The influence of incidental detection of thyroid nodule on thyroid cancer risk and prognosis-A systematic review

Meta-Analysis on the Prevalence and Significance of Incidental Findings in the Thyroid Gland Using Other PET Radiopharmaceuticals Beyond [18F]FDG

Background: Meta-analyses on the prevalence and significance of thyroid incidentalomas at PET (TIP) are available only about [18F]FDG. Focal TIP at [18F]FDG PET is not rare and may be malignant lesions in about one-third of cases. The aim of this study is to perform a meta-analysis on the prevalence and clinical significance of TIP using other PET radiotracers beyond [18F]FDG. Methods: A comprehensive literature search of studies about TIP was carried out using four different databases, screened until 31 December 2024. Only original articles about TIP using radiopharmaceuticals other than [18F]FDG were selected. A proportion meta-analysis on the prevalence and clinical significance of TIP was carried out on a patient-based analysis using a random-effects model. Results: 21 studies (29,409 patients) were included in the meta-analysis. PET was performed using radiolabeled somatostatin analogues (SSA) [n = 5], choline [n = 6], prostate-specific membrane antigen (PSMA) [n = 7], or fibroblast activation protein inhibitors (FAPI) [n = 3]. The uptake pattern of TIP was described as focal, diffuse, or mixed/heterogeneous. The pooled prevalence of TIP was 5.6% for SSA-PET, 6.1% for choline-PET, 4.2% for PSMA-PET, and 3.6% for FAPI-PET. The final diagnosis of TIP with a diffuse pattern was a benign condition or represented a physiological uptake. Conversely, TIP with focal or mixed/heterogeneous pattern may represent a benign condition in most cases, but even a malignant lesion in 6-10% of cases. Conclusions: As for [18F]FDG, TIP using other radiopharmaceuticals is not rare. Most of them are benign, but those with focal or heterogeneous uptake patterns may represent a malignant lesion in some cases (even if the risk of malignancy is lower compared to [18F]FDG PET), thus requiring further evaluation. Further studies are warranted to better clarify the clinical impact of TIP detection.

Evaluation of the clinical efficacy of microwave ablation for benign thyroid nodules based on contrast-enhanced ultrasound

This study evaluates the clinical efficacy of microwave ablation in patients with benign thyroid nodules based on contrast-enhanced ultrasound. A total of 92 patients with benign thyroid nodules admitted to our hospital from January 2020 to December 2022 were selected as research subjects and divided into control group and observation group according to different treatment methods, with 46 cases in each group. All patients received microwave ablation. Imaging examination and monitoring were performed before and after microwave ablation. The control group underwent routine ultrasound examination, and the observation group underwent contrast-enhanced ultrasound examination. It was determined whether or not to terminate ablation therapy according to the imaging examination results. Results of enhanced MRI were used as the gold standard to evaluate the clinical efficacy, thyroid nodule volume, thyroid nodule volume reduction rate, nodule recurrence, and complication rate of the 2 groups. Using the results of enhanced MRI as the gold standard, the total ablation rate of observation group was 96.55%, which was significantly higher than that of control group 85.96%, and the nodule survival rate of 3.45% was significantly lower than that of control group 14.04% (P < .05). After 1 month, 3 months, 6 months, and 12 months, the thyroid nodule volume of both groups was significantly reduced, and the thyroid nodule volume of observation group was significantly smaller than that of control group (P < .05). After 1 month, 3 months, 6 months, and 12 months, the reduction rate of thyroid nodule volume in 2 groups was significantly increased, and the reduction rate of thyroid nodule volume in observation group was significantly higher than that in control group (P < .05). After treatment, the recurrence rate of nodule in observation group was 4.35%, which was significantly lower than that in control group, 15.22% (P < .05). After treatment, the complication rate of observation group was 8.70%, which was significantly lower than that of control group 26.09% (P < .05). Contrast-enhanced ultrasound can effectively monitor the treatment range of benign thyroid nodules by microwave ablation, improve clinical efficacy, reduce the recurrence rate of nodules, and has high effectiveness and safety.

Thyroid cancer epidemiology in Ireland from 1994 to 2019 - Rising diagnoses without mortality benefit

BACKGROUND

The epidemiology and management of thyroid cancer has changed radically in the recent past, with rising international incidence of early-stage papillary thyroid cancer (PTC) in particular. In this paper, we review the epidemiology of thyroid cancer in Ireland.

