Hye Jeong Kim

Associations between body mass index and clinico-pathological characteristics of papillary thyroid cancer.

Epidemiological studies have demonstrated that excess weight increases the risk of thyroid cancer. However, the associations between excess weight and prognostic factors for thyroid cancer are uncertain. We evaluated the relationships between body mass index (BMI) and clinico‐pathological features and outcomes of papillary thyroid cancer (PTC).

Multifocality, But Not Bilaterality, Is a Predictor of Disease Recurrence/Persistence of Papillary Thyroid Carcinoma

BackgroundAlthough papillary thyroid carcinoma (PTC) often presents as multifocal or bilateral tumors, but whether multifocality or bilaterality is associated with disease recurrence/persistence is controversial. We evaluated the association between multifocality and bilaterality of PTC and disease recurrence/persistence. We also analyzed the location and number of tumors in multifocal PTC.MethodsWe reviewed the medical records of 2,095 patients who underwent total thyroidectomy for PTC. Tumors were classified as solitary or multifocal PTC according to the number of tumors present. Multifocal PTCs were subdivided into multifocal-unilateral and multifocal-bilateral PTC based on the tumor location. Solitary tumor or multifocal tumors located in one lobe were classified as unilateral PTC, and tumors in both lobes were classified as bilateral PTC. We analyzed the clinicopathologic features and clinical outcomes in each classification. Logistic regression models were used to assess the relation between multifocality or bilaterality and disease recurrence/persistence.ResultsExtrathyroidal invasion, cervical lymph node metastasis, and advanced TNM stage were significantly more frequent in multifocal PTC than in solitary PTC. Extrathyroidal invasion, cervical lymph node metastasis, advanced TNM stage, and distant metastasis were significantly more frequent in bilateral PTC than in unilateral PTC. The clinicopathologic parameters did not differ significantly between patients with multifocal-unilateral and multifocal-bilateral PTC. Multifocality was found to be an independent predictor of disease recurrence/persistence [odds ratio (OR) 1.45, 95xa0% confidence interval (CI) 1.01–2.10, pxa0=xa00.04]. However, there was no association between bilaterality and disease recurrence/persistence (OR 0.98, 95xa0% CI 0.64–1.48, pxa0=xa00.92). In multifocal PTC, the number of tumors (OR 1.75, 95xa0% CI 1.04–2.97, pxa0=xa00.04), but not the location of tumors (OR 0.56, 95xa0% CI 0.31–1.02, pxa0=xa00.06), was significantly associated with disease recurrence/persistence.ConclusionsAlthough multifocal and bilateral PTC had aggressive pathologic features, only multifocality was associated with an increased risk of disease recurrence/persistence. This suggests that the number of tumor foci, but not their location, is a significant predictor of clinical outcomes.

Radioactive iodine ablation does not prevent recurrences in patients with papillary thyroid microcarcinoma.

Although papillary thyroid microcarcinoma (PTMC) has a favourable long‐term prognosis, disease recurrence after initial treatment remains a problem and controversy exists regarding the role of radioactive iodine (RAI) ablation in PTMC. We performed this study to evaluate the effect of RAI ablation on disease recurrence in patients with PTMC.

Non-HDL-cholesterol/HDL-cholesterol is a better predictor of metabolic syndrome and insulin resistance than apolipoprotein B/apolipoprotein A1

BACKGROUNDnThe ratio of apolipoprotein B (apoB) to apolipoprotein A1 (apoA1) has been reported to be associated with metabolic syndrome (MetS) and insulin resistance (IR). Non-HDL-C is regarded as a surrogate marker for apoB in routine clinical practice. However, it is unclear whether the ratio of non-HDL-C to HDL-C is an equal or a better predictor than the apoB/apoA1 ratio for the identification of MetS and IR.nnnMETHODSnWe performed a retrospective study of 41,821 Korean adults who participated in a routine health screening examination. Anthropometry, fasting glucose, fasting insulin, HOMA-IR, CRP, lipid profiles, apoB, and apoA1 were measured.nnnRESULTSnTo compare the predictive value for MetS between different lipid ratios, we analyzed the ROC curves of apoB/apoA1 and non-HDL-C/HDL-C ratios. ROC analysis showed that the AUCs of non-HDL-C/HDL-C (0.75 [95% CI=0.74-0.76] in men and 0.84 [95% CI=0.83-0.85] in women) were significantly higher than those of apoB/apoA1 (0.66 [95% CI=0.65-0.67] in men and 0.77 [95% CI=0.76-0.78] in women). The non-HDL-C/HDL-C ratio also showed a significantly stronger association with HOMA-IR than the apoB/apoA1 ratio. The optimal cutoff value of the non-HDL-C/HDL-C ratio for detection of MetS in men was 3.39, with a sensitivity of 66.7% and a specificity of 71.8%, whereas the optimal ratio cutoff value in women was 2.89, with a sensitivity of 75.7% and a specificity of 78.1%.nnnCONCLUSIONSnOur findings indicate that the non-HDL-C/HDL-C ratio is a better marker than the apoB/apoA1 ratio for identifying IR and MetS in Koreans.

