Search

Aims: Tumour necrosis and/or increased mitoses define high‐grade papillary thyroid carcinoma (PTC). It is unclear whether angioinvasion is prognostic for PTC. Cut‐offs at five or more mitoses/2 mm2 and four or more angioinvasive foci have been empirically defined based upon data from all forms of aggressive non‐anaplastic thyroid carcinomas. Performance of tumour necrosis, mitoses and vascular invasion in predicting distant metastases when specifically applied to PTC is undefined. Methods: We analysed 50 consecutive PTC cases with distant metastases (DM‐PTC): 16 synchronous and 34 metachronous. A total of 108 non‐metastatic PTC (N‐DM‐PTC, 15.0‐year median follow‐up) were used as controls. Invasive encapsulated follicular variant PTC was excluded. Necrosis, mitoses and angioinvasion were quantified. Receiver operating characteristics (ROC) and area under the curve (AUC) analyses determined best sensitivity and specificity cut‐offs predictive of distant metastases. Results: Metastases correlated with necrosis (any extent = 43.8% all DM‐PTC, 53.1% metachronous DM‐PTC versus 5% N‐DM‐PTC; P < 0.001), mitoses (P < 0.001) and angioinvasion (P < 0.001). Mitoses at five or more per 2 mm2 was the best cut‐off correlating with distant metastases: sensitivity/specificity 42.9%/97.2% all DM‐PTC (AUC = 0.78), 18.8%/97.2% synchronous DM‐PTC (AUC = 0.63), 54.6%/97.2% metachronous DM‐PTC (AUC = 0.85). Angioinvasive foci at five or more was the best cut‐off correlating with distant metastases: sensitivity/specificity 36.2%/91.7% all DM‐PTC (AUC = 0.75), 25%/91.7% synchronous DM‐PTC (AUC = 0.79) and 41.9%/91.7% metachronous DM‐PTC (AUC = 0.73). Positive/negative predictive values (PPV/NPV) were: necrosis 22.6%/98.2%; five or more mitoses 32.3%/98.2%; five or more angioinvasive foci 11.8%/97.9%. After multivariable analysis, only necrosis and mitotic activity remained associated with DM‐PTC. Conclusion: Our data strongly support PTC grading, statistically validating World Health Organisation (WHO) criteria to identify poor prognosis PTC. Angioinvasion is not an independent predictor of DM‐PTC. [ABSTRACT FROM AUTHOR]

Background: The use of ultrasound‐guided ablation procedures to treat both benign and malignant thyroid conditions is gaining increasing interest. This document has been developed as an international interdisciplinary evidence‐based statement with a primary focus on radiofrequency ablation and is intended to serve as a manual for best practice application of ablation technologies. Methods: A comprehensive literature review was conducted to guide statement development and generation of best practice recommendations. Modified Delphi method was applied to assess whether statements met consensus among the entire author panel. Results: A review of the current state of ultrasound‐guided ablation procedures for the treatment of benign and malignant thyroid conditions is presented. Eighteen best practice recommendations in topic areas of preprocedural evaluation, technique, postprocedural management, efficacy, potential complications, and implementation are provided. Conclusions: As ultrasound‐guided ablation procedures are increasingly utilized in benign and malignant thyroid disease, evidence‐based and thoughtful application of best practices is warranted. [ABSTRACT FROM AUTHOR]

Combined application of ultrasound and SPECT/CT has incremental value in detecting parathyroid tissue in SHPT patients. A, inferior thyroid artery; c, common carotid artery; p, parathyroid adenoma; t, thyroid lobe; inf, inferior; sup, superior gl Intraoperative parathyroid hormone testing testing Venous blood sampling was taken three times: before incision (basal level), after manipulation of the adenoma and 7 minutes after its complete excision. Reduced surgical manipulation in a cohort of patients treated by minimally invasive parathyroidectomy with ultrasonography-based visual map The correct localisation of parathyroid adenomas is one of the main difficulties during mini-invasive parathyroidectomy. [Extracted from the article]

Objectives/Hypothesis The aim of this study was to identify any possible predictive factors of lateral neck recurrence in patients with papillary thyroid carcinoma with no ultrasonographic and/or cytological evidence of lymph node metastasis at time of diagnosis. The influence of lateral neck recurrence on survival was also investigated. Study Design Observational retrospective study. Methods Retrospective review of clinical records of 610 patients surgically treated for papillary thyroid carcinoma with clinically negative lymph nodes at the Otolaryngology Unit of the Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy, from January 1984 to December 2008. Results Lateral neck recurrences were ipsilateral to the primary tumor in all cases and were associated with the occurrence of more aggressive histological variants and central neck metastasis. Lateral neck recurrences were more frequently observed in patients with distant metastases and were associated with a reduced disease-specific survival. Conclusion Lateral neck compartment ipsilateral to the tumor was the most common site of recurrence, with about half of cases appearing in the first 28 months of follow-up. In patients with papillary thyroid carcinoma, detection of lateral neck metastases prior to first surgery is crucial to surgical planning. Aggressive histological variants and postsurgical evidence of lymph node metastasis from papillary thyroid carcinoma in central neck compartment are associated with a higher risk of lateral neck recurrence. In these patients, a closer postsurgical ultrasound surveillance of the lateral neck compartments seems worthwhile. Level of Evidence 4. Laryngoscope, 125:2226-2231, 2015 [ABSTRACT FROM AUTHOR]