METHODS

A retrospective cohort study of National Cancer Registry of Ireland data, 1994-2019.

RESULTS

Records from 4158 patients were analysed. 73 % (n = 3040) were female. The average age was 50.4 years. Patient sex did not change over time (p = 0.662), while age decreased significantly (p < 0.0001). The most common diagnoses were PTC (n = 2,905, 70 %) and follicular thyroid carcinoma (n = 549, 13 %). Incidence rose over threefold (1.8-6.2 cases/100000 person-years). The incidence of T1 PTC rose over twelvefold (0.169-2.1 cases/100000 person-years), while the incidence of stage III and IV disease did not change significantly. Five-year disease-specific survival (DSS) was 85 % and varied significantly by diagnosis - 97 % for PTC versus 5 % for anaplastic thyroid carcinoma. Survival did not change significantly over time. Male sex was a risk factor for more advanced disease (p < 0.0001) but did not independently predict overall survival except in PTC (HR 1.6, p = 0.03). The use of radioactive iodine declined markedly from 49 % to 12.5 %. RAI improved DSS for PTC patients aged over 55 years (p = 0.02) without a notable effect on survival for those under 55 years (p = 0.99).

CONCLUSION

The epidemiology and management of thyroid cancer in Ireland has changed dramatically in a manner reflective of international trends.

Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach

We aimed to analyze the management of the ectopic mediastinal thyroid (EMT) with respect to EMT-related cancer and non-malignant findings related to the pathological report, clinical presentation, imaging traits, endocrine profile, connective tissue to the cervical (eutopic) thyroid gland, biopsy or fine needle aspiration (FNA) results, surgical techniques and post-operatory outcome. This was a comprehensive review based on revising any type of freely PubMed-accessible English, full-length original papers including the keywords "ectopic thyroid" and "mediastinum" from inception until March 2024. We included 89 original articles that specified EMTs data. We classified them into four main groups: (I) studies/case series (n = 10; N = 36 EMT patients); (II) malignant EMTs (N = 22 subjects; except for one newborn with immature teratoma in the EMT, only adults were reported; mean age of 62.94 years; ranges: 34 to 90 years; female to male ratio of 0.9). Histological analysis in adults showed the following: papillary (N = 11/21); follicular variant of the papillary type (N = 2/21); Hürthle cell thyroid follicular malignancy (N = 1/21); poorly differentiated (N = 1/21); anaplastic (N = 2/21); medullary (N = 1/21); lymphoma (N = 2/21); and MALT (mucosa-associated lymphoid tissue) (N = 1/21); (III) benign EMTs with no thyroid anomalies (N = 37 subjects; mean age of 56.32 years; ranges: 30 to 80 years; female to male ratio of 1.8); (IV) benign EMTs with thyroid anomalies (N = 23; female to male ratio of 5.6; average age of 52.1 years). This panel involved clinical/subclinical hypothyroidism (iatrogenic, congenital, thyroiditis-induced, and transitory type upon EMT removal); thyrotoxicosis (including autonomous activity in EMTs that suppressed eutopic gland); autoimmune thyroiditis/Graves's disease; nodules/multinodular goiter and cancer in eutopic thyroid or prior thyroidectomy (before EMT detection). We propose a 10-item algorithm that might help navigate through the EMT domain. To conclude, across this focused-sample analysis (to our knowledge, the largest of its kind) of EMTs, the EMT clinical index of suspicion remains low; a higher rate of cancer is reported than prior data (18.8%), incident imagery-based detection was found in 10-14% of the EMTs; surgery offered an overall good outcome. A wide range of imagery, biopsy/FNA and surgical procedures is part of an otherwise complex personalized management.

Thyroid and adrenal incidentalomas on chest CT: Prevalence, diagnostic work-up and outcomes in a cohort of COVID-19 suspected patients

OBJECTIVE

Due to increased use of computed tomography (CT), prevalence of thyroid and adrenal incidentalomas is rising. Yet, previous studies on the outcomes of diagnostic work-up of incidentalomas are subjected to inclusion bias. Therefore, we aimed to investigate prevalence and outcomes of diagnostic work-up of thyroid and adrenal incidentalomas detected on chest CT in a less selected population of COVID-19 suspected patients.