Linking resistin, inflammation, and cardiometabolic diseases

Adipose tissue secretes a variety of bioactive substances that are associated with chronic inflammation, insulin resistance, and an increased risk of type 2 diabetes mellitus. While resistin was first known as an adipocyte-secreted hormone (adipokine) linked to obesity and insulin resistance in rodents, it is predominantly expressed and secreted by macrophages in humans. Epidemiological and genetic studies indicate that increased resistin levels are associated with the development of insulin resistance, diabetes, and cardiovascular disease. Resistin also appears to mediate the pathogenesis of atherosclerosis by promoting endothelial dysfunction, vascular smooth muscle cell proliferation, arterial inflammation, and the formation of foam cells. Thus, resistin is predictive of atherosclerosis and poor clinical outcomes in patients with cardiovascular disease and heart failure. Furthermore, recent evidence suggests that resistin is associated with atherogenic dyslipidemia and hypertension. The present review will focus on the role of human resistin in the pathogeneses of inflammation and obesity-related diseases.

Association of vascular invasion with increased mortality in patients with minimally invasive follicular thyroid carcinoma but not widely invasive follicular thyroid carcinoma

The association of vascular invasion with tumor aggressiveness and poor prognosis in follicular thyroid carcinoma (FTC) remains controversial.

Analysis of the layering pattern of the apparent diffusion coefficient (ADC) for differentiation of radiation necrosis from tumour progression

ObjectivesTo evaluate the added value of diffusion-weighted imaging (DWI) to perfusion-weighted imaging (PWI) for differentiating tumour progression from radiation necrosis.MethodsSixteen consecutive patients who underwent removal of a metastatic brain tumour that increased in size after stereotactic radiosurgery were retrospectively reviewed. The layering of the ADC was categorised into three patterns. ADC values were measured on each layer, and the maximum rCBV was measured. rCBV and the layering pattern of the ADC of radiation necrosis and tumour progression were compared.ResultsNine cases of radiation necrosis and seven cases of tumour progression were pathologically confirmed. Radiation necrosis (88.9xa0% vs. 14.3xa0%) showed a three-layer pattern of ADC with a middle layer of minimum ADC more frequently. If rCBV larger than 2.6 was used to differentiate radiation necrosis and tumour progression, the sensitivity was 100xa0% but specificity was 56xa0%. If the lesions with the three-layer pattern of ADC with moderately increased rCBV (2.6–4.1) were excluded from tumour progression, the sensitivity and specificity increased to 100xa0%.ConclusionsThe three-layer pattern of ADC shows high specificity in diagnosing radiation necrosis; therefore, combined analysis of the ADC pattern with rCBV may have added value in the correct differentiation of tumour progression from radiation necrosis.Key Points•MRI follow-up often reveals increasing size of enhancing lesions after stereotactic radiosurgery•Inflammation around tumour necrosis increases regional cerebral blood volume (rCBV), mimicking progression•A three-layer apparent diffusion coefficient (ADC) pattern on diffusion-weighted MRI suggests radiation necrosis.•The combined use of rCBV and DW MRI enables accurate differentiation.

Lack of association between high serum thyroid-stimulating hormone level and risk of papillary thyroid microcarcinomas

High serum thyroid‐stimulating hormone (TSH) is associated with thyroid carcinoma in patients with thyroid nodules. However, previous studies suggests that TSH is not involved in the pathogenesis of small thyroid carcinomas. We performed this study to evaluate serum TSH as a malignancy predictor in the assessment of small thyroid nodules.

