Thyroid Cancer Research Articles

The Prognostic Impact of Radioiodine Therapy in Patients with Papillary Thyroid Cancer.

Radioiodine (RAI) therapy after surgery, is an important component for the treatment of patients with papillary thyroid cancer (PTC), the most common thyroid cancer. In this study we sought to evaluate the cancer-specific survival (CSS) impact of RAI in specific thyroid cancer subgroups. The Surveillance, Epidemiology, and End Results (SEER) database were used to identify patients with PTC who underwent surgery between 2000 and 2019. Patients not treated with RAI were compared to those treated with RAI using propensity score matching (PSM) on the basis of identical inclusion criteria. A total of 106 333 patients were identified from the SEER database. RAI therapy was associated with improved CSS in the matched cohort (HR: 0.83; 95% CI: 0.72-0.96, p=0.01) but not in the unmatched data set (HR: 1.46; 95% CI: 1.30-1.64, p<0.001) among all PTC patients regardless of disease stage. Detailed analyses, however, showed that only patients with high-risk disease (pT3N1, pT4N1) experienced the greatest benefit in CSS. In the lower disease stages, no significant differences were recognized in the group of PTC patients with or without RAI therapy. One exception: in the group of PTC patients in stage pT1bN0, a significant difference was seen towards RAI. This is, however, most likely due to the large number of patients investigated. In summary, RAI therapy should not be used in low-risk PTC patients and might be used to some extent in intermediate-risk PTC patients. The histological suptype of the tumor needs to be considered in this context.

Long-term clinical outcomes of patients with medullary thyroid cancer: a single institution, tertiary referral centre experience

IntroductionMedullary thyroid cancer (MTC) is a rare form of thyroid cancer with a variable disease course. We aimed to conduct a real-world analysis of the clinical outcomes of patients with MTC, thereby providing further insight into the prognosis and management. MethodsAll patients with MTC whose data were available on electronic patient records since its introduction in 1992 at our institution were collected retrospectively. Data collected include patient characteristics, staging, treatment modalities and survival outcomes. The data extraction cut-off was 31st December 2022. Progression free (PFS) and overall survival (OS) were analysed using Kaplan Maier curves and log rank test. Significance threshold was set at p value <0.05. Results164 patients were included in this study. The median age at presentation was 44 years. Majority of patients (61%) presented with advanced disease; 41% stage IVa, 4% IVb and 16% IVc. The 10-year overall survival (OS) was 92% for stage I-III disease, 77% for stage IVa/b and 38% for stage IVc. Germline rearranged during transfection (RET) mutations were detected in 21% of patients. 98% of patients received primary surgery and 24% received systemic treatment for recurrent/metastatic disease, with high response rate seen with RET-specific inhibitors in those with RET-mutant MTC. Adjuvant radiotherapy improved locoregional control for those with locally advanced disease (p=0.001) but failed to translate into overall survival benefit (p=0.486). ConclusionSurvival outcomes observed in our cohort mirror those reported in the literature and highlight the need for improved therapy options, especially in those presenting with metastatic disease. Our data reaffirmed a lack of survival benefit with adjuvant radiotherapy for MTC with high rate of systemic relapse and future research should focus on evolving mechanisms of resistance to novel tyrosine kinase inhibitors.