DESIGN

A retrospective, observational cohort study.

METHODS

We included all COVID-19 suspected patients who underwent chest CT between March 2020 and March 2021. Radiology reports and medical records were reviewed for the presence and subsequent diagnostic work-up of thyroid and adrenal incidentalomas.

RESULTS

A total of 1,992 consecutive COVID-19 patients were included (59.4% male, median age 71 years [IQR: 71-80]). Thyroid and adrenal incidentalomas were identified in 95 (4.8%) and 133 (6.7%) patients, respectively. Higher prevalence was observed with increasing age, among female patients and in patients with malignancy. Forty-four incidentalomas were further analyzed, but no malignancies were found. Only three lesions were hormonally active (1 thyrotoxicosis and 2 mild autonomous cortisol secretion). Diagnostic work-up did not lead to any change in clinical management in 97.7% of the analyzed patients.

CONCLUSION

Prevalence rates of thyroid and adrenal incidentalomas on chest CT in a less selected COVID-19 cohort were 4.8% and 6.7%, respectively. Yet, as all incidentalomas turned out to be benign and only three lesions were (mildly) hormonally active, this raises the question whether intensive diagnostic work-up of incidentalomas is necessary in all patients.

The Spectrum of Thyroid Nodules at Kinshasa University Hospital, Democratic Republic of Congo: A Cross-Sectional Study

We analyzed the spectrum of thyroid nodules in patients attending the endocrinology unit care of the Kinshasa University Hospital and assessed their associated factors. We conducted a cross-sectional study, performing descriptive statistics and logistic regression. From the 888 enrolled patients, thyroid nodules were detected in 658 patients (74.1%), as mononodules in 22.5% and multiple nodules in 77.5%. Thyroid function was normal in 71.3% cases, while hyperthyroidism and hypothyroidism were found in 26.1% and 2.6% of cases, respectively. Women were more affected than men (75.1% vs. 63.6%; p = 0.03). Patients with thyroid nodules were older (44 ± 12 vs. 38 ± 12 years; p < 0.001), with a family history of goiter (38.3% vs. 27.4%; p = 0.003) and residence in the iodine-deficient region (51.7% vs. 38.8%; p = 0.012); they had a higher proportion of longer delays to consultation (47% vs. 20%; p < 0.001), but a higher rate of normal thyroid function (85.5% vs. 3 1.3%; p < 0.001). Thyroid nodules were associated with the delay to consultation (for duration ≥ three years, OR: 6.560 [95% CI: 3.525−12.208)], multiparity (present vs. absent: 2.863 [1.475−5.557]) and family history of goiter (present vs. absent: 2.086 [95% CI:1.231−3.534]) in female patients alone. The high frequency of thyroid nodules observed requires measures aimed at early detection in the population, the training of doctors involved in the management and the strengthening of technical platforms in our hospitals.

Clinicopathological study of nodular goiter and thyroid malignancy in Tertiary Care Hospital

Nodular goiter is a clinicopathological entity characterized by an increased volume of the thyroid gland with formation of nodules. Nodular goiter occurs due to repeated hyperstimulation of thyroid gland due to iodine deficiency, goitrogens, anti-thyroid drugs and genetic defects. Nodular goiter can have different complications which include tracheal compression, retrosternal extension, malignancy and secondary thyrotoxicosis. The present study attempted to study clinical presentation of nodular goiter and to determine the incidence of thyroid cancer in solitary nodular goiter and multinodular goiter in patients admitted in surgery ward of IGMCRI, Puducherry. Retrospective record-based study and single-center study was carried out between January-2011 to December-2019 on consecutive 230 patients admitted in surgery ward with nodular goiter and age above 18 years. Ethics approval was obtained from Institute Ethics Committee (IEC) of IGMCRI. Demographic variables (age and gender), Diagnosis, FNAC, BIOPSY and Carcinoma frequency was assessed in the present study. Data was entered in Microsoft Excel spreadsheet and the data underwent analysis using descriptive statistics involving tables, graphs and bar diagrams. In our study, majority of the study participants (90.4%) belonged to female gender. Maximum patient cases (34.78%) belonged to adult range within 31-40 years.