1994, 219: 587-93. During thyroidectomy, an area of difficulty for surgeons is the Berry ligament, which tethers the thyroid to the trachea, because the recurrent laryngeal nerve is generally intimately associated with this ligament.7 In inexperienced hands, incomplete resection of the thyroid at the Berry ligament may occur as a result of the surgeon’s attempt to avoid damaging this nerve.8 D’Andrea et al9 studied the rate of residual thyroid tissue after total thyroidectomy and found that 34 of 102 patients (33.3%) had “significant thyroid tissue remnants” in the thyroid bed. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. The aim of this study was to assess I-131 biokinetics in thyroid cancer and remnant tissue in patients with differentiated thyroid cancer using whole-body scan (WBS) and SPECT images acquired after I-131 therapy. after just surgery yes you will have some left. ANOVA analysis showed that recurrent disease demonstrated significantly lower Hounsfield unit values in all 4 phases compared with diseased thyroid (P < .001). Ours and the study of Hunter et al also found the greatest separation between thyroid tissue and recurrence, and adenomas and thyroid tissue in the arterial phase, respectively. Rarely, lymph node, lung, or bone metastases cause the presenting symptoms of small thyroid cancers. Limitations include the retrospective nature of the study and the relatively small number of patients (29 in each category). © 2021 by the American Society of Neuroradiology | Print ISSN: 0195-6108 Online ISSN: 1936-959X. Further investigation is needed in this area. In the United States, between 1975 and 2013, the incidence of thyroid cancer increased by 211% and the average annual increases in incidence and mortality rates were 3.6% and 1.1%, respectively.1 Papillary thyroid carcinoma, the least aggressive type of thyroid cancer, accounts for most new cases.2 In patients with thyroid cancer, thyroid surgery is the mainstay of treatment.3,4, After the operation, approximately 20%–30% of patients experience local recurrence of soft-tissue or nodal metastases.5 Routine follow-up imaging to detect early recurrence includes CT and sonography to assess structural recurrence and thyroid-stimulating hormone and thyroglobulin levels for biochemical assessment.6. This concept is particularly evident in thyroid cancer in which often the entire primary organ is removed and residual normal tissue is ablated with I-131. 3,4 An attempt was made to place the contour 1 mm from the edge of the lesion to minimize the effects of partial volume averaging. This produces high concentrations of radioactive iodine in ROC plots comparing recurrent and benign thyroid through 4 phases. “The first step is to try to optimize the management with According to the international Agency for Research on Cancer, thyroid cancer is the commonest cancer of the endocrine system, ranks ninth on the list of the most common cancers and represents Thyroid cancer is a malignancy of the thyroid gland, a butter-fly shaped gland that lies low in front of the neck. The content on this site is for informational purposes only. Tukey-Kramer adjustment was used to control the overall type I error rate at 5%. Diagnostic tools have become so sensitive that they can detect even the smallest number of cancerous cells that remains after treatment for thyroid cancer. CONCLUSIONS: Recurrent thyroid carcinoma can be distinguished from residual nonmalignant thyroid tissue using multiphasic multidetector CT with high accuracy. Sixteen of 24 patients (19 lesions) received radioactive iodine following thyroidectomy. Any visible surgical clips or calcifications associated with the lesions were excluded. Freehand contouring method of drawing the ROI. During a longer time course, recurrence and residual tissue may have a different appearance. I'm wondering if anyone has had residual thyroid tissue show up during a follow-up body scan? MATERIALS AND METHODS: In this retrospective study, Hounsfield unit values on multiphasic multidetector CT in precontrast, arterial (25 seconds), venous (55 seconds), and delayed (85 seconds) phases were compared in 29 lesions of recurrent thyroid cancer, 29 with normal thyroid, and 29 with diseased thyroid (thyroiditis/multinodular thyroid). 10.1097/00000658-199406000-00001. On univariate logistic regression analysis of benign thyroid versus recurrence, the odds ratios for differentiating the various phases were as follows: precontrast odds ratio, 0.856 (95% CI, 0.767–09.11); arterial OR, 0.92 (95% CI, 0.867–0.952); venous OR, 0.928 (95% CI, 0.892–954); and delayed OR, 0.916 (95% CI, 0.874–0946). Differentiation between these 2 entities is not always straightforward.7 An additional diagnostic challenge is superimposed if there is background benign thyroid disease in the residual thyroid tissue, such as thyroiditis or a multinodular goiter.11 To the best of our knowledge, no prior studies have addressed this issue using CT. Because colloid volume is about 3 times greater than the epithelial cell volume,18 the high electron density of the iodine colloid leads the high attenuation of the thyroid on MDCT.19-21 Our results are confirmed in a report by Han et al,22 who studied the appearance of the thyroid gland using PET/CT. In our study, recurrent disease had a mean of 37 HU in the precontrast phase. Approximately 27 mSv of radiation is administered during a 4D-MDCT examination, with a roughly equal contribution from each phase. Hounsfield unit densities for recurrent, normal, and diseased thyroids were compared precontrast and at 25 (arterial), 55 (venous), and 85 (delayed) seconds. 160. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. I also had residue left after RAI. Benign Thyroid conditions (obstructive goiter, etc.) Cappola follows several steps in treating these patients. From: Abeloff's Clinical Oncology (Fifth Edition), 2014. hypothyroidism) did not increase the ability to detect lesions. Similar ROC curve analysis of Hounsfield units using univariate and multivariate analyses with combinations of 2, 3, or 4 of the 4 phases (precontrast, arterial, venous, and delayed) (Table 5) showed that the area under the ROC curve was slightly greater compared with the precontrast phase alone. FDG-PET is able to localize residual thyroid cancer lesions in patients who have negative diagnostic 131I whole body scans and elevated Tg levels, although it was not sensitive enough to detect minimal residual disease in cervical nodes. Use of this online service is subject to the disclaimer and the terms and conditions. Keywords: thyroid cancer, papillary thyroid cancer, liquid biopsy, minimal residual disease, BEAMing, digital PCR (dPCR) Citation: Almubarak H, Qassem E, Alghofaili L, Alzahrani AS and Karakas B (2020) Non-invasive Molecular Detection of Minimal Residual Disease in Papillary Thyroid Cancer Patients. Because approximately 3 mSv is the estimated yearly natural background radiation exposure, the 4D-MDCT dose in our study is equivalent to the dose received naturally in 9 years.28 The dose for a CT study could potentially be cut to about 6.75 mSv if only 1 phase is acquired (but see next paragraph). Do not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. An optimal clinical protocol could be built from any number of phases but should include a precontrast phase. Drugs Mentioned In This Article NOTE: This is the Professional Version. Updated September 12, 2016, Postoperative recurrence of papillary thyroid carcinoma with lymph node metastasis, Surgical management of recurrent thyroid cancer, Differentiated thyroid cancer: management of patients with radioiodine nonresponsive disease, Recurrence of papillary thyroid cancer after optimized surgery, Cervical distribution of iodine 131 following total thyroidectomy for thyroid cancer, Evaluation of the surgical completeness after total thyroidectomy for differentiated thyroid carcinoma, Thyroid tissue remnants after “total thyroidectomy, Time to separate persistent from recurrent differentiated thyroid cancer: different conditions with different outcomes, Sonographic findings in the surgical bed after thyroidectomy: comparison of recurrent tumors and nonrecurrent lesions, Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography, Accuracy of 4-dimensional computed tomography in poorly localized patients with primary hyperparathyroidism, Imaging characteristics of hyperfunctioning parathyroid adenomas using multiphase multidectector computed tomography: a quantitative and qualitative approach, Diagnostic accuracy of 4D-CT for parathyroid adenomas and hyperplasia, 4D-CT for preoperative localization of abnormal parathyroid glands in patients with hyperparathyroidism: accuracy and ability to stratify patients by unilateral versus bilateral disease in surgery-naive and re-exploration patients, Accuracy of 4DCT for the localization of abnormal parathyroid glands in patients with primary hyperparathyroidism, Studies on functional and morphological aspects in human multinodular simple goiter tissues, Computed tomography in the evaluation of thyroid disease, Thyroid CT number and its relationship to iodine concentration, Clinical evaluation of thyroid CT values in various thyroid conditions, Diagnostic value of CT density in patients with diffusely increased FDG uptake in the thyroid gland on PET/CT images, Characterization of thyroid nodules by 4-dimensional computed tomography: initial experience, Clinical significance of incidental thyroid nodules identified on low-dose CT for lung cancer screening, The prevalence and significance of incidental thyroid nodules identified on computed tomography, Basic mechanisms and general morphology of radiation injury, Thyroid tissue: US-guided percutaneous laser thermal ablation. Residual thyroid tissue after thyroidectomy in a patient with TSH receptor-activating mutation presenting as a neck mass. Thyroid cancer is the fastest rising cancer in women. The maximum information for discrimination is in the precontrast images, then the arterial phase. However, those numbers were all taken while my levels were suppressed. Most of the time, residual cancer can be treated with additional surgery or … Similar overall root mean