The occurrence of malignant thyroid lesions in patients after radioiodine treatment due to benign thyroid diseases

Wstęp: Leczenie radiojodem (RT, radioiodine treatment) chorób łagodnych tarczycy jest uznaną, bezpieczną i skuteczną metodą. W grupie chorych po RT, pozostających pod wieloletnią obserwacją autorów pracy, czasami zdarzały się przypadki zmian nowotworowych w tarczycy. Postanowiono ocenić jak często, mimo wykluczenia zmian złośliwych w tarczycy przed leczeniem, może się to zdarzyć w dłuższym okresie obserwacji. Materiał i metody: Grupa 4314 chorych (7438 osobolat) po RT pozostawała następnie pod obserwacją od 1-8 lat (śr. 20,69 miesięcy). W trakcie badań kontrolnych, oprócz oceny czynności tarczycy, wykonywano między innymi biopsję aspiracyjną cienkoigłową (BAC) zmian ogniskowych w tarczycy lub zmian na szyi, do której kwalifikowano ultrasonograficznie lub klinicznie (pojawienie się zmiany palpacyjnej). Pacjentów z nieprawidłowym BAC analizowano i weryfikowano histopatologicznie. Wyniki: U 12 z 4314 (0,27%) chorych stwierdzono w BAC zmiany podejrzane. Zmiany w tarczycy znaleziono u 9 osób (8 K, 1 M) w wieku 46-73 lat (śr. wieku 56 lat), 3-57 miesięcy po RT. Raka brodawkowatego stwierdzono u dwóch osób, guz z komórek Hürthle’a u jednej osoby, cytologicznie podejrzane komórki u dwóch osób (histopatologicznie zmiany łagodne). Dwie chore nie zgodziły się na leczenie operacyjne: jedna z podejrzeniem raka brodawkowatego, a druga z komórkami cytologicznie podejrzanymi w BAC. Guzek pęcherzykowy był podejrzany u 2 chorych: o jednej z nich nie ma danych, drugi chory został zdyskwalifikowany do leczenia operacyjnego tarczycy z powodu współistniejącego rozpoznania raka płuca. U pozostałych 3 osób stwierdzono zmiany przerzutowe w okolicznych węzłach chłonnych z powodu innych nowotworów. Wnioski: Zmiany nowotworowe w tarczycy u pacjentów po RT z powodu zmian łagodnych zdarzają się sporadycznie, ale wskazana jest okresowa ocena kliniczna i ultrasonograficzna tych chorych. (Endokrynol Pol 2010; 61 (5): 454-457)Introduction: Radioiodine treatment (RT) of benign thyroid diseases is a well-known, safe, and effective treatment. In a group of patients after RT, who remained in long-term follow-up, sporadic cases of malignant thyroid lesions occurred. The aim of the study was to estimate how often it happened despite the exclusion of malignancy before RT. Material and method: A group of 4314 patients (7438 person-years) underwent RT and subsequently were followed-up for 1-8 years (mean 20.69 months). Apart from thyroid function estimation, if needed, fine needle aspiration biopsy (FNAB) of the thyroid or neck focal lesions was performed based on ultrasonographic or clinical examination. Patients with pathological FNAB were analyzed and histopathologically verified. Results: In 12 out of 4314 cases (0.27%) suspicious FNAB results were found. Suspicious thyroid lesion results were found in 9 patients (8 F, 1 M), aged 46-73 (average 56 years) followed up for 3-57 months after RT: papillary cancer in two patients, Hürthle cell tumour in one patient, and suspicious cells in two patients (with benign lesions on postoperative histopathology). Two patients refused surgery (a suspicion of papillary cancer in one case and suspicious cells in FNAB in the second case). A follicular tumour in FNAB was suspected in two cases (no data about the first, and the second with lung cancer was not operable). In the remaining 3 cases FNAB revealed lymph node metastases due to other cancers. Conclusions: Malignant thyroid lesions in patients after RT due to benign thyroid diseases are seldom detected. However, periodical clinical and ultrasonographic evaluation is recommended. (Pol J Endocrinol 2010; 61 (5): 454-457

The diagnostic value of dual-phase SPECT/CT scintigraphy based on transport kinetics of 99mTc-sestamibi confirmed with histopathological findings in patients with secondary hyperparathyroidism — practical consideration

