Jamshid Farahati

Changing trends of incidence and prognosis of thyroid carcinoma in lower Franconia, Germany, from 1981-1995.

BACKGROUNDnA population-based registry (PBR) in Lower Frankonia in southern Germany was conducted to evaluate the changes of incidence and prognosis of thyroid carcinoma (TC) in this area.nnnMETHODSnThe study comprised 476 patients with differentiated thyroid carcinoma (DTC) from Lower Franconia (1.3 x 10(6) inhabitants) registered between 1981 and 1995 at the Regional Tumor Center. The incidence was assessed with respect to gender, age, histology, tumor stage, lymph node involvement and distant metastases in 5-year intervals (1981-1985, 1986-1990, and 1991-1995).nnnRESULTSnAn increasing rate of papillary thyroid carcinoma PTC and a decreasing rate of follicular thyroid carcinoma (FTC) were observed over the three time periods (1981-1985, 1986-1990, and 1991-1995). The overall incidence revealed no significant change with time for both females from 3.22 to 3.25 and 3.73 and males (1.07 to 1.54 and 1.69) between the three time periods. There was a significant improvement in outcome of patients with DTC with respect to life expectancy.nnnCONCLUSIONSnIodine prophylaxis does influence the distribution of the histologic types of thyroid cancer and leads to an increase in the ratio of papillary versus follicular carcinoma. Our study supports the hypothesis that the benefits of correcting iodine deficency outweigh the risks of iodine supplementation.

Current practice of radioiodine treatment in the management of differentiated thyroid cancer in Germany.

Abstract. This prospective, observational study of a cohort of thyroid cancer patients in Germany focusses on the real-world practice in the management of thyroid cancer patients. This report includes data from 2376 patients with primary differentiated thyroid carcinoma first diagnosed in the year 1996. The study reveals considerable differences in actual practice concerning surgery and radioiodine treatment. The results indicate that consensus is lacking with respect to the multimodality treatment approach for differentiated thyroid carcinoma. Our analysis represents the most current and comprehensive national assessment of presenting patient characteristics, diagnostic tests, treatment and complications for thyroid cancer.

Differentiated thyroid cancer in children and adolescents.

Introduction: There have been only a few studies on differentiated childhood thyroid cancer (DTC) in children and adolescents. Methods: We analyzed the characteristics of DTC with respect to age, gender and histology in 114 patients under 18 years of age. In a questionnaire-based survey, data of 114 patients, aged between 3 years and 18 years, was collected from 65 clinical institutions in Germany. Characteristics of 80 females and 34 males were evaluated, and the prognostic effect of age, gender, histology, multicentric growth, tumor stage and N-status on distant metastases was tested using multivariate discriminant analysis. Between-group comparison was performed using student t-test and chi-squared test. Results: The incidence of DTC in females was higher than in males with a peak of female:male ratio at puberty, which was more pronounced in children with papillary thyroid cancer, but not with follicular thyroid cancer. Papillary thyroid cancer was associated with more advanced disease (P = 0.009), more lymph-node involvement (P = 0.007) and more distant metastases (P = 0.02) compared with follicular thyroid cancer. Multivariate analysis showed advanced tumor stage as the only significant factor (P = 0.02) associating with distant metastasis. Conclusion: It can be concluded that in children and adolescents: 1. The incidence of papillary thyroid cancer is higher in females than males, with a peak at puberty. 2. The only significant factor associated with distant metastases is the advanced tumor stage. 3. Childhood thyroid cancer is frequently associated with lymph-node involvement, distant metastases and advanced tumor stage. 4. Papillary childhood thyroid cancer is more aggressive than follicular type.

