Diagnosis Of Thyroid Cancer Research Articles

Knowledge, attitude, and practice towards thyroid nodules and cancer among patients: a cross-sectional study.

This study aimed to explore the knowledge, attitude, and practice (KAP) towards thyroid nodules (TN) and thyroid cancer (TC) among patients. This cross-sectional study enrolled patients with TN or TC at the Second Affiliated Hospital of the University of South China between September 2022 and February 2023. A self-administered questionnaire was developed to collect demographic information of the participants, and their knowledge, attitude and practice (KAP) towards TN and TC. A total of 510 valid questionnaires were collected. Among the participants, 102 (20.00%) were male, and 197 (38.63%) had the diagnosis of TC. The knowledge, attitude and practice scores were 5.76 ± 3.09 (possible range: 0-12), 31.07 ± 2.73 (possible range: 9-45), and 18.97 ± 2.92 (possible range: 5-25), respectively. Multivariate logistic regression showed that age of above 50 years old (OR = 0.27, 95%CI: 0.12-0.64, p = 0.003), junior college or bachelor's degree and above (OR = 4.97, 95%CI: 1.74-14.20, p = 0.003), monthly income of 5,000-10,000 CNY (OR = 2.02, 95%CI: 1.09-3.74, p = 0.025) and > 10,000 CNY (OR = 5.67, 95%CI: 2.49-12.94, p < 0.001) were independently associated with knowledge. The good knowledge (OR = 3.87, 95%CI: 1.89-7.95, p < 0.001), high school or technical secondary school (OR = 0.52, 95%CI: 0.30-0.88, p = 0.016), and monthly income of 5,000-10,000 CNY (OR = 2.02, 95%CI: 1.13-3.63, p = 0.018) were independently associated with practice. Patients demonstrated poor knowledge, moderate attitude, and proactive practice towards TN and TC.

Exploration of aminopeptidase N as new biomarker for early diagnosis of thyroid cancer

False-positive diagnosis and overdiagnosis are ongoing issues in clinical diagnosis of thyroid cancer. Identifying new disease markers is crucial for early diagnosis and improved treatment. Aminopeptidase N (APN) is a promising biomarker for cancer diagnosis due to its critical roles in tumor invasion, metastasis, angiogenesis, and other processes. However, its potential as biomarker for thyroid cancer diagnosis needs further investigation. This study developed an ultra-sensitive near-infrared fluorescence probe, LAN-apn, to investigate the expression level of APN in thyroid cancer and evaluate its potential as biomarker of thyroid cancer. LAN-apn could accurately and sensitively determine APN through fluorescence method (DL = 0.069 ng/mL) and colorimetric method (DL = 4.5 ng/mL). In addition, LAN-apn allowed for successful fluorescence imaging of APN in thyroid cancer cells and thyroid cancer tumors both in vivo and in vitro, and confirmed that APN was significantly upregulated in thyroid cancer. Therefore, APN may become a new biomarker for thyroid cancer diagnosis, and LAN-apn could be used as a new imaging tool for the study of APN-thyroid cancer relationship and the early diagnosis of thyroid cancer.

MASK CLASSIFICATION SEGMENTATION METHOD BASED ON GROUPED CONVOLUTION AND SPATIAL PYRAMIDAL CONVOLUTION MODEL FOR THYROID CANCER IDENTIFICATION

Ultrasound plays different roles in the whole process of thyroid cancer management. With the advancement of ultrasound imaging technology and diagnostic level, it is gradually becoming an irreplaceable role in the diagnosis and treatment of thyroid cancer. However, the diagnosis of thyroid cancer by means of sonographic features is subjective and highly dependent on the operator’s experience and knowledge. To avoid unnecessary puncture biopsies, alleviate anxiety and improve diagnostic efficiency, in this paper, we utilize a purely convolutional model with a pyramid structure strategy to extract sonographic features at different scales. Combined with a per-pixel classification segmentation method, which is different from the previous mainstream, it is used for the intelligent recognition of thyroid cancer. Finally, the experimental results show that our radiologists achieve better performance than five mainstream segmentation methods in four metrics (Sensitivity, Jarccard, Dice, ASD) on the thyroid cancer dataset. It provides the possibility to help radiologists to overcome diagnostic subjectivity and obtain accurate, reproducible and more objective diagnostic results.

