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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.

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Lu Zhang, Marco Castellana, Camilla Virili, Anna Crescenzi, Francesco Giorgino, Emanuele Zucca, Luca Ceriani, Franco Cavalli, Luca Giovanella and Pierpaolo Trimboli

Background

Primary thyroid lymphoma (PTL) is a rare malignancy, and its prognosis depends significantly on its early diagnosis. While fine-needle aspiration (FNA) represents the gold standard to identify differentiated thyroid carcinoma, its reliability for the detection of PTL is still unclear. Here, we conducted a systematic review and meta-analysis to evaluate the diagnostic performance of FNA in PTL.

Research design and methods

A comprehensive literature search of PubMed/MEDLINE and Scopus databases was conducted to retrieve papers reporting histologically proven PTL undergone FNA. The last search was performed in February 2018 without language and time restrictions.

Results

Thirty-two studies describing 593 PTL were included and the pooled FNA sensitivity was 0.48 (95% CI = 0.38–0.58). FNA sensitivity was 0.51 in 20 studies published before 2010 and 0.39 in those published later, 0.50 in six articles with at least 20 cases and 0.44 in nine series enrolled after 2000. This performance was similar in 12 articles including diffuse large B-cell lymphoma (0.54) and those six on marginal zone lymphoma (0.56). Remarkably, FNA sensitivity increased to 0.72 when considering also FNA reports suspicious for PTL reported in 14 articles. Heterogeneity among the series was found. Publication bias was not always detected.

Conclusions

The present meta-analysis demonstrated that FNA has low sensitivity in diagnosing PTL. However, this rate increased when considering also FNA reports suspicious for PTL, which is relevant from a clinical standpoint. This result could support indirectly the use of additional imaging and/or core biopsy when PTL is suspected.