Search Results

You are looking at 1 - 7 of 7 items for

  • Author: Frederik Verburg x
Clear All Modify Search
Free access

Luca Giovanella, Mauro Imperiali, Frederik A Verburg and Pierpaolo Trimboli

Objective

To assess the diagnostic performance of three high-sensitive assays in a cohort of TgAb-negative and TgAb-positive differentiated thyroid cancer (DTC) patients.

Design

Retrospective study on prospectively selected DTC patients.

Methods

Serum samples from 154 DTC patients were obtained 6–12 months after radioiodine ablation and tested by Beckman, Roche, BRAHMS Tg and TgAb assays, respectively. Receiver operating characteristics curves for Tg were plotted using outcome over time as benchmark and assay-specific Tg thresholds were obtained for TgAb-negative and TgAb-positive patients.

Results

The frequency of positive TgAb was 21, 20 and 20% for Beckman, Roche and BRAHMS, respectively. In TgAb-negative patients, clinical sensitivities and specificities of 100% and 85–95%, respectively, were observed across all assays. In TgAb-positive patients, clinical sensitivities and specificities of 80–100% and 92–96%, respectively, were observed using lower thresholds than in patients without TgAb.

Conclusions

Adopting appropriate thresholds, lower than those for TgAb-negative patients, is possible to reliably follow TgAb-positive patients using highly sensitive Tg assays.

Free access

Frederik A Verburg, Uwe Mäder, Markus Luster and Christoph Reiners

Objective

Papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) show considerable differences in disease stage at initial presentation. The aim of this study was to investigate whether there are differences in tumour-specific survival if initial staging is accounted for.

Design

Retrospective chart review study.

Patients

The study sample comprised 875 PTC and 350 FTC patients (856 females, 369 males, mean age 47.8 years) treated in our hospital from 1978 to 2002. All patients received total thyroidectomy with subsequent I-131 ablation except for those patients with an isolated papillary microcarcinoma.

Methods

Kaplan–Meier analyses and Cox-regression analyses were performed to assess the influence of histology on thyroid cancer-specific survival.

Results

FTC patients were on average older, more likely to be male, presented with a larger tumour and more frequently had multifocal carcinoma and distant metastases than PTC patients, whereas they presented less frequently with extrathyroidal invasion or lymph node metastases. Twenty-year tumour-specific survival in PTC was 90.6% and in FTC 73.7% (P<0.001). In multivariate analysis the presence of distant metastases (P<0.001), age (P<0.001), tumour size (P=0.001) and the presence of extrathyroidal invasion (P=0.007), but not histology (P=0.26), were independent determinant variables for tumour-specific survival.

Conclusion

There is no difference in tumour-specific survival between PTC and FTC when accounting for the presence of metastases, age, tumour size and the presence of extrathyroidal invasion.

Free access

Luca Giovanella, Giorgio Treglia, Frederik A Verburg, Massimo Salvatori and Luca Ceriani

Background

This study was undertaken to evaluate serum cytokeratin 19 fragment (Cyfra 21.1) expressions in patients with advanced thyroid carcinoma and to explore the relationship between serum Cyfra 21.1 and the degree of radioiodine (131I) avidity of thyroid carcinoma cells.

Methods

Enrolled were 76 consecutive patients with advanced thyroid carcinoma submitted to high-activity 131I treatment. In each patient, serum thyroglobulin (Tg) and Cyfra 21.1 were measured before 131I administration and compared with the posttreatment whole-body scan results.

Results

Thirty-one (41%) of 76 patients had iodine-avid and 45 (59%) had iodine-refractory diseases respectively. Significantly higher serum Cyfra 21.1, but not Tg, levels were found in patients with 131I-refractory disease compared with patients with iodine-avid disease (P<0.01).

Conclusions

This is the first report describing the potential role of serum Cyfra 21.1 as marker of dedifferentiation and resistance to 131I therapy in patients with advanced thyroid carcinoma.

Free access

Frederik A Verburg, Bart de Keizer, Cornelis J M Lips, Pierre M J Zelissen and John M H de Klerk

Objectives: Currently, little is known about the prognostic significance of achieving successful ablation with the first dosage of I-131 in patients with differentiated thyroid cancer. This study aimed to assess the following: (i) whether successful or unsuccessful ablation at post-ablation follow-up has prognostic consequences; (ii) possible factors predicting success of ablation in a patient.

Methods: In order to do this, we retrospectively studied 180 patients with a median follow-up of 55 months. Ablation was considered to be successful if 1 year after the initial dosage of I-131 patients fulfilled all of the following criteria: not dead from thyroid cancer, no additional therapy needed for any kind for thyroid cancer within the first year, undetectable thyroglobulin (Tg) levels under TSH stimulation, and negative I-131 scintigraphy. Tg levels at the time of ablation (P < .001), lymph node metastasis (P = 0.04) and distant metastasis (P < .001) have a significant influence on the success of ablation. P values were calculated by Mann–Whitney U test and Chi-square test, respectively.

