Value of specimen radiographs in diagnosing multifocality of thyroid cancer
Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea. British Journal of Surgery
(Impact Factor: 5.54).
04/2010; 97(4):517-24. DOI: 10.1002/bjs.6943
Specimen radiography has been used widely to evaluate the complete excision of calcified breast lesions but has not been evaluated for thyroid cancer.
Specimen radiographs were evaluated retrospectively to identify additional cancers that were demonstrated only as calcifications. Receiver operating characteristic curve analysis was performed to compare the combination of specimen radiography and ultrasonography versus ultrasonography alone for detecting multifocality.
Some 122 thyroid cancer specimens were obtained from 122 patients between January and April 2008. Specimen radiography detected 27 cancers (18.5 per cent) not detected by ultrasonography. Diagnoses were changed after evaluation of specimen radiographs in three of these patients. The area under the curve of the combination of specimen radiography and ultrasonography was significantly higher than that of ultrasonography alone (P = 0.005).
Specimen radiography is a potentially useful tool for diagnosing cancer type and predicting the extent of thyroid cancer.
Available from: Marene IB Landström
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ABSTRACT: Anaplastic thyroid carcinoma (ATC) is one of the most malignant tumors in humans, and currently there is no effective treatment. In the present study we investigated the effect of an endogenous estrogen metabolite, 2-methoxyestradiol (2-ME), on the growth of human ATC cells. 2-ME treatment had a strong growth inhibitory effect on five human ATC cell lines (HTh7, HTh 74, HTh83, C643, and SW1736), but showed no effect on one cell line (KAT-4). Cell cycle analysis of the growth-inhibited cells showed that 2-ME induced a G(2)/M-arrest, followed by an increased fraction of cells in sub-G(1). Analysis of internucleosomal DNA laddering as well as DNA fragmentation in a terminal deoxynucleotide transferase-mediated dUTP nick-end labeling (TUNEL) assay demonstrated a high number of cells undergoing apoptosis after 2-ME treatment. An increased activation of caspase-3 and caspase-8 by 2-ME was observed, and inhibition of caspase-3 decreased the apoptotic effect. Addition of 2-ME increased activity of p38 mitogen-activated protein kinase (MAPK) in the sensitive HTh7 as well as the refractory KAT-4 cells, however, activation of stress-activated protein kinase/c-jun aminoterminal kinase (SAPK/JNK) was seen only in the HTh7 cells. Inhibitors of p38 MABK and SAPK/JNK significantly attenuated the 2-ME effect. Taken together, our data demonstrate an antiproliferative and apoptotic effect of 2-ME on ATC cells involving activation of MAPKs.
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ABSTRACT: The purpose of this prospective study was to evaluate the overall performance of sonography for staging papillary thyroid carcinoma.
Ninety-four consecutive patients with papillary thyroid carcinoma underwent preoperative sonography. Two experienced radiologists prospectively evaluated primary tumors (e.g., diameter, number, presence of extrathyroidal invasion) and cervical lymph nodes for metastasis. A 5-point scale grading capsular abutment was used to evaluate the possibility of extrathyroidal invasion. Lymph nodes were divided into central and lateral groups according to N staging requirements. The sonographic criteria for lymph node metastasis were an absent hilum, hyperechoic change, a round shape, calcification, cystic change, or an abnormal color Doppler pattern. Sonographic results were correlated with histopathologic findings.
One hundred twenty-seven cancers in the 94 patients were proven after surgery. Sonography accurately identified 75.9% (22/29) of patients with multifocal cancer and 83.3% (15/18) of patients with bilateral cancers. Using a cutoff value of 50% or more of the tumor abutting the thyroid capsule (grade 2), the sensitivity, specificity, and accuracy of sonography in predicting extrathyroidal invasion were 85.3%, 70.0%, and 74.5%, respectively, and the overall accuracy of sonography for T staging was 67.0% (63/94). One hundred forty-seven cervical lymph node levels were dissected. All six sonographic findings were significantly more frequent in metastatic lymph nodes in the lateral group. However, in the central group, only two criteria-calcification and abnormal Doppler pattern-were found to significantly predict the presence of metastasis. The overall accuracy of sonography for N staging was 71.3% (67/94).
Sonography is a feasible tool to use for the preoperative staging of papillary thyroid carcinoma.
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ABSTRACT: To evaluate the clinical implications and diagnostic approach of lesions showing only diffuse microcalcifications on thyroid ultrasound (US).
From January 2004 to January 2011, a total of 31 patients had lesions showing diffuse microcalcifications alone on thyroid US. Among them, 26 patients (M:F ratio 4:22; mean age 37.5 years, range 15-56 years) who had underwent US-guided fine-needle aspiration biopsy (US-FNAB), subsequent surgery, or follow-up US after 1 year after initial US-FNAB were included. Histopathologic results from surgery or US-FNAB were considered as standard reference. Clinical and US features were compared to standard reference.
Of the disease of 26 patients, 16 (61.5%) were diagnosed as malignancy and 10 (38.5%) as benign. Seventeen (65.4%) of the 26 patients included were diagnosed as having Hashimoto thyroiditis (HT) on a clinical basis. Eight (80.0%) of the 10 benign lesions were diagnosed as benign on initial US-FNAB, and the remaining 2 lesions (20.0%) were nondiagnostic. All malignant lesions were diagnosed as suspicious for papillary thyroid carcinoma (PTC) or PTC by US-FNAB. Of the US features, presence of pathologic lymph nodes were significantly higher in malignant disease compared to benign findings, 10 (62.5%) to 0 (0.0%) (P = 0.003).
Diffuse microcalcifications only lesions of the thyroid show high prevalence of PTC and lymphocytic thyroiditis. US-FNAB shows an acceptable performance in lesions showing microcalcifications only on thyroid US.
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