Denzitometrija (dvoenergetska apsorpciometrija, DXA) je metoda izbora u mjerenju mineralne gustoće kosti te predstavlja „zlatni standard“ za dijagnozu osteoporoze, predviđanje rizika za prijelom i ...praćenje učinka liječenja. Zahvaljujući naprednim programskim podrškama denzitometrijskog uređaja, moguće je mjerenje sastava tijela, detekcija vertebralnih prijeloma i analiza trabekularne mikroarhitekture kosti. Prema najnovijim smjernicama stručnih društava proširene su kliničke indikacije i spoznaje o primjeni denzitometrije uz dodatne preporuke o slikovnim tehnikama procjene kvalitete kosti. Poznavanje denzitometrije, njezinih indikacija i metodologije rada neizostavan su temelj za optimalnu primjenu u kliničkoj praksi.
Background: Indolent nature but a high incidence of differentiated thyroid cancer (DTC) remains a challenge for optimizing patient care. Therefore, prognostic factors present valuable information for ...determining an adequate clinical approach. Methods: This study assessed prognostic features of 1167 papillary (PTC) and 215 follicular (FTC) thyroid cancer patients that had undergone surgery between 1962 and 2012, and were followed-up up to 50 years in a single institution, till April 2020. Age, gender, tumor size, presence of local and distant metastases at presentation, extrathyroidal extension, disease recurrence, and cancer-specific survival were evaluated. Results: In multivariate analysis, factors affecting the worse outcome were age (p = 0.005), tumor size (p = 0.006), and distant metastases (p = 0.001) in PTC, while extrathyroidal extension (p < 0.001), neck recurrence (p = 0.002), and distant metastases (p < 0.001) in FTC patients. Loco-regional recurrence rate was 6% for PTC and 4.7% for FTC patients, while distant metastases were detected in 4.2% PTC and 14.4% of FTC patients. The 10-year cancer-specific survival rates for PTC and FTC were 98.6% and 89.8%, respectively (p < 0.001). Conclusions: Negative prognostic factors, besides distant metastases, were older age and greater tumor size in PTC, and extrathyroidal extension and neck recurrence in FTC patients. The recurrence and mortality rates were very low.
The bone health guidelines for breast cancer (BC) patients recommend bone mineral density (BMD) testing. Patients with low BMD and elevated serum calcium levels (SCLs) are further evaluated for ...primary hyperparathyroidism (PHPT). We aimed to determine the prevalence of PHPT in treated BC patients with low BMD and analyze the association of SCLs with histopathologic tumor features and cancer treatment. This retrospective study included postmenopausal BC patients examined at Osteoporosis Clinic between 2013 and 2020. Clinical and BMD data were collected from patient medical records. Patients with biochemical suspicion of PHPT underwent standard parathyroid imaging procedures. Nine out of 137 (6.6%) patients were diagnosed with PHPT; 8/9 patients underwent parathyroidectomy and one patient was advised to follow-up. Among the rest of 128 non-PHPT patients, higher SCLs showed a trend of positive association with higher tumor grade and axillary lymph node involvement, and received immunotherapy, although without statistical significance. We found a higher prevalence of PHPT in treated BC patients compared to the general population. Higher SCLs show a trend of positive correlation with some more aggressive histopathologic tumor features and with immunotherapy. The results of this study suggest that assessment of SCLs should be routinely performed to rule out PHPT in treated BC patients with low BMD.
Sommario
Le metodiche di imaging delle paratiroidi rivestono un ruolo di cruciale importanza nell’identificazione e nella localizzazione delle paratiroidi iperfunzionanti nei pazienti con ...iperparatiroidismo primario. L’adenoma singolo costituisce la causa più comune di iperparatiroidismo primario. Negli ultimi decenni, il trattamento chirurgico di scelta nella maggior parte dei casi di iperparatiroidismo primario è stato la paratiroidectomia minimamente invasiva (MIP). Una chirurgia efficace, in mani esperte, dipende da una corretta localizzazione preoperatoria del tessuto paratiroideo iperfunzionante. Una fallimentare localizzazione pre-chirurgica delle ghiandole paratiroidi iperfunzionanti spesso rende necessaria una cervicotomia esplorativa bilaterale, pratica chirurgica gravata da maggiori svantaggi e possibili complicanze rispetto alla MIP. L’imaging delle paratiroidi può essere utile prima del trattamento chirurgico anche in caso di iperparatiroidismo secondario o in forme ereditarie, come la MEN 1, 2, e 4, in quanto permette sia la corretta localizzazione delle paratiroidi in sede tipica, sia l’identificazione e la localizzazione delle ghiandole ectopiche e soprannumerarie. Inoltre, permettendo di localizzare le paratiroidi fisiologiche ne consente la loro salvaguardia durante la procedura chirurgica.
