A case study on dynamic thermal imaging evaluation of a thyroid nodule

BACKGROUND:The thyroid gland is a butterfly-shaped organ located in the neck anteriorly to the larynx and trachea, typically extending from the level of C5-T1. It is responsible for the release of hormones that control metabolic rates and thereby modifying obligatory and adaptive thermogenesis. This organ can be affected by nodules and cellular malforma- tions, which can result in malignant neoplasia or benign cysts. Those manifestations may change the normal pattern of skin temperature distribution in the affected area. The aim of this study is to investigate the thermal pattern of a subject presenting a hypervascularized nodule located on the left side of the thyroid. MATERIALS AND METHODS: A male with 40 years old presenting a 11x6 mm nodule in the left side of his thyroid, con- firmed by functional doppler imaging, was examined in a controlled environment using a FLIR E60 thermal camera and two aluminium disks to provide a cooling provocation during one minute on the skin, above the thyroid gland location. Thermal images were taken before and until the fifth minute after cooling at an interval of 1 minute. A 26x26 pixel square region of interest (ROI) was drawn in the analysis software to statistically analyze the temperature values, histogram, mean, median and mode temperature, standard deviation, kurtosis and skewness per ROI and side. RESULTS:The ROI presented at baseline a bilateral difference in mean temperature of 0.4 ºC, after cooling this difference was accentuated, the affected side recovered quickly and showed a hot spot in the area of the nodule identified by Doppler imaging. CONCLUSION:This case study showed evidence of the utility on using dynamic infrared thermal imaging when assess ing thyroid nodules, which was confirmed by Doppler imaging to be highly vascularized. However, for diagnostic pur poses the traditional expensive methods such as biopsy and nuclear medicine are still required. Still the application of IRT imaging should be further researched in possible monitoring and documenting the diagnosis and treatment evaluation applied to thyroid conditions.info:eu-repo/semantics/publishedVersio

Management of surgical diseases of thyroid gland indications of the United Italian Society of Endocrine Surgery (SIUEC)

A task force of the United Italian society of Endocrine Surgery (SIUEC) was commissioned to review the position statement on diagnostic, therapeutic and health-care management protocol in thyroid surgery published in 2016, at the light of new technologies, recent oncological concepts, and tailored approaches. The objective of this publication was to support surgeons with modern rational protocols of treatment that can be shared by health-care professionals, taking into account important clinical, healthcare and therapeutic aspects, as well as potential sequelae and complications. The task force consists of 13 members of the SIUEC highly trained and experienced in thyroid surgery. The main topics concern clinical evaluation and preoperative workup, patient preparation for surgery, surgical treatment, non-surgical options, postoperative management, prevention and management of major complications, outpatient care and follow-up

Management of surgical diseases of thyroid gland indications of the United Italian Society of Endocrine Surgery (SIUEC)

A task force of the United Italian society of Endocrine Surgery (SIUEC) was commissioned to review the position statement on diagnostic, therapeutic and health‑care management protocol in thyroid surgery published in 2016, at the light of new technologies, recent oncological concepts, and tailored approaches. The objective of this publication was to support surgeons with modern rational protocols of treatment that can be shared by health-care professionals, taking into account important clinical, healthcare and therapeutic aspects, as well as potential sequelae and complications. The task force consists of 13 members of the SIUEC highly trained and experienced in thyroid surgery. The main topics concern clinical evaluation and preoperative workup, patient preparation for surgery, surgical treatment, non-surgical options, postoperative management, prevention and management of major complications, outpatient care and follow-up

Advances in the Diagnosis and Treatment of Thyroid Carcinoma

This reprint is related to the latest research in the field of thyroid surgery, including molecular and imaging diagnosis, surgical treatment, and the treatment of recurrent disease and advanced thyroid carcinoma

Adapting ambient ionization mass spectrometry methods for disease characterization and tissue classification