Clinical Diagnosis and Management of Thyroid Cancer

The thyroid gland is the largest organ of the endocrine system. Disorders of the thyroid gland present the most common clinical manifestations compared to other organs of the endocrine system. Thyroid Cancer has a high incidence is one of the leading causes of death worldwide and accounted for 7.6 million deaths (13% of all deaths) in 2008 and this figure continues to increase every year. Along with the increasing prevalence of thyroid cancer in Indonesia, this study was conducted to find out the proper diagnosis and management of thyroid cancer

Per- and polyfluoroalkyl substances (PFAS) exposure and thyroid cancer risk

Although per- and polyfluoroalkyl substances (PFAS) exposure is a potential contributor to the increasing thyroid cancer trend, limited studies have investigated the association between PFAS exposure and thyroid cancer in human populations. We therefore investigated associations between plasma PFAS levels and thyroid cancer diagnosis using a nested case-control study of patients with thyroid cancer with plasma samples collected at/before cancer diagnosis. 88 patients with thyroid cancer using diagnosis codes and 88 healthy (non-cancer) controls pair-matched on sex, age (±5 years), race/ethnicity, body mass index, smoking status, and year of sample collection were identified in the BioMe population (a medical record-linked biobank at the Icahn School of Medicine at Mount Sinai in New York); 74 patients had papillary thyroid cancer. Eight plasma PFAS were measured using untargeted analysis with liquid chromatography-high resolution mass spectrometry and suspect screening. Associations between individual PFAS levels and thyroid cancer were evaluated using unconditional logistic regression models to estimate adjusted odds ratios (ORadj) and 95% confidence intervals (CI). There was a 56% increased rate of thyroid cancer diagnosis per doubling of linear perfluorooctanesulfonic acid (n-PFOS) intensity (ORadj, 1.56, 95% CI: 1.17-2.15, P=0.004); results were similar when including patients with papillary thyroid cancer only (ORadj, 1.56, 95% CI: 1.13-2.21, P=0.009). This positive association remained in subset analysis investigating exposure timing including 31 thyroid cancer cases diagnosed ≥1 year after plasma sample collection (ORadj, 2.67, 95% CI: 1.59-4.88, P<0.001). This study reports associations between exposure to PFAS and increased rate of (papillary) thyroid cancer. Thyroid cancer risk from PFAS exposure is a global concern given the prevalence of PFAS exposure. Individual PFAS studied here are a small proportion of the total number of PFAS supporting additional large-scale prospective studies investigating thyroid cancer risk associated with exposure to PFAS chemicals. National Institutes of Health grants and The Andrea and Charles Bronfman Philanthropies.

Multi-view progression diagnosis of thyroid cancer by integrating platelet transcriptomes and blood routine tests

Thyroid cancer is the most common type of endocrine system cancer. The pre-cancer and early stages are usually benign or slowly growing, and do not need invasive treatments. This study investigated the challenging classification task of four classes of samples, i.e., normal controls (N), thyroid adenomas (TA), papillary thyroid cancers (PTC) and metastasized papillary thyroid cancers (MPTC). We proposed a multi-view progression diagnosis framework ThyroidBloodTest to integrate the two views of RNAseq platelet transcriptomes (View-T) and blood routine (View-B) features. Platelet transcriptome represented the molecular-level information, while the blood routine features were easy to obtain in the clinical practice. Eleven feature selection algorithms and seven classifiers were evaluated for both views. The experimental data suggested the importance of choosing appropriate data analysis algorithms and feature engineering techniques like principal component analysis (PCA). The best ThyroidBloodTest model achieved Acc = 0.8750 for the four-class classification of the N/TA/PTC/MPTC samples based on the integrated feature space of View-T and View-B. The cellular localization cytosol and three post-translational modification types acetylation/phosphorylation/ubiquitination were observed to be enriched in the proteins encoded by the View-T biomarkers. The numbers of different immune cells also contributed positively to the progression diagnosis of thyroid cancer. The proposed multi-view prediction model demonstrated the necessity of integrating both platelet transcriptomes and blood routine tests for the progression diagnosis of thyroid cancer.