Parathyroid scintigraphy with
99m
Tc-MIBI is an imaging technique used in nuclear medicine and performed in patients with suspected hyperparathyroidism (HPT). The objective of this study was to ...evaluate the role of this technique in patients who, along with suspected HPT, also have thyroid nodules. Retrospective analysis included a period of 8 years (2006-2013). The study included 91 patients with clinical or laboratory suspected HPT. Pathologic changes in parathyroid glands were demonstrated in 47 (70%) of 67 patients with positive scintigraphy. Pathologic changes in parathyroid glands were not evident in the remaining 20 (30%) patients. Out of nine patients with negative scintigraphy results but with suspected enlargement of the parathyroid gland examined by ultrasound, eight (89%) patients did not show pathologic changes in the parathyroid gland, whereas one (11%) patient had evident changes. Eight (54%) of 15 patients with suspected scintigraphy had positive ultrasound findings, as well as fine needle aspiration cytology (FNAC) findings with parathyroid hormone (PTH) determination in the aspirate. Seven (46%) patients had negative FNAC findings and PTH in the aspirate. The study showed scintigraphy to have high sensitivity (98%) in detecting patients with pathologic changes in the parathyroid glands. In patients with suspected HPT, scintigraphy needs to be combined with FNAC and PTH determination in the aspirate due to its low specificity of 28%.
Papillary thyroid carcinoma (PTC) is considered one of the most favorable tumors, indolent, with rare distant dissemination. Lungs and bones are the most common metastatic sites. Unusual sites of PTC ...distant metastases are extremely rare. Brain, liver, skin, kidney, pancreas, and adrenal gland PTC metastases have been sporadically reported in the literature. An 86-year-old female patient underwent total thyroidectomy and neck dissection due to PTC. Postoperative whole body iodine-131 scintigraphy with I-131 SPECT/CT of the abdomen revealed radioiodne avid left adrenal gland metastasis together with high postoperative serum thyroglobulin (Tg) value of more than 5000 µg/L and high serum Tg antibodies. Considering the above-mentioned findings, patient's age and multiple comorbidities, radioiodine therapy was applied. PTC metastases to the adrenal gland are extremely rare, and to our knowledge, only nine cases have been reported in the literature. This case report complements rare examples of unusual PTC metastases.
The worldwide incidence of differentiated thyroid cancer (DTC) has increased in recent decades, likely due to frequent use of cervical ultrasonography (US) and US-guided fine needle aspiration biopsy ...(FNA)., US is performed during follow-up after thyroidectomy, and US-guided FNA with cytology is used if suspicious cervical lymph nodes (LN) or thyroid bed masses are detected. Knowing that serum anti-Tg antibodies (sTgAb) affect the use of serum Tg (sTg) as a tumor marker, the aim of our study was to assess the usefulness of Tg determination in needle aspirates (FNA-Tg) in presence of sTgAb. This retrospective study included 149 patients with DTC and 159 aspirations of suspicious LN and thyroid bed masses. As expected, there was a negative correlation between sTg and sTgAb levels (p<0.05), while FNA-Tg levels had a positive correlation with FNA-TgAb levels (p<0.05). Furthermore, we found a positive correlation between sTg and FNA-Tg levels (p<0.05), but not between sTgAb and FNA-TgAb or sTgAb and FNA-Tg. In conclusion, these results show that FNA-Tg values were not affected by sTgAb and that FNA-Tg measurement were highly effective in detecting cervical DTC metastases. However, combined use with cytology is suggested for neck evaluation because cytology could reveal metastases from other tumor sites.
Bone involvement in primary hyperparathyroidism (PHPT) is characterized by reduced bone mineral density (BMD) using dual X-ray absorptiometry (DXA). A hallmark of PHPT is BMD loss at cortical sites ...while trabecular bone remains relatively preserved. PHPT is associated with increased fracture risk at both trabecular and cortical skeletal sites, which cannot be explained based on BMD values alone. The application of the trabecular bone score (TBS), an index of the lumbar spine DXA bone microarchitecture, showed lower TBS values and increased risk of fractures in PHPT patients, independent of BMD. Although further prospective studies are needed, promising data have been published with the use of TBS and some advanced DXA-based imaging modalities in patients with PHPT.