Ambient ionization mass spectrometry (MS) techniques have brought about a new era of clinical MS research by allowing for direct, rapid analysis of biological samples. Methods such as desorption electrospray ionization (DESI) MS enable chemical mapping of biomolecules directly from unprocessed tissue specimens, allowing investigation of disease states and offering insights into dysregulated metabolism. The molecular information obtained can act as a diagnostic fingerprint and be used to discriminate healthy and diseased tissue. Furthermore, handheld ambient MS-based devices such as the MasSpec Pen have recently been developed for analysis of tissues in vivo. These technologies are capable of providing feedback to clinicians in near real-time to aid in surgical decision making, demonstrating potential for translation of MS into a surgical setting. Ambient ionization techniques require minimal sample preparation, allow for rapid analysis of tissue in situ, and can be performed at atmospheric pressure in open air; as such, these techniques have the potential to be easily translated into a clinical workflow. This dissertation describes the development and application of ambient ionization MS methods for disease characterization and tissue classification. Chapter 2 describes the application of DESI-MS imaging to identify altered metabolites in a gene knockout mouse model to help elucidate metabolic processes potentially contributing to the occurrence of neural tube defects. Chapters 3-5 describe the development of ambient ionization MS technologies to address clinical challenges in the diagnosis and treatment of patients with endocrine diseases. In Chapter 3, DESI-MS mass spectral profiles of thyroid tissue sections were used to build statistical models for discriminating benign and malignant tissues. These models were then validated using prospectively collected thyroid fine needle aspiration biopsy samples, demonstrating the capabilities of this method for preoperative classification of thyroid nodules. Next, the performance of the benign thyroid versus papillary thyroid carcinoma classifier was evaluated on an independent dataset collected on a different DESI-MS platform, as outlined in Chapter 4. Chapter 5 discusses the capabilities of the MasSpec Pen for the intraoperative classification of thyroid, parathyroid, and lymph node tissues during cervical endocrine surgeries.Chemistr

Bronchoscopic confocal laser endomicroscopy for lung cancer diagnosis:Shining light on advanced needle techniques

Lung cancer is a global health concern and leading cause of cancer-related deaths. Diagnostic procedures such as bronchoscopy and endosonography regulary yield insufficient tissue due to inadequate needle positioning or sampling errors. The first part of the thesis focused on an emerging imaging technique called needle based confocal laser endomicroscopy (nCLE) to overcome these problems. nCLE is a laser-based imaging technique, providing high-resolution real-time images at the biopsy needle tip in-vivo. Bronchoscopic nCLE-imaging of peripheral lung nodules suspected of lung cancer proved to be feasible, safe and allowed immediate tumor cell visualization. Additionally, by validation of nCLE criteria for surrounding airway and lung parenchyma, nCLE-imaging during (robotic-)bronchoscopic procedures allowed optimization of the needle positioning. Furthermore, nCLE criteria for granulomas were identified and validated in sarcoid mediastinal lymph nodes and lung nodules. Whether the addition of nCLE-imaging to bronchoscopic procedures will result in an improved diagnostic yield needs further exploration. Future integration with artificial intelligence and fluorescent tracers holds promise for improved diagnostic efficiency and potential therapeutic applications. The second part of the thesis focused on endobronchial ultrasound in diagnosing lung cancer, detailing a randomized trial comparing 22G Acquire and Expect biopsy needles for PD-L1 suitability. Despite superior quality in samples obtained with the Acquire needle, no statistically significant difference in the PD-L1 suitability rate between both arms was found. In conclusion, nCLE as a ‘smart needle’ technique has the potential to improve the diagnostic yield of bronchoscopic peripheral lung nodule analysis but further studies are needed before clinical implementation

