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Abstract
Aim is ultrasound and cytological studies of metastases detected in the postoperative period depending on their iodine accumulation capacity. Material and methods. Ultrasound, cytological, immunocytochemical studies on a group of papillary thyroid cancer metastases detected in the postoperative period (after thyroidectomy and radioiodine therapy) (30 — radioiodine-sensitive metastases, 65 — radioiodine-refractory metatases) were performed. Ultrasound
characteristics such as localization of metastases, whether multiple or isolated, echogenicity, echostructure, and the presence of echo (+) inclusions were evaluated. Cytological and immunocytochemical studies on the FNA smears of these metastatic groups, stained according to Romanovsky were performed. Indirect immunoperoxidase method using monoclonal antibodies to thyroid peroxidase and thyroglobulin was used. Statistical analysis using the U-test and the χ2 method in Statistica.11 package was performed. Results. Investigations of ultrasound and cytological characteristics of postoperative metastases
of papillary thyroid carcinomas did not reveal statistically significance difference between groups of radioiodine-resistant and radioiodinesensitive metastases on such ultrasound characteristics as echogenicity and echostructure and presence of echo (+) inclusions It is shown that when hypoechogenicity metastases are detected in the lateral lymphatic collectors, the probability of radioiodine resistance of metastases is 93±2. The ultrasound sign of cystic degeneration was found 1.8 times more frequent in radioiodine-resistance metastases compared to radioiodine-sensitive metastases. Cytological studies demonstrate the phenotypic heterogeneity of epithelium of radiiodine-resistant metastases compared to radioiodine-sensitive metastases and statistically significance difference in the expression of thyroglobulin and thyroid peroxidase were detected. Conclusions. Ultrasound revealed no statistically significant changes that would allow differential diagnosis between radioiodine-resistant and radioiodine-sensitive metastases of papillary thyroid cancer. Cytologic features of radioiodine-resistant metastases of papillary thyroid cancer have been demonstrated, which allow their preoperative prognosis. A statistically significant reduction in the expression of thyroid peroxidase and thyroglobulin in FNA smears of radioiodine-resistant metastases compared with radioiodine-sensitive
metastases, which is the basis of preoperative prognosis of radioiodine-resistance of postoperative metastases has been demonstrated. The metastatic neck lymph nodes, identified by ultrasound diagnostics, allow for further immunocytochemical and cytological studies, which can improve the diagnosis of metastases of highly differentiated thyroid cancer and provide a choice of further treatment.
References
2. Bogdanova T, Saenko V, Shpak V. Long-term analysis of the incidence and histopathology of thyroid cancer in Ukraine in adult patients who were children and adolescents at the time of the Chernobyl accident. In: Yamashita S, Thomas G, eds. Thyroid cancer and nuclear accidents — long term after effects of Chernobyl and Fukushima. Amsterdam: Elsevier. 2017:67-76.
3. Bogdanova T, Zurnadzhy L, Nikiforov Y. Histopathological features of papillary thyroid carcinomas detected during four screening examinations of a Ukrainian-American cohort. Br J Cancer. 2015;113:1556-64.
4. Drozd V, Branovan I, Shiglik N. Thyroid cancer induction: nitrates as independent risk factors or risk modulators after radiation exposure, with a focus on the Chernobyl accident. Eur Thyroid J. 2018;7:67-74.
5. Dzepina D, Zurak K, Petric V, Cupic H. Pathological characteristics and clinical perspectives of papillary thyroid cancer: study of 714 patients. Eur Arch Otorhinolarygol. 2014;271(1):141-8.
6. Lei S, Ding Z, Ge J, Zhao D. Association between prognostic factors and clinical outcome of well-differentiated thyroid carcinoma: a retrospective 10-year follow-up study. Oncol Lett. 2015;10(3):1749-54
7. Markovina S, Grigsby PW, Schwarz JK. Treatment approach, surveillance, and outcome of well-differentiated thyroid cancer in childhood and adolescence. Thyroid. 2014;24(7):1121-6.
8. Machens A, Dralle H. Disease-free survival and time bias in long-term follow-up after complete resection of localized well-differentiated cancer. Ann Surg Oncol. 2011;18(2):600-18.
9. Patel SS, Goldfarb M. Well-differentiated thyroid carcinoma: the role of post-operative radioactive iodine administration. J Surg Oncol. 2013;107(6):665-72.
10. Haugen B, Alexander E, Bible K. American Thyroid Association management guidelines for adult patients with thyroid nodule sand differentiated thyroid cancer: The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26:1-133
11. Worden F. Treatment strategies for radioactive iodine-refractory differentiated thyroid cancer. Ther Adv Med Oncol 2014; 6: 267-79.
12. Vaisman F, Carvalho D, Vaisman M. A new appraisal of iodine refractory thyroid cancer. Endocr Relat Cancer 2015; 22: R301-10.
13. Ahuja AT, Ying M, Ho SY. Ultrasound of malignant cervical lymph nodes. Cancer Imaging. 2008;86:48-56.
14. Yuchen Jina, Douglas Van Nostrand, Lingxiao Chenga, Min Liua, Libo Chena. Radioiodine refractory differentiated thyroid cancer. Oncolog/Hematology. 2018;125:111-20
15. Choi JW, Lee JH, Baek, JH. Diagnostic accuracy of ultrasound and 18-F-FDG PET or PET/CT for patients with suspected recurrent papillary thyroid carcinoma. Ultrasound Med Biol. 2010; 36:1608-15.