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Giovanella L.,Oncology Institute of Southern Switzerland | Bongiovanni M.,Institute of Pathology | Trimboli P.,Section of Endocrinology and Diabetology
Current Opinion in Oncology | Year: 2013

PURPOSE OF REVIEW: Differentiated thyroid cancers (DTCs) have generally an indolent behavior. However, in a minority of these patients cervical metastasis at diagnosis or recurrence during follow-up may occur. Then, in suspicious neck lymph nodes fine-needle aspiration (FNA) is warranted. Thyroglobulin measurement in needle washout fluids (FNA-Tg) since its first description has been reported to increase the diagnostic accuracy of cytology in neck lymph nodes suspicious for metastatic DTC. RECENT FINDINGS: Recent literature suggests that FNA-Tg can substitute conventional cytology and, in turn, simplifies clinical management of DTC patients. However, because of the large difference between these clinical studies, the data are sparse. Thus, neither procedures nor assay method for FNA-Tg have been standardized. SUMMARY: FNA-Tg measurement is the more accurate tool to detect neck recurrences and metastases from DTC. Providing strict standardization of preanalytical and analytical phase, FNA-Tg may suffice to confirm or exclude neck DTC recurrence in patients with concurrent well differentiated papillary cancer type, suspicious neck ultrasound findings and increased serum thyroglobulin after thyroidectomy. On the contrary, FNA-Tg accuracy increases by adding cytological examination when FNA is performed before thyroidectomy, in patients with more aggressive histological types, and if low-undetectable serum thyroglobulin and/or positive serum antithyroglobulin antibodies occur. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Trimboli P.,Section of Endocrinology and Diabetology | Treglia G.,Oncology Institute of Southern Switzerland | Guidobaldi L.,Section of Pathology | Romanelli F.,University of Rome La Sapienza | And 7 more authors.
Clinical Endocrinology | Year: 2015

Background The early detection of medullary thyroid carcinoma (MTC) can improve patient prognosis, because histological stage and patient age at diagnosis are highly relevant prognostic factors. As a consequence, delay in the diagnosis and/or incomplete surgical treatment should correlate with a poorer prognosis for patients. Few papers have evaluated the specific capability of fine-needle aspiration cytology (FNAC) to detect MTC, and small series have been reported. This study conducts a meta-analysis of published data on the diagnostic performance of FNAC in MTC to provide more robust estimates. Research Design and Methods A comprehensive computer literature search of the PubMed/MEDLINE, Embase and Scopus databases was conducted by searching for the terms 'medullary thyroid' AND 'cytology', 'FNA', 'FNAB', 'FNAC', 'fine needle' or 'fine-needle'. The search was updated until 21 March 2014, and no language restrictions were used. Results Fifteen relevant studies and 641 MTC lesions that had undergone FNAC were included. The detection rate (DR) of FNAC in patients with MTC (diagnosed as 'MTC' or 'suspicious for MTC') on a per lesion-based analysis ranged from 12·5% to 88·2%, with a pooled estimate of 56·4% (95% CI: 52·6-60·1%). The included studies were statistically heterogeneous in their estimates of DR (I-square >50%). Egger's regression intercept for DR pooling was 0·03 (95% CI: -3·1 to 3·2, P = 0·9). The study that reported the largest MTC series had a DR of 45%. Data on immunohistochemistry for calcitonin in diagnosing MTC were inconsistent for the meta-analysis. Conclusions The presented meta-analysis demonstrates that FNAC is able to detect approximately one-half of MTC lesions. These findings suggest that other techniques may be needed in combination with FNAC to diagnose MTC and avoid false negative results. © 2014 John Wiley & Sons Ltd. Source

Abbouda A.,University of Rome La Sapienza | Trimboli P.,Section of Endocrinology and Diabetology | Bruscolini A.,University of Rome La Sapienza
Seminars in Ophthalmology | Year: 2014

