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Introduction: The present study aims to assess pre-thyroidectomy thyroid hormone disturbances among patients suffering from differentiated thyroid carcinoma (DTC). Methods: This retrospective study was performed from September 2020 to March 2021. We analyzed the hospital files of 710 patients with DTC who underwent thyroidectomy and referred to nuclear medicine department from April 2013 to September 2019. Demographics, TNM stage, pre-surgery thyroid function tests, timeinterval to achieve a complete response, recurrence rate, one-year response, final response, and the need for alternative treatment modalities were extracted. Then, we analyzed the potential association of pre-surgery TSH levels with the initial disease stage and treatment response. Chi-Square, Analysis-of-variance, and Kruskal-Wallis tests were used where appropriate. Results: The mean age of participants was 40.39 ± 13.85 years. History of Hashimoto's disease was detected in 130 (18.3%) patients. Multi-focal DTC was found in 221 (31.2%) patients. Lymph node involvement was significantly higher among men (p = 0.001). Men also had significantly higher thyroglobulin levels (p = 0.025). No statistically significant association was found between pre-surgery thyroid function status and TNM stage or multifocality of the malignancy. Baseline thyroid function tests also did not show a statistically significant relationship with thyroglobulin, antithyroglobulin antibody, time to first excellent response, and follow-up duration. Conclusion: Baseline thyroid function status may not change the outcome of DTC. It could also be plausible that thyroid dysfunction before surgery would not increase invasiveness nor impact the treatment-response of the tumor compared to euthyroid patients. [ABSTRACT FROM AUTHOR]

Introduction: Negative radioiodine (131I) whole-body scan with elevated serum thyroglobulin (Tg) level are found in 20% of patients with differentiated thyroid cancer (DTC), which can be a diagnostic challenge. We evaluated the efficacy of Technetium-99m-Hydrazinonicotinyl-Tyr3-Octreotide ([99mTc]Tc-HYNIC-TOC) somatostatin receptor scintigraphy (SRS) for detection of non-iodine-avid metastases and its impact on staging and management of these patients. Methods: The study population consisted of 35 DTC patients (25 females; PTC = 88.2%, FTC = 11.8%) who had elevated serum Tg levels despite negative post-ablation radioiodine whole-body scan. All patients underwent whole body SRS 3-4 hours after intravenous injection of 20mCi (740 MBq) of [99mTc]Tc-HYNIC-TOC. Sites of suspected radiotracer accumulation were confirmed with anatomic imaging. Ultimately, corresponding changes in the staging and management were recorded. Results: SRS was positive in 27 (77.1%) cases. Patients with positive scan had significantly higher Tg levels at the time of scan, compared to those with negative scans (154.5±188.6 vs. 28.2±32.7 ng/mL, p-value = 0.005). Interestingly, previous history of neck external beam radiation therapy (EBRT) was significantly correlated with [99mTc]Tc-HYNIC-TOC avidity (Likelihood ratio = 11.2, p = 0.005). Addition of SSTR scintigraphy changed overall staging and management in 11% and 32.4% of the patients, respectively. Conclusion: SRS can be a useful diagnostic adjunct in DTC patients with highly elevated Tg and negative radioiodine wholebody scan. The likelihood of positive findings on [99mTc]Tc-HYNIC-TOC was higher in cases with previous history of EBRT or high Tg levels (i.e. suppressed-Tg >80 ng/mL) at the time of scan. [ABSTRACT FROM AUTHOR]

Objective(s): Accurate detection and competent management of thyroid nodules, as a common disease, basically depends on the reliability of the ultrasonography (US) report. In this research, we evaluated inter and intra-observer variation among ultrasonography reporters, based on ACR-TIRADS. Methods: In this retrospective study, 345 thyroid US images of 150 patients were reviewed. Three clinicians with at least 6-year experience in thyroid US reviewed the images twice at 6-8 weeks' intervals. Composition, echogenicity, shape, margin, and echogenic foci based on ACR-TIRADS were reported, independently. Inter and intra-observer variations were calculated based on Cohen's Kappa statistics. Results: 345 ultrasonography images of 150 patients with thyroid nodules (83 women and 67 men) with a mean age of 65 years were reviewed. Moderate to the substantial intra-observer agreement was achieved with the highest Kapa value in the category of shape (k=0.61-0.77). For TIRADS level, the moderate intra-observer agreement was observed (k=0.42-0.46). Inter-observer agreement for the US category of thyroid nodules was obtained slightly to moderate. Composition (k=0.42 and 0.51) and echogenicity (k=0.45 and 0.46) showed the highest overall agreement and margin showed the lowest overall agreement (k=0.18 and 0.19). In assessing TIRADS level of nodules, a fair agreement was obtained (k=0.23 and 0.29). Conclusion: Moderate to substantial intra-observer agreement and slight to moderate inter-observer variation for evaluation of thyroid nodules; shows the need for a computer-aided diagnosis system based on artificial intelligence to assist our physicians in differentiating thyroid nodule characteristics based on explicit image features. An additional training course based on ACR-TIRADS for physicians can be another useful recommendation. [ABSTRACT FROM AUTHOR]