square error values were then calculated for each phase. Thanks for your comments. Indicates open access to non-subscribers at www.ajnr.org. In our study, there was washout of contrast in the delayed and late phases in all 3 studied groups. Statistical analysis was performed using SAS, Version 9.4 (SAS Institute) and R statistical and computing software, Version 3.5.3 (http://www.r-project.org/). Copyright 2000-2019 © Cancer Survivors Network. Our data suggest that the precontrast imaging for characterizing residual tissue after thyroidectomy actually contains the most valuable information and should certainly be a component of any imaging protocol performed for this purpose. Thyroid cancer is a rare type of cancer that affects the thyroid gland, a small gland at the base of the neck that produces hormones. There are 4 general types of thyroid cancer. The performance of Hounsfield unit values to predict recurrence was evaluated by logistic regression and receiver operating characteristic analysis. :) * Maria E. Cabanillas—UNRELATED: Consultancy: Blueprint Medicines, Ignyta, Bayer Onyx, Loxo Oncology; Grants/Grants Pending: Eisai, Exelixis, Genentech, Kura Oncology; Payment for Lectures Including Service on Speakers Bureaus: various Continuing Medical Education lectures with multiple sponsors; Travel/Accommodations/Meeting Expenses Unrelated to Activities Listed: various Continuing Medical Education lectures. Arterial, venous, and delayed phases each followed with cutoff values of 129, 120.6, and 125, respectively, with sensitivity/specificities of 0.828/1, 0.897/0.931, and 0.966/0.879, respectively. In this study, we address this gap in imaging knowledge and determine whether multiphasic multidetector CT (4D-MDCT) can be used to characterize residual thyroid tissue after an operation as either benign or malignant. We are currently awaiting the results for my thyroglobulin levels and will go from there. Differences between their study and ours are likely related to the inclusion of normal thyroid tissue in the diseased thyroid group in our study, which would not be present in the thyroid nodules studied by Fitzgerald et al.23. Thyroid Cancer a) 1311 therapy has been used for postoperative ablation of thyroid remnants after th~roidectomy. This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking. The 4D-MDCT examinations were performed on a multidetector CT LightSpeed scanner (GE Healthcare) with the following parameters: 140 kV, 220–250 mA, and a 1.25-mm section thickness covering the neck from the bottom of the orbits to the arch of the aorta. Summary of Hounsfield units by phase and lesion type using 3 categories—normal, diseased, and recurrent, Summary of Hounsfield units by phase and lesion type using 2 categories—recurrence and benign (includes both normal and diseased thyroid). Ann Surg. Thyroid Cancer 1% of all new malignant disease 0.5% in men and 1.5% in women 94% are differentiated carcinomas (papillary or follicular) ... Thyroid bed uptake Gross residual disease in neck with adequate radioiodine uptake Metastaticdisease if radioiodine scan positive Thyroglobulin> 10 ngmL The least overlap was present in the precontrast phase with a value of ≤62 HU. In the freehand contouring method, the borders of the lesion were traced on images in the arterial (B), venous (C), and delayed (D) phases of enhancement, with no requirement for the ROI size to remain constant. Disclosures: Mark E. Zafereo—UNRELATED: Grants/Grants Pending: Merck, Eli Lilly, GenePro, Comments: research funding for clinical trials. Mean, SD, and minimum-maximum of the grouped data were calculated to compare recurrence, normal thyroid, and diseased thyroid Hounsfield unit values through the 4 phases of enhancement. The outline from the largest area of enhancement representing the entire lesion was copied onto a similar site on the precontrast phase image. In all 4 phases, the Hounsfield unit value was significantly lower for recurrent thyroid carcinoma than for benign tissue, with diseased thyroid intermediate between recurrent and normal thyroid. Diseased thyroid also had a significantly lower values than normal thyroid (Table 1). 1 Papillary thyroid carcinoma, the least aggressive type of thyroid cancer, accounts for most new cases. 4D-MDCT involves high-resolution helical CT before and during the administration of a bolus of iodinated contrast at specific points in time to allow the changing distribution of contrast to be assessed. Women are 2 to 3 times more likely to develop it than men. Area under ROC curve (univariate analysis), Area under ROC curve for multivariate analysis with P values compared with precontrast phase alone. Thyroid hormones produced from thyroglobulin and iodide are stored within colloid and account for 25% of the iodide of the body. Yes, I have already had surgery and RAI, over 9 months ago. In the freehand contouring technique (Fig 1), the ROI was contoured to the visual outline of the lesion or the thyroid gland through the different phases of enhancement, with no requirement for the ROI size to remain constant. Recurrent PTC from pyramidal