Recurrent Thyroid Cancer Research Articles

Invited commentary: Lymph node yield independently predicts local recurrence in papillary thyroid cancer.

Invited commentary: Lymph node yield independently predicts local recurrence in papillary thyroid cancer.

Income disparities have a significant impact on thyroid cancer recurrence and survival

PurposeIncome inequality profoundly impacts cancer outcomes, yet its specific effects on thyroid cancer remain unclear. Elucidating the influence of socioeconomic disparities is imperative to advance health equity and optimize patient care. This study evaluates associations between median household income and thyroid cancer recurrence and survival using national cancer registry data. Methods139,302 thyroid cancer patients undergoing surgery from 2000 to 2019 were analyzed from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were categorized by median annual household income at the county level (> or <$75,000). Multivariable regression determined the impact of income on recurrence and overall mortality. ResultsHigher-income patients had 26 % lower recurrence odds (OR 0.74, 95 %CI 0.55–0.99, p=0.042) and longer median survival (18.1 vs 17.7 years, p<0.001) compared to lower-income patients. On multivariate analysis, high income remained an independent predictor of reduced mortality after adjusting for demographics, tumor factors, and treatment (adjusted HR=0.84, 95 %CI=0.81–0.87, p<0.001). Cancer-directed surgery (HR=0.28, 95 %CI=0.26–0.30, p<0.001) and radioactive iodine (HR=0.69, 95 %CI=0.66–0.71, p<0.001) were associated with lower mortality risk. ConclusionsIncome disparities have a significant influence on thyroid cancer outcomes, including lower recurrence and reduced mortality. Targeting socioeconomic inequity could substantially reduce recurrence, improve survival, and promote health equity for all patients.

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.

8465 Diagnostic Conundrum: The Mystery of Metastatic Papillary Thyroid Cancer with Persistently Elusive Thyroglobulin

Abstract Disclosure: P. Vemparala: None. M. Bollineni: None. Introduction- Among endocrine malignancies, differentiated thyroid cancers account for the majority with most of them boasting a favorable prognosis. Thyroglobulin, a pivotal biochemical marker, aids in detecting recurrence or persistent disease when combined with neck ultrasound, I-131 scintigraphy, and FDG PET scans. Anti-thyroglobulin antibodies, found in a quarter of cases, can falsely lower serum thyroglobulin levels in immunometric assays. Our intriguing case features a patient with metastatic papillary thyroid cancer, yet thyroglobulin levels persistently eluded detection. CASE PRESENTATION- A 33-year-old female presented initially to an outside facility with neck swelling, leading to a diagnosis of a 4 x 3 cm papillary thyroid cancer (PTC) in the right lobe and a 0.5 x 0.5 cm focus of PTC in the left lobe, accompanied by capsular extension, malignant cells in the left lobe margin, and lymphovascular invasion. After total thyroidectomy and lymph node exploration, radioactive iodine scan detected disease in right-sided lymph nodes, treated subsequently with radioactive iodine ablation. Two years later, she presented to our clinic with neck swelling, voice changes, and fatigue. Thyroglobulin level was measured which returned at &amp;lt;0.1 ng/ml, however thyroglobulin antibodies were elevated at 292 IU/ml, albeit decreased from a value of 431.5 IU/ml at initial diagnosis. Elevated thyroglobulin antibodies complicated interpretation, prompting liquid chromatography-mass spectrometry (LC-MS) for accurate measurement of thyroglobulin, which returned at &amp;lt;0.5 ng/ml. Ultrasound indicated metastatic disease in right cervical lymph nodes, confirmed by fine needle aspiration. In-office ultrasound-guided FNA of additional nodes validated metastasis. Modified radical neck dissection revealed metastatic PTC in 7 out of 34 lymph nodes. Surprisingly, thyroglobulin levels remained &amp;lt;0.5 ng/ml, pre- and post-operatively. Referred for radioactive iodine ablation, her complex journey underscored the challenges in monitoring thyroid cancer recurrence or persistent disease with thyroglobulin levels even by methods such as mass spectrometry. Conclusion- Key learnings from this case highlight the importance of cognizance in utilizing thyroglobulin levels to guide adjuvant therapy decisions and for postoperative monitoring in high risk patients, as low levels do not rule out recurrence or persistence. Anti-thyroglobulin antibodies pose challenges, necessitating techniques like LC-MS. Finally, recognizing “nonsecretor” thyroid cancers, an aggressive subgroup with poorer prognosis, is vital as they often present with low or undetectable thyroglobulin levels. Presentation: 6/2/2024

