Adam Stangierski

Comparison of diagnostic value of conventional ultrasonography and shear wave elastography in the prediction of thyroid lesions malignancy.

Introduction Thyroid nodular disease (TND) is a very common disorder. However, since the rate of malignancy is reported to be 3-10%, only a minority of patients require aggressive surgical treatment. As a result, there is a need for diagnostic tools which would allow for a reliable differentiation between benign and malignant nodules. Although a number of conventional ultrasonographic (US) features are proved to be markers of malignancy, Shear Wave Elastography (SWE) is considered to be an improvement of conventional US. The aim of this study was to compare conventional US markers and SWE diagnostic values in the differentiation of benign and malignant thyroid nodules. Materials and Methods All patients referred for thyroidectomy, irrespective of the indications, underwent a US thyroid examination prospectively. Patients with TND were included into the study. Results of the US and SWE examinations were compared with post-surgical histopathology. Results One hundred and twenty two patients with 393 thyroid nodules were included into the study. Twenty two patients were diagnosed with cancer. SWE turned out to be a predictor of malignancy superior to any other conventional US markers (OR=54.5 using qualitative scales and 40.8 using quantitative data on maximal stiffness with a threshold of 50 kPa). Conclusions Although most conventional US markers of malignancy prove to be significant, none of them are characterized by both high sensitivity and specificity. SWE seems to be an important step forward, allowing for a more reliable distinction of benign and malignant thyroid nodules. Our study, assessing SWE properties on the highest number of thyroid lesions at the time of publication, confirms the high diagnostic value of this technique. It also indicates that a quantitative evaluation of thyroid lesions is not superior to simpler qualitative methods.

Shear Wave Elastography: A New Noninvasive Tool to Assess the Intensity of Fibrosis of Irradiated Salivary Glands in Head and Neck Cancer Patients

The aim of the study was to assess salivary gland parenchyma by means of sonoelastography in patients irradiated for head and neck squamous cell carcinoma (HNSCC). The studied group consisted of 52 patients after radiotherapy (RT) and 54 healthy volunteers. All of the former were treated for advanced larynx (40), oropharynx (9), or maxilla (3) squamous cancers and suffered from chronic dryness. Ultrasonography (US) and elastography (ES) were performed, as well as an assessment of the amount of saliva and Common Terminology Criteria for Adverse Events (CTCAE) scale. There was a statistical difference between ES values in the RT group and in the controls for parotid glands (41.7 kPa versus 26.03 kPa, P = 0.0018) and for submandibular glands (37.6 kPa versus 22.4 kPa; P = 0.005). There was a significant correlation between the CTCAE scores and objective saliva amount (P = 0.0005), and the median amount of saliva in the examined group was lower than in the reference group (1.86 g versus 2.75 g, P = 0.0006). In conclusion sonoelastography adds a new parameter to ultrasonography in “one touch examination” and may be a useful tool for major salivary gland evaluation during the radiotherapy course and follow-up period.

The Usefulness of Standardized Uptake Value in Differentiation between Benign and Malignant Thyroid Lesions Detected Incidentally in 18F-FDG PET/CT Examination

Introduction In the last decade, (18)F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET and PET/CT) has become one of the major diagnostic tools used in oncology. A significant number of patients who undergo this procedure, due to non-thyroidal reasons, present incidental uptake of (18F-FDG) in the thyroid. The aim of the study was to compare the SUVmax (standardized uptake value) of thyroid focal lesions, which were incidentally found on PET/CT, in relation to the results of thyroid fine-needle aspiration biopsy (FNAB) and/or histopathological evaluation. Materials and Methods Patients referred for PET/CT examination, due to non-thyroidal illness, presented focal 18F-FDG uptake in the thyroid and were advised to undergo ultrasonography (US), hormonal evaluation, FNAB and/or total thyroidectomy at our institution. Results 6614 PET/CT examinations performed in 5520 patients were analyzed. Of the 122 patients with focal thyroid 18F-FDG activity, 82 patients (67.2%) underwent further thyroid evaluation using FNAB. Benign lesions were diagnosed in 46 patients, malignant - in 19 patients (confirmed by post-surgical histopathology), while 17 patients had inconclusive results of cytological assessment. Mean SUVmax of benign lesions was 3.2±2.8 (median = 2.4), while the mean SUVmax value for malignant lesions was 7.1±8.2 (median = 3.5). The risk of malignancy was 16.7% for lesions with a SUVmax under 3, 43.8% for lesions with a SUVmax between 3 and 6, and 54.6% for lesions with a SUVmax over 6. In the group of malignant lesions, a positive correlation between the lesion’s diameter and SUVmax was observed (p = 0.03, r = 0.57). Conclusions Subjects with incidental focal uptake of 18F-FDG in thyroid are at a high risk of thyroid malignancy. A high value of SUVmax further increases the risk of malignancy, indicating the necessity for further cytological or histological evaluation. However, as SUVmax correlated with the diameter of malignant lesions, small lesions with focal uptake of 18F-FDG should be interpreted cautiously.