Customized fluorescent probe for peering into the expression of butyrylcholinesterase in thyroid cancer

BackgroundThyroid cancer has been increasingly prevalent in recent years. The main diagnostic methods for thyroid are B-ultrasound scan, serum detection and puncture detection. However, these methods are invasive and complex. It is a pressing need to develop non-invasive or minimally invasive methods for thyroid cancer diagnosis. Fluorescence method as a non-invasive detection method has attracted much attention. Butyrylcholinesterase (BChE) is a common enzyme in the human body, and many diseases affect its reduction. We found that BChE is also a marker for thyroid cancer. Therefore, it is of certain clinical value to explore the expression of BChE in thyroid cancer cells through a customized fluorescent probe to provide valuable experimental data and clues for studying the expression of thyroid cancer marker to reflect thyroid status. ResultsIn this study, we customized a fluorescent probe named Kang-BChE, which is easy to synthesize with a high yield. The experimental results show that the probe Kang-BChE can detect BChE in the linear range of 0–900 U L−1 (R2 = 0.9963), and the detection limit is as low as 3.93 U L−1 (λex/em = 550/689 nm). In addition, Kang-BChE probes have low cytotoxicity, good specificity, and can completely eliminate interference from acetylcholinesterase (AChE). Kang-BChE showed excellent stability in the detection of complex biological samples in serum recovery experiments (95.64–103.12 %). This study was the first time using Kang-BChE to study the low expression of BChE in thyroid cancer cells (Tpc-1 cells). In addition, we observed that H2O2 concentration in Tpc-1 cells was positively correlated with BChE activity. SignificanceKang-BChE is expected to be an important tool for monitoring the change of BChE content in complex biological environments due to its excellent performance. Kang-BChE can also be used to explore the influence of molecules in more organisms on the change of BChE content due to its excellent anti-interference ability. We expect that Kang-BChE can play a significant role in the clinical diagnosis and treatment of thyroid cancer.

Liquid Biopsy as a Method for Minimally Invasive Diagnosis of Thyroid Cancer

Thyroid cancer is the 9th most common cancer in the world. The five-year survival rate for this disease is over 98%. However, in some patients there are cases of rapidly progressive treatment-resistant cancer that cannot be differed from poor-invasive cancer by routine methods. Liquid biopsy could be one of the methods to solve this problem. This procedure consists in the analysis of tumor derivatives (in particular, circulating DNA) in body fluids. The analysis of hotspot mutations and patterns of epigenetic regulation, which are usual for neoplasms with a certain genotype, is used to identify the tumor component in the total mass of circulating DNA. The increase of circulating tumor DNA in the plasma is observed several months ahead of the characteristic signs at MR images of patients, and also surpasses conventional biomarkers such as calcitonin in medullary thyroid carcinoma. In addition, a possibility of minimally invasive determination of the tumor genotype by analyzing circulating DNA is important to select the optimal chemotherapy. This review discusses the current advances in the analysis of circulating tumor DNA in thyroid cancers such as papillary, follicular, medullary, and anaplastic carcinomas.

AI in Thyroid Cancer Diagnosis: Techniques, Trends, and Future Directions

Artificial intelligence (AI) has significantly impacted thyroid cancer diagnosis in recent years, offering advanced tools and methodologies that promise to revolutionize patient outcomes. This review provides an exhaustive overview of the contemporary frameworks employed in the field, focusing on the objective of AI-driven analysis and dissecting methodologies across supervised, unsupervised, and ensemble learning. Specifically, we delve into techniques such as deep learning, artificial neural networks, traditional classification, and probabilistic models (PMs) under supervised learning. With its prowess in clustering and dimensionality reduction, unsupervised learning (USL) is explored alongside ensemble methods, including bagging and potent boosting algorithms. The thyroid cancer datasets (TCDs) are integral to our discussion, shedding light on vital features and elucidating feature selection and extraction techniques critical for AI-driven diagnostic systems. We lay out the standard assessment criteria across classification, regression, statistical, computer vision, and ranking metrics, punctuating the discourse with a real-world example of thyroid cancer detection using AI. Additionally, this study culminates in a critical analysis, elucidating current limitations and delineating the path forward by highlighting open challenges and prospective research avenues. Through this comprehensive exploration, we aim to offer readers a panoramic view of AI’s transformative role in thyroid cancer diagnosis, underscoring its potential and pointing toward an optimistic future.

