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Content available remote Assessment Of Plasma B-Catenin Concentration As Biomarker Of Thyroid Cancer*
New diagnostic methods for thyroid diseases are still being searched for. Immunohistochemical diagnosis is expanded by the introduction of new biomarkers including ß-catenin (B-Cat). Associations are indicated between the cellular expression of this biomarker and tumor stage, nodal metastases and the degree of tumor cell differentiation. Reports are scarce regarding the plasma level of this biomarker in malignant neoplastic diseases. The aim of the study was to analyze the plasma B-Cat concentration and the possibility of it use in the diagnostics of patients with nodular goiter and papillary thyroid carcinoma. Material and methods. Plasma B-Cat concentration was determined in 64 patients with goiter and 15 healthy volunteers. The final histopathological examination revealed 41 cases of papillary thyroid carcinoma (PTC) and 13 cases of nodular goiter (NG). Results. A significant increase in B-Cat (p <0.05) in both groups compared to the control group. No differences in the concentrations of biomarker was demonstrated between the PTC and NG groups. After determining the AUC for the tested biomarker, the B-Cat ratio of the area value 0.721 was the strong diagnostic test. Conclusions. Changes in the plasma B-Cat concentration can be the biomarker of thyroid cancer but it cannot be used for the detection of papillary thyroid carcinoma becouse of concomitant tumor-like lesions in the thyroid gland.
Content available remote Diagnostic problems with follicular thyroid cancer – case study
The diagnosis of follicular thyroid cancer is based on postoperative histopathology assessment. In its minimally invasive form, the signs of vascular invasion and capsular infiltration may sometimes be seen only in a small tumor fragment; hence, the diagnosis should be based on multiple histopathology specimens. This case study is a report on a 70-year-old female who was diagnosed with spinal metastasis of follicular thyroid cancer. This diagnosis was established 5 years after partial strumectomy due to goiter and there were no signs of thyroid cancer in postoperative histopathology assessment. Based on this case and literature reports, the authors conclude that the diagnosis of follicular thyroid cancer, especially its minimally invasive forms, may pose a diagnostic problem even when based on postoperative histopathology.
The recurrent laryngeal nerve (RLN) is particularly prone to injury during thyroidectomy in case of extralaryngeal bifurcation being present in approximately one-third of patients near the inferior thyroid artery or ligament of Berry. Meticulous surgical dissection in this area may be additionally facilitated by the use of intraoperative neuromonitoring (IONM) to assure safe and complete removal of thyroid tissue.The aim of the study was to verify the hypothesis that meticulous surgical technique of tissue dissection in the area of the posterior surface of the thyroid capsule and adjacent RLN may be additionally facilitated by intraoperative neuromonitoring (IONM), and may contribute to increasing the safety and radicalness of total thyroidectomy in patients with well-differentiated thyroid cancer.Material and methods. The outcomes of total thyroidectomy with level VI lymph node clearance for well-differentiated thyroid cancer (WDTC; pT1-3, N0-1, Mx) were retrospectively compared between 151 patients undergoing surgery with IONM (01/2005-06/2009) and 151 patients undergoing surgery without IONM (2003-2004). RLN morbidity (calculated for nerves at risk) was assessed by videolaryngoscopy or indirect laryngoscopy (mandatory before and after surgery and at 12-month follow-up). The anatomical course of the extralaryngeal segment of RLNs were analyzed in detail in each operation. Thyroid iodine uptake (131I) was measured during endogenous TSH stimulation test a week before radioiodine therapy.Results. Among patients operated with vs. without IONM, the early RLN injury rate was 3% vs. 6.7% (p=0.02), including 2% vs. 5% (p=0.04) of temporary nerve lesions, and 1% vs. 1.7% of permanent nerve events (p=0.31), respectively. Extralaryngeal RLN bifurcation was identified in 42 (27.8%) vs. 25 (16.6%) of patients operated with vs. without IONM, respectively (p=0.001). Mean I-131 uptake following total thyroidectomy with vs. without IONM was 0.67 ± 0.39% vs. 1.59 ± 0.69% (p<0.001). 131I uptake lower than 1% was found in 106 (70.2%) vs. 38 (25.2%) patients operated with vs. without IONM, respectively (p<0.001).Conclusions. Most patients with WDTC who undergo total thyroidectomy have a small amount of residual thyroid tissue. The use of IONM may improve the outcomes of surgery among these patients by both increasing the completeness of total thyroidectomy and significantly reducing the prevalence of temporary RLN injury. The possible mechanism of this improvement is the aid in dissection at the level of the Berry's ligament offered by IONM which enhances the surgeon's ability to identify a branched RLN, and allows for reduction of traction injury and neuropraxia of the anterior branch of bifid nerves.
Content available Overdiagnosis of Thyroid Cancer
Overdiagnosis of thyroid cancers contributes to increased incidence of thyroid cancers worldwide, which is already a serious public health problem. A great number of medical tests, helping to detect thyroid cancer, may result in an epidemic of diagnosis. A dramatic increase in the number of detected cases of thyroid cancer may be associated with a great number of neck ultrasounds, fine- needle aspirations and incidental findings during examination. Unfortunately, in response to overdiagnosis, more and more surgeries are being performed. It is important to differentiate stationary cancers from potentially aggressive diseases. Detection of cancer contributes to saving lives. However, in some instances it can be harmful, particularly if the disease is overdiagnosed. The aim of this review is to give a balanced view of thyroid cancer epidemic and controversies arising out of overdiagnosis.