Blue light-driven cell cycle arrest in thyroid cancer via Retinal-OPN3 complex

BackgroundPapillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy, with a rising incidence. Traditional treatments, such as thyroidectomy and radiotherapy, often lead to significant side effects, including impaired thyroid function. Therefore, there is an urgent need for non-invasive therapeutic approaches. This study aims to explore the potential of photobiomodulation therapy (PBMT), a non-invasive treatment using specific wavelengths of light, in the management of PTC.MethodsWe investigated the effects of blue light PBMT on PTC cells, focusing on the Retinal-OPSIN 3 (OPN3) complex’s role in mediating cellular responses. Blue light exposure was applied to PTC cells, and subsequent changes in cellular proliferation, cell cycle progression, and protein expression were analyzed. Statistical tests, including one-way ANOVA and t-tests, were used to evaluate the significance of the findings.ResultsBlue light exposure led to the dissociation of 11-cis-retinal from OPN3, resulting in the accumulation of all-trans retinal. This accumulation disrupted cellular proliferation pathways and induced G0/G1 cell cycle arrest in PTC cells. The Retinal-OPN3 complex was found to be a key mediator in these processes, demonstrating that thyroid cells can respond to specific light wavelengths and utilize their photoreceptive potential for therapeutic purposes.ConclusionsOur findings suggest that PBMT, through the modulation of the Retinal-OPN3 complex, offers a promising non-invasive approach for treating PTC. This study highlights the therapeutic potential of light signal transduction in non-ocular tissues and opens new avenues for non-invasive cancer therapies.

SEOM-GETNE-TTCC Clinical guideline thyroid cancer (2023).

Thyroid cancer (TC) represents 3% of global cancer incidence. Recent changes have optimized treatment decisions based on risk assessment, molecular profiling, and imaging assessment, leading the development of targeted agents that have modified the natural history of this disease. This increasing complexity on treatment options requires careful assessment at the different stages of the disease to provide the most suitable approach from diagnosis to long-term follow-up. This guideline aims to offer a comprehensive and practical overview on the current status and last updates of TC management.

Comparison of British Thyroid Association and TIRADS classifications and their impact on the radiological and surgical management of indeterminate thyroid nodules

BackgroundThe British Thyroid Association (BTA) Guidelines for the Management of Thyroid Cancer advocate for fine-needle aspiration cytology for all thyroid nodules graded indeterminate (U3) at ultrasound assessment. This approach raises concerns regarding potential over-diagnosis of low-risk lesions. Conversely, equivalent Thyroid Imaging Reporting and Data Systems (TIRADS) guidelines permit surveillance or discharge of indeterminate thyroid nodules of certain sizes. This service analysis analyses how guideline choice impacts the fine-needle aspiration cytology rate and subsequent surgical management of indeterminate thyroid nodules. MethodsAll patients with an indeterminate (U3) thyroid nodule identified on ultrasound over a 12-month period were included. Indeterminate thyroid nodules were retrospectively rescored using three equivalent TIRADS classifications by three independent reviewers, blinded to the histopathology. Hypothetical differences in fine-needle aspiration cytology rates and surgical activity were then compared. ResultsNinety-six nodules were identified. Retrospective application of TIRADS guidelines resulted in a hypothetical 44.8-55.2% reduction in fine-needle aspiration cytology performed for indeterminate thyroid nodules compared to BTA. A statistically significant increase in rates of surgical activity for indeterminate thyroid nodules was observed between BTA guidance and all retrospectively applied TIRADS guidelines (p<0.001). Of four confirmed thyroid cancers, three would have been unanimously removed. ConclusionUnder BTA guidance, increased fine-needle aspiration cytology rates for indeterminate thyroid nodules resulted in significantly increased surgical activity in our cohort compared to retrospectively applied TIRADS guidelines.

Topological embedding and directional feature importance in ensemble classifiers for multi-class classification