Comparative Study of FNAC and Histopathology in Diagnosis of Thyroid Swelling

IntroductionFine Needle Aspiration Cytology (FNAC) is important for pre-operative and pre-treatment diagnosis of benign and malignant thyroid lesions, thus decreasing the incidence of unwanted surgeries. The objective of this research is to compare the FNAC and Histopathological findings of thyroid swelling.MethodsThe present study is a cross sectional study conducted on 30 patients in the Department of Otorhinolaryngology Head and Neck Surgery, College of Medical Sciences, Bharatpur, Nepal from January 2022 to December 2022. Thyroid swelling presented to OPD were examined clinically after thorough history taking and admitted to indoor and subsequently underwent surgery were included in this study. After Histopathology they were compared with preoperative FNAC report. In all cases, informed consent was taken prior to the surgery.ResultsFNAC shows thirteen (28.57%) non neoplastic and twenty-two (71.43%) neoplastic. Among non neoplastic thyroid swelling, colloid goiter was common. Among neoplastic thyroid swelling Papillary carcinoma was the most common. Cyto-histopathological correlation of 35 cases was done. Out of thirty-five cases fifteen (42.87%) were non neoplastic and twenty (57.15%) were neoplastic. Colloid goiter was most common. Sensitivity of our study was 88.24%, Specificity was 55.56 % and accuracy was 71.43%.ConclusionsFNAC is a quick, safe, and reliable first-line diagnostic test for thyroid nodules. However, histopathology is the gold standard for the diagnosis of thyroid cancer and provides detailed information on the tumor size, location, and histological type.

FRI470 The Impact Of COVID-19 Lockdown On Thyroid Fine Needle Aspiration Volume And Malignancy Rate

Abstract Disclosure: K. Larkin: None. J. Li: None. T.C. Brandler: None. F. Ling: None. D.A. Cohen: None. Background: During the COVID-19 pandemic many elective procedures were postponed, including thyroid nodule fine needle aspiration biopsies (FNABs). These delays may have led to a lag in diagnosis of thyroid cancer. Our study aims to determine whether there were fewer FNABs performed during and immediately after lockdown, with subsequent higher than baseline volume in the 6–12-months after, before returning to baseline. We hypothesized that due to a stringent threshold for biopsy referral, malignancy rates would be higher during and immediately after lockdown before decreasing to lower than baseline. Our study’s findings may aid in future determination of procedure prioritization during crises. Methods: This single-center retrospective chart review was performed at the Endocrinology Clinic at Robert Wood Johnson Hospital at Rutgers University. The study included over 1800 samples collected from 04/19-03/21 in patients age &amp;gt; 18 years. Patients with history of thyroid cancer were excluded. We assessed raw number and rate of malignancy diagnosed in 60-day periods defined as “pre-lockdown,” “during lockdown,” and “post-lockdown.” We defined malignant FNAB cytology, based on the Bethesda scoring system, as suspicious or positive for malignancy (score of V or VI). Summary statistics were calculated using means or percentages as appropriate. Results: 1862 thyroid nodule FNABs were analyzed. 1046 FNABs were performed in pre-lockdown (4/1/2019-3/10/2020), for an average of 182.44 FNABs per 60-day period. 70 FNABs were performed during lockdown (3/10/2020-6/2/2020), for an average of 50 FNABs per 60-day period. This represents a 72.59% decline in FNAB volume. During post-lockdown, the average number of FNABs performed were 150, 130, 157, 132.78 and 185.17 per 60-day time period. During pre-lockdown, 48 FNABs met our criteria for malignancy, with a true positivity rate of 4.58%. During lockdown, 4 FNABs met criteria, for a true positivity rate of 5.71%. This represents an increase in positivity of 25%. During post-lockdown, true positivity rates were 3.4%, 3.8%, 3.8%, 5.2%, and 5.7%. Discussion and Conclusion: During the COVID-19 lockdown, volume of thyroid nodule FNABs decreased by 72.59% and nodules were 25% more likely to be positive. During post-lockdown, the number of FNABs began to return to baseline. Malignancy rates initially declined and then surpassed pre-lockdown rates. We speculate that given the decrease in number of FNABs performed during lockdown combined with the increased rate of malignancy, thyroid nodules determined to be clinically significant were prioritized. With that, it is likely that malignant nodules were missed, or diagnosis delayed, potentially accounting for higher rates in later post-lockdown periods. This information can aid future situations of crisis, as a more organized and informed approach can give patients the opportunity to seek elective procedures. Presentation: Friday, June 16, 2023