BACKGROUND: Dual phase 99mTc-sestamibi SPECT/CT preoperative parathyroid scintigraphy (PPS) is seldom discussedin terms of the transport kinetics of the tracer.Objectives: To assess the relationship between the characteristic type of tracer transport in particular PPS and histopathologicalfindings in patients with secondary hyperparathyroidism (sHPT).MATERIAL AND METHODS: The study comprised 27 patients (13 females and 14 males) with sHPT. Based on tracer accumulationin early phase (EP) and delayed phase (DP), the following types of accumulation for PPS(+) lesions were identified: EP(–)/DP(+) (type I), EP(+)/DP(+) (type II), EP(+)/DP(–) (type III). EP(–)/DP(–) (type IV) lesions constituted PPS(–) group invisible inSPECT/CT. Overall, 69 lesions 59 PPS(+) and 10 PPS(–) were evaluated histopathologically.RESULTS: Among SPECT/CT PPS(+), types I, II and III occurred in 9 (15%), 49 (83%), and 1 (2%) lesions, respectively. Thefrequency of histopathological diagnosis of normal and abnormal (APG — adenoma or hyperplasia) parathyroid gland, as wellas non-parathyroid (thyroid, lymph nodes, or fat) lesions differed significantly between type I, II, and III lesions (p = 0.036).APG histopathological diagnosis was significantly more frequent in lesions with type II uptake than in lesions with type I uptake(76% vs. 33%, p = 0.0197). Type II lesions had significantly higher odds for histopathological diagnosis of APG or NPG thantype IV, PPS(–) lesions [odds ratio = 13.1 (95% CI: 2.75 to 63.27)].CONCLUSIONS: For SHP patients evaluated with SPECT/CT PPS accumulation type I is a weak premise for surgeon to findparathyroid pathology. Only persistent 99mTc-sestamibi accumulation in both phases - equivocal with accumulation type II— effectively differentiates parathyroid and non-parathyroid lesions as well as indicates with high probability the presence ofadenoma or hyperplasia. Type III consistent with washout pattern is rare in sHPT

Occurrence of malignant lesions in patients referred to 131I therapy due to benign thyroid diseases

Wstęp: Leczenie 131I łagodnych chorób tarczycy można stosować po wykluczeniu występowania patologii wymagającej zabiegu operacyjnego - jest to najczęściej nowotwór lub jego podejrzenie. Celem pracy była analiza częstości współwystępowania nowotworów tarczycy u pacjentów kierowanych do leczenia 131I z powodu nadczynności w przebiegu łagodnych chorób tarczycy. Materiał i metody: W latach 2000-2005 3663 pacjentów skierowano do leczenia 131I. Przed leczeniem 131I u wszystkich pacjentów wykonano: ocenę czynności tarczycy, jodochwytność, scyntygram, USG, a u 505 (13,8%) biopsję aspiracyjną cienkoigłową (BAC) z badaniem cytologicznym. Dawkę leczniczą 131I podano 3083 (84,2%) pacjentom. Wyniki: U 8 (0,22% całości i 1,6% spośród tych, którym wykonano BAC) pacjentek w trakcie badań wstępnych stwierdzono zmianę nowotworową lub jej podejrzenie. Wszystkie chore, z wyjątkiem jednej, nie były wcześniej badane cytologicznie, a średnica zmian wynosiła 6-28 mm. W badaniu cytologicznym stwierdzono: u 3 chorych raka brodawkowatego, u 3 - guza pęcherzykowego, u 1 - guz z komórek Hürthle’a, a w jednym przypadku, ze względu na obecność podejrzanych komórek, zalecono weryfikację histopatologiczną. U 6 pacjentek chorobą podstawową było wole wieloguzkowe nadczynne, a u 2 - choroba Gravesa-Basedowa. Wnioski: 1. Powyższe dane wskazują na konieczność dużej czujności onkologicznej medyków nuklearnych mimo wstępnej już selekcji chorych wykonanej przez lekarzy kierujących do leczenia 131I. 2. Wykonywanie BAC jest bardzo ważnym elementem kwalifikacji do leczenia radiojodem. 3. Scyntygrafia tarczycy jest pomocna przy wyborze miejsca do BAC.Introduction: 131I therapy should be performed after exclusion of any morphological pathology that needs surgery - usually malignancy or its suspicion. The aim of the study was to evaluate the range of this problem in patients considered for radioiodine therapy due to benign thyroid diseases. Material and methods: In 2000-2005 year 3663 patients with hyperthyreosis were referred to 131I therapy. All patients were subjected to routine procedure which comprised of thyroid function assesment, radioiodine uptake, thyroid scan, ultrasound examination. In 505 (13.8%) patients according to indications fine needle biopsy (FNAB) with cytological examination was performed. 131I therapy dose was given to 3083 (84.2%) patients. Results: Eight patients (1.6%) were positive or with suspicion of malignancy on FNAB. All but one had no cytological examination before referral. The diameter of the lesions ranged from 6 to 28 mm. Cytological diagnosis was: in 3 patients - ca papillare, in 3 - follicular tumour, in 1 - Hürthle’a cell tumour, and in one patient histopathological examination was required without definitive cytological diagnosis. In six patients primary diagnosis was toxic nodular goiter, in three patients Graves’ disease. Conclusion: 1. Obtained data underline the need for bigger malignancy alert of nuclear medicine physicians during qualification of patients for 131I treatment despite of patients preselection by referring doctors. 2. Performing FNAB is a very important part of qualification to radioiodine treatment. 3. Thyroid scan is supportive in choosing a proper place for FNAB

