Međunarodni znanstveni simpozij "Tumori štitnjače u kliničkoj praksi"
International Scientific Symposium "Thyroid Cancer in Clinical Practice"
Contributor(s): Lidija Lincender-Cvijetić (Editor)
Subject(s): Methodology and research technology, Health and medicine and law
Published by: Akademija Nauka i Umjetnosti Bosne i Hercegovine
Keywords: Nuclear medicne; Thyroid cancer; thyroid nodules; ultrasonography; cytological puncture; targeted molecular therapy; magnetic resonance imaging; tomotherapy;
Summary/Abstract: Nuklearno-medicinske procedure su krucijalne u dijagnostici, praćenju i terapiji carcinoma štitnjače. U dijagnostici, pored ultrazvuka štitne žlijezde i citologije, važno mjesto ima scintigrafija štitnjače. Ako se potvrdi karcinom štitnjače, slijedi operativni tretman – totalna/ subtotalna tireoidektomija. Potom slijede dijagnostička snimanja i ako je potrebno terapijskeradionuklidne procedure. Dijagnostička scintigrafija određuje koliko rezidualnog tkiva štitnjače je ostalo nakon tireoidektomije i definiše prisustvo funkcionalnih metastaza. Mjerenje Tg je vrijedno kod pacijenata koji su imali operativni tretman i tretman sa I-131. Primjena empirijskih doza radiojodne terapije rezultira uspješnom ablacijom ostataka tkiva štitnjače u najvećeg broja bolesnika, a terapija jodavidnih metastaza provodi se visokim terapijskim dozama radiojoda. Radiojod neavidne metastaze mogu se uspješno vidjeti ili 99mTc-sestamibijem ili 18F-FDG -om. U novije vrijeme koristi se dijagnostička scintigrafija somatostatinskih receptora i u slučaju pozitivnosti provodi PRRT. Ciljana terapija usmjerena je na inhibiranje specifičnih molekula važnih u tumorskom rastu i u progresiji bolesti. Ako serumska razina Tg poraste preporučuje se dodatna obrada u svrhu traženja recidiva: 131I SPECT-CT, 18F-FDG PET, scintigrafija skeleta. Dijagnoza medularnog karcinoma kod pacijenata s tireoidnim čvorom najbolje se postiže s FNAB. Kalcitonin i CEA se mjere u toku follow-up-a. 99mTcvDMSA ima ulogu u postavljanju dijagnoze medularnog karcinoma. 123I-MIBG scintigrafija cijelog tijela može se uraditi prije 131I-MIBG tretmana. Radioaktivno obilježeni octreotide može se koristiti u dijagnostici i tretmanu medularnog karcinoma. PET/CT je odličan za identificiranje mjerljivih metastaza (>5-6 mm), ali nije od koristi za milijarne plućne metastaze ili hepatalne lezije. 18FDG PET/CT ima senzitivnost i specifičnost 80% kod ovih karcinoma. Navedene nuklearno-medicinske procedure direktno utiču na dobru prognozu kod diferenciranih tipova karcinoma štitnjače.
