Zhong-Ling Qiu

Rare metastases of differentiated thyroid carcinoma: pictorial review

Differentiated thyroid cancer (DTC) is usually indolent with good prognosis and long-term survival. However, DTC distant metastasis is often a grave event and accounts for most of its disease-specific mortality. The major sites of distant metastases are the lung and bone. Metastases to the brain, breast, liver, kidney, muscle, and skin are rare or relatively rare. Nevertheless, recognizing rare metastases from DTC has a significant impact on the clinical decision making and prognosis of patients. (131)I single photon emission computed tomography/computed tomography ((131)I-SPECT/CT) can provide both metabolic and anatomic information about a lesion; therefore, it can better localize and define the (131)I-WBS findings in DTC patients. In this pictorial review, the imaging features of a range of rare metastases from DTC are demonstrated, with a particular emphasis on the (131)I-SPECT/CT diagnostic aspect.

Efficacy and Survival Analysis of 131I Therapy for Bone Metastases from Differentiated Thyroid Cancer

OBJECTIVE Our objective was to investigate the clinical efficacy of (131)I therapy for bone metastases from differentiated thyroid cancer (DTC) and prognostic factors as well as to assess patient survival and variables influencing survival. METHODS One hundred six DTC patients with bone metastases treated with (131)I were retrospectively analyzed. The therapeutic efficacy was evaluated based on the change in serum thyroglobulin (Tg), the palliation of bone pain, and the anatomical imaging changes in bone lesions. The overall survival rates were estimated using the life-table method. RESULTS After (131)I therapy, a significant decrease in serum Tg was seen in 37 cases (34.9%), and serum Tg remained stable in 56 patients (52.8%). Among the 61 patients with painful bone metastases, 39 patients obtained a significant relief of bone pain, and the effective rate was 63.9%. The majority of DTC patients (76.4%) exhibited no obvious anatomical imaging changes in metastatic bone lesions after (131)I therapy. Only histopathological type and whether combined with nonosseous distant metastases had statistically significant impacts on changes in serum Tg (P = 0.009 and 0.023), and age over 45 yr and papillary thyroid carcinoma had favorable response on changes in anatomical imaging (P = 0.027 and 0.014). The 5- and 10-yr survival rates were 86.5 and 57.9%, respectively. Multivariate analyses showed that the presence of solitary bone metastases, only bone metastases, and (131)I therapy with previous bone surgery were independent factors associated with a better prognosis (P = 0.024, 0.009, and 0.031). CONCLUSION (131)I therapy is a feasible and effective treatment for DTC bone metastases. A better prognosis can be accomplished in patients who had a single metastatic lesion, only bone metastasis, or underwent bone surgery before (131)I therapy.

Performance of 18F-fluoride PET or PET/CT for the detection of bone metastases: a meta-analysis.

Purpose This study aimed to evaluate the diagnostic accuracy of 18F-fluoride PET or PET/CT compared with 99mTc-MDP bone scintigraphy and 18F-FDG PET/CT in the detection of bone metastases. Patients and Methods An electronic search was conducted using PubMed/MEDLINE and EMBASE. The methodological quality of the included studies was assessed with Quality Assessment of Diagnostic Accuracy Studies 2. All analyses were performed on Stata version 12.0 and Meta-DiSc version 1.4. Results Twenty articles containing 1170 patients were identified. On a patient basis, the pooled sensitivity, specificity, and the area under the summary receiver operating characteristic curve of 18F-fluoride PET or PET/CT were 92% (95% confidence interval [CI], 89%–95%), 93% (95% CI, 91%–95%), and 0.985, respectively. On a lesion basis, the pooled sensitivity, specificity, and area under the summary receiver operating characteristic curve of 18F-fluoride PET or PET/CT were 87% (95% CI, 85%–88%), 95% (95% CI, 94%–96%), and 0.979, respectively. When compared with 99mTc-MDP bone scintigraphy, 18F-fluoride PET or PET/CT showed both higher sensitivity (96% vs. 88%, P = 0.002) and specificity (91% vs. 80%, P = 0.001). When compared with 18F-FDG PET/CT, 18F-fluoride PET/CT showed higher sensitivity (94% vs. 73%, P = 0.003), whereas no significant difference was observed in specificity (88% vs. 98%, P = 0.06). Conclusions 18F-fluoride PET or PET/CT has an excellent diagnostic capacity for the detection of bone metastases and shows advantages when compared with 99mTc-MDP bone scintigraphy and 18F-FDG PET/CT.