lobe is a rare entity, which is mainly due to non-standardized operation. I also had residue left after RAI. Surgery is required if fine-needle aspiration biopsy suggests cancer. If the numbers come back 'normal', I'm guessing they won't do anything....but I still hate knowing that there is anything left in there after surgery and treatment. Recurrence of papillary thyroid carcinoma (PTC) usually requires a second operation, which carries a high complication rate, especially if central neck dissection (CND) is necessary. Only the most skilled and experience thyroid cancer surgery experts should manage such circumstances. The types of primary thyroid cancer were as follows: papillary thyroid carcinoma (n = 21), follicular variant papillary thyroid carcinoma, (n = 3), medullary thyroid carcinoma (n = 3), and Hurthle cell carcinoma (n = 2). Pregnancy. thyroid cancer has been successfully treated, with no evidence for residual disease on physical examination, scanning, or thyroglobulin testing, follow-up may be scheduled at yearly intervals At the same time as the scan is done, a blood test for TSH and the thyroglobulin protein should also be done Thyroid Cancers. However, compared with the precontrast phase, none of these combinations were statistically significant (P > .05) (Table 5). But just because doctors find some thyroid cancer cells does not always mean that additional treatment is necessary, say specialists at Memorial Sloan Kettering Cancer Center, because they may not pose a significant threat to a patient's health. CONCLUSIONS: Recurrent thyroid carcinoma can be distinguished from residual nonmalignant thyroid tissue using multiphasic multidetector CT with high accuracy. Therefore, the purpose of this study was to determine if multiphasic multi-detector computed tomography (4D-MDCT) can differentiate residual nonmalignant thyroid tissue and recurrent thyroid carcinoma after thyroidectomy. This is attributed, at least in part, to the iodine content of normal thyroid tissue and the inclusion of this thyroid tissue in the ROI measurements of the diseased thyroid. Similarly, Hunter et al17 found washout of enhancement of thyroid tissue and parathyroid adenomas in the delayed (55 seconds) and late (100 seconds) phases. 2. Logistic regression analysis determined the optimal cutoff Hounsfield unit value in each of the 4 phases. Thank you for your interest in spreading the word on American Journal of Neuroradiology. PMID: 10404792 The maximum information for discrimination is in the precontrast images, then the arterial phase. CONTRAINDICATIONS 1. Twenty-nine patients with normal thyroid (group 2) (25 women, 4 men; 34–85 years of age; mean, 63 ± 13.2 years) and 29 patients with diseased thyroid (group 3) (18 multinodular goiters, 11 cases of thyroiditis) (23 women, 6 men; 45–86 years of age; mean, 63.5 ± 10.9 years) were also included. Most thyroid cancers manifest as asymptomatic nodules. to check on how effective treatment was. Near-total or total thyroidectomy is the treatment of choice, to be followed by radioiodine ablation of any residual thyroid tissue if a cancer is found (depending on the size, histology, and invasiveness). roid cancer increased by 211% and the average annual increases in incidence and mortality rates were 3.6% and 1.1%, respectively. We hypothesized that 4D-MDCT can be used similarly to differentiate recurrent thyroid carcinoma from residual normal and diseased thyroid tissue. Differentiated thyroid cancer (DTC) includes papillary thyroid cancer (PTC), which accounts for 80% of all thyroid cancers, follicular thyroid cancer (FTC), which accounts for 10% to 20% of all thyroid cancers, and a rare type, Hürthle cell cancer. My doctor called this week and said that my thyroglobulin levels went from .01 (suppressed) to .8 (not suppressed). They found that thyroid density is proportional to colloid volume and inversely proportional to the cellular component of the thyroid and FDG avidity. This was 8 months after Stage 1 Ovarian cancer. BACKGROUND AND PURPOSE: During thyroidectomy incomplete resection of the thyroid gland may occur. CT images were transferred to an ADW-2 workstation (GE Healthcare) with Volume Share 2, Version 4.4, software. The divergence between their findings and ours is likely related to the inclusion of calcification in the study of Lee et al, which was specifically excluded in our study. The optimal cutoff point to differentiate benign thyroid from recurrence in each of the 4 phases by ROC analysis was as follows: precontrast, ≤62 HU; arterial phase, ≤129 HU; venous phase, ≤120.6 HU; and delayed phase, ≤125 HU (Fig 4). Using this type of therapy, the majority of cancers will be either cured or controlled and less than 20 percent will show progression. Radioiodine ablation of residual tissue in thyroid cancer: relationship between administered activity, neck uptake and outcome. Yay! They noted that the higher density of the thyroid gland in the “precontrast phase [as this phase] allows distinction between the iodine-rich thyroid and the surrounding tissue.”