Low-Activity Radioactive Iodine Therapy for Thyroid Carcinomas Exhibiting Nodal Metastases and Extrathyroidal Extension May Lead to Early Disease Recurrence

Chu, Karen; Baker, Sarah; Zenke, Julianna; Morad, Ahmed; Ghosh, Sunita; Morrish, Don; McEwan, Alexander; Williams, David C.; Severin, Diane; McMullen, Todd

doi:10.1089/thy.2017.0136

Cited by 11 publications

(3 citation statements)

References 36 publications

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“…For high-risk thyroid cancer patients, TSH levels are generally maintained below 0.1 mU/L ( 12 ). Moreover, patients with suspected or confirmed lymph node metastasis and extrathyroidal tumor extension might necessitate an increased radioactive iodine dosage to further diminish the risk of recurrence ( 49 ). Consequently, for postoperative patients meeting all the aforementioned risk factors, it seems justifiable to adopt a proactive approach in deciding on TSH suppression therapy and radioactive iodine treatment to minimize the risk of PTC recurrence after surgery.…”

Section: Discussionmentioning

confidence: 99%

Analysis of risk factors for lateral lymph node metastasis in T1 stage papillary thyroid carcinoma: a retrospective cohort study

Fan,

Zheng,

Ran

et al. 2024

Gland Surg

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Background The occurrence of cervical lymph node metastasis in T1 stage papillary thyroid carcinoma (PTC) is frequently observed. Notably, lateral lymph node metastasis (LLNM) emerges as a critical risk factor adversely affecting prognostic outcomes in PTC. The primary aim of this investigation was to delineate the risk factors associated with LLNM in the initial stages of PTC. Methods This retrospective analysis encompassed 3,332 patients diagnosed with T1 stage PTC without evident LLNM at the time of diagnosis. These individuals underwent primary surgical intervention at West China Hospital, Sichuan University between June 2017 and February 2023. The cohort was divided into two groups: patients manifesting LLNM and those without metastasis at the time of surgery. Additionally, T1 stage PTC patients were subdivided into T1a and T1b categories. Factors influencing LLNM were scrutinized through both univariate and multivariate analyses. Results The incidence of LLNM was observed in 6.2% of the cohort (206 out of 3,332 patients). Univariate analysis revealed significant correlations between LLNM and male gender (P<0.001), tumor localization in the upper lobe (P<0.001), maximal volume of the primary tumor (P<0.001), largest tumor diameter (P<0.001), multifocality (P<0.001), and bilaterality (P<0.001), with the exception of age (P=0.788) and duration of active surveillance (AS) (P=0.978). Multivariate logistic regression analysis identified male gender (P<0.001), upper lobe tumor location (P<0.001), maximal primary tumor volume (P<0.001), and multifocality (P<0.001) as independent predictors of LLNM. However, age categories (≤55, >55 years), maximum tumor diameter, bilaterality, and surveillance duration did not exhibit a significant impact. Comparative analyses between T1a and T1b subgroups showed congruent univariate results but revealed differences in multivariate outcomes. In the T1a subgroup, gender, tumor location, and multifocality (all P<0.05) were associated with elevated LLNM risk. Conversely, in the T1b subgroup, tumor location, dimensions, and multifocality (all P<0.05) were significant predictors of LLNM risk, whereas gender (P=0.097) exerted a marginal influence. Conclusions The investigation highlights several key risk factors for LLNM in T1 stage PTC patients, including gender, upper lobe tumor location, larger tumor size, and multifocality. Conversely, prolonged AS and younger age did not significantly elevate LLNM risk, suggesting the viability of AS as a strategic option in selected cases.

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Section: Discussionmentioning

confidence: 99%

Analysis of risk factors for lateral lymph node metastasis in T1 stage papillary thyroid carcinoma: a retrospective cohort study

Fan,

Zheng,

Ran

et al. 2024

Gland Surg

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“…The reported incidence of ETE in the literature ranges from 5% to 34%. 1 , 2 , 7 , 9 , 13 Currently, methods of imaging ETE of PTC include US, CT, MRI, radionuclide imaging, and others. US is the preferred method for ETE due to a number of advantages such as the absence of radiation, the absence of pain, real-time dynamic imaging, and so on.…”

Section: Discussionmentioning

confidence: 99%

“… 6 The American Thyroid Association’s practice guidelines recommend total thyroidectomy for patients with ETE and postoperative radioactive iodine ablation for patients with high-risk PTCs. 5 , 9 , 11 , 12 , 14 As a result, preoperative detection of ETE is critical not only for adequate nodal staging but also for surgical planning.…”

Section: Introductionmentioning

confidence: 99%

Assessing Diagnostic Value of Combining Ultrasound and MRI in Extrathyroidal Extension of Papillary Thyroid Carcinoma

Hu¹,

Zhang²,

Zhong³

et al. 2022

CMAR

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Purpose To explore the separate diagnostic value of preoperative ultrasound (US), magnetic resonance imaging (MRI), and the combination of US and MRI in extrathyroidal extension (ETE) of papillary thyroid carcinoma (PTC). Materials and Methods This retrospective study was approved by the Affiliated People’s Hospital of Jiangsu University review board. A total of 158 PTC patients with ETE received preoperative US and MRI examination and underwent surgery between May 2014 and December 2018 in Affiliated People’s Hospital of Jiangsu University. For each case, the US and MRI features of ETE were retrospectively and independently investigated by two radiologists. The clinical assessment for each case was implemented, respectively, using US imaging only, MRI only, and a combination of both modalities at three different time points with one-month intervals. Results The diagnostic accuracies of US, MRI, and the combined set for T3 (minimal ETE) were 91.7% (88/96), 74.0% (71/96), and 97.9% (94/96), respectively, indicating a significantly different performance (P < 0.001). The diagnostic accuracies for T4 (extensive ETE) were 62.9% (39/62), 87.1% (54/62), and 93.5% (58/62), respectively. The difference between the three methods for T4 was statistically significant (P = 0.000). The diagnostic accuracies for overall ETE were 80.4% (127/158), 79.1% (125/158), and 96.2% (152/158), respectively. The difference between the three methods for ETE was statistically significant (P = 0.001). Conclusion This study suggests that ETE can be predicted most accurately by the combination of preoperative US and MRI.

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Can patients with papillary thyroid carcinoma and low postoperative thyroglobulin in the presence of clinically apparent lymph node metastases (cN1) be spared from radioiodine?

2020

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Low-Activity Radioactive Iodine Therapy for Thyroid Carcinomas Exhibiting Nodal Metastases and Extrathyroidal Extension May Lead to Early Disease Recurrence

Cited by 11 publications

References 36 publications

Analysis of risk factors for lateral lymph node metastasis in T1 stage papillary thyroid carcinoma: a retrospective cohort study

Analysis of risk factors for lateral lymph node metastasis in T1 stage papillary thyroid carcinoma: a retrospective cohort study

Assessing Diagnostic Value of Combining Ultrasound and MRI in Extrathyroidal Extension of Papillary Thyroid Carcinoma

Can patients with papillary thyroid carcinoma and low postoperative thyroglobulin in the presence of clinically apparent lymph node metastases (cN1) be spared from radioiodine?

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