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NCI CANCERLIT® Search: Thyroid Cancer - March 2002
National Cancer Institute®
Ultima Vez Modificado: 1 de marzo del 2002
Table of Contents
1
UI - 9065657
AU - Betka J; Mrzena L; Astl J; Nemec J; Vlcek P; Taudy M; Skrivan J
TI -
Surgical treatment strategy for thyroid gland carcinoma nodal
metastases.
SO - Eur Arch Otorhinolaryngol 1997;254 Suppl 1():S169-74
AD - Department of Otorhinolaryngology, Head and Neck Surgery The First
Medical Faculty, Charles University, Prague, Czech Republic.
The authors present their experience with surgical treatment for nodal
metastases of thyroid carcinoma based on neck dissections. The
specificity of the surgical approach to the lymph nodes was determined
by the biologic behavior of each thyroid tumor. Using the available
literature on metastases from thyroid tumors, an opinion is supported
that surgery for differentiated carcinomas (papillary and follicular
neoplasms) can be more conservative and can be safely limited to
modified neck dissections. In contrast, a more extended type of
selective neck dissection, and only rarely a comprehensive neck
dissection, is needed for medullary carcinoma. Because of its rapid
spread to distant sites local aggressivity, extirpation of individual
lymph nodes or neck dissection is not justified in patients with
anaplastic thyroid carcinoma.
2
UI - 11848332
AU - Agrawal R; Agarwal A; Kar DK; Agarwal G; Jain M; Krishnani N; Gupta S;
TI -
Mithal A; Mishra SK
Parathyroid carcinoma.
SO - J Assoc Physicians India 2001 Oct;49():990-3
AD - Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute
of Medical Sciences, Lucknow, Uttar Pradesh, India.
INTRODUCTION: Parathyroid carcinoma is a rare tumor with an incidence of
0.5 to 4%. Preoperative differentiation from benign adenoma is very
difficult. Several features, though nonspecific, have been used in
differentiating parathyroid carcinoma from the adenoma. MATERIAL AND
METHOD: A retrospective analysis during the period of nine years, four
cases of parathyroid carcinoma were diagnosed on the basis of
per-operative local invasion and on histological evidence of capsular
invasion and vascular invasion. RESULT: We have different observations
to make. Diagnosis of parathyroid carcinoma which was done on the basis
of intra operative suspicion only. One patient died on 6th post
operative day due to development of pancreatitis. At the follow-up of
two years there was no local recurrence or distant metastasis.
CONCLUSION: It is preferable to have a high index of suspicion for
parathyroid carcinoma when these features are present than to miss the
opportunity for surgical cure by failing to consider it in the
differential diagnosis.
3
UI - 11843942
AU - de Vos tot Nederveen Cappel RJ; Bouvy ND; Bonjer HJ; van Muiswinkel JM;
TI -
Chadha S
Fine needle aspiration cytology of thyroid nodules: how accurate is it
and what are the causes of discrepant cases?
SO - Cytopathology 2001 Dec;12(6):399-405
AD - Department of Pathology, Erasmus Medical Centre, Rotterdam, The
Netherlands.
Fine-needle aspiration cytology (FNAC) is widely accepted as the most
accurate, sensitive, specific and cost-effective diagnostic procedure in
the assessment of thyroid nodules and helps to select people
preoperatively for surgery. The purpose of this study was to evaluate
the results of thyroid FNAC in our institution and to determine the
reasons for discrepancies between the cytological and histological
diagnosis. We evaluated the cytological and histological results of 254
FNACs obtained from 231 patients who underwent subsequent thyroid
surgery. All of the material was blindly reviewed for quality control,
by one experienced cytopathologist. All FNACs were carried out under
ultrasound guidance. The cytological diagnosis was classified as benign,
suspicious, malignant or unsatisfactory. The definitive histological
study showed benign lesions in 195 of the 231 patients (84%). A benign
diagnosis based on FNAC was correct in 105 of the 108 benign cases
(97%). FNACs diagnosed as 'suspicious' resulted in a distribution of 49
benign (79%) and 13 malignant (21%) diagnoses. FNAC showed malignancy in
34 cases (13%) and in only one case did the final histology differ from
cytology (correlation 97%). The percentage of FNACs that were inadequate
for diagnosis was 20%. Review of cytological and histological slides did
not lead to any change in the original diagnosis. Our study revealed a
cytological-histological discrepancy (2%) in only 4 out of 231 cases
over a period of 10 years, due to either a diagnostic or sampling error.
4
UI - 11803353
AU - Cohen A; Rovelli A; van Lint MT; Merlo F; Gaiero A; Mulas R; Balduzzi A;
TI -
Corti P; Uderzo C; Bacigalupo A
Secondary thyroid carcinoma after allogeneic bone marrow transplantation
during childhood.
SO - Bone Marrow Transplant 2001 Dec;28(12):1125-8
AD - Department of Pediatrics, San Paolo Hospital, 17100 Savona, Italy.
The aim of this study was to evaluate the incidence and risk factors
related to secondary thyroid carcinoma (STC) in patients who have
undergone allogeneic BMT during childhood. Data related to the primary
hematological disorder and BMT procedure were obtained from the records
of 113 patients (42 F; 71 M) who underwent BMT before the age of 18
(median 10.0 years; range 1.7-18.0) and survived more than 3 years after
transplant with a median follow-up of 10.1 years (range 3.0-19.0).
Sixteen received cranial radiation (CRT) during first-line treatment.
Pre-transplant conditioning included TBI in 85 patients, TAI in two,
while 26 children did not receive irradiation. The standardized
incidence ratio of STC after BMT was significantly higher (P < 0.001)
than that of the general population. STC was found in eight patients,
3.1 to 15.7 years after transplant. All received TBI and three also CRT.