Osteoporotic fractures, also known as fragility fractures, are reflective of compromised bone strength and are associated with significant morbidity and mortality. Such fractures may be clinically ...silent, and others may present clinically with pain and deformity at the time of the injury. Unfortunately, and even at the time of detection, most individuals sustaining fragility fractures are not identified as having underlying metabolic bone disease and are not evaluated or treated to reduce the incidence of future fractures. A multidisciplinary international working group with representation from international societies dedicated to advancing the care of patients with metabolic bone disease has developed best practice recommendations for the diagnosis and evaluation of individuals with fragility fractures. A comprehensive narrative review was conducted to identify key articles on fragility fractures and their impact on the incidence of further fractures, morbidity, and mortality. This document represents consensus among the supporting societies and harmonizes best practice recommendations consistent with advances in research. A fragility fracture in an adult is an important predictor of future fractures and requires further evaluation and treatment of the underlying osteoporosis. It is important to recognize that most fragility fractures occur in patients with bone mineral density T scores higher than −2.5, and these fractures confirm the presence of skeletal fragility even in the presence of a well-maintained bone mineral density. Fragility fractures require further evaluation with exclusion of contributing factors for osteoporosis and assessment of clinical risk factors for fracture followed by appropriate pharmacological intervention designed to reduce the risk of future fracture. Because most low-trauma vertebral fractures do not present with pain, dedicated vertebral imaging and review of past imaging is useful in identifying fractures in patients at high risk for vertebral fractures. Given the importance of fractures in confirming skeletal fragility and predicting future events, it is recommended that an established classification system be used for fracture identification and reporting.
The bone health guidelines for breast cancer (BC) patients recommend bone mineral density (BMD) testing. Patients with low BMD and elevated serum calcium levels (SCLs) are further evaluated for ...primary hyperparathyroidism (PHPT). We aimed to determine the prevalence of PHPT in treated BC patients with low BMD and analyze the association of SCLs with histopathologic tumor features and cancer treatment. This retrospective study included postmenopausal BC patients examined at Osteoporosis Clinic between 2013 and 2020. Clinical and BMD data were collected from patient medical records. Patients with biochemical suspicion of PHPT underwent standard parathyroid imaging procedures. Nine out of 137 (6.6%) patients were diagnosed with PHPT; 8/9 patients underwent parathyroidectomy and one patient was advised to follow-up. Among the rest of 128 non-PHPT patients, higher SCLs showed a trend of positive association with higher tumor grade and axillary lymph node involvement, and received immunotherapy, although without statistical significance. We found a higher prevalence of PHPT in treated BC patients compared to the general population. Higher SCLs show a trend of positive correlation with some more aggressive histopathologic tumor features and with immunotherapy. The results of this study suggest that assessment of SCLs should be routinely performed to rule out PHPT in treated BC patients with low BMD. Key words: Primary hyperparathyroidism; Serum calcium; Breast cancer; Bone mineral density; Cancer treatment Smjernice o kostanom zdravlju za bolesnice s rakom dojke (RD) preporucuju ispitivanje mineralne gustoce kostiju (bone mineral density, BMD). U bolesnica s niskom vrijednosti BMD-a i povisenom razinom kalcija u serumu (RKS) dodatno se procjenjuje primarni hiperparatireoidizam (PHPT). Cilj je bio utvrditi ucestalost PHPT-a u lijecenih bolesnica s RD i snizenom vrijednosti BMD-a te analizirati povezanost RKS s histopatoloskim znacajkama tumora i onkoloskim lijecenjem. Retrospektivna studija obuhvatila je postmenopauzalne bolesnice s RD koje su pregledane u Ambulanti za osteoporozu izmedu 2013. i 2020. godine. Klinicki podaci i podaci o BMD prikupljeni su iz medicinske dokumentacije. Bolesnice s biokemijskom sumnjom na PHPT podvrgnute su standardnim postupcima snimanja paratireoidnih zlijezda. U devet od 137 (6,6%) bolesnica dijagnosticiran je PHPT; 8/9 bolesnica podvrgnuto je paratireoidektomiji, a jednoj je bolesnici savjetovano pracenje. U ostalih 128 bolesnica bez PHPT-a vise RKS pokazale su trend pozitivne povezanosti s visim gradusom tumora, zahvacenoscu aksilarnih limfinih cvorova i primljenom imunoterapijom, iako nije postignuta statisticka znacajnost. Utvrdili smo vecu ucestalost PHPT-a u lijecenih bolesnica s RD u odnosu na opcu populaciju. Vise RKS pokazuju trend pozitivne korelacije s nekim agresivnijim histopatoloskim znacajkama tumora i imunoterapijom. Rezultati ove studije upucuju na to da bi se kod lijecenih bolesnica s RD i s niskom vrijednosti BMD-a trebala rutinski provoditi procjena RKS kako bi se iskljucio PHPT. Kljucne rijeci: Primarni hiperparatireoidizam; Serumski kalcij; Rak dojke; Mineralna gustoca kostiju; Lijecenje karcinoma
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