Cancer is the second leading cause of disease-related death worldwide, and machine learning-based identification of novel biomarkers is crucial for improving early detection and treatment of various cancers. A key challenge in applying machine learning to high-dimensional data is deriving important features in an interpretable manner to provide meaningful insights into the underlying biological mechanismsWe developed a class-based directional feature importance (CLIFI) metric for decision tree methods and demonstrated its use for the The Cancer Genome Atlas proteomics data. The CLIFI metric was incorporated into four algorithms, Random Forest (RF), LAtent VAriable Stochastic Ensemble of Trees (LAVASET), and Gradient Boosted Decision Trees (GBDTs), and a new extension incorporating the LAVA step into GBDTs (LAVABOOST). Both LAVA methods incorporate topological information from protein interactions into the decision function.The different models' performance in classifying 28 cancers resulted in F1-scores of 92.6% (RF), 92.0% (LAVASET), 89.3% (LAVABOOST) and 85.7% (GBDT), with no method outperforming all others for individual cancer type prediction. The CLIFI metric enables visualisation of the model's decision-making functions. The resulting CLIFI value distributions indicated heterogeneity in the expression of several proteins (MYH11, ERα, BCL2) across different cancer types (including brain glioma, breast, kidney, thyroid and prostate cancer) aligning with the original raw expression data.In conclusion, we have developed an integrated, directional feature importance metric for multi-class decision tree-based classification models that facilitates interpretable feature importance assessment. The CLIFI metric can be combined with incorporating topological information into the decision functions of models to introduce inductive bias, enhancing interpretability.

Eggshell Calcifications at Thyroid Ultrasound: A Sample-focused Analysis of Cytological Findings and Post-thyroidectomy Pathological Correlates

Eggshell calcifications at thyroid ultrasound are connected to the challenging field of thyroid nodules and/or malignancy from a multidisciplinary perspective. Calcifications may be found in malignant and benign tumors; typically, micro-calcifications are identified in the papillary type of cancer, being equivalent to psammoma bodies in the pathological report. The risk of macro-calcifications, however, is more nuanced; recent data suggest a potential connection with a differentiated malignancy as well. Eggshell calcifications, a distinct type of macro-calcification, are generally considered benign findings, especially uninterrupted forms. Yet, the real incidence is not clear, which is why the topic remains open. In this narrative review, we analyzed eggshell calcifications in relationship with cytological diagnosis upon fine needle aspiration and post-thyroidectomy histological report. A PubMed-based search of the English-language papers using several keywords identified 171 articles. We only included original studies (no timeline restriction). After removing duplicates and applying the inclusion and exclusion criteria, 14 original studies were analyzed. The number of subjects per study varied (N=61 to 2678) so did the number of analyzed nodules per study (a maximum of 2902). Some studies found connections with benign features; others revealed a higher risk of malignancy at fine needle aspiration. Data remain heterogeneous, and oftentimes, studies investigated it only as a secondary endpoint. A high TI-RADS score is important in malignancy prediction, while eggshell calcification might add to the positive predictive value, yet, this trait is difficult to classify as a standalone element. Nevertheless, an interrupted pattern does not exclude thyroid cancer.

Age Stratification and Prognostic Factor Analysis in Pediatric Differentiated Thyroid Cancer.

Differentiated thyroid cancer (DTC) is rare in the pediatric population. It remains unclear whether younger children are at greater risk of more aggressive disease. We aimed to identify prognostic factors for aggressive pediatric DTC and to define an appropriate age stratification. This retrospective cohort study included all patients aged 18 years or less who were treated for DTC between 1985 and 2021 in a tertiary medical center and were followed up for a minimum of 1.5 years after treatment. Seventy-eight patients were included, all diagnosed with papillary thyroid carcinoma: 30 (38.5%) low-risk, 21 (26.9%) intermediate-risk, and 27 (34.6%) high-risk according to the American Thyroid Association (ATA) risk stratification. The mean duration of follow-up was 11.8 ± 7.8 years. No evidence of disease was documented in 52 patients (66.7%) at 1-year post-treatment and 64 patients (82.1%) at the end of follow-up. On analysis by age, evidence of disease at 1-year post-treatment was found in 66.7% of children younger than 11 years, compared to 25.4% of older children (p = 0.002). There was no significant difference by age in evidence of disease at the last follow-up (p = 0.453). Patients aged <11 years at diagnosis were associated with more aggressive disease features on histopathologic examination, metastatic disease, and high ATA risk level. Patients aged <8 years were associated with more frequent bilateral disease and extrathyroidal extension. Pediatric DTC patients who are younger than 11 years at diagnosis have more aggressive disease features and a lower early remission rate than older patients. Nevertheless, their long-term outcome is satisfactory. 4-retrospective cohort study Laryngoscope, 134:4818-4825, 2024.