7914 Staged Treatment with Radioiodine Following Lobectomy in a Case of High Risk Papillary Thyroid Carcinoma

Abstract Disclosure: L. Pathak: None. A. Sharma: None. K. Rao: None. M.G. Jakoby: None. Introduction: Radioiodine ([1]3[1]I ) is usually reserved for patients with differentiated thyroid carcinoma (DTC) who are at high risk of persistence or recurrence after thyroidectomy. We present a case of papillary thyroid carcinoma (PTC) with extrathyroidal extension managed by lobectomy and staged [1]3[1]I ablation of the contralateral lobe and metastases due to comorbidities that made oncologic resection prohibitive. Case Description: A 58-year-old male had a 2.2 cm focus of PTC in the left thyroid lobe that extended into extrathyroidal soft tissue, adjacent trachea, and completely compromised the left recurrent laryngeal nerve. Due to left vocal cord paralysis and subglottic tracheal stenosis, left lobectomy was performed but oncologic resection (total thyroidectomy and tracheal resection) was deferred. The patient underwent recombinant human TSH (rhTSH) stimulated treatment with 30 mCi (1.1 GBq) of [1]3[1]I for right thyroid lobe ablation followed 60 d later by 180 mCi (6.7 GBq) of [1]3[1]I to treat metastases. Response to treatment was incomplete, with unstimulated thyroglobulin level falling from 293.9 to 18.9 ng/mL 1 y after [1]3[1]I and CT of the neck notable for a 2.7 cm left thyroid bed mass with invasion of adjacent trachea and a 1.0 cm right paratracheal mass, both of which exhibited hypermetabolism on PET imaging and yielded cytology consistent with poorly differentiated thyroid carcinoma (PDTC). A cluster of left supraclavicular lymph nodes showed both hypermetabolism on PET and radioiodine uptake on rhTSH scan. This patient is being prepared for surgical resection of the left thyroid bed and right paratracheal tumors and left lateral lymph node dissection. Discussion: Radioiodine lobar ablation is an alternative to completion thyroidectomy in patients with an unexpected diagnosis of DTC after lobectomy, with a recent meta-analysis finding a success rate of 69%. No difference in thyroid cancer recurrence rates was found in nearly 500 matched pairs of patients undergoing completion thyroidectomy or radioiodine lobar ablation. Unfortunately, staged lobar ablation followed by high dose [1]3[1]I was not successful in treating this high-risk PTC patient. Cases of coexisting PTC and PDTC are reported, and [1]3[1]I treatment was unsuccessful at treating PDTC that was not apparent on postsurgical histopathology. This case indicates that surgery is preferable to staged [1]3[1]I treatment of patients with aggressive PTC, especially if there are no comorbidities that make total thyroidectomy a high-risk procedure. Presentation: 6/2/2024

Overexpression of NR1D1 portends disease recurrence in thyroid cancer.