The Cox's regression analysis, although not statistically significant
due to the small study population, showed an increased risk in those who
had received a cumulative radiation dose higher than 10 Gy and in those
who developed chronic GVHD. Careful follow-up of thyroid status
including annual ultrasound examination is recommended for early
detection of tumor.
5
UI - 11859989
AU - Tuccari G; Barresi G
TI -
Comments to the article 'Immunohistochemical study of ceruloplasmin,
lactoferrin and secretory component expression in neoplastic and
nonneoplastic thyroid gland diseases' by A. Kondi-Pafiti et al. in Acta
Oncologica 2000; 39 (6) 753-6.
SO - Acta Oncol 2001;40(7):875-6
6
UI - 11808145
AU - Mimura T; Ito K
TI -
[Thyroid cancer]
SO - Nippon Rinsho 2001 Nov;59 Suppl 7():386-92
AD - Ito Hospital.
7
UI - 11797396
AU - Takano T; Amino N
TI -
[Aspiration biopsy-RT-PCR(ABRP): lesson from its success]
SO - Rinsho Byori 2001 Dec;49(12):1248-54
AD - Department of Laboratory Medicine, Osaka University Medical School,
Suita 565-0871.
Molecular-based diagnosis of thyroid carcinomas can be more easily
established by utilizing specific mRNAs that are expressed only in
cancer tissues. In a previous study, we introduced a new method of
preoperatively diagnosing thyroid carcinomas. This technique, aspiration
biopsy-RT-PCR(ABRP), facilitated simultaneous cytological and
molecular-based diagnoses by extracting RNA from cells remaining within
the needle used for fine needle aspiration biopsies(FNABs). ABRP
provides both RNA information and a cytological diagnosis without
further invasion to the patient. We proved that by ABRP detection of
oncofetal fibronectin(onfFN) mRNA in FNABs, papillary and anaplastic
carcinomas are accurately diagnosed preoperatively. Further, by
real-time monitoring RT-PCR measuring onfFN mRNA, a fully automated
system was established. It is not clarified, however, why
cancer-specific mRNAs, especially those overexpressed in fetal tissues,
can clearly distinguish benign tissues from carcinomas, while genomic
alternation such as mutations in RAS or P53 gene cannot. Further, a
widely accepted hypothesis, multi-step carcinogenesis, does not explain
some of the clinical and experimental evidence from thyroid carcinomas.
Considering these facts, we propose a new concept of thyroid
carcinogenesis called "germ-cell carcinogenesis", in which cancer cells
are derived from the remnant of fetal thyroid germ cells(thyroblasts)
instead of normal thyroid follicular cells.
8
UI - 11793369
AU - Bohm J; Niskanen L; Tammi R; Tammi M; Eskelinen M; Pirinen R; Hollmen S;
TI -
Alhava E; Kosma VM
Hyaluronan expression in differentiated thyroid carcinoma.
SO - J Pathol 2002 Feb;196(2):180-5
AD - Department of Pathology and Forensic Medicine, University of Kuopio and
Kuopio University Hospital, Kuopio, Finland.
The extracellular polysaccharide hyaluronan (HA) controls cell
migration, differentiation, and proliferation, and is supposed to
contribute to the spreading of several human cancers. Little is known
about the role of HA in the development and progression of
differentiated thyroid carcinoma (DTC). The expression and prognostic
value of HA were therefore evaluated in 204 consecutive patients with
DTC. A biotinylated affinity probe specific for HA was applied to
paraffin-embedded tumour samples to assay the expression of HA in
carcinoma cells and in intra/peritumoural stroma. In a majority of the
samples, a high percentage (>or=90%) of normal thyroid follicle
epithelial cells were HA-positive. This high percentage was also found
in 80 (47%) papillary carcinomas, but only in seven (21%) follicular
carcinomas (p=0.004). Age (>60 years) of the patients was significantly
associated with a low percentage of HA-positive cancer cells (p=0.013).
Cancer cell-associated HA correlated significantly with the percentage
of cells expressing total CD44 and its isoforms containing exons v3 and
v6 (r=0.223-0.289, p<0.001 for all). The tumour stroma was always
positive for HA. Stromal staining intensity did not differ markedly
between papillary and follicular carcinomas. A strong stromal HA
staining intensity was related to distant metastases (p=0.044), high
pTNM stage (p=0.024), old age (>60 years) (p=0.043), and cancer-related
mortality (p=0.001). In a log-rank univariate survival analysis, strong
stromal HA staining intensity was related to DTC mortality (p=0.0007).
Cancer cell-associated HA expression did not significantly correlate
with patient survival. In Cox's multivariate survival analysis, age (>60
years, p=0.0164), gender (p=0.0251), and pTNM stage (p=0.0121) were
significant independent prognostic factors for DTC-related death. These
results suggest that strong stromal HA staining intensity is related to
progression and unfavourable outcome in DTC patients, while the clinical
factors remain more powerful in predicting DTC-related death. Copyright
2001 John Wiley & Sons, Ltd.
9
UI - 11759733
AU - Koike E; Yamashita H; Noguchi S; Murakami T; Ohshima A; Maruta J;
TI -
Kawamoto H; Yamashita H
Effect of combining ultrasonography and ultrasound-guided fine-needle
aspiration biopsy findings for the diagnosis of thyroid nodules.
SO - Eur J Surg 2001 Sep;167(9):656-61
AD - Noguchi Thyroid Clinic and Hospital Foundation, Oita, Japan.