Coexisting parathyroid adenoma, thyroid carcinoma, and tuberculosis of thyroid: a case report

BackgroundCoexisting parathyroid adenoma, thyroid carcinoma, and tuberculosis of thyroid is a very rare phenomenon. Primary thyroid tuberculosis is itself very rare despite high global prevalence of tuberculosis in developing countries. Majority of thyroid tuberculosis identified in postoperative histopathology or cytopathology. The coexistence of thyroid cancer with tuberculosis or parathyroid adenoma has been reported in the literature but not a single case of the three pathologies coexisting together has been found in the literature published. We are presenting a rare case of a constellation of synchronous parathyroid adenoma, thyroid carcinoma, and thyroid tuberculosis. This case report will provoke researchers to work on understanding the association of hypercalcemia or chronic inflammation leading to development of malignancy or parathyroid adenoma in the presence of hypothyroidism will give future perspective in managing such patients.Case presentationA Islam lady aged 45 years old, diagnosed with hypothyroidism, was evaluated for pregnancy loss and rapid weight gain from 13 years back and started on tablets of levothyroxine 25 µg once daily. She was doing well until the past 2 years; there after she noticed insidious onset of a swelling over anterior aspect of right side of the neck and bone pain in back and lower limbs. Patient underwent routine investigations and was found to have raised serum calcium (11.4 mg/dl) and parathyroid hormone (253 pg/ml). Anti-thyroid peroxidase (TPO) and anti-thyroglobulin (Tg) level were normal. Ultrasounds showed multiple nodules in both lobe of thyroid and left inferior parathyroid adenoma. The patient underwent total thyroidectomy with left inferior parathyroidectomy, and final histopathology showed features of subacute granulomatous thyroiditis along with hurthle cell change in right lobe of thyroid. The left lobe additionally showed necrotizing epitheloid cell granulomas, which on Zeihl–Neelson staining revealed presence of acid-fast bacilli. Sections from the isthmus show a focus of papillary thyroid microcarcinoma. The left inferior parathyroid gland sent as a frozen sample was found to be parathyroid adenoma. On 6-month follow-up, the patient was feeling much relief in bone pain and tolerating antitubercular drugs uneventfully.ConclusionCoexistence of parathyroid adenoma, nonmedullary thyroid carcinoma, and thyroid tuberculosis is extremely rare. Surgery is curative for hyper parathyroidism and thyroid carcinoma. Thyroid tuberculosis responds well to current antitubercular drugs. Its etiology needs to be explored more; the probable hypothesis is chronic inflammation due to latent tuberculosis might leads to development of thyroid carcinoma and parathyroid adenoma. Further studies need to be done for better understanding of underlying mechanism and better management options for such patients. To the best of our knowledge, similar cases have not been reported.

Establishing a Novel Pyroptosis-Related Gene Signature and Predicting Chemical Drugs for Papillary Thyroid Cancer.

The present study aimed to construct a novel pyroptosis-related gene signature to predict the prognosis of papillary thyroid cancer (PTC). The gene expression level and survival and prognosis information of PTC were obtained from TCGA. The differentially expressed pyroptosis-related genes (DEPs) between cancer and control groups were selected, followed by subtype analysis. A prognostic model was built using LASSO regression analysis. The samples were then divided into high- and low-risk groups, and the differences in immune cell distribution in different risk groups were compared. The chemical drugs associated with genes in the prognostic model were extracted from the Comparative Toxicogenomics Database. A total of 31 DEPs were selected, and 3 different subtypes were obtained. A prognostic model based on 6 pyroptosis-related genes was constructed. The risk grouping was significantly correlated with the actual prognosis, and the model was found to be an independent prognostic factor. Six immune cells with significant differences in distribution in different risk groups were screened. CGP52608 could target four genes in the prognostic model, including GSDMB, NLRC4, IL1A, and IL6. The present study constructed a pyroptosis-related gene signature that could predict the prognosis of PTC. Additionally, this signature was correlated with tumor immunity.