Series: Posebna izdanja ANUBiH
- E-ISBN-13: 978-9926-410-12-4
- Page Count: 96
- Publication Year: 2016
- Language: Bosnian, English, Croatian, Serbian
ZNAČAJ NUKLEARNE MEDICINE U MENADŽMENTU PACIJENATA S KARCINOMOM ŠTITNJAČE
ZNAČAJ NUKLEARNE MEDICINE U MENADŽMENTU PACIJENATA S KARCINOMOM ŠTITNJAČE
(THE IMPORTANCE OF NUCLEAR MEDICINE IN THE MANAGEMENT OF THYROID CANCER PATIENTS)
- Author(s):Elma Kučukalić - Selimović, Amila Bašić
- Language:Bosnian, Croatian, Serbian
- Subject(s):Health and medicine and law
- Page Range:7-21
- No. of Pages:15
- Keywords:thyroid cancer; thyroid scintigraphy; Tg; WBS with I-131; 18FDG PET/CT;
- Summary/Abstract:Nuclear medicine has a vital role in the diagnosis, follow-up and treatment of thyroid cancer. In addition to thyroid gland ultrasound and cytology, another important diagnostic tool is thyroid scintigraphy. If thyroid cancer is confirmed, the next step is surgical treatment – a total/ near total thyroidectomy according to guidelines. This is followed by diagnostic imaging and, if necessary, radionuclide therapeutic procedures. Diagnostic scintigraphy determines the amount of residual thyroid tissue left over after thyroidectomy and defines the presence of functional metastases. Tg measurement is valuable in patients who have undergone surgical treatment and I-131 treatment. Administration of empirical doses results in a successful ablation of thyroid tissue remnants in the majority of patients after the first administration of radioactive iodine, while therapy for iodine-positive metastases includes high therapeutic doses of radioactive iodine. Radioactive iodine-negative metastases are readily visible using 99mTc-sestamibi or 18F-FDG. More recently, diagnostic scintigraphy of somatostatin receptors is used and, in the event of positive results, PRRT is performed. The targeted therapy is aimed at inhibiting specific molecules that are important for tumor growth and disease progression. If serum Tg rises above previous levels, additional procedures are recommended to check for recurrence: 131I SPECT-CT, 18F-FDG PET, skeletal scintigraphy in suspected bone metastases. Medullar carcinoma diagnosis in patients with a thyroid nodule is best achieved with FNAB. PET/CT is excellent for identifying measurable metastases, but is of no use for miliary pulmonary metastases or hepatic lesions. The nuclear medicine procedures have a direct influence on good prognosis of differentiated thyroid carcinomas.
NODOZNA BOLEST ŠTITNE ŽLIJEZDE: EVALUACIJA ULTRAZVUČNE METODE U DIFERENCIJACIJI BENIGNIH, SUSPEKTNO MALIGNIH I MALIGNIH TIREOIDNIH ČVOROVA
NODOZNA BOLEST ŠTITNE ŽLIJEZDE: EVALUACIJA ULTRAZVUČNE METODE U DIFERENCIJACIJI BENIGNIH, SUSPEKTNO MALIGNIH I MALIGNIH TIREOIDNIH ČVOROVA
(NODULAR THYROID DISEASE: ULTRASONOGRAPHY EVALUATION IN DIFFERENTIATION BENIGN, SUSPECTED MALIGNANT AND MALIGNANT THYROID NODULES)
- Author(s):Amra Jakubović Čičkušić, Belkisa Izić, Maja Sulejmanović, Jasmin Hasanović, Alma Čičkušić
- Language:Bosnian, Croatian, Serbian
- Subject(s):Health and medicine and law
- Page Range:22-39
- No. of Pages:18
- Keywords:thyroid nodules; ultrasonography; thyroid carcinoma;
- Summary/Abstract:The aim of this study was to determine the sensitivity (Se), specificity (Sp), positive (PPV) and negative predictive values (NPV) and diagnostic accuracy of ultrasonography in the evaluation of benign, suspected malignant and malignant thyroid nodules. Methods: This is a retrospective-prospective study of thyroid nodules in 155 patients, of both sexes, the average age of 56.34y132 (85,2%) females and 23 (14,8%) male. The subjects in this study were a specially selected group of patients who had been reffered to a surgeon to have an operation due to suspected cytological findings, the size of goiter or symptoms of compression. Based on ultrasound patterns, thyroid nodules are divided into 3 groups: benign, suspected malignant and malignant lesions. The preoperative ultrasound features of thyroid nodules were compared with postoperative histopathology results. For each tested group - Se, Sp, PPV, NPV and diagnostic accuracy were estimated. Results: The Se, Sp, PPV, NPV and overall diagnostic accuracy of ultrasound methods compared with histological findings in the evaluation of benign thyroid nodules were: 41,74%, 42,30%, 58,90%, 26,82% and 41,93%; in suspect malignant were: 29,50%, 93,61%, 75%, 67,17% and 68,38%; and in malignant thyroid lesions were: 33,87% 94,62%, 80,76%, 68,21% and 70,32%, respectively. Conclusion: The results of this study indicate that the ultrasound examination had high specificity and high PPV in detection suspect malignant and malignant thyroid nodules.