OBJECTIVE: To assess the accuracy of ultrasonography and cytology in
predicting malignancy in thyroid nodules. DESIGN: Prospective open
study. SETTING: Thyroid centre, Japan. SUBJECTS: 329 nodules in 309
patients examined by a new ultrasound scanner and ultrasound-guided
fine-needle aspiration biopsy. INTERVENTIONS: Comparison of
ultrasonographic, cytological, and combined diagnosis with the
histological diagnosis. MAIN OUTCOME MEASURES: Sensitivity, specificity,
and accuracy of each diagnostic method. RESULTS: The sensitivity,
specificity, accuracy were 84%, 87%, 85% for cytological diagnosis, and
82%, 91%, and 87% for ultrasonographic diagnosis. By using
ultrasonographic diagnosis when cytological specimens were inadequate or
gave false negative results, the sensitivity, specificity, and accuracy
went up to 89%, 91%, and 90%, respectively. We could not diagnose
follicular carcinomas accurately by combined cytology and
ultrasonography. CONCLUSION: The combination of ultrasonography and
cytology improves the accuracy of diagnosis of thyroid nodules, but is
less effective with follicular tumours.
10
UI - 11850486
AU - Regalbuto C; Buscema M; Arena S; Vigneri R; Squatrito S; Pezzino V
TI -
False-positive findings on (131)I whole-body scans because of
posttraumatic superficial scabs.
SO - J Nucl Med 2002 Feb;43(2):207-9
AD - Department of Internal Medicine, Garibaldi Hospital, University of
Catania, Catania, Italy. segmeint@mbox.unict.it
Nonspecific (131)I uptake may affect both the specificity and the
accuracy of whole-body scanning (WBS) performed after (131)I
administration in the follow-up of thyroid carcinoma after
thyroidectomy. We report a newly identified cause of false-positive WBS
findings: posttraumatic superficial scabs. METHODS: Four patients who
underwent thyroidectomy for differentiated thyroid carcinoma were
studied after therapeutic administration of 3,700 MBq (131)I. RESULTS:
WBS revealed an area of uptake in the lower limbs, in a site
corresponding to a slight abrasion of the skin that had incidentally
occurred between a few hours before and 24 h after radioiodine
administration. In 2 patients, a radioiodine concentration in the scab
was shown by the disappearance of the radioactivity in the leg after
removal of the scab and by detection of radioactivity in the collected
material. CONCLUSION: Posttraumatic superficial scabs may be a cause of
false-positive WBS findings. High (131)I doses, although providing
increased sensitivity, may also increase the number of false-positive
results.
11
UI - 11858234
AU - Dawry FP
TI -
Online regulatory guide errors.
SO - J Nucl Med 2002 Feb;43(2):284
12
UI - 11856699
AU - Kim EK; Park CS; Chung WY; Oh KK; Kim DI; Lee JT; Yoo HS
TI -
New sonographic criteria for recommending fine-needle aspiration biopsy
of nonpalpable solid nodules of the thyroid.
SO - AJR Am J Roentgenol 2002 Mar;178(3):687-91
AD - Department of Diagnostic Radiology, Research Institute of Radiological
Science, Severance Hospital, Yonsei University College of Medicine, 134,
Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea.
OBJECTIVE: The purpose of our study was to provide new sonographic
criteria for fine-needle aspiration biopsy of nonpalpable solid thyroid
nodules. MATERIALS AND METHODS: Sonographic scans of 155 nonpalpable
thyroid nodules in 132 patients were prospectively classified as having
positive or negative findings. Sonographic findings that suggested
malignancy included microcalcifications, an irregular or microlobulated
margin, marked hypoechogenicity, and a shape that was more tall than it
was wide. If even one of these sonographic features was present, the
nodule was classified as positive (malignant). If a nodule had none of
the features described, it was classified as negative (benign). The
final diagnosis of a lesion as benign (n = 106) or malignant (n = 49)
was confirmed by fine-needle aspiration biopsy and follow-up (>6 months)
in 83 benign nodules, by fine-needle aspiration biopsy and surgery in 44
malignant and 15 benign lesions, and by surgery alone in five malignant
and eight benign lesions. The sensitivity, specificity, positive
predictive value, negative predictive value, and accuracy were
calculated on the basis of our proposed classification method. RESULTS:
Of 82 lesions classified as positive, 46 were malignant. Of 73 lesions
classified as negative, three were malignant. The sensitivity,
specificity, positive predictive value, negative predictive value and
accuracy based on our sonographic classification method were 93.8%, 66%,
56.1%, 95.9%, and 74.8%, respectively. CONCLUSION: Considering the high
level of sensitivity of our proposed sonographic classification,
fine-needle aspiration biopsy should be performed on thyroid nodules
classified as positive, regardless of palpability.
13
UI - 11856700
AU - Wunderbaldinger P; Harisinghani MG; Hahn PF; Daniels GH; Turetschek K;
TI -
Simeone J; O'Neill MJ; Mueller PR
Cystic lymph node metastases in papillary thyroid carcinoma.
SO - AJR Am J Roentgenol 2002 Mar;178(3):693-7
AD - Department of Radiology, University of Vienna, Waehringer Guertel 18-20,
A-1030 Vienna, Austria.
OBJECTIVE: The aim of this study was to illustrate and discuss the
sonographic spectrum of surgically proven cystic nodal metastases from
papillary thyroid carcinoma. By correlative evaluation of the
sonographic imaging findings to gross pathology and histology, our
purpose was to provide useful hints to differentiate cystic lymph node
metastases from other benign cystic neck lesions such as branchial
cysts. MATERIALS AND METHODS: Sonographic examinations of 74 patients
(47 women, 27 men; mean age, 49 years) with 97 histologically confirmed
cystic lymph nodes metastases from papillary thyroid carcinoma were
included in the study. The anatomic relationship of the nodes relative
to the primary tumor was recorded, and all cystic nodes were
qualitatively categorized as either simple (purely cystic) or complex
(thickened outer wall, internal nodules, internal septations, and
calcifications). All imaging findings were compared with gross
pathologic specimens. RESULTS: Most of the cystic metastases were
ipsilateral to the primary tumor (87.8%) and located in the mid or lower
jugular chain (73.2%). In 14.9% of all patients, cystic lymph node
metastases were the initial manifestation of disease. Only 6.2% of all
lymph node metastases were purely cystic (all of these occurred in
patients less than 35 years old). Of the 91 complex metastases, a
thickened outer wall was present in 35.2% of patients, internal nodules
in 42.9%, and internal septations in 57.1%. No calcifications were seen
in the 91 complex metastases, and two or more findings were seen in
23.1%. All sonographic findings were verified by surgery. CONCLUSION: In
most of the patients, cystic lymph node metastases are characterized
sonographically by the presence of a thickened outer wall, internal
echoes, internal nodularity, and septations. However, in younger
patients, the lymph nodes might appear purely cystic, thereby mimicking
branchial cysts and thus requiring biopsy for final diagnosis and
therapy planning.