Anti-thyroid peroxidase antibodies are associated with the absence of distant metastases in patients with newly diagnosed breast cancer

Abstract Background: The presence of thyroid peroxidase antibodies (TPOab) are reported to be associated with improved outcome among breast cancer patients. We evaluated the correlation between TPOab and diagnostic parameters among newly diagnosed breast cancer patients. Methods: Three hundred and fourteen newly diagnosed patients with breast cancer, diagnosed and treated in Bethesda Essen between January 2002 and June 2006, were included in this study; 258 (82.2%) without TPOab (≤100 IU/mL) and 56 (17.8%) with TPOab (>100 IU/mL). Blood analysis was performed to measure serum levels of carcinoembryonic antigen (CEA), cancer antigen 15-3 (CA-15-3), free triiodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone (TSH) and TPOab by radioimmunoassay. Data regarding age, tumor size, grading, TNM classification, receptor status, lymph node, and distant metastases were collected and analyzed from patient reports. Statistics were performed using Pearson’s χ2-test and logistic regression analysis. Results: There were no incidences of distant metastasis among 56 patients with TPOab, whereas 17 (6.6%) of 258 cases without TPOab displayed distant metastases (p=0.04). Logistic regression showed an inverse association of TPOab with CA-15-3 and CEA levels (p<0.001, respectively). Both groups, with and without TPOab, revealed no significant differences with respect to age, tumor size, grading, TNM classification, fT3, fT4, and receptor status. TPOab positive patients had higher TSH levels (2.55±3.58), compared to TPOab negative cases (1.20±1.15) (p<0.001). Conclusions: TPOab occurrence is associated with significantly lower frequency of distant metastases in breast cancer. TPOab level inversely correlates with the conventional tumor markers CA-15-3 and CEA.

Epidemiologie des Schilddrüsenkarzinoms

ZusammenfassungDie Inzidenz des Schilddrüsenkarzinoms hat sich weltweit in den letzten 30–40 Jahren verdoppelt. Dabei nimmt insbesondere der Anteil der papillären Karzinome zu, wohingegen follikuläre und v.xa0a. anaplastische Schilddrüsenkarzinome an Häufigkeit abnehmen. Dieser Trend wird mit einer Verbesserung der Jodversorgung in Zusammenhang gebracht. Wie Autopsie-Untersuchungen zeigen, ist die Prävalenz okkulter Schilddrüsenkarzinome in Abhängigkeit von der Intensität der Aufarbeitung mit bis zu 35% sehr hoch. Nur etwa jedes 10.000. dieser Mikrokarzinome manifestiert sich jedoch klinisch. Zu den gesicherten ätiologischen Faktoren für das Schilddrüsenkarzinom zählt eine Strahlenexposition in der Kindheit. Die Prognose der differenzierten Schilddrüsenkarzinome mit Zehnjahresüberlebensraten in der Größenordnung von 95% für papilläre und 85% für follikuläre Karzinome ist sehr gut. Demgegenüber ist die Prognose für anaplastische Karzinome mit Zehnjahresüberlebensraten von weniger als 15% äußerst schlecht. Prognosebestimmend sind das Lebensalter bei der Diagnosestellung, Organ überschreitendes Tumorwachstum und Fernmetastasen sowie—mit Einschränkung—Lympknotenmetastasen. Dabei ist zu berücksichtigen, dass das Lebensalter kein prognostisch unabhängiger Faktor ist.AbstractThe worldwide incidence of thyroid cancer has doubled during the last 30–40xa0years. Mainly the proportion of papillary cancers has increased, whereas follicular and anaplastic cancers have decreased in frequency. This trend is presumably related to an improvement of nutritional iodine supply. According to autopsy studies, the prevalence of occult thyroid cancer is high in relation to the intensity of the histological work-up (up to 35xa0%); however, only 1 in every 10,000 of these microcarcinomas is clinically relevant. The most important etiological factor for thyroid cancer is radiation exposure in childhood. The prognosis of differentiated thyroid cancer with 10-year survival rates in a range of 95% for papillary and 85% for follicular cancers is very good. In contrast, the prognosis of anaplastic cancer with 10-year survival rates of less than 15% is extremely bad. The prognosis is determined by the patient’s age at the time of diagnosis, tumor growth beyond the thyroid capsule, distant metastases and—with some restrictions—lymph node metastases. In this context it should be taken into consideration that age is not a prognostically independent factor.

