Primary Hyperparathyroidism Patients with Positive Preoperative Sestamibi Scan and Negative Ultrasound Are More Likely to Have Posteriorly Located Upper Gland Adenomas (PLUGs)

BackgroundStandard preoperative imaging for primary hyperparathyroidism usually includes sestamibi scanning (MIBI) and ultrasound (US). In a subset of patients with a positive MIBI and a negative US, we hypothesize that the parathyroid adenomas are more likely to be located posteriorly in the neck, where anatomically they are more difficult to detect by US.MethodsWe retrospectively reviewed the records of 661 patients treated for primary hyperparathyroidism between 2004 and 2009 at a tertiary referral center. We included patients who for their first operation had a MIBI that localized a single lesion in the neck and an US that found no parathyroid adenoma. We excluded patients with persistent or recurrent hyperparathyroidism, and patients with MIBIs that were negative, that had more than one positive focus, or that had foci outside of the neck. Sixty-six cases were included in the final analysis.ResultsA total of 54 patients (83%) had a single adenoma, 4 (6%) had double adenomas, and 7 (11%) had hyperplasia. Thirty-three patients (51%) had a single upper gland adenoma; 19 of these (58%) were posteriorly located upper gland adenomas (PLUGs). PLUGs occurred more often on the right side than on the left (P = 0.048, Fisher's test). PLUGs were also larger than other single adenomas (mean 1.85 vs. 1.48 cm, P = 0.021, t-test). Seventy-six percent of patients successfully underwent a unilateral or focused exploration. Six patients (9%) had persistent disease, which is double our group's overall average (4-5%).ConclusionsPrimary hyperparathyroid patients with preoperative positive MIBI and negative US are more likely to have PLUGs

Characteristics of contralateral carcinomas in patients with differentiated thyroid cancer larger than 1 cm

Purpose: Traditionally, total thyroidectomy has been advocated for patients with tumors larger than 1 cm. However, according to the ATA and NCCN guidelines (2015, USA), patients with tumors up to 4 cm are now eligible for lobectomy. A rationale for adhering to total thyroidectomy might be the presence of contralateral carcinomas. The purpose of this study was to describe the characteristics of contralateral carcinomas in patients with differentiated thyroid cancer (DTC) larger than 1 cm. Methods: A retrospective study was performed including patients from 17 centers in 5 countries. Adults diagnosed with DTC stage T1b-T3 N0-1a M0 who all underwent a total thyroidectomy were included. The primary endpoint was the presence of a contralateral carcinoma. Results: A total of 1

Characteristics of contralateral carcinomas in patients with differentiated thyroid cancer larger than 1 cm

textabstractPurpose: Traditionally, total thyroidectomy has been advocated for patients with tumors larger than 1 cm. However, according to the ATA and NCCN guidelines (2015, USA), patients with tumors up to 4 cm are now eligible for lobectomy. A rationale for adhering to total thyroidectomy might be the presence of contralateral carcinomas. The purpose of this study was to describe the characteristics of contralateral carcinomas in patients with differentiated thyroid cancer (DTC) larger than 1 cm. Methods: A retrospective study was performed including patients from 17 centers in 5 countries. Adults diagnosed with DTC stage T1b-T3 N0-1a M0 who all underwent a total thyroidectomy were included. The primary endpoint was the presence of a contralateral carcinoma. Results: A total of 1313 patients were included, of whom 426 (32 %) had a contralateral carcinoma. The contralateral carcinomas consisted of 288 (67 %) papillary thyroid carcinomas (PTC), 124 (30 %) follicular variant of a papillary thyroid carcinoma (FvPTC), 5 (1 %) follicular thyroid carcinomas (FTC), and 3 (1 %) Hürthle cell carcinomas (HTC). Ipsilateral multifocality was strongly associated with the presence of contralateral carcinomas (OR 2.62). Of all contralateral carcinomas, 82 % were ≤10 mm and of those 99 % were PTC or FvPTC. Even if the primary tumor was a FTC or HTC, the contralateral carcinoma was (Fv)PTC in 92 % of cases. Conclusions: This international multicenter study performed on patients with DTC larger than 1 cm shows that contralateral carcinomas occur in one third of patients and, independently of primary tumor subtype, predominantly consist of microPTC

The Evolution of Biomarkers in Thyroid Cancer—From Mass Screening to a Personalized Biosignature

cancer

Correction: Engineering Multi-Walled Carbon Nanotube Therapeutic Bionanofluids to Selectively Target Papillary Thyroid Cancer Cells.

[This corrects the article DOI: 10.1371/journal.pone.0149723.]

Concentration and time optimization of TSHR targeting bionanofluid to BCPAP cells.

<p>Included in these experimental conditions are, α-THSR-, Thyrogen-, and purified Thyrotropin-Thiol-PEG-CNT conjugates. Control conditions included PBS and CNT alone. <b>A.</b> Determination of optimal cell to conjugate BioNanofluid ratio to achieve specific maximum targeted BCPAP cell killing. Laser exposure time was 30 seconds for all conditions. Ratios are represented as volume:volume ratios, thus for a 1:1 ratio, 100 μL of cells (of 250,000–350,000 cells per ml) were mixed with 100 μL of Conjugated-BioNanofluid of 2 μg/mL concentration. <b>B.</b> Optimal exposure time determination experiment. BCPAP cells were exposed to laser treatment for 20, 30, and 40 seconds, at a 2:1 cell:conjugated- or unconjugated-Thiol-PEG CNT ratio.</p

Bionanofluid conjugate stability assessment.

<p><b>A</b>. α-TSHR- and Thyrogen-Thiol-PEG-CNT conjugates were prepared on day 1 and kept at 4°C for up to 21 days. Conjugates activity was assessed by cell killing assay of BCPAP cells (as described above). <b>B.</b> Similarly, α-TSHR- and Thyrogen-Thiol-PEG-CNT conjugates were prepared on day 1 and were kept at -20°C or -80°C for up to 6 weeks. Conjugates activity was assessed by cell killing assay at day 5, day 7, and every week for up to 6 weeks.</p

Structure and coupling chemistry of Au-modified MWCNTs.

<p><b>A.</b> Scanning electron microscopy (SEM) images of COOH-functionalized Au-labeled Thiol-Carbon derived bionanofluids, at two different magnifications. Au particles have defined spherical structures, highlighted by the arrowhead. <b>B.</b> EDC-NHS coupling chemistry to attach bio-affinity molecules, whether antibody or protein/mitogen to the Thiol-PEG-CNT. PEGylation of the Thiol-CNT is described in the Materials and Methods.</p