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Purpose: The aim of this study was evaluate biochemical incomplete response (BIR) in Middle Eastern differentiated thyroid cancer (DTC), identify factors that could predict BIR before radioactive iodine (RAI) ablation and to investigate the long-term clinical outcome of DTC patient exhibiting BIR to initial therapy. Methods: We retrospectively evaluated 1286 DTCs from Middle Eastern ethnicity who underwent total thyroidectomy and RAI therapy. Demograpic and clinico-pathological factors predicting BIR were evaluated. The outcome of these patients was analyzed using primary outcome of structural disease and disease-free survival (DFS). Results: With a median follow-up of 10 years, 266 (20.7%) patients had BIR. High pre-ablation stimulated thyroglobulin (presTg), presence of lymph node metastasis, male gender and delayed initial RAI therapy (≥3 months) after thyroidectomy were significant independent predictors of BIR. Upon evaluating long-term clinical outcomes in 266 patients with BIR, we found 36.8% of patients developed structural disease. Male sex (OR = 1.56; 95% CI = 1.05–2.30; p = 0.0272) and increasing Tg after initial therapy (OR = 4.25; 95% CI = 1.93–10.82; p = 0.0001) were independent risk factors for structural disease in patients with BIR. DFS was significantly worse if both these risk factors existed concomitantly (p < 0.0001). Conclusion: To achieve the fair efficacy of RAI therapy, early prediction of BIR before RAI ablation is desirable. Our finding of the clinico-pathological factors (high presTg level, LNM, delayed RAI therapy and male gender) could serve as easy and robust early predictors of BIR. In addition, DTC patients exhibiting BIR had a high risk of structural disease and hence personalized management approach would be preferable for BIR patients to ensure best clinical outcome. [ABSTRACT FROM AUTHOR]

Background: Second 131I treatment is commonly performed in clinical practice in patients with differentiated thyroid cancer and biochemical incomplete or indeterminate response (BiR/InR) after initial treatment. Objective: The objective of the is study is to evaluate the clinical impact of the second 131I treatment in BiR/InR patients and analyze the predictive factors for structural incomplete response (SiR). Patients and methods: One hundred fifty-three BiR/InR patients after initial treatment who received a second 131I treatment were included in the study. The clinical response in a short- and medium- long-term follow-up was evaluated. Results: After the second 131I treatment (median 8 months), 11.8% patients showed excellent response (ER), 17% SiR, while BiR/InR persisted in 71.2%. Less than half (38.5%) of SiR patients had radioiodine-avid metastases. Patients who, following the second 131I treatment, experienced SiR had larger tumor size and more frequently aggressive histology and vascular invasion than those experienced BiR/InR and ER. Also, the median values of thyroglobulin on levothyroxine therapy (LT4-Tg), Tg peak after recombinant human TSH stimulation (rhTSH-Tg) and thyroglobulin antibodies (TgAb) were significantly higher in patients who developed SiR. At last evaluation (median: 9.9 years), BiR/ InR persisted in 57.5%, while 26.2% and 16.3% of the patients showed ER and SiR, respectively. About half of BiR/InR patients (71/153 (46.4%)) received further treatments after the second 131I treatment. Conclusions: Radioiodine-avid metastatic disease detected by the second 131I is an infrequent finding in patients with BiR/InR after initial treatment. However, specific pathologic and biochemical features allow to better identify those cases with higher probability of developing SiR, thus improving the clinical effectiveness of performing a second 131I treatment.