Value of 131I SPECT/CT for the evaluation of differentiated thyroid cancer: a systematic review of the literature

PurposeIn the present study, we performed a systematic review of the current literature to assess the incremental value of 131I single photon emission computed tomography (SPECT)/CT for the management of patients with differentiated thyroid cancer (DTC).MethodsThe search of PubMed/MEDLINE and EMBASE databases to identify studies and reference lists for articles was conducted using the terms “SPECT or SPECT/CT or SPECT-CT or single photon emission computed tomography/computed tomography and thyroid carcinoma or thyroid cancer.” Studies reporting the clinical value of 131I SPECT/CT were selected. All studies included were assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2). Two independent reviewers selected the studies, summarized and tabulated the data, and pooled estimates were obtained. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.ResultsA total of 14 studies involving 1,066 patients met the inclusion criteria. Data obtained included the impact of 131I SPECT/CT on staging or risk classification (three studies), diagnostic accuracy (six studies), and follow-up (five studies).ConclusionIntegrated SPECT/CT is a useful tool for the diagnosis, staging, risk stratification, and follow-up of DTC. The impact of 131I SPECT/CT on the management of patients with thyroid cancer was evaluated.

Uncommon metastases from differentiated thyroid carcinoma

Differentiated thyroid carcinoma (DTC) usually behaves in an indolent manner with low metastatic potential. The major sites of distant metastases are the lung and bone. Metastases to the brain, eye, breast, liver, kidney, muscle and skin are rare or relatively rare. These metastases have almost always appeared in patients with advanced disease and are often associated with poor prognosis but overlooked in clinical practice. Recognizing them has a significant impact on clinical decision-making and prognosis of the patients. Treatment in these patients should be individualized and an alternative therapeutic approach should be considered. Care should be taken to determine whether a (131)I uptake focus found at an unexpected site of (131)I- whole body scan (WBS) is a DTC metastasis or a false-positive (131)I uptake. Imaging with (131)I-SPET/CT is of incremental value in the finding of rare metastases from DTC. In conclusion, DTC can have unusual metastatic presentations and patterns. Post-therapy (131)I-WBS and (131)I-SPET/CT play an important role in the management of patients with DTC.

Localization and identification of parapharyngeal metastases from differentiated thyroid carcinoma by 131I-SPECT/CT.

Parapharyngeal metastasis is a rare event in differentiated thyroid carcinoma (DTC). The 131I‐single photon emission CT (SPECT)/CT allows better localization and definition for metastases in DTC. The aim of this study was to assess the value of 131I‐SPECT/CT for the diagnosis of parapharyngeal metastasis in patients with DTC.

Circulating Long Non-Coding RNAs Act as Biomarkers for Predicting 131I Uptake and Mortality in Papillary Thyroid Cancer Patients with Lung Metastases

Purpose: The aims of the current study were to explore plasma lncRNAs as a novel biomarker panel for the diagnosis of non-131I-avid lung metastases of PTC and to investigate the plasma lncRNA expression levels associated with survival in PTC patients with lung metastases. Methods: The expression of lncRNAs was examined using an lncRNA microarray chip. The lncRNAs with the most significant difference in expression between PTC patients with non-131I-avid lung metastases and PTC patients with 131I-avid lung metastases were verified by quantitative reverse-transcription polymerase chain reaction. The Kaplan-Meier method was used to determine whether the plasma lncRNA levels might be indicative of patient prognosis. Results: Compared with 131I-avid lung metastases, we discovered that two lncRNAs (ENST00000462717 andENST00000415582) were upregulated and two (TCONS_00024700 and NR_028494) were downregulated in the non-131I-avid lung metastases of PTC. Receiver operating characteristic curve (ROC) analyses indicated that the use of these four lncRNAs had high diagnostic sensitivity and specificity for predicting non-131I-avid lung metastases of PTC. The merged areas under the curve for ENST00000462717, ENST00000415582, TCONS_00024700,and NR_028494 in the training and validation sets were 0.890, 0.936, 0.975, and 0.918, respectively. Low (ENST00000462717 and ENST00000415582) and high plasma lncRNA levels(TCONS_00024700and NR_028494) were also found to be associated with better prognosis of PTC patients with lung metastases(P<0.001). Conclusions: ENST00000462717, ENST00000415582, TCONS_00024700, and NR_028494 may be used as novel and minimally invasive markers for the diagnosis and prognostic assessment of non-131I-avid lung metastases from PTC.

Comparison of the diagnostic and prognostic values of 99mTc-MDP-planar bone scintigraphy, 131I-SPECT/CT and 18F-FDG-PET/CT for the detection of bone metastases from differentiated thyroid cancer.