Individual plasma ghrelin changes in the same patients in hyperthyroid, hypothyroid and euthyroid state

Ghrelin is a multifunctional peptide of widespread expression. Since it has been shown to influence energy homeostatis, its potential role in thyroid dysfunction may have clinical significance. In this study, plasma ghrelin changes have been analyzed in the same patients in three different thyroid states for the first time. The study group consisted of 16 patients who had been diagnosed with hyperthyroidism, were treated with radioiodine, developed hypothyroidism after treatment, and finally became euthyroid on l-thyroxine substitution. In the initial state of hyperthyroidism plasma ghrelin levels correlated negatively with fT3 and fT4. In hypothyroidism ghrelin concentration increased significantly (p<0.05). Although the mean value of plasma ghrelin tended to decrease in the euthyroid state, the individual difference between hypothyroidism and euthyroidism was not significant. Plasma ghrelin in euthyroidism was still significantly higher than in hyperthyroidism (p<0.05), and correlated positively with ghrelin levels in hyperthyroidism and hypothyroidism. In our opinion, plasma ghrelin fluctuations may reflect metabolic changes in patients with thyroid dysfunction. Moreover, it cannot be excluded that in thyroid disorders ghrelin acts as a compensatory factor, helping to balance metabolic disturbances.

How to select nodules for fine-needle aspiration biopsy in multinodular goitre. Role of conventional ultrasonography and shear wave elastography — a preliminary study

INTRODUCTION The wide prevalence and relatively low malignancy ratio of thyroid nodular disease (TND) make the selection of suspicious lesions for fine-needle aspiration biopsy (FNAB) a vital problem in endocrinology. Apart from the decision as to whether FNAB is necessary, there is often a second problem - which nodule or nodules to choose in a case of multinodular goitre (MNG), when the number of lesions may be high. The aim of this study was to compare the usefulness of conventional ultrasonography (US) to that of a novel method of tissue stiffness assessment - shear wave elastography (SWE) - in differentiating between malignant and benign nodules and in selecting the most suspicious lesions in MNG. MATERIAL AND METHODS Patients with MNG, referred for thyroidectomy irrespectively of indications for surgery, underwent thyroid US and SWE examination before surgery, between August and December 2010. Results of these examinations were correlated with the histopathological outcomes. RESULTS 80 patients with 339 thyroid nodules were included. Ten thyroid cancers (TCs) in ten patients were diagnosed in histopathology. All ten cancers were the least elastic lesions in MNG (using quantitative data on maximal tissue stiffness). Four cancers appeared as the biggest lesions in MNG, while one was equally the biggest in a particular goitre (there were other lesions of the same size) taking into account maximal diameter. Three of ten cancers possessed the highest number of suspicious features in MNG, a further four had the highest number equally, with at least one other lesion in the same goitre. CONCLUSIONS On the basis of our results, the relatively high stiffness of a lesion compared to other nodules from the same MNG should be considered as a strong argument for choosing that particular one for FNAB.