Strong association of relatively low and extremely excessive iodine intakes with thyroid cancer in an iodine-replete area.

AbstractPurposenThe relationship between iodine intake and development of thyroid diseases shows a U-shaped curve with an increase of risk in both deficient and excessive iodine intakes. Our aim was to investigate the relationship between iodine intake and thyroid cancer in patients with thyroid nodules in an iodine-replete area.MethodsRetrospective analysis of 1170 patients with thyroid nodules was performed. Urinary iodine concentration (UIC) was measured by inductively-coupled plasma mass spectrometry. Predictive factors for thyroid cancer were evaluated using multivariate logistic regression models.ResultsnThe median UIC in all patients with thyroid nodules was 360xa0μg/L (range from 4 to 9631xa0μg/L). More than half of the patients (650/1170, 56xa0%) belonged to the category of excessive iodine intake (UICxa0≥xa0300xa0μg/L) according to WHO iodine recommendations. Patients with thyroid cancer were more likely to be distributed in UICxa0<xa0300xa0μg/L and in UICxa0≥xa02500xa0μg/L than those with benign thyroid nodules. Male gender (OR 1.528, pxa0=xa00.028) and UIC were independent predictors for thyroid cancer. The multivariate-adjusted OR (95xa0% CI) in the relatively low (UICxa0<xa0300xa0μg/L) and extremely excessive (UICxa0≥xa02500xa0μg/L) iodine intake groups for thyroid cancer were 1.519 (1.099–2.098) and 1.874 (1.094–3.208), respectively, compared to the other iodine intake group (300–2499xa0μg/L).ConclusionMale gender and UIC were independent predictors of thyroid cancer in patients with thyroid nodules. This study suggests that relatively low and extremely excessive iodine intakes are associated with thyroid cancer in an iodine-replete area.

Association between excessive urinary iodine excretion and failure of radioactive iodine thyroid ablation in patients with papillary thyroid cancer.

BACKGROUNDnA low-iodine diet (LID) is usually recommended for a week or two before radioactive iodine (RAI) ablation therapy in papillary thyroid cancer (PTC) patients after total thyroidectomy. However, it is still controversial whether an LID affects ablation outcomes. We therefore evaluated the association between urinary iodine excretion and the rate of successful ablation and investigated the determinants of successful RAI ablation outcomes.nnnMETHODSnWe retrospectively reviewed the records of 295 consecutive patients with PTC who received 1110u2009MBq RAI remnant ablation therapy with thyroid hormone withdrawal after total thyroidectomy. Successful ablation was defined as either no visible or faint uptake on a follow-up scan (definition 1), or no visible or faint uptake on a follow-up scan and a stimulated thyroglobulin level <2u2009ng/mL (definition 2).nnnRESULTSnThe proportion of patients with appropriate LID status (defined as a urinary iodine concentration [UIC] <66.2u2009μg iodine/g creatinine [μg/gCr]) was significantly higher in the successfully ablated group (81% vs. 67%, p=0.03). Based on definition 1, 80.3% (237/295) of patients were successfully ablated. The ablation rate was significantly lower in patients who had a UIC >250u2009μg/gCr at the time of RAI ablation (p<0.05). In multivariate analysis, a UIC >250u2009μg/gCr was the only significant variable associated with ablation failure (p=0.002, odds ratio [OR] 4.74 [95% confidence interval (CI) 1.78-12.63]). Based on definition 2, 74.9% (221/295) of patients were successfully ablated. A UIC >250u2009μg/gCr at RAI administration showed a significant association with ablation failure (p<0.05). The OR of a UIC >250u2009μg/gCr for ablation failure was 3.88 [CI 1.42-10.57] (p=0.008).nnnCONCLUSIONnExcessive iodine intake (UIC >250u2009μg/gCr) was associated with poor RAI ablation outcomes. Because this amount of iodine is very high, we propose that the level of strictness of the LID protocol should be modified according to the region that the patient is from and the food that the patient is accustomed to eating. Even in those areas where iodine intake is high, overly strict compliance with an LID protocol is not necessary and simple recommendations to avoid iodine-rich foods would be appropriate.