Systemic Immune-Inflammation Index and Systemic Inflammation Response Index Predict the Response to Radioiodine Therapy for Differentiated Thyroid Cancer

Systemic Immune-Inflammation Index and Systemic Inflammation Response Index Predict the Response to Radioiodine Therapy for Differentiated Thyroid Cancer

Machine Vision–Detected Peritumoral Lymphocytic Aggregates Are Associated With Disease-Free Survival in Patients With Papillary Thyroid Carcinoma

Papillary thyroid carcinoma (PTC) is the most prevalent form of thyroid cancer, with a disease recurrence rate of around 20%. Lymphoid formations, which occur in nonlymphoid tissues during chronic inflammatory, infectious, and immune responses, have been linked with tumor suppression. Lymphoid aggregates potentially enhance the body’s antitumor response, offering an avenue for attracting tumor-infiltrating lymphocytes and fostering their coordination. Increasing evidence highlights the role of lymphoid aggregate density in managing tumor invasion and metastasis, with a favorable impact noted on overall and disease-free survival (DFS) across various cancer types. In this study, we present a machine vision model to predict recurrence in different histologic subtypes of PTC using measurements related to peritumoral lymphoid aggregate density. We demonstrate that quantifying peritumoral lymphocytic presence not only is associated with better prognosis but also, along with tumor-infiltrating lymphocytes within the tumor, adds additional prognostic value in the absence of well-known second mutations including TERT. Annotations of peritumoral lymphoid aggregates on 171 well-differentiated PTCs in the Cancer Genome Atlas Thyroid Carcinoma (TCGA-THCA) data set were used to train a deep-learning model to predict regions of lymphoid aggregates across the entire tissue. The fractional area of the tissue regions covered by these lymphocytes was dichotomized to determine the following 2 risk groups: a significant and low density of peritumoral lymphocytes. DFS prognosticated using these risk groups via the Kaplan-Meier analysis revealed a hazard ratio (HR) of 2.51 (95% CI: 2.36, 2.66), tested on 170 new patients also from the TCGA-THCA data set. The prognostic performance of peritumoral lymphocyte aggregate density was compared against the univariate Kaplan-Meier analysis of DFS using the fractional area of intratumoral lymphocytes within the primary tumor with an HR of 2.04 (95% CI: 1.89, 2.19). Combining the lymphocyte features in and around the tumor yielded a statistically significant improvement in prognostic performance (HR, 3.17 [95% CI: 3.02, 3.32]) on training and were independently evaluated against 62 patients outside TCGA-THCA with an HR of 2.44 (95% CI: 2.19, 2.69). Multivariable Cox regression analysis on the validation set revealed that the density of peritumoral and intratumoral lymphocytes was prognostic independent of histologic subtype with a concordance index of 0.815.

Deep Learning and Handcrafted Features for Thyroid Nodule Classification

ABSTRACTIn this research, we present a refined image‐based computer‐aided diagnosis (CAD) system for thyroid cancer detection using ultrasound imagery. This system integrates a specialized convolutional neural network (CNN) architecture designed to address the unique aspects of thyroid image datasets. Additionally, it incorporates a novel statistical model that utilizes a two‐dimensional random coefficient autoregressive (2D‐RCA) method to precisely analyze the textural characteristics of thyroid images, thereby capturing essential texture‐related information. The classification framework relies on a composite feature vector that combines deep learning features from the CNN and handcrafted features from the 2D‐RCA model, processed through a support vector machine (SVM) algorithm. Our evaluation methodology is structured in three phases: initial assessment of the 2D‐RCA features, analysis of the CNN‐derived features, and a final evaluation of their combined effect on classification performance. Comparative analyses with well‐known networks such as VGG16, VGG19, ResNet50, and AlexNet highlight the superior performance of our approach. The outcomes indicate a significant enhancement in diagnostic accuracy, achieving a classification accuracy of 97.2%, a sensitivity of 84.42%, and a specificity of 95.23%. These results not only demonstrate a notable advancement in the classification of thyroid nodules but also establish a new standard in the efficiency of CAD systems.