Gender-specific determinants of goiter

Despite the strong implications of differences between females and males in the risk of goiter, gender-specific issues have not been extensively addressed in investigations of goiter prevalence. The objective of our analysis was to investigate the gender-specific determinants of goiter. Between April 2001 and April 2002. A total of 853 healthy employees from 4 institutions in the western part of Germany between 18 and 68 yr of age were examined by ultrasound of the neck to determine the thyroid volume. Information on sex, age, daily use of iodized salt, the history of goiter in the first-degree relatives, type and amount of smoking, oral contraceptives, and number of pregnancies were assessed by standardized questionnaires. Gender-specific predictors of goiter prevalence were assessed by multivariate logistic regression. The overall prevalence of goiter among study subjects was 204/853 (23.9%). Goiter was present in 80 out of 370 females (21.6%) vs 124/483 (25.7%) in males. In general, smoking (p<0.0001), increasing age (p<0.0001), and lack of daily intake of iodized salt (p=0.004) were associated with goiter prevalence, but not sex (p=0.39) and family history of goiter (p=0.16). In 370 females, parity (p=0.004) and lack of daily intake of iodized salt (p=0.01) were the major determinants for goiter, whereas age (p=0.18), oral contraceptives (p=0.82), family history of goiter (p=0.33), and smoking (p=0.09) did not affect goiter prevalence. In 483 males, smoking (p<0.0001) and age (p<0.001) affected goiter prevalence, but not family history of goiter (p=0.39), and the iodine status failed just to reach the significant level (p=0.08) in this analysis. Gender-specific determinants of goiter are parity and iodine status in females and smoking and increasing age in males.

Ethnicity, Clothing Style, and Body Mass Index are Significant Predictors of Vitamin D Insufficiency in Germany

OBJECTIVEnTo analyze risk factors for vitamin D insufficiency in Germany with respect to ethnicity, sex, and clothing style.nnnMETHODSnWe analyzed the routine diagnostic work-ups of 1,231 adult (45.9 ± 17.9 years old) German (n = 1,034) and Turk residents (n = 197) referred with nonspecific symptoms to the Thyroid Centers at St. Elisabeth-Hospital in Dorsten, Germany and Bottrop, Germany to assess for metabolic diseases. All subjects underwent a routine examination that consisted of a questionnaire, lab tests for 25-hydroxyvitamin-D (25OHD), and thyroid profile. Turk females with traditional clothing (headscarf and covered legs and arms) were considered to wear covered clothing. Logistic-regression was performed to identify factors that could predict vitamin D deficiency (<20 ng/mL) and insufficiency (20-30 ng/mL).nnnRESULTSnVitamin D insufficiency was seen in 33% of Germans and 74.1% of Turks, and vitamin D deficiency was present in 11.3% and 44.2% of Germans and Turks, respectively (P<.001). The mean 25OHD value in Turk females with covered clothes was lower than that in Turk females with conventional clothing (16.3 ± 12.3 vs. 27.2 ± 15.8, P<.001). Vitamin D insufficiency was present in 86.0% of Turk females with covered clothing versus 62.8% with conventional clothing (odds ratio [OR] = 3.6, P = .002). Ethnicity, body mass index (BMI), and clothing style were significant predictors of vitamin D deficiency and insufficiency by logistic regression (P<.001).nnnCONCLUSIONSn(1) Vitamin D insufficiency among Turk residents in Germany is higher compared to Germans. The highest prevalence was present in Turk females with covered clothing. (2) Monitoring vitamin D in Turk residents in Germany is warranted. (3) Vitamin D supplements and access to facilities with sunlight exposure for females with covered clothing and all individuals with poor diets or limited access to sun exposure may prevent future health burden due to vitamin D insufficiency.

