Development and Validation of a Risk Scoring System Derived from Meta-Analyses of Papillary Thyroid Cancer

Suh, Sunghwan; Goh, Tae Sik; Kim, Yun Hak; Oh, Sae‐Ock; Pak, Kyoungjune; Seok, Ju Won; Kim, In Joo

doi:10.3803/enm.2020.35.2.435

Cited by 3 publications

(3 citation statements)

References 21 publications

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“…N1b LN metastasis has been further recognized as a predictive factor for recurrence [ 33 ]. A meta-analysis suggested that a tumor size over 2 cm (OR 2.69, 95% CI 2.06–3.50) and LN metastasis (OR 3.24, 95% CI 2.61–4.02) were predictive factors for recurrence [ 34 ]. Wang et al demonstrated that male sex, tumor size, and LN metastasis were associated with tumor recurrence of PTC in their large, multicenter study [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Multifocality on the Recurrence of Papillary Thyroid Carcinoma

Woo

Kim

Kwon

2021

JCM

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The incidence of thyroid cancer has dramatically increased over the last few decades, and up to 60% of patients have multifocal tumors. However, the prognostic impact of multifocality in patients with papillary thyroid carcinoma (PTC) remains unestablished and controversial. We evaluate whether multifocality can predict the recurrence of PTC. A total of 1249 patients who underwent total thyroidectomy for PTC at the Ewha Medical Center between March 2012 and December 2019 were reviewed. In this study, multifocality was found in 487 patients (39.0%) and the mean follow-up period was 5.5 ± 2.7 years. Multifocality was associated with high-risk features for recurrence, including extrathyroidal extension, lymph node metastasis, and margin involvement. After adjustment of those clinicopathological features, 10-year disease-free survival was 93.3% in patients with multifocal tumors, whereas those with unifocal disease showed 97.6% (p = 0.011). Multivariate Cox regression analysis indicated that male sex (HR 2.185, 95% CI 1.047–4.559), tumor size (HR 1.806, 95% CI 1.337–2.441), N1b LN metastasis (HR 3.603, 95% CI 1.207–10.757), and multifocality (HR 1.986, 95% CI 1.015–3.888) were independent predictors of recurrence. In conclusion, multifocality increased the risk of recurrence in patients with PTC. Patients with multifocal PTCs may need judicious treatment and follow-up approaches.

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Section: Discussionmentioning

confidence: 99%

Impact of Multifocality on the Recurrence of Papillary Thyroid Carcinoma

Woo

Kim

Kwon

2021

JCM

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“…However, ∼10-30% of DTC patients develop metastatic or recurrent diseases, among whom 33-50% eventually progress into radioiodine-refractory (RAI-R) diseases (1,2). The identification of predictors of clinical outcomes for DTC patients is of immense clinical value (3,4). 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT), combining functional and anatomic information, has become a valuable tool for the staging, treatment response assessment, prognosis prediction, and surveillance of patients with various malignancies (5).…”

Section: Introductionmentioning

confidence: 99%

“…However, ~10–30% of DTC patients develop metastatic or recurrent diseases, among whom 33–50% eventually progress into radioiodine-refractory (RAI-R) diseases ( 1 , 2 ). The identification of predictors of clinical outcomes for DTC patients is of immense clinical value ( 3 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

Investigating 18F-FDG PET/CT Parameters as Prognostic Markers for Differentiated Thyroid Cancer: A Systematic Review

Wang

Dai

et al. 2021

Front. Oncol.

