Ecos da ETA 2017

  Grupo de Estudo da Tiroide da SPEDM
  com o apoio Merck, s.a.

Médicos portugueses apresentaram trabalhos no 1.º dia do Congresso

Nas sessões de poster do primeiro dia foi apresentado um trabalho do Serviço de Endocrinologia do Centro Hospitalar de São João que pretendeu comparar o doseamento de tireoglobulina com dois métodos diferentes (convencional Vs alta-sensibilidade) nos doentes com carcinoma diferenciado da tiroide.

Por sua vez, o IPO de Coimbra apresentou um trabalho que avaliou a utilidade do doseamento da calcitonina no lavado da agulha de citologia no diagnóstico de metástases ganglionares do carcinoma medular da tiroide.

Já o Serviço de Endocrinologia do Centro Hospitalar de Coimbra apresentou um caso clínico sobre carcinoma da tiroide, abordando os vários métodos de diagnóstico disponíveis.

Ana Saavedra 1 , Elisabete Rodrigues 1 , Pedro Souteiro 1 , Luísa Rafael 2 ,João Tiago Guimarães 2 , Davide Carvalho 1
1Department of Endocrinology Diabetes and Metabolism, Centro Hospitalar S. João, Faculty of Medicine, University of Porto, Instituto de Investigação e Inovação Em Saúde, University of Porto, Porto, Portugal, 2 Department of Clinical Pathology, Centro Hospitalar S. João,Porto, Portugal

Introduction: Serum thyroglobulin (TGB) is the primary biochemical tumour marker of well differentiated thyroid cancer (WDTC).
Objective: To compare TGB levels measured with two commercial assays: conventional/first generation (cTGB) vs. high-sensitive/second generation (hsTBG) in patients with WDTC.
Methods: During 3 consecutive months, serum of adult patients collected during the usual WDTC follow-up were evaluated using two TGB assays: cTGB – Siemens (Immulite) ® and hsTGB – Roche Elecsys Tg II ®.
Results: We included 85 patients [90,6% female; age at diagnosis 50.5(±15.2) years; follow-up 7(±6) years]. All patients underwent total thyroidectomy; 10 performed cervical lymphadenectomy. AJCC/TNM staging system (7 th edition): stage I 67.1% patients, stage II 19.6%, stage III 16.5% stage IVa 5.9%. According to initial stratification for recurrence: 56.5% were low, 36.5% intermediate and 6,1% high risk. 72.9% of patients received 131 Iodine therapy. TGB was detectable in 14,1% of patients with cTGB assay vs. 24.7% with hsTGB assay. Comparison of average TGB levels within sub-groups of recurrence risk didn ́t showed any significant statistical difference. In 72 of 85 patients, TGB results were concordant between two assays (positive correlation r=0.56; p<0.001). Eleven patients with undetectable cTGB had measurable values in hsTGB assay. Seven out of 67 patients reclassified as “Excellent Response to therapy” and with undetectable levels in cTGB had measurable values in hsTGB assay (average 0.16 ± 0.01ng/mL).
Conclusions: In accordance with published literature, hsTGB assays seem to be more useful in the follow-up of WDTC as they permit to document the TGB evolution in patients in which TGB would be undetectable if followed with a first generation assay.
Bernardo Marques 1 , Raquel Martins 1 , Nuno Cunha 1 , Joana Couto 1 , Jacinta Santos 1 , Teresa Martins 1 , Ana Paula Moniz 1 , Olga Ilhéu 1 , Frederico Valido 1 , Paulo Figueiredo 1 , Fernando Rodrigues 1 1Portuguese Institute of Oncology of Coimbra Fg, Epe, Coimbra, Portugal

Introduction: The diagnostic value of calcitonin (CT) measurement in fine-needle aspiration biopsies (FNAB-CT) for medullary thyroid cancer (MTC) lymph node (LN) metastasis remains to be determined. It may increase the diagnostic sensitivity, along with FNA cytology, but, unlike the well-established method of thyroglobulin measurement in FNA washout, the data on this subject is sparse. Our study aimed to evaluate the utility of FNA-CT in the diagnosis of LN metastasis of MTC.
Methods/Design: This was a retrospective study of 72 consecutive cytologies of FNA from 45 patients identified from our institutional database, who underwent FNA citology and CT measurement in needle washout for suspicious LN, between 2012 and 2016.
Results: From the total of 72 FNA cases, 26 (36.1%) had personal history of MTC. MTC was detected in 18 FNA cytologies (25%) and CT was detectable in needle washout in 21 cases (median was 4653ng/mL (interquartile range: 214.5-27668 ng/mL). LN ressection was performed in 34 cases (47.2%), based on the combined results of FNA-CT and FNA cytology. Histology reported LN metastasis of MTC in 21 lesions (62%).
Regarding the diagnosis of MTC LN metastasis, FNA citology showed sensitivity 100% and specificity 86% and FNAB-CT values above 0.2ng/mL showed sensitivity 96% and 95% specificity. Combining both diagnostic strategies showed superior diagnostic power than using either strategy alone (sensitivity 100% and specificity 100%).
We evaluated the optimal cutoff value of FNAB-CT in determining LN metastasis of through ROC analysis and the optimal cutoff value was 8.85 ng/mL (sensitivity 95%; specificity 100%).
Conclusion: FNAB-CT may be a valuable diagnostic tool for detection of MTC LN metastasis, along with FNA citology and it should be included in the clinical work-up of lateral neck adenopathies when suspected.
Mara Ventura 1 , Miguel Melo 1 , Gracinda Costa 1 , Cristina Ribeiro 1 , Luís Cardoso 1 , Nuno Vicente 1 , Diana Martins 1 , Diana Oliveira 1 , Adriana Lages 1 , Nelson Cunha 1 , Francisco Carrilho 1
1 Hospitais Da Universidade de Coimbra, Coimbra, Portugal

Introduction: Several options for imaging differentiated thyroid cancer (DTC) in nuclear medicine have been proposed in the last years. Theranostic radioiodine molecular imaging, which combines diagnostic testing and therapeutic imaging modalities, has been a useful tool on this issue.
Case Report: A 55-year-old female presented with lower back pain for the past six months. A Computed Tomography (CT) showed a lytic bone lesion in the left sacrum with 7,5x4,8x4,1 cm. The biopsy was consistent with a metastasis of a carcinoma with probable origin in the thyroid. The patient was submitted to total thyroidectomy, and the histological exam showed a 1,7cm minimally invasive and angioinvasive follicular carcinoma (pT 1 NxM 1 ). Positron-emission tomography (PET)/CT with 2-[(18)F]fluoro-2-deoxy-d-glucose (18F-FDG) was performed and a single-photon emission computed tomography (SPECT)/CT was obtained after radioiodine (131I) therapy. For therapeutic decision, all imaging procedures were fused in one single image. The two functional imaging used, representing iodine and glucose metabolism, showed different uptake patterns within the mass. 131I uptake was present in the lower and upper poles, while most of the lesion only demonstrated glucose uptake, indicating a less differentiated area. The following treatment procedure was radiotherapy, because the mass was predominant 18F-FDG positive and 131I negative.
Conclusions: In Oncology, the combination of diagnostic and treatment imaging procedures (Theranostic) is growing and promotes a tailor based therapy strategy. If multiple diagnostic procedures are used, a method that allows the integration of all information, in a single image, may enable a more accurate in vivo picture of the tumour biology. Gathering information about the distribution, within a tumour mass, of the metabolism and the state of cell differentiation, help us to predict treatment response and give us a real-time prognostic tool.

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