MOGUĆNOSTI ULTRAZVUČNE DIJAGNOSTIKE U DIFERENCIJACIJI TUMORA ŠTITNE ŽLIJEZDE
MOGUĆNOSTI ULTRAZVUČNE DIJAGNOSTIKE U DIFERENCIJACIJI TUMORA ŠTITNE ŽLIJEZDE
(THE BENEFITS OF ULTRASONOGRAPHY IN THE DIFFERENTIATION OF THYROID TUMOR)
- Author(s):Sanja Šehović, Nina Jurić, Amela Begić, Lidija Lincender-Cvijetić
- Contributor(s):Elza Hajduk (Translator)
- Language:Bosnian, Croatian, Serbian
- Subject(s):Health and medicine and law
- Page Range:40-53
- No. of Pages:14
- Keywords:thyroid gland; ultrasonography; cytological puncture;
- Summary/Abstract:Purpose: The purpose of this study was to compare ultrasonography (US) results with results of targeted cytological puncture of a nodule of the thyroid, as well as to assess the capabilities of ultrasonography in screening patients with potentially present tumor for cytological puncture. Material and method: The study analyzed results of 133 patients, men and women, between the age of 16 and 75. The patients had a standard ultrasound exam of the thyroid and ultrasound guided cytological puncture. Results: The research showed that nodular diseases of the thyroid were presented in 2/3 of women patients, and in 1/3 of men patients. The largest presence of nodules was among the group of 40-49 years of age. Nodules are the most common in the lower right lobe of the thyroid. The size increase of nodules also increases probability to be malignant. Furthermore, this research has shown that there is a statistically significant connection between ultrasonography results and the cytological puncture test results. Conclusion: Ultrasonography is a reliable method of diagnosis for selecting patients to have a cytological puncture.
RADIOIODINE THERAPY OF DIFFERENTIATED THYROID CANCER – PRINCIPLES AND PRACTICE
RADIOIODINE THERAPY OF DIFFERENTIATED THYROID CANCER – PRINCIPLES AND PRACTICE
(RADIOIODINE THERAPY OF DIFFERENTIATED THYROID CANCER – PRINCIPLES AND PRACTICE)
- Author(s):Amela Begić, Elma Kučukalić - Selimović
- Contributor(s):Zada Sirćo (Translator)
- Language:English
- Subject(s):Health and medicine and law
- Page Range:54-57
- No. of Pages:4
- Keywords:thyroid cancer; radioiodine therapy I-131; follow-up;
- Summary/Abstract:Differentiated thyroid cancer is defined as a carcinoma deriving from the follicular epithelium and retaining basic biological characteristics of healthy thyroid tissue. Differentiated thyroid carcinoma is an uncommon disease clinically, but worldwide, its incidence shows a noticeable increase. When appropriate treatment is given, the prognosis of the disease is generally excellent. Although the 10-year survival rate in cases of distant metastasis is approximately 25-40%, the 10-year overall cause-specific survival for differentiated thyroid carcinoma patients as a whole is estimated at approximately 85%. Radioiodine therapy is defined as the systemic administration of iodine I-131 for selective irradiation of thyroid remnants, microscopic differentiated thyroid carcinoma or other nonnresectable differentiated thyroid carcinoma or both purposes. The first form, radioiodine ablation, is a post-surgical adjuvant modality. Ablation also allows sensitive “post-therapy” whole- body scintigraphy that may detect previously occult metastases and serves to treat any microscopic tumour deposits. Ablation success is evaluated 6-12 months after the ablation procedure. Conclusion: Lifelong follow-up is needed in all differentiated thyroid carcinoma survivors and subsequent therapy in an appreciable number of patient.