The agreement of the different cytological categories used worldwide is a long lasting and highly debated topic. Although the systems are broadly similar, some differences still exist especially in grey areas, i.e. the poorly defined classes like Thy3a. Trying to reduce the interobserver variability, we limit the diagnosis of THY3a to cases with scanty atypia (SA), which is the first and most important pattern described by Van der Horst et al. and encompasses cases in which some atypical features are present but their interpretation can be influenced by cell scarcity, artefacts and cystic changes. [ABSTRACT FROM AUTHOR]

Objective To report the Italian experience on cinacalcet use following its approval by the European Medical Agency ( EMA) to control hypercalcaemia in patients with primary hyperparathyroidism ( PHPT). Design Retrospective data collection from 100 patients with sporadic (s PHPT) and 35 with familial PHPT (f PHPT) followed in eight Italian centres between October 2008 and March 2011. Measurements Albumin-adjusted serum calcium, PTH, 25 OHD, daily cinacalcet dose and adverse events were recorded during the follow-up (1-46 months). Results Baseline serum calcium was 2·90 ± 0·27 nmol/l in s PHPT and 2·75 ± 0·17 nmol/l in f PHPT patients ( P = 0·007). The cinacalcet EMA labelling was met in 53% s PHPT and 26% f PHPT patients. High surgical risk (34%), negative preoperative imaging (19%), control of hypercalcaemia before parathyroidectomy ( PTx) (24%), and refusal of PTx (19%) accounted for cinacalcet prescription in 96% of s PHPT patients. Conversely, initial treatment (34%), persistent/relapsing PHPT after surgery (31%), and refusal of PTx (14%) were the indications in 79% f PHPT patients. Cinacalcet was started at 30 mg/daily in 64% of s PHPT and 91% of f PHPT and increased until normocalcaemia was reached or side effects occurred. The final daily dose ranged between 15 and 120 mg. The majority of patients (65% of s PHPT and 80% of f PHPT) become normocalcaemic. Treatment was withdrawn in six patients because of side effects. Conclusions There is a wide heterogeneity in the prescription of cinacalcet in PHPT patients in Italy and the EMA labelling is not always followed, particularly in f PHPT patients. Cinacalcet effectively reduces serum calcium in patients with either s PHPT or f PHPT. [ABSTRACT FROM AUTHOR]

OBJECTIVE Insulin-like growth factor binding-protein-1 (IGFBP-1) has a role in glucose homeostasis and is present at high concentrations in hyperthyroidism. We have investigated the relationship between IGFBP-1 concentration and glucose homeostasis in hyperthyroidism. DESIGN Patients and controls had intravenous glucose tolerance tests (IVGTT) and/or oral glucose tolerance tests (OGTT). Patients were tested when hyperthyroid and when euthyroid whilst the controls were tested once. The IVGTT was used to assess insulin sensitivity and the OGTT to establish that the study group had abnormal glucose tolerance. The hyperthyroid patients were treated with methimazole to restore euthyroidism. PATIENTS Ten patients (9 females) and 13 healthy controls (9 females) consented to the study. Ten patients and nine controls (7 females) had IVGTT. Six patients (5 females) and six controls (4 females) had OGTT. MEASUREMENTS Glucose, insulin, glucagon, GH and IGFBP-1 were measured during GTT. IGF-I, free thyroid hormones, and TSH concentrations were measured basally. RESULTS Hyperthyroid subjects were insulin resistant and 67% had impaired glucose tolerance. Fasting IGFBP-1 levels were doubled in hyperthyroid subjects compared to healthy controls and correlated positively with free T4 (r = 0.84, P < 0.0001), with peak glucose during the OGTT (r = 0.68, P < 0.005) with peak insulin during the IVGTT (r = 0.51, P < 0.005) and negatively with glucose disappearance constant (r = - 0.52, P < 0.005). IGFBP-1 was highly phosphorylated in hyperthyroid and control subjects. Fasting insulin and IGFBP-1 levels were unrelated but IGFBP-1 suppressed acutely during GTT in all groups. GH levels fell less in patients with hyperthyroidism than in normals during GTTs. CONCLUSIONS We conclude that in hyperthyroidism thyroid hormones directly increase fasting IGFBP-1 concentration but acute regulation of IGFBP-1 by insulin is normal and that elevated fasting phosphorylated IGFBP-1 concentration is... [ABSTRACT FROM AUTHOR]