Molecular theranostics: principles, challenges and controversies.

Theranostics is a new term for long-established principles in nuclear medicine. The generalisability of the term means there is a very broad use of the term across the medical literature, not all of which is consistent with the intent in nuclear medicine. The term molecular theranostics better reflects the philosophy and application in nuclear medicine. Even with a clearer definition, there are a number of challenges or controversies whose debate provides a richer understanding of the principles and applications of molecular theranostics. Radioiodine imaging and therapy of hyperthyroidism and thyroid cancer provide the historical context for theranostics. The prototype molecular theranostic is the 68Ga/177Lu DOTATATE pair that targets somatostatin receptor subtype 2 in neuroendocrine tumors. The potential value of precision medicine of radiation dosimetry in molecular theranostics needs a balanced discussion with limitations of reactive dosimetry and the opportunities for predictive or pre-treatment dosimetry. Despite challenges and limitations, molecular theranostics is a powerful tool in the precision medicine landscape. Molecular theranostics is a vehicle for improved outcomes in cancer patients with a future-facing portfolio of opportunities.

A Comparative Study on BRAFV600E Mutation, Sonographic Findings, and Pathologic Characteristics in Non-invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP) and Invasive Follicular Variant of Papillary Thyroid Carcinoma (IFVPTC)

Objective: Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) comprise a new subgroup of thyroid tumors of follicular origin with borderline histologic features that lack evidence of either capsular or vascular invasion. In contrast to the invasive follicular variant of papillary thyroid carcinoma (IFVPTC), adverse events such as cancer-related death, distant or regional metastases, and structural or biochemical recurrence do not occur in patients with NIFTP. Many studies have been done to elucidate these two specific types of papillary thyroid cancer (PTC) and reduce aggressive therapeutic actions. This study compares molecular, cytological, and radiologic features of NIFTP and IFVPTC. Materials and Methods: Two groups of patients with NIFTP and IFVPTC (n = 18 in each group) who were referred to the endocrine clinic, at Imam Reza Hospital, were enrolled in this crosssectional study. Molecular analysis for BRAFV600E mutation of thyroid tissue was evaluated for all cases. Patient data included: age, sex, type of surgery, thyroid sonographic findings, and prior cytological diagnosis with the Bethesda system for reporting thyroid cytopathology. Results: Only two cases in the IFVPTC group were positive for BRAFV600E mutation. The majority of NIFTP cases were diagnosed as benign lesions (8/18). In contrast, the majority of IFVPTC cases were diagnosed as suspicious for malignancy on cytology (7/18). The mean nodule size in ultrasound in the NIFTP group (41.81 ± 20.43 mm) was larger than the IFVPTC group (36.72 ± 20.73 mm) (p =0.47). Most cases in the IFVPTC group had significantly multiple nodules (72.2%), while most cases in the NIFTP group (81.3%) had solitary nodules. Nodule composition in both groups was solid and complex; however, no cystic nodules were detected in ultrasound examinations. Furthermore, no calcification or lymphadenopathy was seen in the majority of cases in ultrasound. In the IFVPTC group, 47.1% and 35.3% of nodules were hyperechoic and hypoechoic, respectively, while 23.1%, 38.5%, and 23.1% of nodules in the NIFTP group were heterogenic, hyperechoic, and hypoechoic, respectively. Conclusion: According to our findings, only 11.1% of IFVPTC cases were BRAFV600E-positive, while none of the patients in the NIFTP group showed this mutation. However, IFVPTC was predominantly associated with a preceding diagnosis of PTC on FNA, and NIFTP was associated with the preceding diagnosis of benign lesions and follicular neoplasm. Sonographic findings failed to distinguish NIFTP from IFVPTC.