SAVREMENI TERAPIJSKI ASPEKTI KOD RADIOJOD NEGATIVNIH PACIJENATA S KARCINOMOM ŠTITNJAČE
SAVREMENI TERAPIJSKI ASPEKTI KOD RADIOJOD NEGATIVNIH PACIJENATA S KARCINOMOM ŠTITNJAČE
(CURRENT THERAPEUTIC ASPECTS IN RADIOACTIVE IODINE-NEGATIVE THYROID CANCER PATIENTS)
- Author(s):Elma Kučukalić - Selimović, Amila Bašić
- Language:Bosnian, Croatian, Serbian
- Subject(s):Health and medicine and law
- Page Range:58-64
- No. of Pages:7
- Keywords:thyroid cancer; PET/CT imaging; Ga-68 DOTATOC; PRRT; targeted molecular therapy;
- Summary/Abstract:Treatment of well-differentiated thyroid cancer includes total/near total thyroidectomy, treatment with radioactive iodine I-131 and lifelong thyroid hormone suppressive therapy. On the other hand, patients with radioactive iodine-negative cancers have limited therapeutic options. Before deciding on treatment, diagnostic procedures are performed which may affect therapy selection for certain patients. Tc-99m sestamibi is used in the diagnosis ofiodine-negative changes in thyroid cancers. 18-FDG PET imaging can help in determining the extent of disease and selecting a therapeutic method. Risk stratification in patients with radioactive iodine-negative thyroid cancer is also based on repeated determination of thyroglobulin levels, which reflects an occult tumor or metastases. Somatostatin receptor imaging using 68Ga-DOTA-TOC as a tracer for PET is also included in the diagnostic algorithm in patients with iodine-negative changes. 68Ga-DOTA-TOC-PET is of great diagnostic value in terms of determining the extent and localization of the disease, providing a much more accurate diagnosis in radioactive iodine-positive and radioactive iodine-negative thyroid cancer patients, as well as in mixed tumor types. This procedure also offers information for the possible use of peptide receptor radionuclide therapy (PRRT). Furthermore, in patients with a negative somatostatin receptor scan and with no PRRT indication, targeted molecular therapy with multikinase inhibitors or protease inhibitors may be considered (sunitinib, sorafenib, bortezomib and others). In conclusion, we can say that for patients with radioactive iodinenegative thyroid cancer, treatment methods should be adapted to the findings of prior targeted diagnostic procedures and, of course, the tumor type, disease stage and overall clinical condition of the patient.
SLIKANJE MAGNETSKOM REZONANCOM TUMORA ŠTITNE ŽLIJEZDE
SLIKANJE MAGNETSKOM REZONANCOM TUMORA ŠTITNE ŽLIJEZDE
(MAGNETIC RESONANCE IMAGING OF THYROID NEOPLASMS)
- Author(s):Šerif Bešlić, Selma Milišić
- Language:Bosnian, Croatian, Serbian
- Subject(s):Health and medicine and law
- Page Range:65-75
- No. of Pages:11
- Keywords:thyroid neoplasms; magnetic resonance imaging (MRI);
- Summary/Abstract:Purpose: To define the position, role, methods and possibilities of magnetic resonance imaging (MRI) of thyroid neoplasms in early diagnosis, staging and the selection of treatments. Background: Malignant tumors of the thyroid gland are the most common endocrine neoplasms. However, mortality from them is relatively rare, especially if they are detected early and if it is a less malignant type of cancinoma. Therefore, their diagnosis at an early stage is of outmost importance. Methods: Although it is a small organ, diagnosis of malignant tumors of the thyroid gland is very complex and includes practically all available imaging methods in addition to clinical evaluation and laboratory findings. Lately magnetic resonance imaging (MRI) has ensured its place among imaging methods, and it is evolving rapidly. Disscusion: In this paper we discuss the role of MRI in the diagnosis and staging of thyroid gland neoplasms due to the rapid development of MR techniques such as MR spectroscopy (MRS), Diffusion Weighted Imaging (DWI), molecular imaging in oncology (MIO), with their advantages such as such as excellent spatial resolution, the ability of entire body imaging and so far little known noxiousness (no radiation), as well as low invasiveness of the method and tissue characterization between healthy and pathological tissues. Conclusions: From the above said it can be concluded that MRI imaging of thyroid gland neoplasms, especially with the application of old and the newly introduced methods, has its place in certain circumstances in the diagnosis, staging and pretherapeutical treatment of the patient in order to achieve the best therapeutical effect.
