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Background: An important side effect of radioactive iodine (RAI) therapy in patients treated for papillary thyroid cancer (PTC) is chronic sialadenitis. Neck ultrasonography (US) easily recognizes radioiodine-induced salivary gland abnormalities. The objectives of this study were to determine the prevalence of US-detected sialadenitis caused by RAI and to identify the risk factors associated with this damage. Methods: This nonconcurrent cohort study includes all PTC-operated patients who were treated with RAI between 2007 and 2017 and were systematically evaluated with preoperative and follow-up neck US that included targeted exploration of the major salivary glands. Patients with pre-existing salivary gland diseases were excluded. The anatomical damage (diminished glandular volume, wavy contours, hypoechogenicity, and heterogeneity) was qualitatively assessed and compared with the preoperative study. RAI activity, sex, age, and preparation method were evaluated as risk factors using univariate and multivariate analyses with logistic regression. Results: Enrolled in this study were 570 patients who received a median RAI activity of 3700 MBq (100 mCi). On US, we found 143 patients (25.1%) with damage in at least one of their salivary glands: all had parotid damage (77 bilaterally) and 14 (9.8%) also had submandibular gland damage (7 of them bilaterally). The multivariate analysis indicated that the risk of sialadenitis was significantly (p < 0.01) correlated with both RAI activity and sex (14.1% of males vs. 28.5% of females). However, the main risk factor was RAI activity; no injury was detected in 156 patients who received 1110 MBq (30 mCi) and 1850 MBq (50 mCi) of RAI. In the groups of patients receiving 3700 MBq (100 mCi), 5550 MBq (150 mCi) and ≥7400 MBq (≥200 mCi), atrophy was found in 21%, 46.9%, and 77.7% of patients, respectively. Age and preparation method were not related to an increased risk of atrophy in this study. Conclusions: Chronic sialadenitis is common and affects approximately one fourth of patients who receive 3700 MBq (100 mCi) or higher RAI activity. The main risk factor for this injury is the total RAI activity administered. By using the lowest effective activity possible, irreversible anatomical damage in salivary glands can be minimized. US is an excellent tool to diagnose post-RAI atrophy. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the atypical papillary thyroid carcinoma (PTC) US patterns, comparing them with typical cases and to describe their main characteristics. Methods and materials: Retrospective review of thyroidectomies between 2013 and 2016 with PTC. Classical PTCs (Group A) were separated from those that showed atypical patterns (Group B). These were compared according to age, gender, size, histological subtype and association with Hashimoto's thyroiditis (HT). Shapiro-Wilk, chi-2, Students t tests or Mann-Whitney- Wilcoxon tests were used. Results: A total of 453 PTC met inclusion criteria. In 51 cases (11.2%) [19 men (38%), median age 41 years (14-68)] an atypical pattern was observed. Median size: 14 mm (5- 50 mm), 32 (63%)> 10 mm. 27% were associated with HT. A significant difference was found between Groups A and B in terms of gender (p <0.025), size (p <0.001) and histological subgroup (p <0.01), finding more men, larger lesions and more follicular variant of PTC with atypical pattern. The dominant characteristics observed in Group B were: solidcystic mixed structure, similar to colloid nodule but without hyperechoic foci 23 (45%), isoechogenicity 19 (37%) and presence of capsule 20 (40%), findings that were shared in the majority of the cases, with or without association to calcifications. In addition, pooled microcalcifications without associated nodule were detected in 6 cases (12%). Conclusion: One in every 10 PTCs has an atypical ultrasound appearance. lt is important to recognize the characteristics described as concerning for malignancy in order to recommend FNAs in a timely manner, since 63% are macrocarcinomas. [ABSTRACT FROM AUTHOR]

Purpose: To describe ultrasonographic (US) findings of mayor salivary glands (MSG) atrophy in patients who received radio-iodine (RAI) treatment for papillary thyroid cancer (PTC). Determine MSG damage prevalence and associated risk factors. Methods and materials: IRB approved, prospective non-concurrent cohort study. Patients that had CPT surgery with subsequent RAI between 2005-2015, were included. All had a preoperative US and at least one follow-up US 12 months after RAI administration. Patients with prior MSG altered findings were excluded. Uni and multivariate analysis with logistic regression was performed using US gland damage as dependent variable and RAI dose, gender and age as independent variables. Statistical significance was defined as p<0.05. Results: in total 328 patients [average age: 42.47(1QR 34- 53), female: 263 (80.2%)] met inclusion criteria, receiving a median dose of 105mCi (IQR 100-150). Follow-up period: 12-107months. In 103 patients (31.4%) US detected salivary gland atrophy (size reduction, wavy contours, hypoechogenicity and heterogenous structure) in at least one MSG. Univariate analysis indicated that total RAI dose received was significantly associated with atrophy (p<0.01). No actin injury was present in patients treated with a total dose lower than 100mCi. Multivariate logistic regression revealed total radiation dose OR of 2.35 (1C95% 1.80 to 3.06) and women OR of 2.17 (IC 95% 1.017 to 4.42) for MSG atrophy. Conclusion: Actinic sialoadenitis is common, affecting approximately one-third of patients. Cumulative dose is the main factor related to this damage. For the first time, US was used to prospectively and systematically evaluate the MSG of patients with RAI treatment. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the role of US in predicting benignity or malignancy of lesions decisions (follow-up, re-puncture or surgery). Methods and materials: IRB approved retrospective descriptive study. Thyroid fine needle aspirations (FNA) with clot technique, performed between 2010-2015 were reviewed. Nodules classified as Bethesda III (Atypia of Undetermined Significance = AUS; Follicular lesion of undetermined significance = FLUS) and IV (Follicular Neoplasm = FN and Suspicion of Follicular Neoplasia = SFN) were selected. Only patients who underwent thyroidectomy were included for thig analysis. Nodules were considered low risk on US when presenting as TIRADS score 2, 3, 4A and intermediate-high risk with TIRADS 4, 48, 5, US risk was compared with the presence of malignancy in the surgical specimen. Results: In total 3.738 FNAs were performed in the period studied; 269 (7,2%) were Bethesda lll and 46 (1.2%) Bethesda IV. Ninety patients (65 FLUS, 11 AUS and 14 FN/ SFN) underwent surgery. In TIRADS 4, 4B and 5 nodules malignancy was 12,2% (6/49) in FLUS, 100% (10/10) in AUS and 50% (6/12) in FN/SFN. Meanwhile, in TIRADS 2, 3 and 4A nodules, no malignancy was identified (0/19). Conclusion: The high presence of AUS malignancy is highlighted. No malignancy was detected for Bethesda lIl-IV nodules presenting with low risk US TIRADS patterns. This information could assist the clinician on making therapeutic decisions. [ABSTRACT FROM AUTHOR]