Context: The clinical response after surgery is a determinant in the management of patients with medullary thyroid carcinoma (MTC). In case of excellent or structural incomplete response, the follow-up strategies are well designed. Conversely, in case of biochemical incomplete response (BiR) the management is not clearly defined. Objective: This work aimed to evaluate the overall and per-site prevalence of structural disease detection in sporadic MTC patients with BiR and to assess the predictive value of various clinical, biochemical, and genetic features. Methods: We evaluated data of 599 consecutive patients surgically treated for sporadic MTC (2000-2018) and followed-up at the endocrine unit of the University Hospital of Pisa. Results: After a median of 5 months from surgery, 145 of 599 (24.2%) patients were classified as BiR. Structural disease was detected in 64 of 145 (44.1%), after a median time of 3.3 years. In 73.6%, structural disease was detected at a single site, prevalently cervical lymph nodes. Among several others, at the time of first evaluation after surgery, only basal calcitonin (bCTN) and stage IVa/b were independent predictive factors. Also, structural disease was more frequent in patients with shorter CTN doubling time and somatic RET mutation. Conclusion: In sporadic MTC patients with BiR, the risk of detection of structural disease was about 50% at 10 years. Higher bCTN levels and staging predicted the risk of detecting structural disease. According to these findings, stricter follow-up should be reserved for MTC with BiR and elevated values of bCTN and to those with an advanced stage. Long follow-up should be considered for all BiR patients since 50% of them develop structural disease within 10 years. [ABSTRACT FROM AUTHOR]

Background and purpose: The prognosis of differentiated thyroid cancer (DTC) patients with suspicious high thyroglobulin (Tg) concentration and without explicit structural lesions varies from each other, hence the clinical treatment decisions including 131I therapy remain controversial. This study aimed to explore the effects of 131I treatment and the therapeutic dose on the clinical outcome of these patients. Methods: The study included 138 DTC patients treated in Department of Nuclear Medicine, Peking Union Medical College Hospital from 2007 to 2021, who had undergone total thyroidectomy and subsequent 131I therapy. All patients were divided into 3 groups as low dose (dose=1.11 GBq), medium dose (1.11 GBq

Objective: The application of radiofrequency ablation (RFA) for recurrent thyroid cancer has been demonstrated to effectively manage lesions at critical locations, such as abutting the trachea, with limited complications. Comprehensive investigation of both biochemical (B) and structural (S) change after RFA remains limited. We herein present the first single-center experience of RFA for the treatment of locoregional recurrent thyroid cancer in Taiwan. Design: 23 patients were enrolled, and the treatment responses after RFA were divided into four groups (E, S(+), B(+), and SB(+)), and then compared. The RFA technique, follow-up strategy, changes in pre-and post-operative status, and complications are presented. The volume reduction rate at 1, 3, and 6 months, and the differing responses between lesions abutting/not abutting the trachea are also discussed. Results: In patients with pre-RFA structural and biochemical incomplete (SB(+)) status, presenting with lesion with an initial maximum diameter of >3.2cm, a higher rate of structural incomplete status at the 6-month follow-up was noted in ROC analysis, with a sensitivity of 57% and specificity of 91%. Favorable structural remission after RFA was noted, and 60.9% of patients achieved biochemical complete status. No significant correlation was noted between the trachea-abutted lesion number and complete remission (p= 0.474). No significant difference in RFA efficacy was noted between the lesions abutting/not abutting the trachea. Conclusions: This retrospective study reveals that RFA can achieve both structural and biochemical improvements for locoregionally recurrent thyroid cancer, with a low complication rate. Nearly half of the patients achieved an excellent response after RFA, while a favorable treatment response can be achieved despite the lesion abutting the trachea, with a mean VRR of 84.74%. [ABSTRACT FROM AUTHOR]

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Objective: Little is known regarding parameters predicting persistence/recurrence for differentiated thyroid cancer (DTC) patients exhibiting biochemical incomplete response (BIR) to initial therapy. High post-ablation stimulated thyroglobulin (ps-Tg) levels have undetermined prognostic significance in DTC patients with BIR. The goal of this bi-center study was to systemically assess the prognosis of DTC patients with BIR in relation to ps-Tg levels and to establish the determinants of clinical outcomes. Design and methods: The retrospective study of consecutive 81 DTC patients from two tertiary centers who were classified as BIR after total thyroidectomy and radioiodine ablation between January 2010 to December 2019 were analyzed. BIR was defined as ps-Tg > 10 ng/mL measured under thyroid hormone withdrawal at 9–12 months followed by radioiodine ablation, negative anti-Tg antibodies, and no structural evidence of disease. Multivariable regression models were used to evaluate potential risk factors associated with clinical outcomes. Results: With a median follow-up of 5.4 years, 28 patients (34.6%) showed no evidence of disease and 50 patients (61.7%) were of a biochemical persistent status at the time of final follow-up. Conversely, 3 patients (3.7%) developed structural evidence of disease. Ps-Tg of 20.2 ng/mL or greater displayed the high positive predictive value (81%) for disease persistence/recurrence. Multivariate analysis revealed that only a high ps-Tg level (>20.2 ng/mL) was an independent risk factor for persistent/recurrent disease (odds ratio = 5.6; p < 0.001). Conclusion: The ps-Tg (>20.2 ng/mL) was a valuable predictor of disease persistence/recurrence in DTC patients with BIR. [ABSTRACT FROM AUTHOR]