Results: Patients with successful ablation had a better prognosis than those with unsuccessful ablation: disease-free survival was 87% versus 49% after 10 years; additionally, thyroid-cancer related survival was 93% versus 78%.

Conclusion: We conclude that the extent of the remaining normal or neoplastic thyroid tissue influences the outcome of ablation, and that successful ablation leads to a better prognosis. It seems that it is very important to achieve complete ablation as soon as possible in order to ensure the best possible prognosis for a patient.

Free access

Robbert B T Verkooijen, Frederik A Verburg, Johannes W van Isselt, Cornelis J M Lips, Jan W Smit and Marcel P M Stokkel

Introduction

The aim of the study was to compare the success rate of an uptake-related ablation protocol in which the dose depends on an I-131 24-h neck uptake measurement and a fixed-dose ablation protocol in which the dose depends on tumour stage.

Methods

All differentiated thyroid carcinoma patients with M0 disease who had undergone (near-) total thyroidectomy followed by I-131 ablation were included. In the uptake-related ablation protocol, 1100 (uptake >10%), 1850 (uptake 5–10%) and 2800 MBq (uptake <5%) were used. In the fixed-dosage ablation strategy, 3700 (T1–3, N0 stage) and 5550 MBq (N1 and/or T4 stage) were applied. We used I-131 uptake on whole-body scintigraphy and thyroglobulin-off values to evaluate the ablation 6–12 months after treatment.

Results

In the uptake-related ablation protocol, 60 out of 139 (43%) patients were successfully treated versus 111 out of 199 for the fixed-dose ablation protocol (56%) (P=0.022). The differences were not statistically significant for patients with T4 (P=0.581) and/or N1 (P=0.08) disease or for patients with T4N1 tumour stage (P=0.937).

Conclusion

The fixed-dose I-131 ablation protocol is more effective in ablation of the thyroid remnant in differentiated thyroid carcinoma patients than an uptake-related ablation protocol. This difference is not observed in patients with a N1 and/or T4 tumour stage.

Open access

Luca Giovanella, Penelope M Clark, Luca Chiovato, Leonidas Duntas, Rossella Elisei, Ulla Feldt-Rasmussen, Laurence Leenhardt, Markus Luster, Camilla Schalin-Jäntti, Matthias Schott, Ettore Seregni, Herald Rimmele, Jan Smit and Frederik A Verburg

Differentiated thyroid cancer (DTC) is the most common endocrine cancer and its incidence has increased in recent decades. Initial treatment usually consists of total thyroidectomy followed by ablation of thyroid remnants by iodine-131. As thyroid cells are assumed to be the only source of thyroglobulin (Tg) in the human body, circulating Tg serves as a biochemical marker of persistent or recurrent disease in DTC follow-up. Currently, standard follow-up for DTC comprises Tg measurement and neck ultrasound combined, when indicated, with an additional radioiodine scan. Measurement of Tg after stimulation by endogenous or exogenous TSH is recommended by current clinical guidelines to detect occult disease with a maximum sensitivity due to the suboptimal sensitivity of older Tg assays. However, the development of new highly sensitive Tg assays with improved analytical sensitivity and precision at low concentrations now allows detection of very low Tg concentrations reflecting minimal amounts of thyroid tissue without the need for TSH stimulation. Use of these highly sensitive Tg assays has not yet been incorporated into clinical guidelines but they will, we believe, be used by physicians caring for patients with DTC. The aim of this clinical position paper is, therefore, to offer advice on the various aspects and implications of using these highly sensitive Tg assays in the clinical care of patients with DTC.

Free access

Hanneke M van Santen, Erik K Alexander, Scott A Rivkees, Eva Frey, Sarah C Clement, Miranda P Dierselhuis, Chantal A Lebbink, Thera P Links, Kerstin Lorenz, Robin P Peeters, Christoph Reiners, Menno R Vriens, Paul Nathan, Arthur B Schneider and Frederik Verburg

The incidence of differentiated thyroid carcinoma (DTC) has increased rapidly over the past several years. Thus far, the only conclusively established risk factor for developing DTC is exposure to ionizing radiation, especially when the exposure occurs in childhood. Since the number of childhood cancer survivors (CCS) is increasing due to improvements in treatment and supportive care, the number of patients who will develop DTC after surviving childhood cancer (secondary thyroid cancer) is also expected to rise. Currently, there are no recommendations for management of thyroid cancer specifically for patients who develop DTC as a consequence of cancer therapy during childhood. Since complications or late effects from prior cancer treatment may elevate the risk of toxicity from DTC therapy, the medical history of CCS should be considered carefully in choosing DTC treatment. In this paper, we emphasize how the occurrence and treatment of the initial childhood malignancy affects the medical and psychosocial factors that will play a role in the diagnosis and treatment of a secondary DTC. We present considerations for clinicians to use in the management of patients with secondary DTC, based on the available evidence combined with experience-based opinions of the authors.