Dysregulation of circadian rhythms has been linked to cancer susceptibility. Thyroid cancer cells demonstrate altered circadian oscillations in endogenous clock transcripts. Our previous research identified NR1D1, a component of the circadian clock, as one of the recurrence-associated genes in papillary thyroid cancer. The objective of this study was to investigate the expression pattern of NR1D1 in thyroid cancer and explore its prognostic and translational implications. We assessed NR1D1 expression using immunohistochemical analysis and examined its correlation with clinicopathological parameters. In vitro and in vivo experiments were performed to elucidate the oncogenic roles of NR1D1 and potential mechanisms. Nuclear NR1D1 expression was present in thyroid follicular epithelial-derived cancers, whereas normal thyroid tissue and benign nodular goiter showed no detectable NR1D1 immunoreactivity. Patients with high expression of NR1D1 had more advanced disease stages, extrathyroidal extension, lymphovascular invasion, and shorter recurrence-free survival compared to those with low levels of NR1D1. Through gain- and loss-of-function studies, we demonstrated that NR1D1 modulation affected the growth of organoids, resistance to anoikis, and the invasive and migratory capacity of thyroid cancer cells. The invasion-promoting effect of NR1D1 was regulated by the β-catenin/ZEB1 axis. Moreover, the overexpression of NR1D1 accelerated xenograft growth and lung metastasis in vivo. NR1D1 is overexpressed in malignant thyroid tumors and has prognostic significance. Our findings suggest therapeutic potential in targeting NR1D1 for thyroid cancer.

B-085 Optimizing Thyroglobulin Antibody Interference Thresholds to Minimize Turn-around Time

Abstract Background Serum thyroglobulin (Tg) is a key biomarker used to detect disease recurrence in patients with differentiated thyroid cancers who have undergone complete thyroidectomy. Thyroglobulin antibodies (TgAb) can interfere with accurate measurement of serum Tg levels, producing falsely low results in automated immunoassays. Thus before measurement of Tg, TgAb levels are measured to determine if in-house immunoassays can be used or if the patient’s sample will need to be sent out for radioimmunoassay (RIA) or mass spectrometry methodologies, which are less sensitive to TgAb interference. We recently transitioned to new instrumentation and noted a sharp increase in Tg samples with TgAb interference that needed to be sent out when we used the limit of detection (LOD) of the Roche TgAb assay. This increases turnaround times for patients and increases laboratory costs. We hypothesized that the LOD of the Roche TgAb assay is below the level of interference in Tg immunoassays. To test this we compared the performance of TgAb immunoassays (IA) and Tg measurements by IA and RIA with the intention of proposing a more appropriate threshold for TgAb interference for the Roche TgAb assay. Methods We collected 121 serum specimens, which were above the LOD of the Roche TgAb (R-TgAb) assay, which is 10 IU/mL. These specimens were sent as part of standard care to USC for measurement of TgAb by Kronus (K-TgAb) and Tg by RIA. On these split samples we also measured Tg by Beckman Access (B-Tg). We compared the detection of TgAb by USC to varying thresholds of Roche TgAb measurements (10 IU/mL [LOD], 20 IU/mL, and 115 IU/mL [reference interval for autoimmunity]), and assessed the agreement between Tg measurements by Beckman IA and USC RIA for different Roche TgAb thresholds. Analyses were performed in Prism Graphpad using linear regression. Results Qualitatively, the concordance for R-TgAb to RIA (reference) at 10 IU/mL was 31%, at 20 IU/mL was 90%, and at 115 IU/mL was 80%. Quantitative agreement between the B-Tg immunoassay and RIA for the TgAb thresholds of: TgAb &amp;gt;10 IU/mL gave an R2=0.97 for Tg comparison, &amp;gt;20 IU/mL gave an R2=0.99, and &amp;gt;115 IU/mL R2=0.99. Conclusions Prior studies have shown that TgAb immunoassays can produce significant qualitative and quantitative differences. In our study, we attempt to validate the use of the Roche immunoassay with a cutoff of 20 IU/mL to minimize interference between Tg and TgAb in order to accurately detect recurrence of thyroid cancer. We found that a TgAb cutoff of 20 IU/mL we maintained acceptable agreement between Tg methods indicating no significant interference up to 20 IU/mL. With the TgAb cutoff of 20 IU/mL, we would be able to reduce sendouts for this cohort from 121 to 42, reducing sendouts by 65% and allowing a faster turnaround time for a significant proportion of our patients.

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.