Introduction: Thyroid ophthalmopathy is a complication most commonly associated with Grave's disease. The disease course ranges from mild to severe, with severe cases resulting in major visual impairment. Methods: A complete ophthalmic examination in a 35-year-old secundigravida to 14 weeks of gestation presented to the hospital for a routine ophthalmological examination with eyelid retraction in the right eye was made. We studied the course of ocular disease through the gestation with orbit ecography and a 3T MRI. Results: A diagnosis of Grave's Ophthalmopathy was made. Conclusion: This case presents an unusual course of the GD during pregnancy and a normal post-partum relapse, according to the Th1/Th2 balance. The frequent follow-up and the use of MRI allowed a prompt identification and complete control of the disease. © 2014 Informa Healthcare USA, Inc. Source

Trimboli P.,Section of Endocrinology and Diabetology | Crescenzi A.,Biomedical University of Rome
Endocrine | Year: 2015

Recently, the microhistologic evaluation by core needle biopsy (CNB) has been reported as high accurate to diagnose thyroid nodules with previous indeterminate or not adequate fine-needle aspiration cytology. In addition, sparse data have been reported regarding the use of CNB in other conditions. Aim of this review was to furnish the state of the art of this topic by summarizing published data about the diagnostic performance of CNB in thyroid lesions, and provide an easy to use reference for clinical practice. Sources encompass studies published through May 2014. Original articles were investigated and following specific aspects were discussed: 1. The “large” needle biopsy in 90’s; 2. Complications by and patient’s comfort with thyroid CNB; 3. Advantages provided by examination of a microhistologic sample of thyroid nodule; 4. Use of CNB in thyroid nodules with previous not adequate (Thy 1/Class 1/Category I) cytology; 5. Use of CNB in thyroid neoplasms (Thy 3/Class 3/Category III–IV) cytology; 6. Use of CNB in specific ultrasonographic presentations of thyroid nodules or in patients with peculiar clinical contexts; 7. First-line approach by CNB in thyroid nodules; 8. Immunohistochemistry and molecular tests on CNB samples; and 9. Future perspective. © 2014, Springer Science+Business Media New York. Source

Trimboli P.,Section of Endocrinology and Diabetology | Trimboli P.,Oncology Institute of Southern Switzerland | Giovanella L.,Oncology Institute of Southern Switzerland
Clinical Chemistry and Laboratory Medicine | Year: 2015

Generally, calcitonin (CT) values below the upper reference limit rule-out medullary thyroid carcinoma (MTC) with very high accuracy. However, sparse cases of serum-calcitonin-negative MTC (CT-NEG-MTC) have been reported. Here we reviewed CT-NEG-MTC reported in literature, discussed the potential causes and proposed a practical laboratory and clinical approach. A comprehensive literature search was conducted by using the terms "medullary thyroid carcinoma" AND "non-secreting calcitonin" OR "undetectable calcitonin". The search was updated until December 2014. Original articles that described CT-NEG-MTC were eligible for inclusion. Only MTC cases with preoperative CT below the upper reference limit were included in the present review. Eleven papers with 18 CT-NEG-MTC cases (age 50 years, size 26 mm) were retrieved. Four patients with poorly differentiated MTC died within 3 years. Different CT assays were employed and different reference values were adopted. Preoperative serum CT values were below the institution cut-off levels in all cases, and undetectable in four patients. In some papers negative CT results were confirmed by additional tests. Further laboratory investigations were performed in some of the included studies. In patients with well founded suspicious of MTC and within the reference limits/undetectable CT other laboratory investigations [carcinoembryonic antigen (CEA), procalcitonin, CT stimulation, CT in washout of nodule's aspiration] have to be performed. Surgical approach to CT-NEG-MTC does not differ from those secreting CT. Postoperative follow-up of these rare cases should include periodical imaging and measurement of all potential markers. Patients with poorly differentiated MTC are at higher risk of disease-related death, and require more aggressive follow-up strategy. © 2015 by De Gruyter. Source

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