SAT564 Metastatic Malignant Pleural Effusion In A Patient With Remote History Of FTC

Abstract Disclosure: D.M. Lee: None. M. Gong: None. C. Czerlanis: None. A. Arif: None. R. Arceo-Mendoza: None. Introduction: Differentiated thyroid follicular epithelial-derived cancers include Papillary (PTC) and Follicular Thyroid Cancer (FTC). FTC is less common, accounting for only 5-15% of all thyroid cancers. It is more common in older patients and spreads via hematogenous route, with distant metastases in 10-15% of patients, commonly in the lungs and bone. We describe an unusual case of a patient with a remote history of FTC who presents with recurrence more than 50 years later in the form of a malignant pleural effusion. Clinical Case: A 79/M with a remote history of FTC that was diagnosed in the 1960s presents with one week of L sided pleuritic chest pain and dyspnea. CXR on admission showed opacification of the L hemidiaphragm. A chest CT confirmed the L sided pleural effusion. Thyroid US showed surgically absent thyroid and a 1.1cm solid nodule in the L surgical bed. PET/CT demonstrated hypermetabolic rim of L pleural effusion with no uptake in the neck. Thoracentesis was done which showed exudative pleural fluid concerning for malignancy. Immunohistochemical stains were positive for TTF-1 and thyroglobulin, consistent with metastatic thyroid cancer. He also underwent L supraclavicular lymph node FNA with findings suspicious for metastatic thyroid cancer with follicular features, with NO nuclear features of PTC. On further history, the patient reports having radiation therapy for acne around age 17 and was then diagnosed with FTC in his 20s. He underwent total thyroidectomy and RAI treatment. He recalls being told that he had a few weeks to live, and an “experimental treatment” was offered at the time, which we suspect was cobalt radiation. The patient unfortunately was eventually lost to endocrine follow up but denies any known recurrence prior to this admission. Upon discharge, an I-123 WBS was performed showing multiple foci in the R neck. Uptake is also noted in bilateral lung base, greater on the left. He was treated with 250 mCi I-131. He is currently doing well overall, asymptomatic, and with stable surveillance imaging. He is on levothyroxine suppression therapy with Tg level on a downward trend. Clinical Lesson/Conclusion: Involvement of pleural fluid by metastatic thyroid cancer though reported, is relatively rare, accounting for only less than 1% in all the patients with malignant pleural effusion. To our knowledge, there are no reported cases of malignant pleural effusions from metastatic FTC presenting remotely so many years after the initial diagnosis. The diagnosis of metastatic thyroid cancer in pleural fluid can be challenging and knowledge of the clinical context, even with remote history dating back 50 years ago just like in our case, and supporting immunohistochemical stains is essential for making the right diagnosis. Presentation Date: Saturday, June 17, 2023

SAT576 Change Is Not Always For The Best! A Transformation of Papillary Into Metastatic Anaplastic Thyroid Carcinoma