Thyroid Cancer Recurrence: Risk Factors and Preventive Strategies

&amp;lt;i&amp;gt;Introduction&amp;lt;/i&amp;gt;: Several risk factors influence the recurrence of thyroid cancer, including age, tumor size, lymph node involvement, and other prognostic indicators. The purpose of this study is to evaluate the impact of these risk factors on the recurrence rates of thyroid cancer, with the aim of improving diagnostic and treatment strategies for better patient outcomes. &amp;lt;i&amp;gt;Aim of the study&amp;lt;/i&amp;gt;: The aim of the study was to evaluate risk factors for thyroid cancer recurrence and preventive strategies. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: This retrospective cohort study conducted at the Department of Otolaryngology-Head &amp; Neck Surgery at Bangabandhu Sheikh Mujib Medical University (BSMMU) included 108 thyroid cancer patients treated between April 2023 and March 2024. Patients were categorized into low-risk and high-risk groups based on prognostic factors. Follow-up for three years assessed recurrence and survival through outpatient visits and telephone interviews. Statistical analyses using SPSS version 22.0 included descriptive statistics, chi-square tests for recurrence rates, and Kaplan-Meier survival analysis. Result: The study identified Differentiated Thyroid Carcinoma (DTC) as the most common type, with Papillary Thyroid Carcinoma being the predominant subtype. Recurrence rates were notably higher in patients aged ≥45 and in males. Significant predictors of recurrence included age, gender, tumor diameter, and lymph node metastasis. High-risk patients mostly received Total Thyroidectomy, Radioiodine ablation, and Thyroxin. Follow-up showed recurrence rates of 8.33% in low-risk and 7.55% in high-risk patients over three years. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: The study highlights the critical role of age, gender, tumor diameter, and lymph node metastasis in predicting thyroid cancer recurrence, emphasizing the need for personalized treatment and monitoring based on risk levels.

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.

Match Point: Nuclear Medicine Imaging for Recurrent Thyroid Cancer in TENIS Syndrome-Systematic Review and Meta-Analysis.

Background/Objectives: Disease recurrence and resistance to radioiodine (RAI) therapy are major challenges in the management of differentiated thyroid cancer (DTC). In particular, the TENIS (Thyroglobulin Elevated Negative Iodine Scintigraphy) syndrome, characterised by elevated thyroglobulin (Tg) serum levels in addition to a negative radioiodine whole body scan (WBS), complicates disease monitoring and treatment decisions. Conventional imaging techniques often fail to detect disease in WBS-negative patients with rising Tg levels, leading to limitations in therapeutic intervention. This systematic review and meta-analysis aims to evaluate the diagnostic accuracy of nuclear imaging modalities in detecting disease recurrence in patients with the TENIS syndrome and to provide insights to guide therapeutic approaches in this complex clinical scenario. Methods: A comprehensive search of PubMed/MEDLINE and EMBASE databases up to March 2024 was performed according to PRISMA guidelines. Eligible studies were selected, and quality assessment was performed with the QUADAS-2 tool. For each study, relevant data were extracted and synthesised. A meta-analysis of the diagnostic accuracy of [18F]FDG PET/CT was performed, and patient-based pooled sensitivity and specificity were calculated using a random-effects model. Statistical heterogeneity between studies was assessed using the I2 statistic. Results: Of the 538 studies initially identified, 22 were included in the systematic review, of which 18 were eligible for meta-analysis. The eligible studies, mainly focused on [18F]FDG PET/CT, showed variable sensitivity and specificity for the detection of RAI-refractory thyroid cancer lesions. For [18F]FDG PET/CT, pooled estimates displayed a sensitivity of 0.87 (95% CI: 0.82-0.90) and a specificity of 0.76 (95% CI: 0.61-0.86), with moderate heterogeneity between studies. Conclusions: [18F]FDG PET/CT remains central in the detection of disease recurrence in patients with the TENIS syndrome. The emergence of novel radiopharmaceuticals with specific molecular targets is a promising way to overcome the limitations of [18F]FDG in these patients and to open new theranostics perspectives. This review highlights the great potential of nuclear medicine in guiding therapeutic strategies for RAI-refractory thyroid cancer.