Success rate of repeated fine needle aspiration biopsy of clinically suspicious thyroid nodules

UNLABELLEDnIn this study we evaluated the success rate of double fine needle aspiration biopsy (FNAB) of clinically suspicious thyroid nodules in one session.nnnAIMnThe success rate of FNAB in clinical setting is quite low. There were several attempts made to improve the success rate of this method. It is anticipated that a double FNAB in one session would increase the success rate of FNAB.nnnPATIENTS, METHODSn176 consecutive patients (130 women, 46 men; mean age 56 years ± 11) with at least one clinically suspicious nodule were included in this study. Each individual nodule was biopsied twice (20G- and 21G-needle). In 33 patients, two suspicious nodules were biopsied, accounting for a total of 209 biopsied thyroid nodules. To evaluate the success rate the number of cell formations and the total number of cells in each cell formation were counted.nnnRESULTSnThe biopsy with the 20G needle provided in mean 40 cell cluster with a mean of 830 cells whereas the 21G needle provided in mean 41 cell cluster with a mean of 1010 cells. With the 20G needle the success rate was 73%, with the 21G needle 78% and the combination of the both biopsies provided a success rate of 87% (p = 0.01). Based on the number of cell formations and the total number of cells, the difference between the two needle sizes was not significant (p = 0.5 for cell formations and p = 0.9 for the total number of cells, respectively).nnnCONCLUSIONnA double FNAB of suspicious thyroid nodules in one session provides a higher success rate, and a 21G needle is sufficient enough.

Use of various diagnostic methods in a patient with Gaucher disease type I.

A series of plain radiographs, bone scans, bone marrow scans, and MRIs is reported in a patient with Gaucher disease type I, in whom two episodes of acute bone crisis developed during a 6-year period of follow-up. Acute bone crisis and global indolent bone marrow displacement could both be assessed by bone marrow scintigraphy, whereas MRI could better clarify the corti-comedullary alteration after bone infarction. Thus, MRI and bone marrow scintigraphy could be used as complementary imaging methods in the management of patients with Gaucher disease.

Positron emission mammography in the diagnosis of breast cancer. Is maximum PEM uptake value a valuable threshold for malignant breast cancer detection

AIMnTo evaluate the diagnostic value (sensitivity, specificity) of positron emission mammography (PEM) in a single site non-interventional study using the maximum PEM uptake value (PUVmax).nnnPATIENTS, METHODSnIn a singlesite, non-interventional study, 108 patients (107 women, 1 man) with a total of 151 suspected lesions were scanned with a PEM Flex Solo II (Naviscan) at 90 min p.i. with 3.5 MBq 18F-FDG per kg of body weight. In this ROI(region of interest)-based analysis, maximum PEM uptake value (PUV) was determined in lesions, tumours (PUVmaxtumour), benign lesions (PUVmaxnormal breast) and also in healthy tissues on the contralateral side (PUVmaxcontralateral breast). These values were compared and contrasted. In addition, the ratios of PUVmaxtumouru2009/u2009PUVmaxcontralateral breast and PUVmaxnormal breastu2009/u2009PUVmaxcontralateral breast were compared. The image data were interpreted independently by two experienced nuclear medicine physicians and compared with histology in cases of suspected carcinoma.nnnRESULTSnBased on a criteria of PUV>1.9, 31 out of 151 lesions in the patient cohort were found to be malignant (21%). A mean PUVmaxtumour of 3.78 ± 2.47 was identified in malignant tumours, while a mean PUVmaxnormal breast of 1.17 ± 0.37 was reported in the glandular tissue of the healthy breast, with the difference being statistically significant (p < 0.001). Similarly, the mean ratio between tumour and healthy glandular tissue in breast cancer patients (3.15 ± 1.58) was found to be significantly higher than the ratio for benign lesions (1.17 ± 0.41, p < 0.001).nnnCONCLUSIONnPEM is capable of differentiating breast tumours from benign lesions with 100% sensitivity along with a high specificity of 96%, when a threshold of PUVmax >1.9 is applied.