Objective The aim of this study was to compare the diagnostic and prognostic values of 99mTc-MDP-planar bone scintigraphy (99mTc-MDP-BS), 131I single-photon emission computed tomography/computed tomography (131I-SPECT/CT) and 18F-fluorodeoxyglucose (18F-FDG)-PET/CT for the detection of bone metastases from differentiated thyroid cancer (DTC). Methods Eighty patients with DTC with suspected bone metastases from DTC were retrospectively analysed. All patients were examined with 99mTc-MDP-BS, 131I-SPECT/CT and 18F-FDG-PET/CT, with a maximum interval of 2 months between scans. The diagnostic performances of 99mTc-MDP-BS, 131I-SPECT/CT and 18F-FDG-PET/CT were investigated and compared. Univariate and multivariate analyses were carried out to evaluate the effects of variables on the survival of patients. Results Out of the 80 patients with 148 foci, 43 with 106 foci were diagnosed as being true positive for bone metastases from DTC. In patient-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 99mTc-MDP-BS were 79.07, 83.78, 85.00, 77.50 and 81.25%, respectively; those of 131I-SPECT/CT were 93.02, 97.30, 97.56, 92.31 and 95.00%, and those of 18F-FDG-PET/CT were 86.05, 94.59, 94.87, 85.36 and 87.80%, respectively. In lesion-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 99mTc-MDP-BS were 72.64, 73.81, 87.50, 51.67 and 72.97%, respectively; those of 131I-SPECT/CT were 92.45, 97.62, 98.99, 83.67 and 93.92%, and those of 18F-FDG-PET/CT were 85.85, 88.10, 94.50, 71.15 and 86.49%, respectively. Comparing the receiver-operating characteristic area using the McNemar test, both 131I-SPECT/CT and 18F-FDG-PET/CT were found to be superior to 99mTc-MDP-BS for the detection of bone metastases from DTC in patient-based and lesion-based analyses (P<0.05). Patient-based analysis showed that there were no significant differences between 131I-SPECT/CT and 18F-FDG-PET/CT (P=0.087) but lesion-based analysis revealed that 131I-SPECT/CT was superior to 18F-FDG-PET/CT (P=0.002). For the association between these image patterns and the prognosis of DTC patients, 18F-FDG positivity was the factor predicting a poor prognosis. Conclusion 131I-SPECT/CT and 18F-FDG-PET/CT demonstrated high diagnostic performance in detecting bone metastases from DTC. 99mTc-MDP-BS might be completely replaced by 131I-SPECT/CT in combination with 18F-FDG-PET/CT in the management of DTC patients with bone metastases. 18F-FDG-PET/CT positivity was an independent factor associated with poor prognosis.

Comparison of SPET/CT, SPET and planar imaging using 99mTc-MIBI as independent techniques to support minimally invasive parathyroidectomy in primary hyperparathyroidism: A meta-analysis.

OBJECTIVE Successful performance of minimally invasive parathyroidectomy (MIP) is based on the accuracy of preoperative parathyroid localization studies. Despite the various methodologies available, no consensus has been reached so far on the optimal imaging technique. The aim of our meta-analysis was to determine the accuracy of technetium-99m-hexakis methoxyisobutylisonitrile single photon emission tomography/computed tomography ((99m)Tc-MIBI SPET/CT), SPET and MIBI scintigraphy for the preoperative localization of primary hyperparathyroidism (PHPT) lesions, thus facilitating better management of these patients. METHODS Publications were screened by a comprehensive computer search of PubMed and EMBASE for 25 years. Data were extracted from included articles and forest plots of sensitivity and positive predictive value were calculated to investigate the diagnostic accuracy of SPET/CT, SPET and MIBI scintigraphy. RESULTS Eighteen articles were included in our study. The sensitivities of SPET/CT, SPET and planar scintigraphy were 84% (95% CI: 78%-90%), 66% (95% CI: 57%-74%) and 63% (95% CI: 51%-74%), respectively. The PPV of the above three imaging modalities were: 95% (95% CI: 92%-98%), 82% (95% CI: 73%-89%) and 90% (95% CI: 96%-99%), respectively. CONCLUSION Our present meta-analysis showed that using (99m)Tc-MIBI, combining anatomical information of CT and functional abnormalities on SPET, as presented on SPET/CT was by far more sensitive and accurate than SPET or planar scintigraphy in localizing PHPT lesions. We firmly believe that this technique will be the main diagnostic means, to detect PHPT lesions and support minimally invasive parathyroidectomy.

MicroRNAs as a potential tool in the differential diagnosis of thyroid cancer: a systematic review and meta-analysis.

Thyroid cancer is the most common endocrine malignancy, and its incidence has been increasing over the last 30 years. Several studies have suggested that miRNAs may play a significant role in the differential diagnosis of indeterminate thyroid nodules. To systematically evaluate the utility of miRNAs in discriminating malignant thyroid nodules from benign ones on fine‐needle aspiration biopsy (FNAB) samples, a systematic review and meta‐analysis of the published literatures were carried out.