NOVE TEHNIKE U RADIOTERAPIJI KARCINOMA ŠTITNE ŽLIJEZDE
NOVE TEHNIKE U RADIOTERAPIJI KARCINOMA ŠTITNE ŽLIJEZDE
(NEW RADIOTHERAPY TECHNIQUES FOR THYROID CARCINOMA)
- Author(s):Nermina Kantardžić, Velda Smailbegović
- Language:Bosnian, Croatian, Serbian
- Subject(s):Methodology and research technology, Health and medicine and law
- Page Range:76-84
- No. of Pages:9
- Keywords:thyroid cancer; radiotherapy; IMRT; IGRT; tomotherapy;
- Summary/Abstract:Aim: To discuss new technologies in radiotherapy treatment for thyroid carcinoma. Traditional radiotherapy for thyroid carcinoma has certain restrictions because spinal medulla is close to the tumor. The radiotherapy dose must therefore be reduced in order to prevent the damage to this structure. Introducing Intensity modulated radiotherapy (IMRT), Image guided radiotherapy (IGRT) or tomotherapy can improve target coverage in cases that are difficult to treat. Patients and methods: According to the hospital malignant diseases register of Clinical Center of Sarajevo University (UKCS) there were 149 patients diagnosed with thyroid cancer and treated in this institution from 2009 to 2013. Retrospective analysis of data from Oncology Clinic during this period showed that 18 patients were treated at the Oncology Clinic of UKCS. Results: Most patients treated at the Oncology Clinic received palliative treatment, and only one patient received curative treatment. 16 patients had metastatic disease at the time of presentation for treatment, and one developed metastases after our treatment. One patient currently shows no signs of disease. Conclusion: In most cases radiotherapy is reserved for palliative treatments, due to the dosage restrictions. New techniques such as IMRT, IGRT and/or tomotherapy have demonstrated efficacy in precise treatment for tumors and also an increase in disease control, while at the same time ensuring a better protection of organs at risk from exposure to unnecessary radiation and thereby reducing long-term toxicity. For these reasons, new techniques may be considered a viable option in the treatment for thyroid cancer.
HIRURŠKA TERAPIJA KARCINOMA ŠTITASTE ŽLEZDE
HIRURŠKA TERAPIJA KARCINOMA ŠTITASTE ŽLEZDE
(HIRURŠKA TERAPIJA KARCINOMA ŠTITASTE ŽLEZDE)
- Author(s):Ivan Paunović
- Language:Bosnian, Croatian, Serbian
- Subject(s):Health and medicine and law
- Page Range:85-94
- No. of Pages:10
- Keywords:well differentiated carcinoma (DTC); medullary carcinoma (MTC); anaplastic carcinoma (ATC); thyroid gland;
- Summary/Abstract:Aim: There is still no clear solution for appropriate surgical management of thyroid gland carcinoma. Background: Thyroid gland carcinomas are most frequent carcinomas of endocrine organs, but rare comparing to the carcinomas of other localizations. Unlike other carcinomas, surgical treatment of thyroid carcinomas is primarily the best way of treatment, which means that the thyroid carcinomas are surgical disease. The origin of the cells of the thyroid gland from which the cancer arises determinates histopathological and clinical classification of the thyroid gland carcinomas as well as treatment and follow-up. Well-differentiated (papillary and follicular carcinoma) (DTC) and undifferentiated (anaplastic carcinoma) (ATC) are thyroid carcinomas of the follicular origin. Medullary thyroid carcinoma (MTC) arises from the “C” (calcitonin producing cells) cells of the thyroid gland, which are still incorrectly referred as parafollicular cells even though that “C” cell can be found intrafolliculary. Methods: The published studies were analyzed and compared with author’s personal experience in connection with surgical management of different types of thyroid gland carcinomas. Discussion: In the field of thyroid surgery for DTC discussion about appropriate type of surgery for DTC lasted previous thirty years and from the author opinion will last next thirty years. The author’s thirty year experience in the field of thyroid surgery is that every patient either with preoperative confirmed DTC, or patient with suspicious DTC should be approached individually. Type of the operation should depend of the local findings, age, presence or absence of cervical lymphonodopathy and presence or absence of distant metastases. Compared to DTC, there is no doubt that total thyroidectomy with central node dissection is appropriate surgical procedure both for sporadic and hereditary MTC. From author’s experience ATC diagnosis in the region of Western Balkans is often established lately, when only tumor reduction in order to deliberate trachea is possible. Since, in this area, the ATC is commonly found with coexistent multinodular goiter in author’s opinion, continuous control of these patients and emergency operation in case of FNB biopsy diagnosed ATC are highly recommended. Conclusion: Endocrine surgeon must always have a clear idea about surgical approach to the patient with thyroid gland carcinoma. Preoperative and intraoperative evaluation of the surgeon and the surgeon’s ability to understand the unique characteristic of thyroid gland carcinomas compared to carcinomas of other localizations are still the basis of the successful operation.