14
UI - 11856701
AU - Lewis BD; Hay ID; Charboneau JW; McIver B; Reading CC; Goellner JR
TI -
Percutaneous ethanol injection for treatment of cervical lymph node
metastases in patients with papillary thyroid carcinoma.
SO - AJR Am J Roentgenol 2002 Mar;178(3):699-704
AD - Department of Radiology, Mayo Clinic and Mayo Foundation, 200 First St.,
SW, Rochester, MN 55905, USA.
OBJECTIVE: The objective of this study was to evaluate the technique,
efficacy, and side effects of percutaneous ethanol injection in patients
with limited cervical nodal metastases from papillary thyroid carcinoma.
SUBJECTS AND METHODS: Fourteen patients who had undergone thyroidectomy
for papillary thyroid carcinoma presented with limited nodal metastases
2000. All patients had received previous iodine-131 ablative therapy
with a mean total dose per patient of 7,548 MBq. Ten of the patients
either were considered poor surgical candidates or preferred not to have
surgery, and all were unresponsive to iodine-131 therapy. Each
metastatic lymph node was treated with percutaneous ethanol injection,
and patients received both clinical and sonographic follow-up. RESULTS:
Twenty-nine metastatic lymph nodes in our 14 patients were injected.
Mean sonographic follow-up was 18 months (range, from 2 months to 6
years 5 months). All treated lymph nodes decreased in volume from a mean
of 492 mm(3) before percutaneous ethanol injection to a mean volume of
76 mm(3) at 1 year and 20 mm(3) at 2 years after treatment. Six nodes
were re-treated 2-12 months after initial percutaneous ethanol injection
because of persistent flow on color Doppler sonography (n = 4), stable
size (n = 1), or increased size (n = 1). Two patients developed four new
metastatic nodes during the follow-up period that were amenable to
percutaneous ethanol injection. Two patients developed innumerable
metastatic nodes that precluded retreatment with percutaneous ethanol
injection. No major complications occurred. All patients experienced
long-term local control of metastatic lymph nodes treated by
percutaneous ethanol injection. In 12 of 14 patients, percutaneous
ethanol injection was successful in controlling all known metastatic
adenopathy. CONCLUSION: Sonographically guided percutaneous ethanol
injection is a valuable treatment option for patients with limited
cervical nodal metastases from papillary thyroid cancer who are not
amenable to further surgical or radioiodine therapy.
15
UI - 11869012
AU - Zhou XH
TI -
Primary squamous cell carcinoma of the thyroid.
SO - Eur J Surg Oncol 2002 Feb;28(1):42-5
AD - Department of Head and Neck Surgery, Chongqing Cancer Hospital,
Chongqing, China. zhouxh78@yahoo.com.cn
AIMS: To investigate the clinical features and treatment protocol of
squamous cell carcinoma of the thyroid (SCCT). METHOD: Clinical records
of four SCCT patients treated during 1985--99 were retrospectively
reviewed and evaluated. RESULTS: Two patients who underwent surgical
excision plus radiotherapy died of local tumour recurrence, 6 and 13
months, respectively, post-operatively. One who accepted surgery only
died 4 months later of respiratory distress. The fourth patient who had
radical surgery coupled with radiotherapy and chemotherapy was
disease-free at 26-month follow-up. CONCLUSION: SCCT is a very rare but
highly malignant carcinoma. Early diagnosis and an aggressive radical
surgery portend a better prognosis. Radiotherapy and chemotherapy are
secondary applicable methods for the patients with certain condition.
Copyright Harcourt Publishers Limited.
16
UI - 11686537
AU - Ohshima A; Yamashita H; Noguchi S; Uchino S; Watanabe S; Toda M;
TI -
Yamashita H; Koike E; Takatsu K; Inomata M; Arita T
Usefulness of endoscopic ultrasonography (EUS) in diagnosing esophageal
infiltration of thyroid cancer.
SO - J Endocrinol Invest 2001 Sep;24(8):564-9
AD - Noguchi Thyroid Clinic and Hospital Foundation, Beppu, Oita, Japan.
admin@noguchi-med.or.jp
Pre-operative evaluation of esophageal infiltration is sometimes
difficult in patients with advanced thyroid cancer even with recent
imaging modalities. We evaluated the accuracy of endoscopic
ultrasonography (EUS) in diagnosing esophageal infiltration of thyroid
cancer. Twenty-nine patients with advanced thyroid cancer underwent EUS
and other imaging examinations before surgery. The diagnostic accuracy
of EUS was compared with that of magnetic resonance imaging (MRI) and
esophagography based on pathologic findings in 27 of the 29 cases. EUS
clearly demonstrated the 5-layer structure of the esophageal wall. EUS
detected cancer invasion into the muscularis propria of the esophagus
correctly in 8 of 10 patients diagnosed pathologically with muscular
infiltration. EUS was significantly more accurate than MRI and
esophagography (88.9% vs 63.0% and 66.7%, respectively). The specificity
of EUS was also significantly better than the specificities of MRI or
esophagography (94.1% vs 58.8% and 64.7%, respectively). The
sensitivity, positive predictive value and negative predictive value of
EUS tended to be better than those of MRI and esophagography. EUS is
useful in evaluating the esophageal infiltration of thyroid cancer. This
method has the further advantage of detecting the exact depth of cancer
invasion into the esophageal wall.
