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Background: Minimally invasive parathyroidectomy (MIP) in patients with a parathyroid adenoma (PA) requires imaging modalities for precise localization. Parathyroid hormone assay on ultrasound-guided fine-needle aspiration washout, or PTH washout, can be used for this purpose. It is unclear whether PTH washout complements traditional PA localization techniques such as a sestamibi (MIBI) scan or diminishes its need. This study aims to determine whether a positive PTH washout obviates the need for an MIBI scan in the preoperative localization of a PA. Method: A multi-center retrospective, comparative review comprised adult patients who underwent MIP at 2 McGill University teaching hospitals between 2018 and 2022. Patients who had both PTH washout and MIBI scan for preoperative localization of PA, final histopathology reports available, and preoperative/postoperative results recorded were included in the final analysis. Results: Of the 193 patients' charts reviewed, 87 were included in this study. Of these 87 patients, 74.7% (65/87) had a positive PTH washout result. Among those, MIBI correctly detected 90.8% (59/65) of the PAs. The MIBI scan did not contribute meaningful information for any of the 65 patients who had positive PTH washout results. Conclusion: These findings strongly support the use of preoperative dedicated ultrasound as the initial standard procedure. When a PA candidate on ultrasound is found, a PTH washout should be performed. If positive, it could suffice as the sole localization method for MIP surgery. When a PA was identified on ultrasound and confirmed with PTH washout, the MIBI scan did not add more information. Benefits include fewer patient tests, less exposure to ionizing radiation, and reduced healthcare expenses. [ABSTRACT FROM AUTHOR]

Simple Summary: This study explores the impact of telomerase reverse transcriptase (TERTp) molecular alterations on the behavior of thyroid nodules, exploring the differential behavior of these molecular alterations occurring alone versus with concurrent molecular alterations. By analyzing the data from thyroid cancer patients treated between 2017 and 2024, this study aimed to clarify how the genetic landscape of TERTp molecular alterations relates to severity and various clinical and histopathological features of disease. The study found that thyroid cancers harboring both TERTp and concurrent molecular alterations were more likely to be classified as high-risk and have aggressive histology in contrast to nodules with TERTp molecular alterations in isolation, which generally showed less aggressive behavior. These findings suggest that identifying concurrent molecular alterations in TERTp-positive thyroid nodules could improve cancer risk assessment and prognosis and inform more tailored treatment strategies. Background/Objectives: Molecular testing of thyroid nodules enables the detection of genetic alterations, which can help assess the risk of malignancy and tumor behavior. While telomerase reverse transcriptase (TERTp) mutations are known to be associated with aggressive disease, their exact prognostic significance when occurring alone or with other molecular alterations remains underreported. Methods: This study examined patients with thyroid cancer treated at two tertiary care hospitals from 2017 to 2024. We compared tumor behavior in patients with TERTp molecular alterations occurring alone and with concurrent molecular alterations. Aggressive histologic subtypes were defined as tall-cell, hobnail, and columnar variants of papillary carcinoma, as well as poorly differentiated and anaplastic carcinoma. High-risk disease was defined according to the 2015 ATA guidelines as gross extrathyroidal extension, lymph node metastasis >3 cm, postoperative elevated serum thyroglobulin, distant metastases, and/or positive resection margins. Statistical analysis was performed to assess differences between groups. Results: 30 patients with TERTp-positive thyroid malignancies were included. TERTp/BRAF V600E was the most prevalent mutation combination (n = 13, 43.3%), followed by TERTp alone (n = 8, 26.7%) and TERTp/RAS (n = 7, 23.4%). TERTp/EIF1AX/GNAS and TERTp/EIF1AX/PIK3CA were the least common combinations (n = 1, 3.3% each). Nodules with TERTp and concurrent mutations were significantly more likely to be classified as high-risk (p = 0.006) and were more frequently associated with aggressive histologic subtypes (p = 0.003) compared to those with TERTp mutations alone, which tended to exhibit more benign behavior. Conclusions: Thyroid carcinomas harboring both TERTp and concurrent molecular alterations are associated with more aggressive features and a higher likelihood of being classified as high-risk. In contrast, TERTp mutations occurring alone do not confer an elevated risk. [ABSTRACT FROM AUTHOR]

