1,721,021 research outputs found
Radioiodine remnant ablation in low-risk differentiated thyroid cancer: the “con” point of view
No full textA growing body of evidence is challenging the indiscriminate use of postoperative radioiodine for remnant ablation (RRA) in low-risk (LR) differentiated thyroid cancer patients. We critically reviewed the current evidence on which the rationale for RRA is based for LR patients and analyzed the new evidence-based recommendations for LR patients from the draft of the 2015 American Thyroid Association (ATA) guidelines. Cost-effective tools for staging and follow-up, such as neck ultrasonography and serial thyroglobulin testing, are useful for monitoring non-RRA-treated patients. Recurrence rates are very low in non-RRA-treated LR patient cohorts. Most RRA side effects are mild and transient, but can impair a patient's quality of life. RRA is appropriately not routinely recommended in LR patients according to the draft 2015 ATA guidelines and should be reserved for higher-risk patients
Studio osservazionale prospettico sull’outcome clinico dei pazienti affetti da carcinoma della tiroide
Full text linkAim: To identify clinical and molecular prognostic factors in differentiated thyroid cancer (DTC)
Methods: A web based longitudinal database of newly diagnosed DTC was settled down. The risk of recurrence and the response to treatment were classified according to the American Thyroid Association (ATA) guidelines. Circulating miR analysis of sera collected before surgery and about 1 months and 1-2 years after surgery was performed with TaqMan MicroRNA Assay.
Results: 2730 patients had a follow-up ≥1 year. The ATA risk of recurrence was low in 1386 (50.8%), intermediate in 1168 (42.8%) and high in 176 (6.4%). The response to treatment was excellent in 1675 (61.3%), biochemical incomplete in 63 (2.3%), structural incomplete in 70 (2.6%), and indeterminate in 922 (33.8%). A significantly higher rate of structural disease was found in intermediate (2.7%, Odds ratio 4.85, 95% confidence interval 2.18 - 12.23, p<0.01) and high risk (17.1% Odds ratio 35.21, 95% confidence interval 15.41 - 90.66, p<0.01) patients compared with low risk patients (0.6%). Of the 829 patients that had a follow up of ≥3 years, only 3 (0.6%) intermediate risk patients experienced relapse.
Serum samples of 44 patients with papillary thyroid cancer (PTC) were available for miR profiling. After a screening analysis, miR-146a-5p and miR-221-3p were selected for validation because of superior accuracy in PTC identification from healthy controls and benign thyroid nodules. The trend over time of miR-146a-5p and miR-221-3p was decreasing in patients with disease remission and increasing in patients with structural disease. In 3 cases miR profile was more informative than the serum thyroglobulin.
Conclusion: The ATA risk stratification is an effective clinical prognostic tool for structural disease prediction in DTC. One third of the patients has an indeterminate response to treatment due to low detectable serum markers (thyroglobulin or anti thyroglobulin antibodies). miR profile may represents a promising alternative marker of disease status for these patients
Low and intermediate Risk Differentiated Thyroid Cancer and Radioiodine Remnant Ablation: A systematic review of the literature
No full textBackground: Radioiodine remnant ablation (RRA) has traditionally been one of the cornerstones of differentiated thyroid cancer (DTC) treatment. The decision to use RRA in low (LR) and intermediate risk (IR) patients is controversial. The aim of this review is to examine the evidence of RRA benefit in the staging, follow up, and recurrence prevention in LR and IR DTC patients. Methods: From a PubMed research we selected original papers (OP) using the following inclusion criteria: a) DTC; b) LR and IR patients; C) non-RRA treated patients or RRA vs non-RRA treated groups; d) reporting of the outcome of cancer recurrence; e) published since 2008. Results: Neck ultrasonography is superior to WBS for disease detection in the neck. A rising or declining serum thyroglobulin (Tg) over time provide an excellent positive or negative predictive value, respectively, even in non-RRA treated patients. No OP demonstrating RRA benefit on recurrence in LR patients was found; two OP found no evidence of benefit. We found 11 OP that observed some benefit in reducing recurrence rates with RRA in IR patients, and 13 OP that failed to show benefit from RRA in this group. Conclusions: Neck ultrasonography and serum Tg measurement are equivalent or superior in detecting and localizing residual disease compared to RxWBS. There is no evidence of RRA benefit in recurrence prevention for LR patients. There are conflicting data on IR patients, and only a few studies with homogenous and properly stratified populations. A careful evaluation of tumor pathologic features and patient characteristics and preferences should guide RRA decision making
ENDOCRINE TUMOURS: Imaging in the follow up of differentiated thyroid cancer: current evidence and future perspectives for a risk-adapted approach
Full text linkThe clinical and epidemiological profiles of differentiated thyroid cancers (DTCs) have changed in the last three decades. Today's DTCs are more likely to be small, localized, asymptomatic papillary forms. Current practice is though moving towards more conservative approaches (e.g. lobectomy instead of total thyroidectomy, selective use of radioiodine). This evolution has been paralleled and partly driven by rapid technological advances in the field of diagnostic imaging. The challenge of contemporary DTCs follow up is to tailor a risk-of-recurrence-based management, taking into account the dynamic nature of these risks, which evolve over time, spontaneously and in response to treatments. This review provides a closer look at the evolving evidence-based views on the use and utility of imaging technology in the post-treatment staging and the short- and long-term surveillance of patients with DTCs. The studies considered range from cervical US with Doppler flow analysis to an expanding palette of increasingly sophisticated second-line studies (cross-sectional, functional, combined-modality approaches), which can be used to detect disease that has spread beyond the neck and, in some cases, shed light on its probable outcome.