17
UI - 11686551
AU - Morpurgo PS; Corsi A; Corbetta S; Vicentini L; Spada A
TI -
In vitro release of activin A from human normal and pathological thyroid
tissues.
SO - J Endocrinol Invest 2001 Sep;24(8):RC25-7
AD - Institute of Endocrine Sciences, University of Milan, Italy.
Activin A is a dimeric glycoprotein belonging to the transforming growth
factor beta (TGF-beta) superfamily characterized by the ability to
affect FSH secretion. Activin A was originally indicated as a gonadal
product but the expression of activin A has been successively identified
in several different tissues, including the thyroid gland. The aim of
this study was to evaluate the release of activin A from human normal
and pathological thyroid tissues in culture. Activin A concentration was
evaluated in media obtained from primary culture of perinodular normal
tissues (no.=2), hyperplastic hyperfunctioning thyroid tissues due to
Graves' disease (no.=3) and autonomous thyroid adenomas (no.=3).
Detectable levels of activin A were found in the incubation media from
all tissues, without significant differences between normal and
pathological samples. We conclude that activin A is secreted by follicle
thyroid cells in normal and pathological conditions.
18
UI - 11801706
AU - Shankar LK; Yamamoto AJ; Alavi A; Mandel SJ
TI -
Comparison of 123I scintigraphy at 5 and 24 hours in patients with
differentiated thyroid cancer.
SO - J Nucl Med 2002 Jan;43(1):72-6
AD - Division of Nuclear Medicine, Department of Radiology, University of
Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
This study was performed to determine differences in 123I image quality
at 5 and 24 h for the detection of residual thyroid or recurrent disease
in patients with differentiated thyroid cancer and to evaluate which of
these approaches provides the optimal yield compared with scans obtained
after 131I therapy. METHODS: The study included 99 patients (70 women,
29 men). Histopathology included 88 papillary cancers, 7 follicular
cancers, and 4 Hurthle cell tumors. Each patient previously had a
near-total thyroidectomy. Seventy patients were receiving initial 131I
therapy, and 29 had undergone prior radioablative therapy with 131I.
Whole-body images and spot views of the neck and chest were obtained
with a dual-head scanner at 5 and 24 h after the oral administration of
56 MBq (1.5 mCi) Na123I. In addition, tomographic images of the neck and
chest were obtained in 26 patients. The images obtained at 5 and 24 h
were evaluated for the number of lesions visualized and the image
quality. Seventy-four patients received radioablative therapy after this
diagnostic work-up. Whole-body images were obtained on these patients 7
d after 131I therapy and were compared with the diagnostic scans.
RESULTS: Overall, images acquired 5 and 24 h after oral administration
of 56 MBq (1.5 mCi) 123I were concordant in 73% of patients. For 25
patients (25%), 24-h scanning was superior by detecting additional neck
foci or confirming equivocal neck foci (20 patients) and confirming
equivocal pulmonary uptake (5 patients). In the subset of patients
undergoing surveillance imaging after prior 131I ablation therapy with
positive scans, 24-h images were superior in 66%. In 3 patients, SPECT
revealed additional foci compared with planar images at 5 h. These foci
were also clearly identified on the planar images obtained at 24 h.
Images obtained after therapy did not identify additional sites of tumor
involvement compared with those noted on 24-h images but did reveal more
foci of residual thyroid tissue in 5 patients. CONCLUSION: The
diagnostic yield of planar diagnostic 123I scintigraphy at 24 h was
superior to that at 5 h for lesion detection and image quality, and
images obtained after 131I therapy did not reveal unknown metastatic
foci.
19
UI - 11815400
AU - Horn-Ross PL; Hoggatt KJ; Lee MM
TI -
Phytoestrogens and thyroid cancer risk: the San Francisco Bay Area
thyroid cancer study.
SO - Cancer Epidemiol Biomarkers Prev 2002 Jan;11(1):43-9
AD - Northern California Cancer Center, 32960 Alvarado-Niles Road, Suite 600,
Union City, CA 94587, USA. phornros@nccc.org
Epidemiological and pathological data suggest that thyroid cancer may
well be an estrogen-dependent disease. The relationship between thyroid
cancer risk and dietary phytoestrogens, which can have both estrogenic
and antiestrogenic properties, has not been previously studied. We
present data from a multiethnic population-based case-control study of
thyroid cancer conducted in the San Francisco Bay Area. Of 817 cases
diagnosed between 1995 and 1998 (1992 and 1998 for Asian women), 608
(74%) were interviewed. Of 793 controls identified through random-digit
dialing, 558 (70%) were interviewed. Phytoestrogen consumption was
assessed via a food-frequency questionnaire and a newly developed
nutrient database. The consumption of traditional and nontraditional
soy-based foods and alfalfa sprouts were associated with reduced risk of
thyroid cancer. Consumption of "western" foods with added soy flour or
soy protein did not affect risk. Of the seven specific phytoestrogenic
compounds examined, the isoflavones, daidzein and genistein [odds ratio
(OR), 0.70; 95% confidence interval (CI), 0.44-1.1; and OR, 0.65, 95%
CI, 0.41-1.0, for the highest versus lowest quintile of daidzein and
genistein, respectively] and the lignan, secoisolariciresinol (OR, 0.56;
95% CI, 0.35-0.89, for the highest versus lowest quintile) were most
strongly associated with risk reduction. Findings were similar for white
and Asian women and for pre- and postmenopausal women. Our findings
suggest that thyroid cancer prevention via dietary modification of soy
and/or phytoestrogen intake in other forms may be possible but warrants
further research at this time.