• LNR was independently associated with postoperative Tg levels. • Patients with a high LNR were more likely to have biochemical incomplete response. • The mean LNR in the central neck was 0.22. • The mean LNR in the lateral neck was 0.06. • Twenty patients (16.9%) had postablative uTg ≥ 1 ng/mL. To investigate the impact of the lymph node ratio (LNR) on postoperative thyroglobulin (Tg) levels in patients with papillary thyroid carcinoma (PTC). This was a retrospective, cohort study. The association between clinicopathological variables and postoperative unstimulated Tg (uTg) levels, preablative-stimulated Tg (sTg) levels, and postablative unstimulated Tg levels was analysed. A total of 300 patients with PTC were identified. Multivariate logistic analysis showed that M classification (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.62–3.34), and postoperative thyroid-stimulating hormone levels (OR, 1.01; 95% CI, 1.01–1.02) were independently associated with postoperative uTg levels. One hundred and sixteen patients underwent radioactive iodine (RAI) therapy. Multivariate analysis showed that LNR in the central neck (OR, 1.24; 95% CI, 1.02–1.51), LNR in the lateral neck (OR, 1.73; 95% CI, 1.09–2.77), RAI dose (OR, 1.43; 95% CI, 1.21–1.69), and M classification (OR, 1.79; 95% CI, 1.22–2.61) were independently associated with preablative sTg levels. Tumour size (OR, 1.01; 95% CI, 1.00–1.01), LNR in the central neck (OR, 1.28; 95% CI, 1.08–1.51), LNR in the lateral neck (OR, 1.66; 95% CI, 1.10–2.49), RAI dose (OR, 1.54; 95% CI, 1.34–1.79), and M classification (OR, 1.56; 95% CI, 1.12–2.19) were also independently associated with postablative uTg levels. LNR was independently associated with postoperative Tg levels in patients with PTC. Patients with high LNR were more likely to have incomplete biochemical responses after surgery. [ABSTRACT FROM AUTHOR]

Introduction: Patients with incomplete response to initial therapy of thyroid cancer can be managed with ongoing observation or potentially additional therapies. Our aim was to assess the effect of a second radioactive iodine treatment (RAIT) and its relationship with causes and clinical variables., Material and Methods: Patients undergoing a second RAIT for biochemical or structural incomplete response to initial therapy of DTC were retrospectively included (n=120). They were categorised based on the American Thyroid Association (ATA) classification of response to initial therapy. Patients were reclassified in the following 6-18 months after second RAIT based on imaging findings and measurements of thyroglobulin and antithyroglobulin antibody levels. The associations of a downgrading of response category and progression-free survival (PFS), and the related variables, were evaluated., Results: Sixty-six patients (55%) had a downgrading on ATA response category after second RAIT. A significant interdependence of causes for second RAIT and outcomes was found (χ 2 =29.400, p=0.001), with patients with neck reoperation showing a higher rate of indeterminate or excellent responses. A significant association between ATA response to second RAIT and absence of structural progression was found (χ 2 =44.914, p<0.001), with less structural progression in patients with downgrading on ATA response (χ 2 =30.914, p<0.001). There was also significant interdependence to some clinical variables, such as AJCC stage (χ 2 =8.460, p=0.015), ATA risk classification (χ 2 =10.694, p=0.005) and initial N stage (χ 2 =8.485, p=0.004)., Conclusions: In selected cases, a second RAIT could lead to more robust responses with a potential improvement in prognosis in patients with incomplete response to initial DTC treatment., (Copyright © 2023 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved.)