Incidental 18 F-FDG uptake in the thyroid in patients diagnosed with PET/CT for other malignancies

BACKGROUND The value of PET/CT imaging in diagnosis of different cancers has been widely described. PET/CT may contribute to visualization of additional findings that were not the indication to the study and did not refer to initial diagnosis. In a small number of PET/CT scans an incidentally found focal ¹⁸F-FDG uptake in the thyroid gland is found. The goal of the study was to estimate the prevalence and evaluate the clinical significance of incidental thyroid ¹⁸F-FDG uptake in a cohort of patients diagnosed for different malignancies. MATERIAL AND METHODS 2478 PET/CT scans using ¹⁸F-FDG were performed in 1925 subjects for evaluation of different, non-thyroid malignancies. For PET/CT examination, a Discovery ST (General Electric) PET/CT scanner was used. Patients with focal ¹⁸F-FDG activity were further evaluated by means of fine needle aspiration biopsy (FNAB). If cytological examination disclosed malignancy or suspicion of malignancy, thyroidectomy was performed. Both cytological and histopathological results were then analyzed. RESULTS Focal increased ¹⁸F-FDG uptake was found in 71 patients (3.7%), and cytological or histopathological results were evaluable in 20 of them. In general, 8 cases of thyroid cancer were found, which accounts for 40% probability of malignancy. The predominant histopathological diagnosis was papillary thyroid carcinoma (5 out of 8 cases). Additionally, in one case (5%) thyroid metastasis of lung cancer was detected. Diffused ¹⁸F-FDG activity in both thyroid lobes was observed in 120 subjects (6.2%)--in most cases chronic thyroiditis was confirmed. CONCLUSIONS The probability of malignancy of focal thyroid incidentalomas in ¹⁸F-FDG PET/CT scans is rather high. Therefore, thorough evaluation of such lesions is highly recommended in each case. Most thyroid malignancies incidentally detected in PET/CT are papillary carcinomas.

Dysfunction of the thyroid gland during amiodarone therapy: a study of 297 cases

Aim This study aims to explore and compare the efficacy of radioiodine treatment (RIT) in hyperthyroid and euthyroid patients who have been treated with amiodarone (AM) in the past or are currently undergoing AM treatment. Clinical observation of a group of patients with amiodarone-induced hypothyroidism during a 12-month follow-up period was used for comparison. Design This was a observational, two-centered study. Patients were assessed at baseline and at 2 months, 6 months, 8 months, and 12 months after RIT. Patients Group A: At baseline (61 males [M] and 17 females [F], mean age 50±19 years), there were 78 euthyroid patients with cardiac arrhythmias, who were treated with AM and developed amiodarone-induced thyrotoxicosis, and currently require retreatment with AM. Group B: Hyperthyroid patients (92 M and 26 F, mean age 72±11.8 years) after AM therapy in the past. Group C: Hyperthyroid patients (66 M and 13 F, mean age 63.9±13.2 years) currently treated by AM. Group D: Hypothyroid patients (6 M and 16 F, mean age 61.4±10.4 years) after AM therapy. The patients from Groups A, B, and C were retreated with AM after ~3–6 weeks of RIT. Results In Group A, after 12 months of RIT therapy, recurrent thyrotoxicosis was observed in six (7.7%) cases, and persistent hypothyroidism was diagnosed in 42 (53.8%) cases. In Group B, hyperthyroidism occurring during treatment with AM was found in 40 (33.9%) patients, and permanent hypothyroidism was observed in eleven (12.5%) cases. After annual follow-up in Group C, nine (11.4%) patients were diagnosed with hypothyroidism, while 27 (34.1%) patients were diagnosed with hyperthyroidism. In Group D, all patients had permanent hypothyroidism and when the concentration of serum thyroid-stimulating hormone was >10 µIU/mL, l-thyroxine was applied. Conclusion Our study showed that radioiodine administration is advisable in certain circumstances, even in euthyroid patients. It allows for continuation of further long-term AM treatment. Additionally, RIT allows for the reintroduction of AM therapy that was previously terminated. Hence, it can help control life-threatening tachyarrhythmias and decrease episodes of thyrotoxicosis.

Comparison of diagnostic yield of core-needle and fine-needle aspiration biopsies of thyroid lesions: Systematic review and meta-analysis