20
UI - 11815401
AU - Sakoda LC; Horn-Ross PL
TI -
Reproductive and menstrual history and papillary thyroid cancer risk:
the San Francisco Bay Area thyroid cancer study.
SO - Cancer Epidemiol Biomarkers Prev 2002 Jan;11(1):51-7
AD - Northern California Cancer Center, 32960 Alvarado-Niles Road, Suite 600,
Union City, CA 94587, USA.
Thyroid cancer rates are three times higher in women than men during the
period between puberty and menopause, suggesting that the etiology of
thyroid cancer may be related to female sex hormones and reproductive
function. However, the results from epidemiological studies have been
mixed. To assess this hypothesis, data on menstrual history, pregnancy
history, and exogenous hormone use were analyzed from a
population-based, case-control study conducted in the San Francisco Bay
Area. Of 817 incident thyroid cancer patients (cases), ages 20-74 years,
who were diagnosed in 1992-1998 and 793 controls, identified by
random-digit dialing and frequency matched to cases on age and
race/ethnicity, 608 (74%) cases and 558 (70%) controls were interviewed.
Of these cases, 544 were of papillary histology and included in the
present analysis. Women who reported onset of menarche before age 12 or
after age 14 were at about 50% increased risk for papillary thyroid
cancer; however, this effect differed among age- and ethnic-specific
subgroups. Among parous women younger than age 45, risk was elevated for
several variables measuring recency of pregnancy. Risk was reduced for
women who had ever used oral contraceptives [odds ratio (OR), 0.73; 95%
confidence interval (CI), 0.52-0.97], but there was no trend with
duration of use. Although it remains unclear how sex hormones influence
thyroid carcinogenesis, these relationships warrant further
investigation.
21
UI - 11849802
AU - Chow SM; Law SC; Mendenhall WM; Au SK; Chan PT; Leung TW; Tong CC; Wong
TI -
IS; Lau WH
Papillary thyroid carcinoma: prognostic factors and the role of
radioiodine and external radiotherapy.
SO - Int J Radiat Oncol Biol Phys 2002 Mar 1;52(3):784-95
AD - Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong,
China. chowsm@ha.org.hk
PURPOSE: To evaluate the role of radioiodine and external radiotherapy
treatment in papillary thyroid carcinoma (PTC). METHODS AND MATERIALS:
This is a retrospective study of 842 patients with the diagnosis of PTC
registered from 1960 to 1997 at the Department of Clinical Oncology,
Queen Elizabeth Hospital, Hong Kong. The mean follow-up was 9.2 years.
The stage distribution according to UICC/AJCC TNM staging was as
follows: 58.6%, Stage I; 9.6%, Stage II; 26.1%, Stage III; 2.3%, Stage
IV; and 3.4%, not stated. RESULTS: The 10-year cause-specific survival
(CSS) rates were as follows: Stage I, 99.8%; Stage II, 91.8%; Stage III,
77.4%; and Stage IV, 37.1%. Multivariate analysis showed that the
statistically significant poor prognostic factors for CSS were as
follows: age older than 45, postoperative gross locoregional (LR)
residual disease, distant metastasis (DM) at presentation, and lack of
radioactive iodine (RAI) treatment. In patients with no DM and no
postoperative LR disease, adjuvant RAI ablation reduced both LR failure
(RR [relative risk] = 0.29) and DM (RR = 0.2), although the CSS was not
affected. In the subgroup of T1N0 M0 disease, no patient with RAI
treatment had a relapse. External radiotherapy reduced the risk of LR
failure to 0.35. Subgroup analysis revealed that external radiotherapy
was particularly effective in increasing the probability of LR control
of disease in patients with gross postoperative LR disease (RR = 0.36).
CONCLUSIONS: Both RAI and external radiotherapy were effective treatment
in PTC. Total or near-total thyroidectomy followed by RAI treatment
appears to result in the best outcome. External radiotherapy to improve
LR control is indicated in patients with gross postoperative residual
disease. Treatment should be individualized for patients with T1N0 M0
disease.
22
UI - 11854692
AU - Civelek AC; Ozalp E; Donovan P; Udelsman R
TI -
Prospective evaluation of delayed technetium-99m sestamibi SPECT
scintigraphy for preoperative localization of primary
hyperparathyroidism.
SO - Surgery 2002 Feb;131(2):149-57
AD - Russell H. Morgan Department of Radiology and Radiological Science,
Division of Nuclear Medicine, The Johns Hopkins Medical Institutions,
Baltimore, MD, USA.
BACKGROUND: Delayed technetium-99m sestamibi single photon emission
computed tomography (SPECT) scans were prospectively analyzed in a large
series of patients with primary hyperparathyroidism. METHODS: Three
hundred thirty-eight patients underwent sestamibi-SPECT and were
explored. Prospective data included preoperative demographics, clinical,
sestamibi, and operative findings, laboratory values, and pathologic and
follow-up laboratory results from all patients. RESULTS: Between 1994
and 2000, 287 unexplored patients (85%) and 51 re-explored patients
(15%) participated. The abnormal parathyroid glands excised from 336 of
338 patients included 299 single adenomas (88%) and 23 double adenomas
(7%), and 14 patients had multigland hyperplasia (4%). Sestamibi SPECT
correctly lateralized 349 of 400 abnormal parathyroid glands, with an
overall sensitivity of 87%, an accuracy of 94%, and a positive
predictive value of 86%. Precise localization occurred in 82% of the
abnormal parathyroid glands. Sestamibi sensitivity was similar in
unexplored (87%) and reoperative (92%) cases; two hundred eighty-six of
299 (96%) solitary adenomas, 38 of 46 (83%) double adenomas, but only 25
of 55 (45%) hyperplastic glands were identified. The mean weight of the
true-positive glands (1252 +/- 1980 mg) was greater than that of the
false-negative glands (297 +/- 286 mg) (P <.005). Three patients had
persistent primary hyperparathyroidism, in spite of the excision of
sestamibi-identified lesions in 2 cases. Follow-up indicated curative
resection in 99% of the unexplored cases and 94% of the remedial cases.