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Aims: The aim of this study was to determine whether 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) parameters might be prognostic markers for patients with differentiated thyroid carcinoma (DTC).Methods: We searched for eligible articles in PubMed, EMBASE (Ovid), Cochrane Library, and ClinicalTrials.gov from inception to February 2021. We included studies addressing the association between 18F-FDG PET/CT parameters and clinical outcomes among patients with DTC. Quality assessment was performed using the Quality in Prognosis Studies (QUIPS) tool.Results: A total of 25 studies including 2,954 patients (1,994 females, 67.5%) were included; 2,416 patients (81.8%) had papillary thyroid carcinoma (PTC), and the mean or median follow-up time ranged from 19.1 months to 17.1 years. Thirteen (52.0%) studies were assessed as “unclear” for the domain of study participation. The most common timing of PET/CT scans was after thyroidectomy (in 20 of 25 studies, 80%), especially in patients with an elevated thyroglobulin (Tg) and a negative radioiodine whole-body scan (WBS). The most common PET parameter was FDG uptake. Twelve of 17 (70.6%) and 12 of 12 (100%) studies showed an association between PET/CT parameters and disease progression and survival in patients with DTC, respectively.Conclusion:18F-FDG PET/CT parameters alone or combined with other variables can serve as prognostic markers to identify DTC patients with poor outcomes, especially in the setting of an elevated Tg and a negative WBS. Future research is needed to confirm these findings and to examine the prognostic value of PET/CT parameters for DTC patients, considering the heterogeneity in PET/CT parameters, unclear information of patients, and PET/CT-adapted treatment modifications.

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Comparative Uptake Patterns of Radioactive Iodine and [18F]-Fluorodeoxyglucose (FDG) in Metastatic Differentiated Thyroid Cancers

Diwanji,

Carrodeguas,

Seo

et al. 2024

JCM

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Background: Metastatic differentiated thyroid cancer (DTC) represents a molecularly heterogeneous group of cancers with varying radioactive iodine (RAI) and [18F]-fluorodeoxyglucose (FDG) uptake patterns potentially correlated with the degree of de-differentiation through the so-called “flip-flop” phenomenon. However, it is unknown if RAI and FDG uptake patterns correlate with molecular status or metastatic site. Materials and Methods: A retrospective analysis of metastatic DTC patients (n = 46) with radioactive 131-iodine whole body scan (WBS) and FDG-PET imaging between 2008 and 2022 was performed. The inclusion criteria included accessible FDG-PET and WBS studies within 1 year of each other. Studies were interpreted by two blinded radiologists for iodine or FDG uptake in extrathyroidal sites including lungs, lymph nodes, and bone. Cases were stratified by BRAF V600E mutation status, histology, and a combination of tumor genotype and histology. The data were analyzed by McNemar’s Chi-square test. Results: Lung metastasis FDG uptake was significantly more common than iodine uptake (WBS: 52%, FDG: 84%, p = 0.04), but no significant differences were found for lymph or bone metastases. Lung metastasis FDG uptake was significantly more prevalent in the papillary pattern sub-cohort (WBS: 37%, FDG: 89%, p = 0.02) than the follicular pattern sub-cohort (WBS: 75%, FDG: 75%, p = 1.00). Similarly, BRAF V600E+ tumors with lung metastases also demonstrated a preponderance of FDG uptake (WBS: 29%, FDG: 93%, p = 0.02) than BRAF V600E− tumors (WBS: 83%, FDG: 83%, p = 1.00) with lung metastases. Papillary histology featured higher FDG uptake in lung metastasis (WBS: 39%, FDG: 89%, p = 0.03) compared with follicular histology (WBS: 69%, FDG: 77%, p = 1.00). Patients with papillary pattern disease, BRAF V600E+ mutation, or papillary histology had reduced agreement between both modalities in uptake at all metastatic sites compared with those with follicular pattern disease, BRAF V600E− mutation, or follicular histology. Low agreement in lymph node uptake was observed in all patients irrespective of molecular status or histology. Conclusions: The pattern of FDG-PET and radioiodine uptake is dependent on molecular status and metastatic site, with those with papillary histology or BRAF V600E+ mutation featuring increased FDG uptake in distant metastasis. Further study with an expanded cohort may identify which patients may benefit from specific imaging modalities to recognize and surveil metastases.

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Development and Validation of a Risk Scoring System Derived from Meta-Analyses of Papillary Thyroid Cancer

Cited by 3 publications

References 21 publications

Impact of Multifocality on the Recurrence of Papillary Thyroid Carcinoma

Impact of Multifocality on the Recurrence of Papillary Thyroid Carcinoma

Investigating 18F-FDG PET/CT Parameters as Prognostic Markers for Differentiated Thyroid Cancer: A Systematic Review

Comparative Uptake Patterns of Radioactive Iodine and [18F]-Fluorodeoxyglucose (FDG) in Metastatic Differentiated Thyroid Cancers

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