Real word outcomes of cabozantinib therapy in poorly differentiated thyroid carcinoma.

Poorly differentiated thyroid carcinomas (PDTCs) are rare and aggressive head and neck malignancies with a poor prognosis. Systemic treatment for incurable PDTC consists of multi-kinase inhibitors (MKIs) based on extrapolation from the experience with radioiodine refractory differentiated thyroid cancer (DTC). Cabozantinib is an approved second line MKI therapy for DTC, but there are limited data regarding safety and efficacy of cabozantinib for PDTC. We conducted a single institution, retrospective analysis of patients with PDTC who received cabozantinib in any line of therapy. Baseline demographics, disease characteristics, treatment history, toxicity, and clinical outcomes were abstracted from the electronic medical record. Median PFS and OS were primary endpoints and estimated using Kaplan-Meier methodology. Seven patients with PDTC who received cabozantinib, were included. 4/7 (57%) patients had a partial response to cabozantinib, while 2/7 (29%) had SD as their best response. Median time on treatment for cabozantinib was 10.53 months. Median PFS from start of cabozantinib was 12.9 months and median OS was 14.21 months. Most adverse events to treatment (5/6) were low grade. Two (29%) patients were alive at date of last follow up. Cabozantinib is an effective and reasonably well-tolerated treatment option for patients with PDTC. Prospective studies are needed to further investigate the role of cabozantinib in the treatment of PDTC, alone and in combination with other agents including checkpoint inhibitors.

Predicting thyroid cancer ablation success: Pre-ablative 99mTc-Pertechnetate and post-ablative 131I scan comparison

IntroductionThe purpose of this study was to evaluate the relationship between pre-ablative 99mTc-pertechnetate scintigraphy, and therapeutic iodine-131 (131I) whole-body scan (TxWBS), with ablation status and to investigate the possible predictive factors for successful ablation in differentiated thyroid carcinoma (DTC) patients. Materials and methodsA total of 330 DTC patients underwent 99mTc-pertechnetate scintigraphy after thyroidectomy. Uptake values were determined using the region-of-interest technique. All patients had neck ultrasonography and TxWBS. Both scintigraphic scans were interpreted visually and qualitatively. The ablation status was evaluated with a diagnostic 131I whole-body scan. ResultsThe success rate for residual thyroid ablation was 88.8%. The sensitivity, specificity, accuracy, PPV, and NPV of 99mTc-Pertechnetate scintigraphy were 82.4%, 87.5%, 82.7%, 99.2%, and 20.2%, respectively. Pre-ablative TG values and 99mTc uptake (%) were significantly lower in successfully ablated patients. The 99mTc uptake was determined as a significant predictive factor for ablation success (P=0.000). The optimal 99mTc uptake cut-off value of 0.75% was demonstrated for successful ablation. There were significant positive correlations between the visual and the calculated uptake (%) of residual tissues on both scintigraphic scans, Considering the number of remnant tissue foci, significant positive correlations were found between 99mTc-Pertechnetate scintigraphy, TxWBS, and USG. ConclusionPre-ablative 99mTc-Pertechnetate uptake (%) value of the remnant tissue can predict the ablation status in DTC patients. 99mTc-Pertechnetate scintigraphy, which is an easily applicable and accessible imaging method, has maintained its place in the postoperative and pre-ablative period in DTC patients over the years and has not lost any of its value.

