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Background Surgery is the elective treatment for cervical relapse from differentiated thyroid cancer (DTC) but it is technically challenging, with risk of failure and morbidity. We explored the feasibility and the efficacy of Radioguided Occult Lesion Localization (ROLL) with intratumoral 99mTc radiolabeled human albumin macroaggregates ([99mTc]MAA) injection in this setting. Methods Fifteen patients who underwent ROLL by ultrasonography (US)-guided intratumoral injection of [99mTc]MAA between December 2013 and October 2016 for DTC recurrence were considered for this study. An hand-held gamma-probe was employed for intrasurgical lesion detection. Mini-invasive ROLL-guided excision for soft tissue recurrence and ROLL-assisted modified radical neck dissection for lymph-node metastases were performed respectively. Results DTC recurrence was located in loco-regional lymph-nodes (n=8 patients) and in thyroid bed (n=7 patients). A total of 27 lesions was identified and injected before surgery. On a total of 124 lesions resected, histology showed 38 DTC metastases. In particular, 26 out of 27 lesions injected with [99mTc]MAA were correctly detected intra-operatively and resected without surgical complications. Ten patients received subsequent radioactive iodine (RAI) treatment to verify the complete recurrence resection. At a median follow-up of 16 months patients were classified in complete response (n=4), biochemical incomplete response (n=3), indeterminate response (n=1) with no evidence of structural disease. The remaining 7 patients were classified as structural incomplete response for cervical persistent disease (n=2), for cervical recurrence (n=2) and for both cervical and lung metastases progression (n=3). Conclusions ROLL is a simple and safe procedure in the surgical management of DTC loco-regional relapse.

Primary hyperparathyroidism (PHPT) is a common endocrine disorder that can be cured only by parathyroidectomy. Cervical ultrasonography and scintigraphy are the imaging studies most widely used for preoperative localization of the affected glands. The aim of this retrospective comparative study was to define the respective roles of ultrasonography and parathyroid scintigraphy in these cases.We analyzed 108 patients who had undergone parathyroidectomies for PHPT following cervical ultrasonographic and scintigraphic examinations. The ultrasound examinations were carried out by an expert physician sonographer in 61 cases and by various physician sonographers with different levels of experience in 47 cases. Sonographic and scintigraphic findings were compared with surgical findings and the diagnostic performance of the two imaging methods was evaluated by means of statistical analysis.The operator dependency of ultrasonography was confirmed by marked variations in sensitivity related to the experience of the sonographer. When sonography was performed by an expert, the sensitivity of combined use of the two methods was not significantly higher than that of sonography alone.In expert hands, the diagnostic yield of ultrasound is appreciably superior. It can therefore be used as the main and possibly sole method for preoperative localization of pathological parathyroid tissues. Combined use of ultrasound and scintigraphy is not cost-effective in these cases. Scintigraphy is indicated only when the ultrasound examination produces negative results.L’iperparatiroidismo primitivo (PHPT) è una frequente patologia endocrina che ha come unico trattamento risolutivo quello chirurgico (paratiroidectomia). L’ecografia del collo e la scintigrafia sono gli esami strumentali più comunemente utilizzati nella localizzazione preoperatoria delle paratiroidi patologiche. Scopo di questo studio retrospettivo è definire il ruolo dell’ecografia, confrontandolo con quello della scintigrafia paratiroidea.108 pazienti sottoposti a intervento di paratiroidectomia per PHPT che hanno eseguito pre-operatoriamente sia l’ecografia del collo che la scintigrafia. L’ecografia è stata eseguita in 61 pazienti da un medico ecografista esperto e in 47 pazienti da più medici ecografisti con esperienza eterogenea. Gli esiti dell’ecografia e della scintigrafia sono stati confrontati con le risultanze dell’atto operatorio e i dati relativi alle loro prestazioni diagnostiche sono stati elaborati mediante analisi statistica.L’ecografia si è confermata metodica operatore-dipendente, dipendendo la sua sensibilità in modo marcato dall’esperienza dell’operatore. Nel caso dell’operatore esperto, l’incremento di sensibilità ottenuto con il contemporaneo uso della scintigrafia si è dimostrato poco rilevante.Se eseguita da un operatore esperto, l’ecografia ha una resa diagnostica sensibilmente superiore e può assumere il ruolo di principale ed eventualmente unica metodica di localizzazione preoperatoria delle paratiroidi patologiche. L’uso parallelo dell’ecografia e della scintigrafia risulta in tal caso non giustificato e non cost-effective. Si ritiene invece corretto esclusivamente il loro uso seriale (esecuzione della scintigrafia solamente in caso di negatività dell’ecografia).

BACKGROUND The term poorly differentiated (PD) carcinoma was proposed 20 years ago to define aggressive, follicular-derived thyroid carcinomas with behavior intermediate between follicular/papillary and anaplastic carcinomas. Among the variable histologic patterns recognized in such tumors, trabecular-insular-solid (TIS) areas usually are predominant. Conversely, some authors pointed out that PD carcinomas are characterized by unequivocal, high-grade histology with atypias, high mitotic counts, and necrosis rather than by a specific growth pattern. METHODS The clinicopathologic features of a series of 183 thyroid carcinomas with predominant (n = 165 tumors) or focal (n = 18 tumors) TIS growth patterns were studied by univariate and multivariate overall survival analyses and were compared with clinical outcomes. Subgroups included tumors with predominant oxyphilic features (n = 66 tumors) and (residual) papillary carcinoma features (n = 24 tumors). Control groups of papillary (n = 68 tumors), follicular (n = 71 tumors), and anaplastic (n = 35 tumors) carcinomas also were included for overall survival analysis. RESULTS TIS carcinomas had an intermediate behavior between papillary/follicular and anaplastic carcinomas (P 45 years (P = 0.007), the presence of necrosis (P 3 per 10 high-power fields (P = 0.01) were associated with poor outcome. A simplified scoring system based on statistically significant parameters allowed the identification of three prognostic subgroups (P < 0.0001). CONCLUSIONS PD TIS carcinomas overall followed a more aggressive course compared with differentiated thyroid carcinomas, irrespective of the extent of the TIS component. However, a numeric scoring system applied to specific clinicopathologic parameters further may identify three prognostic categories of patients who have significantly different survival rates at 5 years and 10 years. Cancer 2004;100:950–7. © 2004 American Cancer Society.