIR can be further stratified as meaningfully rapidly or slowly progressive patients (P=0.012). A convenient user-friendly nomogram model was developed with good predictive efficacy for RAIR. The progression of RAIR can be further stratified as rapidly or slowly progressive by using 1.50 as a cut-off value of Δs-Tg/Δs-TSH.

SPECT/CT-based dosimetry of salivary glands and iodine-avid lesions following 131I therapy

The purpose was to provideuptake and radiation dose estimates to salivary glands (SG) and pathologic lesions following radioiodine therapy (RIT)of differentiated thyroid cancer patients (DTC). A group of DTCpatients (n = 25) undergoing 131I therapy joined this study with varying amounts of therapeuticactivity. SequentialSPECT/CT scanswere acquiredat 4 ± 2, 24 ± 2, and 168 ± 3h following administration of 3497-9250MBq131I. An earlier experiment withAcrylic glass body phantom (PET Phantom NEMA 2012 / IEC 2008) was conducted for system calibration includingscatter, partial volume effect and count loss correction.Dose calculation was made via IDAC-Dose 2.1 code. The absorbed dose to parotid glands was 0.04-0.97Gy/GBq (median: 0.26Gy/GBq). The median absorbed dose to submandibular glands was 0.14Gy/GBq (0.05 to 0.56Gy/GBq). The absorbed dose to thyroid residues was from 0.55 to 399.5Gy/GBq (median: 21.8Gy/GBq), and that to distal lesions ranged from 0.78 to 28.0Gy/GBq (median: 3.12Gy/GBq). 41% of the thyroid residues received dose > 80Gy, 18% between 70-80Gy, 18% between 40-70Gy, and 23% has dose < 40Gy. In contrast, 18% of the metastases exhibited a dose > 80Gy, 9% between 40-60Gy, and the dose to the vast majority of lesions (64%) was < 40Gy. It was inferred that dose estimation after RIT with SPECT/CT is feasible to apply, together with good agreement with published 124I PET/CT dose estimates. A broad and sub-effective dose range was estimated for thyroid residues and distal lesions. Moreover, the current methodology might be useful for establishing a dose-effect relationship and radiation-induced salivary glands damage after RIT.

The effect of sodium iodide symporter protein on ablation success in patients with differentiated thyroid cancer.

This study aimed to investigate immunohistochemical staining of sodium iodide symporter (NIS) and its effect on response to I-131 therapy in differentiated thyroid carcinoma patients. We evaluated NIS expression, the intracellular distribution of NIS, iodine-131 uptake in residual tissues on post-ablation I-131 whole body scan, and the ablation status after 100mCi I-131 therapy. We also investigated NIS expression and localization in tumoral paraffin-embedded tissues. In this retrospective study, 35 patients (mean age 44.17 ± 12.9years, 27 female, 8 male) were studied. Twenty-one of these patients responded to radioiodine therapy, and 14 did not. NIS expression and iodine-131 uptake in residual tissues post-ablation I-131 whole body scan were not statistically significant. When we compared the patients who responded to radioiodine therapy and the poor responder group, NIS expression and iodine-131 uptake in residual tissues did not demonstrate statistically significant difference [(p = 0.308) (p = 0.985) respectively]. 47.6% of the patients in the successful ablation group and 85.7% in the unsuccessful ablation group had intracellular NIS immunostaining. The difference was not statistically significant (p = 0.139). 52.4% of the patients in the successful ablation group and 7% in the unsuccessful ablation group had NIS immunostaining at the basolateral membrane. The difference was statistically significant (p < 0.05). In conclusion, we did not find any significant difference between successful and unsuccessful ablation groups in terms of NIS expression; however, we concluded that the intracellular (cytoplasmic) localization of NIS is one of the leading causes of ablation failure regardless of NIS expression in DTC patients.