Background: Oncocytic thyroid carcinoma (OTC) was previously considered a variant of follicular thyroid carcinoma (FTC) but has recently been reclassified as a separate form of thyroid cancer. This study aimed to demonstrate that FTC and OTC are fundamentally distinct entities that can potentially be differentiated preoperatively through cytology and/or molecular testing. Methods: A retrospective chart review of patients diagnosed with FTC and OTC operated upon at two university health centers from January 2016 to September 2023 (n = 3219) was conducted. Molecular testing results were correlated with histopathologic diagnosis. Results: Fifty patients met the inclusion criteria. FTC was identified in 27 (54.0%) patients, and OTC in 23 (46.0%) patients. Patients with OTC were older (61.8 years) than FTC patients (51.2 years) (p = 0.013). Moreover, aggressive tumors were found in 39.1% (9/23) of OTCs compared to 11.1% (3/27) of FTCs (p = 0.021). Amongst Bethesda category III and IV nodules, 17 out of 20 (85.0%) OTC cytology reports demonstrated an oncocytic subtype compared to only 5 out of 24 FTC cytology reports (20.8%) (p = 0.002). On molecular testing, the EIF1AX alteration was exclusively present in OTCs while the PAX8/PPARy and PTEN alterations were exclusively found in FTCs. Copy number alterations (CNAs) were found to be more prevalent in OTC (66.7%) compared to FTC (33.3%), and they were not indicative of tumor aggressiveness. Within the OTC group, all three patients who had a TP53 alteration were diagnosed with aggressive cancer. Lastly, the OTCs exhibited a higher frequency of multiple alterations on molecular testing (66.7%) compared to FTCs (33.3%). Conclusion: To our knowledge, this is the largest study to date comparing the clinical application of abnormalities found on molecular testing for FTC and OTC. It further demonstrates the distinct clinicopathological and molecular characteristics of OTC. [ABSTRACT FROM AUTHOR]

Background: Repair of sagittal proximal phalanx (P1) and parasagittal metacarpal/metatarsal III (MC/MTIII) fractures has evolved over recent decades from a procedure carried out solely under general anaesthesia, to one commonly performed under standing sedation. To date, standing fracture repair has not been evaluated for large cohorts. Objective s : To determine short‐term (survival to discharge) and long‐term (return to racing) outcomes of horses undergoing standing repair of MC/MTIII and P1 fractures, and to compare pre‐surgical and post‐surgical racing performance. Study design: Single‐centre retrospective cohort study. Methods: Retrospective clinical record review of 245 cases undergoing standing repair of MC/MTIII or P1 fractures, 1 January 2007–30 June 2021. Data on signalment, fracture configuration and complications were collected and full race records were retrieved from the Racing Post Database (www..racingpost.com). Chi‐squared and Mann–Whitney U tests were used to determine any difference in variables between horses that raced after surgery compared to those that did not. McNemar change and Wilcoxon signed‐rank tests were used to compare pre‐ and post‐surgical racing performance, p ≤ 0.05. Results: Ninety‐eight percent [95% confidence interval (CI): 96.2%–99.7%] of horses survived hospital discharge, and 75.1% (95% CI: 68.9%–81.4%) raced after surgery, a median of 241 days later. Horses that raced post‐surgery were significantly less likely to have suffered from complications during hospitalisation than those that did not race again [17.3% (95% CI: 11%–24%) vs. 36.5% (95% CI: 23%–50%), p = 0.005]. Comparing pre‐ and post‐operative racing performance, there was no significant difference in earnings per start [median £628.00, interquartile range (IQR) 115.90–1934.80 vs. £653.20, 51.00–1886.40, p = 0.7] or proportion of horses winning [51% (95% CI: 41%–61%) vs. 54% (95% CI: 44%–64%), p = 0.8] or being placed first–third [77% (95% CI: 68%–85%) vs. 71% (95% CI: 62%–80%, p = 0.5] in at least one race. Main limitations: Retrospective nature of study with reliance on clinical records and public databases, limiting data available for analysis. Conclusions: Standing fracture repair is a viable treatment option for MC/MTIII or P1 fractures that returns horses to the racetrack within an acceptable time frame and is capable of restoring pre‐surgical athletic ability. [ABSTRACT FROM AUTHOR]