Risk of second primary cancers in nodal non-Hodgkin lymphoma patients by primary lymph node location: a retrospective cohort population-based study

Background: Non-Hodgkin lymphoma (NHL) is a diverse group of blood cancers with increasing incidence and survival rates due to advancements in treatment and early detection. However, NHL survivors are at significant risk of developing second primary cancers, which can adversely impact their long-term survival. Methods: This retrospective population-based cohort study utilized data from the Surveillance, Epidemiology, and End Results database, covering 17 geographic areas in the United States from 2000 to 2021. The authors included patients diagnosed with nodal NHL as a first primary cancer and excluded those diagnosed at autopsy or via death certificate only. Standardized Incidence Ratios, Absolute Excess Risks, and Person-Years at Risk were calculated to evaluate the risk of developing SPCs according to the primary lymph node site and stratified by latency periods following the initial NHL diagnosis. Results: The cohort included 54 012 NHL patients. The authors’ results showed that for most SPCs, the risk of development was different for different primary NHL lymph node locations. The highest risks were observed for thyroid cancer, acute myeloid leukemia, and Hodgkin lymphoma. Notably, the risk for thyroid cancer was highest in the first year post-diagnosis, while hematological malignancies such as acute myeloid leukemia and Hodgkin lymphoma showed elevated risks in the intermediate and late latency periods. Conclusion: NHL survivors are at an increased risk of developing SPCs, influenced by the primary lymph node site and latency period. These findings highlight the need for tailored surveillance strategies and preventive measures to mitigate the long-term risks of SPCs in NHL survivors. Further research is necessary to elucidate the underlying mechanisms and to develop targeted interventions for this high-risk population.

Patterns of loco-regional progression and patient outcomes after definitive-dose radiation therapy for anaplastic thyroid cancer

BackgroundThe aim of this study is to characterize the patterns of loco-regional progression (LRP) and outcomes after definitive-dose intensity modulated radiation therapy (IMRT) for anaplastic thyroid cancer (ATC) with macroscopic neck disease at the time of IMRT. MethodsDisease/treatment characteristics and outcomes for patients with unresected or incompletely resected ATC who received IMRT (≥45 Gy) were retrospectively reviewed. For those with LRP after IMRT, progressive/recurrent gross tumor volumes (rGTV) were contoured on diagnostic CTs and co-registered with initial planning CTs using deformable image registration. rGTVs were classified based on established spatial/dosimetric criteria. ResultsForty patients treated between 2010–2020 formed the cohort. Median IMRT dose was 66 Gy (45–70 Gy); altered fractionation (AF) was used in 24 (60 %). All received concurrent chemotherapy. In addition to areas of gross disease, target volumes (TVs) commonly included: central compartment/upper mediastinum (levels VI/VII), neck levels II-V in an involved, and levels III-IV in an uninvolved lateral neck. Median overall survival was 7.1 m. Median progression free survival was 7.4 m for patients with locoregional disease and 1.8 m for patients with distant metastasis at the time of IMRT. Twenty-one patients (53 %) developed LRP at median of 10.9 m; freedom from LRP at 3 m and 12 m was 71 % (95 %CI 58–87 %) and 47 % (95 %CI 32–68 %). Forty-one individual rGTVs were identified and most occurred within the high dose (HD) TVs: Type A/central HD (n = 29, 71 %) and B/peripheral HD (n = 3, 7 %). ConclusionsDespite an intensive treatment schedule, including AF and concurrent chemotherapy, classic radio-resistant and rapid Type A failures predominated; isolated extraneous dose failures were rare. While these findings support the IMRT and TV delineation strategies described herein, they highlight the importance of identifying novel strategies to further improve LRC for patients with unresectable disease without targetable mutations for contemporary neo-adjuvant strategies.

Assessment of Healthcare Professionals’ Knowledge and Practices About Radioactive Iodine Preparation in Thyroid Cancer Patients

Assessment of Healthcare Professionals’ Knowledge and Practices About Radioactive Iodine Preparation in Thyroid Cancer Patients