Value of radiofrequency ablation for treating locally recurrent thyroid cancer: a systematic review and meta-analysis for 2-year follow-up.

To evaluate the safety and efficacy of radiofrequency ablation (RFA) in treating locoregional recurrent thyroid cancer (LRTC) after a 2-year follow-up time. PubMed, Embase and Cochrane Library were searched from inception until 20 September 2022 to find studies reporting the safety and efficacy of RFA in LRTC patients after a 2-year follow-up. Two radiologists performed the data extraction and methodological quality assessment according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We analyzed 6 studies, 229 LRTC patients with 319 locally recurrent tumors were treated with RFA. The mean follow-up time of each study was ≥24 months. The pooled changes in the largest diameter and volume were 7.22 mm (95% confidence interval (CI), 6.35-8.09 mm) and 164.28 mm3 (95% CI, 87.78-240.77 mm3), respectively; the pooled volume reduction rate was 95.03% (95% CI, 87.56-102.49%). The total complete disappearance rate after treatment was 92% (95% CI, 83-100%). The pooled decrease of serum thyroglobulin levels was 0.02 ng/ml (95% CI, -0.00-0.04 ng/ml). The pooled proportion of recurrence rate was 6% (95% CI, 0-13%). The pooled complication rate was 5% (95% CI, 0-10%). The major complications were voice change and hoarseness, only one patient developed permanent vocal cord paralysis; minor complications were cough and pain. Ultrasound-guided RFA is an effective and safe treatment for LRTC based on 2-year follow-up results.

Nuclear Imaging Modalities in the Diagnosis and Management of Thyroid Cancer.

In this review we have brought forward various nuclear imaging modalities used in the diagnosis, staging, and management of thyroid cancer. Thyroid cancer is the most common endocrine malignancy, accounting for approximately 3% of all new cancer diagnoses. Nuclear imaging plays an important role in the evaluation of thyroid cancer, and the use of radioiodine imaging, FDG imaging, and somatostatin receptor imaging are all valuable tools in the management of this disease. Radioiodine imaging involves the use of Iodine-123 [I-123] or Iodine-131 [I-131] to evaluate thyroid function and detect thyroid cancer. I-123 is a gamma-emitting isotope that is used in thyroid imaging to evaluate thyroid function and detect thyroid nodules. I-131 is a beta-emitting isotope that is used for the treatment of thyroid cancer. Radioiodine imaging is used to detect the presence of thyroid nodules and evaluate thyroid function. FDG imaging is a PET imaging modality that is used to evaluate the metabolic activity of thyroid cancer cells. FDG is a glucose analogue that is taken up by cells that are metabolically active, such as cancer cells. FDG PET/CT can detect primary thyroid cancer and metastatic disease, including lymph nodes and distant metastases. FDG PET/CT is also used to monitor treatment response and detect the recurrence of thyroid cancer. Somatostatin receptor imaging involves the use of radiolabeled somatostatin analogues to detect neuroendocrine tumors, including thyroid cancer. Radiolabeled somatostatin analogues, such as Indium-111 octreotide or Gallium-68 DOTATATE, are administered to the patient, and a gamma camera is used to detect areas of uptake. Somatostatin receptor imaging is highly sensitive and specific for the detection of metastatic thyroid cancer. A comprehensive search of relevant literature was done using online databases of PubMed, Embase, and Cochrane Library using the keywords "thyroid cancer," "nuclear imaging," "radioiodine imaging," "FDG PET/CT," and "somatostatin receptor imaging" to identify relevant studies to be included in this review. Nuclear imaging plays an important role in the diagnosis, staging, and management of thyroid cancer. The use of radioiodine imaging, thyroglobulin imaging, FDG imaging, and somatostatin receptor imaging are all valuable tools in the evaluation of thyroid cancer. With further research and development, nuclear imaging techniques have the potential to improve the diagnosis and management of thyroid cancer and other endocrine malignancies.