Abstract Disclosure: J. Syeda: None. R. Zafar: None. K. Rajamani: None. INTRODUCTION: Anaplastic thyroid carcinoma (ATC) can occur de-novo or from preexisting well-differentiated thyroid carcinoma (1). The presence or absence of certain driver mutations can help predict the likelihood of this transformation process. We present a case of an elderly female with an initial diagnosis of well-differentiated papillary thyroid cancer (PTC) with a transformation into metastatic anaplastic thyroid carcinoma (ATC). CASE PRESENTATION: An 81-year-old female patient was initially seen 8 years ago with a 35-year history of goiter. At the initial presentation, she felt well and did not have any symptoms. Physical examination revealed an enlarged thyroid gland with left lobe nodularity. A thyroid ultrasound showed a multinodular thyroid gland including a 2x1.7x1.2 cm solid nodule with macro calcifications in the right lobe, 2.8x2.6x2.5 cm solid nodule, and 1.6x1.3x1.6 cm heterogeneous solid nodule with calcifications and irregular margins in the left lobe. She had a fine needle aspiration of these three nodules. The right nodule was non-diagnostic and both left nodules were positive for PTC. She underwent a total thyroidectomy and central lymph node dissection. Radioactive iodine treatment with 163mCi was administered after surgery. One and a half years after surgery, her thyroglobulin levels started trending upward. This led to a further workup including a PET/CT scan, which showed a hyper metabolic 6 mm left supraclavicular lymph node. Needle biopsy of this lymph node disclosed metastatic PTC. The pathologic diagnosis following surgical resection was positive for metastatic poorly differentiated thyroid carcinoma. A subsequent PET/CT scan and a thyroid ultrasound showed an abnormal uptake of the left neck lymph node and additional metastatic nodes in the left neck respectively. A core needle biopsy of these lesions was positive for ATC. Foundation One CDx testing was positive for BRAF V600E, TP53, and TERT promoter mutations. Cellblock from the initial thyroidectomy was reevaluated by pathology and confirmed no evidence of ATC. Foundation One CDx testing of the thyroidectomy specimen was positive for BRAF V600E and TERT promoter mutations. Surveillance imaging shows mediastinal adenopathy, left pleural thickening, and bone and liver metastases. DISCUSSION: Anaplastic transformation is not uncommon (1). This case supports the evidence that TERT promoter mutations may not trigger anaplastic transformation but may predispose to the aggressive PTC phenotype prone to conversion to ATC when one of the ATC-related “second hit” genetic events occurs (2). This case suggests that the “second hit” event is a TP53 mutation. The detection of a TP53 mutation in PTC with an aggressive phenotype may help predict anaplastic transformation. REFERENCES: 1-Endocrine Pathology. 2021 Mar; 32(3):347-356. 2- Semin Cancer Biol. 2020 Apr; 61: 23-29. Presentation: Saturday, June 17, 2023

SAT555 Utility of 18F-DOPA PET/CT in the Diagnosis of Medullary Thyroid Cancer in a Patient with Multiple Endocrine Neoplasia Type 2B

Abstract Disclosure: D.G. Varghese: None. S. Akshintala: None. A. Jha: None. S. Gubbi: None. A. Reno: None. J. Klubo-Gwiezdzinska: None. K. Pacak: None. J. Glod: None. J. Del Rivero: None. Background: MEN2B is a cancer predisposition syndrome caused by an activating mutation in the RET proto-oncogene. It is characterized by medullary thyroid cancer (MTC), pheochromocytoma (PHEO), and extra endocrine features. U/S, CT, MRI and 18F-fluorodeoxyglucose (18F-FDG), 18F-fluorodihyroxyphenylalanine (18F-FDOPA), 68Ga-DOTA-(0)-Tyr(3)-octreotate (68Ga-DOTATATE) PET/CT scans have been used for the diagnosis and follow up of MTC. However, there is increasing evidence of 18F-FDOPA PET as more specific imaging modality in the diagnosis of MTC since L-type amino acid transporters have shown to be present in MTC cells.Clinical Case: 26-year-old female presented with HTN at the age of 17. The patient developed episodes of nausea/vomiting, intermittent headaches with systolic BP in the 190’s. Further work-up revealed bilateral adrenal nodules with elevated plasma metanephrines. The patient underwent left adrenalectomy and a year later, right adrenal nodule resection confirming PHEO. On follow up, calcitonin was elevated, and the patient underwent a total thyroidectomy with bilateral central lymph node dissection. At age 19 she was diagnosed with MEN2B (RET mutation, p.Met918Thr). With rising calcitonin, she was referred to our institution for further evaluation. Her serum calcitonin was 31986(&amp;lt;7.6 pg/ml), CEA 631 (0.8-3.4 ng/ml), fractionated plasma normetanephrine 565 (18-112 pg/ml), and metanephrine 304 (12-61 pg/mL). MRI of the abdomen showed enlarging adrenal masses. 18F-FDG PET/CT scan showed a focus of uptake (SUVmax of 8.5) in posterior right thyroid bed, uptake in the liver (SUVmax of 7.5) and uptake in the right adrenal gland and left adrenal bed; 68Ga-DOTATATE PET/CT scan showed a faint uptake in the right thyroid lobe (SUVmax of 2.7) and an 18F-FDOPA PET/CT scan showed intense uptake in both lobe of the thyroid, multiple lesions in the liver and suspicious focus in the right adrenal bed. The patient underwent bilateral adrenalectomy for recurrent PHEO and her plasma metanephrines normalized. Conclusion: This case adds to the mounting evidence in the usage of 18F-FDOPA PET/CT scan as a useful imaging modality for MTC especially in the setting of MEN2B syndrome. A head-to-head comparison in 18 patients, both per patient and per lesion sensitivity by 18F-FDOPA PET/CT (72%, 85%) was found to be statistically superior compared to 68Ga-DOTATATE PET/CT (33%, 20%), and 18F-FDG PET/CT (17%, 28%). A meta-analysis conducted in MTC consisting of 306 patients from 14 studies, 18F-FDOPA compared to 18F-FDG and 68Ga-DOTATATE showed the highest surface under the cumulative ranking curve (SUCRA) value in both patient and lesion-based analyses irrespective of serum calcitonin/CEA values or calcitonin doubling time. The potential for use of 18F-FDOPA as a diagnostic agent and the potential to provide insight into possible therapeutic targets are unknown and should be further studied. Presentation Date: Saturday, June 17, 2023