AbstractObjectivesThyroid nodular disease is one of the most commonly observed medical conditions. Cytological evaluation of the specimens obtained with fine-needle aspiration biopsy (FNAB) is the most accurate tool for selecting nodules which should be further surgically removed. A major limitation of this method is the high occurrence of non-diagnostic results. This indicates the need for improvement of the thyroid biopsy technique. The aim of this meta-analysis was to compare the diagnostic value of thyroid core-needle biopsies (CNBs) and FNABs.Materials and methodsPubMed/MEDLINE, Cochrane Library, Scopus, Cinahl, Academic Search Complete, Web of Knowledge, PubMed Central, PubMed Central Canada and Clinical Key databases were searched. Risk ratios (RRs) of non-diagnostic results were meta-analysed using the random-effects model.ResultsEleven studies were included in the quantitative analysis. CNB yielded significantly more diagnostic results – the pooled risk ratio (RR) of gaining a non-diagnostic result was 0.27 (p<0.0001). For lesions with one previous non-diagnostic FNAB, RR was 0.22 (p<0.0001).ConclusionsCNB seems to be a valuable diagnostic technique yielding a higher proportion of diagnostic results than conventional FNAB. It is also significantly more effective in case of nodules with a prior non-diagnostic result of FNAB results than repeated FNABs.Key Points• Core-needle biopsy yields a higher proportion of diagnostic results than fine-needle biopsy. • Core-needle biopsies may decrease the amount of unnecessary thyroidectomies. • Probability of gaining non-diagnostic result using core-needle biopsy is almost four times lower.

The usefulness of fluorine-18 fluorodeoxyglucose PET in the detection of recurrence in patients with differentiated thyroid cancer with elevated thyroglobulin and negative radioiodine whole-body scan.

IntroductionPET/computed tomography (CT) using fluorine-18 fluorodeoxyglucose (18F-FDG) has been used in the diagnosis of recurrence and metastases of differentiated thyroid cancer (DTC) in cases of negative whole-body scan (WBS) despite elevated concentrations of stimulated thyroglobulin (Tg). AimTo assess the utility of PET/CT in the detection of recurrence among patients with DTC with increased Tg levels and negative results of WBS. Materials and methodsPET/CT results were retrospectively analyzed in patients with DTC with increased Tg and negative results of WBS as well as negative cervical ultrasonography and chest radiography. PET-CT was performed 1–2 weeks after recent diagnostics under conditions of endogenous or exogenous thyroid-stimulating hormone stimulation. PET/CT was performed using a Discovery ST scanner 1 h after an intravenously 18F-FDG injection (activity 4–5 MBq/kg). To determine the cutoff value of Tg, receiver operating characteristic curves were analyzed. ResultsSixty-nine patients with DTC (48 women, 21 men) aged 22–83 years (mean 50.9±17.5 years) were qualified. In 44 patients (63.8%), PET/CT indicated lesions of DTC. Thirty (43.5%) patients had 18F-FDG positive findings. In the remaining 14 patients (20.3%), lesions were found in CT only. Patients with a positive PET/CT scan had significantly higher Tg values than patients with a negative PET/CT (mean 143.8 vs. 26.5 ng/ml, P=0.03). The cutoff value of Tg concentration measured with the receiver operating characteristic analysis was 32.9 ng/ml. ConclusionPET/CT is a useful tool in the detection of recurrence among thyroid cancer patients in cases of conflicting results of standard procedures, particularly for those with high Tg levels and negative WBS. The probability of obtaining a positive PET-CT result increases with the level of Tg.

Badanie elastyczności miąższu dużych gruczołów ślinowych w wybranych stanach patologicznych

INTRODUCTION Sonoelastography is a novel technique useful in noninvasive assessment of tissue elasticity. This method was found to date to be useful in noninvasive differentiation of benign and malignant lesions of multiple organs: thyroid gland, liver, prostate and breast. Elastograms were scored upon conventional subjective color scale and the detailed stiffness values in kPa were collected. THE AIM OF THE STUDY was to examine usefulness of sonoelastography in assessment of salivary glands lesions. Material and Methods the group consisted of 99 patients treated in Department of Otolaryngology. 52 patients after radiotherapy for head and neck cancer, 4 treated for inflammatory disease - 2 Sjoegren syndrome, 2 acute sialoadenitis and 43 consecutive patients with parotid tumors. The control group constituted 54 healthy volunteers. RESULTS the mean stiffness value in 10 malignant tumors was 146.6 kPa and 88.7 kPa in 33 benign, the mean stiffness value of glandular parenchyma after radiotherapy was 43.18 kPa and in inflammatory disease 63.66 kPa. Mean elasticity of reference glandular tissue was 24.23 kPa. CONCLUSIONS sonoelastography is fast, repetitive, noninvasive and objective method and it is useful in assessment of salivary glands lesions.