Magseed application for detecting recurrent lymph node metastasis in papillary thyroid cancer: A novel minimally invasive Approach

Papillary thyroid cancer is associated with lymph node metastasis and tumor recurrence that need repeated surgery, entailing surgical challenges with a high risk of complications such as nerve damage and bleeding. Magseed is a metal coil used to detect non-palpable lesions and is an established modality in breast cancer surgery. In this case series, we explore the feasibility of Magseed in metastasis surgery of papillary thyroid cancer. Under the guidance of ultrasonography, Magseed is injected into the target tissue and intraoperatively detected with a handheld magnetometer probe, Sentimag®. Five patients with recurrence of papillary thyroid cancer were operated on with focused Magseed-guided localization. All patients had repeated surgery and radioiodine treatments. Four of the patients had lymph node metastasis hidden in the fibrosis, and one patient had recurrent tumor tissue on the left side of the larynx. Magseed was easy to use, safe, and precise in detecting the target tissue.

Applying Translaryngeal Ultrasonography in Unilateral Vocal Cord Paralysis before Thyroid Cancer Reoperation: A Single Center Study

Background: One of the most dangerous complications of thyroid surgery is recurrent laryngeal nerve (RLN) paralysis. The gold standard method to assess this damage is Videolaryngoscopy. However, we aimed to modify this approach by using Translaryngeal Ultrasonography (TLUS). We performed TLUS with a highly trained thyroid sonographer and an endocrine surgeon in 47 patients with recurrent thyroid cancer and unilateral RLN paralysis preoperatively, and compared the results with Videolaryngoscopy. The experienced sonographer identified 45 injuries in 47 patients, and the endocrine surgeon found 39 vocal cord injuries. It appears that TLUS, when performed by experienced practitioners, is a more accurate and safe modality for assessing vocal cord function in the preoperative setting of thyroid cancer reoperation.

Risk factors predicting papillary thyroid cancer recurrence: a single-surgeon experience

Risk factors predicting papillary thyroid cancer recurrence: a single-surgeon experience

Determination of Possible Biomarkers for Predicting Well-Differentiated Thyroid Cancer Recurrence by Different Ensemble Machine Learning Methods

Objective: Well-differentiated thyroid cancer (WDTC) is the most common thyroid malignancy and although it is curable, the risk of recurrence is high. In this study, classification algorithms based on clinicopathologic features of WDTC patients were used to determine the possible of recurrence in WDTC and to evaluate potential predictive factors, and possible biomarkers based on the optimal model were identified. Method: In this study, open access data on 383 patients with WDTC, 108 with recurrence and 275 without recurrence, were used. In order to predict recurrence in WDTC patients, features were selected using recursive feature elimination variable selection method among features and classification was performed with two ensemble learning methods (Random Forest, Adaboost). Results: Two different ensemble learning models used to classify recurrence in WDTC were Random Forest with an accuracy of 0.957, sensitivity of 0.889, specificity of 0.978, positive predictive value of 0.923, negative predictive value of 0.967, Matthews correlation coefficient of 0.878, G-mean of 0.945, F1-score of 0.906, and accuracy of 0.940, sensitivity of 0.889, specificity of 0.955, positive predictive value of 0.857, negative predictive value of 0.966, Matthews correlation coefficient of 0.833, G-mean of 0.910, F1-score of 0.873. Conclusion: According to variable importance based on the Random Forest, the 5 possible clinical biomarkers for predicting WDTC recurrence are Response, Risk, Node, Tumor, and age. In the light of these findings, patient management and treatment planning can be organized.

Effectiveness of microvascular flow imaging for radiofrequency ablation in recurrent thyroid cancer: comparison with power Doppler imaging.

