Risk stratification of neck lesions detected sonographically during the follow-up of differentiated thyroid cancer

Context: The European Thyroid Association (ETA) has classified post-treatment cervical ultrasound findings in thyroid cancer patients based on their association with disease persistence/recurrence. Objective: To assess this classification's ability to predict the growth and persistence of such lesions during active post-treatment surveillance of patients with differentiated thyroid cancer (DTC). Design: Retrospective, observational study Setting: Thyroid cancer center, large Italian teaching hospital. Patients: Center referrals (2005–2014) were reviewed and patients selected with pathologically confirmed DTC; total thyroidectomy, with or without neck dissection and/or radioiodine remnant ablation; abnormal findings on ≥2 consecutive post-treatment neck sonograms; subsequent follow-up consisting of active surveillance. Baseline ultrasound abnormalities (thyroid bed masses, lymph nodes) were classified according to the ETA system. Patients were divided into group S (those with ≥1 lesion classified as ‘suspicious’) and group I (‘indeterminate’ lesions only). We recorded baseline and follow-up clinical data through 30 June 2015. Main Outcomes: Patients with growth (> 3 mm, largest diameter) of ≥1 lesion during follow-up, patients with ≥1 persistent lesion at the final visit. Results: The cohort included 58 (9%) of the 637 DTC cases screened. A total of 113 lesions were followed (18 thyroid bed masses, 95 lymph nodes). During surveillance (median 3.7 years), group I had significantly lower rates than group S of lesion growth (8% vs. 36%, p=0.01) and persistence (64% vs. 97%, p=0.014). Median time to scan normalization: 2.9 years. Conclusions: The ETA's evidence-based classification of sonographically detected neck abnormalities can help identify PTC patients eligible for more relaxed follow-up

TERT Promoter Mutations in Papillary Thyroid Microcarcinomas

Small papillary thyroid carcinomas have contributed to the worldwide increased incidence of differentiated thyroid cancer observed over the past decades. However, the mortality rate has not changed over the same period of time, raising questions about the possibility that thyroid cancer patients, especially those with small tumors, are overdiagnosed and overtreated. Molecular prognostic marker able to discriminate aggressive thyroid cancers from those with an indolent course would be of great relevance to tailor the therapeutic approach and reduce overtreatment. Mutations in the TERT promoter were recently reported to correlate strongly with aggressiveness in advanced forms of thyroid cancer, holding promise for a possible clinical application. The occurrence and potential clinical relevance of TERT mutations in papillary thyroid microcarcinomas (mPTCs) is currently unknown. This study aimed to analyze the occurrence of two TERT promoter mutations (-124C>T and -146C>T) and their potential association with unfavorable clinical features in a large cohort of mPTCs

Clinical Aggressiveness and Long-Term Outcome in Patients with Papillary Thyroid Cancer and Circulating Anti-Thyroglobulin Autoantibodies

Objective: The association between papillary thyroid cancer (PTC) and Hashimoto's thyroiditis is widely recognized, but less is known about the possible link between circulating anti-thyroglobulin antibody (TgAb) titers and PTC aggressiveness. To shed light on this issue, we retrospectively examined a large series of PTC patients with and without positive TgAb. Methods: Data on 220 TgAb-positive PTC patients (study cohort) were retrospectively collected in 10 hospital-based referral centers. All the patients had undergone near-total thyroidectomy with or without radioiodine remnant ablation. Tumor characteristics and long-term outcomes (follow-up range: 2.5-24.8 years) were compared with those recently reported in 1020 TgAb-negative PTC patients with similar demographic characteristics. We also assessed the impact on clinical outcome of early titer disappearance in the TgAb-positive group. Results: At baseline, the study cohort (mean age 45.9 years, range 12.5-84.1 years; 85% female) had a significantly higher prevalence of high-risk patients (6.9% vs. 3.2%, p < 0.05) and extrathyroidal tumor extension (28.2% vs. 24%; p < 0.0001) than TgAb-negative controls. Study cohort patients were also more likely than controls to have persistent disease at the 1-year visit (13.6% vs. 7.0%, p = 0.001) or recurrence during subsequent follow-up (5.8% vs. 1.4%, p = 0.0001). At the final follow-up visit, the percentage of patients with either persistent or recurrent disease in the two cohorts was significantly different (6.4% of TgAb-positive patients vs. 1.7% in the TgAb-negative group, p < 0.0001). At the 1-year visit, titer normalization was observed in 85 of the 220 TgAb-positive individuals. These patients had a significantly lower rate of persistent disease than those who were still TgAb positive (8.2% vs. 17.3%. p = 0.05), and no relapses were observed among patients with no evidence of disease during subsequent follow-up. Conclusions: PTC patients with positive serum TgAb titer during the first year after primary treatment were more likely to have persistent/recurrent disease than those who were consistently TgAb-negative. Negative titers at 1 year may be associated with more favorable outcomes