Postoperative hypoparathyroidism - Current and novel preventative methods

Background Hypocalcaemia is the most common complication following thyroid surgery. It is associated with significant short and long-term patient morbidity. Many studies have assessed and reported on risks, predictive and preventative factors for post-operative hypocalcaemia. The aims of this research were to search the literature for useful preventative measures of post-thyroidectomy hypoparathyroidism and to assess two novel modalities for their potential in the early intraoperative identification and preservation of parathyroid glands to avoid postoperative hypocalcaemia. The objectives of the study were: 1- To perform a systematic review and meta-analysis of the effectiveness of preventative and other surgical measures on post-thyroidectomy hypocalcaemia. 2- To study Methylene Blue (MB) emitted fluorescence from soft tissue structures in the rabbit neck thereby examining its potential for use in human surgery to differentiate between thyroid and parathyroid glands. 3- To determine the electrical impedance patterns of the thyroid, parathyroid and other soft tissue structure in the rabbit neck thereby examining the potential of impedance spectroscopy as an intraoperative tool for parathyroid identification. Methods Systematic review and meta-analysis: A comprehensive search of PubMed, EMBASE, and Cochrane databases was performed for studies reporting on preventative and other surgical measures and their effect on reducing post-thyroidectomy hypoparathyroidism. Quality of included papers was assessed using the Cochrane risk of bias tool or a modified Newcastle-Ottawa Scale (NOS). The results of all included studies were summarized and meta-analyses were performed where appropriate. Two animal experiments were then carried out to assess the potential role of two novel modalities, near-infrared (NIR) fluorescence imaging using intravenous (IV) MB and electrical impedance spectroscopy (EIS), in the prevention of post-operative hypocalcaemia. Near-infrared (NIR) fluorescence imaging using intravenous MB: Thyroid and external parathyroid glands (PGs) were exposed in six New Zealand White (NZW) rabbits under anaesthesia. Varying doses of MB (0.025 - 3 mg/kg) were injected through the marginal ear vein. NIR fluorescence from exposed tissues was recorded at different time intervals (0 - 74 minutes) using Fluobeam®700 device. Electrical Impedance Spectroscopy (EIS): The central neck compartment was dissected in nine freshly culled NZW rabbits. In vivo and ex vivo electrical impedance (EI) were measured from thyroid lobes, external PGs, adipose tissue and strap muscle using APX100TM device. The glands identified in these experiments were resected and sent for histological assessment. Results Systematic review and meta-analysis: This included 39 randomised controlled trials (RCTs) and 37 observational studies. Interventions studied included; haemostatic techniques, extent of thyroidectomy and central neck dissection, surgical approach, supplements (calcium, vitamin D and thiazide diuretics), parathyroid gland auto-transplantation (PGAT) and intra-operative parathyroid gland (PG) identification, truncal ligation of inferior thyroid artery (ITA), pre-operative magnesium infusion, and use of magnification loupes and surgicel. Measures associated with significantly lower rates of transient hypocalcaemia in meta-analysis were: post-operative calcium and vitamin D supplementation compared to either calcium supplements alone (odds ratio (OR) 0.66; p=0.04) or no supplements (OR 0.34; p=0.007), and bilateral subtotal thyroidectomy (BST) compared to Hartley Dunhill (HD) procedure (OR 0.35; p=0.01). Meta-analyses did not demonstrate any measure to be significantly associated with a reduction in permanent hypocalcaemia. NIR fluorescence: Thyroid and external PGs were the only neck structures to demonstrate significant fluorescence in the central neck compartment. External PGs demonstrated lower fluorescence intensities and reduced washout times at all MB doses compared to the thyroid gland. A dose of 0.1 mg/kg MB was adequate to identify fluorescence; this also delineated the blood supply of the external PGs. EIS: The impedance was higher for thyroid tissue at lower frequencies and for parathyroid tissue at higher frequencies. Ex vivo electrical impedance spectra were significantly higher compared to the in vivo spectra across all frequencies for thyroid and parathyroid tissues (p < 0.001). The ratio of low to high frequency in vivo impedance of thyroid, parathyroid and muscle was significantly different (p < 0.001), allowing for differentiation between these tissues. Histology confirmed correct identification of all excised thyroid and PGs in both experiments. Conclusions The systematic review identified post-operative calcium and vitamin D supplementation and bilateral subtotal thyroidectomy (over HD) as being effective in prevention of transient hypocalcaemia. However, the majority of RCTs were of low quality, primarily due to lack of blinding. The wide variability in study design, outcome definitions and assessment methods prevented meaningful summation of results from studies on a number of preventative measures and for permanent hypocalcemia. NIR fluorescence with IV MB helps to differentiate between thyroid and PGs in the rabbit. This has the potential to improve outcomes in thyroid and parathyroid surgery by increasing the accuracy of parathyroid identification. The use of low doses of MB may also avoid the side effects associated with currently used doses in humans (3-7mg/kg). Electrical impedance spectra of rabbit thyroid and parathyroid glands are distinct and different from each other and from skeletal muscle. If these results are replicated in human tissue, they have the potential to improve patient outcomes by achieving early identification and preservation of PGs

Heating technology for malignant tumors: a review

The therapeutic application of heat is very effective in cancer treatment. Both hyperthermia, i.e., heating to 39-45 degrees C to induce sensitization to radiotherapy and chemotherapy, and thermal ablation, where temperatures beyond 50 degrees C destroy tumor cells directly are frequently applied in the clinic. Achievement of an effective treatment requires high quality heating equipment, precise thermal dosimetry, and adequate quality assurance. Several types of devices, antennas and heating or power delivery systems have been proposed and developed in recent decades. These vary considerably in technique, heating depth, ability to focus, and in the size of the heating focus. Clinically used heating techniques involve electromagnetic and ultrasonic heating, hyperthermic perfusion and conductive heating. Depending on clinical objectives and available technology, thermal therapies can be subdivided into three broad categories: local, locoregional, or whole body heating. Clinically used local heating techniques include interstitial hyperthermia and ablation, high intensity focused ultrasound (HIFU), scanned focused ultrasound (SFUS), electroporation, nanoparticle heating, intraluminal heating and superficial heating. Locoregional heating techniques include phased array systems, capacitive systems and isolated perfusion. Whole body techniques focus on prevention of heat loss supplemented with energy deposition in the body, e.g., by infrared radiation. This review presents an overview of clinical hyperthermia and ablation devices used for local, locoregional, and whole body therapy. Proven and experimental clinical applications of thermal ablation and hyperthermia are listed. Methods for temperature measurement and the role of treatment planning to control treatments are discussed briefly, as well as future perspectives for heating technology for the treatment of tumors