CONCLUSIONS: Sestamibi SPECT is highly accurate for the localization of
parathyroid adenomas in unexplored and re-explored cases, where it is
often the only imaging required. Its sensitivity is limited in
multiglandular disease.
23
UI - 11854713
AU - Hodin R
TI -
The value of sestamibi scans.
SO - Surgery 2002 Feb;131(2):238-9
24
UI - 11839571
AU - Liu W; Asa SL; Fantus IG; Walfish PG; Ezzat S
TI -
Vitamin D arrests thyroid carcinoma cell growth and induces p27
dephosphorylation and accumulation through PTEN/akt-dependent and
-independent pathways.
SO - Am J Pathol 2002 Feb;160(2):511-9
AD - Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
We investigated the effects of 1,25-dihydroxycholecalciferol vitamin
D(3) (VD) and its noncalciomimetic analog EB1089 on thyroid carcinoma
cell growth. VD and EB1089 exhibited anti-proliferative effects in a
dose-dependent manner as determined by [(3)H]thymidine incorporation and
MIB-1 immunolabeling. VD or EB1089 resulted in similar G(1)-phase
arrest. Neither apoptosis nor differentiation was affected. VD and
EB1089 induced increased nuclear protein expression of the
cyclin-dependent kinase inhibitor, p27(kip1) (p27). VD/EB1089 effects
paralleled but were not additive to those of the proteasome inhibitor
LLnL, consistent with reduced p27 degradation. As p27 phosphorylation
and association with Skp2 is a key step in its degradation, we examined
the effects of VD/EB1089 on this reaction. Despite increased total p27,
the pThr content of p27 remained unaffected, an effect confirmed by
diminished association with Skp2 as well as in situ phosphorylation.
Moreover, phosphatase inhibition abrogated the effect of VD/EB1089 on
p27 accumulation consistent with a role for phosphatase action in
mediating this VD effect. Although VD/EB1089 resulted in comparable
increases in p27 in WRO and NPA cells, only WRO but not NPA cells
demonstrated a change in the phosphatase PTEN and its downstream target
pAkt/PKB in response to VD/EB1089. Transfection of PTEN resulted in p27
accumulation and was partially additive to the effect of VD/EB1089.
Moreover, treatment with PI-3 kinase inhibitors decreased pAkt/PKB and
increased p27 in both WRO and NPA cells highlighting the potential role
of this downstream pathway in regulating p27 in the thyroid. These
findings point to a novel mechanism of action for VD/EB1089 inhibition
of thyroid carcinoma cell growth by p27 hypophosphorylation, diminished
association with Skp2, and consequent accumulation. This effect can be
mediated but is not essentially dependent on the phosphatase
PTEN/Akt/PKB pathway. These properties support the potential utility of
VD analogs in the treatment of thyroid carcinomas irrespective of their
PTEN/pAkt status.
25
UI - 11769992
AU - Misiolek M; Waler J; Namyslowski G; Kucharzewski M; Podwinski A; Czecior
TI -
E
Recurrent laryngeal nerve palsy after thyroid cancer surgery: a
laryngological and surgical problem.
SO - Eur Arch Otorhinolaryngol 2001 Nov;258(9):460-2
AD - II ENT Department Silesian Medical University, Zabrze, Poland.
misiol@mp.pl
Recurrent laryngeal nerve paralysis is one of the most frequent
complications after thyroid surgery due to goiter and cancers. A higher
probability of this complication occurs after secondary procedure of the
thyroid and in malignant cases. The symptoms may differ and depend on
many factors. Generally, patients need careful ENT and surgical care
including diagnosis and treatment. Four hundred and sixty-six patients
who underwent thyroid operation due to cancer were analyzed. The group
was composed of 227 papillary carcinoma, 87 follicular carcinoma, 51
medullary carcinoma, and 101 anaplastic carcinoma. Two hundred and
fifty-three total thyroidectomies, 82 lobectomies and subtotal second
lobe operations, 91 subtotal thyroidectomies, and 40 biopsies (wedge
resections) were performed. In all 426 total and subtotal
thyroidectomies an attempt to identify the recurrent laryngeal nerves
was carried out. For 360 patients (77%) the surgical procedure was
primary and for 106 patients (23%) the operation was secondary.
Preoperative and postoperative laryngoscopic examinations were performed
in all patients. Every patient with palsy underwent special
laryngological procedures if needed (tracheotomy, phoniatric
rehabilitation, conservative treatment and surgery in lack of
improvement). The rate of postoperative vocal cord paralysis was 4.7%.
The permanent palsy rate was 3.5%. In 1.2% recovery was observed. Of the
4.7% palsy rate, 3.2% concerned unilateral palsy and 1.5% bilateral
pathology. Using the chi2 test, no significant differences between the
rate of unilateral and bilateral paralysis and between temporary and
permanent paralysis were found. On the basis of our material and
results, identification the recurrent laryngeal nerves should be
mandatory at surgery, thereby avoiding paralysis. Special laryngological
procedures and surgical care from the beginning of paralysis are
necessary for patients with vocal cord palsy. It allows to diagnose and
treat patients with quite good results.
26
UI - 11819103
AU - Brauckhoff M; Walls G; Brauckhoff K; Thanh PN; Thomusch O; Dralle H
TI -
Identification of the non-recurrent inferior laryngeal nerve using
intraoperative neurostimulation.