Fine needle aspiration cytology (FNAC) is considered as the gold-standard diagnostic test in the diagnostics of thyroid nodules. It is a cost-effective procedure that provides specific diagnosis rapidly with minimal complications. It plays an important role in the determination of treatment - patients with suspected malignancy diagnosis can be subjected to surgery. On the other hand, it can decrease the rate of unnecessary surgeries. Aim: The aim of this study was to evaluate and compare the correlation, accuracy of fine needle aspiration cytology (FNAC) in the diagnostics of thyroid lesions with the final histopathologic diagnosis based on the surgical specimens. Materials and Methods: In our study we performed a retrospective analysis of a case series of patients who had been admitted to the Department of Endocrine, General and Oncological Surgery of the Hospital of M. Kopernik in Łodź (Poland) between May 2016 and December 2017 and underwent FNAC with subsequent surgery. Cytological diagnosis was classified into six Bethesda categories. Results: On cytological examination, 1070/1262 cases were reported as benign, 49 as malignant and 143 as suspicious. On histopathological examination, 956/1070 cases were confirmed as benign but there were 114 discordant cases. Among the other cases histopathology diagnosis confirmed malignancy in 45/49 cases and 128/143 suspicious cases. The sensitivity and specificity were 60,28% and 98,05% respectively. False positive rate was 1.95% and false negative rate was 39.72%. The positive predictive value was 90.1% and negative predictive value was 89.35%. Accuracy of FNA in differentiating benign from malignant thyroid lesions was 89.46%.
Thoracic duct injuries are a rare complication of thyroid surgery. This report documents two cases of thoracic duct injury complicated by formation of chyloma following thyroid surgery. The injury was identified post-operatively and treated successfully. We review the diagnostic and therapeutic options and discuss their applicability to our patients.
Background. The study aimed to determine the effect of iodine deficiency and increased radiation on morbidity of thyroid cancer in patients living in the Ternopil region of Ukraine. The task was solved by comparing the patients with thyroid cancer from the district areas with iodine deficiency and increased radiation with those coming from the regions with normal iodine content and a normal radioactive background. Material and methods. The area of the Ternopil region was divided into the following 1) the northern area, with sufficient iodine content in food, radiation background – 0.09 mcSv/h; 2) the central and western areas, endemic in terms of iodine content and increased background radiation (up to 0.13 mcSv/h); and 3) the southern area, with sufficient iodine but increased background radiation (up to 0.15 mcSv/h). To conduct the analysis and determine the sickness rate, the patients were grouped depending on sex and age. Results. The sickness rate and prevalence of thyroid cancer in males in 2016 were 4-6 times lower when compared to females in all areas. The sickness rate of the females in the areas with increased radiation turned out to be age-dependent with a 1.25-3.2 times increase when compared to the areas with normal conditions. In the areas of the increased background radiation and dietary iodine insufficiency, the sickness rate of females was 1.54-5.4 times higher than the index in the areas with normal conditions. Conclusions. The highest rates prevalence and sickness rate of thyroid cancer in Ternopil region of Ukraine were observed in women over 51 years. The prevalence was 2 times, and the sickness rate 3 times higher in women over 51 years in the areas with iodine deficiency and an increased radiation background when compared to those in the areas with normal iodine and radiation background.
Wprowadzenie. Celem pracy było określenie wpływu niedoboru jodu i zwiększonej radiacji na zachorowalność na raka tarczycy pacjentów mieszkających w ukraińskim obwodzie tarnopolskim. Porównano grupę pacjentów chorujących na nowotwory tarczycy pochodzącą z obszarów, gdzie stwierdzono niedobór jodu i zwiększone promieniowanie z pacjentami, z grupą u których stwierdzono tę samą chorobę, ale pochodzą z regionów o normalnej zawartości jodu i normalnym promieniowaniu radioaktywnym. Materiał i metody. Obwód tarnopolski został podzielony na następujące sfery: 1) północną, z wystarczającą ilością jodu w żywności oraz promieniowaniem − 0,09 mcSv / h; 2) centralną i zachodnią, endemiczną pod względem zawartości jodu oraz zwiększonym promieniowaniem (do 0,13 mcSv / h); oraz 3) południową, z wystarczającą ilością jodu, ale zwiększonym promieniowaniem (do 0,15 mcSv / h). Aby przeanalizować częstotliwość występowania choroby, pacjentów pogrupowano w zależności od płci i wieku. Wyniki. W 2016 r. wskaźnik zachorowalności i częstość występowania raka tarczycy u mężczyzn był 4-6 razy niższy niż u kobiet we wszystkich badanych obszarach. Wskaźnik zachorowalności u kobiet na obszarach o podwyższonym promieniowaniu skutkował średnim wzrostem, w zależności od wieku, tj. o 1,25-3,2, w stosunku do osób pochodzących z obszarów nienapromieniowanych. Na terenach zwiększonego promieniowania i niedoboru jodu wskaźnik zachorowalności u kobiet był 1,54-5,4 razy wyższy od spotykanego na obszarach nieskażonych. Wnioski. Najwyższe wskaźniki zachorowalności na raka tarczycy w tym regionie Ukrainy zaobserwowano u kobiet powyżej 51 roku życia. Częstotliwość występowania raka na obszarach z niedoborem jodu i zwiększonym promieniowaniem była 2 razy większa, a liczba zachorowań 3 razy większa, niż u kobiet pochodzących z obszarów o normalnym poziomie jodu i promieniowania.
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