Parotid metastasis originated from papillary thyroid carcinoma is extremely rare, especially as the first presentation of the disease. We present a 70-year-old man with a history of painless swelling in the right side of the neck. He was evaluated for parotid tumor and histopathologic examination revealed a poorly differentiated carcinoma in the parotid gland with suspicion of thyroid origin. The thyroid was examined and a small nodule was palpable in the right lobe of the thyroid that was found to be dedifferentiated papillary thyroid carcinoma upon total thyroidectomy. He received 5.5GBq of 131I and post-ablation whole body iodine scan showed thyroid remnant, cervical lymph node metastasis, lung and pericardial metastases and pleural effusion. He succumbed to his disease 8 months after diagnosis despite further treatments efforts including chemoradiation. [ABSTRACT FROM AUTHOR]

Objective(s): Lymph node metastases are the most significant prognostic factor in localized non-small cell lung cancer (NSCLC). Identification of the first nodal drainage site (sentinel node) may improve detection of metastatic nodes. Extended surgeries, such as lobectomy or pneumonectomy with lymph node dissection, are among the therapeutic options of higher acceptability. Sentinel node biopsy can be an alternative approach to less invasive surgeries. The current study was conducted to evaluate the accuracy of sentinel node mapping in patients with NSCLC using an intraoperative radiotracer techniques. Methods: This prospective study was conducted on 21 patients with biopsy-proven NSCLC who were candidates for sentinel node mapping during 2012-2014. All patients underwent thoracoabdominal computed tomography, based on which they had no lymph node involvement. Immediately after thoracotomy and before mobilizing the tumor, peritumoral injection of 2mCi/0.4 mL Tc-99m- phytate was performed in 4 corners of tumor. After mobilization of the tumoral tissues, the sentinel nodes were searched for in the hillar and mediastinal areas using hand-held gamma probe. Any lymph node with in vivo count twice the background was considered as sentinel node and removed and sent for frozen section evaluation. All dissected nodes were evaluated by step sectioning and hematoxylin and eosin staining (H&E).The recorded data included age, gender, kind of pathology, site of lesion, number of dissected sentinel nodes, number of sentinel nodes, and site of sentinel nodes. Data analysis was performed in SPSS software (version 22). Results: The mean age of the patients was 58.52±11.46 years with a male to female ratio of 15/6. The left lower lobe was the most commonly affected site (30.09%). Squamous cell carcinoma and adenocarcinoma were detected in 11 and 10 subjects, respectively. A total of 120 lymph nodes were harvested with the mean number of 5.71±2.9 lymph nodes per patient. At least one sentinel node was identified in each patient, resulting in a detection rate of 95.2%. The mean number of sentinel nodes per patient was 3.61±2. Frozen section results showed 100% concordance with the results of hematoxylin and eosin staining. Conclusion: Based on the findings, sentinel node mapping can be considered feasible and accurate for lymph node staging and NSCLC treatment. [ABSTRACT FROM AUTHOR]

A 10-year-old boy was referred to us for evaluation of FUO accompanied with bone pain in both calves. Three hours after intravenous injection of 13 mCi of 99mTc-MDP, whole body scan in multiple spot views was performed. The scan showed symmetrical areas of diffusely increased tracer uptake in multiple long bones. Histopathologic evaluation confirmed osteosclrosis and fibrotic changes without any bacterial growth in the specimen culture. Based on patient's history, lab results, bone scan and histopathologic findings, chronic recurrent multifocal osteomyelitis (CRMO) was considered as the most likely diagnosis. Dramatic response to NSAIDs and pamidronate therapy confirmed the diagnosis of CRMO. [ABSTRACT FROM AUTHOR]

Introduction: Sentinel node mapping is a new technique of lymph nodal staging in solid tumors, which can decrease the morbidity of regional lymph node dissection considerably. Intra-thoracic tumors including non-small cell lung cancer (NSCLC) and esophageal carcinoma (EC) are among the solid tumors in which sentinel node (SN) mapping has been applied. In the current systematic review, we gathered the best available evidence (systematic reviews) in this regard and presented the results in a systematic review format. Material and methods: We searched MEDLINE and SCOPUS since the inception till 13 December 2014 using the following keywords: (lung OR esophagus OR esophageal) AND sentinel AND ("systematic review" OR meta-analysis OR metaanalysis). No language limit was imposed on the search strategy. Systematic reviews and metaanalyses on SN mapping in EC or NSCLC were included in the current study. Narrative review articles were excluded from the study. Results: Overall five systematic review were included. One of the included studies was on SN mapping in NSCLC and four were on EC. Overall detection rate and sensitivity for EC and NSCLC were high and both were related to mapping technique, pathological involvement of the mediastinal nodes, size and location of the tumors. Conclusion: SN mapping is feasible and highly accurate in EC and NSCLC. Attention to the technique (using radiotracers, peri-tumoral injection) and restriction of the patients to less advanced cases (cN0 and T1, 2) would ensure the best results with high detection rate and sensitivity. [ABSTRACT FROM AUTHOR]

Thyroid Computer-Aided Diagnosis (CAD) systems have been developed to assist radiologists in improving efficiency, reliability, and diagnosis performance. Often the performance of these CAD systems is evaluated with different datasets that make it incomparable. A valuable thyroid ultrasound (US) dataset is presented in this work. This dataset consists of 2450 thyroid US images from 2018 to 2020 in Prospective Epidemiological Research Studies in Mashhad, Iran (PERSIAN), a large national cohort study. These US images have the ROI of thyroid nodules and the associated American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TIRADS) features by expert physicians provided in XML format. Dataset's images are categorized into five groups based on the ACR-TIRADS (Tirads1-Tirads5). The presented dataset is expected to be a valuable resource to develop and assess thyroid CAD systems to help radiologists better diagnose.