SAT523 Molecular Profile of Local vs. Regional Aggressive Thyroid Cancer: A Multicenter Study

Abstract Disclosure: I. Tessler: None. N. Gecel: None. R. Payne: None. G. Avior: None. A. Eran: None. Background: Genetic testing for the diagnosis of thyroid cancer has rapidly evolved in recent years. While commonly applied for diagnosis, its role in predicting genotype-phenotype correlation and guiding management is emerging. Here we evaluate differences in the molecular profile of local vs. regional aggressive disease. Methods: We performed a retrospective multicenter study of patients who underwent molecular profiling for DTC between 2018-2021, dividing them into three groups: low-risk, locally aggressive, and regional aggressive. We analyzed the patients' basic characteristics, disease aggressive features (extranodal extension, perineural invasion), lymphovascular invasion, and extrathyroidal extension), and the mutation distribution according to disease aggressiveness. Genetic variants were stratified by risk levels according to the 2015 ATA guidelines. Results: The study included a total of 652 patients, 414 in the low-risk group, 73 in the locally aggressive group, and 165 in the regional aggressive group. The regional aggressive group had the lowest age at diagnosis (mean age of 44.64±13.78 years vs. 52.52±14.53 and 53.58±14.93 for the low-risk and locally-aggressive, respectively, p&amp;gt;0.001), the highest rate of mutation-positive nodules (86.1% vs. 6.6% and 67.1%), and the highest rate of aggressive mutation (76.4% vs. 17.6 and 39.7). On the contrary, RAS mutations were more common in the low-risk (31.4% vs. 19.2% and 6.1% in the local- and regional aggressiveness groups). Conclusion: This study showed that local and regional aggressive thyroid cancer has a distinct molecular profile, with a higher prevalence of high-risk mutations in the regional group. These findings may enhance the use of genetic testing in predicting disease aggressiveness and guiding management in thyroid cancer. Presentation Date: Saturday, June 17, 2023

An eXplainable Artificial Intelligence analysis of Raman spectra for thyroid cancer diagnosis

Raman spectroscopy shows great potential as a diagnostic tool for thyroid cancer due to its ability to detect biochemical changes during cancer development. This technique is particularly valuable because it is non-invasive and label/dye-free. Compared to molecular tests, Raman spectroscopy analyses can more effectively discriminate malignant features, thus reducing unnecessary surgeries. However, one major hurdle to using Raman spectroscopy as a diagnostic tool is the identification of significant patterns and peaks. In this study, we propose a Machine Learning procedure to discriminate healthy/benign versus malignant nodules that produces interpretable results. We collect Raman spectra obtained from histological samples, select a set of peaks with a data-driven and label independent approach and train the algorithms with the relative prominence of the peaks in the selected set. The performance of the considered models, quantified by area under the Receiver Operating Characteristic curve, exceeds 0.9. To enhance the interpretability of the results, we employ eXplainable Artificial Intelligence and compute the contribution of each feature to the prediction of each sample.