Semi-quantitative method for the assessment of focal lesions in parathyroid scintigraphy with relation to histopathology: a prospective study

BBACKGROUND: The aim of this paper was to analyse our own semi-quantitative method of assessing focal lesions localised in pre-operative diagnostic scintigraphy of primary hyperparathyroidism (PHPT) using 99mTc-MIBI with washout and comparing these data with the result of the histopathological examination (HP). MATERIAL AND METHODS: A total of 40 (37 female, 3 male, average age 58.7 years) patients with a suspicion of PHPT were enrolled for prospective analysis. Dual phase planar and SPECT/CT examination with 99mTc-MIBI were performed. The tumour to background ratios in the 10th and 120th minute were calculated (TBR10 and TBR120) on the basis of the planar acquisition. PTH, ionised calcium and phosphate levels were measured. Parathyroid surgery alone or combined with subtotal/total thyreoidectomy was conducted in 23 (57.5%) and 17 (42.5%) patients, respectively. A HP was performed in all patients. RESULTS: Average concentration of PTH in the whole group was 243.95 pg/ml. There was a statistically significant correlation between medians of PTH concentration and parathyroid histopathological results (p = 0.01). A total of 45 lesions of increased uptake were found in 32 (80.0%) and 34 (85%) patients in the early phase and the delayed phase, respectively. The post-operative material contained 20 (44.5%) parathyroid adenomas, 11 (24.5%) cases of hyperplasia, 2 (4.4%) cancers, 4 (8.9%) cases of normal parathyroid tissue, 2 (4.4%) lymph nodes and 6 (13.3%) cases of thyroid gland tissue. The medians of TBR10 and TBR120 for lesions examined in the HP were respectively: 3.64 and 2.59 for adenoma; 3.08 and 2.18 for hyperplasia; 7.7 and 5.5 for parathyroid cancer, 4.89 and 3.16 for normal tissue and 5.26 and 2.95 for lymph nodes or thyroid gland tissue. A high correlation coefficient of TBR10 to TBR120 in the parathyroid adenoma and parathyroid hyperplasia groups was observed with r = 0.867 and r = 0.964, respectively. The ρr correlation coefficient of TBR10 to TBR120 for normal parathyroid was 0.4. There was a statistically significant association between the HP and TBR10 medians (p = 0.047), but not between histopathology and TBR120 medians (p = 0.840). CONCLUSIONS: The washout technique in pre-operative 99mTc-MIBI scintigraphy is effective in detecting lesions of the parathyroid (cancer, adenoma, hyperplasia, normal tissue of the parathyroid). Parathyroid cancers in semi-quantitative analysis were characterised by a slightly higher TBR. However, it is impossible to differentiate lesions based on this data. Histopathology results are significantly associated with TBR and PTH

The 3020insC Allele of NOD2 Predisposes to Cancers of Multiple Organs

The NOD2 gene has been associated with susceptibility to Crohn's disease and individuals with Crohn's disease are at increased risk for cancer at a number of organ sites. We studied the association between the 3020insC allele of the NOD2 gene and cancer among 2604 cancer patients and 1910 controls from Poland. Patients were diagnosed with one of twelve types of cancer in the Szczecin region between 1994 and 2004. Significant associations were found for colon cancer (OR = 1.8; 95% CI 1.2 to 2.6), for lung cancer (OR = 1.7; 95% CI = 1.1 to 2.5) and for ovarian cancer (OR = 1.6; 95% CI 1.1 to 2.3). In addition, a significant association was found for early-onset laryngeal cancer (OR = 2.9; 95% CI 1.4 to 6.2) and for breast cancer in the presence of DCIS (OR = 2.1 95% CI = 1.2 to 3.6). The NOD2 3020insC allele is relatively common (in Poland 7.3% of individuals) and may be responsible for an important fraction of cancer cases. We estimate that the lifetime cancer risk among carriers of this allele is 30% higher than that of individuals with two wild-type alleles

Przyśpieszona pooperacyjna radioterapia u chorych na zaawansowanego raka krtani

Aim: The aim of study was test effi cacy of accelerated postoperative radiotherapy – concomitant boost in patients with advanced larynx cancer. Methods and Materials: The prospective study included 112 patients with advanced larynx cancer after radical surgical treatment. Patients had postoperative radiation therapy, conventional (C) or accelerated (CB). Results: The 3-year overall survival in CB was 59%, in C – 58% (p=0,2), 3-year locoregional control in CB – 83%, in C – 75% (p=0.01), the 3-year disease free survival was in CB – 72%, C – 66% (p=0.1). Conclusion: Concomitant boost postoperative radition therapy did not improove overall survival, loco-regional control, disease free survival. Patients with close surgical margins, longer interval between surgery and radiation, high level of hemoglobin, T4 had benefi t from accelerated radiotherapy

CEJI 1-2-2005.qxp

Abstract TPMT is an enzyme that catalyses S-methylation of thiopurine drug