Recent advances in managing differentiated thyroid cancer [version 1; referees: 2 approved]
Full text linkThe main clinical challenge in the management of thyroid cancer is to avoid over-treatment and over-diagnosis in patients with lower-risk disease while promptly identifying those patients with more advanced or high-risk disease requiring aggressive treatment. In recent years, novel clinical and molecular data have emerged, allowing the development of new staging systems, predictive and prognostic tools, and treatment approaches. There has been a notable shift toward more conservative management of low- and intermediate-risk patients, characterized by less extensive surgery, more selective use of radioisotopes (for both diagnostic and therapeutic purposes), and less intensive follow-up. Furthermore, the histologic classification; tumor, node, and metastasis (TNM) staging; and American Thyroid Association risk stratification systems have been refined, and this has increased the number of patients in the low- and intermediate-risk categories. There is now a need for new, prospective data to clarify how these changing practices will impact long-term outcomes of patients with thyroid cancer, and new follow-up strategies and biomarkers are still under investigation. On the other hand, patients with more advanced or high-risk disease have a broader portfolio of options in terms of treatments and therapeutic agents, including multitarget tyrosine kinase inhibitors, more selective BRAF or MEK inhibitors, combination therapies, and immunotherapy
Screening for differentiated thyroid cancer in selected populations
No full textThe main purpose of cancer screening programmes should not be to detect all cancers, but to discover potentially fatal or clinically relevant cancers. The US Preventive Services Task Force recommends against screening for thyroid cancer in the general, asymptomatic adult population, as such screening would result in harms that outweigh any potential benefits. This recommendation does not apply to patients with symptoms or to individuals at increased risk of thyroid cancer because of a history of exposure to ionising radiation (in childhood, as radioactive fallout, or in medical treatment as low-dose radiotherapy for benign conditions or high-dose radiation for malignancy), inherited genetic syndromes associated with thyroid cancer (eg, familial adenomatous polyposis), or one or more first-degree relatives with a history of thyroid cancer. We discuss the evidence for and against screening individuals who are at high risk, and consider the different screening tools available
Treatment of refractory thyroid cancer
No full textDistant metastases from thyroid cancer of follicular origin are uncommon. Treatment includes levothyroxine administration, focal treatment modalities with surgery, external radiation therapy and thermal ablation, and radioiodine in patients with uptake of 131I in their metastases. Two-thirds of distant metastases become refractory to radioiodine at some point, and when there is a significant tumor burden and documented progression on imaging, a treatment with a kinase inhibitor may provide benefits
Selective use of radioactive iodine therapy for papillary thyroid cancers with low or lower-intermediate recurrence risk
No full textContext: Current guidelines recommend a selective use of radioiodine treatment (RAI) for papillary thyroid cancer (PTC).
Objective: To determine how policy changes affect the use of RAI and the short-term outcomes of patients.
Design: Retrospective analysis of longitudinal data.
Setting: Academic referral center.
Patients: Patients with non-aggressive PTC variants; no extrathyroidal invasion or limited to soft tissues, no distant metastases, and ≤5 central-compartment cervical lymph node metastases. In Cohort 1, standard treatments were total thyroidectomy and RAI (May 2005-June 2011); in Cohort 2 decisions on RAI were deferred for ~12 months after surgery (July 2011-December 2018). Propensity score matching was used to adjust for sex, age, tumor size, lymph node status, and extrathyroidal extension.
Intervention: Immediate RAI or deferred choice.
Main outcome measures: Responses to initial treatment in ≥3 years of follow-up.
Results: In Cohort 1, RAI was performed in 50/116 patients (51.7%), while in Cohort 2, it was far less frequent: immediately in 10/156 (6.4%), and in 3 more patients after the first follow-up data. The frequencies of structural incomplete response were low (1-3%), and there were no differences between the two cohorts at any follow-up visit. Cohort 2 patients had higher rates of "gray-zone responses" (biochemical incomplete or indeterminate response).
Conclusions: Selective use of RAI increases the rate of patients with "uncertain" status during early follow-up. The rate of structural incomplete responses remains low regardless of whether RAI is used immediately or not. Patients should be made aware of both the advantages and drawbacks of omitting RAI
Is thyroid nodule location associated with malignancy risk?
Full text linkPURPOSE:
Nodules located in the upper pole of the thyroid may carry a greater risk for malignancy than those in the lower pole. We conducted a study to analyze the risk of malignancy of nodules depending on location.
METHODS:
The records of patients undergoing thyroid-nodule fine-needle aspiration cytology (FNAC) at an academic thyroid cancer unit were prospectively collected. The nodules were considered benign in cases of a benign histology or cytology report, and malignant in cases of malignant histology. Pathological findings were analyzed based on the anatomical location of the nodules, which were also scored according to five ultrasonographic classification systems.
RESULTS:
Between November 1, 2015 and May 30, 2018, 832 nodules underwent FNAC, of which 557 had a definitive diagnosis. The prevalence of malignancy was not significantly different in the isthmus, right, or left lobe. Among the 227 nodules that had a precise longitudinal location noted (from 219 patients [155 females], aged 56.2±14.0 years), malignancy was more frequent in the middle lobe (13.2%; odds ratio [OR], 9.74; 95% confidence interval [CI], 1.95 to 48.59). This figure was confirmed in multivariate analyses that took into account nodule composition and the Thyroid Imaging, Reporting, and Data System (TIRADS) classification. Using the American College of Radiologists TIRADS, the upper pole location also demonstrated a slightly significant association with malignancy (OR, 6.92; 95% CI, 1.02 to 46.90; P=0.047).
CONCLUSION:
The risk of thyroid malignancy was found to be significantly higher for mid-lobar nodules. This observation was confirmed when suspicious ultrasonographic features were included in a multivariate model, suggesting that the longitudinal location in the lobe may be a risk factor independently of ultrasonographic appearance
- …