SO - Langenbecks Arch Surg 2002 Jan;386(7):482-7
AD - Klinik fur Allgemeinchirurgie, Martin-Luther-Universitat
Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097 Halle/Saale, Germany.
michael.brauckhoff@medizin.uni-halle.de
INTRODUCTION: The non-recurrent inferior laryngeal nerve occurs at a
frequency of about 0.5% and usually on the right side. The
identification of a non-recurrent laryngeal nerve may be difficult. We
describe a new method for its identification using intraoperative
neurostimulation. METHODS: We examined nine patients with a
non-recurrent inferior laryngeal nerve and five patients with a normal
inferior laryngeal nerve anatomy who were operated on trans-sternally.
Neurostimulation of the vagal nerve producing electromyographic signal
in the intrinsic laryngeal musculature was performed at different points
proximally and distally. RESULTS:: Electromyographic signals were found
proximally but not distally of the separation of the inferior laryngeal
nerve from the vagus in 14 patients. In nine patients with a
non-recurrent inferior laryngeal nerve, we performed neurostimulation of
the vagus opposite the lower and the upper thyroid poles. In all
patients we found no electromyographic signals at the distal stimulation
point. In contrast, proximal neurostimulation of the vagus opposite the
upper thyroid pole produced positive electromyographic signals.
CONCLUSION: Neurostimulation of the vagal nerve distally of the
separation of the inferior laryngeal nerve did not produce
electromyographic signals in the intrinsic laryngeal musculature,
perhaps due to the different modalities in the vagal fascicles. Negative
electromyographic signals following neurostimulation of the distal vagal
nerve opposite the lower thyroid pole should lead to proximal
neurostimulation of the vagus opposite the upper thyroid pole. Positive
electromyographic signals proximally and negative electromyographic
signals distally predict the occurrence of a non-recurrent inferior
laryngeal nerve which allows its diagnosis before surgical dissection of
the thyroid gland and may prevent nerve palsy.
27
UI - 11819104
AU - Cupisti K; Dotzenrath C; Simon D; Roher HD; Goretzki PE
TI -
Therapy of suspected intrathoracic parathyroid adenomas. Experiences
using open transthoracic approach and video-assisted thoracoscopic
surgery.
SO - Langenbecks Arch Surg 2002 Jan;386(7):488-93
AD - Klinik fur Allgemein- und Unfallchirurgie, Universitatsklinikum,
Heinrich-Heine-Universitat Dusseldorf, Moorenstrasse 5, 40225
Dusseldorf, Germany. cupisti@uni-duesseldorf.de
BACKGROUND AND AIMS: Ectopic mediastinal parathyroid adenoma as a cause
of primary hyperparathyroidism (pHPT) can normally be resected from
conventional collar incision. In rare cases with adenomas deeper in the
chest, a transthoracic approach is necessary. PATIENTS/METHODS: We
report our experience of 19 patients with suspected mediastinal
parathyroid adenomas from a total of 1035 patients with pHPT who were
operated on between 1986 and 2000 using an open approach (sternotomy or
thoracotomy) or video-assisted mediastinal or thoracoscopic surgery
(VAMS/VATS). RESULTS: Fourteen patients underwent an open approach with
a success rate of 71% (10 of 14). Four patients remained hypercalcaemic.
There were four complications in three patients: three permanent
recurrent nerve palsies and one chylus fistula, requiring further
surgery. VATS was successful in three of four patients with conversion
to sternal splitting because of a false-negative frozen section in one
patient. Another patient had parathyroid adenoma retrosternally which
could not be resected by means of VAMS and had to be excised using a
transsternal approach. There were no complications of minimal invasive
procedures. All five patients were normocalcaemic after the operation.
CONCLUSION: Ectopic parathyroid adenomas not resectable by means of a
collar incision are rare causes of pHPT and comprise 1.25% of all
patients with pHPT in our series. For these patients, VATS revealed an
alternative to conventional open procedures. In questionable cases,
however, the collar incision should precede the VATS procedure.
28
UI - 11740046
AU - Lloyd RV
TI -
Distinguishing benign from malignant thyroid lesions: galectin 3 as the
latest candidate.
SO - Endocr Pathol 2001 Fall;12(3):255-7
29
UI - 11740048
AU - Nascimento MC; Bisi H; Alves VA; Longatto-Filho A; Kanamura CT;
TI -
Medeiros-Neto G
Differential reactivity for galectin-3 in Hurthle cell adenomas and
carcinomas.
SO - Endocr Pathol 2001 Fall;12(3):275-9
AD - Thyroid Unit (LIM-25), Univ Sao Paulo Med School, Sao Paulo, Brazil.
Hurthle cell carcinomas behave as the most aggressive variant of
differentiated thyroid carcinoma of follicular origin, with frequent
recurrences and higher morbidity. Its differential diagnosis with
Hurthle cell adenoma remains a problem for the clinician and for the
pathologist. The vertebrate lectins, galectin-1 and galectin-3 have been
implicated in the regulation of cellular growth, differentiation, and
malignant transformation in thyroid neoplasms. Galectin-3, a
beta-galactoside binding protein, has been recently found to be highly
expressed in papillary and follicular carcinomas. The current study was
undertaken to investigate immunohistochemical reactivity for galectin-3
of thyroid specimen tissues with Hurthle cell adenomas (n = 14) and
carcinomas (n = 17), follicular (n = 14) and papillary (n = 11)
carcinomas, colloid goiter (n = 30), Hashimoto's thyroiditis (n = 11),
follicular adenoma (n = 9), and normal thyroid tissues (n = 18).
Follicular (78.5%) and papillary (82.0%) carcinomas were frequently
reactive for galectin-3, more often when some H rthle cells were
present. There was no galectin-3 immunostaining in any of the specimens
from Hashimoto's
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