To compare microvascular flow imaging (MVFI) and power Doppler ultrasonography imaging (PDUS) for detecting intratumoral vascularity in recurrent thyroid cancer both before and after radiofrequency ablation (RFA). This retrospective study included 80 patients (age, 57 ± 12 years; 54 women) with 110 recurrent tumors who underwent RFA between January 2021 and June 2023. A total of 151 PDUS and MVFI image sets were analyzed (85 pre-RFA, 66 post-RFA). Two readers assessed vascularity on the images using a four-point scale with a 2-week interval between PDUS and MVFI to estimate inter-reader agreement. Intra-reader agreement was determined by reinterpreting images in reverse order (MVFI-PDUS) after a 1-month gap. Additionally, diagnostic performance for identifying viable tumors after RFA was assessed in 44 lesions using thyroid-protocol CT as a reference standard. MVFI demonstrated higher vascular grades than PDUS, both before (reader 1: 3.04 ± 1.15 vs. 1.93 ± 1.07, p < 0.001; reader 2: 3.20 ± 0.96 vs. 2.12 ± 1.07, p < 0.001) and after RFA (reader 1: 2.44 ± 1.28 vs. 1.67 ± 1.06, p < 0.001; reader 2: 2.62 ± 1.23 vs. 1.83 ± 0.99, p < 0.001). Inter-reader agreement was substantial (κ = 0.743) and intra-reader agreement was almost perfect (κ = 0.840). MVFI showed higher sensitivity (81.5%-88.9%) and accuracy (84.1%-86.4%) than PDUS (sensitivity: 51.9%, p < 0.01; accuracy: 63.6-70.5%, p < 0.04), without sacrificing specificity. MVFI was superior to PDUS for assessing intratumoral vascularity and showed good inter- and intra-reader agreement, highlighting its clinical value for assessing pre-RFA vascularity and accurately identifying post-RFA viable tumors in recurrent thyroid cancer. Microvascular flow imaging (MVFI) is superior to power-Doppler US for assessing intratumoral vascularity; therefore, MVFI can be a valuable tool for assessing vascularity before radiofrequency ablation (RFA) and for identifying viable tumors after RFA in patients with recurrent thyroid cancer. The value of microvascular flow imaging (MVFI) for evaluating intratumoral vascularity is unexplored. MVFI demonstrated higher vascular grades than power Doppler US before and after ablation. Microvascular flow imaging showed higher sensitivity and accuracy than power Doppler US without sacrificing specificity.

241 Predictors of Post-Radioiodine Ablation Outcomes in Thyroid Cancer: Analysis of Four Years of Data from a Regional Centre

Abstract Aim To assess correlations between patient demographics, tumour and lymph node pathology and outcomes for patients with non-metastatic thyroid cancer. Outcomes examined were evidence of post-ablation residual disease on blood testing or ultrasound or thyroid cancer recurrence. Method Electronic records for thyroid cancer patients at a regional centre undergoing thyroidectomy followed by Radioiodine-131 ablation in the years 2018-2021 were reviewed with 191 records contributing to the analysis. Patient demographics, tumour characteristics, numbers of positive lymph nodes and radioiodine dosages were compared against patient outcomes. Results Increasing age, T stage of the tumour and lymph node involvement demonstrated the strongest correlations with negative outcomes. Age appeared to be a strong risk factor for thyroid cancer recurrence with 70% of the patient’s experiencing recurrence aged over 60 despite patients over 60 making up only 33% of the sample. Removal of over 4 metastatic lymph nodes has previously been found to predict poorer patient outcomes. The findings support this however over 50% of positive nodes removed had a stronger correlation with negative outcomes compared with raw numbers retrieved. 52.2% of patients with over 50% positive lymph nodes experienced poorer outcomes compared with 40.1% who had over 4 positive nodes removed. The correlation was stronger still for those with over 4 positive nodes of which over 50% were positive of whom 57.9% demonstrated poor outcomes. Conclusions Rather than raw numbers of lymph nodes removed, proportion of metastatic nodes of those harvested or a combination of total numbers and proportion appeared to give a better indicator of prognosis.

The Prediction of Thyroid Cancer Recurrence with the XGBoost Method: The Clinicopathological Feature-Based Approach

The Prediction of Thyroid Cancer Recurrence with the XGBoost Method: The Clinicopathological Feature-Based Approach