Screening leading to diagnosis of C-cell hyperplasia

SCOPUS: ch.binfo:eu-repo/semantics/publishe

Characterization of desialylated human thyroxine-binding globulin by immunochemical techniques

SCOPUS: NotDefined.jinfo:eu-repo/semantics/publishe

Anaplastic thyroid carcinoma: Advances in molecular profiling and targeted therapy

Purpose of reviewAnaplastic thyroid carcinomas (ATCs) are rare cancers with a globally very poor prognosis, because of their immensely aggressive behaviour, resulting in predominantly advanced stage of disease at diagnosis. Response to available therapies is still disappointing. Aim of the present review is to illustrate the diverse new strategies under investigation, to improve the poor outcome of these patients.Recent findingsApplying molecular analysis in ATC is unravelling potentially actionable targets of therapy. If a mutation of BRAF V600E is found, a combination of Dabrafenib and Trametinib is the recommended treatment. In the presence of another druggable mutation, a specific targeted therapy may be proposed. In the absence of druggable mutations, immunotherapy is an alternative approach, especially in case of significant PD-L1 expression.SummaryThe molecular profiling of tumour samples is elucidating the genetic alterations involved in ATC development, and new preclinical models are under study to define innovative approaches for individualized treatment of such patients. Hopefully this approach could improve ATC prognosis.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Absence of circulating desialylated thyroxine-binding globulin in patients with hepatobiliary disease

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Calcitonin and Carcinoembryonic Antigen for the Diagnosis and Management of Medullary Thyroid Carcinoma

The neoplastic proliferation of parafollicular thyroid cells (C cells), generically defined as C cell disease, may occur as either medullary thyroid carcinoma (MTC) or C cell hyperplasia (CCH).The preoperative diagnosis of C cell disease is difficult. CCH, in fact, can only be recognized at surgical pathology. MTC, typically presenting as a thyroid nodule, may often be overlooked by traditional fine needle aspiration cytology (FNAC).Because neoplastic C cells maintain calcitonin (CT) expression, the hormone constitutes a very sensitive pre- and postoperative marker of C cell disease, with high prognostic value.MTC patients also present increased serum CEA levels. At variance with circulating CT, however, serum CEA displays a poor preoperative sensitivity for MTC diagnosis and a more limited efficacy as a prognostic factor.In the preoperative settings, in fact, circulating CT is the most specific and sensitive disease marker for MTC, while CEA displays a lower diagnostic accuracy, and both are of prognostic utility, allowing accurate estimation of tumor burden.During the postsurgical follow-up of MTC patients, the evolution of both CT and CEA levels allows a good estimate of MTC progression, and their increase reliably heralds persistence/relapse. Nevertheless, some patients may present discrepant results with disproportionately low circulating CT as compared to CEA levels. In such instance, the clinician should be alerted and consider the possibility of dedifferentiated, more aggressive MTC.In recent years, CT and CEA doubling times (DT) have been proposed as prognostic factors, being CT-DT a more precise indicator of MTC progression than CEA-DT.Circulating CT and CEA levels represent also accurate markers of response to local treatment in early and advanced/recurrent MTC, but their suitability for the evaluation of response to systemic therapy needs confirmation.info:eu-repo/semantics/publishe

In vitro effects of thyroid hormones on red blood cell Ca++-dependent ATPase activity

SCOPUS: ar.jinfo:eu-repo/semantics/publishe