. BACKGROUND. Their results in the precontrast phase were similar to ours because the precontrast attenuation of malignant nodules was significantly lower than that of benign lesions (36 versus 61 HU, P = .05). b) 13 I therapy has been used to treat residual thyroid cancer and metastatic disease after partial or complete thyroidectomy. Summary of univariate logistic regression model using Hounsfield units to predict lesion status (benign thyroid and recurrence). 4D-MDCT is in common clinical use for the localization of parathyroid adenomas, which show characteristic contrast handling attributes that allow accurate localization.12-17. The influence of thyroid stimulating hormone (TSH) stimulation method on the kinetics was also evaluated. Combined benign thyroid (normal and diseased thyroid) was also significantly different from recurrence (P < .001) in all 4 phases using a 2-sample t test (Table 2). 2 In patients with thyroid can-cer,thyroidsurgeryis the mainstayoftreatment. Abstract. In the arterial phase, we found an increase in Hounsfield unit values within normal thyroid tissue, diseased thyroid, and recurrence. Fitzgerald et al23 found no significant difference in Hounsfield unit values between the benign (74 HU) and malignant nodules (98 HU) in the delayed phase (P = .3). RESULTS: All 3 tissue types had near-parallel enhancement characteristics, with a wash-in–washout pattern. The problem this creates in the imaging follow-up of these patients is that residual tissue needs to be correctly characterized as either benign or malignant. They measured it and then sent me on my way saying--the RAI will kill it whether it's cancer or not. Logue JP(1), Tsang RW, Brierley JD, Simpson WJ. Accurate delineation of thyroid bed tissue as residual thyroid may avoid an unnecessary operation with complications including damage to the recurrent laryngeal nerve as well as the inherent risks of anesthesia. with >15 years of experience in head and neck radiology who was not blinded to the tissue type results drew ROIs around the recurrent lesions and areas of normal and diseased thyroid using freehand contouring. Another limitation is that patients with a multinodular thyroid as part of the diseased thyroid group could conceivably have had an undetected indolent thyroid cancer. i am waiting for my 1 year point to find out how effective the radiation treatment is and to set up a baseline for my thyroglobulin levels hopeing to be undetectable or such. Blessings! To validate these findings, we made an effort to combine the phases into an indicator with better performance, but matrix scatterplots revealed 2 outlier cases that were misclassified regardless of phase, indicating that a combination of phases could not be used to improve performance (though there might be clinical reasons to include >1 phase). Front. From these patients, we identified 2 groups of patients: patients with a normal thyroid, defined as a homogeneously enhancing thyroid gland on 4D-MDCT (group 2); and patients with a diseased-but-nonmalignant thyroid, defined as a thyroiditis with increased vascular flow or benign multinodular goiter on sonography or pathology, and a heterogeneously enhancing thyroid gland on 4D-MDCT (group 3). Clinical needs might demand that contrast-enhanced sequences be a part of the imaging protocol (for example to demonstrate lymph nodes and vascular anatomy). Seventy-five separate patients underwent 4D-MDCT for localization of a parathyroid adenoma. Thyroid cancer is more common in people who have a history of exposure to high doses of radiation, have a family history of thyroid cancer, and are older than 40 years ... residual thyroid tissue is called radioactive iodine ablation. The mean time-enhancement curves ran parallel and did not cross in any phase. I panicked when I saw it on the screen but the Nuclear Med doctor didn't seem concerned by it at all because my initial thyroglobulin numbers have come back low, undetectable the last time. She said that with the numbers still being low the tissue must be 'normal' and that I will not have to undergo any further treatment at this time. While spread of the cancer to the lymph nodes in the neck is common at the time of surgery, the prognosis is usually excellent. Patrick McCaffery was diagnosed with thyroid cancer in the 2014 season, around the time the Hawkeyes were preparing to play in the NCAA tournament. The largest area, the venous phase in this example, was then copied onto the (A) precontrast phase, where the lesion contrast with background was typically worse. Surgeons at the Thyroid Cancer Program are experts in the treatment of thyroid tumors. *Money paid to the institution. It's most common in people in their 30s and those over the age of 60. Each individual phase, in other words, yields quite acceptable performance, but the precontrast phase, according to our data, contains the most diagnostic information for this application. We also hypothesized that recurrent tumor and normal and diseased thyroid would have diagnostic patterns of contrast enhancement that allow them to be clearly discriminated.

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