Diagnosis and Prognosis of Thyroid Cancer by Immune-related Genes.

Thyroid carcinoma (THCA) is the most common malignant endocrine tumor with low mortality and a relatively good prognosis. Immune genes have attracted much attention as molecular markers of THCA prognosis and potential targets of immunotherapy. Our study analyzed the transcriptome and clinical data of immune-related genes (IRGs) of THCA in gene expression omnibus, the cancer genome atlas-THCA, and ImmPort databases. By univariate Cox regression analysis, 15 genes were significantly correlated with the survival of patients with THCA. Five IRGs ( NMU, UBE2C, CDKN2A, COL19A1, and GPM6A ) were selected by LASSO regression analysis as independent prognostic factors to construct a disease-free survival-related prognostic risk model. Kaplan-Meier survival analysis showed that there was a significant difference in disease-free survival between high and low-risk groups. The higher the risk score, the worse the survival of patients. Clinical correlation analysis showed that age and Stage stage of patients were correlated with risk score ( P < 0.05). Quantitative real-time polymerase chain reaction confirmed that there were differences in the expression of 5 IRGs between tumor tissues and normal thyroid tissues. Spearman correlation analysis indicated that the relative expression levels of NMU, CDKN2A, UBE2C, COL19A1 , and GPM6A were positively correlated with programmed death-ligand 1 and recombinant a disintegrin and metalloproteinase with thrombospondin 1. Based on the bioinformatics method, we constructed a prognosis evaluation model and risk score system of IRGs in THCA, which provided a reference for predicting the prognosis of patients with THCA.

Clinical Diagnosis and Management of Thyroid Cancer

The thyroid gland is the largest organ of the endocrine system. Disorders of the thyroid gland present the most common clinical manifestations compared to other organs of the endocrine system. Thyroid Cancer has a high incidence is one of the leading causes of death worldwide and accounted for 7.6 million deaths (13% of all deaths) in 2008 and this figure continues to increase every year. Along with the increasing prevalence of thyroid cancer in Indonesia, this study was conducted to find out the proper diagnosis and management of thyroid cancer.

124 Xe 가스 재활용 공정장치 및 123 I 회수 시스템 구현 및 성능검증

123 I is a crucial nuclide used in the production of radiopharmaceuticals, particularly for diagnosing thyroid cancer and creating various labeled compounds. The demand for 123 I is increasing annually, leading to a rise in 123 I production. 123 I is generated through cyclotron-based beam irradiation of 124 Xe gas. However, transporting high-purity 124 Xe gas in Dewar containers can result in gas loss due to temperature and pressure variations during transit. To address this challenge, we have developed a system aimed at minimizing 124 Xe gas loss and efficiently recycling the used 124 Xe. Given the costliness of 124 Xe gas, effective management is essential. Additionally, ensuring the safe and loss-free transfer of the produced 123 I to the designated column is paramount. We have implemented a cleaning system utilizing high-purity helium and a heater to prevent pipeline contamination after production. This paper discusses the strategies employed in the design, manufacturing, and trial operation of GPM, HCS, and WPM. Through these measures, we have succeeded in significantly reducing 124 Xe loss and minimizing residual 124 Xe and 123 I with in the pipelines. The result is a highly efficient radiopharmaceutical production system.

Langerhans Cell Histiocytosis With Thyroid Involvement on 18F-FDG PET/MR.

An 18-month-old otherwise healthy girl presented with 1 month of neck swelling. Based on ultrasonography that showed diffusely enlarged heterogeneous thyroid gland, a presumed diagnosis of thyroid cancer was made. Subsequent core needle biopsy revealed Langerhans cell histiocytosis extensively involving the thyroid. 18F-FDG PET/MR was performed for staging and to evaluate the local extent of the disease in the neck. PET/MR demonstrated a hypermetabolic neck mass inseparable from the thyroid gland. The mass encased the major vessels, trachea, and esophagus without compression or invasion. Osseous involvement was excluded by both skeletal survey and PET/MR.